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PubMedDate not supplied

Toward the development of an objective index of dysphonia severity: a four-factor acoustic model.

During assessment and management of individuals with voice disorders, clinicians routinely attempt to describe or quantify the severity of a patient's dysphonia. This investigation used acoustic measures derived from sustained vowel samples to predict dysphonia severity (as determined by auditory-perceptual ratings), for a diverse set of voice samples obtained from 134 adult females, with and without voice disorders. Stepwise multiple regression analysis on all voice samples, followed by randomized and repeated cross-validation (random selection of 75% of the original 134 voice sample corpus; 100 iterations) indicated that a four-variable model comprised of time and spectral-based acoustic measures was able to strongly predict perceived severity of dysphonia (mean R = .880; mean R(2) = .775). A cepstral-based measure (CPP/EXP ratio) was determined to be the most significant contributor to the prediction of dysphonia severity, though it is clear that the addition of other acoustic measures (pitch sigma; shimmer (dB); and the Discrete Fourier Transformation ratio, a measure of low versus high frequency spectral energy) add substantially to the accurate prediction of severity. The results are interpreted and discussed with respect to the key acoustic characteristics that contributed to the prediction of severity, the value of identifying a subset of time and spectral-based acoustic measures which appear sensitive to a perceptually diverse set of voices, and the possible use of acoustic models in guiding auditory-perceptual ratings.

Adult↗
PubMed2006

Diagnostic value of voice acoustic analysis in assessment of occupational voice pathologies in teachers.

It has been shown that teachers are at risk of developing occupational dysphonia, which accounts for over 25% of all occupational diseases diagnosed in Poland. The most frequently used method of diagnosing voice diseases is videostroboscopy. However, to facilitate objective evaluation of voice efficiency as well as medical certification of occupational voice disorders, it is crucial to implement quantitative methods of voice assessment, particularly voice acoustic analysis. The aim of the study was to assess the results of acoustic analysis in 66 female teachers (aged 40-64 years), including 35 subjects with occupational voice pathologies (e.g., vocal nodules) and 31 subjects with functional dysphonia. The acoustic analysis was performed using the IRIS software, before and after a 30-minute vocal loading test. All participants were subjected also to laryngological and videostroboscopic examinations. After the vocal effort, the acoustic parameters displayed statistically significant abnormalities, mostly lowered fundamental frequency (Fo) and incorrect values of shimmer and noise to harmonic ratio. To conclude, quantitative voice acoustic analysis using the IRIS software seems to be an effective complement to voice examinations, which is particularly helpful in diagnosing occupational dysphonia.

Adult↗
PubMed1984

[Detection of latent velopharyngeal hyperfunction with the Lombard trial].

If subjected to Lombard conditions several patients with voice disturbances (17,7%) react by producing hyponasal speech which can be proved sonagraphically. The reason for this effect seems to be a habitual velopharyngeal hyperfunction, manifesting itself during bilateral deafening, while kinesthetic and reflectory mechanisms compensate for the auditory feedback loss. The deafening procedure using the Lombard effect can therefore be useful for diagnosis of functional components of voice disorders as well as in the therapy of functional voice disturbances.

Adult↗
PubMed1980

[Effects of phoniatric therapy on the phonetogram].

A phonetogram was performed in 38 patients at the beginning and at the end of a phoniatric treatment for voice disorder, with for each case, a part of functional voice therapy. Average values are markedly positive for the F0-range, the loudness-dynamics, and the phonatory area. Some interesting physio-pathological conclusions may be deduced from a comparison with the phonatory coefficient, and with the acoustical analysis of usual voice.

Female↗
PubMed1993

[Psychogenic aspects of functional dysphonia].

In order to estimate the significance of the psychogenic factor in the etiology of functional voice disorders on the basis of relevant psychological dimensions we compared patients with functional dysphonia, aphonia and a normal control group by means of an empirical-psychological test procedure. Psychogenic conditions proved to be a major factor in the etiology of aphonia, whereas such an interrelation turned out only partially in patients with functional dysphonia. The conclusion can be that psychogenic aspects are not necessarily of exceeding importance in the etiology of functional dysphonia. If no differentiation is made between the two kinds of voice disorders an overestimation of psychogenic influence might occur.

Adult↗
PubMed1993

Long-time average spectrograms of dysphonic voices before and after therapy.

Tape recordings before and after successful voice therapy from 174 subjects with non-organic voice disorders (functional dysphonia) were analysed by long-time averaged voice spectrograms (LTAS). In female as well as in male voices there was a statistically significant increase in level in the first formant region of the spectra. In the female voices there was also an increase in level in the region of the fundamental. The LTAS were compared to the results of a perceptual evaluation of the voice qualities by a small group of expert listeners. There was no significant change of the LTAS in voices with negligible amelioration after therapy. In the voices, where the change after therapy was perceptually rated to be considerable, the LTAS showed only an increase in intensity, but the general configuration of the spectral envelope remained unchanged. There was only a weakly positive correlation between the quality ratings and parameters of the spectra.

Adult↗
PubMed2005

Chaos in voice, from modeling to measurement.

Chaos has been observed in turbulence, chemical reactions, nonlinear circuits, the solar system, biological populations, and seems to be an essential aspect of most physical systems. Chaos may also be central to the interpretation of irregularity in voice disorders. This presentation will summarize the results from a series of our recent studies. These studies have demonstrated the prescence of chaos in computer models of vocal folds, experiments with excised larynges, and human voices. Methods based on nonlinear dynamics can be used to quantify chaos and irregularity in vocal fold vibration. Studies have suggested that disordered voices from laryngeal pathologies such as laryngeal paralysis, vocal polyps, and vocal nodules might exhibit chaotic behaviors. Conventional parameters, such as jitter and shimmer, may be unreliable for analysis of periodic and chaotic voice signals. Nonlinear dynamic methods, however, have differentiated between normal and pathological phonations and can describe the aperiodic or chaotic voice. Chaos theory and nonlinear dynamics can enchance our understanding and therefore our assessment of pathological phonation.

Analysis of Variance↗
PubMed1995

G. Paul Moore Lecture. Rational thought: the impact of voice science upon voice care.

Recent evolution in scientific knowledge and technology has led to monumental improvement in the standard of care for patients with voice disorders. New concepts in anatomy, physiology, measurement, and analysis have provided voice care professionals with not merely better understanding, but moreover an extensive vocabulary with which to think about voice function and dysfunction. Previously, we had to depend too much upon anecdote and "the art of medicine." Thanks to scientific advances, we now have the tools we need for rational thought about the human voice. This is the fundamental change responsible for recent great advances in voice care.

Humans↗
PubMed2005

[Determination of subjective impairment in dysphonia. A methodological comparison].

OBJECTIVE: The purpose of this study was to estimate the correlation between the voice handicap index (VHI) and the voice related quality of life (VRQOL) questionnaire with respect to gender and diagnosis (functional vs organic dysphonia). MATERIALS AND METHODS: A total of 52 German speaking patients aged 48.8+/-22.0 years suffering from dysphonia of different benign etiologies (functional dysphonia: 18 women, 9 men; organic dysphonia: 13 women, 12 men) completed German versions of both the VHI and the VRQOL questionnaire without prior information on their individual diagnosis. Another 52 individuals without voice complaints served as age and sex matched controls. Complete data sets of all participants were analyzed using the Microsoft Excel and MATLAB software packages. RESULTS: The results of both questionnaires correlate at a significant level, both for total score (r=-0.9) and the subscores (r=-0.74-r=-0.84) with only slight differences when comparing women and men and patients with functional and organic voice disorders. CONCLUSIONS: Both questionnaires provide very similar results. Thus, for clinical purposes, it seems justified to restrict oneself to using only one of the questionnaires. Whenever basic information on the patients' self perception of a voice disorder is required, the VRQOL questionnaire with only ten items may be easier to handle than the VHI questionnaire with 30 items.

Disability Evaluation↗
PubMed1997

Patient-reported problems associated with dysphonia.

In the UK there has been little assessment of the efficacy of therapy for patients with dysphonia. Current objective assessment methods (e.g. acoustical analysis) do not correlate well with patient symptoms. Existing subjective measures are based on clinical impression. To date, no measure has been based on the patient's experience and the aim of this study was to explore the difficulties that patients encounter as a consequence of their illness or disability. One hundred and thirty-three dysphonic patients completed an open-ended questionnaire where they were asked to make a list of the problems they experienced due to their voice disorder. Responses were categorized using the WHO International Classification of Impairments, Disabilities and Handicaps. A total number of 467 problems were listed: 60% impairments, 26% disabilities and 14% were handicap related. The six major impairments related to altered voice and throat symptoms. Although the majority of disabilities resulted from lack of projection and clarity, the most frequently reported was singing. Reported handicaps encompassed psychological, emotional and employment-related difficulties and effects on family and friends. People with dysphonia experience social, lifestyle and employment difficulties as a consequence of their voice disorder. Responses to the open-ended questionnaire have considerable practical applications in targeting more comprehensive treatment strategies.

Adolescent↗
PubMed1990

An in vivo canine model for testing treatment effects in laryngeal hyperadduction disorders.

Adductor spastic dysphonia is a voice disorder characterized by a strained, squeezed, effortful voice produced by true and false cord hyperadduction. An in vivo canine model has been developed to simulate hyperadduction of the true cords. Using this model, the thyroarytenoid muscle was found to have a greater effect on intraglottic and subglottic pressure than cricothyroid muscle contraction. The intraglottic and subglottic pressure was reduced after simulated recurrent laryngeal paralysis. This model can be used in future studies to compare laryngeal treatment modalities for disorders that have a component of vocal cord hyperadduction, such as spastic dysphonia.

Animals↗
PubMed2006

Model-based classification of nonstationary vocal fold vibrations.

Classification of vocal fold vibrations is an essential task of the objective assessment of voice disorders. For historical reasons, the conventional clinical examination of vocal fold vibrations is done during stationary, sustained phonation. However, the conclusions drawn from a stationary phonation are restricted to the observed steady-state vocal fold vibrations and cannot be generalized to voice mechanisms during running speech. This study addresses the approach of classifying real-time recordings of vocal fold oscillations during a nonstationary phonation paradigm in the form of a pitch raise. The classification is based on asymmetry measures derived from a time-dependent biomechanical two-mass model of the vocal folds which is adapted to observed vocal fold motion curves with an optimization procedure. After verification of the algorithm performance the method was applied to clinical problems. Recordings of ten subjects with normal voice and ten dysphonic subjects have been evaluated during stationary as well as nonstationary phonation. In the case of nonstationary phonation the model-based classification into "normal" and "dysphonic" succeeds in all cases, while it fails in the case of sustained phonation. The nonstationary vocal fold vibrations contain additional information about vocal fold irregularities, which are needed for an objective interpretation and classification of voice disorders.

Adult↗
PubMedDate not supplied

Tourette disorder and mutational falsetto.

Speech, language and voice disorders associated with Tourette Disorder (TD) are reviewed. Two cases of TD associated with falsetto are presented. The relationship between abnormalities in vocal pitch and tic symptomatology is explored.

Adolescent↗
PubMed2006

A novel treatment for hypophonic voice: Twang therapy.

UNLABELLED: A hypophonic voice, characterized perceptually as weak and breathy, is associated with voice disorders such as vocal fold atrophy and unilateral vocal fold paralysis. Although voice therapy programs for hypophonia typically address the vocal folds or the sound source, twang voice quality was examined in this study as an alternative technique for increasing vocal power by altering the epilarynx or the sound filter. OBJECTIVE: This study investigated the effect of twang production on physiologic, acoustic, and perceived voice handicap measures in speakers with hypophonia. DESIGN/METHODS: This prospective pilot study compared the vocal outcomes of six participants with hypophonia at pre- and posttreatment time points. Outcome measures included mean airflow rate, intensity in dB sound pressure level (SPL), maximum phonation time, and self-report of voice handicap. RESULTS: All subjects improved in at least three of the four vocal outcome measures. Wilcoxon signed-rank test of paired differences revealed significant differences between pre- and posttherapy group means for airflow rate, SPL, and Voice Handicap Index scores. CONCLUSION: The twang voice quality as a manipulation of the sound filter offers a clinical complement to traditional voice therapies that primarily address the sound source.

Aged↗
PubMed1987

EMG biofeedback as a function of voice-quality change.

Changes in electromyography (EMG) accompanying changes in voice quality are reported. Audio recordings were obtained from four normal speakers during production of sustained vowels, counting and reading. These were uttered first in a normal voice and then in a voluntarily produced harsh voice. Perceptual ratings of voice quality of these utterances were made and compared to averaged EMG values obtained during the productions. The surface electrode placement remained unchanged over each of the cricothyroid areas for both normal and harsh voice. For one of the speakers, changes in EMG paralleled changes in vocal quality. For the other three, changes in EMG were variable, and sometimes minimal, in comparison to changes in voice. The results are discussed in relation to the clinical use of EMG for voice disorders.

Biofeedback, Psychology↗