Journal of Voice

Insights Into the Role of Elastin in Vocal Fold Health and Disease

Jaime Moore, Susan Thibeault — 2011-06-27

Summary: Elastic fibers are large, complex, and surprisingly poorly understood extracellular matrix macromolecules. The elastin fiber, generated from a single human gene—elastin, is a self assembling integral protein that endows critical mechanical proprieties to elastic tissues and organs such as the skin, lungs, and arteries. The biology of elastic fibers is complex because they have multiple components, a tightly regulated developmental deposition, a multistep hierarchical assembly, and unique biomechanical functions. Elastin is present in vocal folds, where it plays a pivotal role in the quality of phonation. This review article provides an overview of the genesis of elastin and its wide-ranging structure and function. Specific distribution within the vocal fold lamina propria across the lifespan in normal and pathological states and its contribution to vocal fold biomechanics will be examined. Elastin and elastin-derived molecules are increasingly investigated for their application in tissue engineering. The properties of various elastin-based materials will be discussed and their current and future applications evaluated. A new level of understanding of the biomechanical properties of vocal fold elastin composites and their molecular basis should lead to new strategies for elastic fiber repair and regeneration in aging and disease.

A New Hypothesis for Fluidification of Vocal-Fold Mucus: Scintigraphic Study

Milton Melciades Barbosa Costa, Carmelindo Maliska — 2011-06-27

Summary: Objective: Our aim was to establish a new hypothesis for the fluidification of the mucus of the vocal folds, by using a scintigraphic method to analyze the relationship of the saliva from the oral and pharyngeal cavities to the mucosa of the laryngeal vestibule.Study Design: We theorized that the saliva that is adsorbed on the oral and pharyngeal mucosa enters the larynx and is also adsorbed on its mucosa, as a natural layer, fluidizing the mucus of the vestibule wall.Method: A saline solution of sodium pertechnetate (Na99mTcO4) with radioactivity of 1.0mCi was sprayed in the oral cavity of seven healthy volunteers, who were instructed to chew a piece of apple for as long as possible without swallowing. The migration of the radioactive saliva was recorded by a gamma-chamber apparatus.Results: We observed radioactivity in the laryngeal mucosa in six of the seven volunteers, who developed no complaints and no respiratory-defense reactions. The results for frequency were statistically significant (Mann-Whitney test, P=0.05).Conclusion: The results indicate that an increased volume of saliva enters the larynx and is adsorbed in its mucosa, producing mucus fluidification. This supports our alternative hypothesis to the unlikely concept that hydration by water ingestion is the factor responsible for reduction of the mucus viscosity of the vocal folds.

Phonation Instability Flow in Excised Canine Larynges

2011-05-10

Summary: Objective: Disordered voices are often associated with abnormal changes in aerodynamic parameters of subglottal pressure (Ps) and airflow. Phonation instability pressure (PIP) has been previously proposed to evaluate Ps at the onset of chaotic phonation. We propose the concept of and measure phonation instability flow (PIF), the airflow at which phonation becomes chaotic. Phonation flow range (PFR), PIF minus phonation threshold flow (PTF), is proposed to assess the range over which normal vocal fold vibration occurs.Study Design: Repeated measures with each ex vivo larynx serving as its own control.Methods: Pressure and airflow were measured at phonation onset and chaos onset in seven excised canine larynges under three experimental conditions: 0% elongation with no glottal gap; 20% elongation with no glottal gap; 20% elongation with a 3-mm posterior glottal gap. Paired t tests were performed to determine if experimental measurements differed between elongations (0% and 20%) or degrees of abduction (20% elongation with and without a 3-mm glottal gap).Results: Both PIF and PFR were dependent on abduction but not elongation. PIP was not significantly dependent on either condition. PIF and PFR showed greater differences for abduction than either phonation threshold pressure (PTP) or PTF.Conclusions: PIF and PFR may be useful parameters in the experimental or clinical settings, particularly when evaluating disorders characterized by a glottal gap, such as vocal fold paralysis and presbylaryngis.

Effects of the Epilarynx Area on Vocal Fold Dynamics and the Primary Voice Signal

2011-06-27

Summary: For the analysis of vocal fold dynamics, sub- and supraglottal influences must be taken into account, as recent studies have shown. In this work, we analyze the influence of changes in the epilaryngeal area on vocal fold dynamics. We investigate two excised female larynges in a hemilarynx setup combined with a synthetic vocal tract consisting of hard plastic and simulating the vowel /a/. Eigenmodes, amplitudes, and velocities of the oscillations, the subglottal pressures (Psub), and sound pressure levels (SPLs) of the generated signal are investigated as a function of three distinctive epilaryngeal areas (28.4mm2, 71.0mm2, and 205.9mm2).The results showed that the SPL is independent of the epilarynx cross section and exhibits a nonlinear relation to the insufflated airflow. The Psub decreased with an increase in the epilaryngeal area and displayed linear relations to the airflow.The principal eigenfunctions (EEFs) from the vocal fold dynamics exhibited lateral movement for the first EEF and rotational motion for the second EEF. In total, the first two EEFs covered a minimum of 60% of the energy, with an average of more than 50% for the first EEF. Correlations to the epilarynx areas were not found. Maximal values for amplitudes (up to 2.5mm) and velocities (up to 1.57mm/ms) changed with varying epilaryngeal area but did not show consistent behavior for both larynges.We conclude that the size of the epilaryngeal area has significant influence on vocal fold dynamics but does not significantly affect the resultant SPL.

Pitch-Matching in Poor Singers: Human Model Advantage

Yohana Lévêque, Antoine Giovanni, Daniele Schön — 2011-08-05

Summary: Previous studies on action imitation have shown an advantage for biological stimuli compared with nonbiological stimuli, possibly because of the role played by the mirror system. By contrast, little is known on whether such an advantage also takes place in the auditory domain, related to voice imitation.Objectives/Hypothesis: In this study, we wanted to test the hypothesis that auditory stimuli could be more accurately reproduced when the timbre is human than when the timbre is synthetic.Methods: Eighteen participants judged as poor singers and 14 controls were presented with vocal and synthetic singing models and had to reproduce them.Results and Conclusion: Results showed that poor singers were significantly helped by the human model. This effect of the human model on production might be linked to the preactivation of motor representations (auditory mirror system) during voice perception, which may in turn facilitate the imitative vocal gesture.

The Effect of Experience on Classification of Voice Quality

Jessica L. Sofranko, Robert A. Prosek — 2011-11-15

Summary: Objectives/Hypothesis: The purpose of this study was to compare the agreement among several groups of listeners with different types of experience in regard to classifying voice quality.Study Design: This is a retrospective cross-sectional quasi-experimental design.Method: This study compared three groups: speech-language pathologists who specialize in voice, singing voice teachers, and inexperienced listeners. All groups were asked to classify voice samples as breathy, rough, or normal.Results: Results show a significant difference across all groups with speech-language pathologists demonstrating a substantial interrater agreement, κ=0.67, z=103.07 (P<0.01); singing voice teachers demonstrating a moderate interrater agreement, κ=0.53, z=79.10 (P<0.01); and inexperienced listeners demonstrating a fair interrater agreement, κ=0.24, z=35.82 (P<0.01).Conclusions: Experienced listeners demonstrated a higher interrater agreement as compared with inexperienced listeners, with speech-language pathologists demonstrating a superior agreement as compared with all groups.

Effects of Consensus Training on the Reliability of Auditory Perceptual Ratings of Voice Quality

Jenny Iwarsson, Niels Reinholt Petersen — 2011-08-16

Summary: Objectives/Hypothesis: This study investigates the effect of consensus training of listeners on intrarater and interrater reliability and agreement of perceptual voice analysis. The use of such training, including a reference voice sample, could be assumed to make the internal standards held in memory common and more robust, which is of great importance to reduce the variability of auditory perceptual ratings.Study Design: A prospective design with testing before and after training.Methods: Thirteen students of audiologopedics served as listening subjects. The ratings were made using a multidimensional protocol with four-point equal-appearing interval scales. The stimuli consisted of text reading by authentic dysphonic patients. The consensus training for each perceptual voice parameter included (1) definition, (2) underlying physiology, (3) presentation of carefully selected sound examples representing the parameter in three different grades followed by group discussions of perceived characteristics, and (4) practical exercises including imitation to make use of the listeners' proprioception.Results: Intrarater reliability and agreement showed a marked improvement for intermittent aphonia but not for vocal fry. Interrater reliability was high for most parameters before training with a slight increase after training. Interrater agreement showed marked increases for most voice quality parameters as a result of the training.Conclusion: The results support the recommendation of specific consensus training, including use of a reference voice sample material, to calibrate, equalize, and stabilize the internal standards held in memory by the listeners.

Identification of Children's Gender and Age by Listeners

Ofer Amir, Merav Engel, Esther Shabtai, Noam Amir — 2011-08-16

Summary: Objectives: Voice carries abundant information about the speaker. This acoustic information changes throughout life. Although the ability of identifying audible cues on a speaker's gender and age is considered an intuitive task, little is known about the ability to identify and decipher this perceptual information. Most studies in the field have examined the ability to identify adults' gender and age, thus the purpose of the present study was to evaluate listeners' ability to identify gender and age of children and adolescents.Methods: A total of 120 children in six age groups, 8, 10, 12, 14, 16, and 18 years, were recorded while producing isolated vowels and fixed sentences. The recordings were evaluated by a group of 38 untrained naive listeners, who were asked to identify the speakers' gender and age.Results: Listeners were able to identify children's gender at an overall rate of 81.81%. This task was performed more successfully based on recordings of sentences (85.39%) than on isolated vowels (78.22%). Listeners were able to identify the children's age group at an overall rate of 37.16%. This task was also performed more successfully based on recordings of sentences (39.58%) than on isolated vowels (34.71%). Furthermore, when an error of ±1 age group was allowed, correct responses for age identification exceeded 80%.Conclusions: Listeners have the ability to identify children's gender and age, based on short audio recordings, even before puberty. The success rates in these perceptual tasks are dependent on the child's age and gender.

Can Listeners Hear Who is Singing? What is the Pitch Bandwidth of Singer Discrimination in Untrained Listeners?

Molly L. Erickson — 2011-09-02

Summary: Objective/Hypothesis: This study sought to determine the pitch bandwidth of singer discrimination based on singer gender, pitch range, and same-different voice category.Study Design: Repeated measures factorial design.Methods: This study used a forced-choice paradigm, where listeners heard two different singers (singer 1 and singer 2) producing /ɑ/ at an identical pitch and an unknown singer (either singer 1 or singer 2) producing /ɑ/ at a different pitch. It was the listener's task to identify which singer (singer 1 or singer 2) was the unknown singer. Two baritones and two tenors were recorded producing /ɑ/ at the pitches C3, E3, G3, B3, D4, and F4. Two sopranos and two mezzo-sopranos were recorded producing /ɑ/ at the pitches C4, E4, G4, B4, D5, and F5. For each group of stimuli, male and female, all possible pairs of singers were constructed for the lowest pitch (C2 or C3, respectively) and highest pitch (F4 or F5, respectively). The unknown singer was varied across the remaining pitches.Results: For between category comparisons, the ability to discriminate singers diminished monotonically with pitch interval, reaching below chance levels between the intervals of the 9th and 11th. For within category comparisons, it was much harder to discriminate singers across pitch, particularly when the voices were female.Conclusion: Timbre is not perceived as invariant across the entire singing range, and the bandwidth of this timbre invariance depends on multiple factors, including pitch range, gender, and same-different voice category.

Health Information-Seeking Behaviors Among Classically Trained Singers

Brian E. Petty — 2011-08-24

Summary: Understanding health information-seeking behaviors (HISBs) within a particular patient demographic group is an important part of effective clinical outreach and education efforts. Although the community of classically trained singers has long been recognized by specialized health care providers, no studies have yet addressed the processes by which they search for voice-related health information, and little is known about how they use and access medical care. An electronic questionnaire focusing on HISB and voice-related health care issues was administered to 151 self-identified classically trained singers and 49 nonsinger controls. Outcomes of interest were tested for association with groups of singers and controls, followed by tests of association between demographic variables (age, gender, insurance status) with each outcome of interest. Results showed significant differences in specialty care access including point of first contact (P=0.0085), gender-associated delay of treatment initiation (P=0.0324), and use of home remedies for vocal problems (P≤0.0001). Significant differences in HISB were noted as well, including history of having undertaken an information search (P≤0.0001), likelihood of having concerns about information quality (P≤0.0001), and difficulty knowing where to find information (P≤0.0001). Differences were influenced by singing status, age, and gender. The insights provided by these data may inform decision-making processes regarding patient care, patient education, and clinical outreach to the target population.

Determination of Fundamental Frequency and Voice Intensity in Iranian Men and Women Aged Between 18 and 45 Years

Farzad Izadi, Ramin Mohseni, Ahmad Daneshi, Nazila Sandughdar — 2011-09-02

Summary: Objectives: Acoustic measurements have become an essential aspect of voice assessment during the last few decades, and studies have established that normative data is necessary for acoustic analysis. In this study, two aspects of voice are reviewed. These two factors are fundamental frequency and intensity. This study was designed to establish the normal acoustic analysis parameters in normal Iranian adults.Methods: In this cross-sectional study, 200 healthy randomly selected subjects (100 men and 100 women) were assessed. Data collection was carried out using the Studio Speech software and Laryngograph processor (Laryngograph Ltd, London, UK), type: PCLX at the Larynx and Voice Disorders Clinic of Rasoul-e-Akram Hospital under comfortable phonation.Results: The value of fundamental frequency in reading was greater for women (170–240Hz) than for men (107–140Hz). Also, the value of intensity was greater for women (73.54–84.99dB) than for men (72.40–86.03dB).Conclusion: The present study developed the normal data for fundamental frequency and intensity in Iranian speakers aged between 18 and 45 years. We concluded, fundamental frequency has significant differences between men and women, but intensity has no significant difference between them.

Acoustic Measures of the Voices of Older Singers and Nonsingers

Barbara Prakup — 2011-09-02

Summary: Objectives: This study investigated whether there were differences in the acoustic measures of fundamental frequency (Fo), jitter, intensity, and shimmer of older amateur singers and nonsingers and whether there were significant correlations between these acoustic measurements and listener judgments of speaker age.Methods: Acoustic measurements were obtained on 60 speaker participants from a sustained vowel production. Study participants included 30 male and female singers and 30 male and female nonsingers between the ages of 65 and 80 years. In addition, 10 speech-language pathology graduate students were recruited as listener participants to estimate the age of speaker participants from recorded vowel sounds.Results: The results of this study indicate that participants were perceived as significantly younger than their real ages, and male and female singers were perceived to be significantly younger than male and female nonsingers. Significant differences were found between male and female singers and nonsingers regarding jitter and intensity, with singers displaying significantly less jitter and significantly greater intensity than nonsingers. Perceived age was found to be related to jitter in male singers and nonsingers and female singers. Perceived age was found to be related to intensity in female nonsingers. No statistically significant differences were found between singers and nonsingers regarding Fo or shimmer. No significant correlations were found between perceived age and intensity in male singers, male nonsingers, or female singers.Conclusions: Acoustic and auditory-perceptual features of the aging voice appear to be factors associated with participation in amateur singing.

Animal Model for Training and Improvement of the Surgical Skills in Endolaryngeal Microsurgery

2012-02-02

Summary: Animal models for training of surgical skills were widely used for a long time in the education of medical practitioners. It is recognized, however, that endolaryngeal microsurgery requires highly refined skills to handle the delicate structures of the vocal folds under the microscope. The availability of fresh human laryngeal specimens is markedly restricted by legal and hygienic issues. The aim of this work was to report on the design of a feasible and effective model to provide the much needed skills in an animal laryngeal model that is as close as possible to the human vocal fold structure. In the initial phase of the research, three animal larynges were studied: porcine/pig, bovine/calf, and ovine/sheep larynges. The pig/porcine larynx was chosen for this experimental training model because it closely resembled the human laryngeal/glottal configurations. A study was carried out on 10 porcine/pig larynges to assess the dimensions of the glottis and study the histology of the layered structure of the vocal fold. The study was pursued to confirm the resemblance of this animal specimen to the human vocal fold. A wooden box with a black finished interior was prepared with an acrylic bed at its floor. This bed allows placement of the porcine/pig larynx. The design of the box allows the endoscopic exposure of the porcine/pig larynx through a rubber diaphragm. The darkness and confinement of the box, apart from the light of the endoscope, approximates the situation in live endoscopy. The operating microscope is then used to expose the glottis. Routine fine microlaryngeal instruments were used for training in the prescribed skills.

Developing Auditory-Perceptual Judgment Reliability in Otolaryngology Residents

S. Misono, A.L. Merati, T.L. Eadie — 2011-10-24

Summary: Objectives: To determine how standard residency training and educational background affect otolaryngology resident auditory-perceptual judgments compared with inexperienced listeners. A secondary aim was to assess the impact of a brief training session on the reliability of judgments among otolaryngology residents.Study Design: Mixed cross-sectional and cohort study.Methods: Twenty adult dysphonic and four normal speaker samples were selected from a database. Fifteen listeners at various stages of residency in otolaryngology judged all samples for breathiness and roughness using visual analog scales. Fifteen inexperienced listeners judged the same samples. Subsequently, 12 otolaryngology residents underwent a brief training session. During training, listeners were provided definitions of rating dimensions and accuracy feedback while rating 20 novel (training) stimuli. The feedback included averaged responses from experienced clinicians who had previously evaluated the same speech samples. The residents then completed posttraining evaluations.Results: As a group, otolaryngology resident listeners had significantly better interrater agreement for judgments of roughness compared with inexperienced listeners (P<0.05) and trended toward better interrater agreement for judgments of breathiness (P=0.058). Posttraining, no significant improvement in interrater agreement for judgments of roughness was observed; however, a significant improvement was found in interrater agreement of judgments of breathiness (P<0.05).Conclusions: Compared with inexperienced (untrained) listeners, otolaryngology resident listeners had better interrater agreement overall for judgments of dysphonia. A short training module was associated with improved reliability in resident evaluation of breathiness. Results have implications for improving and standardizing resident evaluation of dysphonia.

Study on the Simplified Chinese Version of the Voice Handicap Index

Hongyan Li, Zhigang Huang, Rong Hu, Li Zhang, Wen Xu — 2011-05-10

Summary: Objectives: To investigate the characteristics of the simplified Chinese versions of the Voice Handicap Index (VHI).Methods: Cluster analysis was performed on the VHI scores of 1766 dysphonic patients to screen for items to compile different simplified Chinese VHI versions. The VHI scores of 3825 dysphonic patients (in which 424 patients have undertaken surgical treatment) and 120 control subjects were assessed using the simplified versions, and the results were compared between the simplified versions and the original version.Results: Two simplified versions of VHI-10 (10 items) and VHI-13 (13 items) were compiled after the cluster analysis. Their internal consistency reliabilities were 0.939 and 0.936, the test-retest reliability coefficients were 0.995 and 0.993, and their correlation coefficients to the original VHI questionnaire were 0.972 and 0.973, respectively. The scores of VHI-10 and VHI-13 were significantly higher in dysphonic patients than in control subjects (Z=17.42, Z=17.46; P=0.000). The mean ratios of the VHI-10 and VHI-13 scores to the original VHI questionnaire scores in dysphonic groups were found to be consistently greater than expected (0.333 and 0.433, respectively). The VHI scores from the simplified versions were classified on the basis of the overall grade severity of dysphonia according to the physicians’ subjective auditory assessment, and when the scores among the different groups were compared, there was a statistical difference between the VHI-10 and VHI-13 scores (Z=5.735–9.861, P=0.000). The VHI-10 and VHI-13 patient scores declined significantly after treatment (P<0.05).Conclusions: Both of the simplified Chinese versions, VHI-10 and VHI-13, had good reliability and validity. They could be used in the dysphonic self-assessment as the simplified Chinese VHI questionnaire. VHI-10 was found to be more concise and more widely applicable than VHI-13.

Evaluating the Outcome of Phonosurgery: Comparing the Role of VHI and VoiSS Questionnaires in the Greek Language

2011-08-12

Summary: Objectives/Hypothesis: The objective was to study the role of the Greek version of Voice Handicap Index (VHI) in comparison with Voice Symptom Scale (VoiSS) in terms of measuring voice surgery outcome in patients with benign laryngeal lesions.Study Design: Nonrandomized prospective.Methods: Forty-six patients operated for benign laryngeal lesions were enrolled in the present study. All patients were assessed according to the European Laryngological Society guidelines. In terms of self-evaluation, patients answered the Greek versions of both VHI and VoiSS, preoperatively and 6 weeks postoperatively, and the results were statistically analyzed.Results: The strongest correlation was observed between the functional subscale of VHI and the impairment subscale of VoiSS, as well as, between the emotional subscales of both VHI and VoiSS, pre- and postoperatively. A statistically significant change in subscale and total scores was found. VHI and VoiSS subscales and total scores correlated with the stroboscopic and aerodynamic measurements in a variable manner. Perceptual measurements, as well as shimmer and harmonic-to-noise ratio showed significant correlation with both VHI and VoiSS subscale and total scores postoperatively.Conclusion: VHI and VoiSS are considered useful tools in evaluating voice surgery outcome, in the Greek language.

A Comparison of the VHI, VHI-10, and V-RQOL for Measuring the Effect of Botox Therapy in Adductor Spasmodic Dysphonia

Sanjay Morzaria, Edward J. Damrose — 2010-10-21

Summary: Background: Although disease-specific quality-of-life (QOL) instruments are an invaluable outcome measure in spasmodic dysphonia, there is no consensus on which QOL instrument should be used.Objective: To determine the responsiveness of the Voice Handicap Index (VHI), Voice Handicap Index-10 (VHI-10), and Voice-Related Quality of Life (V-RQOL) to the treatment effect of botulinum toxin (Botox) in adductor spasmodic dysphonia (ADSD).Setting: Stanford University Voice and Swallowing Center.Design: Prospective case series (level of evidence=4).Methods: Consecutive ADSD patients with a stable Botox dose-response relationship were recruited prospectively. VHI, VHI-10, and V-RQOL scores were obtained pretreatment and during the middle third of the posttreatment injection cycle.Results: Thrity-seven patients completed the follow-up. The average total Botox dose was 0.88 units. The average follow-up time after injection was 7.84 weeks. The pretreatment QOL scores reflected the burden of the disease. All the three instruments were highly correlated in subscale and total scores. After treatment, all three instruments showed significant improvement.Conclusion: The VHI, VHI-10, and V-RQOL all reflected the morbidity associated with ADSD and were significantly responsive to the effect of Botox therapy. The choice of instrument should be based on physician preference.

Voice Quality After Treatment of Early Glottic Carcinoma

2011-08-16

Summary: Objectives: Increasing incidence of laryngeal carcinoma and advancement in diagnostics and therapy methods, have led to constant exploration in that field. Early glottic carcinoma can be treated successfully with several procedures: cordectomy through laryngofissure, laser cordectomy, and radiotherapy. Our objective was to assess the voice quality after these different modalities of treatment.Study Design: Prospective controlled study with 69 patients, treated in a 1-year period for glottic Tis and T1a carcinoma at the tertiary medical centre.Methods: Nineteen of our patients were treated endoscopically with CO2 laser (types III–IV cordectomy according to recommended European Laryngological Society classification of endoscopic cordectomies). Thirty-five patients underwent cordectomy through laryngofissure, 15 patients had radiotherapy. Multidimensional computer analysis of voice and speech was conducted 1, 6, and 12 months after the treatment. Three programs included 14 parameters, which were observed.Results: While comparing the parameters between the groups, there were significant differences in the values of fundamental frequency (Hz), jitter (%), normalized noise energy (dB), standard deviation of fundamental frequency (Hz), percent silent time (%), and sound-pressure level in the different follow-up periods (P<0.05).Conclusion: In the long run, patients treated with radiotherapy show better voice quality in comparison with other two groups.

Automatic Intelligibility Assessment of Speakers After Laryngeal Cancer by Means of Acoustic Modeling

2011-08-08

Summary: Objective: One aspect of voice and speech evaluation after laryngeal cancer is acoustic analysis. Perceptual evaluation by expert raters is a standard in the clinical environment for global criteria such as overall quality or intelligibility. So far, automatic approaches evaluate acoustic properties of pathologic voices based on voiced/unvoiced distinction and fundamental frequency analysis of sustained vowels. Because of the high amount of noisy components and the increasing aperiodicity of highly pathologic voices, a fully automatic analysis of fundamental frequency is difficult. We introduce a purely data-driven system for the acoustic analysis of pathologic voices based on recordings of a standard text.Methods: Short-time segments of the speech signal are analyzed in the spectral domain, and speaker models based on this information are built. These speaker models act as a clustered representation of the acoustic properties of a person’s voice and are thus characteristic for speakers with different kinds and degrees of pathologic conditions. The system is evaluated on two different data sets with speakers reading standardized texts. One data set contains 77 speakers after laryngeal cancer treated with partial removal of the larynx. The other data set contains 54 totally laryngectomized patients, equipped with a Provox shunt valve. Each speaker was rated by five expert listeners regarding three different criteria: strain, voice quality, and speech intelligibility.Results/Conclusion: We show correlations for each data set with r and ρ≥0.8 between the automatic system and the mean value of the five raters. The interrater correlation of one rater to the mean value of the remaining raters is in the same range. We thus assume that for selected evaluation criteria, the system can serve as a validated objective support for acoustic voice and speech analysis.

Long-Term Efficacy of Voice Therapy in Patients With Voice Problems After Treatment of Early Glottic Cancer

2011-08-16

Summary: Objective: The purpose of the present pilot study is to investigate whether the beneficial short-term effects of voice therapy in patients with voice problems after treatment of early glottic cancer as reported in our earlier study remain present on the long term.Study Design: In this prospective study, 12 patients, selected based on a screening questionnaire about voice problems and randomly assigned for treatment with voice therapy (vs no treatment), were evaluated with a mean of 13 months after finishing voice therapy to evaluate the long-term voice effects.Methods: Voice assessment consisted of the Voice Handicap Index (VHI) and acoustic analyses (percent jitter, percent shimmer, and noise-to-harmonics ratio).Results: Statistical analysis showed that the beneficial short-term effect on the mean VHI, percent jitter, and shimmer remained stable after more than a year of follow-up.Conclusions: The present study provides initial evidence that the beneficial effect of voice therapy is not just a short-lived voice improvement but may result in a better voice for a period of at least 1 year. Future long-term randomized controlled trials are needed to confirm our findings.

The Effect of Resonance Tubes on Glottal Contact Quotient With and Without Task Instruction: A Comparison of Trained and Untrained Voices

Christopher S. Gaskill, Dana M. Quinney — 2011-05-10

Summary: Phonation into narrow tubes or straws has been used as a voice training and voice therapy technique and belongs to a group of techniques known as semi-occluded vocal tract exercises. The use of what are called resonance tubes has received renewed attention in the voice research literature, in both theoretical and empirical studies. The assumption is that the partially occluded and lengthened vocal tract alters supraglottal acoustics in such a way as to allow phonation near a lowered first vocal tract formant, which has been suggested as a way to bring about a more efficient glottal closure pattern for sustained oscillation. In this study, two groups of male participants, 10 with no vocal training and 10 with classical vocal training, phonated into a resonance tube for approximately 1 minute. Electroglottography was used to estimate glottal contact quotient (CQ) during spoken /a/ vowels before tube phonation, during tube phonation, and again during spoken /a/ vowels after tube phonation. Half of each group of participants was made to keep pitch and loudness consistent for all phases of the experiment, replicating the method of a previous study by this author. The other half was instructed to practice phonating into the resonance tube before collecting data and was encouraged to find a pitch and loudness combination that maximized ease of phonation and a sense of forward oral resonance. Glottal CQ altered considerably from baseline for almost all participants during tube phonation, with a larger variability than that during vowel production. Small differences in glottal CQ were found as a function of training and instruction, with most participants’ CQ increasing during tube phonation. A small post-tube phonation effect was found primarily for the trained and instructed group. Secondary single-subject analyses revealed large intersubject variation, highlighting the highly individualized response to the resonance tube task. Continued study of resonance tubes is recommended, comparing both male and female as well as vocally trained and untrained participants. Future studies should continue to examine systematic variations in task instruction, length of practice, and resonance tube dimensions.

Activity Patterns in Latissimus Dorsi and Sternocleidomastoid in Classical Singers

Alan H.D. Watson, Caitlin Williams, Buddug V. James — 2011-07-04

Summary: Objectives: The aim of this study was to investigate and compare the roles of the accessory respiratory muscles, latissimus dorsi (LD), and sternocleidomastoid, in classical singing.Methods: Electromyography was used to record the activity of these muscles in six classically trained female singers carrying out a number of singing and nonsinging tasks. Movements of the chest and abdominal walls were monitored simultaneously using inductive plethysmography, and the sound of the phonations was recorded.Results: In normal breathing, LD is active transiently during very deep inhalations and in inhalation against resistance. During exhalation it becomes active again as residual capacity is approached or when air is expelled with great force. Sternocleidomastoid (SCM) supports inhalation when lung volume nears 100% vital capacity or when this is very rapid. All singers engaged LD in supported singing where it was associated with maintaining an expanded thorax. In coloratura singing, pulses of activity of increasing amplitude were often seen in LD toward the end of the breath. These were synchronized with each note. During a short phrase typical of the end of an aria, which was sung at full volume with the projected voice, both LD and SCM were active simultaneously. Spectral analysis of muscle activity demonstrated that in some singers, activity in LD and more rarely SCM, fluctuated in phase with vibrato.Conclusions: LD appears to play a significant role in maintaining chest expansion and the dynamic processes underlying vibrato and coloratura singing in classically trained singers.

Resolution of Vocal Fold Polyps With Conservative Treatment

Hideki Nakagawa, Makoto Miyamoto, Toshiyuki Kusuyama, Yuko Mori, Hiroyuki Fukuda — 2011-11-15

Summary: Objectives: Vocal fold polyp is generally thought to require surgical removal. However, a certain proportion of polyps resolve with conservative treatment. This study was performed to clarify the frequency of spontaneous resolution of vocal fold polyp and identify features associated with polyps that are likely to resolve without surgery.Study Design: Retrospective study.Methods: A review of the medical records of patients diagnosed with vocal fold polyps in Tokyo Voice Center from January 2001 to December 2008.Results: Of 644 patients with the diagnosis of vocal fold polyp, 132 received conservative treatment, 433 were treated surgically, and 79 dropped out without attending for further consultation after the initial visit. Of those treated conservatively, 55 experienced complete resolution after a mean of 5.1 months of follow-up from the outset, and 29 showed lesion shrinkage after a mean of 4.1 months of follow-up. Polyps that resolved with conservative therapy were more likely than those that remained unchanged or enlarged to occur in women, be smaller, and have a shorter duration of symptoms. We could not determine the superiority of voice therapy.Conclusions: At least 9.7% of vocal fold polyps might resolve without surgery. Conservative treatment should be considered as an option for selected patients with smaller and more recent-onset polyps.

Habitual Use of Vocal Fry in Young Adult Female Speakers

Lesley Wolk, Nassima B. Abdelli-Beruh, Dianne Slavin — 2011-09-15

Summary: The purpose of this study was to examine the use of vocal fry in young adult Standard American-English (SAE) speakers. This was a preliminary attempt (1) to determine the prevalence of the use of this register in young adult college-aged American speakers and (2) to describe the acoustic characteristics of vocal fry in these speakers. Subjects were 34 female college students. They were native SAE speakers aged 18–25 years. Data collection procedures included high quality recordings of two speaking conditions, (1) sustained isolated vowel /a/ and (2) sentence reading task. Data analyses included both perceptual and acoustic evaluations. Results showed that approximately two-thirds of this population used vocal fry and that it was most likely to occur at the end of sentences. In addition, statistically significant differences between vocal fry and normal register were found for mean F0 minimum, F0 maximum, F0 range, and jitter local. Preliminary findings were taken to suggest that use of the vocal fry register may be common in some adult SAE speakers.

What About the “Actor’s Formant” in Actresses’ Voices?

Suely Master, Noemi Grigolleto De Biase, Sandra Madureira — 2011-03-07

Summary: Spectrographic analysis of male actors’ voices showed a cluster, the “actor’s formant” (AF), which is related to the perception of good and projected voice quality. To date, similar phenomena have not been described in the voices of actresses. Therefore, the objective of the current investigation was to compare actresses’ and nonactresses’ voices through acoustic analysis to verify the existence of the “AF” cluster or the strategies used to produce the performing voice. Thirty actresses and 30 nonactresses volunteered as subjects in the present study. All subjects read a 40-second text at both habitual and loud levels. Praat (v.5.1) was then used to analyze equivalent sound pressure level (Leq), speaking fundamental frequency (SFF), and in the long-term average spectrum window, the difference between the amplitude level of the fundamental frequency and first formant (L1−L0), the spectral tilt (alpha ratio), and the amplitude and frequency of the “AF” region. Significant differences between the groups, in both levels, were observed for SFF and L1−L0, with actresses presenting lower values. There were no significant differences between groups for Leq or alpha ratio at either level. There was no evidence of an “AF” cluster in the actresses’ voices. Voice projection for this group of actresses seemed to be mainly a result of a laryngeal setting instead of vocal tract resonances.

Reflux Symptom Index and Reflux Finding Score in Otolaryngologic Practice

2011-04-08

Summary: Objectives: To evaluate whether patients with abnormal Reflux Symptom Index (RSI) and Reflux Finding Score (RFS) benefit from proton pump inhibitor (PPI) therapy.Study Design: Open, multicenter, prospective longitudinal cohort study.Methods: Patients with suspected reflux-associated laryngologic symptoms were evaluated by 40 community practice otolaryngologists using RSI and RFS. Patients were treated with pantoprazole 40–80mg/d for 8–12 weeks if RSI was greater than 9 and RFS greater than 7. Pre- and posttherapeutic RSI and RFS were compared using Wilcoxon signed rank test and additionally controlled with the symmetry test of Bowker.Results: A total of 1044 patients were included over a period of 20 months. Median total score of RSI before therapy was 12 and decreased to 3 (P≪0.001). Median total score of RFS before therapy was 16 and decreased to 6 (P≪0.001). Assessment of the treatment effect by otolaryngologists and patients was judged as being excellent in at least 50%. In 2% of the patients, gastrointestinal side effects were documented.Conclusion: RSI and RSF are easy to administer in the routine care of patients suspected of having laryngopharyngeal reflux. Patients identified by positive results of these tests have a high likelihood of excellent improvement after 8–12 weeks of PPI treatment. By implementation of RFS and RSI in daily use, most patients may not need time-consuming and cost-intensive examinations in the first-line assessment of LPR. These examinations can be reserved for nonresponders, and uncontrolled prescription of PPIs can be restricted.

2012-05-01

Editorial Board

2012-05-01

Calendar

2012-05-01

Calendar Listings

2012-05-01

Instructions for Contributors

2012-05-01

Journal of Voice

Insights Into the Role of Elastin in Vocal Fold Health and Disease

A New Hypothesis for Fluidification of Vocal-Fold Mucus: Scintigraphic Study

Phonation Instability Flow in Excised Canine Larynges

Effects of the Epilarynx Area on Vocal Fold Dynamics and the Primary Voice Signal

Pitch-Matching in Poor Singers: Human Model Advantage

The Effect of Experience on Classification of Voice Quality

Effects of Consensus Training on the Reliability of Auditory Perceptual Ratings of Voice Quality

Identification of Children's Gender and Age by Listeners

Can Listeners Hear Who is Singing? What is the Pitch Bandwidth of Singer Discrimination in Untrained Listeners?

Health Information-Seeking Behaviors Among Classically Trained Singers

Determination of Fundamental Frequency and Voice Intensity in Iranian Men and Women Aged Between 18 and 45 Years

Acoustic Measures of the Voices of Older Singers and Nonsingers

Animal Model for Training and Improvement of the Surgical Skills in Endolaryngeal Microsurgery

Developing Auditory-Perceptual Judgment Reliability in Otolaryngology Residents

Study on the Simplified Chinese Version of the Voice Handicap Index

Evaluating the Outcome of Phonosurgery: Comparing the Role of VHI and VoiSS Questionnaires in the Greek Language

A Comparison of the VHI, VHI-10, and V-RQOL for Measuring the Effect of Botox Therapy in Adductor Spasmodic Dysphonia

Voice Quality After Treatment of Early Glottic Carcinoma

Automatic Intelligibility Assessment of Speakers After Laryngeal Cancer by Means of Acoustic Modeling

Long-Term Efficacy of Voice Therapy in Patients With Voice Problems After Treatment of Early Glottic Cancer

The Effect of Resonance Tubes on Glottal Contact Quotient With and Without Task Instruction: A Comparison of Trained and Untrained Voices

Activity Patterns in Latissimus Dorsi and Sternocleidomastoid in Classical Singers

Resolution of Vocal Fold Polyps With Conservative Treatment

Habitual Use of Vocal Fry in Young Adult Female Speakers

What About the “Actor’s Formant” in Actresses’ Voices?

Reflux Symptom Index and Reflux Finding Score in Otolaryngologic Practice

Table of Contents

Editorial Board

Calendar

Calendar Listings

Instructions for Contributors