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At least 973 records · Page 54Linked to original sources
PubMed2002

Multidimensional voice program analysis (MDVP) and the diagnosis of pediatric vocal cord dysfunction.

BACKGROUND: Vocal cord dysfunction (VCD) can present with signs and symptoms that mimic asthma. This may lead to unnecessary pharmacologic treatment or more invasive measures including intubation. Presently, the diagnosis of VCD can only be confirmed when a patient is symptomatic, via pulmonary function testing (PFT) or visualization of adduction of the vocal cords during inspiration by direct laryngoscopy. OBJECTIVE: Multidimensional Voice Program (MDVP) analysis. a computer program which analyzes various aspects of voice, can detect abnormal voice patterns of patients with upper airway pathology. We determined whether MDVP analysis was useful in the diagnosis of VCD. METHODS: We conducted chart reviews of patients referred to our department from 1995 to 1998 with the presumed diagnosis of VCD who had undergone MDVP analysis. The diagnosis of VCD was based on the presenting history, PFT results, laryngoscopy results, as well as voice evaluation conducted by a speech-language pathologist. We analyzed six consecutive patients referred for this investigation. We delineated common trends in the variables measured on MDVP analysis in VCD patients. and compared these with controls and other vocal cord pathology. RESULTS: Five cases of possible VCD had abnormalities in the MDVP variable of soft phonation index (SPI). All five also had abnormalities in the variation in fundamental frequency (vFo). In one case, MDVP analysis was conducted pre- and posttreatment for VCD, and SPI and vFo both normalized. In a sixth case of possible VCD. the diagnosis was not confirmed as the patient had normal PFTs and laryngoscopy. MDVP analysis was normal in this individual. The pattern of abnormal SPI and vFo was not seen in a group of normal controls or in patients with vocal cord nodules. CONCLUSIONS: MDVP analysis may be a useful tool when diagnosingVCD, as well as in evaluating response to treatment.

Adolescent↗
PubMed2002

A computer system for acoustic analysis of pathological voices and laryngeal diseases screening.

A system for acoustic analysis of pathological voices is proposed. The vocalized part of the voice signal is separated and all glottal cycles are traced by means of a cross-correlation detector. Based on the so determined beginning and duration of all glottal cycles, shimmer, jitter, several harmonics-to-noise ratios and other widely used acoustic parameters are calculated. New parameters are also introduced for estimation of the turbulent noise in voice signals (Turbulent Noise Index - TNI) and for the "breathy" voice characterization (Normalized First Harmonic Energy - NFHE). These parameters are applied for laryngeal pathology detection. An identification accuracy of 96.1% by the K-nearest neighbors' method has been achieved. The system is clinically tested.

Algorithms↗
PubMedDate not supplied

Vocal assessment in patients submited to CO2 laser cordectomy.

AIM: To evaluate voice outcomes in patients with early glottic carcinoma treated by CO2 laser cordectomy. METHOD: 15 patients with glottic Tis and T1 squamous cell carcinoma treated with CO2 laser were analyzed. The assessment consisted of perceptual voice analysis, objective voice evaluation and video-laryngo-stroboscopic exam. In addition, patients rated their voices and completed the Voice related Quality of Life (VR-QOL) questionnaire. The results were compared with those obtained in a matched control group. RESULTS: Most of the patients presented some degree of hoarseness on perceptual voice analysis, mainly rough and breathy voices. Their acoustic evaluation compared with the control group showed a small increase in fundamental frequency, but with no statistically significant difference, and the values of jitter, shimmer and noise to harmonic ratio were worse and statistically significant. As regards to videolaryngo-stroboscopic findings, better results were achieved in the less extensive resection group. Patients have had minimal repercussion in their life quality in respect to voice. CONCLUSIONS: In spite of voice alterations in patients submitted to cordectomy by CO2 laser, functional results are acceptable, with minimal repercussion in their quality of life.

Adult↗
PubMed2006

Comparative analysis of perceptual evaluation, acoustic analysis and indirect laryngoscopy for vocal assessment of a population with vocal complaint.

UNLABELLED: As a result of technology evolution and development, methods of voice evaluation have changed both in medical and speech and language pathology practice. AIM: To relate the results of perceptual evaluation, acoustic analysis and medical evaluation in the diagnosis of vocal and/or laryngeal affections of the population with vocal complaint. STUDY DESIGN: Clinical prospective. MATERIAL AND METHOD: 29 people that attended vocal health protection campaign were evaluated. They were submitted to perceptual evaluation (AFPA), acoustic analysis (AA), indirect laryngoscopy (LI) and telelaryngoscopy (TL). RESULTS: Correlations between medical and speech language pathology evaluation methods were established, verifying possible statistical signification with the application of Fischer Exact Test. There were statistically significant results in the correlation between AFPA and LI, AFPA and TL, LI and TL. CONCLUSION: This research study conducted in a vocal health protection campaign presented correlations between speech language pathology evaluation and perceptual evaluation and clinical evaluation, as well as between vocal affection and/or laryngeal medical exams.

Adolescent↗
PubMed2005

[Proposal of measurement of vertical larynx position at rest].

AIM: The purpose of this research is to propose a procedure to measure the vertical larynx position in the neck at rest, of young adults without vocal complaint. STUDY DESIGN: Transversal cohort study. MATERIAL AND METHOD: A number of 68 subjects, aged between 18 to 44 years, 33 female and 35 male, participated in this study. The referential points used for this research were the right and left jaw angle (RJA and LJA), the centre of the cricoid arch cartilage (CC) and the centre of the sternal furculum (SF). In order to obtain the measures, the subjects were asked to be sitting still with their heads stretched up to the highest possible position. The devices used were a drawing compass and a 20-centimeter ruler. RESULTS: The measurement procedure demonstrated to be easily executed and it didn't show any discomfort to the participants. There was no statistically significant difference between sexes related to the vertical larynx position in the neck; however the women presented higher larynx position than men. The vertical larynx position was easily obtained and it seems to be a very interesting parameter to intra-subject clinical follow-up.

Adolescent↗
PubMed1986

Surgical treatment of Reinke's oedema (long-term results).

The purpose of this investigation was to evaluate the extent to which voice quality recovers and is retained in the long term, and the incidence of recurrence of Reinke's oedema, in patients treated by stripping of the vocal cords. Of 120 patients treated consecutively over an eight-year period, 111 comprised the follow-up investigation group. Only 19 per cent had a normal voice. The remaining 81 per cent had voice problems, and of these, 68 per cent displayed obvious hoarseness, with recurrence of Reinke's oedema in 58 per cent. It is concluded that the long term curative effect of this traditional treatment is over-estimated, and that the elimination of various etiological factors, particularly habitual tobacco smoking and voice abuse, is of prime importance.

Adult↗
PubMed1990

Vocal fold sulcus.

Vocal fold sulcus is a cause of dysphonia which has not been recognized until recently. Awareness of its existence combined with use of laryngostroboscopy would enhance the management of this group of patients. Five such cases were treated initially by voice therapy and subsequently combined with microlaryngeal Teflon injections of the vocal cord. Representative photomicrographs and the end results of treatment are presented. A good voice, subjectively and objectively, was obtained in three patients, with satisfactory improvement in the other two.

Adult↗
PubMed1997

Predictive assessment of vocal efficiency (PAVE). A method for voice therapy outcome measurement.

A prospective study was carried out to examine the degree to which a standard voice assessment could discriminate between the potential benefits of two different voice therapy programmes for individual patients. The study encompassed 200 dysphonia subjects who were referred for voice therapy and had completed treatment within a prescribed two-year period. A standard assessment procedure was carried out on first attendance for each patient and guidelines were used to assign patients to different treatment programmes on the basis of the assessment results. The assessment discriminated well between patients requiring voice therapy to change physiological parameters of voice usage and patients able to self adjust voice usage, and provided an objective means of measuring outcomes.

Humans↗
PubMed1999

Tracheo-oesophageal puncture by retrograde passage of a gastroscope via mini-laparotomy and gastrotomy.

Secondary tracheo-oesophageal puncture is frequently used for voice restoration after laryngectomy. A method utilizing a flexible gastroscope passed via a mini-laparotomy and gastrotomy in a retrograde manner is described in a patient where extensive pharyngeal resection made it impossible to cannulate the upper aerodigestive tract. The patient suffered minimal morbidity and produced reasonable speech.

Carcinoma, Squamous Cell↗
PubMed2006

Management of the transgender voice.

Transsexualism is a condition involving a paradoxical feeling of belonging to the opposite sex. Acquiring a sex-appropriate voice is a crucial part of the patient gaining acceptance in their new gender. Speech and language therapists and otolaryngologists play an important role in influencing communication behaviour in transgender patients by altering the fundamental frequency of speech to one acceptable for the patient's sex. Review of the literature suggests that speech and language therapy is successful at creating an acceptable fundamental frequency in transgender patients, as well as influencing other communication behaviours. Laryngeal surgery, such as cricothyroid approximation, has an important role in raising the fundamental frequency in those who do not achieve acceptable voice via non-surgical means. There is little information on patient satisfaction and quality of life measures. Research is currently underway to explore this aspect further.

Female↗
PubMed2001

Acoustic discrimination of pathological voice: sustained vowels versus continuous speech.

We investigated the ability of acoustic measures to discriminate between normal and pathological talkers. Two groups of measures were compared: (a) those extracted from sustained vowels and (b) those based on continuous speech samples. Nine acoustic measures, which include fundamental frequency and amplitude perturbation measures, long term average spectral measures, and glottal noise measures were extracted from both sustained vowel and continuous speech samples. Our experiments were performed on a published database of 53 normal talkers and 175 talkers with a pathological voice. The classification performance of the nine acoustic measures was quantified using linear discriminant analysis and receiver operating characteristic (ROC) curve analysis. When individual measures were considered in isolation, classification was more accurate for measures extracted from sustained vowels than for those based on continuous speech samples. Classification accuracy improved when combinations of acoustic parameters were considered. For such combinations of measures, classification results were comparable for measures extracted from continuous speech samples and for those based on sustained vowels.

Adult↗
PubMed2002

Direct magnitude estimation and interval scaling of naturalness and severity in tracheoesophageal (TE) speakers.

The purpose of this study was to determine the psychophysical character and validity of auditory-perceptual ratings of naturalness and overall severity for tracheoesophageal (TE) speech. This was achieved through use of direct magnitude estimation (DME) and equal-appearing interval (EAI) scaling procedures. Twenty adult listeners judged speech naturalness and overall severity from connected speech samples produced by 20 adult male TE speakers. A comparison of DME- and EAI-scaled judgments yielded a metathetic continuum for naturalness and a prothetic continuum for overall severity. These data provide support for the use of either DME or EAI scales in auditory-perceptual ratings of naturalness, but they provide support only for DME scales in judging overall severity for TE speech. The present results suggest that the nature of perceptual phenomena (prothetic vs. metathetic) for TE speakers is consistent with findings for the same dimensions produced by normal laryngeal speakers. These data also support a need for further study of perceptual dimensions associated with TE voice and speech in order to avoid the inappropriate and invalid use of EAI scales frequently found in diagnosis, assessment, and evaluation of this clinical population.

Adult↗
PubMed2003

Perception of vocal tremor.

Vocal tremors characterize many pathological voices, but acoustic-perceptual aspects of tremor are poorly understood. To investigate this relationship, 2 tremor models were implemented in a custom voice synthesizer. The first modulated fundamental frequency (F0) with a sine wave. The second provided irregular modulation. Control parameters in both models were the frequency and amplitude of the F0 modulating waveform. Thirty-two 1-s samples of /a/, produced by speakers with vocal pathology, were modeled in the synthesizer. Synthetic copies of each vowel were created by using tremor parameters derived from different features of F0 versus time plots of the natural stimuli or by using parameters chosen to match the original stimuli perceptually. Listeners compared synthetic and original stimuli in 3 experiments. Sine wave and irregular tremor models both provided excellent matches to subsets of the voices. The perceptual importance of the shape of the modulating waveform depended on the severity of the tremor, with the choice of tremor model increasing in importance as the tremor increased in severity. The average frequency deviation from the mean F0 proved a good predictor of the perceived amplitude of a tremor. Differences in tremor rats were easiest to hear when the tremor was sinusoidal and of small amplitude. Differences in tremor rate were difficult to judge for tremors of large amplitude or in the context of irregularities in the pattern of frequency modulation. These results suggest that difference limens are larger for modulation rates and amplitudes when the tremor pattern is complex. Further, tremor rate, regularity, and amplitude interact, so that the perceptual importance of any one dimension depends on values of the others.

Adult↗
PubMed2003

Vocal dose measures: quantifying accumulated vibration exposure in vocal fold tissues.

To measure the exposure to self-induced tissue vibration in speech, three vocal doses were defined and described: distance dose, which accumulates the distance that tissue particles of the vocal folds travel in an oscillatory trajectory; energy dissipation dose, which accumulates the total amount of heat dissipated over a unit volume of vocal fold tissues; and time dose, which accumulates the total phonation time. These doses were compared to a previously used vocal dose measure, the vocal loading index, which accumulates the number of vibration cycles of the vocal folds. Empirical rules for viscosity and vocal fold deformation were used to calculate all the doses from the fundamental frequency (F0) and sound pressure level (SPL) values of speech. Six participants were asked to read in normal, monotone, and exaggerated speech and the doses associated with these vocalizations were calculated. The results showed that large F0 and SPL variations in speech affected the dose measures, suggesting that accumulation of phonation time alone is insufficient. The vibration exposure of the vocal folds in normal speech was related to the industrial limits for hand-transmitted vibration, in which the safe distance dose was derived to be about 500 m. This limit was found rather low for vocalization; it was related to a comparable time dose of about 17 min of continuous vocalization, or about 35 min of continuous reading with normal breathing and unvoiced segments. The voicing pauses in normal speech and dialogue effectively prolong the safe time dose. The derived safety limits for vocalization will likely require refinement based on a more detailed knowledge of the differences in hand and vocal fold tissue morphology and their response to vibrational stress, and on the effect of recovery of the vocal fold tissue during voicing pauses.

Female↗
PubMed2006

Voice training and therapy with a semi-occluded vocal tract: rationale and scientific underpinnings.

PURPOSE: Voice therapy with a semi-occluded vocal tract has a long history. The use of lip trills, tongue trills, bilabial fricatives, humming, and phonation into tubes or straws has been hailed by clinicians, singing teachers, and voice coaches as efficacious for training and rehabilitation. Little has been done, however, to provide the scientific underpinnings. The purpose of the study was to investigate the underlying physical principles behind the training and therapy approaches that use semi-occluded vocal tract shapes. METHOD: Computer simulation, with a self-oscillating vocal fold model and a 44 section vocal tract, was used to elucidate source-filter interactions for lip and epilarynx tube semi-occlusions. RESULTS: A semi-occlusion in the front of the vocal tract (at the lips) heightens source-tract interaction by raising the mean supraglottal and intraglottal pressures. Impedance matching by vocal fold adduction and epilarynx tube narrowing can then make the voice more efficient and more economic (in terms of tissue collision). CONCLUSION: The efficacious effects of a lip semi-occlusion can also be realized for nonoccluded vocal tracts by a combination of vocal fold adduction and epilarynx tube adjustments. It is reasoned that therapy approaches are designed to match the glottal impedance to the input impedance of the vocal tract.

Computer Simulation↗
PubMed1978

Self-perception of speaking pitch levels.

The literature has noted that speakers often perceive their own speaking pitch levels differently than listeners perceive them. However, little information is available regarding the specific characteristics of such perceptual differences. Speaking pitch level self-perception was explored in a group of 11 young adult males who served both as talkers and listeners. As a talker, each subject judged his own speaking pitch level in the process of speaking (live judgments) and during taped replay (taped judgments). The subjects' self-rankings in these two tasks and the rank order of taped voices as judged by listeners were compared to fundamental frequency rankings for the voices. The results indicated that the subjects judged their own taped voices in the same way that the listeners judged them, and the judgments corresponded to fundamental frequency rankings. During the live judgments, the subjects avoided extreme self-rankings, preferring to rank themselves closer to an average pitch level. The findings may have clinical significance in the remediation of certain voice disorders.

Acoustics↗
PubMed1980

Voice therapy: a need for research.

Studies concerning the effectiveness of voice are lacking. There is little experimental verification that therapy techniques actually achieve specific change in abusive vocal function. Guidelines are presented regarding conceptual and methodological consideration for future investigations. Divergent terminology, philosophy, and issues of voice therapy are presented to serve as an overview and as a basis for research direction. Suggestions are offered for selecting experimental designs.

Humans↗