Vocal Resonance Research Articles

Feminization Laryngoplasty: 17-Year Review on Long-Term Outcomes, Safety, and Technique.

Transfeminine patients can experience significant gender dysphoria in vocal communication. Feminization laryngoplasty (FL) is a gender-affirming surgery developed to elevate speaking vocal range, as well as alter vocal resonance and laryngeal cosmesis. The purpose here was to appraise FL's long-term voice outcomes across a 17-year review period. Level III, retrospective study and description of technique. A single-institution transfeminine voice clinic. Voice data (speaking fundamental frequency [F0], lowest F0, highest F0, F0 range in both Hertz and semitones, and maximum phonation time [MPT]) were collected and assessed. Self-assessment of voice femininity and complications were documented. The 162 patients, all transfeminine women, had a mean age of 40 years with 36-month mean follow-up. There were significant increases in mean speaking F0 (Δ = 50 ± 30 Hz, Δ = 6 ± 3 semitones; P < .001) and mean change in lowest F0 (Δ = 58 ± 31 Hz, Δ = 8 ± 4 semitones; P < .001). There was no significant difference in mean change in highest F0 or MPT. There was significant improvement (Δ = 60% ± 39%; P < .001) in perceptual self-assessment of vocal femininity. There was a 1.2% rate of major postoperative complications requiring inpatient admission or operative intervention. There were no differences in vocal outcomes between those patients who had less than 1-year follow-up and those who had 5-year follow-up. FL in this cohort was a safe and effective technique for increasing mean speaking F0, mean lowest F0, and voice gender perception over a prolonged follow-up period. These findings add to the possible treatments aimed at addressing the morbid dysphoria related to voice and communication for our transfeminine patients.

Speech Movement Variability in People Who Stutter: A Vocal Tract Magnetic Resonance Imaging Study.

PurposePeople who stutter (PWS) have more unstable speech motor systems than people who are typically fluent (PWTF). Here, we used real-time magnetic resonance imaging (MRI) of the vocal tract to assess variability and duration of movements of different articulators in PWS and PWTF during fluent speech production.MethodThe vocal tracts of 28 adults with moderate to severe stuttering and 20 PWTF were scanned using MRI while repeating simple and complex pseudowords. Midsagittal images of the vocal tract from lips to larynx were reconstructed at 33.3 frames per second. For each participant, we measured the variability and duration of movements across multiple repetitions of the pseudowords in three selected articulators: the lips, tongue body, and velum.ResultsPWS showed significantly greater speech movement variability than PWTF during fluent repetitions of pseudowords. The group difference was most evident for measurements of lip aperture using these stimuli, as reported previously, but here, we report that movements of the tongue body and velum were also affected during the same utterances. Variability was not affected by phonological complexity. Speech movement variability was unrelated to stuttering severity within the PWS group. PWS also showed longer speech movement durations relative to PWTF for fluent repetitions of multisyllabic pseudowords, and this group difference was even more evident as complexity increased.ConclusionsUsing real-time MRI of the vocal tract, we found that PWS produced more variable movements than PWTF even during fluent productions of simple pseudowords. PWS also took longer to produce multisyllabic words relative to PWTF, particularly when words were more complex. This indicates general, trait-level differences in the control of the articulators between PWS and PWTF.Supplemental Material https://doi.org/10.23641/asha.14782092

A case of noncardiogenic pulmonary edema and pleural effusion following diclofenac administration

The acute manifestations of diclofenac allergy vary from mild urticaria or skin rash to severe and life-threatening complications such as ARDS, and anaphylactic shock. Very few cases of diclofenac allergy have been reported in literature especially with respect to pulmonary manifestations. We are reporting a case of a 31-year-old who presented in respiratory distress consequent to diclofenac hypersensitivity. Our patient had non-cardiogenic pulmonary oedema and bilateral minimal pleural effusion 3 days following diclofenac administration. On examination the patient was conscious, alert and oriented, PR- 88 bpm, BP- 150/100 mmHg, RR-22 cpm temperature 98.6°F with oxygen saturation of 95% on room air. Her respiratory system examination revealed a dull note on percussion and decreased vocal fremitus, decreased vocal resonance, diminished air entry in bilateral infra scapular and infra axillary areas with fine inspiratory crepitations. The diagnosis of ARDS was ruled out as the ratio of PaO2 to FiO2 was 410. After treatment with I.V diuretics, antibiotics and inhalational bronchodilators she improved over a period of 5 days. She had complete resolution of her chest symptoms and chest findings both clinically and radiologically. Pulmonary manifestations such as ARDS, eosinophilic pneumonitis, pleural effusion, eosinophilic pneumonia, pulmonary oedema, hemoptysis, pulmonary infiltrates with eosinophilia and asthmatic attacks are rare. The temporal relationship between symptom onset and drug administration is the most important piece of history while making the diagnosis. History of allergic reaction to NSAIDs should be evaluated in detail. It is therefore important that the physician keep this in mind while prescribing.

Effect of Ventricular Folds on Vocalization Fundamental Frequency in Domestic Pigs (Sus scrofa domesticus)

This study investigates the effect of the ventricular folds on fundamental frequency (fo) in the voice production of domestic pigs (Sus scrofa domesticus). The excised larynges of six subadult pigs were phonated in two preparation stages, with the ventricular folds present (PS1) and removed (PS2). Vocal fold resonances were tested with a laser vibrometer, and a four-mass computational model was created. Highly significant fo differences were found between PS1 and PS2 (means at 93.7 and 409.3 Hz, respectively). Two tissue resonances were found at 115 Hz and 250-290 Hz. The computational model had unique solutions for abducted and adducted ventricular folds at about 150 and 400 Hz, roughly matching the fo measured ex vivo for PS1 and PS2. The differing fo encountered across preparation stages PS1 and PS2 is explained by distinct activation of either a high or a low eigenfrequency mode, depending on the engagement of the ventricular folds. The inability of the investigated larynges to vibrate at frequencies below 250 Hz in PS2 suggests that in vivo low-frequency calls of domestic pigs (pre-eminently grunts) are likely produced with engaged ventricular folds. Allometric comparison suggests that the special, mechanically coupled "double oscillator" has evolved to prevent signaling disadvantages. Given these traits, the porcine larynx might - apart from special applications relating to the involvement of ventricular folds - not be an ideal candidate for emulating human voice production in excised larynx experimentation.

Effect of Removable Complete Dentures on the Fundamental Frequency of Speech

Removable complete dentures alter the spectrum of speech sounds by changing the elasto-plastic properties of certain areas of the oral cavity walls, and the geometric characteristics of the vocal resonator. These relationships predetermine largely the aims of conventional studies on the effect of prosthetic dentures on speech function. To investigate the effect removable dentures have on the fundamental frequency of speech during different stages of the adapta-tion period. We analysed 96×2 digital sound recordings made by 64 patients (32 male and 32 female). Each patient was asked to say 'three, two, one, zero, start' three times: before denture placement, after denture placement, and after a two-week adaptation period. The pitch contours of F0 and the numeric values were obtained using the Speech Analyzer - SIL Language Technology software. Immediately after denture placement, in male patients F0 increased by 12% on the average, and in female patients - by 10%. Two weeks after denture placement, F0 regained its normal value (p.

The Influence of Smoking Habit to Voice Handicap Index Score

Introduction: The health voice production depends on vocal folds vibration and resonance. Anatomical changes of the vocal folds soft tissue (epithelium, ligament, muscle) can cause functional problems results in voice disorders. The vocal folds react to smoking, from irritate the mucous to the tissue changes or dysplasia that degradation of voice performance in daily living.Aim: This study determined the influence of smoking habits to the voice handicap score by Voice Handicap Index score (VHI).Patients and Methods: The design was a retrospective cohort study from 96 adults that identified level of voice fatigue through VHI. They were divided into 3 groups: a group of active smokers, passive smokers and nonsmokers. Chi-square test and regression nominal test was used in this study.Results: Voice fatigue (VHI score > 20) in both active smokers (13.54%) and passive smokers (15.62%) compared with nonsmokers (6.25%), by Chi-square test results was p = 0.047 (p <0.05). Nominal regression test between 3 groups of samples were (RR = 3.0, CI 95% = 0.95 to 9.21) between the group of active smokers and passive smokers (RR = 3.8, CI 95% = 1.23-11.80).Conclusion: Smoking habits influence the voice handicap score in both active smokers and passive smokers compared with nonsmokers. Active smokers have a risk of voice fatigue 3 times than nonsmokers and passive smokers have a risk 3.8 times than non-smokers.

Subvocalization in singers: Laryngoscopy and surface EMG effects when imagining and listening to song and text

Subvocalization has been described as a series of attenuated movements of the vocal tract during silent reading and imagination. This two-part study investigated covert laryngeal activations among singers during the perception and imagination of music and text. In the first part, 155 singers responded to an online survey investigating their self-perceived corporal activation when listening to live or recorded singing. Respondents reported frequent corporal activation in their larynx and other body parts in response to live singing and, to a lesser extent, recordings. In the second part, an exploratory experiment was conducted to investigate physiological correlates of subvocalization in singers during the perception and imagery of melody and text stimuli, using simultaneous measurements of laryngeal activation both externally, with surface electromyography, and internally, with nasolaryngoscopy. Experimental results indicate the occurrence of subvocalization during imagination—but not during listening—of both stimuli and suggest that laryngoscopy is more sensitive to detection of subvocalization in singers. The results may point to vocal resonance or empathy in the perception of singers.

MUCOEPIDERMOID CARCINOMA OF LUNG

SESSION TITLE: Monday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: Mucoepidermoid carcinoma is a very rare malignancy of lung, originated from minor salivary gland tissue of proximal tracheobronchial tree, affecting mostly young patients, grows as a polyp like growth in central bronchial region CASE PRESENTATION: 22 years old housewife, lactating mother, presented with right sided chest pain, cough with white sputum (single episode of bloody sputum) for 3 months and shortness of breath for 1 month. In Past, she has taken Antituberculous drugs (CAT-1) for 9 months a year ago empirically. On examination she was pale, febrile with respiratory rate of 24 breaths/min. On Chest Examination, respiratory movements decreased on right chest, dull percussion note on right chest from 4th intercostal space downwards with decreased air entry and vocal resonance in the same region. Rest of the systemic examination was normal. Chest x-ray showed right lower zone opacity with cardiac and diaphragmatic silhouette sign positive and shifting of mediastinum to right side, suggestive of collapse. On CBC, TLC was 20.8 (N 87%), ESR 123 mm 1st hour. RFT, LFT normal. Work up for PTB negative. Sputum for routine CS showed heavy growth of Moraxella Catarrhalis, antibiotic according to sensitivity started. CT chest with contrast showed Elongated endobronchial lesion extending from right mainstem bronchus into Bronchus Intermedius, causing obstruction, lobar collapse consolidation of right middle and right lower lobes. Multiple mediastinal and right hilar lymph nodes noted. Bronchoscopy showed large whitish rounded endobronchial growth covered with shiny mucosa obliterating right bronchus intermedius. Endobronchial biopsy for Histopathology showed features consistent with Mucoepidermoid Carcinoma. DISCUSSION: Mucoepidermoid carcinoma is a malignant tumor of bronchial tree comprising about 0.1%-0.2% of all lung cancers. It originates from glandular tissue in submucosa of tracheobronchial tree, occurs in relatively young with equal sex distribution in central bronchial region. Patient may be asymptomatic or can have cough, blood in sputum, shortness of breath or wheezes. On chest x-ray it presents as collapse or consolidation while CT scan shows endobronchial growth with or without collapse and consolidation. On histology it can be cystic, papillary or solid structure consisting of mucus producing cells. It can be of lowgrade (squamous cell predominantly) and highgrade (glandular cells predominantly). Lowgrade Mucoepidermoid carcinoma has better prognosis (5 year survival rate of 95%) than highgrade Mucoepidermoid carcinoma. Radical surgery is the choice of treatment with no adjuvant therapy usually needed. CONCLUSIONS: Mucoepidermoid carcinoma of the bronchus, a rare primary lung malignancy, usually presents with symptoms of airway obstruction and recurrent pneumonia. Therefore this rare entity in patients who are unresponsive to regular treatment should be kept in mind. Reference #1: Kitada et al. Journal of Cardiothoracic Surgery 2011, 6:132 Reference #2: Primary Mucoepidermoid Carcinoma of the Lung, El-Sameed, Yaser Abu MBBS; Al Marzooqi, Saeed H. Journal of Bronchology & Interventional Pulmonology: July 2012 - Volume 19 - Issue 3 - p 203–205 Reference #3: Sujay R. Belgod, Rajashekara H.V. Reddy, and Suma P. Kumar, Oxford Medical Case Reports, 2015 , 203–205 DISCLOSURES: No relevant relationships by Zunair Ahmed Khan, source=Web Response No relevant relationships by Sidra Hameed, source=Web Response No relevant relationships by Faisal Faiyaz Zuberi, source=Web Response

TB OR NOT TB: A CASE OF NONTB MYCOBACTERIAL LUNG DISEASE

SESSION TITLE: Wednesday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM INTRODUCTION: Nontuberculous mycobacteria (NTM) are naturally-occurring organisms found in water and soil. NTM lung infection occurs when a person inhales the organism from their environment. Most people do not become ill but some susceptible individuals develop progressive and destructive lung disease. CASE PRESENTATION: 80-year-old female with a past medical history of emphysema presented with complaints of malaise and fatigue for 3-4 months. She also complained of dry cough, shortness of breath, hoarseness of voice and right upper chest wall discomfort. She was a non-smoker and retired nurse by profession. Physical exam was notable for a thin, frail build, supraclavicular hollowing, along with increased vocal fremitus and vocal resonance in the right upper lung fields. Further history revealed that she had secondhand smoke exposure from her husband years ago as well as a history of suspected Tuberculosis when she was young. Chest X-Ray and follow up CT scan revealed a 7 cm cavity in her right upper lobe. Her vitals and labs were within normal limits and her Sputum Acid Fast Bacilli smear x 3 was negative. Sputum cultures grew out mycobacteria 6 weeks later. Rapid speciation via Mass spectrometry revealed Mycobacterium abscessus. The patient was started on a long course of a triple-drug regimen of parenteral Amikacin and Imipenem along with oral Clarithromycin for treatment. DISCUSSION: M. abscessus is 1 of the 3 clinically relevant species among Nontuberculous mycobacteria. It is the third most frequently recovered nontuberculous mycobacteria in the US and accounts for 80% of the rapidly growing mycobacteria respiratory disease isolates. The demographic affected by M. abscessus generally include white nonsmoking females over the age of 60 with no predisposing lung conditions and those who were less than 50 years of age usually had a recognized underlying lung disease. There are clinical and microbiological criteria required for diagnosing nontuberculous mycobacterial lung disease, and it is a diagnosis of exclusion. M. abscessus are uniformly resistant to the standard anti-tuberculous agents. As per current guidelines, the only predictable curative therapy for limited (focal) lung disease is surgical resection combined with multidrug therapy, including a macrolide and one or more parenteral agents over several months to help control symptoms and progression. The major drawback of therapy stems from the adverse drug reactions associated with long-term use of parenteral agents. CONCLUSIONS: In the United States, the incidence of nontuberculous mycobacterial lung disease is rising, particularly among the elder age groups and hence must be considered in the differential diagnosis once more common etiologies have been excluded. Unfortunately, at present there are recommendations but there is no reliable and dependable antibiotic regimen to produce a cure for extensive Mycobacterium abscessus lung disease. Reference #1: Griffith DE, Aksamit T, Brown-Elliott BA, Catanzaro A, Daley C, Gordin F, An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. Am J Respir Crit Care Med. 2007;175:367–416. DOIPubMed Reference #2: Pillai SK, Beekmann SE, Santibanez S, Polgreen PM. The Infectious Diseases Society of America Emerging Infections Network: bridging the gap between clinical infectious diseases and public health.Clin Infect Dis. 2014;58:991–6. DOIPubMed Reference #3: Lyu J, Jang HJ, Song JW, Choi CM, Oh YM, Lee SD, Outcomes in patients with Mycobacterium abscessus pulmonary disease treated with long-term injectable drugs. Respir Med. 2011;105:781–7.DOIPubMed DISCLOSURES: No relevant relationships by Sneha Lakshman, source=Web Response

A RARE MALIGNANCY

SESSION TITLE: Monday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: Ewing's sarcoma is a malignant neoplasm which arises from the skeletal bones. It most commonly affects children and young adults with a female preponderance. Ewing’s sarcoma of the rib is a rare enity as long bones are usually affected . CASE PRESENTATION: A 24 year-old male presented with complaints of shortness of breath , cough and left chest pain for 1 month. He also had episodes of seizures since last 3 years. He had multiple soft cutaneous nodules and macular patches over chest , back and upper limbs. There was bulging of left anterior chest wall with shifting of trachea as well as apex beat to right. There was increased vocal fremitus as well dull percussion note on left. There were reduced breath sounds with increased vocal resonance on left. Routine blood investigations were within normal limits. Chest X -ray revealed a homogeneously white left hemithorax with shifting of mediastinum to the right. Pleural fluid cytology had features suggestive of small round cell tumor. CECT thorax revealed a large heterogeneous mass in the left hemithorax with shifting of mediastinum to right and lytic destruction of left 6 th rib. There was minimal left pleural effusion with nodular pleural deposits. USG guided trucut biopsy from the left lung mass revealed small cell neuroendocrine carcinoma. The tumour was CD 99, Synaptophysin, CD 56 , FLI-1 - positive and negative for CK, CK7, TTF-1 and chromogranin. Dermatology opinion favoured the skin nodules to be neurofibromatosis. So a final diagnosis of Ewing’s sarcoma left sixth rib with Neurofibromatosis and seizure disorder was made. The patient received Vincristine , Adriamycine and Cyclophosphamide (VAC),alternating with Ifosfamide and Etoposide as well as was planned for radiotherapy DISCUSSION: Ewing sarcoma is an uncommon disease, which usually arises from the skeletal bones. It constitutes approximately 10 % of all primary malignant bone tumours. Only 40 % of such cases are seen in flat bones like innominate, ribs, scapula and sterum #1.A characteristic chromosomal translocation, (11; 22) (q24; q12) can be detected in 90% of cases .Patients with Ewing's Sarcoma of the ribs present with breathlessness, weight loss and painful chest wall mass. #2 pleural effusion as in our case, is an unusual finding #3 . The tumour has propensity to spread inwards towards the thoracic cavity and thus,may manifest as an extra pleural mass.our case unique in a wayas it had several other associated finding like neurofibromatosis,seizure disorder as well as skin lesion although such association are not commonly reported CONCLUSIONS: This case showcases the significance of IHC an important tool in diagnosis of lung malignancies and lays stress on excluding extrathoracic involvement in all such cases. Reference #1: MirraJM. Bone tumors: clinical, radiologic, and pathologic correlations. Philadelphia: Lea&Febiger, 1989; 1087-1117. Reference #2: Gladish GW, Sabloff BM, Munden RF, Truong MT, Erasmus JJ, Chasen MH. Primary thoracic sarcomas. Radiographics 2002 May-Jun;22(3):621-637 Reference #3: Wolf G, Aigner RM, Schwarz T. Massive pleural effusion with dyspnea in a 17-year-old boy as the first sign of ewing sarcoma. J Pediatr Hematol Oncol 2002 Jun-Jul;24(5):420 DISCLOSURES: No relevant relationships by UMER AHMED SYED, source=Web Response

A COOPERATION BETWEEN VOCAL TEACHER AND SPEECH AND LANGUAGE THERAPIST IN THE TREATMENT OF MULTIFACTORIAL VOICE DISORDERS

The aetiology of voice disorders is multifactorial. Neglecting of vocal hygiene and medical factors are common causes of voice disorders. The critical elements of the holistic approach to voice therapy are postural alignment, breathing and support, phonation and the speaking voice. The aim of the study is to make an analysis of the efficiency of the interdisciplinary treatment approach in a client with multifactorial voice disorders. Methods. This is a case study. The 57 years old female with moderate functional dysphonia received intervention by the vocal teacher and speech-language therapist. The following voice assessment methods were used in the study: a gathering of anamnesis, voice acoustic analysis, voice self-assessment. The vocal teacher used the following treatment methods: postural alignment exercises, Anna Sims’s breathing exercises, vocal and articulation exercises. Stemple’s Vocal function exercises, resonance therapy and biofeedback, were used by the speech-language therapist.Results. The harmonisation of posture, breathing, vocal folds vibration was achieved during the therapy. The objective measurements demonstrate improvement in Dysphonia Severity Index as well as the Voice Handicap Index. The client demonstrated satisfaction with the improvement of voice function.Conclusion. The cooperation of vocal teacher and speech-language therapist diversifies therapeutic approaches which allow finding unique, client-oriented intervention and achieving positive output.

Acoustic characteristics of voice in examinees with moderately-severe hearing loss

&amp;lt;p&amp;gt;Introduction.Voice is the result of vocal cord vibrations and resonance effects of the vocal tract, therefore, the instrumental monitoring of the vibrations themselves is one of the essential aspects of objective instrumental assessment of voice. Inadequate height and volume, as well as increased nasality, represent the basic characteristics of voice in hearing-impaired persons. The aim of the study was to perform a detailed analysis of the acoustic structure of vowel /a/ in the hearing-impaired persons and in those with normal hearing and voice. Methods. The sample comprised 40 participants, aged 17 to 20 years (18.50 &amp;amp;plusmn;1.13), both sexes (50% males), divided into two groups. The first group consisted of 20 participants with moderately-severe hearing loss (56-70 dB), while the second group included 20 normal-hearing participants. Members of both groups were equal to each other in sex and age (&amp;amp;plusmn; 3 months). The research was conducted in secondary schools, the Faculty of Medicine in Foča, as well as in Special School with a Student's Dormitory &amp;quot;Bubanj&amp;quot; in Ni&amp;amp;scaron; during May 2018. Results. A statistically significant difference between hearing-impaired and normal-hearing speakers was found in 11 out of 14 tested acoustic parameters of vowel /a/: Standard Deviation of Fundamental Frequency (STD), Absolute Jitter (Jitta), Percentage of Jitter (Jitt), Relative Average Perturbation (RAP), Fundamental Frequency Variation (vFo), Shimmer (Shdb), Percentage of Shimmer (Shim), Amplitude Perturbation Quotient (APQ), Noise-to-Harmonic Ratio (NHR), Soft Phonation Index (SPI) and Frequency Tremor Intensity Index (FTRI) whereby the hearing-impaired participants showed higher values of the above-mentioned parameters. Conclusion: The obtained results show pathological changes in the voice of hearing-impaired persons, as well as the need for voice rehabilitation.&amp;lt;/p&amp;gt;

Lung Consolidation Detection through Analysis of Vocal Resonance Signals.

Consolidation of the lung is a common pathology which is sometimes life threatening. One of the primary causes is the infection of lung tissue (pneumonia). Vocal resonance and vocal fremitus are part of the routine clinical examination of the respiratory system by physicians, which although time consuming, helps in the diagnosis of consolidation of the lung. In this paper, we suggest a possible automatic lung consolidation detection system that can be used by health workers with basic training. Analysis is performed on the vocal resonance sound signals recorded using an electronic stethoscope from the chest walls of normal subjects and patients. We show that for the detection system, use of signal loudness, which is generally considered by physicians, would be infeasible and propose that signal power spectral density computed using our system be considered. Certain frequency regions in the power spectral density (periodogram) are proved to be significant indicators of lung consolidation using t-tests. These findings are then applied to design the detection system using Gaussian naive Bayes classifiers.

Vocal Resonance

We observe the advent of body-area networks of pervasive wearable devices, whether for health monitoring, personal assistance, entertainment, or home automation. For many devices, it is critical to identify the wearer, allowing sensor data to be properly labeled or personalized behavior to be properly achieved. In this paper we propose the use of vocal resonance, that is, the sound of the person's voice as it travels through the person's body -- a method we anticipate would be suitable for devices worn on the head, neck, or chest. In this regard, we go well beyond the simple challenge of speaker recognition: we want to know who is wearing the device. We explore two machine-learning approaches that analyze voice samples from a small throat-mounted microphone and allow the device to determine whether (a) the speaker is indeed the expected person, and (b) the microphone-enabled device is physically on the speaker's body. We collected data from 29 subjects, demonstrate the feasibility of a prototype, and show that our DNN method achieved balanced accuracy 0.914 for identification and 0.961 for verification by using an LSTM-based deep-learning model, while our efficient GMM method achieved balanced accuracy 0.875 for identification and 0.942 for verification.

Effects of functional endoscopic sinus surgery on the acoustics of the sinonasal tract

Nasal and paranasal cavities are supposed to contribute substantially to the vocal tract resonator properties. However, their acoustical effects as well as the effects of sinus surgery on the voice remain unclear. In this work we investigate resonance phenomena of paranasal sinuses prior to and after various rhinosurgical procedures in cadaveric human sinonasal tracts and corresponding 3D casts. Nasal and paranasal cavities of formalin-preserved cadavers and corresponding 3D replicas were excited by sine-tone sweeps from an earphone placed in the epipharynx. The response was picked up by a microphone at the nostrils. Different FESS procedures were performed and the acoustical responses following excitation were recorded. The measured acoustical changes in the obtained transfer functions were then evaluated. Marked low frequency dips were detected in the transfer functions when sinus cavities were included in the nasal resonator system. These dips showed a significant correlation with sinus volumes. Following FESS procedures they moved upwards in frequency depending on the extent of the surgical intervention. The transfer functions obtained in cadaveric situs and 3D replicas showed dips at the resonance frequencies of the paranasal cavities. Marked acoustic effects in terms of increase in dip frequency following FESS procedures were reproducibly documented.

The emergence of the linguistic sign : vocomimesis, symmetry and enaction

STEELS postulates that the origins of the linguistic sign were both self-referential and vocomimetic. More precisely, vocal resonances accompanying bilaterally symmetrical, close-open movements of the jaw may have been unconsciously recruited by Homo to refer back to the jaw and its anatomical region, before being mapped homologously to other bilaterally symmetrical parts of the body located to each side of the median plane, or along it. I claim that this body-naming strategy, which may still be detectable submorphemically in certain Proto-Indo-European body-part words, involves key enactive concepts such as sense-making and embodiment, and neurophysiological phenomena such as mirror neuron systems.

Unusual cause of opaque hemithorax

A 40-year-old male presented with progressive breathlessness and hoarseness of voice. He denied any history of chest pain, cough, haemoptysis, palpitations or paroxysmal nocturnal dyspnoea. He was a smoker with...

Efficacy of Voice Therapy for Patients With Early Unilateral Adductor Vocal Fold Paralysis

Although a variety of therapeutic techniques have been suggested for patients with unilateral adductor vocal fold paralysis (UAVFP), they were not aimed specifically at determining the efficacy of early intervention for these patients. The purposes of this study are to explore a protocol of voice therapy and to investigate its efficacy in voice therapy for patients with early UAVFP. A 12-week planned voice therapy protocol, including vocal function exercise, hard attack, and resonance voice therapy, was given to 10 patients within 6 months of initial diagnosis. Additionally, nine patients diagnosed with UAVFP within 6 months served as controls. Multidimensional evaluations of voice function were obtained for statistical analyses. Compared to a control group, the experimental group receiving voice therapy exhibited significant improvement in the following: (1) glottal closure; (2) voice quality of grade, breathiness, monotone, and resonance; (3) acoustic measurements of jitter, shimmer, and noise-to-harmonic ratio; (4) aerodynamics measurements of maximum phonation time, phonation threshold pressure, and phonation quotient; and (5) Voice Handicap Index of functional subscale. This prospective study established an effective protocol of early intervention of voice therapy in patients with UAVFP and demonstrated its efficacy in data on laryngeal physiology, voice quality, voice stability, voice efficiency, and communication function.

Hyoid Suspension Neck Lift.

The shape of the deep cervical structures is the shape of an aesthetic neck. With age, changes can obstruct visualization of that shape. Achieving a youthful contour requires removal of excess skin and fat but also control of the platysma to allow skin to redrape like a blanket over an underlying framework. The authors' technique makes the platysma part of the deep cervical structures whose shape underlies an attractive neck and allows the skin to redrape to that contour. To make the platysma conform closely to the deep cervical structures and allow the skin to show that new form, the authors developed a procedure that includes removal of excess fat, attaching the platysma to the hyoid fascia, approximating the edges of the platysma above and below that suture, and wide undermining of skin to allow it to re-drape naturally over those deeper structures. Over 7 years, 110 patients underwent aesthetic facial surgery that included hyoid suspension of the platysma. One patient had recurrence of platysmal bands after failure of the key suture. Complications included hematoma in three patients and submental seromas in three patients, but no permanent nerve injury, no skin loss from vascular compromise, no reported changes in vocal resonance, and no complaints of difficulty swallowing. This method allows the skin to redrape over a youthful framework and produces reliable aesthetic and long lasting results. It is a simple, reproducible, teachable technique that enables surgeons to achieve results previously difficult to obtain in a single operation. Therapeutic, IV.

The effects of rapid maxillary expansion on voice function.

To evaluate the effects of rapid maxillary expansion (RME) on vocal function in patients with bilateral maxillary crossbite. We designed our research as a prospective, controlled, clinical study. The treatment group and the control group each had 20 subjects for a total of 40 subjects. Acoustic voice samples were recorded from all patients at T1 and T2 by the Multi-Dimensional Voice Program (MDVP Model 5105) for acoustic analysis in Computerized Speech Lab (CSL). No statistically significant differences were found between the treatment and control groups in the means of any parameters. RME does not change vocal quality or resonance, so it can be safely used with patients.