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At least 865 records · Page 48Linked to original sources
PubMed1999

Consequences of voice impairment in daily life for patients following radiotherapy for early glottic cancer: voice quality, vocal function, and vocal performance.

PURPOSE: To assess consequences of voice impairment in daily life for patients following radiotherapy for early glottic cancer, by means of a multidimensional analysis protocol including voice quality, vocal function, and vocal performance measures. METHODS AND MATERIALS: A total of 60 men treated with radiotherapy (66 Gy/33 fractions, 60 Gy/30 fractions, 60 Gy/25 fractions) for early T1 glottic cancer and 20 matched control speakers filled in questionnaires on vocal performance. Furthermore, perceptual analyses of voice quality and stroboscopic measures of vocal function were performed. There was a longitudinal group of 10 patients from whom data were collected before, as well as 6 months and 2 years after, radiation. Furthermore, data were collected on 5 separate groups of 10 patients each: before, 6 months after, 2 years after, 3-7 years after, and 7-10 years after radiation. RESULTS: High correlations were found between self-ratings of vocal performance and several voice measures. Patients before radiotherapy experienced poor voice characteristics that improved 6 months to 10 years after treatment, and became comparable to vocal performance of control speakers in 50% of the patients. Following radiotherapy, deviant voice characteristics and consequences in daily life occurred significantly more often for patients in whom initial diagnosis consisted of stripping the vocal cord instead of biopsies and for patients who continued smoking after treatment. CONCLUSION: Voice characteristics of patients diagnosed with early glottic cancer improved after radiotherapy, and became normal in half of our patients. Stripping the vocal cord for initial diagnosis and continued smoking after treatment decreased deviant voice characteristics.

Aged↗
PubMed2002

Voice outcome following thyroplasty in patients with longstanding vocal fold immobility.

OBJECTIVE: Length of time elapsed between recurrent laryngeal nerve (RLN) injury and surgery may affect voice result. The purpose of this study was to compare voice outcome after thyroplasty in patients with short- and long-term vocal fold immobility. METHODS: Thirty-five patients with longstanding vocal fold immobility (8.3 years) and 35 patients more acutely denervated (10 months) underwent type I thyroplasty. Trained listeners before and after surgery rated perceptual judgments of voice. Acoustic and aerodynamic data were analyzed. RESULTS: Voice outcome did not differentiate the two groups with respect to objective measures. Perceptual ratings of post-operative voice quality favored the short-term patients, with the long-term group having a mildly 'constricted' quality. CONCLUSION: Thyroplasty yields a functional voice result even when substantial time has elapsed. Patients with chronic immobility may be unable to release longstanding hyperfunctional voicing behaviors even after surgery has afforded them an improved mechanism. In five of 35 long-term patients, therapy enhanced voice quality.

Acute Disease↗
PubMed1999

Speech rehabilitation after laryngectomy with the amatsu tracheoesophageal shunt.

The Amatsu vocal rehabilitation technique is a tracheoesophageal shunt using a posterior tracheal flap associated with a sphincter made of esophageal muscular wall. Since march 1991 the procedure was done in 33 men and 2 women. ages ranging from 30 to 78 years. Previous radiotherapy, hypopharynx lesions, need for postoperative radiotherapy or use of myocutaneous flap were not considered contraindications. Vocalization was achieved in 76% of our patients and the quality was considered superior than that obtained by the esophageal voice. In only one case the shunt had to be closed surgically because of aspiration. In conclusion, the Amatsu tracheoesophageal shunt is an inexpensive technique that obtain a good quality of vocal rehabilitation in a high percentage of patients, it has few complications and it should be considered for all candidates to a laryngectomy, mainly for those with a good prognosis and a desire to return to their social environment.

Adult↗
PubMed1999

Acoustic assessment of voice signal deformation after partial surgery of the larynx.

OBJECTIVE: The main objective of the present study was to assess the degree of voice signal impairment among patients who had undergone partial surgery of the larynx due to cancer of this organ. Such on evaluation may be helpful in the selection of the optimal surgical technique for the treatment of tumors displaying a varying degree of local advancement. METHODS: A prospective examination was carried out among 128 patients. Additionally a comparative study of the control group consisting of 36 healthy males was carried out. Acoustic tests were carried out in an echo-free chamber. The temporal changes in the value of acoustic pressure of the uttered text were registered. The 'distance' between the normal speech signal and the pathological voice has been established. RESULTS: The values of the fundamental frequency increase together with an increase of the range of resection of anatomical structures. The biggest differences in the value of results describing the distance from the standard were observed after hemilaryngectomy. The shortest distance from the acoustic standard was observed after chordectomy. No significant differences in the degree of voice signal impairment among patients who had undergone extended chordectomy and hemilaryngectomy were observed. CONCLUSION: The above findings can be of help in arriving at an optimum solution in cases of partial surgery of the larynx. The problem is particularly important in situations where there is the choice between different types of surgery.

Adult↗
PubMed2000

Dysphonia associated with inhaled steroids.

The use of inhaled steroids in the treatment of asthma is not without its complications. In some studies up to 50% of such patients complain of oropharyngeal and voice problems. We present the findings in 22 patients complaining of dysphonia who underwent videostrobolaryngoscopy (VSL) and computerized speech analysis. A number of abnormalities were identified. On VSL, these included mucosal changes (noted in 58%), apposition abnormalities (noted in 43%), and supraglottic hyperfunction (noted in 40%). On speech analysis, cycle-to-cycle irregularity was frequently noted (mean of 39%). Maximum phonation time was reduced in 73%. Our findings did not confirm the widely held views that steroid dysphonia is due primarily to a fungal infection or a steroid-induced adductor myasthenia of the larynx. A larger-scale prospective study is indicated.

Administration, Inhalation↗
PubMed2000

PVCM, PVCD, EPL, and irritable larynx syndrome: what are we talking about and how do we treat it?

Paroxysmal vocal cord movement/motion (PVCM), paroxysmal vocal cord dysfunction (PVCD), episodic paroxysmal laryngospasm (EPL), and irritable larynx syndrome (ILS) are terms used to describe laryngeal dysfunction masquerading as asthma, upper airway obstruction, or functional and organic voice disorders. The differential diagnosis of PVCM, PVCD, EPL, and ILS is critical to successful medical and behavioral management of the patient. During the past 10 years, 27 subjects, ages 15-79 years, were identified to have paroxysms of inspiratory stridor, acute respiratory distress, associated aphonia and dysphonia, resulting in misdiagnosis and unnecessary emergency treatments, including endotracheal intubation, cardiopulmonary resuscitation, massive pharmacotherapy, or tracheostomy. A multifactorial management program is proposed utilizing principles of motor learning, neurolinguistic programming model, respiratory and phonatory synchronization, relaxation techniques, concurrent monitoring of behavioral adjustments, and formal psychological counseling.

Adolescent↗
PubMed2000

The Towne-Heuer Reading Passage--a reliable aid to the evaluation of voice.

The science of voice evaluation and assessment has profited from technological advancement and objective measurement of voice parameters has become an integral part of the voice examination, however, subjective voice evaluation remains a vital component of any voice examination. The Towne-Heuer Reading Passage was developed in 1970 to provide a reading sample that would facilitate subjective voice evaluation. The reliability of the passage was established using three judges listening to 15 normal Philadelphia speakers and 15 vocal abuse-misuse clients with verified vocal nodules. The frequency of hard glottal attack (HGA) was determined for the two groups and high interjudge and intrajudge correlation was found. A difference in the frequency of HGA was found between the two groups.

Adolescent↗
PubMed2000

Effects of stimulation techniques on vocal responses: implications for assessment and treatment.

During voice evaluation and treatment it is customary for clinicians to elicit samples of the vowel /a/ from clients using various elicitation techniques. The purpose of this study was to compare the effects of four commonly used stimulation tasks on the laryngeal mechanism. Eleven female singing students, studying at a university music school, served as subjects for the study. The subjects phonated the vowel /a/ using 4 vocal stimulation techniques: yawn-sigh, gentle onset, focus, and the use of the voiceless fricative. Videoendoscopic and acoustic evaluations of their productions were done. Results show that, in the first 100 ms following the end of the formant transition, these techniques affected voice differently. The fundamental frequency was found to be highest in the yawn-sigh condition, whereas the maximum frequency perturbation was obtained for the voiceless fricative condition. Planned comparisons were made by comparing the data across 2 dimensions: (1) vowels elicited with voiced contexts versus those elicited with voiceless consonantal contexts and (2) vowels elicited with obstruent versus vowels elicited with nonobstruent consonantal contexts. Some changes in acoustic parameters brought about by these stimulation techniques may be explained on the basis of coarticulatory effects of the consonantal context.

Adolescent↗
PubMed2000

Functional imaging of vocal fold vibration: digital multislice high-speed kymography.

For the diagnosis of voice disorders, and especially for the classification of hoarseness, direct observation of vocal fold vibration is essential. Furthermore, a quantitative description of the movement of the vocal fold becomes increasingly necessary to document and compare findings as well as the progression of speech therapy. On the base of digital high-speed sequences of vocal fold vibration, multiple "functional images"-also called digital kymograms-are obtained using image- and signal-processing algorithms. Digital kymograms can serve as a powerful aid for visualization, description, and classification of vocal fold vibration and as an intermediate step for image interpretation by biomechanical modeling. This visualization technique will be discussed and compared to other techniques currently available: videokymography and videostroboscopy. The technique is applied to several clinical examples: aperiodic processes (phonation onset), irregular vocal fold vibration (paralysis of the recurrent nerve), particular vibration modes (anterior-posterior modes), and running speech.

Humans↗
PubMed2001

Voice quality changes following phonatory-respiratory effort treatment (LSVT) versus respiratory effort treatment for individuals with Parkinson disease.

Perceptual ratings of hoarseness and breathiness were used to assess the efficacy of two intensive methods for treating dysarthrophonia in individuals with idiopathic Parkinson disease. One method emphasized phonatory-respiratory effort (the Lee Silverman Voice Treatment, LSVT) and the other emphasized respiratory effort alone (RET). Perceptual ratings were performed by two expert listeners based on random order presentation of the patients' pretreatment and posttreatment recordings of the "Rainbow Passage." The listeners were blinded to the patients and their treatment group. Statistically significant pretreatment to posttreatment improvement in hoarseness and breathiness was observed in the LSVT group but not in the RET group. The present findings are consistent with acoustic and physiologic findings reported previously, providing further evidence for the efficacy of the LSVT.

Aged↗
PubMed2001

Acoustic analysis of voice quality with or without false vocal fold displacement after cordectomy.

Conventional cordectomy by means of a laryngofissure is one of the therapeutic options for treatment of early glottic cancer. To improve the poor voice quality related to this kind of operation, many authors have developed different techniques to repair the mucosal defect. We analyzed voice quality acoustically and compared it after cordectomy alone and after cordectomy with the reconstruction of the vocal cord in a group of 14 patients affected by T1 glottic carcinoma. All the patients underwent postoperative speech therapy. Three patients who underwent cordectomy with reconstruction showed the presence of diplophonia, while two patients without reconstruction showed the presence of bitonality. The differences of the acoustic parameters (jitter, shimmer, harmonic-to-noise ratio) between the two groups of patients were not statistically significant. Reconstruction of the vocal cord does not seem to improve voice quality after cordectomy even in combination with postoperative speech therapy.

Aged↗
PubMed2001

The adjustable laryngeal implant.

An adjustable laryngeal implant made of titanium has been developed for the treatment of unilateral vocal fold paralysis. The implant includes three parts: a plate that allows fixation to the thyroid cartilage, a block of titanium which includes the adjustable part, and a micrometric screw in the middle of the lateral side of the block, which moves the adjustable part. Precise medialization is accomplished by regulating the screw which also permits easy secondary adjustments, if needed in the future. This retrospective study assesses clinical outcomes of medialization laryngoplasty with the titanium adjustable implant, in patients with unilateral vocal fold paralysis. This study has the limitations of a retrospective study. However, preliminary results are encouraging. Analysis of subjective responses confirmed marked improvement in laryngeal function, speech, and swallowing. Objective voice analysis confirmed improvement in the aerodynamic measures. The adjustable laryngeal implant has many advantages including: precise medialization, ease of secondary adjustment, and preseveration of the mucosal wave. This implant is biocompatible, no migration is possible (it is fixed to the cartilage) and no extrusion of the implant has occurred. Titanium is magnetic resonance imaging (MRI)-safe.

Adult↗
PubMed2001

Use of speech recognition software: a vocal endurance test for the new millennium?

Speech recognition software for the personal or office computer is a relatively new area of technology. As the number of these products has increased so has use of this software. Some individuals will employ speech recognition systems due to difficulty with the conventional keyboard and mouse interface: others will use it for perceived efficiency or simply novelty. Regardless of the reason for use of this technology, the voice demands associated with extended or frequent use can be high, placing the user at risk for vocal difficulties. This paper reviews the case of an individual referred to our multidisciplinary voice care program for evaluation and treatment of vocal difficulties that began secondary to utilization of speech recognition software. We discuss medical and vocal histories, examination findings, treatment, and treatment outcomes.

Adult↗
PubMed2001

Plasticity of voice quality: a prognostic factor for outcome of voice therapy?

Plasticity of voice quality is defined here as the degree of improvement in deviant voice quality that can be achieved immediately or quasi-immediately by changing basic voicing conditions, posture, articulation or resonance, breathing mechanics, laryngeal position, or auditory feedback. Thirty-two adult patients with various benign organic voice pathologies, and who had a (preoperative) functional voice therapy, were scored before therapy using a weighted multidimensional Index of Voice Plasticity (IVP). The hypothesis is that IVP could be a predictor of the final outcome of functional voice therapy, and therefore a correlation with a comparable quantification of the actual results of the therapy was investigated. The IVP shows a satisfactory correlation (Spearman's rho = 0.68) with the efficacy of (preoperative) voice therapy. The IVP also significantly differs between diagnostic categories. Although its predictive value remains limited, the Index of Voice Plasticity seems helpful in decision making for indication of (presurgical) voice therapy.

Humans↗
PubMed2001

Deviant vocal fold vibration as observed during videokymography: the effect on voice quality.

Videokymographic images of deviant or irregular vocal fold vibration, including diplophonia, the transition from falsetto to modal voice, irregular vibration onset and offset, and phonation following partial laryngectomy were compared with the synchronously recorded acoustic speech signals. A clear relation was shown between videokymographic image sequences and acoustic speech signals, and the effect of irregular or incomplete vocal fold vibration patterns was recognized in the amount of perceived breathiness and roughness and by the harmonics-to-noise ratio in the speech signal. Mechanisms causing roughness are the presence of mucus, phase differences between the left and right vocal fold, and short-term frequency and amplitude modulation. It can be concluded that the use of simultaneously recorded videokymographic image sequences and speech signals contributes to the understanding of the effect of irregular vocal fold vibration on voice quality.

Aged↗
PubMed2001

Vocal tract resonance analysis of aging voice using long-term average spectra.

This study is the first to use long-term average spectra (LTAS) to investigate resonance characteristics of dynamic speech in young adulthood and old age. A total of 80 speakers participated, divided equally by age group and gender. All elderly speakers were healthy, active members of the community. Measurement of the first three spectral peaks in LTAS from the first paragraph of the Rainbow Passage revealed significant lowering of peak 1 from young adulthood to old age in both men and women. Peaks 2 and 3 also lowered significantly across the adult lifespan in women and showed a tendency to lower in men. These acoustic findings are consistent with anatomic data suggesting that aging results in lengthening of the supraglottic vocal tract. Findings that women demonstrate more substantial lowering of spectral peaks with aging than men suggest that women may undergo more pronounced age-related lengthening of the supraglottic vocal tract. Alternatively, it is possible that elderly men systematically alter tongue position during vowel articulation while elderly women are less inclined to do so. Taken in conjunction with previous research, these findings suggest a "mixed model" of vocal tract resonance changes with aging in which an interaction exists between gender, the resonance effects of laryngeal lowering, and vowel articulatory patterns.

Adult↗
PubMed2001

Objective voice quality analysis before and after onset of unilateral vocal fold paralysis.

This study was designed to investigate objective voice quality measurements in unilateral vocal fold paralysis (UVFP) by eliminating intersubject variability. To our knowledge this is the first report objectively analyzing paralytic dysphonia as compared to the same voice before onset of UVFP. The voices of two male subjects were prospectively recorded before and after the onset of iatrogenic UVFP (thoracic surgery). The following acoustic measurements of the vowel /a/ were performed using the CSL and MDVP (Kay Elemetrics): jitter, shimmer, harmonics-to-noise ratio, cepstral peak prominence, the relative energy levels of the first harmonic, the first formant and the third formant, the spectral slope in the low-frequency zone (0-1 kHz and 0-2 kHz), and the relative level of energy above 6 kHz. Distribution of spectral energy was analyzed from a long-term average spectrum of 40 seconds of text. Laryngeal aerodynamic measurements were obtained for one patient before and after onset of paralysis using the Aerophone II (Kay Elemetrics). Pitch and amplitude perturbation increased secondary to UVFP, while the harmonics-to-noise ratio and the cepstral peak prominence decreased. A relative increase in the mid-frequency and high-frequency ranges and a decrease in the low-frequency spectral slope were observed. Mean airflow rate and intraoral pressure increased, and glottal resistance and vocal efficiency decreased secondary to UVFP. The findings of this self-paired study confirm some but not all the results of previous studies. Measures involving the fundamental and the formants did not corroborate previous findings. Further investigation with vocal tract modeling is warranted.

Aged↗
PubMed2001

Efficacy of a behaviorally based voice therapy protocol for vocal nodules.

The aim of this study was to assess the effects on vocal function of voice therapy for vocal nodules. Perceptual and physiological progressive changes were examined during a strictly structured, behaviorally based voice therapy protocol in which 11 women with vocal nodules participated. Randomized audio recordings from pretherapy and from each of the therapy approaches (vocal hygiene, respiration, direct facilitation, carryover) were used for perceptual evaluations. Six speech-language pathologists rated ten voice quality parameters. Two evaluation procedures were performed and compared. Interlistener reliability was sufficiently high in both tests. Significant effects of therapy were found for decreased overall dysphonia, press, instability, gratings, roughness, vocal fry, and "scrape." Nonsignificant group effects were found for breathiness, aphonic instances, and lack of sonority. No significant parameter changes occurred between baseline assessment and the completion of the initial (vocal hygiene) phase of therapy. Significant changes were found following the direct facilitation and respiration phases of therapy. Videostroboscopic evaluations made by two laryngologists showed that in no case were the nodules completely resolved. However, the nodules had decreased in size and edema was reduced after therapy for all clients, but one. Combined results suggest: (1) Alterations in vocal function were reflected in perceptual parameters, and (2) the voice therapy had a positive effect on voice quality, vocal status, and vocal function for the majority of the vocal nodule clients.

Adult↗