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PubMed2001

Quantification of static and dynamic supraglottic activity.

For estimating supraglottic compression in disordered voice production, categorical rating scales of true vocal fold coverage by supraglottic structures are the current standard. Quantification of change in the position of supraglottic structures compared to no supraglottic activity would be a better method for distinguishing between and within voice-disordered groups. This study developed a method for quantifying static supraglottic activity and extent of false vocal fold (FVF) motion during dynamic supraglottic activity. Twelve control participants and 12 individuals with voice disorders (6 with complaints of vocal fatigue and 6 with vocal fold nodules) were enrolled in the study. These individuals participated in a transnasal fiberoptic laryngeal examination in which various speech tasks were recorded. Single-frame images were selected to represent the positions of minimum and maximum supraglottic compression for each speech task. Two individuals rated these single-frame images using a categorical rating scale. Two other individuals measured the anterior-to-posterior (A-P) distance, vocal fold length, and vocal fold area. A-P and FVF compression were derived from these three measures. Reliability was demonstrated between judges for the ratings and between and within judges for the measures. Significant differences in normalized static supraglottic compression measures corresponded to the rating scale categories. Significant differences in normalized dynamic supraglottic compression measures corresponded to the differences in category ratings between minimum and maximum compression. Using the normalized measures, the voice-disordered groups demonstrated significantly greater static A-P compression (t test, p < .03) than did the control participants. These results suggest that static supraglottic activity may be diagnostic of voice disorder. Normalized dynamic FVF compression ratios were not significantly different between groups. This supports a previous hypothesis that dynamic supraglottic activity serves as an articulatory function at the level of the larynx and is part of the linguistic/phonemic system, rather than evidence of disordered laryngeal function.

Adult↗
PubMed2003

Vocal fold vibration irregularities caused by different types of laryngeal asymmetry.

The common symptom of hoarseness is regarded to be caused by (1) turbulences and air loss due to incomplete glottic closure and (2) irregular vibrations of the vocal folds. With real time resolution, the latter can only be observed using high-speed recording techniques (> or =2,000 images/s). In this paper an actual recording method is described, called high-speed glottography (HGG), which quantifies vibration irregularities. It combines imaging and image processing techniques with a functional endoscopy of the disordered voice and delivers motion curves separately for each vocal fold. They are fitted with a computer simulation in order to identify the underlying driving parameters of the vibration. A vocal fold is assumed to vibrate as a system of two coupled oscillators ("two-mass model"). From the model fit to bilateral motion curves, the subglottal pressure, muscular tension and oscillating masses of the vocal folds can be computed with reasonable accuracy. Besides normal voices, HGG has been applied to selected clinical cases of voice disorders. Two types of irregularities have been measured: there is a frequency difference either between left and right vocal folds (horizontal asymmetry) or on one side between the ventral and dorsal third (vertical asymmetry). By modeling, both categories of irregular motion curves can be explained in detail. It is presumed that laryngeal asymmetry (either in mass or tension) causes irregular vibrations.

Adult↗
PubMed1996

Sources of error in estimation of laryngeal airway resistance in persons with spasmodic dysphonia.

Estimation of laryngeal airway resistance is a noninvasive method that has proven useful in the study of people with normal and some types of disordered voices. We were interested in examining more closely the application of this method to persons with spasmodic dysphonia (SD), a voice disorder sometimes associated with fluctuating airflow. We speculated unstable airflow could affect the estimation of subglottal pressure and laryngeal airway resistance. Oral pressure and airflow were collected from 10 subjects with SD and 10 control subjects during repetition of /pi/. The coefficient of variation (COV) of airflow during vowel production was calculated to quantify stability of airflow. The results indicated that although some SD subjects produced steady flows during the syllable repetition task, others exhibited substantially varying flows. Inability on the part of the subject to attain steady flows could compromise the usefulness of a midpoint measure of airflow and/or estimation of subglottal pressure, resulting in sources of error in estimation of laryngeal airway resistance. As a result, of the 10 subjects with SD in this study, laryngeal airway resistance could not be estimated in 6 subjects with unsteady flows. Laryngeal airway resistance was estimated in 4 SD subjects who produced steady airflow. Two of these subjects exhibited high laryngeal airway resistance; the others exhibited normal laryngeal airway resistance.

Adult↗
PubMed2006

Voice care knowledge among clinicians and people with healthy voices or dysphonia.

An important clinical component in the prevention and treatment of voice disorders is voice care and hygiene. Research in voice care knowledge has mainly focussed on specific groups of professional voice users with limited reporting on the tool and evidence base used. In this study, a questionnaire to measure voice care knowledge was developed based on "best evidence." The questionnaire was validated by measuring specialist voice clinicians' agreement. Preliminary data are then presented using the voice care knowledge questionnaire with 17 subjects with nonorganic dysphonia and 17 with healthy voices. There was high (89%) agreement among the clinicians. There was a highly significant difference between the dysphonic and the healthy group scores (P = 0.00005). Furthermore, the dysphonic subjects (63% agreement) presented with less voice care knowledge than the subjects with healthy voices (72% agreement). The questionnaire provides a useful and valid tool to investigate voice care knowledge. The findings have implications for clinical intervention, voice therapy, and health prevention.

Attitude to Health↗
PubMed2004

The voice use reduction program.

The purpose of this article is to describe a structured behavior modification approach to the reduction of voice use by clients with voice disorders. The Voice Use Reduction (VUR) Program is conceptualized as part of a comprehensive approach to the treatment of voice. The VUR Program provides guidelines for the classification of voice use situations, the assignment of voice use units to different situations, and the calculation of the maximum number of units per day and per week in a severe, moderate, and low voice use reduction program. Two case examples are described to illustrate the application of the VUR Program. The results of an evaluation of the VUR Program by 10 female students who presented with vocal nodules and applied the program also are included.

Adult↗
PubMed1999

Self-organizing map for the classification of normal and disordered female voices.

The goal of this research was to train a self-organizing map (SOM) on various acoustic measures (amplitude perturbation quotient, degree of voice breaks, rahmonic amplitude, soft phonation index, standard deviation of the fundamental frequency, and peak amplitude variation) of the sustained vowel /a/ to enhance visualization of the multidimensional nonlinear regularities inherent in the input data space. The SOM was trained using 30 spasmodic dysphonia exemplars, 30 pretreatment functional dysphonia exemplars, 30 post-treatment functional dysphonia exemplars, and 30 normal voice exemplars. After training, the classification performance of the SOM was evaluated. The results indicated that the SOM had better classification performance than that of a stepwise discriminant analysis over the original data. Analysis of the weight values across the SOM, by means of stepwise discriminant analysis, revealed the relative importance of the acoustic measures in classification of the various groups. The SOM provided both an easy way to visualize multidimensional data, and enhanced statistical predictability at distinguishing between the various groups (over that conducted on the original data set). We regard the results of this study as a promising initial step into the use of SOMs with multiple acoustic measures to assess phonatory function.

Adult↗
PubMed1991

Voice therapy. Techniques and applications.

Voice therapy is the cornerstone of treatment for patients with voice disorders. The therapeutic role of the speech pathologist is important in patients with functional and organic voice disorders. Voice rest and various other treatment options, techniques, and applications for voices disorders are examined in this article.

Humans↗
PubMed2004

Development and validation of the voice handicap index-10.

OBJECTIVES/HYPOTHESIS: The objective was to develop an abbreviated voice handicap assessment instrument and compare it with the Voice Handicap Index (VHI). STUDY DESIGN: Item analysis of the VHI in individuals without voice disorders and patients with voice disorders and creation and validation of the abbreviated VHI. METHODS: Clinical consensus review of the VHI items was held to prioritize the clinical value of each of the VHI items (30 items in all). Item analysis of the VHI was performed using the VHI responses of 100 patients with voice problems and 159 control subjects. The 10 most robust VHI items were selected using the item analysis and clinical consensus results to form the Voice Handicap Index-10 (VHI-10). Statistical analysis comparing the validity of the VHI-10 with the VHI was performed with 819 patients representing a wide spectrum of voice disorders. RESULTS: Statistical analysis of the VHI and VHI-10 scores from the study group showed no statistically significant differences between the VHI and the VHI-10. Irrespective of diagnosis, the correlation between the VHI and the VHI-10 was greater than .90 (P = .01). The ratios of the VHI-10 to VHI scores for a variety of voice disorder categories were analyzed and found to be consistently greater than the expected value (33%). This suggests that the VHI-10 may be a more robust instrument than the VHI. CONCLUSION: The VHI-10 is a powerful representation of the VHI that takes less time for the patient to complete without loss of validity. Thus, the VHI-10 can replace the VHI as an instrument to quantify patients' perception of their voice handicap.

Disability Evaluation↗
PubMed2005

A holistic approach to voice therapy.

Therapy approaches designed to improve the disordered voice may be equally effective when used to enhance the normal voice. A holistic approach to voice therapy is based on a continuum of voice wellness from the disordered voice to the elite voice of the healthy performer. Individuals take charge of the wellness of their voices by following good principles of vocal hygiene and exercising the vocal mechanism in a healthful manner. All voices may be improved on this continuum toward the ideal. When voice therapy techniques attend to the three subsystems of voice production, respiration, and phonation and resonance, the techniques fall into the category of holistic voice therapies. Vocal Function Exercises is one holistic voice therapy approach that has been found to be effective in improving those with voice disorders and enhancing the normal voice. This article introduces the concept of holistic voice therapy and describes the specific Vocal Function Exercise Program.

Holistic Health↗
PubMed1999

Effects of systematized vocal warm-up on voices with disorders of various etiologies.

This investigation studied the effect of a systematized vocal warm-up procedure on voices with disorders. There were 4 subjects with voice disorders. To optimize vocal function a systematized vocal warm-up system was developed by the author for singers and nonsingers alike. Subjects were asked to practice the vocal warm-up exercises daily, with weekly monitoring in the studio. Data from independent raters and subjects' self-ratings were compared to and corroborated with computer analysis of audio samples. Results indicated significant improvement in subjects' voices that were increasingly maintained over time.

Adult↗