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At least 937 records · Page 52Linked to original sources
PubMed1993

Perceptual-acoustic relationships in spasmodic dysphonia.

Perceptual ratings were obtained from voice samples of 19 patients with adductor spasmodic dysphonia before and 1 week after unilateral treatment with Botulinum toxin. Five experienced listeners judged samples of sustained phonation using a seven-point equal-interval scale. The perceptual parameters assessed were overall severity, strain-strangled voice quality, and breathiness. Perceptual results were related to the standard deviation of fundamental frequency and the voice break factor, two acoustic parameters previously shown to be significantly improved following Botulinum toxin injection. Results indicate that in general the spasmodic dysphonia voice is perceived as less severe, less strain-strangled, and more breathy 1 week after treatment. Interrelations among perceptual parameters and relationships with acoustic analyses are discussed.

Botulinum Toxins↗
PubMed1993

Tracking change in dysphonia: a case study.

This longitudinal case study of a woman with nodules examines the relationship between clinical and acoustic measures of change. Relative changes in voice quality, vocal fold condition, and patient symptoms were compared to measures of mean fundamental frequency (MFF), jitter, and fundamental frequency range (FFR). Seven assessments were performed over a 2-year period. The findings indicated that voice quality judgments tended to relate to changes in degree of vocal fold pathology and patient report of vocal function. However, acoustic measures of MFF, FFR, and jitter did not relate to measures of clinical change. The discussion focuses on explanations for the acoustic findings, the need for using connected speech samples for perceptual and acoustic analysis, and a suggestion for future study.

Adult↗
PubMed1996

Meaningful features of voice range profiles from patients with organic vocal fold pathology: a preliminary study.

This preliminary study identifies features that have the potential to be meaningful descriptors of voice range profiles (VRPs) for 15 patients with organic vocal fold pathologies before and after laryngeal surgery. This study also explores the utility of the VRP as an outcome measure of change in vocal function after surgery. Potentially meaningful features for these patients are the semitone range, intensity level of the lower contour, frequency locus of the lower frequency values, smoothness of the contours, and the presence of intermittencies in the VRP contours. These features are not suggested for differential diagnosis, but for aiding the understanding of each individual patient's phonatory status. Initial use of these features suggests that the VRP may be a useful outcome measure for these patients.

Adult↗
PubMed1996

The Parkinson larynx: tremor and videostroboscopic findings.

Patients with Parkinson's disease have a high incidence of speech, voice, and laryngeal abnormalities. To characterize laryngeal abnormalities, visual-perceptual ratings of endoscopic and stroboscopic examinations of 22 patients diagnosed with idiopathic Parkinson's disease and 7 patients with Parkinson's-plus syndromes were carried out by for trained viewers. Incidence of tremor, tremor location, phase closure, phase symmetry, amplitude, and mucosal waveform were scored. Tremor was observed in one or more of these conditions-rest, normal pitch and loudness, or loud phonation-for most of the 29 patients. Fifty-five percent of the idiopathic Parkinson's disease patients had tremor, with the primary location being vertical laryngeal tremor. Sixty-four percent of the Parkinson's-plus patients had tremor, with the arytenoid cartilages being the primary location. Laryngeal tremor was observed early in the disease in these Parkinson's disease patients. The most striking stroboscopic findings for the idiopathic Parkinson's disease patients were abnormal phase closure and phase asymmetry. Amplitude and mucosal wave-form were essentially within normal limits in the majority of the idiopathic Parkinson patients.

Aged↗
PubMed1996

Dynamic magnetic resonance imaging in the study of vocal tract configuration.

Studies of vocal tract configuration using magnetic resonance imaging (MRI) techniques have relied on static images. These images fail to identify transient movements and are subject to distortion from motion artifact limiting research application to stable motor events. This paper describes a dynamic MRI technique that permits study of transient movements within the vocal tract during speech and nonspeech tasks. Following description of the technique, results of two preliminary studies are presented. The initial study evaluated issues of measurement error and reliability. Results indicated that distance and area measurements obtained from this technique are accurate in reference to a calibration referent and reliable both within and among judges. The second study compared two aspects of vocal tract configuration in patients with adductor spasmodic dysphonia before and following treatment with Botox injection. Changes in vocal tract configuration are discussed in reference to prior observations of patients with spasmodic dysphonia. These preliminary investigations suggest that dynamic MRI has promise as a useful technique in the study of vocal tract configuration.

Aged↗
PubMed1996

Vocal fold microsurgery in singers.

Some singers with benign vocal fold mucosal lesions remain unacceptably impaired vocally in spite of compliance with a regimen of medical treatment and voice therapy lasting several months-or even years. I present here my experience with 62 singers who, because of this predicament, chose to undergo vocal fold microsurgery. This series is the second largest reported to date in English literature. Procedures are presented which were used for patient selection, education, and vocal retraining, as well as for surgery itself and postoperative care. Results reported here include (a) comparison of my auditory-perceptual ratings of singing voice impairment before and after surgery, (b) preoperative versus postoperative videostroboscopic findings, (c) postoperative rate of return to public singing, and (d) postoperative patient questionaires which sought to uncover patient/singer perceptions of the results of vocal fold surgery. Excellent results were achieved overall with a very low incidence of untoward results, and no complications were encountered.

Cysts↗
PubMed1996

Migration of the anterior segment following anterior commissure advancement: a case report.

A 53-year-old man with severe vocal fold atrophy underwent bilateral type 1 thyroplasty and anterior commissure advancement. Postoperatively, he developed a strained voice with less projection and volume than prior to surgery. This was verified by objective assessment of vocal function. Videoendoscopy revealed bilateral false vocal fold fullness and blunting of the anterior commissure. Magnetic resonance imaging demonstrated cephalic migration of the posterior ends of the implants and retrusion of the anterior commissure segment. Surgical exploration revealed that the type 1 implants had rotated and buckled. The anterior commissure segment was rotated and displaced inferiorly, and its inferior surface was tethered to the cricoid by scar tissue. The implants were removed, the anterior segment was repositioned and rigidly fixed, and bilateral lipoinjection performed. Vocal function was significantly improved, and endoscopy revealed normal tension and length of the vocal folds and restoration of the anterior commissure. This case demonstrates the importance of stable fixation during laryngeal framework surgery.

Atrophy↗
PubMed1997

Acoustic voice analysis in patients with Parkinson's disease treated with dopaminergic drugs.

To quantify several acoustic features of the voice in patients with Parkinson's disease (PD), 41 patients and 28 age and sex-matched controls were studied. PD severity was assessed with the Unified PD Rating Scale (UPDRS) and the Hoehn and Yahr staging. The Computerized Speech Lab 4300 program (Kay Elemetrics) was used. Two seconds of a sustained /a/ and a sentence were captured with a microphone and laryngograph equipment. Measures included fundamental frequency (F0), frequency perturbation (jitter), intensity perturbation (shimmer), and harmonic/noise ratio (H/N) of the vowel /a/, and frequency and intensity variability of a sentence, phonational range, dynamic range at the natural frequency, maximum phonational time and s/z ratio. All subjects underwent indirect laryngoscopy and/or laryngeal fibroscopy. When compared with controls, PD patients showed higher jitter, lower H/N ratio, lower frequency and intensity variability of the sentence, and lower phonational range and reported a higher frequency of the presence of low voice-intensity, monopitch, voice arrests, and struggle. These features seem to be unaffected by the duration and severity of the disease.

Aged↗
PubMed1997

Clinical relevance of the fractal dimension of F0 perturbations computed by the box-counting method.

The box-counting method for determining the fractal dimension (Dfj) was applied to the fundamental frequency (F0) perturbations in normal and pathological voices in order to assess its clinical value. The upper limit of these Dfj values was similar for both groups, but the distribution for pathological voices extended to lower values than for the normal voices. However, these lower values were most probably the result of one or a few outlying frequency points due to incorrect determination of the vocal period. The Dfj of normal voices were within the range of values found for randomly varying F0 values. It was concluded, that the vocal perturbations in pathological voices are also more or less randomly distributed. So, the Dfj, at that least determined with the box-counting method, do not contain clinically relevant information in addition to the traditional measures for the extent of the vocal period perturbations. An exception is special perturbation types like diplophonia. The result of the computation is very sensitive for voice breaks and vibrato and depends on the number of periods.

Electronic Data Processing↗
PubMed1997

Psychological correlates of functional dysphonia: an investigation using the Minnesota Multiphasic Personality Inventory.

Abnormal psychological factors have been implicated in the development of functional dysphonia (FD). This investigation describes the personality and psychological characteristics of 25 female subjects who had received the diagnosis of FD. In all subjects symptoms were resolved after voice therapy. While vocally asymptomatic, these remitted subjects with FD completed the Minnesota Multiphasic Personality Inventory (MMPI), an objective personality questionnaire. When compared with a medical outpatient control group, the results showed that subjects with FD scored significantly higher on 7 of 10 clinical scales, suggesting an elevated degree of emotional maladjustment. A stepwise logistic discriminant analysis identified 2 clinical scales that provided valuable discriminatory power between the two groups. Scale 1 (Hs-hypochondriasis), which measures the number and type of reported somatic complaints, and scale 7 (Pt-psychasthenia), a measure of diffuse anxiety, discriminated the groups with 88% sensitivity and 89% specificity. The results suggested that in spite of symptom improvement after voice therapy, the subjects with FD continued to exhibit poor levels of adaptive functioning, which may represent trait-like vulnerability. The clinical implications of these results for voice practitioners are discussed.

Adolescent↗
PubMed1997

Changes in sustained production tasks among women with bilateral vocal nodules before and after voice therapy.

The purpose of the current study was to determine how maximum phonation duration (MPD) of five notes (C4, D4, E4, F4, G4) sustained on /o/, sustained vowels (/i/, /ae/, /a/, /u/), and s/z ratio (sustained /s/ and /z/) changed during voice therapy for vocal nodules. Voices of adult females before treatment and after resolution of vocal nodules were analyzed via the PM Pitch Analyzer. Treatment included tension reduction, abuse identification and elimination, laryngeal strengthening, and home exercises. Results indicate there was no significant difference in maximum phonation duration or S/Z ratio before and after treatment. Results revealed that females with vocal nodules demonstrate measurements before therapy similar to measures considered to be normal in persons without vocal nodules. Application of findings to clinical practice is discussed.

Adult↗
PubMed1997

Combined surgical medialization and nerve-muscle pedicle reinnervation for unilateral vocal fold paralysis: improved functional results and prevention of long-term deterioration of voice.

Including those patients that were the subject of our previous report in 1990 (1) a total of 52 patients with unilateral vocal fold paralysis have been managed by combined surgical medialization and nerve-muscle pedicle reinnervation. The technique has been modified only slightly since 1985, when the first such surgery was performed. Short- and long-term voice results determined by a panel of sophisticated listeners are reported, as well as details of patient selection and complications. Better functional results were noted than were observed with surgical medialization alone, and long-term deterioration of the voice improvement initially achieved was prevented with this technique.

Female↗
PubMed1997

Acoustic analysis of the speaking voice after thyroidectomy.

Voices of 47 female patients were analyzed before and after thyroidectomy, with preservation of the recurrent and superior laryngeal nerves and normal vocal fold motility during the observation period. A mean decrease of the speaking fundamental frequency (SFF) of 12 Hz was found on day 4; in 8 patients the postoperative vocal pitch was more than 2 semitones lower. The distance between the highest and lowest F0 during speaking was diminished (speech was more monotone) and the vocal jitter was elevated. In the frequency spectrum, there was a diminished prominence of the harmonics. The other spectral parameters (as the slope of the spectrum and the H1/H2 ratio) were unchanged. All changes had disappeared the fifteenth day, except for a lower SFF (> 2 semitones) in 2 cases. It is concluded that after normal dissection of the laryngeal nerves, and in the absence of vocal fold paresis, other reasons for voice changes immediately after thyroidectomy remain: alterations in the neck muscles, in the laryngeal mucosa, and in the patient's general condition. Although the effects seem limited and of short duration, knowledge of them is helpful when informing the patient before thyroid surgery.

Female↗
PubMed1997

The singing/acting mature adult--singing instruction perspective.

Complete knowledge of anatomy and physiology of the vocal mechanism and tract is essential for the voice teacher to be maximally effective. Possible contributing factors to vocal attrition in the mature singer/actor are outlined: poor posture, inadequate respiratory function, lack of adequate hydration, phonatory hyperfunction, habitual speaking pitch at too low a frequency, lack of resonance, tongue tension affecting phonation, resonation, and articulation. Techniques for rehabilitation of the damaged voice are recommended.

Adult↗
PubMed1997

Acoustic analysis of voice in individuals with amyotrophic lateral sclerosis and perceptually normal vocal quality.

Currently, early phonatory changes in amyotrophic lateral sclerosis (ALS) are not well understood. The aim of this study was to compare acoustic parameters of voice in ALS subjects who demonstrated perceptually normal vocal quality on sustained phonation with a control group. We hypothesized that objective analysis of voice would reveal significant differences on specific acoustic parameters of voice compared to the control group. Results revealed statistically significant differences between the two groups on measures related to frequency range and phonatory stability. The findings suggest that early bulbar signs affecting the laryngeal system may be present in patients with ALS before the occurrence of perceptually aberrant vocal characteristics.

Adult↗
PubMed1997

Adductor spasmodic dysphonia: case reports with acoustic analysis following botulinum toxin injection and acupuncture.

We analyzed frequency and duration parameters of voice and speech in two men with adductor spasmodic dysphonia (SD). One was treated with botulinum toxin injection; the other received acupuncture therapy. Improvement after acupuncture therapy in terms of standard deviation of fundamental frequency, acoustic perturbation measurements, durational measurements of voice and speech, and spectrographic analysis was comparable to the results achieved with botulinum toxin injection. Voice and speech parameters were stable 1 year after acupuncture therapy.

Acupuncture Therapy↗
PubMed1998

Voice problems among teachers: differences by gender and teaching characteristics.

This study describes the effects of teaching activities on voice problems in male (n = 274) and female teachers (n = 280). Over 38% of the teachers studied complained that teaching had an adverse impact on their voice and 39% of those had cut back teaching activities as a result. Compared to males, female teachers more frequently reported a voice problem (38% vs. 26%, p<.05), acute (p<.05), and chronic (p<.05) voice problems, six specific voice symptoms, and five symptoms of physical discomfort. However, there were no gender differences in the perception that a voice problem adversely affected their current or future teaching career. For every type of course taught, women had a higher probability of reporting voice problems compared to men: odds ratio (OR) = 1.7-2.1. Compared with other courses, the teaching of physical education also was associated with an increased risk of developing a voice problem (OR = 3.7, 95% CI: 1.4-9.4) independent of gender, age, hours/day, or years taught. This is the first study to show that in the same occupation, females report a higher frequency of vocal symptoms than males even when teaching characteristics and years employment are similar.

Adult↗