Vocal Dysfunction Research Articles

Variations in adductor spasmodic dysphonia: acoustic evidence.

Acoustic analysis was used to gain information about the normal, as well as the abnormal acoustic events associated with adductor spasmodic dysphonia (ADSD). This analysis was completed to determine whether specific acoustic events could be used to differentiate the voice of individuals with ADSD from those with normal voice. A group comparison between 14 women diagnosed with ADSD and 14 women (age-matched) with no evidence of vocal pathology or vocal dysfunction was completed. Phonatory breaks, aperiodicity, and frequency shifts, acoustic parameters previously identified in ADSD, were found throughout sustained vowel productions. The duration of the phonatory breaks and aperiodic segments was calculated and the amount of frequency shift was determined. The location of each acoustic event was marked relative to the onset of the vowel production. The subjects with ADSD presented with normal phonation and various amounts of each of the three acoustic parameters. Aperiodic segments primarily characterized the phonation of ADSD, followed by frequency shifts and phonatory breaks. The location of each of these acoustic events was within the midportion of the vowel production. The advantages of segmenting the acoustic waveform into these measures and separating the spasmodic events from normal phonation when examining laryngeal motor control of spasmodic dysphonics is discussed.

Effects of laryngeal endoscopy on the vocal performance of young adult females with normal voices.

This study investigated changes in maximum phonation time and acoustic and perceptual measures of voice following topical anesthesia and laryngeal endoscopy with the flexible endoscope. Forty-four females, aged 18-33 years and with normal voices, performed four vocal tasks: (a) 3-second /i/ prolongation, (b) maximum phonation time on /i/, (c) stepwise scale-singing, and (d) reading a standard passage. Subjects performed these tasks prior to anesthesia, after anesthesia, and again during laryngeal endoscopy. Voice samples were analyzed forjitter, shimmer, harmonic-to-noise ratio, speaking fundamental frequency, maximum phonational frequency range, maximum phonation time, harshness, and breathiness. Results demonstrated significant reductions in maximum phonational frequency range following anesthesia and, during laryngeal endoscopy, reductions in maximum phonation time and increases in speaking fundamental frequency, minimum fundamental frequency on scale-singing, and breathiness. Clinicians using laryngeal endoscopy for evaluation and management of vocal dysfunction should, therefore, consider the possible effects of these procedures on vocal functioning.

Prevalence of voice problems in teachers

Teachers are frequently cited as experiencing a high rate of vocal dysfunction (1-7). Despite considerable research in the area of voice problems in teachers, the prevalence of voice disorders in this group is unknown. This study investigated the prevalence of self-reported voice problems in teachers using a mail survey of a simple random sample of 1168 state school teachers (preschool-Grade 12) in South Australia. As part of the survey, teachers were asked to report voice problems for the day of the survey, during the current teaching year, and during their careers. The response rate was 75%, with 16% of teachers reporting voice problems on the day of the survey, 20% reporting problems during the current teaching year, and 19% reporting problems at some time during their career. Females were twice as likely as males to report voice problems. These findings clearly indicate a need for further investigation of the causes of vocal dysfunction in teachers and for the development of educational programs aimed at preventing voice problems in this group of professional voice users.

Gender-Specific Vocal Dysfunctions in Parkinson's Disease: Electroglottographic and Acoustic Analyses

Electroglottographic (EGG) and acoustic recordings were obtained during sustained vowel production in men and women suffering from Parkinson's disease (PD). The computed EGG spectrograms allowed us to differentiate various kinds of phonatory disturbances: intervals with subharmonic energy ("low-frequency segments"), "noise-like regions," and abrupt shifts of fundamental frequency (F0). Female PD subjects presented with a significantly increased portion of subharmonic segments and with significantly more abrupt F0 shifts as compared to both controls and male PD subjects. Presumably, these alterations in spectral energy distribution reflect different oscillatory modes of the glottal source. Thus, PD seems to have a differential impact on phonation in men and women. Conceivably, these gender-specific vocal dysfunctions are determined by the well-known sexual dimorphism of laryngeal size.

Einsatzmöglichkeiten des “Speech Viewer II” zum Stimmtraining bei Stimmlippenparesen*

Referring to traditional therapeutical concepts of vocal fold paralysis a microphone-controlled computer programme was used for voice treatment in 13 patients with unilateral vocal fold paralysis. 6 of these patients were female, 7 were male. The age ranged from 18 to 72 years (mean: 50 years). The etiology of the paralysis was distributed as follows: post strumectomy (4 cases), post operation of the aortic arch (3 cases), post mediastinoscopy (1 case), post operation of the cervical vertebrae (1 case). 2 cases are not decided yet, 2 are probably idiopathic. The vocal fold dysfunction lasted between 24 hours and 8 years before our first examination, less than 4 weeks in 11 cases. With 1 exception (intermediate) the vocal fold position was classified as paramedian. 8 patients suffered from left, and 5 patients from right vocal fold paralysis. The voice treatment took place with a microphone-controlled speech viewer including an audio capture and playback adapter. 7 of the 15 training modules of the computer programme were chosen to be useful for voice training. Those modules can be differentiated in physical-technical modules showing voice spectra or pitch scales and in object-related modules showing images such as landscapes, animals and others. These programme-specific modules (monitor exercises) were primarily built to train the following voice qualities separately: loudness, pitch, voicing, voice onset, fundamental frequency, sustained phonation etc. Modifying certain therapeutic instructions (see Tables 1 and 2) the monitor exercises were used to improve the coordination of different voice parameters, thus resembling physiological speech.(ABSTRACT TRUNCATED AT 250 WORDS)

Laryngeal dysfunction in dysarthric speakers following severe closed-head injury.

The laryngeal function of 19 severely closed head-injured subjects with a perceptible dysarthria was assessed using electrolaryngography and a computerized airflow/air pressure analysis system (Aerophone II). Variables measured included parameters of the Lx waveform (Fo, duty cycle and closing time) as well as aerodynamic parameters such as subglottal pressure, glottal resistance, average phonatory sound pressure level, phonatory flow rate and ad/abduction rate. Values were compared to those recorded from a non-neurologically impaired control group matched for age and sex, and correlated with the findings of a perceptual speech analysis. The findings are discussed in relation to the effects of a severe closed-head injury on laryngeal function. The clinical implications of the findings for the assessment and treatment of vocal dysfunction in head-injured subjects are also discussed.

Children's Voice Problems: The Frog in Your Classroom

Children's voice disorders can interfere with their ability to interact successfully in the classroom. Moreover, vocal dysfunction can signal the underlying presence of chronic or incipient illness. Although many such problems can be remediated, this population is typically underserved in many rural public school settings due to personnel shortages and in-frequent contact between classroom teachers and speech/language pathologists. Suggestions are made for increasing the efficiency of identification of voice-disordered children and for reduction of such problems through classroom prevention activities.

Carbon dioxide laser microtrapdoor flap for anterior glottic webs

Congenital laryngeal webs are manifestations of devel­ opmental arrest in the embryologic larynx.' Acquired la­ ryngeal webs are the result of trauma to the anterior or posterior commissure and are slightly more common than the congenital webs. The characteristic appearance of a web is that of a band of tissue stretching from one side of the glottis to the other side. Webs may be supra­ glottic, glottic, or infraglottic. They may be thin or thick, and may be insignificant in size or completely obstruct the lumen of the airway. Patients with laryngeal webs that do not obstruct the airway present with variable degrees of hoarseness or vocal dysfunction, Most often, the diagnosis is made on indirect laryngoscopy. The hoarseness is a function of the limitations of vibration of the vocal fold. Congenital webs with airway compromise present at birth with stri­ dor or serious airway distress and immediate attention to establishment of an airway is necessary. While indirect examination may show the presence of a web, direct laryngoscopy is required for complete exam­ ination and characterization of the location and quality of the web . Most webs are glottic in location as opposed to supraglottic or subglottic. Posterior glottic webs are in­ frequent. Treatment is dependent primarily on the quality of the web (ie, thin vs thick). Historically, thin glottic webs have been treated by direct scissors lysis, bougienage, or more recently CO 2 laser incision.P'' For the thin laryn­ geal web, all these methods have had moderate to good success. Thick glottic webs require more aggressive interven­ tion. Lysis with scissors or CO 2 laser frequently fails with reformation of the web. Open or endoscopic incision and placement of a laryngeal keel has been the traditional method of treatment for thick laryngeal webs? In 1984, McGuirt et al 2 reported the use of the CO2 laser to de­ velop a mucosal flap for treatment of the glottic web. In their technique, mucosa was elevated from the oppo­ site vocal fold to ensure enough tissue for flap transfer. They reported 10 cases, with good voice postoperatively in 6. With the development of the newer generations of microspot micromanipulators for the CO 2 laser, this tech­ nique has been modified with the use of a microtrapdoor flap for mucosal tissue transfer in the treatment of these webs. The older laser micromanipulator used in 1984

The Spectrum of Vocal Dysfunction

Levels of vocal use, types of vocal complaints, and the spectrum of vocal dysfunction are discussed in this article. Functional voice disorders account for 40% and organic conditions for 60% of patients presenting with voice disorders. Twelve percent of the patients are children.

Geriatrie Voice and Laryngeal Dysfunction

Vocal disorders are a common dysfunction associated with aging that can have a significant effect on the quality of life. An appreciation for the many causes of vocal dysfunction in the elderly is a first step to providing better care for the geriatric patient with complaints about voice dysfunction.

Vocal dysfunction following cricothyroidotomy: A prospective study

Voice dysfunction is a known consequence of cricothyroidotomy, but few detailed analyses have been published. This study reports an investigation of voice function in 19 patients who underwent cricothyroidotomy during a 12-month period (54 were patients operated on, 29 survived the primary disease or injury, and 19 agreed to participate in the investigation). The patients were interviewed regarding signs of dysfunction of the cricothyroid muscles, or a diminished external tensor effect on the vocal folds. Laryngoscopy with a magnifying-angled endoscope, stroboscopy, phonetography, determination of mean speaking fundamental frequency, perceptual analysis of the voice, and electromyogram of the cricothyroid muscle were all performed. Four patients had signs of diminished external tensor effect on the vocal folds (mild or moderate voice dysfunction), 5 patients had other voice disorders, and 10 were classified as having normal voice. Elective cricothyroidotomy should be avoided in patients with professional or other activities that place heavy demands on the voice.

Electroglottogram waveform types of untrained speakers

Electroglottography is a useful, non-invasive technique that can assist in the assessment of vocal fold dysfunction. However, if it is to become a useful clinical tool, there is a need for normative studies of the electroglottogram waveform types that characterize different groups of speakers. This report compares the electroglottogram waveform types characterizing one trained professional voice user phonating in 15 experimental sessions under various fundamental frequencies, intensities and voice qualities with those obtained from 52 untrained non-professional speakers.

Evaluation of voice by patients and close relatives following different laryngeal cancer treatments

The purpose of this study was to assess perception of life style change among laryngeal cancer patients. Seventy-five patients (total laryngectomy 35, supraglottic laryngectomy 15, hemilaryngectomy 12, radiotherapy eight, laser cordectomy five) and close relatives responded to a questionnaire and interview eliciting perception of: 1) posttreatment voice quality; 2) side effects of treatment vocationally and socially; and 3) degree of vocal or communicative change associated with vocational or social change. Whereas 43% of the patients reported vocational change and 37% reported social change, 88% expressed satisfaction with their posttreatment voices. This may have been due to the perceptions of the relatives, who generally had a more positive view of the patients' voices. Although laryngeal cancer had an impact on patient life style, patients seldom related this to vocal dysfunction.

Whither belting?

An explanation of belting appears necessary for practical as well as scholarly reasons. Tentative definitions are available in the literature; however, they are controversial, especially since most are based on personal opinion. Further, many individuals involved in the use and care of the voice believe that singers who employ this technique have a disproportionately high incidence of vocal dysfunction. In any event, a review of what is known about belting, its nature, and the difficulties associated with it would appear helpful in its understanding and the prediction of fruitful avenues of research. An explanation of belting appears necessary for practical as well as scholarly reasons. Tentative definitions are available in the literature; however, they are controversial, especially since most are based on personal opinion. Further, many individuals involved in the use and care of the voice believe that singers who employ this technique have a disproportionately high incidence of vocal dysfunction. In any event, a review of what is known about belting, its nature, and the difficulties associated with it would appear helpful in its understanding and the prediction of fruitful avenues of research.

声帯ポリープにおける病変の程度と音声検査成績との関係

Relationships between the degree of lesion and that of vocal dysfunction were investigated in 122 cases of vocal fold polyp. A normalized size of polyps and glottic gap were correlated to the results of phonatory ability tests, stroboscopic investigations, acoustic analyses, and perceptual evaluations. There was no significant correlation between the size and the gap. The size of polyp was negatively correlated to fundamental frequency, whereas it was positively correlated to roughness of voice, asymmetry of vocal fold vibration, irregularity of vocal fold vibration, pitch perturbation quotient, amplitude perturbation quotient, and normalized noise energy. The glottic gap showed negative correlations to maximum phonation time and sound pressure level, and positive correlations to mean airflow rate and fundamental frequency.

Office-based system for voice analysis.

There has been recent growing interest in the analysis of various electronically recorded signals as potential tools for objective assessment of vocal dysfunction. In the past, analysis of such signals required an expensive multitrack FM recorder, mainframe computer system, customized software, and significant time commitment. This report describes an adaptation of commercially available components that allow digital recording of multiple electronic signals, storage of data, and subsequent signal analysis using an inexpensive personal microcomputer system. Commercially available software for manipulation and examination signals is discussed as adapted for examination of glottographic and acoustic signals. The relatively inexpensive availability of similar computer systems will, hopefully, encourage assessment of the clinical applications of objective techniques of voice quality.

Vocal fatigue and dysphonia in the professional voice user: Bogart-Bacall syndrome.

Over the past 5 years, the authors have treated 67 adult professional voice users with a musculoskeletal tension disorder involving the larynx and supporting structures and leading to vocal dysfunction. Common clinical features in both sexes were muscle tension in the neck, poor control of the breath stream, and an abnormally low-pitched speaking voice. Most of the men sounded like Humphrey Bogart and the women like Lauren Bacall. These cases represent a discrete clinical vocal fatigue syndrome, the treatment of which is patient education and voice therapy.

Electroglottogram waveform types.

Electroglottography is a useful, non-invasive technique that can assist in the assessment of vocal fold dysfunction. However, if it is to become a useful clinical tool, there is a need for normative studies of the electroglottogram waveform types that characterize trained professional voice users, untrained non-professional speakers and patients with voice disorders and for a way of quantifying and objectively comparing similarities and differences. This report describes our methodology and an investigation into the waveform types characterizing one trained professional voice user phonating in 15 experimental sessions under various fundamental frequency, intensity and voice quality conditions. A number of strong tendencies were noted. In normal voice the lower frequencies and intensities represent one pole of a scale of a mode of phonation, while the higher frequencies and intensities depict the other pole. In these studies breathy voice data overlapped the lower end of the scale and tense voice data overlapped the upper end.

Preliminary evaluation of selected acoustic and glottographic measures for clinical phonatory function analysis

Summary Acoustic and glottographic measures may provide important information that could enhance clinical management and documentation of vocal dysfunction. Acoustic measures such as jitter and shimmer reflect “short-term” perturbations, or instabilities of the voice, and the coefficients of variation for frequency and for amplitude reflect “long-term” perturbations. Interpretations of these acoustic measures are based on the assumption that vocal perturbations may be related to laryngeal tissue abnormalities, asymmetries in vocal fold movement, or neuromuscular fluctuations in the respiratory, laryngeal, or vocal tract systems. The abduction quotient is a glottographic measure related to laryngeal adduction and is obtained from an analysis of the electroglottograph signal. The adduction measure appears to be independent of the acoustic perturbation measures. Interpretations of the acoustic and adductory measures may, therefore, complement each other for greater understanding of a patient's laryngeal behavior. Visual displays of the acoustic and glottographic signals also are discussed to demonstrate their value in voice signal interpretations. Case studies illustrate potential interpretations of the acoustic perturbation and abduction quotient measures.

Acoustic and perceptual analysis of vocal dysfunction

The purpose of the present study was to evaluate the usefulness of structuring perceptual voice characterizing categories by factor analysis and to provide data for a combined acoustic—perceptual evaluation of the vocal dysfunction. A set of normal and pathological voices representing various voice disorders were presented to a jury of voice clinicians who evaluated the voices on a five-point scale for each of 26 voice describing parameters. Factor analysis of the pathological subgroup of 26 voices revealed five bipolar factors accounting for 66% of the total variance. Significant correlations were found between three of these factors and acoustic data extracted from long-time average spectra, fundamental frequency distribution analysis and frequency perturbation. Also, some of the individual voice characterizing parameters correlated significantly with acoustic data.