Acoustic Voice Research Articles

Detection of Neurogenic Voice Disorders Using the Fisher Vector Representation of Cepstral Features

Neurogenic voice disorders (NVDs) are caused by damage or malfunction of the central or peripheral nervous system that controls vocal fold movement. In this paper, we investigate the potential of the Fisher vector (FV) encoding in automatic detection of people with NVDs. FVs are used to convert features from frame level (local descriptors) to utterance level (global descriptors). At the frame level, we extract two popular cepstral representations, namely, Mel-frequency cepstral coefficients (MFCCs) and perceptual linear prediction cepstral coefficients (PLPCCs), from acoustic voice signals. In addition, the MFCC features are also extracted from every frame of the glottal source signal computed using a glottal inverse filtering (GIF) technique. The global descriptors derived from the local descriptors are used to train a support vector machine (SVM) classifier. Experiments are conducted using voice signals from 80 healthy speakers and 80 patients with NVDs (40 with spasmodic dysphonia (SD) and 40 with recurrent laryngeal nerve palsy (RLNP)) taken from the Saarbruecken voice disorder (SVD) database. The overall results indicate that the use of the FV encoding leads to better identification of people with NVDs, compared to the defacto temporal encoding. Furthermore, the SVM trained using the combination of FVs derived from the cepstral and glottal features provides the overall best detection performance.

The acoustic voice quality index, version 2.06 and 3.01, for the Persian-speaking population

IntroductionDysphonia assessment includes approaches like acoustic analysis, which is non-invasive and easy to use and provides an understandable numerical output. The Acoustic Voice Quality Index (AVQI) is an acoustic model that can detect dysphonia. The Persian language is spoken by around 70,000,000 native speakers. Since AVQI versions 2.06 and 3.01 have not been validated for the Persian yet, this study investigated their concurrent validity and diagnostic accuracy among the Persian-speaking population. MethodsThis scale development study was conducted from 2020 to 2021 on 180 normophonic and dysphonic native Persian-speaking residents of Mashhad, Iran. Five raters rated the samples by auditory-perceptual-judgments, including Grade from the Grade-Rough-Breathy-Asthenic-Strained (an ordinal scale) and the overall dysphonia severity from the Persian version Consensus Auditory Perceptual Evaluation of Voice (a continuous scale) to investigate both versions’ concurrent validity. The intra- and inter-rater reliability and concurrent validity were evaluated for both scales. Both versions’ diagnostic accuracy was assessed by the receiver operating characteristic, and the optimal thresholds were determined. ResultsAVQI-version-2-Persian thresholds of 3.47 and 4.04 provided sensitivity of 88.30% and 85.53% and specificity of 79.07% and 85.58% by the ordinal and continuous scales, respectively. AVQI-version-3-Persian thresholds of 3.07 and 3.03 also rendered sensitivity of 74.47% and 85.53%, and specificity of 97.67% and 91.35% by the ordinal and continuous scales sequentially. ConclusionThe significant values of concurrent validities and diagnostic accuracies of both versions of AVQI-Persian confirmed that it can discriminate between normal and pathological voices among the Persian-speaking population. Hence, it can be used for screening or diagnosis purposes.

Voice Biofeedback via Bone Conduction Headphones: Effects on Acoustic Voice Parameters and Self-Reported Vocal Effort in Individuals With Voice Disorders

This study explores sidetone amplification (amplified playback of one's own voice) provided via bone conduction in participants with voice disorders. The effects of bone conduction feedback on acoustic voice parameters and vocal effort ratings are examined. Speech samples of 47 participants with voice disorders were recorded in three auditory feedback conditions: two with sidetone amplification delivered via bone conduction and one condition with no alteration of the feedback. After each task, the participants rated their vocal effort on a visual analog scale. The voice recordings were evaluated by a speech-language pathologist through the GRBAS scale and processed to calculate the within-participant centered sound pressure level (SPL) values, the mean pitch strength (PS), the time dose (Dt%), and cepstral peak prominence smoothed (CPPS). The effects of the feedback conditions on these acoustic parameters and vocal effort ratings were analyzed. The high sidetone amplification condition resulted in a statistically significant decrease in the within-participant centered SPL values and mean pitch strength across all participants. The feedback conditions had no statistically significant effects on the vocal effort ratings, time dose (Dt%), or CPPS. This study provides an evidence that bone conduction sidetone amplification contributes to a consistent adaptation in the within-participant centered SPL values (ΔSPL) in patients with vocal hyperfunction, glottal insufficiency, and organic/neurological laryngeal pathologies compared to conditions with no feedback.

Cricothyroid Dysfunction in Unilateral Vocal Fold Paralysis Females Impairs Lexical Tone Production.

In this cross-sectional study, we compared voice tone and activities relating to the laryngeal muscle between unilateral vocal fold paralysis (UVFP) patients with and without cricothyroid (CT) muscle dysfunction to define how CT dysfunction affects language tone. Eighty-eight female surgery-related UVFP patients were recruited and received acoustic voice analysis and laryngeal electromyography (LEMG) when the patient was producing the four Mandarin tones. The statistical analysis was compared between UVFP patients with (CT+ group, 17 patients) and without CT muscle (CT- group, 71 patients) involvement. When producing Mandarin Tone 2, the voice tone in the CT+ group had smaller rise range (p = 0.007), lower rise rate (p = 0.002), and lower fundamental frequency (F0) at the offset point of the voice (p = 0.023). When producing Mandarin Tone 4, the voice tone in the CT+ group had smaller drop range (p = 0.019), lower drop rate (p = 0.005), and lower F0 at voice onset (p = 0.025). The CT+ group had significantly lower CT muscle activity when producing the four Mandarin tones. In conclusion, CT dysfunction causes a limitation of high-rising tone in Tone 2 and high-falling tone in Tone 4, a property that dramatically limits the tonal characteristics in Mandarin, a tonal language. This limitation could further impair the patient's communication ability.

Prospective voice assessment after uncomplicated thyroidectomy: A comprehensive analysis of a single centre experience.

Voice change after uncomplicated thyroidectomy has been an important issue in the field of thyroid surgery. The aim of this study was to promote understanding of voice change after uncomplicated thyroidectomy by analysing the results for a large number of patients from a single institute. We retrospectively reviewed the medical records of 2879 consecutive patients who underwent thyroidectomy and voice evaluation between January 2014 and December 2019 in a single institute. All the patients had their vocal status assessed using videostroboscopy, acoustic voice analyses, aerodynamic study, and Thyroidectomy-related Voice and Symptom Questionnaire (TVSQ) scores preoperatively and at 1, 3, and 6months postoperatively. We analysed the pattern of voice changes over time and differences in voice parameters based on clinical factors. To confirm the usefulness of the TVSQ, the correlation between TVSQ scores and objective parameters was analysed. Lastly, predictive factors for persistent voice symptoms were analysed. Tertiary referral hospital. The frequency ranges and TVSQ scores exhibited significant deterioration until 6months following surgery. Among clinical factors, the extents of thyroidectomy and neck dissection were associated with worse voice parameters. The TVSQ score was significantly correlated with objective voice parameters. The extents of thyroidectomy and neck dissection were predictive of persistent voice symptoms at 6months after thyroidectomy. After uncomplicated thyroidectomy, most voice parameters tended to recover, but some parameters remained aggravated even at 6months after surgery. With more extensive surgery, worse voice quality and the higher risk of persistent voice symptoms may be anticipated.

Effects of laryngeal vibratory asymmetry on voice acoustics and perception

Laryngeal vibratory asymmetry is commonly observed in many talkers, but its acoustic and perceptual consequences remain poorly understood. This study evaluates the relationships among vibratory symmetry, acoustic measures, and voice quality perception. We first test how the degree of left-right asymmetry in thyroarytenoid (TA) muscle activation relates to changes in voice quality as quantified by cepstral peak prominence (CPP). Using an in vivo canine phonation model, we stimulated each of the left and right TA muscles in a graded manner. Left-right asymmetry in vocal fold vibration was visually assessed, and CPP was measured from stable phonation. Results show that CPP is the highest at conditions of symmetric vibration and significantly decreases with increasing levels of asymmetry. In the subsequent audio rating experiment, 89 listeners ranked the phonation samples based on the quality (from worst to best). Overall, listeners prefer voices with higher CPP over those with lower CPP and voices with symmetric vibration over those with asymmetries. Results further reveal that listeners do not distinguish voices that fall within certain degrees of asymmetry. The relation between neuromuscular asymmetry and phonatory sound quality identified in this study has implications for clinical evaluation of the voice. [Work supported by NIH.]

Immediate Effects of Combining Kinesio Tape with Voice Therapy in Patients with Muscle Tension Dysphonia

The present study investigated the immediate effect of adding Kinesio taping along with voice therapy for the treatment of muscle tension dysphonia patients. Twenty patients with primary muscle tension dysphonia (MTD) (12 males and 8 females) with a mean age of 36.95 ± 9.58 years participated in the study. Participants were assigned to two groups: one group (6 males and 4 females) received only traditional voice therapy (VT) and the other group (6 males and 4 females) received Kinesio taping (KT) and voice therapy (VT). The VT group received laryngeal manual therapy (LMT) (for 15 minutes) and voice therapy techniques including humming, chewing, and yawn-sigh (for 15 minutes). The VT+KT group received both KT and the same VT as the first group. KT was applied to the sternocleidomastoid, infralaryngeal, and supralaryngeal muscles of the neck. Auditory-perceptual assessments using CAPE-V, acoustic voice analysis, and assessments of vocal tract discomfort and pain were used to evaluate the effects of a single treatment session. The Wilcoxon and Mann-Whitney U tests were used for data analysis. The results of within-group comparison of the auditory-perceptual assessment (overall severity, roughness, breathiness, and strain) in both sustained vowels and connected speech tasks showed a significant reduction in all mentioned items in both groups (P < 0.05). Acoustic voice analysis showed significant improvement of HNR in the KT+VT group for both sustained vowels and connected speech tasks, and significant improvement of jitter in the VT group for sustained vowels (P < 0.05). Regarding vocal tract discomfort, the symptom of tightness in the KT+VT group, irritability and pain in the VT group, and the overall score of vocal tract discomfort in both groups, significantly decreased (P < 0.05). A significant decrease in pain severity in the front of the neck, throat, and larynx was reported by MTD patients in both groups (P < 0.05). Between-group comparisons indicated a significant difference only in the pain item of the VTD scale (P < 0.05) with greater pain decrease for the VT group. Comparison of the mean of differences showed that the VT group reduced irritability more than the KT+VT group (P < 0.05). The present study showed that voice therapy with and without Kinesio taping can improve patients' voice quality (auditory-perceptual and acoustic voice analysis) and reduce vocal tract discomfort and pain in MTD patients after one therapy session. Moreover, MTD patients treated with KT+VT did not experience more significant improvements compared to those treated with VT alone. More studies in this area are recommended to better determine the effects of KT in MTD patients especially for long term effects of KT.

A Comprehensive Application for Grading Severity of Voice Based on Acoustic Voice Quality Index v.02.03

Acoustic Voice Quality Index is a six-variable acoustic model for the multiparametric measurement developed by Maryn et al. Studies have provided evidence regarding the practical usefullness, internal consistency, external validity, diagnostic accuracy, and responsiveness to change of AVQI. Recently, researchers have been exploring the utility of AVQI in classifying the voice severity. The aim of the present study was to determine the diagnostic accuracy of the AVQI v.02.03 in discriminating across the perceptual levels of dysphonia severity in 18-40 years age range in Kannada speaking population; and to develop an application to depict the AVQI based severity of dysphonia. For the study, 163 individuals in normophonic and 134 individuals in dysphonic group were considered in the age range of 18-40 years. All participants were native speakers of Kannada language. The sustained vowel /a/ and reading of standard Kannada passage were considered as stimuli for extracting AVQI analysed using AVQI script version 02.03. The AVQI cut-off values obtained were 2.50 (AROC=0.894; Sensitivity= 84.7%; Specificity= 83.1%), 4.17 (AROC=0.953; Sensitivity= 84.4%; Specificity= 88.5%) and 6.23 (AROC=1.000; Sensitivity= 100%; Specificity= 100%) for normal vs. mild, mild vs. moderate and moderate vs. severe respectively. A user friendly application was developed which provides a simplified output for AVQI cut-off values which can be comprehendible by patients with voice disorder/ non-professionals and health professionals.

Voice Quality in Telephone Interviews: A preliminary Acoustic Investigation

To investigate the impact of standardized mobile phone recordings passed through a telecom channel on acoustic markers of voice quality and on its perception by voice experts in normophonic speakers. Continuous speech and a sustained vowel were recorded for fourteen female and ten male normophonic speakers. The recordings were done simultaneously with a head-mounted high-quality microphone and through the telephone network on a receiving smartphone. Twenty-two acoustic voice quality, breathiness and pitch-related measures were extracted from the recordings. Nine vocologists perceptually rated the G, R and B parameters of the GRBAS scale on each voice sample. The reproducibility, the recording type, the stimulus type and the gender effects, as well as the correlation between acoustic and perceptual measures were investigated. The sustained vowel samples are damped after one second. Only the frequencies between 100 and 3700Hz are passed through the telecom channel and the frequency response is characterized by peaks and troughs. The acoustic measures show a good reproducibility over the three repetitions. All measures significantly differ between the recording types, except for the local jitter, the harmonics-to-noise ratio by Dejonckere and Lebacq, the period standard deviation and all six pitch measures. The AVQI score is higher in telephone recordings, while the ABI score is lower. Significant differences between genders are also found for most of the measures; while the AVQI is similar in men and women, the ABI is higher in women in both recording types. For the perceptual assessment, the interrater agreement is rather low, while the reproducibility over the three repetitions is good. Few significant differences between recording types are observed, except for lower breathiness ratings on telephone recordings. G ratings are significantly more severe on the sustained vowel on both recording types, R ratings only on telephone recordings. While roughness is rated higher in men on telephone recordings by most experts, no gender effect is observed for breathiness on either recording types. Finally, neither the AVQI nor the ABI yield strong correlations with any of the perceptual parameters. Our results show that passing a voice signal through a telecom channel induces filter and noise effects that limit the use of common acoustic voice quality measures and indexes. The AVQI and ABI are both significantly impacted by the recording type. The most reliable acoustic measures seem to be pitch perturbation (local jitter and period standard deviation) as well as the harmonics-to-noise ratio from Dejonckere and Lebacq. Our results also underline that raters are not equally sensitive to the various factors, including the recording type, the stimulus type and the gender effects. Neither of the three perceptual parameters G, R and B seem to be reliably measurable on telephone recordings using the two investigated acoustic indexes. Future studies investigating the impact of voice quality in telephone conversations should thus focus on acoustic measures on continuous speech samples that are limited to the frequency response of the telecom channel and that are not too sensitive to environmental and additive noise.

Developing a voice monitoring smartphone app: Acoustic acquisition and processing considerations

With the advent of smartphone technology, there has been an increase in at-home health monitoring. Yet, there are few applications (apps) available to track voice acoustics for those with voice disorders. Therefore, we completed two investigations into the acquisition and processing of the acoustic signal to help develop a voice monitoring app. Study 1: We investigated how microphone distance and phone tilt impact the accuracy of acoustic measures of voice. A total of 58 participants with (n = 47) and without (n = 11) voice disorders completed speech tasks of sustained vowels and the rainbow passage. Concurrent recordings were collected using the participant’s phone, as well as a stationary headset microphone for comparison. We determined that the voice measures of fundamental frequency (Hz), voicing duration (seconds), and cepstral peak prominence (dB) were impervious to phone distance and tilt. Study 2: Focusing on the three acoustic measures from study 1, we investigated the correspondence between acoustic measures attained with clinically available software (e.g., Praat) and those from our own lab-developed algorithms specialized for on-app processing. Preliminary results show strong relationships (r &amp;gt; .90) between the different processing techniques. Further work is needed to understand how participant-specific factors (age, dysphonia severity) may improve algorithm accuracy.

Tracking Occupational Voice State with a Visual Analog Scale: Voice Quality, Vocal Fatigue, and Effort.

Due to elevated vocal health risk in industries such as call centers, there is a need to have accessible and quick self-report tools for voice symptoms. This study aimed to determine if the concurrent and construct validity of three visual analog scales (VASs) of voice quality and symptoms could be used as a screening tool in call center agents. A cross-sectional study was carried out in three call center companies. The Voice Handicap Index-10 (VHI-10) and a vocal hygiene and symptoms survey were administered to 66 call center workers. Further, acoustic parameters including harmonics-to-noise ratio (HNR), smoothed cepstral peak prominence (CPPs), L1-L0 slope, and Alpha ratio were collected. Finally, workers completed three VASs capturing self-perception of vocal effort (VAS-1), voice quality (VAS-2), and vocal fatigue (VAS-3). Linear regression models with bootstrapping evaluated the possible relationship between the three VASs measurements, self-perceived vocal symptoms, and acoustic parameters. VAS-1 scores were associated with HNR and voice breaks, VAS-2 with voice breaks, and VAS-3 with Alpha ratio. Using the area under a receiver operating characteristic curve (AUC), the highest AUC for detecting an altered VHI-10 questionnaire score was observed for the three VASs. Also, the highest AUC for detecting altered CPPs was reached for the VAS-1. VAS as a self-report instrument of vocal symptoms is related to psychosocial voice impairment and alterations of acoustic voice parameters in call center workers. Such instruments could be easily implemented to identify voice complaints in these populations. 2 (Diagnosis research question) Laryngoscope, 133:1676-1682, 2023.

Voice Quality of Choir Singers and the Effect of a Performance on the Voice

The voice use of choir singers is understudied despite the imbalance of high vocal demands versus low vocal education, and consequently increased risk for voice problems. Also, there is a lack of information on the effects of a performance on choristers' voices. Available studies included performances of at least one hour. To date, no studies investigated the effects of a choir performance with a duration resembling vocal warm-ups. The first purpose of this study was to determine the voice quality, capacities, symptoms and voice-related quality of life of choir singers. Secondly, the effect of a short choir performance, resembling warm-up duration (15 minutes), on the choristers' voices was investigated. A randomized controlled trial was used. Thirty adult choir singers (25 women, 5 men; mean age: 32 years) were assigned randomly to an experimental group or a control group. Participants in the experimental group sung in choir for 15 minutes immediately after their pre voice assessment, whereas the control group was instructed to have standard voice use (one-on-one conversation with the investigator, no singing) across that time span. A second voice assessment was repeated afterwards. The choir singers showed excellent voice quality and capacities with mean scores on the Dysphonia Severity Index and Acoustic Voice Quality Index of 7.5 and 2.0, respectively. Auditory-perceptually, the mean grade score was 5/100 corresponding with a normal to mildly deviant voice quality. Patient-reported outcome measures showed mean deviant scores, indicating a considerable singing voice handicap. The choir singers seem vulnerable for stress with a high occurrence rate of 76.7% (23/30). Compared with the control group, the Dysphonia Severity Index significantly improved, whereas the self-perceived presence of vocal fatigue and complaints increased after 15 minutes of choir singing. Fundamental frequency increased in both groups, being more outspoken in the experimental group. Choir singers show excellent voice quality and capacities, that further improve after a short choir performance of 15 minutes. Vocal fatigue and complaints, on the other hand, already increased after that short time span. Realizing that vocal load is much higher in real-life rehearsals, competitions and performances, choristers deserve and need a qualitative voice training and a strict follow-up. Future research should focus on effective vocal warm-up and cool-down programs for this population.

Acoustic Voice Measures in Benign Mass Lesions

Objectives: The present study aims to compare acoustic voice parameters in patients with vocal cord nodules, polyps, and normal subjects. Methods: In this cross-sectional case-control study, the participants were selected by convenience sampling, including 30 patients with vocal polyps for the first group, 38 patients with vocal nodules for the second group, and 42 participants without voice pathologies as the control group. For each group, participants were examined by a speech and language pathologist (SLP) using an Endo-vision laryngoscope. Acoustic voice parameters were measured by MDVP software in Visi-Pitch; then, these parameters were compared in groups in terms of sex. Results: Three groups showed significant differences in terms of fundamental frequency (P&lt;0.001), jitter (P&lt;0.001), shimmer (P&lt;0.001), and noise-to-harmonic ratio (NHR) values (P&lt;0.001). Women in three groups had the substantial differences in terms of fundamental frequency (P&lt;0.001), jitter (P&lt;0.001), shimmer (P&lt;0.001), and NHR (P&lt;0.001). For men, the three groups showed a significant difference for jitter (P&lt;0.001) and shimmer (P=0.001), but for NHR (P=024), and fundamental frequency (P=0.93) no signification difference were observed. Discussion: It seems that the existence of benign mass lesions, such as vocal cord nodules and polyps affects the acoustic parameters of the voice. The measurement of acoustic voice parameters may help us to differentiate between the voices of normal people and patients with vocal cord nodules and polyps as a supplementary assessment in clinical procedures.

Profiles and predictors of onset based differences in vocal characteristics of adults with auditory neuropathy spectrum disorder (ANSD)

PurposeOnset-based differences are understudied in Auditory Neuropathy Spectrum Disorder (ANSD) in dimensions such as voice, which is addressed in the study. The study aimed to profile and predict the best metrics of onset-related differences in acoustic vocal characteristics of early and late-onset ANSD patients. Methods31 participants (15 early and 16 late-onset) aged 15–30 years diagnosed with ANSD were included in the study. The sustained phonation of vowel /i/ recorded by the participants using android based smartphones of selected configuration was sent over email to the experimenter. Acoustic parameters (fundamental frequency, harmonic frequencies, jitter, shimmer, harmonic-to-noise ratio, cepstral peak prominence -CPP, and pitch sigma) were analysed using Praat software. ResultsResults revealed significantly increased (p < 0.05) fundamental frequency along with decreased F2 and F3 of /i/ in the early-onset ANSD compared to the late-onset group, which can be explained based on differences in the pathophysiology of the disorder. Although not statistically significant, mean perturbations (jitter and shimmer), harmonic-to-noise ratio, cepstral peak prominence, and pitch sigma were more affected in the early-onset group, reflective of lowered auditory feedback and periodicity in their voice samples. Results of discriminant analysis marked the emergence of F2, F3, and CPP as the most sensitive metrics for onset-based group differences in voice characteristics. ConclusionsThe findings from the study highlight the role of acoustical voice evaluation (especially CPP, F2 & F3) in verifying the onset of ANSD disorder. The insights from the onset-based differences seen in vocal characteristics can indirectly help audiologists in deciding the management options for ANSD.

An iOS-based VoiceScreen application: feasibility for use in clinical settings-a pilot study.

To elaborate the application suitable for smartphones for estimation of Acoustic Voice Quality Index (AVQI) and evaluate its usability in the clinical setting. An elaborated AVQI automatization and background noise monitoring functions were implemented into a mobile "VoiceScreen" application running the iOS operating system. A study group consisted of 103 adult individuals with normal voices (n = 30) and 73 patients with pathological voices. Voice recordings were performed in the clinical setting with "VoiceScreen" app using iPhone 8 microphones. Voices of 30 patients were recorded before and 1month after phonosurgical intervention. To evaluate the diagnostic accuracy differentiating normal and pathological voice, the receiver-operating characteristic statistics, i.e., area under the curve (AUC), sensitivity and specificity, and correct classification rate (CCR) were used. A high level of precision of AVQI in discriminating between normal and dysphonic voices was yielded with corresponding AUC = 0.937. The AVQI cutoff score of 3.4 demonstrated a sensitivity of 86.3% and specificity of 95.6% with a CCR of 89.2%. The preoperative mean value of the AVQI [6.01(SD 2.39)] in the post-phonosurgical follow-up group decreased to 2.00 (SD 1.08). No statistically significant differences (p = 0.216) between AVQI measurements in a normal voice and 1-month follow-up after phonosurgery groups were revealed. The "VoiceScreen" app represents an accurate and robust tool for voice quality measurement and demonstrates the potential to be used in clinical settings as a sensitive measure of voice changes across phonosurgical treatment outcomes.

The Effect of Platelet-Rich Plasma Injection on Short Term Vocal Outcomes Following Phonosurgery-A Pilot Study.

Background and Objectives: The efficiency and optimal voice rest period following phonosurgery remains debatable. Platelet-rich plasma (PRP) is a safe and cheap alternative to many bioactive agents being studied on animal models, and is already in use in many medical areas. We investigate the short-term effects of PRP and voice rest on voice outcomes following phonosurgery as an alternative to voice rest alone. Materials and Methods: A prospective single-blinded pilot study was conducted. Sixteen patients with a diagnosis of vocal fold cyst and polyps were included, forming equal groups (PRP and voice rest vs. voice rest alone). Voice analysis was carried out on the preoperative day, day three, and week three following surgery. The measured parameters were fundamental frequency (F0), noise–signal ratio (NSR), harmonic poverty (HP), attack alteration (AL), pitch instability (PI), and amplitude instability (AI).VHI(Voice Handicap Index)-30 questionnaires were carried out before surgery and three weeks following surgery to assess the impact of subjective voice change on quality of life. PRP was obtained using commercial kits with separator gel. Results: An average 3.68-fold increase in platelets was obtained with PRP. No side effects were noted after injection. All voice parameters improved on day three and week three following surgery. Statistical significance was noted only in the fundamental frequency of male patients (p = 0.048) in favor of the PRP-voice rest group. In addition, the VHI- 30 questionnaire results between preoperative and postoperative assessments showed statistically significant differences in total VHI score (p = 0.02) as well as the physical (p = 0.05) and emotional (p = 0.02) scale in favor of the PRP-voice rest group. Conclusions: PRP presents short term safety in patients who undergo phonosurgery, although long-term outcomes are unknown. PRP and voice rest are superior to voice rest alone when considering subjective assessment of the voice. When analyzing acoustic parameters, PRP and voice rest are not superior to voice rest alone.

VOICE PROFILING IN YOUNGSTERS FOLLOWING CLUB PARTY

Introduction. Club parties are becoming very common among youngsters at present days. They tend to shout, yell, scream and indulge in other vocally abusive behaviors beyond their vocal range and for a long period during club parties. Vocal abuse in presence of high background noise with poor vocal hygiene and various other environmental factors have a disastrous effect on one's voice. The present study aimed to show and correlate theObjective. effect of vocal abuse (during vocally demanding situations like club parties) on the perceptual and objective vocal features of youngsters. This study included a total of 20 youngsters with equal gender distribution, age range 18-23 years.Methodology. Pre-test and post-test research designs were applied. Perceptual scales such as GRBAS, Video laryngoscopic examination(otopront 1CCD), and Acoustic voice analysis (CSL-4500) were used for all the candidates. Appropriate statistic analysis was done for the values obtained to measure and compare pre and post-club-party effects on samples. TheResult. post-party effect represented vocal effects on the GRBAS scale, VLS examination, and acoustic values on CSL. However, changes that were more prominent and statistically signicant for Females (P&lt;0.05- SPI, jitter, shimmer, APQ) may be due to laryngeal precipitating factors in female vocal cords. Changes in vocal margins were evident on VLS examination with are correlated with CSL. However, the non-signicance on a few parameters was also found, concluding that few parameters were less suspectable to the temporary effects on vocal function. Youngsters who shout very loudly during club partiesConclusion. have throat pain, hoarseness, and breathiness following the party in our present study. Females have more prominent changes as compared to boys may be due to boys having more hyaluronic acid which prevents vocal folds from scarring. However, any signicant changes are not reported in just one day of exposure but if such a situation persists it may lead to permanent change altering their vocal range. It is thought that attending club parties once in a while may not be altering vocal symptoms but youngsters must abstain from continuing such activities in the long run, to avoid permanent vocal pathologies. Meanwhile, youngsters should follow vocal hygiene to avoid such vocal conditions.

Endoscopic treatment of anterior laryngeal web using keel designed from ePTFE followed by voice therapy: a refined technique

BackgroundTreatment of laryngeal web is challenging due to possibility of recurrence and affected voice quality. Optimal treatment of laryngeal web should emphasize on improving both airway and vocal function. We refined the traditional endoscopic method using a new keel designed from expanded polytetrafluoroethylene (ePTFE) membrane. Our objective is to evaluate the voice outcomes following the endoscopic treatment and voice therapy.ResultsTen subjects presented with anterior laryngeal web. Auditory perceptual assessment, stroboscopic examination and acoustic studies were performed pre- and postoperatively. Endoscopic excision of laryngeal web was performed with cold instruments. An individually designed ePTFE keel was fixed by Nylon thread 2–0 at the anterior commissure and tied subcutaneously in the neck. The keel left for 3–5 weeks followed by voice therapy using abdomino-diaphragmatic breathing exercise and relaxation method. Vocal parameters measured were perceptual voice quality using Grade-Roughness-Breathiness-Asthenia-Strain voice scale (GRBAS), stroboscopic score, fundamental frequency (F0), jitter, shimmer, pitch perturbation question (PPQ), amplitude perturbation question (APQ) and harmonics-to-noise ratio (HNR). Significant decrease in GRBAS (P < 0.001) and significant increase in stroboscopic scores (P < 0.001) were noticed after operation and voice therapy. Also, acoustic voice parameters showed significant improvements. The mean jitter, shimmer, PPQ and APQ showed significant decrease (p = 0.0028, 0.0032, 0.0026, 0.0014, and 0.006 respectively). Overall, 90 % of our subjects have satisfactory voice outcome.ConclusionEndoscopic excision of anterior laryngeal with cold instrument followed by ePTFE keel fixation achieved good long-term voice results. The ePTFE is soft biocompatible material which does not make reaction. The keel should be left in place for sufficient period of time (3–5 weeks). This ensures perfect healing with less or no recurrence. Absence of foreign body reactions in the vocal folds is important for mucosal integrity and good voice outcome. So, the ePTFE could be good alternative for laryngeal keel. Hyperfunctional dysphonia with ventricular hypertrophy may develop in longstanding anterior laryngeal web which needs intensive voice therapy after operation. Our treatment targeted both the organic etiology of dysphonia and the underlying cause of the possible associated functional element of dysphonia.

Linguistically Informed Acoustic and Perceptual Analysis of Bilingual Children's Speech Productions: An Exploratory Study in the Jamaican Context.

The aim of this study was to characterize speech acoustics in bilingual preschoolers who speak Jamaican Creole (JC) and English. We compared a standard approach with a culturally responsive approach for characterizing speech sound productions. Preschoolers' speech productions were compared to adult models from the same linguistic community as a means for providing confirmatory evidence of typical speech patterns specific to JC-English speakers. Two protocols were applied to the data collected using the Diagnostic Evaluation of Articulation and Phonology (DEAP) Articulation subtest: (a) the standardized DEAP protocol and (b) a culturally and linguistically adapted protocol reflective of the Jamaican post-Creole (English to Creole) continuum. The protocols were used to analyze responses from JC-English-speaking preschoolers (n = 119) and adults (n = 15). Responses were analyzed using acoustic (voice onset time, whole-word duration, and vowel duration) and perceptual (percentage of consonant correct-revised and response frequencies) measures. The culturally responsive protocol captured variation in the frequency and acoustic differences produced in the post-Creole continuum, with higher amounts of "other" responses compared to "standard" target responses for both children and adults. Adults' whole-word durations were shorter and showed more consistent prevoicing during initial plosives compared to the children. Applying culturally responsive methods, including knowledge of the variation produced in the post-Creole continuum and with adult models from the same linguistic community, improved the ecological validity of speech characterizations for JC-English preschoolers. Acoustic properties of speech should be investigated further as a means of describing bilingual development and distinguishing between difference and disorder. https://doi.org/10.23641/asha.20249382.

The effect of type 1 diabetes mellitus on voice in pediatric patients.

The aim of this prospective case-control study was to determine the effect on the voice of type 1 diabetes mellitus (T1DM) in paediatric patients. The study included patients aged 6-18years followed up for at least 1year because of T1DM, and a control group of age and gender-matched healthy volunteers. Following an Ear, Nose, and Throat (ENT) examination, all subjects underwent flexible endoscopic laryngeal examination. Fasting venous blood samples were taken in the morning for the examination of fasting blood glucose (FBG), HgbA1C, and kidney, liver, and thyroid function tests. Data were recorded from the patient files of age, gender, comorbidities, and the development of diabetes-related complications. Voice recordings were taken and the Voice Handicap Index (VHI)-10 form was completed. The patients and control group were compared in respect of the parameters of fundamental frequency, jitter, shimmer, and acoustic voice quality index (AVQI). Evaluation was made of 64 children and adolescents as 32 in the patient group (Group 1) and 32 healthy control subjects (Group 2). Group 1 comprised 17 females and 15 males with a mean age of 12.75 ± 3.23years. Group 2 comprised 17 females and 15 males with a mean age of 12.75 ± 3.33years. In Group 1, mean disease duration was 5.21 ± 3.17years (range, 1-13years), the FBG value was mean 216.6 ± 122.3mg/dl, mean HgbA1c was 10.7 ± 2.8, as ≤ 7 in 4 patients, 7-9 in 4, and > 9 in 24. Maximum phonation time (MPT) was determined as 10.66 ± 3.6 secs in Group 1 and 12.11 ± 4.43 in Group 2. VHI was determined as 2.33 ± 3 in Group 1 and 2.31 ± 2.77 in Group 2. No statistically significant difference was determined between the groups was determined in respect of acoustic analysis, perturbation parameters, AVQI and body mass index. This study is the first to have investigated the effects of T1DM on the voice in paediatric patients. The study results showed that the AVQI value was higher in the patient group but not to a statistically significant level. Therefore, there is a need for further studies with larger samples. The current study can be of guidance for further studies in this field.