Voice Range Profile Research Articles

Register transitions in an in vivo canine model as a function of intrinsic laryngeal muscle stimulation, fundamental frequency, and sound pressure level.

Phonatory instabilities and involuntary register transitions can occur during singing. However, little is known regarding the mechanisms which govern such transitions. To investigate this phenomenon, we systematically varied laryngeal muscle activation and airflow in an in vivo canine larynx model during phonation. We calculated voice range profiles showing average nerve activations for all combinations of fundamental frequency (F0) and sound pressure level (SPL). Further, we determined closed-quotient (CQ) and minimum-posterior-area (MPA) based on high-speed video recordings. While different combinations of muscle activation favored different combinations of F0 and SPL, in the investigated larynx there was a consistent region of instability at about 400 Hz which essentially precluded phonation. An explanation for this region may be a larynx specific coupling between sound source and subglottal tract or an effect based purely on larynx morphology. Register transitions crossed this region, with different combinations of cricothyroid and thyroarytenoid muscle (TA) activation stabilizing higher or lower neighboring frequencies. Observed patterns in CQ and MPA dependent on TA activation reproduced patterns found in singers in previous work. Lack of control of TA stimulation may result in phonation instabilities, and enhanced control of TA stimulation may help to avoid involuntary register transitions, especially in the singing voice.

Quantifying Vocal Repertoire Tessituras Through Real-Time Measures.

Voice teachers use anecdotal evidence and experience in determining the appropriateness of repertoire for each student's development. Tessitura is important in that determination, but until recently a straightforward, repeatable, and quantifiable method for determining tessitura has not existed. However, technology exists to provide the means to estimate the tessituras of standard vocal repertoire by measuring sung pitch (fundamental frequency) and vocal dose (amount of phonation) in real-time performance. The purpose of this study was to examine the combined use of tessituragrams, Voice Range Profiles (VRPs), a singer's self-perception of a performance, and expert listeners perception of a performance towards the goal of a more systematic way of selecting appropriate voice repertoire for singers. The following research questions guided this investigation: 1) How do Performance Range Profiles (PRPs, performance-based tessituragrams computed from neck skin surface vibration during singing), compare to score-based tessituragrams of the same selection in the same key? 2) How do PRPs of the same vocal score compare when performed in three different keys? 3) How do singer VRPs compare with PRPs of three performances of a score, each sung in a different key? and 4) How do singer and expert panel perceptions of the selection's "fit" in three different keys compare with the alignment of each singer's VRP to their PRPs? Four female singers and five expert voice pedagogues were enlisted to address these questions. The distribution (histogram) of the score-based tessituragram closely matched the distribution of performance-based tessituragrams (PRP), suggesting that score-based tessituragrams have promise in accurately reflecting the performance-based tessitura of a musical vocal work. Acquired data revealed relationships of practical importance between score-derived tessituragrams, PRPs, acquired VRPs, and singer perceptions of ease in singing. These data suggest that score-based tessituragrams aligned with singer VRPs show promise in repertoire selection. However, there was only a minor relationship between expert panel perceptions of ease in singing and the acquired PRPs or singer perceptions of ease. Creation of a score-based tessituragram database could be combined with singer VRPs to assist in appropriate repertoire selection.

The Impact of Omega-3 Polyunsaturated Fatty Acid Supplementation on Singing Training in Vocal Performers: A Non-Randomized Double-Blind Placebo-Controlled Study

Introduction: Vocal performers often seek natural treatments to improve their vocal capability. Omega-3 polyunsaturated fatty acid (PUFA) supplementation may reduce inflammation and cause changes in body composition, such as loss of fat mass. The purpose of this study was to determine if omega-3 PUFA supplementation in combination with a singer’s training regimen enhances singing training and body composition. Methods: This was a non-randomized, double-blind, placebo-controlled trial. Forty-three college-level students were recruited and volunteered to serve as study participants. 3.0 g of omega-3 PUFA per day or 3.0 g of placebo per day were provided over a 10-week intervention. Participants completed Singing Voice Handicap Index (SVHI), Reflux Symptom Index (RSI), Evaluation of Ability to Sing Easily (EASE), Voice Range Profile (VRP), food records, and body composition measures at baseline and study end. Results: Thirty-five participants completed the study. SVHI was significantly different between groups (p = 0.0152; ƞ2 = 0.153). A minor third was added to the bottom of the range in 50% of males in the supplement group (placebo = 0%). Body composition measures were not statistically significant, although those in the supplement group lost more fat mass than placebo, p = 0.101. Discussion/Conclusion: Omega-3 PUFA supplementation may be beneficial to improve how active singers feel about their voice and could potentially improve voice range in conjunction with voice lessons; however, more research is necessary to confirm the latter.

Analysis of the Outcomes of Immediate Recurrent Laryngeal Nerve Reconstruction During Thyroid Surgery for Prevention of Vocal Fold Paralysis

Recurrent laryngeal nerve (RLN) injury and the resulting paralysis is the most common and known complicationof thyroid surgery. Several surgical techniques, such as medialization thyroplasty with or without arytenoid adduction and injection laryngoplasty, have been developed to treat RLN injury, but these procedures have specific limitations and complications. In this study, we present the outcomes for our patients who underwent immediate RLN reconstruction during thyroid surgery by analyzing both subjective and objective outcomes. A retrospective study was conducted for patients who underwent total or subtotal thyroidectomy between May 2012 and March 2020. Among them, patients who underwent immediate RLN reconstruction due to unilateral RLN injury were followed for at least 12 months. The voice perceptual evaluation, acoustic analysis, voice range profile, and Voice Handicap Index (VHI) scores were obtained preoperatively, 1 month, 6 months, and 12 months after surgery. Among the 11 patients, 6 patients (54.5%) underwent direct anastomosis, and 5 patients (45.5%) underwent nerve grafts using ansa cervicalis and great auricular nerve. The grade and breathiness in the GRBAS (grade, roughness, breathiness, asthenia, and strain) scale and jitter item showed significant improvement at 12 months postoperatively, and although not statistically significant, the rest of the items also tended to improve. The total, functional, and physical scores on VHI improved significantly at 12 months postoperatively. Moreover, when comparing the voice analysis of the direct anastomosis group and the nerve graft group, there was no significant difference between the groups in objective and subjective results. Immediate RLN reconstruction demonstrated significant voice improvement postoperatively, and reconstructing the nerve immediately and combining follow-up treatment in the event of RLN injury will greatly help patients improve their long-term voice outcomes.

Funkční hodnocení laryngoskopického vyšetření a souvislost s kvalitou hlasu a parametry hlasového pole

Summary Introduction: Previous laryngoscopy evaluation protocols have mostly focused on assessment of glottal status and morphological description of vocal folds’ shape and oscillations. The basic functional manifestations of laryngeal use, according to new protocols, include a description of supraglottic laryngeal activity. Methods: Laryngoscopic evaluation was performed as a perceptual test, performed online, using a web-based application. The degree and type of glottal insufficiency and the degree of anterior, posterior compression and lateral-medial (L-M) compression separately for each side were evaluated by a total of 15 respondents in a total of 26 video recordings of laryngoscopic examinations. In addition, the correlations between listening evaluations of the voice using modified GRBAS scales and voice range profile parameters were investigated. Results: The ratings of the laryngoscopic scales had well to excellent agreement. Agreement for type of insufficiency was just moderate. The associated ratings of L-M compression on the right and left sides showed correlations. For listening evaluation, medial compression was found to be related to the perception of habitual voice strain, and to strain and instability in the pitch range of the change of registers of the singing voice. Degree of insufficiency predicted less fullness of habitual voice in general but was also related to vocal dyspnea and weakness when calling. At the same time, it was largely responsible for the deterioration of the quality of the singing voice. Medial compression systematically reduced pitch range and the area of the voice range profile. Conclusion: The results of the perceptual evaluation can be used in further education. On their basis, didactic material for training the assessment of supraglottic laryngeal activity was prepared and published in the form of an online tutorial. The degree of insufficiency generally affects various characteristics of the speaking and singing voice. Medial compression systematically affects only the strain of the speaking voice, while in the singing voice it accentuates the strain and instability of the transitional region between registers and impairs the production of high pitches. Key words laryngoscopy – visual evaluation – voice range profile – GRBAS

Associations of Personality, Physical and Mental Health with Voice Range Profiles

There is evidence in the literature that voice characteristics are linked to mental and physical health. The aim of this explorative study was to determine associations between voice parameters measured by a voice range profile (VRP) and personality, mental and physical health. Cross-sectional population-based study. As part of the LIFE-Adult-Study, 2639 individuals aged 18-80 years, randomly sampled from the general population, completed both speaking and singing voice tasks and answered questionnaires on depression, anxiety, life satisfaction, personality and quality of life. The voice parameters used were fundamental frequency, sound pressure level, their ranges and maximum phonation time. The associations were examined with the help of correlation and regression analyses. Wider ranges between the lowest and highest frequency, between the lowest and highest sound pressure level and longer maximum phonation time were significantly correlated with extraversion and quality of life in both sexes, as well as openness and agreeableness in women. Smaller ranges and shorter maximum phonation time were significantly correlated with depression. Neuroticism in men was inversely correlated with the maximum phonation time. In the speaking VRP, the associations for sound pressure level were more pronounced than for the fundamental frequency. The same was true in reverse for the singing VRP. Few associations were found for anxiety, life satisfaction and conscientiousness. Weak associations between voice parameters derived from the VRP and mental and physical health, as well as personality were seen in this exploratory study. The results indicate that the VRP measurements in a clinical context are not significantly affected by these parameters and thus are a robust measurement method for voice parameters.

Passaggio on chorists' voice range profile: preliminary study of frequency and intensity.

To analyze the passaggio in the voice range profile of choristers, by identifying the fundamental frequencies and intensities, both in the change to the high and low registers, comparing them, by voice types. 67 choristers participated, mean age of 27.79 (± 7.50) years old, of the following voice types: soprano (n = 20), alto (n = 17), tenor (n = 15) and bass (n = 15). For data collection and analysis, the Vocalgram software (CTS Informática) was used, which recorded the emission of the vowel / Ɛ / in ascending and descending glissando, up to the lowest and highest note in the weakest and strongest intensities possible. The values of frequencies and respective intensities of the passaggio were identified in ascending and descending, strong and weak emissions in all voice types. There was a higher occurrence of voice break in the high voices, compared to the low ones. The average values ​​of the frequencies found corresponded to different tones from those established in the literature for all voice types. The passaggio identified in the vocal range profile of choristers, based on their frequencies and intensities were more frequent in soprano na tenor, compared to alto and bass, in changes to the low and high registers.

Nota de passagem no perfil de extensão vocal de coristas: estudo preliminar de frequência e intensidade

ABSTRACT Purpose To analyze the passaggio in the voice range profile of choristers, by identifying the fundamental frequencies and intensities, both in the change to the high and low registers, comparing them, by voice types. Method 67 choristers participated, mean age of 27.79 (± 7.50) years old, of the following voice types: soprano (n = 20), alto (n = 17), tenor (n = 15) and bass (n = 15). For data collection and analysis, the Vocalgram software (CTS Informática) was used, which recorded the emission of the vowel / Ɛ / in ascending and descending glissando, up to the lowest and highest note in the weakest and strongest intensities possible. Results The values of frequencies and respective intensities of the passaggio were identified in ascending and descending, strong and weak emissions in all voice types. There was a higher occurrence of voice break in the high voices, compared to the low ones. The average values of the frequencies found corresponded to different tones from those established in the literature for all voice types. Conclusion The passaggio identified in the vocal range profile of choristers, based on their frequencies and intensities were more frequent in soprano na tenor, compared to alto and bass, in changes to the low and high registers.

음성장애 성인 여성과 정상음성 성인 여성 간 진성구와 가성구의 음성범위프로파일 비교*

This study compared voice range profiles (VRPs) of modal and falsetto register in 53 dysphonic and 53 non-dysphonic adult women with gliding vowel /a/’. The results shows that maximum fundamental frequency (F0_MAX), maximum intensity (I_MAX), F0 range (F0_RANGE), and intensity range (I_RANGE) are lower in the dysphonic group than in the non-dysphonic group. F0_MAX and F0_RANGE are significantly higher in falsetto register than modal register in both groups. I_MAX and I_RANGE are significantly higher in falsetto register in the non-dysphonic group, but those are not different between two registers in the dysphonic group. There was no statistically significant difference in minimum F0 (F0_MIN) and minimum intensity (I_MIN) between the two groups. Modal-falsetto register transition occurred at 378.86 Hz (F4#) in the dysphonic group and 557.79 Hz (C5#) in the non-dysphonic group, which was significantly lower in the dysphonic group. It can be seen that both modal and falsetto registers in dysphonic adult women are reduced compared to non-dysphoinc adult women, indicating that the vocal folds of dysphonic adult women are not easy to vibrate in high pitches. The results of this study would be the basic data for understanding the acoustic features of voice disorders.

Multidimensional voice assessment after Lee Silverman Voice Therapy (LSVT®) in Parkinson's disease.

SUMMARYObjectiveTo investigate the effectiveness of Lee Silvermann Voice Treatment (LSVT®) in improving prosody in patients with Parkinson’s disease over medium-term follow-up.Methods15 patients with Parkinson’s disease were assessed before LSVT®, within one week, and 3 and 6 months after treatment. Subjective and objective evaluation included: Voice Handicap Index - 10 (VHI-10), perceptual assessment by GRBAS scale and item 18 of the Unified Parkinson’s Disease Rating Scale III (UPDRS III), maximum phonation time (MPT /s/) and acoustic analysis by means the Voice Range Profile (VRP) and the “Intonation Stimulability Protocol” of the Motor Speech Profile (MSP).ResultsA significant increase of the mean values of Imax and rF0 was observed until 6 months post-therapy (p < 0.001), whereas Running Speech Standard Deviation (rSTD) (p = 0.004), Amplitude Variability (rVAm) (p = 0.02) and Frequency Variability (rvF0) (p = 0-01) improved significantly after 3 months, but returned to pre-therapy levels after 6 months. The score of item 18 of the UPDRS III increased significantly early post-therapy (p = 0.03), but did not maintain the improvement at 3 and 6 months. Median values of Grade (G), Asthenia (A) and mean values VHI-10 score significantly decreased at each post-therapy control (p < 0.05).ConclusionsIn addition to the subjective and perceptual beneficial effect of LSVT®, we found a long-lasting increase of loudness and fundamental frequency. There was also improvement of acoustic parameters related to prosody, although it was temporary.

The Effect of Semi-Occluded Vocal Tract Exercise (SOVTE) and Traditional Vocal Warm-up (TVW) on the Vocal Quality of Untrained Female Singers in Malaysia: A Comparison

Vocal warm-up has garnered much research attention these recent years. This study compared the short-term effects of straw phonation (SP) with a traditional vocal warm-up (TVW) on the vocal quality of untrained female singers. It also determined the effect of exercise type on the vocal economy and skill acquisition. Vocal quality was measured using voice range profile (VRP), multi-parametric index, acoustic, and aerodynamic parameters. Eighty participants were randomly recruited and divided into two equal groups to perform vocal warm-ups at a frequency of two 10-minute sessions per day for three weeks. Voice data were collected using Praat and Vocalgrama software, while the statistical results were analysed using Statistical Product and Service Solution (SPSS). As a result, some parameters, i.e., fundamental frequency maximum (F0-max), maximum intensity (max Int) and area of VRP, fundamental frequency (F0), jitter, shimmer, harmonics-to-noise ratio (HNR), and dysphonia severity index (DSI), projected significant changes after three weeks of warming up exercise in TVW group. In the SP group, the participants experienced significant changes in max Int and area of VRP only. Both groups did not exert significant changes to min Int, which indirectly measures phonation threshold pressure (PTP), signifying no improvement for the vocal economy. Participants from the TVW group benefitted the most from vocal warm-ups due to notable improvement in vocal quality, technical singing skills (i.e., skill acquisition), and vocal efficiency. Meanwhile, the SP group only benefitted in terms of enhanced vocal efficiency. Acoustic parameters, aerodynamic, dysphonia severity index, semi-occluded vocal tract exercise, traditional vocal warm-up, vocal quality, voice range profile

Effects of the Voiced Tongue Trill Technique in Glissandos on the Voice Range Profile of Choir Members: A Preliminary Study

The objective of this study was to verify the immediate effect of the voiced tongue trill technique in ascending and descending glissandos on the voice range profile of choir members. A total of 25 sopranos, mezzo-sopranos, contraltos, tenors, and baritones participated in the study. They were choir members, aged 20 to 45 years, with no voice symptoms, and able to perform the voiced tongue trill technique. Their voice range profile was analyzed before and after performing the ascending and descending technique for 2 and 5 minutes. The maximum fundamental frequency values in the study groups increased after performing the ascending and descending technique for 2 minutes (P=0.001) and 5 minutes (P=0.003). The range in Hz increased after 2 minutes (P=0.010) and 5 minutes (P=0.050) of the ascending technique and after 2 minutes (P=0.001) of the descending technique, and the minimum fundamental frequency mean value suffered interference from the type of technique (ascending/descending). The immediate effects of VTTT in glissandos on the VRP of choir members' considering the two factors: condition and time, in ascending and descending glissandos for 2 and 5 minutes increased the maximum frequency and the range in Hz of choristers. Regarding volume levels results, no difference was found in intensity after applying the technique.

Vocal Outcome After Cordectomy by Transoral CO2 Laser Microsurgery in Patients With Laryngeal Intraepithelial Neoplasia and Non-neoplastic Lesions

This study investigates vocal outcome after cordectomy by transoral CO2 laser microsurgery (TLM-cordectomy) in patients with laryngeal intra-epithelial neoplasia (LIN) or non-neoplastic lesions (NNL), for improved individual patient advice and potential adjustment of national treatment strategy by which patients suspected to have glottic LIN or T1a cancer are offered TLM-cordectomy, without prior biopsy. Prospective, longitudinal, quasi-experimental time series. Consecutively included patients (n=155) with LIN (n=84) or NNL (n=71) who underwent voice assessments before and after TLM-cordectomy. The multi-dimensional voice assessment protocol comprised voice and speech range profiles, aerodynamics, acoustic analysis, self-evaluated voice handicap, and perceptual auditory voice ratings. Median follow-up time was 195 (range 50-1121) days for patients with LIN and 193 (range 69-1294) days for patients with NNL. Statistically significant changes, LIN: in voice handicap index (VHI) and breathiness after TLM-cordectomy. Statistically significant changes, NNL: voice range profile (voice range area, intensity range, and frequency range) and VHI after TLM-cordectomy. All group-wise changes were to less disordered voices. Previous smokers had the largest decreases in VHI and breathiness. Patients with baseline VHI scores >65 had smaller increases in VHI, however 13-19% of the patients had increases in VHI above the clinically relevant threshold after TLM-cordectomy. Overall, TLM-cordectomy in patients with LIN and NNL improved vocal outcome and our study thus supports the current Danish treatment strategy and improves the basis for proper patient advice. Multi-dimensional voice assessment is suggested preoperatively and six-nine months postoperatively, with focus on individual vocal differences and voice demands.

Effects of Traditional Turkish Music Education on Voice Range Profile and Voice Quality

Aim: The aim of this study; to investigate whether traditional Turkish music education is as effective on voice range profile and voice quality as classical music education. Methods: Twenty volunteers in the Conservatory and 10 volunteers the Turkish Amateur Music Choir were included in the study. Digital recordings of the subjects’ voices were obtained before and after 8 months of voice training. Voice recordings were analyzed with the Dr. Speech voice analysis program. Voice analysis results were compared between groups. Results: Voice range profile was found expanded as 3, 2, and 5 semitones in group 1 (29 to 32 semitones), group 2 (30 to 32 semitones) and group 3 (23 to 28 semitones), respectively. The parameters of harmonic component of voice such as HNR, SNR, and NNE improved in all groups after voice training. GRBAS scores were normal in the conservatory group before training and improved following training in all groups, with the amateur group being the most obvious. When the alterations were compared between the groups, no significant differences were observed between the first and second conservatory groups, whereas a significant difference was observed between the amateur group and the first and second conservatory groups in seven parameters (amplitude tremor, HNR, SNR, NNE and GRBAS). Conclusions: This is the first study about the effects of traditional Turkish music education on subjective and objective parameters of the singing voice. Our research shows that traditional Turkish music education improved the singing voice improvements as much as with classical music.

Effect of FFP2/3 Masks on Voice Range Profile Measurement and Voice Acoustics in Routine Voice Diagnostics

Introduction: Voice diagnostics including voice range profile (VRP) measurement and acoustic voice analysis is essential in laryngology and phoniatrics. Due to COVID-19 pandemic, wearing of 2 or 3 filtering face piece (FFP2/3) masks is recommended when high-risk aerosol-generating procedures like singing and speaking are being performed. Goal of this study was to compare VRP parameters when performed without and with FFP2/3 masks. Further, formant analysis for sustained vowels, singer’s formant, and analysis of reading standard text samples were performed without/with FFP2/3 masks. Methods: Twenty subjects (6 males and 14 females) were enrolled in this study with an average age of 36 ± 16 years (mean ± SD). Fourteen patients were rated as euphonic/not hoarse and 6 patients as mildly hoarse. All subjects underwent the VRP measurements, vowel, and text recordings without/with FFP2/3 mask using the software DiVAS by XION medical (Berlin, Germany). Voice range of singing voice, equivalent of voice extension measure (eVEM), fundamental frequency (F0), sound pressure level (SPL) of soft speaking and shouting were calculated and analyzed. Maximum phonation time (MPT) and jitter-% were included for Dysphonia Severity Index (DSI) measurement. Analyses of singer’s formant were performed. Spectral analyses of sustained vowels /a:/, /i:/, and /u:/ (first = F1 and second = F2 formants), intensity of long-term average spectrum, and alpha-ratio were calculated using the freeware praat. Results: For all subjects, the mean values of routine voice parameters without/with mask were analyzed: no significant differences were found in results of singing voice range, eVEM, SPL, and frequency of soft speaking/shouting, except significantly lower mean SPL of shouting with FFP2/3 mask, in particular that of the female subjects (p = 0.002). Results of MPT, jitter, and DSI without/with FFP2/3 mask showed no significant differences. Further mean values analyzed without/with mask were ratio singer’s formant/loud singing, with lower ratio with FFP2/3 mask (p = 0.001), and F1 and F2 of /a:/, /i:/, /u:/, with no significant differences of the results, with the exception of F2 of /i:/ with lower value with FFP2/3 mask (p = 0.005). With the exceptions mentioned, the t test revealed no significant differences for each of the routine parameters tested in the recordings without and with wearing a FFP2/3 mask. Conclusion: It can be concluded that VRP measurements including DSI performed with FFP2/3 masks provide reliable data in clinical routine with respect to voice condition/constitution. Spectral analyses of sustained vowel, text, and singer’s formant will be affected by wearing FFP2/3 masks.

Voice Therapy Outcome: A Comparison Between Imitation Model Voice Therapy and Verbal Instructions Model Voice Therapy

The aim was to compare voice outcomes over time in patients treated with Imitation Model voice therapy and Verbal Instructions Model voice therapy. A prospective clinical trial was performed with 56 consecutive patients diagnosed with a primary or secondary functional voice disorder. Thirty-one patients were included for voice therapy following the Imitation Model and 25 patients for the Verbal Instructions Model. Assessments included a self-rated Voice Handicap Index, self-perceived hoarseness and vocal fatigue, perceptual voice evaluation by a Speech Language Pathologist, and maximum Voice Range Profiles. All assessments were completed before therapy, at end of therapy, at six-months posttherapy follow-up and 12-months posttherapy follow-up. For maximum Voice Range Profiles group differences were also compared for effects from end-of-treatment to follow-up assessments. Linear mixed models were used for analysis. Comparison between treatment groups showed significantly larger long-term improvement from the baseline, for verbal instructions model as compared to imitation model for Voice Handicap Index total, and also the physical and emotional subscales, while there was no difference between groups for the functional subscale. Also, voice quality improved more after verbal instructions model, as compared to imitation model, at end of therapy. Results from self-rated hoarseness and vocal fatigue showed no difference between groups. There was no difference between treatment groups in the change of maximum Voice Range Profile from end-of-treatment to follow-up assessments. The study showed that both Imitation Model voice therapy and Verbal Instructions Model voice therapy improved voice function. Compared to Imitation Model, the Verbal Instructions model showed larger long-term effect on physical and emotional aspects of voice function in everyday life. The two approaches for voice therapy might have different impacts on patients' learning.

Prognostic Indicators of Non-Transection Nerve Injury and Vocal Fold Motion Impairment After Thyroid Surgery - Correlation Between Intraoperative Neuromonitoring Findings and Perioperative Voice Parameters.

ObjectivesIn patients with recurrent laryngeal nerve (RLN) injury after thyroid surgery, unrecovered vocal fold motion (VFM) and subjective voice impairment cause extreme distress. For surgeons, treating these poor outcomes is extremely challenging. To enable early treatment of VFM impairment, this study evaluated prognostic indicators of non-transection RLN injury and VFM impairment after thyroid surgery and evaluated correlations between intraoperative neuromonitoring (IONM) findings and perioperative voice parameters.Methods82 adult patients had postoperative VFM impairment after thyroidectomy were enrolled. Demographic characteristics, RLN electromyography (EMG), and RLN injury mechanism were compared. Multi-dimensional voice program, voice range profile and Index of voice and swallowing handicap of thyroidectomy (IVST) were administered during I-preoperative; II-immediate, III-short-term and IV-long-term postoperative periods. The patients were divided into R/U Group according to the VFM was recovered/unrecovered 3 months after surgery. The patients in U Group were divided into U1/U2 Group according to total IVST score change was <4 and ≥4 during period-IV.ResultsCompared to R Group (42 patients), U Group (38 patients) had significantly more patients with EMG >90% decrease in the injured RLN (p<0.001) and thermal injury as the RLN injury mechanism (p=0.002). Voice parameter impairments were more severe in U Group compared to R Group. Compared to U1 group (19 patients), U2 Group (19 patients) had a significantly larger proportion of patients with EMG decrease >90% in the injured RLN (p=0.022) and thermal injury as the RLN injury mechanism (p=0.017). A large pitch range decrease in period-II was a prognostic indicator of a moderate/severe long-term postoperative subjective voice impairment.ConclusionThis study is the first to evaluate correlations between IONM findings and voice outcomes in patients with VFM impairment after thyroid surgery. Thyroid surgeons should make every effort to avoid severe type RLN injury (e.g., thermal injury or injury causing EMG decrease >90%), which raises the risk of unrecovered VFM and moderate/severe long-term postoperative subjective voice impairment. Using objective voice parameters (e.g., pitch range) as prognostic indicators not only enables surgeons to earlier identify patients with low voice satisfaction after surgery, and also enable implementation of interventions sufficiently early to maintain quality of life.

Correlation Between Objective and Subjective High-Pitched Voice Impairment in Patients After Thyroid Surgery.

ObjectivesHigh-pitched voice impairment (HPVI) is not uncommon in patients without recurrent laryngeal nerve (RLN) or external branch of superior laryngeal nerve (EBSLN) injury after thyroidectomy. This study evaluated the correlation between subjective and objective HPVI in patients after thyroid surgery.MethodsThis study analyzed 775 patients without preoperative subjective HPVI and underwent neuromonitored thyroidectomy with normal RLN/EBSLN function. Multi-dimensional voice program, voice range profile and Index of voice and swallowing handicap of thyroidectomy (IVST) were performed during the preoperative(I) period and the immediate(II), short-term(III) and long-term(IV) postoperative periods. The severity of objective HPVI was categorized into four groups according to the decrease in maximum frequency (Fmax): <20%, 20-40%, 40-60%, and >60%. Subjective HPVI was evaluated according to the patient’s answers on the IVST.ResultsAs the severity of objective HPVI increased, patients were significantly more to receive bilateral surgery (p=0.002) and have subjective HPVI (p<0.001), and there was no correlation with IVST scores. Among 211(27.2%) patients with subjective HPVI, patients were significantly more to receive bilateral surgery (p=0.003) and central neck dissection(p<0.001). These patients had very similar trends for Fmax, pitch range, and mean fundamental frequency as patients with 20-40% Fmax decrease (p>0.05) and had higher Jitter, Shimmer, and IVST scores than patients in any of the objective HPVI groups; subjective HPVI lasted until period-IV.ConclusionThe factors that affect a patient’s subjective HPVI are complex, and voice stability (Jitter and Shimmer) is no less important than the Fmax level. When patients have subjective HPVI without a significant Fmax decrease after thyroid surgery, abnormal voice stability should be considered and managed. Fmax and IVST scores should be interpreted comprehensively, and surgeons and speech-language pathologists should work together to identify patients with HPVI early and arrange speech therapy for them. Regarding the process of fibrosis formation, anti-adhesive material application and postoperative intervention for HPVI require more future research.

Do Flexible Silicone Tubes Immersed in Water Combined With Vocalise Improve the Immediate Effect on Voice?

This study aimed to analyze the immediate effect on a singer's voice of a flexible silicone tube immersed in water combined with ascending and descending vocalise scales compared with ascending and descending vocalise scales alone. A pre- and post-intervention quasi-experimental study was conducted. Thirty adult singers between 18 and 45 years old with no laryngeal disorders performed the two techniques for 3 min each on different days. Acoustic measurements of frequency, jitter, shimmer, glottal-to-noise excitation ratio, noise, smoothed cepstral peak prominence (CPPS), maximum phonation time (MPT), voice range profile, and self-perceived vocal effort (Borg Category Ratio 10-BR Scale adapted for vocal effort) were assessed before and after performing the techniques. The results indicated an increase in singers' CPPS and MPT values and a decrease in shimmer and noise when performing with a flexible silicone tube immersed in water combined with vocalise. The singers reported a perception of decreased vocal effort after both methods. However, the diminished perceived vocal effort became more pronounced with the tube phonation technique combined with vocalise. Phonation in tubes combined with vocalise improved the vocal acoustic parameters (including cepstral measurements), increased MPT, and diminished perceived vocal effort. Although using vocalise alone diminished perceived vocal effort, this decrease was more pronounced in the tube phonation technique combined with vocalise.

Two Cases Using the Praat-Based Automatic Voice Analysis Program as an Alternative to CSL

There are a number of voice analysis programs around the world. Domestic voice analysis is performed by relying heavily on specific commercial program. We intend to develop coding for voice analysis using Praat and apply it to clinical practice. This study consisted of Experiment 1 and Experiment 2. Experiment 1 was the development of automated voice analysis coding based on Praat. The coding was largely divided into a recording, an analysis, and a storage section. Experiment 2 was applied to the voice analysis of 2 male patients pre- and post-operation with this coding. The analysis parameters of this coding provided 26 parameters for vowel /a/, nine parameters for sentence analysis, and a total of 4 parameters for voice range profile analysis. In two male patients, the pitch and the intensity increased, the voice quality improved, and the sentence length decreased after surgery. The coding was well made, so the output was good in real time. The code is automated as much as possible to block manual errors and increases convenience and efficiency by generating the result sheet in real time.