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PubMed2006

Should singing activities be included in speech and voice therapy for prepubertal children?

Customarily, speaking and singing have tended to be regarded as two completely separate sets of behaviors in clinical and educational settings. The treatment of speech and voice disorders has focused on the client's speaking ability, as this is perceived to be the main vocal behavior of concern. However, according to a broader voice-science perspective, given that the same vocal structure is used for speaking and singing, it may be possible to include singing in speech and voice therapy. In this article, a theoretical framework is proposed that indicates possible benefits from the inclusion of singing in such therapeutic settings. Based on a literature review, it is demonstrated theoretically why singing activities can potentially be exploited in the treatment of prepubertal children suffering from speech and voice disorders. Based on this theoretical framework, implications for further empirical research and practice are suggested.

Child↗
PubMed2006

[Perceptual method and videostroboscopy in patients with vocal fold hypertrophy underwent microsurgery].

INTRODUCTION: Chronic hypertrophic laryngitis concerns many people in our population. Their etiopathogenesis is complicated and usually connected with exogenous harmful factors like occupational or environmental exposure. Organic voice disorders of the larynx, particularly concerning vocal folds are the cause of dysphonia. Both surgical and conservative methods in the treatment of patients with laryngeal hypertrophy are applied. Objective assessment of the voice improvement after microsurgery is the subject of discussion of many authors. The problem of voice improvement is rarely approached to in the comprehensive way, that is with reference to activity and anatomy of the larynx. The basic aim of this research was to asses phonation function of the larynx after microsurgery on the basis of subjective and videostroboscopic voice analysis. The second aim was to estimate the surgical treatment effectiveness depending on vocal fold hypertrophy extensiveness. MATERIAL AND METHOD: The research was conducted on 50 subjects chosen from the population of patients with vocal fold hypertrophy treated at the Department of Laryngology Silesian Medical Academy in Zabrze from January to December 2003. All the examined patients underwent classical microsurgery. Voice quality examinations were done just before microsurgery and 3 months after the operation. On the basis of histopathological results, following diagnosis were established: vocal fold polyps (oedematosus, teleangiectaticus and inflammatorius), oedema Reincke, laryngeal papilloma, laryngeal granuloma and cyst. The research methodology included: perceptual voice examination based on GRBAS scale (G--grade; R--roughness; B--breathiness; A--asthenicity; S--strain) and assessment of vibrations of vocal folds in videostroboscopy. Examination results in two groups with different extensiveness of vocal fold hypertrophy were compared. The control group presented 30 subjects without any voice disorders who did not use their voice for professional purposes. RESULTS: In both groups (with minor and extensive vocal fold lesions) significant improvement in perceptual and videostroboscopic voice parameters was observed. The results in the group with minor vocal fold lesions were better after microsurgery. CONCLUSIONS: The methodology based on the application of the two methods of voice examination could be an objective rate in the estimation of the treatment progress.

Adult↗
PubMed1998

Vocal problems among teachers: a review of prevalence, causes, prevention, and treatment.

Voice disorders are thought to be one of the major occupational hazards of school teaching. The resulting symptoms can affect teachers' ability to function in the classroom and prevent them from developing effective working relationships with other staff and students. Sick leave, speech pathology management, and surgical intervention can be costly. Severe voice problems can also result in a teacher permanently leaving the classroom. Despite the significant implications of voice disorders for teachers, this review of published research demonstrates that findings concerning the prevalence of voice problems in teachers and the causes and contributing factors of those voice problems are inconclusive. Similarly, previous research on the efficacy of prevention programs and treatment of voice problems in teachers provide few firm conclusions. Further research based on sound empirical data is needed, as many past studies have relied on anecdotal or self-report data. More operational definitions of what constitutes a voice disorder and the associated contributing factors should be adopted, along with the use of more instrumental measures and careful attention to methodology and appropriate statistical analyses. Only then will we have a sound basis for the development of effective prevention and education programs for teachers.

Female↗
PubMed2005

Multidimensional scaling of breathy voice quality: individual differences in perception.

Experiments on disordered voice quality with multidimensional scaling (MDS) have resulted in solutions with low R-square and have failed to show consistent dimensions across different listeners. These findings have been suggested to indicate large individual differences in the perception of voice quality. However, these inconsistencies may originate from several factors, including random stimulus selection, instructions that encourage listeners to respond to global difference in pairs of voices, and noisy perceptual data. This experiment used MDS techniques to study individual differences in perception of breathiness. The voices in the experiment were selected to have a relatively wide variation in breathiness but only minimal variation in roughness, strain, and fundamental frequency. Additionally, listeners were instructed specifically to rate similarities in breathiness rather than judging global differences in voices, and several judgments from each listener were averaged to minimize noise in the data. It was hypothesized that these modifications would result in an MDS solution that accounted for greater variance in perceptual data than previously shown. Results show that averaging multiple responses from each listener increased the R-square from 45% to approximately 75%. The poor R-square and large individual differences in voice quality perception observed in past research may have partly resulted from the experimental procedures in previous studies. These findings suggest that individual differences in the perception of voice quality are not as large as previously thought, and a model of voice quality perception for an "average" listener may be a good representation for the general population.

Adult↗
PubMed2005

Effects of breathy voice source on ratings of hypernasality.

OBJECTIVE: To investigate the effects of breathy voice sources on ratings of hypernasality using synthesized speech. METHODS: Speech samples were obtained from children with cleft palates who demonstrated varying degrees of hypernasality and from a child with a voice disorder. Sources with 6 degrees of breathiness were created: a breathy source and five synthesized sources with lowered harmonics-to-noise ratio (HNR) values by the addition of impulses. These sources and each original (clear) source were combined with three kinds of filters: mild, moderate, and severely hypernasal. Consequently, 21 ([6 + 1] x 3) stimuli for each vowel (/a/ and /i/) were obtained for ratings. PARTICIPANTS: Thirteen speech pathologists with academic training and various clinical experiences with cleft palate speech rated hypernasality of the stimuli on a 5-point scale. MAIN OUTCOME MEASURES: Ratings of hypernasality for breathy and clear stimuli were analyzed using a repeated measures analysis of variance. RESULTS: The effects of breathy source on ratings of hypernasality were significant for the following filters: mild hypernasal /a/, severe hypernasal /a/, mild hypernasal /i/, and moderate hypernasal /i/. A post-hoc comparison test demonstrated that the more breathy sources (BH0 or BH2) generally increased the hypernasality score for mild hypernasal filters and decreased it for moderate and severe hypernasal filters. The less breathy sources (BH3, BH4, and BH5) hardly affected the ratings. CONCLUSION: The effects of breathiness on ratings of hypernasality seem to moderate rather than to mask perceived hypernasality. That is, breathiness raises slight hypernasality, whereas it reduces severe hypernasality.

Child↗
PubMed1999

Validation of an instrument to measure voice-related quality of life (V-RQOL).

When a patient presents for care of a voice disorder, the clinician attempts to diagnose the problem, quantify the degree of dysphonia, and prescribe appropriate treatment. Quantification of the degree of dysphonia is often difficult, as no universal index of vocal function exists. Decisions about the nature and intensity of treatment are often based on the magnitude of the voice-related problems experienced by the patient and the importance that the patient places on those problems, that is, the impact that the voice disorder is having on the patient's voice-related quality of life (V-RQOL). Measurement of post-treatment outcome is also not standardized. Regardless of how the clinician measures response to treatment, it will typically be measured by the patient in terms of how his or her voice-related problems are affected by the treatment. Measurement of quality of life has not been a traditional part of the evaluation of the dysphonic patient. This study was undertaken to develop and validate an instrument for measuring V-RQOL using a population of 109 voice and 22 non-voice patients. The 10-item V-RQOL measure performs well in tests of reliability, validity, and responsiveness, and it carries a low burden. Measurement of V-RQOL is a valuable addition to the evaluation of dysphonic patients and their treatment outcomes.

Adult↗
PubMed2006

Involuntary glottal closure during inspiration in muscle tension dysphonia.

OBJECTIVE/HYPOTHESIS: The purpose of this study was to examine respiratory function in a group of patients with muscle tension dysphonia (MTD) DESIGN: Cross-sectional analytical study. METHODS: Participants included 15 people with a diagnosis of MTD referred to speech pathology for management of their voice disorder, fiberoptic evidence of glottal or supraglottic constriction during phonation with or without posterior chink, or bowing combined and deviation in perceptual voice quality. A second group of 15 participants with no history of voice disorder served as healthy controls. Baseline pulmonary function test measures included forced expiratory volume in the first second (FEV1), FVC, FEF25 to 75, FIF50, FEV1/FVC, ratio and FEF50/FIF50 ratio. Hypertonic saline challenge test measures included FEV1 and FIF50 after provocation, dose response slope, and provocation dose. RESULTS: Compared with healthy controls, participants with MTD demonstrated a higher prevalence of glottal constriction during inspiration after provocation with nebulized hypertonic saline as demonstrated by a reduction in FIF50 after the hypertonic saline challenge. There was no significant difference between the MTD and healthy control groups in baseline pulmonary function testing. Participants with MTD demonstrated a higher prevalence than healthy controls of abnormal glottic closure during inspiration similar to paradoxical vocal fold movement (PVFM). This suggests that they either had previously undiagnosed coexisting PVFM or that the condition of MTD could be expanded to include descriptions of aberrant glottic function during respiration. This study enhances the understanding of PVFM and MTD by combining research advances made in the fields of otolaryngology and respiratory medicine.

Adult↗
PubMed2006

Voice problems experienced by Finnish comprehensive school teachers and realization of occupational health care.

A survey was conducted among teachers to explore 1) risk factors of voice disorders, 2) the number and nature of problems experienced, 3) the need for medical help, and 4) how occupational health care reacts to this need. Additionally, the knowledgeability of occupational health care physicians and the way treatment of voice disorders is currently organized was explored. Of the 181 teachers who responded, 42% reported voice symptoms occurring daily or weekly. Every tenth teacher also had vocal nodules, and 40% of those with recurring voice problems had been on sick-leave. The respondents suggested improvements in occupational health care: it should also cover prevention, waiting times need to be shortened and care chains established, and resources need to be allocated for voice therapy services.

Adult↗
PubMed2005

Speech treatment for Parkinson's disease.

Researchers estimate that 89% of people with Parkinson's disease (PD) have a speech or voice disorder including disorders of laryngeal, respiratory, and articulatory function. Despite the high incidence of speech and voice impairment, studies suggest that only 3-4% of people with PD receive speech treatment. The authors review the literature on the characteristics and features of speech and voice disorders in people with PD, the types of treatment techniques available, including medical, surgical, and behavioral therapies, and provide recommendations for the current efficacy of treatment interventions and directions of future research.

Articulation Disorders↗
PubMed1981

Clinical investigations of intermittent breathy dysphonia.

Case history and voice data for 17 patients who presented with intermittent moments of breathy dysphonia (IBD) in contextual speech were analyzed. From recorded samples of vowel prolongation four variants of phonation were identified. Of 13 patients examined neurologically, 10 (77%) had positive neurologic signs. Psychiatric and physical illnesses were often associated with onset of the voice disorder. Sex ratio of the patients in this study was nearly the same as that for adductor spastic dysphonia. Age at onset was similar to that which has been described for "functional" voice disorders. Different therapies were generally ineffective in alleviating the disorder. Although not conclusive, patients presenting with IBD in connected speech may have an underlying neurologic or psychologic disorders.

Adolescent↗
PubMed1999

Effect of caffeine on the vocal folds: a pilot study.

Caffeine is considered to be a dehydrating agent with detrimental effects on the quality of voice of persons ingesting it. This has led medical personnel dealing with voice disorders, especially in the case of professional voice users, to give advice against the use of caffeine. Yet this is an anecdotal truth as an extensive Medline literature search did not reveal any scientific evidence of caffeine being proven to have adverse effects on the vocal folds. We, therefore, initiated this pilot study to ascertain the connection between caffeine and voice quality on a laboratory basis. Two hundred and fifty mg of caffeine were provided to eight volunteers in tablet form, and blood levels along with laryngograph readings were recorded to document the changes produced. Analysing the irregularities of frequencies in a) free speech b) a reading passage and c) singing 'Happy Birthday', substantial changes were seen to authenticate the fact that caffeine does produce alterations in voice quality but these alterations have considerable intra-subject variability. A full study with wider parameters is to be performed on this subject as we consider it to be of importance in the management of voice disorders.

Adult↗
PubMed1991

The spectrum of vocal dysfunction.

Levels of vocal use, types of vocal complaints, and the spectrum of vocal dysfunction are discussed in this article. Functional voice disorders account for 40% and organic conditions for 60% of patients presenting with voice disorders. Twelve percent of the patients are children.

Humans↗
PubMed2001

Preparation of the speech-language pathologist specializing in voice: an educational survey.

This study investigates the academic and clinical preparation a speech-language pathologist receives in the area of voice. The purpose is to determine how to structure continuing education and specialty training in vocology, defined as the science and practice of voice habilitation. Surveys were sent to the graduate programs in speech-language pathology accredited by the American Speech-Language-Hearing Association (ASHA) in 1994, and again in 1999. Results from the 1994 survey indicated that students received limited information and clinical experience in handling typical voice cases. Although most programs required a voice disorders course, fewer mandated coursework in normal voice production or clinical experience with voice patients. The follow-up survey showed that the educational environment in 1999 is similar to that in 1994. It is evident that the programs are in compliance with the Educational Training Board model developed by ASHA for basic clinical competence, but no structure for specialty training has yet emerged.

Humans↗
PubMed2006

Occupational voice complaints and objective acoustic measurements-do they correlate?

To enable the development of appropriate diagnostics and treatment for occupational voice disorders, this study addresses connections between subjective voice complaints and objective observations. The subjects of this study were 24 female customer advisors, who mainly use the telephone during their working hours. During one working day, at four different times, speech samples covering 20 minutes of telephone conversation by the customer service advisors (CSAs) were recorded. In addition, the CSAs filled in a questionnaire (visual analogue scale) concerning their voice problems. To represent the vocal symptoms three variables were used: vocal fatigue, hoarseness and a general sum-variable. A 5-minute sample was taken from recordings for further analyses. This included fundamental frequency, sound pressure level, alpha ratio (the ratio between the spectral energy below and above 1000 Hz) and number of vocal fold vibrations. In the objective acoustic measurements, it was found that fundamental frequency (F0) rose significantly during the working day. Also the self-reported voice symptoms increased significantly during the working day. However, correlations between vocal symptoms and acoustic measures were not found.

Adult↗
PubMedDate not supplied

Perceptual and acoustic correlates of abnormal voice qualities.

A set of 17 voices representing various voice disorders were presented to a jury of voice experts who rated them on a 5-point scale for each of 28 terms frequently used for describing voices. A statistical treatment of these ratings yielded 5 bipolar factors accounting for 85% of the total variance. Significant correlations were found between four of these factors and certain acoustic data extracted fron long-time-average spectra and fundamental frequency distribution analysis of the same voice sample.

Humans↗
PubMed1993

Analysis of vocal abuse: fluctuations in phonation time and intensity in 4 groups of speakers.

We have seen many patients with a voice disorder due to vocal abuse. However, there is little information about the speaking behaviour of such patients. The object of this study was to analyze speaking behaviour and to evaluate the relationship between the cause of voice disorders and its effects on speech. We had previously measured phonation time with a speech time accumulator. Recently, we have developed a speech intensity/speech time accumulator. We obtained data by accumulating the phonation time at 4 degrees of vocal intensity, ranging from weak to strong. By using this instrument, we measured the speaking habits of 29 subjects for 131 days and collected data about the criteria for vocal abuse. Our results showed that the office workers exhibited a phonation time (33.6 +/- 13.6 min for 8 h) three times shorter than that of teachers and patients with vocal fold nodules (102.1 +/- 22.9 min for 8 h). For the teachers and patients with a long phonation time, half of the total phonation time was at high intensity.

Acoustics↗
PubMed1983

The voice clinic: an interdisciplinary approach.

The University of British Columbia Voice Clinic provides care to patients with various types of voice disorder, and the effectiveness of therapy is enhanced by an interdisciplinary approach. The Voice Clinic team includes an otolaryngologist, speech pathologist, psychiatrist, and singing teacher consultant. This paper particularly highlights the interactions between the speech pathologist and psychiatrist in their therapy programs for voice disordered patients.

British Columbia↗