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PubMedDate not supplied

[Functional damage of the larynx].

INTRODUCTION: The basic mechanism of the development of functional voice disorders is an excessive collision pressure between the vocal folds during phonation, which occurs between the membranous folds, and/or the vocal processes. Functional-traumatic lesions of the vocal folds appear mainly at the junction between the anterior and the middle thirds of the vocal folds, slightly below the free edge. This is the "predilection site" of the vocal folds, which is the most active part of the vocal folds during phonation, and is therefore mostly exposed to functional-traumatic changes. This study is aimed at establishing the most frequent benign lesions of the vocal folds, which appear at the predilection sites of the vocal folds, and discussing their functional-traumatic aetiology. MATERIAL AND METHODS: During the past 10 years 1550 patients underwent various microsurgical procedures for benign lesions of the vocal folds. They were studied for the precise localization of the lesions by the use of indirect videostroboscopy or microstroboscopy, and direct microlaryngoscopy related to the technique which has been used in each particular patient. In this way an overall number of lesions was established, which were located at the predilection sites of the vocal folds, indicating their functional-traumatic aetiology. RESULTS: It has been established that 1068 lesions (68.6%) were located at the predilection site of the vocal folds (Table 1). Namely, these were nodular lesions, polyps, cysts, and haematoma. Contact hyperplasia appeared at the posterior third of the vocal folds due to a special mechanism of its development. DISCUSSION: Functional-traumatic lesions are mucous stranding, nodular lesions, polyps, cysts, contact hyperplasia and haematoma. All these lesions are either of functional origin or functional voice disorders which contribute, to some degree, to their development.

Humans↗
PubMed1989

[The Hamburg concept for the treatment of functional dysphonia in patients with speech occupations (pedagogy) from the holistic viewpoint].

Literature on functional voice disorders, on their etiopathogenetic criteria linked in a complex way, on the multifaceted aspects of the symptoms, and on the varieties, which arise out of influences during the long-term course of the disease has reached a considerable volume. In relation to this fact, the description of therapeutic methods is thin and there is only sparse attention given to quantitative facts, such as intensity and duration of therapy and the possible influences of patients' professional field on the therapeutic course. However, there is general agreement that qualitative features and quantitative volume of therapy should be enlarged under the holistic aspect of an adequate therapy of voice function, depending on individual necessities. Under such a holistic aspect, two fundamental ways of therapy are possible and both ways have advantages and disadvantages, which originate from principal differences: out-patient therapy and in-patient therapy. The Hamburg-Concepts of out-patient therapy of professional voice disorders which were created, tested, corrected and in a long-lasting process finally structured in terms of operational diagrams are discussed in this paper under different points of view: the precondition is a complete evaluation of all influencing factors in an interdisciplinary process. In closing, a new program of cooperation between the institution for in-patient voice therapy in Werscherberg/Osnabrück and the Hamburg Team is mentioned, a program which, though very complex and risky, is intended to close the gap between in-patient and out-patient therapy.

Humans↗
PubMed2001

Adductor spasmodic dysphonia and botulinum toxin treatment: the effect on well-being.

Adductor spasmodic dysphonia (AdSD) is a controversial and enigmatic voice disorder. It is generally accepted that it has a neurologic, although undetermined, cause, and it is accompanied by much psychological and physical distress. In this prospective study, standardized psychometric tests were used to assess the personality characteristics and psychological and somatic well-being of 46 patients with AdSD. Moreover, the effect of botulinum toxin (Botox) treatment on their well-being was evaluated. No significant differences could be detected between patients and a representative norm group concerning 7 personality characteristics. Nevertheless, before treatment, there were significantly more psychological and somatic complaints. After establishment of a normal to near-normal voice with Botox injections, these complaints were reduced to normal levels--a finding suggesting these phenomena to be secondary to the voice disorder. These findings, and the normal personality characteristics, do not support a psychogenic cause of AdSD.

Adult↗
PubMed2006

Artificial neural network-based classification to screen for dysphonia using psychoacoustic scaling of acoustic voice features.

SUMMARY: For diagnosis and classification of dysphonia, voice specialists can choose from an array of diagnostic tools like perceptual tests or acoustic voice analysis. These methods have in common that they require a high level of specialized training and experience, and therefore are mostly reserved to specialized centers. We aimed at developing an acoustic voice analysis system that could be used as a screening device to monitor, document, and diagnose voice problems that are also encountered by non-voice specialists, such as anesthesiologists, head and neck surgeons, and general surgeons before surgery of the thyroid gland and the upper thoracic aperture. An acoustical feature extraction paradigm that focused on jitter, shimmer, standard deviation of fundamental frequency, and the glottal-to-noise excitation ratio was used to reanalyse 120 voice samples previously analyzed by Schönweiler et al (A Novel Approach to Acoustical Voice Analysis Using Artificial Neural Networks. JARO. 2000:1;270-282). An improved artificial neural network (ANN) was used for classification. Building on this preliminary work, we modified the mathematical algorithm to further improve classification accuracy. Eighty percent of all voice samples could be classified correctly as either healthy or hoarse (sensitivity: 63.0%; specificity: 93.9%; area under the curve: 0.854). The adaptation of the ANN-voice analysis system for mobile use may facilitate its use and acceptance by non-voice specialists for the discovery and documentation of preexisting voice disorders, and may thereby lead to a timely initiation of further diagnosis and therapy by voice specialists.

Diagnosis, Differential↗
PubMed1977

[Observations on the accent-method of Smith in the management of voice and speech disturbances. Part II (author's transl)].

In an earlier paper [HNO 25, 102 (1977)], the accent-method for the treatment of voice disorders has been described in detail. The rhythmical pronunciation of stressed ("accentuated") syllables with a physiologically correct phonatory respiration and a loose articulation form the basis for this method, and allow treatment of voice disorders as well as problems related to abnormal speech behavior. Further discussion is based on present theories of the physics and the physiology of voice function as well as on concepts from modern psychology and pedagogics.

Humans↗
PubMedDate not supplied

Dysphonia subsequent to severe traumatic brain injury: comparative perceptual, acoustic and electroglottographic analyses.

We tested the applicability of the Goettinger Hoarseness Diagram (GHD) for quantitative evaluation of voice disorders after severe traumatic brain injury (TBI) and compared the obtained data with those from established voice analysis systems such as the Multi-Dimensional Voice Program (MDVP), electroglottography (EGG) and perceptual ratings using sustained vowel productions from 10 patients with TBI dysarthrophonia at late stages postinjury and of 10 healthy control speakers. Statistical analyses revealed significant intergroup differences with respect to various acoustic and perceptual measures, i.e., irregularity component, noise component, noise-to-harmonic ratio, shimmer, jitter, roughness, creakiness, strained-strangledness, hypernasality. By contrast, the considered EGG estimates, i.e., open quotient and speed quotient, did not allow for separation of patients and controls. In addition, the two GHD components exhibited close correlations to perceived roughness and creakiness, on the one hand, and breathiness and, to some degree, nasality, on the other, whereas the MDVP parameters failed to differentiate between these two perceptual modes of phonation.

Adult↗
PubMed1989

Objective assessment of vocal hyperfunction: an experimental framework and initial results.

This report describes the experimental design and initial results of an ongoing clinical investigation of voice disorders. Its major focus is the development and use of quantitative measures to provide objective descriptions of conditions referred to as "vocal hyperfunction." The experimental design for this project is based on a descriptive theoretical framework, which holds that there are different types and stages of hyperfunctionally related voice disorders. Data consist of indirect measures derived from noninvasive aerodynamic and acoustic recordings including (a) parameters derived from inverse filtered approximations of the glottal air flow waveform; (b) estimates of transglottal pressure, average glottal air flow, glottal resistance and vocal efficiency; and (c) measures of vocal intensity and fundamental frequency. Initial results (based on comparisons among 15 voice patients and 45 normal speakers) support major assumptions that underlie the theoretical framework, and indicate that the measurement approach being utilized is capable of differentiating hyperfunctional from normal voices and hyperfunctional conditions from one another. Organic manifestations of vocal hyperfunction (nodules, polyps, contact ulcers) are accompanied by abnormally high values for the glottal waveform parameters of AC flow and maximum flow declination rate, suggesting increased potential for vocal fold trauma due to high vocal fold closure velocities and collision forces. In contrast, nonorganic manifestations of hyperfunction (functional disorders) tend to be associated with abnormally high levels of unmodulated DC flow, without high values for AC flow and maximum flow declination rate, suggesting reduced potential for vocal fold trauma. Measures also suggest different underlying mechanisms for nodules and polyps as compared to contact ulcers. Results are discussed relative to predictions based on the theoretical framework for vocal hyperfunction.

Adult↗
PubMed1999

Borderline personality disorder: the voice of patients.

The purpose of this interpretive phenomenological study was to generate knowledge about the experience of living with the diagnosis of borderline personality disorder. Persons identified as meeting DSM-III-R (American Psychiatric Association, 1987) or DSM-IV (American Psychiatric Association, 1994) criteria for borderline personality disorder were invited to participate in a private interview focusing on what it means to live with the diagnosis. The data were analyzed using the procedures of interpretive phenomenological data analysis (Benner, 1994; Diekelmann, Allen, & Tanner, 1989). Three themes were identified: (a) living with a label, (b) living with self-destructive behavior perceived as manipulation, and (c) living with limited access to care. The findings suggest that mental health care for persons with borderline personality disorder could be improved by confronting prejudice, understanding self-harm, and safeguarding opportunities for dialogue.

Attitude of Health Personnel↗
PubMed2003

Nontraditional tools helpful in the treatment of certain types of voice disturbances.

Voice therapy has evolved considerably over the past decade. Our field has learned to draw from other disciplines to help facilitate the restoration of vocal function by implementing a more holistic approach and utilizing principles of motor learning to create our therapy programs. Clinicians have learned to recognize that the voice is more than just the larynx. Rather, it is a whole body system, and breakdowns in systems throughout the body can be responsible for vocal disturbances. This review will cover the nontraditional approaches that aid in treating certain voice disorders that often are not discussed in textbooks or classrooms. Facilitating techniques include principles from singing and acting voice production, Feldenkrais, Alexander technique, Qigong, and circumlaryngeal massage.

Humans↗
PubMed1981

[The measuring of voice area, a method of examination for the otolaryngological practice (author's transl)].

It is reported about the measuring of voice area as a completion of phoniatric diagnosis. This is a more objective procedure that is qualified for the documentation of voice disorders, especially for medical certificates. It gives valuable information for qualification ratings and supports the developmental control of voice therapy and training of singers. The whole procedure lasts about 10 minutes usually.

Adult↗
PubMed1997

Analysis of voice changes after thyroplasty using linear predictive coding.

Objective measurement of vocal quality is difficult in patients with severe voice disorders. Improved success has been reported using a modeling technique known as linear predictive coding. This technique uses an inverse filter to estimate a glottic excitation signal. The pitch amplitude is defined as the height of the first peak of the autocorrelation of the glottic excitation signal. In this study linear predictive coding was used to analyze voice disorders in patients with vocal fold immobility. Voice recordings were made in 16 patients undergoing vocal fold medialization and 10 patients who had no surgical procedure between measurements. The voice quality was rated by three speech pathologists. Five acoustic parameters were calculated from the samples. The best agreement with the listeners' perceptual analysis was achieved using the pitch amplitude. Both pitch amplitude and the perceptual ratings of voice quality improved in patients undergoing vocal fold medialization. Therefore the linear model of speech production and inverse filtering are useful in measuring vocal quality in patients with vocal fold immobility.

Acoustics↗
PubMed2003

Effects of a vocally fatiguing task and systemic hydration on men's voices.

Voice disorders, specifically vocal fatigue, are more commonly reported by women than by men. Previously, 4 women with normal untrained voices read loudly for 2 hours in an attempt to fatigue the voice. Vocal function deteriorated, as indicated by increases in phonation threshold pressure (PTP) and self-perceived phonatory effort. The increase in PTP was delayed or attenuated to some degree in 3 of the women when they drank ample amounts of water before the experiment. The current study examined the same vocal-loading task and water-drinking condition in 4 vocally normal men. PTP increased after the loud-reading task. Although 2 of the men appeared to benefit from increased systemic hydration (PTP increased more when they were underhydrated than well-hydrated), the other 2 men's data changed in the opposite direction. Phonatory effort correlated well with PTP; this varied across subject and pitch. Laryngeal endoscopy revealed an anterior glottal gap in two men after the loud-reading task. Amplitude of vocal fold vibration was judged to be reduced after the loud-reading task in three subjects when underhydrated and one subject when well hydrated. The high between-subject variability prohibits a conclusion that drinking water is beneficial to vocal function in men, but all subjects studied to date demonstrated detrimental vocal effects of prolonged loud talking.

Adult↗
PubMed2005

The effect of speaking task on perceptual judgment of the severity of dysphonic voice.

This study investigated the effect of speaking task on auditory-perceptual judgment of the severity of dysphonia. Three speech-language pathologists experienced in evaluating of disordered voices rated 29 recorded speakers, each of whom produced speech elicited via the same three tasks: sustained vowel /a/, oral reading of a standard passage, and connected speech describing a standard picture. Stimuli were played in sound field, and raters used direct magnitude estimation with a visual analog scale. A repeated measures analysis of variance (ANOVA) revealed a statistically significant (P < .05) effect of speaking task, with post hoc analyses that indicate a statistically significant difference between ratings for the sustained vowel versus connected speech elicited via picture description (P < .05). No statistically significant difference in ratings was found between oral reading and picture description or between oral reading and the sustained vowel. The ANOVA also revealed a statistically significant difference among raters (P < 0.001), but no statistically significant task by rater interaction. Possible reasons for an effect of speaking task are discussed. Also, the implications of one task for determination of dysphonic severity are discussed, as is the possibility of a task effect when determining other clinically useful vocal parameters.

Adult↗
PubMed1991

Bio-feedback and the yawning breath pattern in voice therapy: a clinical trial.

A breathing technique, or effective breath method is important for both singers and speakers for effective vocalization, and also useful for helping people with a voice problem. Here a diaphragm support breath pattern was used in voice therapy for patients with vocal nodules, recurrent laryngeal nerve paralysis, and incomplete glottal closure. Singing teachers use a technique, called the diaphragm breath support. This is called the yawning breath pattern (YBP) in our voice clinic and is used in teaching the patients with some kinds of voice disorder. In order to correct patients' breath pattern, an equipment system was designed to check their breath patterns conveniently in voice therapy practice. A respiratory kinematic sensor which connected to a TV monitor was attached to the patients' rib cage near the diaphragm, and by bio-feedback, patients could observe and adjust their breath pattern to the desired pattern during vocalization. In each of the 10 outpatient sessions, the patients performed for 20 to 30 min, and were instructed to practice at home for 3 or more times daily. The YBP method was applied to 91 patients, 17 males and 74 females, with ages ranging from 17 to 79 years. Of the 91 patients 41 had vocal nodules, 20 had recurrent laryngeal nerve paralysis and 30 had incomplete glottal closure associated with chronic laryngitis and sulcus vocalis. Most of the patients could master the YBP technique successfully. The higher the patients' ability to master the YBP was the better the results of both voice tests and subjective evaluation. The scientific background of the YBP method and its clinical effects in voice therapy was reviewed.

Adolescent↗
PubMed2005

What have we learned about laryngeal physiology from high-speed digital videoendoscopy?

PURPOSE OF REVIEW: The purpose of this review is to describe recent developments in high-speed videoendoscopy. The applications of this technique are highlighted and important findings regarding vocal fold physiology and voice pathology are discussed. RECENT FINDINGS: The number of applications for digital high-speed imaging has increased during recent years because of the development of camera image sensor systems with increased image resolution of video and television quality. Other improvements are related to computer processing speed and storage capacity and the development of automatic algorithms for quantification and measurements both in time and room dimensions. This is enhanced by combining high-speed videoendoscopy with laser-based measurement systems, acoustic analyses or other glottographic methods, such as flow glottography or electroglottography. High-speed videoendoscopy is currently used in studies of voice mechanisms of phonation (e.g., the voice source can be examined with a high sampling rate, from 1000 to over 8000 frames per second), and in phonation onset or offset. High-speed imaging is also useful in linguistic studies and in the examination of different artistic singing styles, such as extremely high-pitched singing, throat singing, or different pop and rock styles. High-speed videoendoscopy is also used in the examination of patients with voice disorders, particularly with irregular vocal fold vibrations, ventricular phonation, or the phonation of individuals who have had a laryngectomy. SUMMARY: Findings from studies of normal voice physiology and of voice disorders using high-speed imaging are presented and their relevance is discussed.

Electrokymography↗
PubMed2004

[Effect of smoking on phonation].

The aim of this paper was presentation of voice estimation in smokers, who did not complain of voice disorders. The examination was performed in 20 patients with history of chronic tobacco using (at least 20 years). The videolaryngostroboscopy and acoustic voice analysis were performed. The specific changes as in organic dysphonia were found in larynx in both examinations. The most important finding in acoustic voice analysis was abnormal parameter describing vFo--Fundamental Frequency Variation and lower comparing to normal voices fundamental frequency.

Adult↗
PubMed1999

[Objective evaluation of vocal pathology in childhood].

Voice disorders in children are often described as existing on a continuum with anatomic or physiologic causes at one end and functional or psychogenic causes at the other. In this study we report the objective evaluation of the voice disorders on 48 school children. The evaluation was made by means of laryngostroboscopy, acoustic analysis of the voice and narrow-band spectrography. The stroboscopic examination was performed on more than a half of the patients, resulting in the change of diagnose in six cases. The severity of the hoarseness was classified in four groups according Yanagihara method. A multivariate analysis was carried out using jitter, shimmer and harmonic-to-noise ratio as variables. Only the harmonic-to-noise ratio predicts the severity of the spectrographic record. Classification of degrees of hoarseness is found to be clinically useful in two respects: the degree of hoarseness can be numerically expressed and the objective acoustic degree of hoarseness based on this method closely agrees with subjective perceived degree of hoarseness.

Adolescent↗