Voice Quality In Children Research Articles

Analysis of Voice Quality in Children With Smith-Magenis Syndrome

The production of phonation involves very complex processes, linked to the physical, clinical, and emotional state of the speaker. Thus, in populations with neurological diseases, it is possible to find the imprint in the voice signal left by the deterioration of certain cortical areas or part of the neurocognitive mechanisms that are involved in speech. In previous works, the authors determined the relationship between the pathological characteristics of the voice of the speakers with Smith-Magenis syndrome (SMS) and a lower value in the Cepstral Peak Prominence (CPP) with respect to normative speakers. They also described the presence of subharmonics in their voices. ObjectivesThe present study aims to verify whether both characteristics can be used simultaneously to differentiate SMS voices from neurotypical voices. It will also be analyzed if there is variation in the trajectory of the formants coinciding with the subharmonics. MethodsTo do this, the effect of subharmonics in the voices of 12 SMS individuals was isolated to see if they were responsible for the lower CPP values. An evaluation of the CPP was also carried out in the areas of subharmonic presence, from the peak that reflected the value of f0, rather than using the most prominent peak. This offered us a baseline for the CPP value in the presence of subharmonics. It was checked if changes in the formants occurred synchronously to the appearance of those subharmonics. If so, the muscles that control the position of the jaw and tongue would be affected at the same time as the larynx. The latter was difficult to observe since the samples were very short. A comparison of phonatory performance of a sustained /a/ between a normotypical group and non-normotypical group of children was carried out. These groups were balanced and matched in age and gender. The Spanish Association of Smith-Magenis Syndrome (ASME) provides almost 20% of the population in Spain. ResultsThe CPP allows differentiating between normative speakers and those wit SMS, even when isolating the effect of subharmonics. ConclusionsThe CPP is a robust index for determining the degree of dysphonia. It makes possible to differentiate pathological voices from healthy voices even when subharmonics are present. The presence of subharmonics is a characteristic of voices of SMS individuals and is not present in healthy ones. Both indexes can be used simultaneously to differentiate SMS voices from neurotypical voices.

Impact of chronic rhinosinusitis on the laryngeal mucosa and voice quality in children aged from 6 to 18 years old

Impact of chronic rhinosinusitis on the laryngeal mucosa and voice quality in children aged from 6 to 18 years old

Developmental Changes in the Perception of Vocal Loudness and Voice Quality in 3- to 6-Year-Old Children.

The study's primary aim was to investigate developmental changes in the perception of vocal loudness and voice quality in children 3-6 years of age. A second aim was to evaluate a testing procedure-the intermodal preferential looking paradigm (IPLP)-for the study of voice perception in young children. Participants were categorized in two age groups: 3- to 4-year-olds and 5- to 6-year-olds. Children were tested remotely via a Zoom appointment and completed two perceptual tasks: (a) voice discrimination and (b) voice identification. Each task consisted of two tests: a vocal loudness test and a voice quality test. Children in the 5- to 6-year-old group were significantly more accurate than children in the 3- to 4-year-old group in discriminating and identifying differences between voices for both loudness and voice quality. The IPLP, used in the identification task, was found to successfully detect differences between the age groups for overall accuracy and for most of the sublevels of vocal loudness and voice quality. Results suggest that children's ability to discriminate and identify differences in vocal loudness and voice quality improves with age. Findings also support the use of the IPLP as a useful tool to study voice perception in young children.

Voice Quality of Children With Cerebral Palsy.

Purpose Many children with cerebral palsy (CP) are described as having altered vocal quality. The current study utilizes psychoacoustic measures, namely, low-amplitude (H1*-H2*) and high-amplitude (H1*-A2*) spectral tilt and cepstral peak prominence (CPP), to identify the vocal fold articulation characteristics in this population. Method Eight children with CP and eight typically developing (TD) peers produced vowel singletons [i, ɑ, u] and a story retell task with the same vowels in the words "beets, Bobby, boots." H1*-H2*, H1*-A2*, and CPP were extracted from each vowel. Results were analyzed with mixed linear models to identify the effect of Group (CP, TD), Task (vowel singleton, story retell), and Vowel [i, ɑ, u] on the dependent variables. Results Children with CP have lower spectral tilt values (H1*-H2* and H1*-A2*) and lower CPP values than their TD peers. For both groups, vowel singletons were associated with lower CPP values as compared to story retell. Finally, the vowel [ɑ] was associated with higher spectral tilt and higher CPP values as compared to [i, u]. Conclusions Children with CP have more constricted and creaky vocal quality due to lower spectral tilt and greater noise. Unlike adults, children demonstrate poorer vocal fold articulation when producing vowel singletons as compared to story retell. Finally, low vowels like [ɑ] seem to be produced with less constriction and noise as compared to high vowels.

Impact of Allergic Rhinitis on Voice in Children

Introduction: The purpose of the present study was to determine the possible effect of allergic rhinitis (AR) on voice change in children with acoustic analysis and Turkish children’s voice handicap index-10 (TR-CVHI-10). Methods: This is a case-control study. Forty-one children with AR, and a positive skin prick test, as well as 39 children of controls who had produced a negative skin prick test and lacked a history of allergic disease, were selected for the study. Each assessment included recordings for the purposes of acoustic voice analysis (fundamental frequency [f0], jitter %, shimmer %, and harmonics-to-noise ratio (HNR)), and aerodynamic analysis (maximum phonation time (MPT) and s/z ratio). All participants completed TR-CVHI-10. Results: The mean TR-CVHI-10 score of the AR group was significantly higher than the control group (p = 0.013). No difference was observed between the AR and control groups in terms of jitter, shimmer, HNR, and MPT values and s/z ratio (p > 0.05). Conversely, the f0 value was more pronounced in controls (270.9 ± 60.3 Hz) than in the AR group (237.7 ± 54.3 Hz) (p = 0.012). Conclusion: The study’s results revealed that AR can have an effect on fundamental frequency and voice quality in children. The diagnostic process should include AR as a potential cause of voice disorders in children.

Vocal quality of children with altered frenulum in the tongue

Children with a disordered lingual frenulum are said to be more prone to various difficulties in the development process. Although these children tend to present changes in chewing, swallowing and speech, it can be assumed that the voice is practically not focused, with few studies concerned on vocal function (Camargo et al, 2017, 2017a). With the aim of investigating voice quality in children with and without lingual frenulum disorder, 61 children were clinically evaluated regarding the characteristics of the lingual frenulum (Marchesan, 2012) and the perceptual judgments of voice quality in semi-spontaneous (audio) speech samples. Video samples of orofacial clinical examinations and semi-spontaneous (audio) speech samples were recorded in a soundproof room. 28 children presented altered lingual frenulum (19 boys and 09 girls) and 33 frenulum without alterations (20 boys and 13 girls). We adopted the phonetic description of voice quality model as the theoretical background (Laver, 1980) and the Vocal Profile Analysis Scheme – VPAS (Laver et al, 1981; adapted for brazilian portuguese: Camargo, Madureira, 2008) for perceptual data analysis. Voice quality settings regarding the position of lips, tongue (tip and body), jaw, pharyngeal cavity configuration and vocal tract muscle tension occurred in a greater proportion (in terms of number of the occurrences and the degree of manifestation) in children with lingual frenulum disorded. When observing the data differently by male and female subgroups, we estimate that the former accounted for most of the occurrences related to labiodentalization, retracted and lowered tongue body and pharyngeal constriction. In the girls' subgroup, pharyngeal constriction was also recurrent. With regard to our previous explorations on the topic (Camargo et al, 2017, 2017a), we were able to advance in terms of a broader understanding of children's voice quality profiles and, particularly, those related to congenital orofacial motricity limitations. The relationships between size and position of the hyoid bone in children with an altered frenulum of the tongue (Ardekani et al, 2016), especially the raised and posterior position of the hyoid bone and the posteriorization of the jaw compared to children without frenulum disorerss, seem to influence the voice quality findings reported in this study. The high incidence rates of dysphonia in childhood tend to make it difficult to associate the alterations of the lingual frenulum to phonatory settings, although they may, hypothetically, appear as aggravating factors for dysphonia.

The Others Are Too Loud! Children's Experiences and Thoughts Related to Voice, Noise, and Communication in Nordic Preschools.

BackgroundHigh noise levels affect hearing, voice use, and communication. Several studies have reported high noise levels in preschools and impaired voice quality in children. Noise and poor listening conditions impair speech comprehension in children more than in adults and even more for children with hearing or language impairment, attention deficits, or another first language.AimThe aim of this study was to explore how children in Finland, Sweden, and Iceland describe the preschool environment in relation to noise, voice, and verbal communication; what were their experiences, knowledge and ideas in relation to voice, noise, and communication. Children’s awareness of effects of noise, reactions, and coping strategies were also studied. In addition, country and gender differences were analyzed.MethodsEighteen Icelandic, 14 Finnish, and 16 Swedish children were interviewed using a common interview-guide. Swedish and Finnish children were interviewed in focus groups and Icelandic children individually. All interviews were transcribed verbatim and analyzed thematically by the native speaker. The interviews were translated to English to be re-analyzed for inter-judge reliability of identified themes. Inter-judge reliability was calculated using percentage absolute agreement.ResultsThe interviews resulted in 1052 utterances, 471 from focus groups, and 581 from individual interviews. Three themes were identified, Experiences, Environment, and Strategies with two to three subcategories. Inter-judge agreement for the themes was excellent, 92–98%. Experiences occurred in 55% of the utterances. The subcategories were bodily and emotional experiences and experiences of hearing and being heard. Environment occurred in 20% of the utterances, with subcategories indoor vs. outdoor and noise. Strategies was found in 15%, with subcategories games and problem oriented actions. The only significant difference between the countries was for the theme Strategies where the Swedish children produced more utterances than the Finnish. No gender differences were found.ConclusionChildren are aware of high noise levels and mainly blame other children for making noise and shouting. They describe reactions and strategies related to noise like impaired communication and effects on hearing but are less aware of effects on voice. Expressed thoughts were similar across countries. No gender differences were found.

Vocal Symptoms and Voice Quality in Children With Allergy and Asthma

The background for dysphonia is multifactorial, and health-related factors have been listed among the factors affecting voice. In previous studies with adult participants, allergy and asthma have been indicated to have a connection to vocal symptoms. With the majority of previous research being studies involving adult participants, it is unclear what the effect of allergy and asthma on children's voices is. The aim of this study was to investigate if allergies and asthma are risk factors for having vocal symptoms. The material was collected through paper questionnaires distributed to the parents of new pediatric patients at an allergy clinic. The participants were 108 children aged 9 months to 17 years and 1 month. Of the children whose parents had filled in the questions on vocal symptoms, 18.2% (n = 18) had frequently occurring vocal symptoms, which was defined as having two or more vocal symptoms every week or more often. The most common vocal symptoms were throat clearing and coughing. There was a significant connection between inhalant allergy and having frequently occurring vocal symptoms. The connection between cough that lasted for more than 4 weeks and having frequently occurring vocal symptoms was also significant. In this study, we found no significant connection between having an asthma diagnosis and having frequently occurring vocal symptoms. Based on the results of this study, voice screening for children with inhalant allergy would be advisable. Prolonged cough should be taken seriously and be treated, as the mechanical trauma caused by cough seems to have a connection to vocal symptoms.

Perception of breathiness in pediatric speakers

Extensive research has been done to determine acoustic metrics for voice quality. However, few studies have focused on voice quality in the pediatric population. Instead, metrics evaluated on adults have directly been applied to children’s voices. Some variables, such as pitch, that differ between adult and pediatric voices, have been shown to be critical in the perception of breathiness. Furthermore, it is not known whether adults perceive voice quality similarly for pediatric and adult speakers. In this experiment, 10 listeners judged breathiness for 28 stimuli using a single-variable matching task. The stimuli were modeled after four pediatric speakers and synthesized using a Klatt-synthesizer to have a wide range of aspiration noise and open quotient. Both of these variables have been shown to influence the perception of breathiness. The resulting data were compared to that previously obtained for adult speakers using the same matching task. Comparison of adult and pediatric voices will help identify differences in the perception of breathiness for these groups of speakers and to develop more accurate metrics for voice quality in children. [Research supported by NIH (R01 DC009029).]

Reflux in Children and Its Effects on Assessment and Management of Voice Disorders From a Speech-Language Pathologist's Perspective

Voice disorders in the pediatric population are common, but have been understudied. Inflammation, trauma, and neurologic and congenital anomalies all can result in childhood dysphonia. Laryngopharyngeal reflux, an extraesophageal variation of gastroesophageal reflux, has been associated with laryngeal symptoms of dysphonia, globus sensation, throat clearing, and chronic cough in children. This article reviews the current evaluation and treatment techniques of reflux and the effects of laryngopharyngeal reflux on voice quality in children. A case study illustrates the importance of treating laryngeal inflammation to achieve an accurate diagnosis.

Quality of Life and Voice Outcomes after Thyroid Ala Graft Laryngotracheal Reconstruction in Young Children

(1) To assess the long-term impact of thyroid ala cartilage laryngotracheal reconstruction (TAC-LTR) on health-related quality of life (QOL) in infants using 4 validated instruments: Health Utility Index version 3 (HUI3), Pediatric Voice-Related QOL (PVRQOL), Impact on Family Questionnaire, and a visual analog scale and (2) to perform acoustic and perceptual voice assessments to evaluate longterm voice quality outcomes. Prospective study. Tertiary academic pediatric hospital. Eligible children who received TAC-LTR before the age of 24 months between 1995 and 2007. Interviews with parents and children using 4 validated instruments, voice analyses, and endoscopic evaluation were performed. Twelve patients (7 male, 5 female, median age 10 years) were enrolled over a 6-month period. The mean age at LTR was 5 months (range, 1-20 months), and the mean study followup period was 9 years (range, 2-14 years). The average speech HUI3, PVRQOL, and Impact on Family scores were 0.83 (95% confidence interval = 0.74, 0.92), 0.93 (interquartile range [IQR] = 0.81, 1.00), and 0.65 (IQR = 0.54, 0.92), respectively. All acoustic scores were either normal or mildly abnormal for the variables jitter, shimmer, noise-to-harmonic ratio, peak amplitude variation, and fundamental frequency. The Consensus Auditory-Perceptual Evaluation of Voice overall severity score was in the normal to mildly abnormal range for 8 of 9 patients. This is the first study to explore and quantify longterm QOL and voice quality in children following LTR with thyroid ala graft at a very young age. Most patients had very good functional voice outcome as evidenced by the HUI3 and PVRQOL scores. This was corroborated by acoustic and perceptual voice assessments.

Correlation of Vocal Fold Nodule Size in Children and Perceptual Assessment of Voice Quality

We examined the relationship between the size of vocal fold nodules and perceptual rating of voice quality in children. We carried out an Institutional Review Board-approved retrospective study in a voice clinic within a tertiary-care pediatric medical center. We studied children seen between 2000 and 2009 with a primary diagnosis of vocal fold nodules as the cause of their voice disturbance. Pediatric vocal fold nodule size was rated with a published validated scale, and voice quality was rated on the Consensus Auditory-Perceptual Evaluation of Voice scale. One hundred forty-five patients met the inclusion criteria. Small nodules were noted in 23% of patients, medium nodules in 39%, and large nodules in 37%. Univariate and multivariate analyses demonstrated a statistically significant relationship (p < 0.05) between vocal fold nodule size and rated perceptual qualities of overall severity of voice disturbance, roughness, strain, pitch, and loudness. With the exception of loudness, as vocal fold nodule size increased, the mean value of perceptual characteristics became larger. The age of the patient was a significant factor associated with the overall severity of the voice disturbance and roughness. The overall severity of a child's voice disturbance and qualities of roughness, strain, pitch, and loudness have a strong correlational relationship with pediatric vocal fold nodule size, which is suggestive of causality.

Evaluation and Treatment of Pediatric Gastroesophageal Reflux and Its Effects on Voice

AbstractVoice disorders in the pediatric population are common, but have been understudied. Inflammation, trauma, neurologic, and congenital anomalies can all result in childhood dysphonia. Laryngopharyngeal reflux, an extra-esophageal variation of gastroesophageal reflux, has been associated with laryngeal symptoms of dysphonia, globus sensation, throat-clearing, and chronic cough in children. This article reviews the current evaluation and treatment techniques of reflux, and the effects of laryngopharyngeal reflux on voice quality in children. A case study illustrating the importance of a multidisciplinary approach in diagnosing and treating this challenging disorder is presented.

The voice quality of children after being treated for glottic and subglottic stenosis

The voice quality of children after being treated for glottic and subglottic stenosis

The impact of gender and age on voice related quality of life in children: Normative data

Although several instruments are available to measure voice quality in children, their application to a normal population and major demographic subgroups has not been described. It is hypothesized that there is no measurable difference in self-reported voice related quality of life between gender and age groups within a population of normal children as measured by the Pediatric Voice-Related Quality of Life (PVRQOL) instrument. The PVRQOL instrument was used to prospectively survey a cohort of children in series at the Wisconsin State Fair. PVRQOL scores may range from 0 (complete dysfunction) to 100 (no dysfunction). Comparisons were made between age and gender groups in order to test the null hypothesis. Of the 100 surveys completed by parents of children, 93 were performed correctly and had evaluable data (age range 2-17 years, mean 9.8). The mean PVRQOL score was 97.0+/-5.6. There was no difference between females and males (97.5+/-5.83 versus 96.5+/-5.3, p>0.05, unpaired t-test); however, within the pre-pubescent school age subjects, a diminished PVRQOL was reported for boys (95.5+/-6.37) as compared to girls (98.5+/-3.10, p<0.05, unpaired t-test). Further subgroup analysis revealed no significant difference (p>0.05) between age groups or gender. Amongst a random group of children without voice complaints queried outside of a medical center, self-reported PVRQOL showed no significant dysfunction. This is the first report of gender and age-specific normative PVRQOL data in children. A score of 86 or greater on the PVRQOL instrument represents a normal voice related quality of life.

A case study of the speech, language and vocal skills of a set of monozygous twin girls: one twin with a cochlear implant

This case study reports on the speech, language and vocal skills of a set of monozygous twin girls; one with a pre-lingual hearing impairment and subsequent cochlear implant, the other with functionally normal hearing. The twins' skills were analysed and compared on two occasions over a seven-month period. Results from standardized assessments indicate that the speech-production and language skills of both girls were within normal limits, although analysis of their pragmatic, syntactic and discourse skills indicated that the implanted twin had some persisting difficulties. Analysis of the voice of the implanted twin indicated qualitative and quantitative abnormalities. The results suggest the need for an investigation into the voice quality of children with cochlear implants. The study also indicates the importance of early intervention and the potential benefit of early implantation and/or signing pre-implant.

A case study of the speech, language and vocal skills of a set of monozygous twin girls: one twin with a cochlear implant

This case study reports on the speech, language and vocal skills of a set of monozygous twin girls; one with a pre-lingual hearing impairment and subsequent cochlear implant, the other with functionally normal hearing. The twins' skills were analysed and compared on two occasions over a seven-month period. Results from standardized assessments indicate that the speech-production and language skills of both girls were within normal limits, although analysis of their pragmatic, syntactic and discourse skills indicated that the implanted twin had some persisting difficulties. Analysis of the voice of the implanted twin indicated qualitative and quantitative abnormalities. The results suggest the need for an investigation into the voice quality of children with cochlear implants. The study also indicates the importance of early intervention and the potential benefit of early implantation and/or signing pre-implant.