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PubMed2006

Evaluation of voice pathology based on the estimation of vocal fold biomechanical parameters.

Voice disorders are a source of increasing concern as normal voice quality is a social demand for at least one third of the population in developed countries in cases where voice is an essential resource in professional exercise. In addition, the growing exposure to certain pathogenic factors such as smoking, alcohol abuse, air pollution, and acoustic contamination, and other problems such as gastro-esopharyngeal reflux or allergy as well as aging, aggravate voice disorders. Voice pathologies justify the assignment of larger resources to prevention policies, early detection, and less aggressive treatments. Traditional pathology detection relies on perceptive evaluation methods (GRABS), acoustic analysis, and visual inspection (indirect laryngoscopy, and modern fibro-endo-stroboscopy). This article describes a method for voice pathology detection based on the noninvasive estimation of vocal cord biomechanical parameters derived from voice using specific signal processing methods. Preliminary results using records from patients showing four frequent causes of voice pathology (nodules, polyps, chronic laryngitis, and Reinke's edema) are given. The results show that the alteration (distortion, unbalance, or deviation) of cord biomechanical parameters may serve as an indicator of pathology. Statistical methods based on hierarchical clustering and principal component analysis reveal that combining biomechanical estimates with classic perturbation parameters increases the accuracy of acoustic analysis, improving the detection of voice pathology. This research could open new possibilities for noninvasive screening of vocal fold pathologies and could be used in the implantation of e-health voice care services.

Biomechanical Phenomena↗
PubMed2000

Personality traits and psychological factors in voice pathology: a foundation for future research.

It has been argued that personality, emotions, and psychological problems contribute to or are primary causes of voice disorders and that voice disorders in turn create psychological problems and personality effects. This article (a) briefly reviews the literature surrounding the role of psychological and personality processes in individuals with functional dysphonia (FD), vocal nodules (VN), and spasmodic dysphonia (SD); (b) provides an overview of recent concepts in personality and trait structure; and (c) summarizes the fundamental tenets of a theoretical synthesis proposed by Roy and Bless (2000) to explain the dispositional bases of FD and VN. This theory links FD and VN to the signal sensitivities and behavioral response biases of neurotic introverts and neurotic extraverts, respectively. In a companion article, the merits of the Roy and Bless theory are evaluated.

Humans↗
PubMed1984

Motor disorders of voice and speech in Reye's syndrome survivors.

Disorders of voice and speech were studied in 43 survivors of Reye's syndrome (RS). During hospital convalescence 26 (60%) of 43 were aphonic, hoarse, or had other alterations of speech production. These disorders occurred in those patients with the worst severity of RS. Four patients (9% of survivors) had a persistent motor voice or speech disorder at follow-up examination 1 1/2 to five years after recovery. All of the patients have breathy, low-intensity voice quality, whereas three of the four exhibit rapid and slurred speech. These four children have no difficulty with the symbolic aspects of language and their motor voice and speech impairment cannot be ascribed to global intellectual deficit. Although other neurologic deficits are present in three of these four children, the disorders of voice and speech are the major permanent disabling handicap in our RS survivors.

Adolescent↗
PubMedDate not supplied

[Developmental disorders in the fourth edition of the American classification: diagnostic and statistical manual of mental disorders (DSM IV -- optional book)].

In 1991 the American Psychiatric Association proposed a draft version of the IV edition of the Diagnostic and Statistical Manual of Mental Disorders--the DSM IV Options Book. Authors of this version wanted to increase clarity of the criteria sets and to provide compatibility with the Tenth Edition of the International Classification of Diseases (ICD - 10). The purpose of this Options Book is to propose some changes in wording, diagnostic divisions and to discuss various options concerning the placement of sections and disorders within the classification. The "Disorders of Infancy, Childhood or Adolescence" section was renamed "Disorders Usually First Evident in Infancy, Childhood or Adolescence" and moved to the front of the classification and also was expended to 11 groups of disorders. Several suggestions have been made about including new diagnostic groupings such as: Rett's Disorder, Eating Disorders and Voice Disorder. The Options Book introduces a superior category for Attention Deficit Disorders (with and without hyperactivity) and for Conduct Disorder/Oppositional Defiant Disorder. Several options are proposed regarding The Anxiety Disorders of Childhood or Adolescence. There is no evidence for a distinction in this category according to the age criterion. One option would be to move these disorders into the adult anxiety section (similarly as in the Mood Disorders and Schizophrenia). In the new version the title "Specific Developmental Disorders" is omitted. The suggestion is to include Phonological Disorder (Articulation Disorders) and Elective Mutism into Speech and Language Disorders section.

Age Factors↗
PubMedDate not supplied

Outcomes research in pediatric otolaryngology.

There are several validated outcomes instruments available for use in the pediatric otolaryngology population. These include instruments for otitis media, rhinosinusitis, tonsil and adenoid disease; sleep-disordered breathing, voice disorders and tracheotomy. In addition, several prospective outcomes studies have been performed on common pediatric otolaryngology conditions. These studies have typically indicated that the quality of life impact of diseases such as otitis media and recurrent tonsillitis is quite high, and that surgical treatments (such as tympanostomy tube placement and adenotonsillectomy) result in significant improvements in quality of life and disease-specific health status. In addition, cost-effectiveness studies of cochlear implantation have indicated that implantation is a very cost-effective intervention when performed in children.

Child↗
PubMed2003

Do vocal warm-up exercises alleviate vocal fatigue?

Vocal warm-up (WU) exercises of varying types and durations have been suggested as a way of improving vocal function. However, limited research has been conducted to assess the effects of vocal WU exercises on normal or disordered voices. This study attempted to manipulate vocal function, assessed by phonation threshold pressure (PTP) and self-perceived phonatory effort (PPE) at 3 pitches, in 8 young women who reported symptoms of chronic vocal fatigue. Predictions were that PTP and PPE would decrease after 20 min of vocal WU exercises, increase after 1 hr of loud reading, and decrease after 30 min of vocal silence. Furthermore, greater increases in PTP and PPE were expected when the loud-reading task was preceded by a placebo condition of vocal rest than by vocal WU exercises. Results failed to reveal statistically significant changes in PTP or PPE after any of the experimental tasks. High between-subject variability contributed to this result. Removal of 1 outlier from the sample resulted in a statistically significant difference for PTP across tasks, although post hoc pairwise comparisons failed to detect specific effects. Informal inspection of the data indicated that the most obvious difference was an increase in PTP after the loud-reading task at the highest pitch.

Adult↗
PubMed1989

[Personality and coping with stress in patients with functional dysphonia].

The study was done to prove the etiopathogenetical power of some personality traits, proceeding life events, and strain effects when exposed to an experimental work-stress. 20 functional dysphonics, 14 individuals suffering from organic voice disorders and a group of 20 control persons were examined. The results show that the group of functional dysphonics produced a significant more positive self-evaluation regarding their personality with a clear tendency to restraint. Compared to the control group they showed a higher level of state anxiety in situations causing stress. Furthermore the influence of proceeding life events for the etiopathogenesis of functional dysphonia has become clear.

Adaptation, Psychological↗
PubMed1994

Spectral pattern recognition of improved voice quality.

The self-organizing map (a neural network) was applied to the spectral pattern recognition of voice quality in 34 subjects: 15 patients operated on because of insufficient glottal closure and 19 subjects not treated for voice disorders. The voice samples, segments of sustained /a/, were perceptually rated by six experts. A self-organized acoustic feature map was first computed from tokens of /a/ and then used for the analysis of the samples. The locations of the samples on the map were determined and the distances from a normal reference were compared with the perceptual ratings. The map locations corresponded to the degree of audible disorder: the samples judged as normal were overlapping or close to the normal reference, whereas the samples judged as dysphonic were located further away from it. The comparison of pre- and postoperative samples of the patients showed that the perceived improvement of voice quality was also detected by the map.

Adult↗
PubMed2006

Effects of biofeedback in phonatory disorders and phonatory performance: a systematic literature review.

The purpose of this article was to systematically review the literature on the effects of biofeedback therapy in the domain of phonatory disorders and phonatory performance, using studies in peer-reviewed journals. An extensive definition of biofeedback is given and its place in voice treatment is defined. Eighteen group or case studies or reports considering the effects of electromyographic, laryngoscopic and acoustic biofeedback in dysphonic patients (hyperfunctional voice disorders, hypofunctional voice disorders, psychogenic voice disorder, laryngeal trauma, total laryngectomy, vocal cord dysfunction) and participants with normal voices are included and an analysis of procedure as well as research design and results is presented. The usefulness of biofeedback in phonatory disorders and performance was to be interpreted based on tendencies, since there is a lack of randomized controlled efficacy studies. In only 3 of 18 studies (16.7%) did biofeedback therapy fail to improve voice quality or not result in better results than other forms of therapy. Recommendations for improved methodologies are made, which include the use of acoustic voice quality parameters.

Acoustic Stimulation↗
PubMedDate not supplied

Voice and resonance disorders in genetic syndromes: a meta-analysis.

It is well known that many genetic syndromes are associated with communication disorders and especially with disorders of voice and resonance. This paper reports the results of a meta-analysis with the aim of documenting the occurrence of voice and resonance disorders in genetic syndromes. The analysis studied the occurrence of voice and resonance disorders in general, the occurrence in different etiological subtypes of syndromes and the association with other disorders, in particular clefting, a cognitive impairment and hearing problems. The database for the analysis was a list by Sphrintzen of 299 different syndromes all of which have been reported to entail communication disorders. Major findings are that disorders of voice and resonance in genetic syndromes are only rarely isolated problems, that causal mechanisms are not a major factor in determining the presence of voice and resonance disorders and, foremost, that voice and resonance disorders in genetic syndromes constitute an underresearched area.

Cognition Disorders↗
PubMedDate not supplied

Voice dysfunction in dysarthria: application of the Multi-Dimensional Voice Program.

Phonatory dysfunction is a frequent component of dysarthria and often is a primary feature noted in clinical assessment. But the vocal impairment can be difficult to assess because (a). the analysis of voice disorder of any kind can be challenging, and (b). the voice disorder in dysarthria often occurs along with other impairments affecting articulation, resonance, and respiration. A promising assessment tool is multi-parameter acoustic analysis, such as the Multi-Dimensional Voice Program (MDVP). Part 1 of this paper recommends procedures and standards for the acoustic analysis of voice, including (1). selection of the sample to be analyzed, (2). signal quality requirements, (3). availability of normative data for both genders and different ages of speakers, (4). reliability of analysis, and (5). correlation of acoustic results with results from other methods of analysis. In Part 2, acoustic data are reviewed for the dysarthria associated with Parkinson disease (PD), cerebellar disease, amyotrophic lateral sclerosis (ALS), traumatic brain injury (TBI), unilateral hemispheric stroke, and essential tremor. Tentative profiles of voice disorder are described for these conditions. These profiles may serve as hypotheses for future research. Although several issues remain to be resolved in the acoustic analysis of voice disorder in dysarthria, steps can be taken now to promote the reliability, validity, and clinical utility of such analyses. (1). As a result of this activity, the participant will be able to describe ways in which an optimal multi-dimensional analysis of voice can be performed with modern acoustic analysis systems. (2). As a result of this activity, the participant will be able to apply multi-dimensional acoustic analysis of voice to individuals who have a dysarthria-related voice disorder. (3). As a result of this activity, the participant will be able to identify major sources of normative data on the Multi-Dimensional Voice Program.

Amyotrophic Lateral Sclerosis↗
PubMed1998

[Perceptive and instrumental examination of voice quality in patients with lip-jaw-palate clefts].

BACKGROUND: In Anglo-American literature, prevalences as high as 41% are reported for voice disorders in cleft lip and palate (CLP) patients. Because of considerable variability in the reported findings and because no prevalence data are available for the German-speaking area, a screening study was conducted. METHOD: 154 patients with CLP were examined. Voice quality was assessed perceptively according to the rbh-system (roughness, breathiness, hoarseness). Suprasegmentals and nasal resonance were also assessed. Using a new computer programme for the apparative analysis of voice quality, data for pitch, intensity and pertubation (jitter and shimmer) were obtained for 4 sustained vowels. RESULTS: Based on perceptual analysis, we found that the prevalence of severe voice disorders in CLP patients was 6.5% which is lower than reported in most other studies. The incidence of voice disorders in CLP patients is numerically only slightly higher than in the normal population. The acoustic measurements confirm the results of perceptual analysis. Since the prevalence of severe voice disorders was low, none of the pertubation quotients differentiated between modal and disordered voices. A weak correlation was found between jitter and the ratings for hoarseness. CONCLUSIONS: 1. While it is appropriate to assume a higher potential risk for vocal dysfunction in CLP patients the actual prevalence in the patients examined is numerically only slightly higher than in normals. 2. For patients with voice disorders, apparative diagnostics of voice quality is a useful and practical adjunct to perceptual analysis which helps profiling individual patients and helps the professional to make decisions for therapy.

Adolescent↗
PubMed2002

[Results of videostroboscopic examinations of vocally healthy candidates for voice intensive professions].

BACKGROUND: Questions regarding the vocal aptitude for voice professions are common in the daily phoniatrical and otorhinolaryngological practice. According to the classification by Koufman, Isaccson and Stemple professions can be classified into four groups. While it is common to perform laryngeal investigations and analyses of the vocal efficacy for candidates of elite vocal performers (level 1), i. e. singers and actors, those examinations are usually not executed for voice and speaking intensive professions (level 2) like teachers, as there is no legal base. This group is, however, predisposed with regard to professional voice disorders. METHODS: Aim of the study was therefore to determine the frequency of laryngeal findings in a group of previously asymptomatic subjects using videostroboscopic examinations and to assess the risk concerning the emergence of professional voice disorders. 545 candidates for voice intensive professions have been examined with regard to the existence of any organic or secondary organic alterations on the vocal folds. RESULTS: One third of the subjects showed benign laryngeal alterations, which were not consequentially associated with auditive alterations of the voice sound and/or a consciousness of a voice disorder. Apart from 33 organic laryngeal alterations 129 phonation associated alterations of the vocal fold were determined. CONCLUSIONS: These subjects should especially in cases of excessive vocal demand and additional the efficacy reducing factors be regarded as a high risk group with regard to the emergence of professional voice disorders. The results underline the necessity to require vocal examinations and vocal assessment analyses for candidates of voice intensive professions in order to avoid professional voice disorders.

Adolescent↗
PubMed2003

Quantitative analysis of professionally trained versus untrained voices.

The aim of this study was to compare healthy trained and untrained voices as well as healthy and dysphonic trained voices in adults using combined voice range profile and aerodynamic tests, to define the normal range limiting values of quantitative voice parameters and to select the most informative quantitative voice parameters for separation between healthy and dysphonic trained voices. Three groups of persons were evaluated. One hundred eighty six healthy volunteers were divided into two groups according to voice training: non-professional speakers group consisted of 106 untrained voices persons (36 males and 70 females) and professional speakers group--of 80 trained voices persons (21 males and 59 females). Clinical group consisted of 103 dysphonic professional speakers (23 males and 80 females) with various voice disorders. Eighteen quantitative voice parameters from combined voice range profile (VRP) test were analyzed: 8 of voice range profile, 8 of speaking voice, overall vocal dysfunction degree and coefficient of sound, and aerodynamic maximum phonation time. Analysis showed that healthy professional speakers demonstrated expanded vocal abilities in comparison to healthy non-professional speakers. Quantitative voice range profile parameters- pitch range, high frequency limit, area of high frequencies and coefficient of sound differed significantly between healthy professional and non-professional voices, and were more informative than speaking voice or aerodynamic parameters in showing the voice training. Logistic stepwise regression revealed that VRP area in high frequencies was sufficient to discriminate between healthy and dysphonic professional speakers for male subjects (overall discrimination accuracy--81.8%) and combination of three quantitative parameters (VRP high frequency limit, maximum voice intensity and slope of speaking curve) for female subjects (overall model discrimination accuracy--75.4%). We concluded that quantitative voice assessment with selected parameters might be useful for evaluation of voice education for healthy professional speakers as well as for detection of vocal dysfunction and evaluation of rehabilitation effect in dysphonic professionals.

Adolescent↗
PubMed2005

Quality of life in dysphonic patients.

Voice disorders can affect social life. Dysphonic patients report symptoms of psychological distress as a direct consequence of their dysphonia. It is assumed that their health-related quality of life (HRQL) is reduced. The purpose of this study was to find out whether changes of HRQL depend on the kind of voice disorder (organic or functional) and on the sex of the person affected. A total of 108 adult patients took part in the study, and patients with malignancies were excluded. Test persons were asked to complete the SF-36 questionnaire on their health-related quality of life without prior information about their individual diagnosis. The results of this study show that voice disorders significantly influence patients' HRQL. There are no statistically significant differences between patients suffering from organic and functional voice disorders or between dysphonic women and men. When comparing the results obtained in this study with those in the literature, surprisingly, it seems that the manner in which a person experiences a voice disorder depends on the individual cultural background. Patients with functional voice disorders have similar reduction in HRQL as those with organic voice disorders. HRQL in dysphonic women does not differ from the one in dysphonic men. The results allow for the conclusion that changes of HRQL do not depend on the kind of voice disorder and not on the sex of the person affected.

Adult↗
PubMed1985

Use of the phonation analyzer as a clinical tool.

Isshiki's (1981) proposed index of glottal flow efficiency (ac/dc ratio) and an instrument designed to measure the index (PA 500) were evaluated. Measurements of glottal flow, SPL, and fundamental frequency obtained from the PA 500 were compared with measurements obtained from more established laboratory instruments and found to be similar. Then the PA 500 was used to obtain measurements from 50 subjects without voice disorders or laryngeal pathology, 14 subjects with voice disorders and no laryngeal pathology, and 41 subjects with voice disorders and laryngeal pathology. Comparisons of ac/dc ratios revealed some significant differences among subject groups. However, when Isshiki's proposed cutoff ratio (ac/dc = 0.50) was used to determine which subjects had laryngeal pathology, 33% of the 105 subjects were misidentified. Data collected in the study provided an opportunity to evaluate Hirano's (1981) suggestion that glottal flow rates of 200 cc/s may be considered abnormal. When this flow rate was used as a cutoff score to determine which subjects had laryngeal pathology, 24% of the 105 subjects were misidentified. High variability in measurements obtained from subjects in each of the groups studied suggest that it is unlikely that ac/dc ratios or glottal flow measures, by themselves, will prove to be effective in identifying subjects with laryngeal pathology.

Adolescent↗
PubMed2006

Voice and upper airway symptoms in people with chronic cough and paradoxical vocal fold movement.

Chronic cough (CC) and paradoxical vocal fold movement (PVFM) share several common features; however, there has been no systematic comparison of these two conditions. The aims of this study were to contrast and compare the symptom profiles of CC and PVFM, to clarify the relationship between the two conditions, and to explore how symptom characteristics could be used to design an individualized treatment program. Participants included 55 people with a combination of PVFM and CC that was refractory to medical treatment, 8 people with PVFM alone, 56 people with CC alone, 25 people with voice disorders, and 27 normal controls. Symptoms and descriptive features of CC, PVFM, and voice disorders were assessed via structured case history interview, symptom frequency, and severity ratings, ratings of activity limitation, and anxiety/depression ratings. Results indicated consistent overlap in the symptom profile between people with CC and those presenting with a combination of CC and PVFM. Participants with PVFM without cough and those with voice disorders overlapped with the participants with CC on some dimensions; however, there were still some significant differences between them. These data suggest that CC and PVFM are related and manifestations of a common underlying condition but that voice disorders are a discrete entity. Most participants had normal ratings on screening for anxiety and depression. Results indicated that there were no consistent psychiatric symptoms in any of the groups studied, and they do not support the label of psychogenic cough for CC that is refractory to medical treatment. Characteristics of CC such as nature and timing of the cough provide important information for developing behavioral treatment programs for individual patients who have exhausted medical options. A template has been provided that is a practical method of designing an integrated behavioral treatment program based on those individual patient characteristics.

Adult↗