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PubMed1998

[Voice prostheses with sound-producing metal reed element--an experimental study and initial clinical results].

BACKGROUND: Following total laryngectomy the voice is produced by esophageal speech as well as with voice prostheses by vibrations of pharyngeal mucosal folds. This pharyngeal sound normally has a significantly lower fundamental frequency than the healthy voice (men about 120 Hz, women about 240 Hz, pharyngeal voice about 70 Hz), which is a handicap especially for female laryngectomy patients. In order to improve the postlaryngectomy voice, a new type of voice prostheses containing an integrated sound-producing metallic reed element was developed (ADEVA Company, Lübeck, Germany). METHODS/PATIENTS: Thirty-five of these new sound-producing voice prostheses were tested in vitro for different prosthesis-specific physical parameters (pressure, flow, sound pressure, flow resistance, frequency range). In 15 voice prosthesis speakers, a sound-producing prosthesis was introduced during a routine outpatient visit. Besides measurement of the above mentioned physical parameters in patients with conventional and sound-producing prostheses, the resulting voice as also evaluated by means of a video recording. RESULTS: In vitro all prostheses with the metallic reed element produced a clear sound. Flow resistance of the prostheses was slightly elevated by the reed element. Insertion of the prostheses was hindered by the reed element. Period of uninterrupted sound production was prolonged after insertion of a sound-producing prosthesis and patients could speak on a lower pressure level, but the sound of the reed element was permanently distinguishable only in 6 of 15 patients. CONCLUSIONS: In principle a variation of the pharyngeal voice by means of a sound producing element, which is integrated into a voice prosthesis, is possible. The current design of the metallic reed element tested is not yet suitable for routine clinical use: 1. The reed element is too sensitive and is easily damaged during insertion, so the insertion device has to be improved. 2. The sound producing element is blocked by small amounts of tracheal secretions, so that this element should be replaceable separately without requiring removal of the silicone value (if possible by the patient himself). Prior to insertion of the sound producing voice prosthesis the maximum air flow through the shunt should be measured to determine if the patient can produce the necessary air flow for activation of the reed element. A further improvement for these special types of voice prostheses would be a sound producing element, which generates a variable frequency of sound. Limiting the patient to only one fundamental frequency creates a monotone, which does not sound naturally. Initial progress toward a sound-producing voice prostheses has been made. This should be followed by the necessary improvements in order to improve the feasibility of this design for routine clinical use.

Equipment Failure Analysis↗
PubMed1994

[Applications of the "Speech Viewer II" in voice training in vocal cord paralysis].

Referring to traditional therapeutical concepts of vocal fold paralysis a microphone-controlled computer programme was used for voice treatment in 13 patients with unilateral vocal fold paralysis. 6 of these patients were female, 7 were male. The age ranged from 18 to 72 years (mean: 50 years). The etiology of the paralysis was distributed as follows: post strumectomy (4 cases), post operation of the aortic arch (3 cases), post mediastinoscopy (1 case), post operation of the cervical vertebrae (1 case). 2 cases are not decided yet, 2 are probably idiopathic. The vocal fold dysfunction lasted between 24 hours and 8 years before our first examination, less than 4 weeks in 11 cases. With 1 exception (intermediate) the vocal fold position was classified as paramedian. 8 patients suffered from left, and 5 patients from right vocal fold paralysis. The voice treatment took place with a microphone-controlled speech viewer including an audio capture and playback adapter. 7 of the 15 training modules of the computer programme were chosen to be useful for voice training. Those modules can be differentiated in physical-technical modules showing voice spectra or pitch scales and in object-related modules showing images such as landscapes, animals and others. These programme-specific modules (monitor exercises) were primarily built to train the following voice qualities separately: loudness, pitch, voicing, voice onset, fundamental frequency, sustained phonation etc. Modifying certain therapeutic instructions (see Tables 1 and 2) the monitor exercises were used to improve the coordination of different voice parameters, thus resembling physiological speech.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1998

[Perceptive and instrumental examination of voice quality in patients with lip-jaw-palate clefts].

BACKGROUND: In Anglo-American literature, prevalences as high as 41% are reported for voice disorders in cleft lip and palate (CLP) patients. Because of considerable variability in the reported findings and because no prevalence data are available for the German-speaking area, a screening study was conducted. METHOD: 154 patients with CLP were examined. Voice quality was assessed perceptively according to the rbh-system (roughness, breathiness, hoarseness). Suprasegmentals and nasal resonance were also assessed. Using a new computer programme for the apparative analysis of voice quality, data for pitch, intensity and pertubation (jitter and shimmer) were obtained for 4 sustained vowels. RESULTS: Based on perceptual analysis, we found that the prevalence of severe voice disorders in CLP patients was 6.5% which is lower than reported in most other studies. The incidence of voice disorders in CLP patients is numerically only slightly higher than in the normal population. The acoustic measurements confirm the results of perceptual analysis. Since the prevalence of severe voice disorders was low, none of the pertubation quotients differentiated between modal and disordered voices. A weak correlation was found between jitter and the ratings for hoarseness. CONCLUSIONS: 1. While it is appropriate to assume a higher potential risk for vocal dysfunction in CLP patients the actual prevalence in the patients examined is numerically only slightly higher than in normals. 2. For patients with voice disorders, apparative diagnostics of voice quality is a useful and practical adjunct to perceptual analysis which helps profiling individual patients and helps the professional to make decisions for therapy.

Adolescent↗
PubMed1992

[What is the value of measuring "singer's formant" in phoniatry?].

The singing formant is the product of an articulatory gesture. Devices for phonetogram measurement often claim the ability to determine it. However, they measure rather the overtone content or the noise of the voice than the formant. Moreover, the voice efficiency (ratio of the sound pressure in the frequency band 2-5 kHz to the total sound pressure), also measured by these devices, is not defined in a physical or physiological sense. Such measurement does not evaluate the efficiency of the vocal apparatus.

Humans↗
PubMed1997

[Voice disorders. Emphasis in diagnosis and therapy].

The knowledge required in this field exceeds by far the area of traditional laryngology. The paper provides an overview of some basic measures, concentrating on functional aspects that are considered indispensible for the competence of the ENT doctor prescribing voice therapy to be carried out by non-medical therapists.

Diagnosis, Differential↗
PubMed1996

[In situ sound pressure measurement in a professional violinist with bilateral tinnitus].

BACKGROUND: A case of a professional violinist suffering from a bilateral tinnitus is presented. The musician reported the tinnitus to be louder and more straining when playing his Vuillaume violin (France 1840) as compared with his Carcassi violin (Italy 1763). CASE REPORT: In the 42-year-old musician, audiometry revealed a normal hearing threshold in the right ear and a slight hearing loss in the left ear of up to 20 dB between 2 kHz and 8 kHz. Transitory evoked otoacoustic emissions could only be measured in the right ear. The tinnitus could be masked (distance type); residual inhibition was only seen in the right ear. By sound intensity measurements in both external auditory canals, the different sound spectra of both violins could be demonstrated. When playing with "forte" intensity, sound pressure reached peaks of over 90 dB. The tinnitus was ameliorated by lidocaine infusions. DISCUSSION AND CONCLUSIONS: The different sound spectra of both violins may be the reason for the enhancement of the musician's tinnitus. Interference of air and bone-conducted sound could lead to a cochlear overlap and thus influence the tinnitus although such a phenomenon can not be verified. It was previously reported that high-pitched instruments may cause tinnitus sensations in performing musicians. A review of the literature surprisingly reveals that although professional musicians are exposed to sound pressure levels that may cause hearing impairment, only very few do develop one. This fact has to be taken into account whenever an occupational disease is suspected.

Adult↗
PubMed1995

[Practical significance of measuring high formant spectra in phoniatric voice assessment].

The measurement of sound energy in the spectral region between 2 and 5 kHz provides additional information to the auditive assessment of voice quality. It can be applied to healthy an sick voices, e. g. in tracing the therapeutic course. Devices for measuring voice range profiles with the possibility of evaluating the high formant region are especially useful and valuable. But, nonetheless, simultaneous auditive assessment is crucial to avoid misinterpretation. Calculation of the quotient of the sound pressure level in the region between 2 and 5 kHz by the total sound pressure level allows to determine vocal sound characteristics and changes of the sound. Pre- and postoperative sound spectra obtained from the voices of patients with diseases of the vocal folds illustrate the improvement of the harmonic structure and the decrease of noise components. The measurement of the high formant intensity has proven to be appropriate for the registration of the voice quality before and after therapy in 130 cases. Although the value of these measurements is highly validated in the phoniatric practice, extensive studies and, especially, expert discussions are still needed. The authors come to terms with opinions that question the validity of the described methods.

Follow-Up Studies↗
PubMed1995

[Context effects in speech recognition of sentences].

Context plays an important role in speech recognition. The goal of the present study was to quantify context effects in speech recognition using the Basle Sentence Understanding Test. This test consists of two types of sentences according to the amount of contextual information: they contain sentences with highly predictable (HP) final words and sentences with low predictable (LP) final words. The effect of different contextual situations on speech recognition was investigated in this study using the Basle Sentence Understanding Test. The speech recognition threshold of HP sentences was found to be 6 dB lower than that of LP sentences. However, contextual effects can only be demonstrated if the context is clearly understandable. In the Basle Sentence Understanding Test, this is achieved by special masking techniques. The significance of the recognition of the contextual part of the sentence with respect to the recognition of the whole sentence is different in HP and LP sentences.

Adolescent↗
PubMed1995

[Diagnosis of auditory threshold with frequency-specific recording of auditory evoked potentials: personal results and methodological aspects].

Results and Overview of Methods: Auditory brain stem responses are widely used in objective assessment of hearing function in both children and adults. Because of the lack of frequency specificity, several attempts were made to optimize responses using tone stimuli. Tone stimuli are characterized by intensity, frequency, and duration. Hence, there are important influences on the waveforms with respect to rise, plateau, and fall time. In addition, noise masking techniques are used to suppress both spectral sidebands of the stimulus and cochlear response not corresponding to the test frequency. In this paper, results on tone burst stimulation in notched noise masking are presented. Using this technique, reproducible waveforms (Jewett I to V resembling peaks) including a middle latency component could be obtained. Various stimulus characteristics (clicks, tone pips, tone bursts, Gaussian shaped stimuli), masking techniques (high-pass noise, notched noise), spectral characteristics, and time saving strategies are critically discussed.

Acoustic Stimulation↗
PubMed1993

[Short-term changes in the larynx and voice after intubation].

The endoscopic and stroboscopic picture of the larynx as well as the voice were examined pre-operatively and on the first or second post-operative day in 75 patients who had been anaesthesized with intubation. The stroboscopic findings were evaluated according to the criteria suggested by Schürenberg (1990). The quality of the voice was estimated with a voice purity index (Moser 1984) and the dynamic and frequency range of the voice was measured. After intubation, we found alterations of the mucous membrane in 73% of the patients: increased amount of visible blood vessels, bleeding into the vocal cords or the trachea, bruises at the processus vocals or the arytenoid cartilages. The stroboscopic picture showed deterioration: pre-operatively large amplitudes and/or mucosal waves became even larger postoperatively, small amplitudes and mucosal waves decreased even further. The timing and the spatial symmetry of the vocal cord movements also deteriorated. On the average, the dynamic range and the frequency range of the voice did not change. However, in individual cases the changes were considerable. The same was true for the parameters of the voice purity index. There was no statistically significant dependency on sex or age of the patients, the duration of the intubation or the diameter of the intubation tube.

Adolescent↗
PubMed1991

[Computer-assisted phonetography as a diagnostic aid in functional dysphonia].

A total of 160 voice-trained and untrained subjects with functional dysphonia were given a "clinical rating" according to their clinical findings. This was a certain value on a scale that recorded the degree of functional voice disorder ranging from a marked hypofunction to an extreme hyperfunction. The phonetograms of these patients were approximated by ellipses, whereby the definition and quantitative recording of several phonetogram parameters were rendered possible. By means of a linear combination of phonetogram parameters, a "calculated assessment" was obtained for each patient that was expected to tally with the "clinical rating". This paper demonstrates that a graduation of the dysphonic clinical picture with regard to the presence of hypofunctional or hyperfunctional components is possible via computerised phonetogram evaluation. In this case, the "calculated assessments" for both male and female singers and non-singers must be computed using different linear combinations. The method can be introduced as a supplementary diagnostic procedure in the diagnosis of functional dysphonia.

Adolescent↗
PubMed1990

[Temporary threshold shift after nuclear magnetic resonance tomography].

The third-octave band levels of the noises produced in a MR-imager (1.0 Tesla Magneton, Siemens) were measured. Corresponding sounds presented through earphones have been used in simulation experiments to produce in normal-hearing listeners a temporary threshold shift lasting several minutes. These effects could be verified objectively using otoacoustic emissions. The consequences especially for patients with already impaired hearing are discussed: ear protection is strongly recommended.

Auditory Fatigue↗
PubMed1989

[The voice of the singer in the phonetogram].

Phonetograms were subdivided into areas approximating voice registers. By means of an analytical description of the areas, parameters could be established for a differentiation of voice categories and efficiency. The evaluation of 21 untrained and 34 trained voices showed a significant difference between the two groups. Male singers demonstrated more efficiency in the head and chest registers than male non-singers; female singers showed a stronger efficiency only in the head voice in comparison with their non-singer counterparts. Proceeding from voice sound alone, voices are often misclassified regarding the voice categories, and voice problems arise. Moreover, enhanced training of only chest or head voice function results in functional disorders in the singing voice. Such cases can be demonstrated by means of phonetograms.

Adult↗
PubMed1989

[How can one recognize a velum snorer?].

In ten habitually snoring subjects and ten patients with obstructive sleep apnea syndrome, preoperative snoring sounds above a preset sound pressure level were recorded and a frequency spectrum analysis by means of time series Fast Fourier Transformation was performed. All patients underwent uvulopalato-pharyngoplasty after which the snoring sounds were recorded again and analysed under the same conditions. Preoperative frequency spectra in heavy snorers were dominated by a component which results from the movement of the soft palate and uvula and which presents as a low-frequency vibration of 25 to 50 c/s and its harmonics up to several hundred c/s. After UPPP the sound pressure level of the snoring noise in heavy snorers was reduced by 20 to 30 decibels and could not be recorded any more. The frequency spectrum of snoring noises in patients with obstructive sleep apnea syndrome differed from those of heavy snorers. In apnea patients the snoring noise usually consisted of other and higher frequency components which masked the vibration of the soft palate and uvula to a more or less high degree. An extreme degree of masking is reached in snoring noises following apneic episodes when identification of the movement of the soft palate is impossible. After performing UPPP in an apneic patient the low-frequency content of the spectrum below about 400 Hz was reduced dramatically but higher frequency parts were still present. This resulted in only minor reduction of snoring noise sound pressure level. Our results are in agreement with other authors in showing that UPPP is not successful when the site of obstruction is not in the velo-pharyngeal plane.(ABSTRACT TRUNCATED AT 250 WORDS)

Airway Obstruction↗
PubMed1989

[Evaluation of impulse noise].

The assessment of the risk of hearing loss due to impulse-weighted sound levels in working places leads to wrong results at often intermittent noise exposures, since the energy-equivalent continuous noise level does not consider the recovering of hearing due to noise pauses. In these cases the LAeq without impulse addition can lead to a correct assessment, as Pfeiffer and Maue demonstrated for the construction professions, but it cannot be excluded that LAeq on the one side can lead to underestimation of the risk of hearing loss at continuous exposure to impulse noise, on the other side even to overestimation in cases of height portion of pauses.

Hearing Loss, Noise-Induced↗
PubMed1993

[Prosodic disorders in neurologic diseases--a review of the literature].

The prosodic quality of speech comprises intonation, accent pattern, and rhythm. Among others, these dimensions contribute to the linguistic structure of an utterance and subserve emotional behaviour. Both cortical and subcortical dysfunctions can give rise to impaired speech prosody. The present paper reviews the clinical and linguistic features of the various dys- and aprosodic syndromes as well as their neuroanatomic substrates. 1. Sporadically, lesions of the left hemisphere present with dysprosody in terms of a "foreign accent". In most instances this syndrome seems to be due to apraxia of speech. 2. Some authors consider dysprosodic speech a characteristic feature of Broca's aphasia. The dysprosody of these patients predominantly reflects disturbed temporal organisation of speech utterances. Altered intonation contours, presumably, result from disordered sentence planning rather than from deficits of pitch processing. Wernicke aphasics may show increased variability of intonational patterns. 3. Impaired discrimination and identification of affective prosody has been observed in patients with temporoparietal lesion of the right hemisphere ("auditory affective agnosia"). With respect to linguistic prosody, controversial findings are reported on. Besides pitch extraction from acoustic signals the right hemisphere seems to provide categorical representations of emotional behaviour required for the "interpretation" of perceived intonation. 4. Damage to the right hemisphere can give rise to monotonous speech devoid of affective modulation ("motor aprosodia"). It is unsettled to which extent linguistic suprasegmental features are also distorted. The available data indicate an underlying dysfunction of basal ganglia loops and/or transcallosal projections. 5. Both Parkinson's and Huntington's disease may present with reduced prosodic modulation of speech. Probably, these deficits reflect disordered motor control of articulatory and phonatory functions. At least with respect to Parkinsonian patients perceptual and acoustic studies have so far failed to provide sufficient evidence of impaired prosodic planning.

Adult↗
PubMed1999

Technology in the assessment of voice disorder.

The purpose of this article is to describe salient technologies available for assessing patients with disorders of voice. Measurements of jitter, shimmer, harmonic-to-noise ratio, fundamental frequency of the speaking voice, basal frequency, ceiling frequency, computation of pitch range, speaking intensity, intensity increase potential, vital capacity, laryngeal airflow during phonation, and laryngeal videoendoscopy-stroboscopy are covered. Some of the common instruments available to measure these voice components are described. Clinical case examples are provided to illustrate the importance of technology in the assessment of patients with voice disorder.

Aged↗
PubMed1999

Use of technology in phonological intervention.

Microcomputers can support phonological intervention in a variety of ways. Software and hardware can assist clinicians in identifying errors and establishing appropriate treatment targets. Technology can also help to determine the nature of errors so that optimal intervention methods are used. Specific technology tools for addressing phonological errors due to problems with articulation, phonemic identification, and phonetic mapping are discussed. The use of technology to document and analyze treatment performance is also addressed.

Adolescent↗