Search PubMed⌕ Search

Biomedical subjects

B R Gerratt

Publications and source records attributed to B R Gerratt.

At least 37 records · Page 2Linked to original sources

Comparing internal and external standards in voice quality judgments.

A new descriptive framework for voice quality perception (Kreiman, Gerratt, Kempster, Erman, & Berke, 1993) states that when listeners rate a voice on some quality dimension (e.g., roughness), they compare the stimulus presented to an internal standard or scale. Hypothetically, substituting explicit, external standards for these unstable internal standards should improve listener reliability. Further, the framework suggests that internal standards for vocal qualities are inherently unstable, and may be influenced by factors other than the physical signal being judged. Among these factors, context effects may cause drift in listeners' voice ratings by influencing the internal standard against which judgments are made. To test these hypotheses, we asked 12 clinicians to judge the roughness of 22 synthetic stimuli using two scales: a traditional 5-point equal appearing interval (EAI) scale and a scale with explicit anchor stimuli for each scale point. The stimulus set included a relatively large number of normal and mildly rough voices. We predicted that this would produce an increase in the perceived roughness of moderately rough stimuli over time for the EAI ratings, but not for the explicitly anchored ratings. Ratings made using the anchored scale were significantly more reliable than those gathered using the unanchored paradigm. Further, as predicted, ratings on the unanchored EAI scale drifted significantly within a listening session in the direction expected, but ratings on the anchored scale did not. These results are consistent with our framework and suggest that explicitly anchored paradigms for voice quality evaluation might improve both research and clinical practice.

Adult↗

Perceptual evaluation of voice quality: review, tutorial, and a framework for future research.

The reliability of listeners' ratings of voice quality is a central issue in voice research because of the clinical primacy of such ratings and because they are the standard against which other measures are evaluated. However, an extensive literature review indicates that both intrarater and interrater reliability fluctuate greatly from study to study. Further, our own data indicate that ratings of vocal roughness vary widely across individual clinicians, with a single voice often receiving nearly the full range of possible ratings. No model or theoretical framework currently exists to explain these variations, although such a model might guide development of efficient, valid, and standardized clinical protocols for voice evaluation. We propose a theoretical framework that attributes variability in ratings to several sources (including listeners' backgrounds and biases, the task used to gather ratings, interactions between listeners and tasks, and random error). This framework may guide development of new clinical voice and speech evaluation protocols, ultimately leading to more reliable perceptual ratings and a better understanding of the perceptual qualities of pathological voices.

Adolescent↗

Measurement of Young's modulus in the in vivo human vocal folds.

Currently, surgeons have no objective means to evaluate and optimize results of phonosurgery intraoperatively. Instead, they usually judge the vocal folds subjectively by visual inspection or by listening to the voice. This paper describes a new device that measures Young's (elastic) modulus values for the human vocal fold intraoperatively. Physiologically, the modulus of the vocal fold may be important in determining the nature of vocal fold vibration in normal and pathologic states. This study also reports the effect of recurrent laryngeal nerve stimulation on Young's modulus of the human vocal folds, measured by means of transcutaneous nerve stimulation techniques. Young's modulus increased with increases in current stimulation to the recurrent laryngeal nerve. Ultimately, Young's modulus values may assist surgeons in optimizing the results of various phonosurgeries.

Adult↗

Effect of tension, stiffness, and airflow on laryngeal resistance in the in vivo canine model.

This study used an in vivo canine model of phonation to determine the effects of airflow on glottal resistance at low, medium, and high levels of recurrent laryngeal nerve (RLN) and superior laryngeal nerve (SLN) stimulation. Static and dynamic trials of changing airflow were used to study the effects of airflow on glottal resistance during phonation. As reported previously, glottal resistance varies inversely as a function of airflow. Increasing levels of RLN stimulation resulted in a statistically significant increase in glottal resistance for each level of airflow evaluated. Variation in SLN stimulation had no statistically effects on the relationship between flow and resistance. At airflow rates greater than 590 milliliters per second (mL/s), glottal resistance approached 0.1 mm Hg per mL/s for all levels of RLN and SLN stimulation tested. These data support the collapsible tube model of phonation.

Airway Resistance↗

Determination of vocal fold mucosal wave velocity in an in vivo canine model.

The vocal fold traveling wave is essential to normal voice production. The present investigation examined whether the velocity of the traveling wave (TWV) could be consistently determined in an in vivo canine model and if traveling wave velocity is affected by changes in the amplitude of recurrent laryngeal nerve stimulation (RLNS) and superior laryngeal nerve stimulation (SLNS). The results showed that traveling wave velocity increased with an increase in recurrent laryngeal nerve stimulation at low constant superior laryngeal nerve stimulation, but was poorly correlated with increases in recurrent laryngeal nerve stimulation at a high level of superior laryngeal nerve stimulation. Furthermore, traveling wave velocity was significantly correlated with superior laryngeal nerve stimulation at constant recurrent laryngeal nerve stimulation. This study demonstrated the feasibility of objectively measuring traveling wave velocity in vivo.

Air↗

Individual differences in voice quality perception.

Sixteen listeners (10 expert, 6 naive) judged the dissimilarity of pairs of voices drawn from pathological and normal populations. Separate nonmetric multidimensional scaling solutions were calculated for each listener and voice set. The correlations between individual listeners' dissimilarity ratings were low. However, scaling solutions indicated that each subject judged the voices in a reliable, meaningful way. Listeners differed more from one another in their judgments of the pathological voices (which varied widely on a number of acoustic parameters) than they did for the normal voices (which formed a much more homogeneous set acoustically). The acoustic features listeners used to judge dissimilarity were predictable from the characteristics of the stimulus sets: only parameters that showed substantial variability were perceptually salient across listeners. These results are consistent with prototype models of voice perception. They suggest that traditional means of assessing listener reliability in voice perception tasks may not be appropriate, and highlight the importance of using explicit comparisons between stimuli when studying voice quality perception.

Adult↗

Videostroboscopy of human vocal fold paralysis.

Previous stroboscopic studies of human vocal cord paralysis have been infrequent and have lacked documentation of the site of lesion. In order to study human laryngeal paralysis, the recurrent and superior laryngeal nerves were infiltrated unilaterally with lidocaine hydrochloride in three human volunteers. Vagal paralysis was simulated by combined (superior and recurrent) infiltration in one volunteer. Additionally, 20 patients with untreated laryngeal paralysis were studied from the voice laboratory at UCLA. In addition to videostroboscopic analysis, photoglottography and electroglottography were performed and synchronized with the stroboscopic images. The most significant finding in stroboscopy of the paralyzed larynx was the asymmetry of traveling wave motion. The traveling wave on the normal vocal fold had a faster wave velocity that created a phase difference in the vibration of the two folds. The wave also traversed a greater distance along the vocal fold mucosa on the normal side. No patient or volunteer with untreated laryngeal paralysis had a symmetric traveling wave, either in superior or recurrent laryngeal nerve paralysis. Synchronization with glottography indicated that the differentiated electroglottographic waveform provides useful information about the timing of glottic opening and closure in states of asymmetric laryngeal vibration. Implications for future studies and for the diagnosis of laryngeal paralysis are discussed.

Adult↗

Point-touch technique of botulinum toxin injection for the treatment of spasmodic dysphonia.

Intralaryngeal injections of botulinum toxin (Botox), under electromyographic guidance, have emerged as an effective treatment for adductor spasmodic dysphonia. To remain effective, these injections must be repeated every 3 to 9 months as the symptoms recur. One drawback to the current method is the need for electromyographic confirmation of needle placement into the thyroarytenoid muscle. This report describes an anatomic approach to Botox injection that requires only flexible nasopharyngeal endoscopy and careful evaluation of the anatomic landmarks. This technique has been used successfully on 13 patients, and objective pretreatment and posttreatment measures are reported.

Adult↗

Effect of asymmetric vocal fold stiffness on traveling wave velocity in the canine larynx.

The vocal fold (VF) traveling wave is essential to normal voice production. The present investigation describes a new method to determine traveling wave velocity (TWV) in the in vivo canine phonatory model. This method synchronizes photoglottographic and electroglottographic waveforms with videostroboscopic images to determine the duration of time the traveling wave moves between two tattoos placed a known distance apart between the upper and lower margins of each VF. Using this method, we compared the TWV of a paralyzed VF with the TWV of the contralateral, electrically stimulated VF during phonation in two canines. In addition, the presumed VF stiffness asymmetry in the simulated acute recurrent laryngeal nerve paralysis state was confirmed by measuring Young's modulus of each VF. The results indicated that the TWV of the paralyzed VF averaged 55% of the TWV of the normal, stiffer VF when the glottal gap was small and entrainment occurred. This study demonstrated the feasibility of quantifying traveling wave motion in asymmetric VF stiffness disorders. The potential use of TWV in human beings as a target to optimize the phonosurgical results in asymmetric VF stiffness disorders is discussed.

Animals↗

Laryngeal paralyses: theoretical considerations and effects on laryngeal vibration.

The neurological causes of vocal fold paralyses have been well documented. However, the effect of these disorders on laryngeal vibration is not well understood. A theoretical four-mass model of the larynx, based on the work of Ishizaka and Isshiki (1976) and Koizumi, Taniguchi, and Hiromitsu (1987), was developed and adapted to simulate laryngeal biomechanical behavior. The model was used to evaluate various states of asymmetric laryngeal vibration. Input parameters that relate observed laryngeal function and model simulation were developed. Laryngeal paralyses were simulated by their predicted effect on these parameters. Simulations were compared with available data on glottal vibration in laryngeal paralyses. Complex modes of vibration were seen with certain combinations of asymmetrical lower mass stiffness and initial glottal gap.

Computer Simulation↗

Listener experience and perception of voice quality.

Five speech-language clinicians and 5 naive listeners rated the similarity of pairs of normal and dysphonic voices. Multidimensional scaling was used to determine the voice characteristics that were perceptually important for each voice set and listener group. Solution spaces were compared to determine if clinical experience affects perceptual strategies. Naive and expert listeners attended to different aspects of voice quality when judging the similarity of voices, for both normal and pathological voices. All naive listeners used similar perceptual strategies; however, individual clinicians differed substantially in the parameters they considered important when judging similarity. These differences were large enough to suggest that care must be taken when using data averaged across clinicians, because averaging obscures important aspects of an individual's perceptual behavior.

Clinical Competence↗

Frequency, intensity, and target matching effects on photoglottographic measures of open quotient and speed quotient.

Measurements of Open Quotient (OQ) and Speed Quotient (SQ) were made from photoglottographic signals of normal male subjects during phonation. Samples were obtained at spontaneous levels of fundamental frequency and intensity, and at nine specified frequency/intensity combinations. OQ increased with fundamental frequency. OQ change was not significant for change in intensity and there was no significant interaction between frequency and intensity. Changes in SQ with variations of frequency and intensity were not significant. However, SQ did increase significantly when spontaneous phonation was compared to target matching phonation at similar frequency/intensity. Changes in both OQ and SQ across comfortable frequency and intensity ranges were relatively small in comparison to changes in OQ and SQ reported for pathological phonation.

Adult↗

The effect of air flow and medial adductory compression on vocal efficiency and glottal vibration.

This study used an in vivo canine model to investigate the effects of varying vocal fold resistance by electrically stimulating the recurrent laryngeal nerve while monitoring medial adductory compression of the vocal folds, glottal airflow, and vocal intensity. The effects of increasing airflow on glottal vibration were also examined stroboscopically and by measurement of open quotient. The results indicated that increasing intensity by medial adductory compression was more efficient than by increasing airflow. Increasing airflow produced a significantly greater open quotient and vocal fold vibratory excursion.

Animals↗

Office-based system for voice analysis.

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

Analog-Digital Conversion↗

Current and future horizons in laryngeal and voice research.

Voice dysfunction is associated with neuromuscular impairment of laryngeal control and is often difficult to diagnose by indirect examination of the larynx. The newer techniques, currently used in the UCLA-Veterans Administration Medical Center Laboratories, provide some methods that aid in the diagnosis of voice impairment by providing documented objective data. Illustrative case reports of disorders of neuromuscular dysfunction of the larynx are presented and future research needs and direction are discussed.

Aged↗

The effect of recurrent laryngeal nerve stimulation on phonation in an in vivo canine model.

The present investigation was designed to examine the effect of variation in recurrent laryngeal nerve stimulation (RLNS) on vocal fold vibration. Photoglottography (PGG), electroglottography (EGG), and subglottic pressure (Psub) were measured in seven mongrel dogs using an in vivo canine model of phonation. The PGG, EGG, and Psub signals were examined at three fundamental frequencies (F0) (100 Hz, 130 Hz, and 160 Hz) for RLNS, using a constant rate of air flow. Increasing RLNS, which caused activation of the intrinsic laryngeal muscles, produced a modest increase in F0, a marked increase in Psub, no change in the open quotient (OQ), and an increase in the closing quotient (CQ). Phase quotient (Qp), which describes the interval between opening of the lower and upper fold margins, decreased with increasing RLNS.

Animals↗

An accurate method of Teflon injection using functional phonosurgery.

A technique for Teflon injection is described that allows the laryngologist to assess vocal fold vibration during general anesthesia. A tracheostomy tube fitted with a rostral air line allows translaryngeal airflow. During endoscopy with a bivalved laryngoscope, the cords are approximated manually. Vocal fold vibration is produced with the cords adducted. The precise site of defects in glottic closure is clearly seen and corrected with Teflon injection. In cases where standard Teflon injection has failed, utilization of this method has allowed substantial voice improvement. The ability to assess vibratory function of the vocal folds during direct suspension laryngoscopy enhances the precision of vocal fold augmentation techniques in difficult rehabilitation cases.

Aged↗

Glottographic measures of vocal fold vibration: an examination of laryngeal paralysis.

Photoglottography and electroglottography were applied to groups of patients with recurrent laryngeal nerve paralysis, superior laryngeal nerve paralysis, and combined recurrent and superior laryngeal nerve paralyses of idiopathic causes. Individual patients with resection of the vagal nerve above the origin of the superior laryngeal nerve were also studied. Open Quotient and Speed Quotient were calculated from the photoglottography signals. Speed Quotient values significantly differentiated recurrent laryngeal nerve paralysis from idiopathic paralysis and superior laryngeal nerve paralysis, as well as from normal function. Data from patients with vagal resection clearly differentiated them from patients with recurrent laryngeal nerve paralysis. The measure of Open Quotient distinguished pathological phonation from normal, but was not as useful for separation of differing lesions. Electroglottography appeared to be less useful than photoglottography. The pathophysiology underlying the observed glottographic signals is discussed.

Adult↗