Advertisement

Symptom Expression Across Voiced Speech Sounds in Adductor Laryngeal Dystonia

Published:November 21, 2022DOI:https://doi.org/10.1016/j.jvoice.2022.10.002

      Summary

      Objectives

      Differential diagnosis for adductor laryngeal dystonia (AdLD) is often carried out by comparing symptom expression during sentences with either all voiced or voiced and voiceless consonants. However, empirical research examining the effects of phonetic context on symptoms is sparse. The purpose of this study was to examine whether symptom probabilities varied across voiced speech segments in an all-voiced sentence, and whether this variability was systematic with respect to phonetic features.

      Methods

      Eighteen speakers with AdLD read aloud a sentence comprised entirely of voiced speech sounds. Speech segment boundaries and AdLD symptoms (phonatory breaks, frequency shifts, and creak) were labeled separately, and speech segments were coded as symptomatic or asymptomatic based on their temporal overlap. Generalized linear mixed effects models with a binomial outcome variable were used to compare the probability of symptom expression across: 1) all speech segments in the sentence, and 2) four speech sound classes (vowels, approximants, nasals, and obstruents).

      Results

      Significant symptom variability was found across voiced speech segments in the sentence. Furthermore, the estimated probability of a symptom occurring on vowels and approximants was significantly greater than that of nasals and obstruents.

      Conclusion

      These results indicate that AdLD symptoms are not uniformly distributed across voiced speech segments with systematic variation across speech sound classes.To explain these findings, future work should investigate how the complex interactions between the vocal tract articulators and glottal configurations may influence symptom expression in this population.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Voice
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Simonyan K
        • Barkmeier-Kraemer J
        • Blitzer A
        • et al.
        Laryngeal dystonia: multidisciplinary update on terminology, pathophysiology, and research priorities.
        Neurology. 2021; 96: 989-1001https://doi.org/10.1212/WNL.0000000000011922
        • Patel AB
        • Bansberg SF
        • Adler CH
        • et al.
        The mayo clinic arizona spasmodic dysphonia experience: a demographic analysis of 718 patients.
        Ann Otol Rhinol Laryngol. 2015; 124: 859-863https://doi.org/10.1177/0003489415588557
        • Blitzer A
        • Brin MF
        • Simonyan K
        • et al.
        Phenomenology, genetics, and CNS network abnormalities in laryngeal dystonia: a 30-year experience.
        Laryngoscope. 2018; 128: S1-S9https://doi.org/10.1002/lary.27003
        • Leonard R
        • Kendall K.
        Differentiation of spasmodic and psychogenic dysphonias with phonoscopic evaluation.
        Laryngoscope. 1999; 109: 295-300https://doi.org/10.1097/00005537-199902000-00022
        • Simonyan K
        • Ostuni J
        • Ludlow CL
        • et al.
        Functional but not structural networks of the human laryngeal motor cortex show left hemispheric lateralization during syllable but not breathing production.
        J Neurosci. 2009; 29: 14912-14923https://doi.org/10.1523/JNEUROSCI.4897-09.2009
        • Simonyan K
        • Ludlow CL.
        Abnormal structure-function relationship in spasmodic dysphonia.
        Cereb Cortex. 2012; 22: 417-425https://doi.org/10.1093/cercor/bhr120
        • Termsarasab P
        • Ramdhani RA
        • Battistella G
        • et al.
        Neural correlates of abnormal sensory discrimination in laryngeal dystonia.
        Neuroimage Clin. 2015; 10: 18-26https://doi.org/10.1016/j.nicl.2015.10.016
        • Mantel T
        • Dresel C
        • Welte M
        • et al.
        Altered sensory system activity and connectivity patterns in adductor spasmodic dysphonia.
        Sci Rep. 2020; 10 (10179-w)https://doi.org/10.1038/s41598-020-67295-w
        • Worthley A
        • Simonyan K.
        Suicidal ideations and attempts in patients with isolated dystonia.
        Neurology. 2021; 96: e1551-e1560https://doi.org/10.1212/WNL.0000000000011596
        • Murry T
        • Cannito MP
        • Woodson GE.
        Spasmodic dysphonia. emotional status and botulinum toxin treatment.
        Arch Otolaryngol Head Neck Surg. 1994; 120: 310-316https://doi.org/10.1001/archotol.1994.01880270056010
        • Tanner K
        • Roy N
        • Merrill RM
        • et al.
        Spasmodic dysphonia: onset, course, socioemotional effects, and treatment response.
        Ann Otol Rhinol Laryngol. 2011; 120: 465-473https://doi.org/10.1177/000348941112000708
        • Ludlow CL.
        Spasmodic dysphonia: a laryngeal control disorder specific to speech.
        J Neurosci. 2011; 31: 793-797https://doi.org/10.1523/JNEUROSCI.2758-10.2011
        • Barkmeier JM
        • Case JL
        • Ludlow CL.
        Identification of symptoms for spasmodic dysphonia and vocal tremor: a comparison of expert and nonexpert judges.
        J Commun Disord. 2001; 34 (S0021-9924(00)00039-3 [pii]): 21-37
        • Ludlow CL
        • Domangue R
        • Sharma D
        • et al.
        Consensus-based attributes for identifying patients with spasmodic dysphonia and other voice disorders.
        JAMA Otolaryngol Head Neck Surg. 2018; 144: 657-665https://doi.org/10.1001/jamaoto.2018.0644
        • Creighton FX
        • Hapner E
        • Klein A
        • et al.
        Diagnostic delays in spasmodic dysphonia: a call for clinician education.
        J Voice. 2015; 29: 592-594https://doi.org/10.1016/j.jvoice.2013.10.022
        • de Lima Xavier L
        • Simonyan K.
        The extrinsic risk and its association with neural alterations in spasmodic dysphonia.
        Parkinsonism Relat Disord. 2019; 65 (S1353-8020(19)30255-X [pii]): 117-123
        • Ludlow CL
        • Adler CH
        • Berke GS
        • et al.
        Research priorities in spasmodic dysphonia.
        Otolaryngol Head Neck Surg. 2008; 139: 495-505https://doi.org/10.1016/j.otohns.2008.05.624
        • Bloch CS
        • Hirano M
        • Gould WJ.
        Symptom improvement of spastic dysphonia in response to phonatory tasks.
        Ann Otol Rhinol Laryngol. 1985; 94: 51-54https://doi.org/10.1177/000348948509400111
        • Guiry S
        • Worthley A
        • Simonyan K.
        A separation of innate and learned vocal behaviors defines the symptomatology of spasmodic dysphonia.
        Laryngoscope. 2019; 129: 1627-1633https://doi.org/10.1002/lary.27617
        • Sapienza CM
        • Walton S
        • Murry T.
        Acoustic variations in adductor spasmodic dysphonia as a function of speech task.
        J Speech Lang Hear Res. 1999; 42: 127-140https://doi.org/10.1044/jslhr.4201.127
        • Roy N
        • Gouse M
        • Mauszycki SC
        • et al.
        Task specificity in adductor spasmodic dysphonia versus muscle tension dysphonia.
        Laryngoscope. 2005; 115 (00005537-200502000-00023 [pii]): 311-316
        • Roy N
        • Mazin A
        • Awan SN.
        Automated acoustic analysis of task dependency in adductor spasmodic dysphonia versus muscle tension dysphonia.
        Laryngoscope. 2014; 124: 718-724https://doi.org/10.1002/lary.24362
        • Sapienza CM
        • Walton S
        • Murry T.
        Adductor spasmodic dysphonia and muscular tension dysphonia: Acoustic analysis of sustained phonation and reading.
        J Voice. 2000; 14 (S0892-1997(00)80008-9 [pii]): 502-520
        • Roy N
        • Mauszycki SC
        • Merrill RM
        • et al.
        Toward improved differential diagnosis of adductor spasmodic dysphonia and muscle tension dysphonia.
        Folia Phoniatr Logop. 2007; 59 (000098341 [pii]): 83-90
        • Cannito MP
        • Chorna LB
        • Kahane JC
        • et al.
        Influence of consonant voicing characteristics on sentence production in abductor versus adductor spasmodic dysphonia.
        J Voice. 2014; 28 (394.e13-394.e22)https://doi.org/10.1016/j.jvoice.2013.10.010
        • Edgar JD
        • Sapienza CM
        • Bidus K
        • et al.
        Acoustic measures of symptoms in abductor spasmodic dysphonia.
        J Voice. 2001; 15 (S0892-1997(01)00038-8 [pii]): 362-372
        • Bidus KA
        • Thomas GR
        • Ludlow CL.
        Effects of adductor muscle stimulation on speech in abductor spasmodic dysphonia.
        Laryngoscope. 2000; 110: 1943-1949https://doi.org/10.1097/00005537-200011000-00033
        • Ludlow CL
        • Connor NP.
        Dynamic aspects of phonatory control in spasmodic dysphonia.
        J Speech Hear Res. 1987; 30: 197-206https://doi.org/10.1044/jshr.3002.197
        • Erickson ML.
        Effects of voicing and syntactic complexity on sign expression in adductor spasmodic dysphonia.
        Am J Speech Lang Pathol. 2003; 12: 416-424https://doi.org/10.1044/1058-0360(2003/087
        • Lorch M
        • Whurr R.
        Cross-linguistic study of vocal pathology: perceptual features of spasmodic dysphonia in french-speaking subjects.
        J Multilingual Commun Disorders. 2003; 1: 35-52https://doi.org/10.1080/1476967021000044351
        • Dedo HH
        • Shipp T.
        Spastic Dysphonia: A Surgical and Voice Therapy Treatment Program.
        College Hill Press, San Diego, CA1980
        • Shipp T
        • Izdebski K
        • Reed C
        • et al.
        Intrinsic laryngeal muscle activity in a spastic dysphonia patient.
        J Speech Hear Disord. 1985; 50: 54-59https://doi.org/10.1044/jshd.5001.54
        • Shipp T
        • Izdebski K
        • Schutte HK
        • et al.
        Subglottal air pressure in spastic dysphonia speech.
        Folia Phoniatrica et Logopaedica. 1988; 40: 105-110https://doi.org/10.1159/000265895
        • Smith ME
        • Roy N
        • Wilson C.
        Lidocaine block of the recurrent laryngeal nerve in adductor spasmodic dysphonia: A multidimensional assessment.
        Laryngoscope. 2006; 116: 591-595https://doi.org/10.1097/01.mlg.0000205588.04450.ac
        • Roy N
        • Mauszycki SC
        • Merrill RM
        • et al.
        Toward improved differential diagnosis of adductor spasmodic dysphonia and muscle tension dysphonia.
        Folia Phoniatrica et Logopaedica. 2007; 59: 83-90https://doi.org/10.1159/000098341
        • Roy N
        • Whitchurch M
        • Merrill RM
        • et al.
        Differential diagnosis of adductor spasmodic dysphonia and muscle tension dysphonia using phonatory break analysis.
        Laryngoscope. 2008; 118: 2245-2253https://doi.org/10.1097/mlg.0b013e318184577c
        • Pitman MJ.
        Treatment of spasmodic dysphonia with a neuromodulating electrical implant.
        Laryngoscope. 2014; 124: 2537-2543https://doi.org/10.1002/lary.24749
        • Buckley DP
        • Cadiz MD
        • Eadie TL
        • et al.
        Acoustic model of perceived overall severity of dysphonia in adductor-type laryngeal dystonia.
        J Speech, Lang HearRes. 2020; 63: 2713-2722https://doi.org/10.1044/2020_jslhr-19-00354
        • Yuan J
        • Liberman M.
        Speaker identification on the SCOTUS corpus.
        J Acoust Soc Am. 2008; 123: 3878https://doi.org/10.1121/1.2935783
      1. Boersma P, Weenink D. Praat: Doing phonetics by computer. 2022;Version 6.2.09, retrieved 15 February 2022 from http://www.praat.org/

        • Marks KL
        • Feaster TF
        • Baker S
        • Díaz-Cádiz ME
        • Doyle PC
        • Stepp CE
        Spectral aggregate of the high-passed fundamental frequency and its relationship to the primary acoustic features of adductor laryngeal dystonia.
        J Speech Lang Hear Res. 2022; 65: 4085-4095https://doi.org/10.1044/2022_JSLHR-22-00157
        • Keating PA
        • Garellek M
        • Kreiman J.
        Acoustic properties of different kinds of creaky voice.
        ICPhS Proc. 2015; 1: 2-7
        • Bates D
        • Mächler M
        • Bolker B
        • et al.
        Fitting linear mixed-effects models using lme4.
        J Stat Soft. 2015; 67 (Available at): 1https://doi.org/10.18637/jss.v067.i01
        • Titze Ingo R
        Voice training and therapy with a semi-occluded vocal tract: rationale and scientific underpinnings.
        J Speech, Lang, Hear Res. 2006; 49: 448-459https://doi.org/10.1044/1092-4388(2006/035)
        • Maxfield L
        • Titze I
        • Hunter E
        • et al.
        Intraoral pressures produced by thirteen semi-occluded vocal tract gestures.
        null. 2015; 40: 86-92https://doi.org/10.3109/14015439.2014.913074
        • Bickley CA
        • Stevens KN.
        Effects of a vocal-tract constriction on the glottal source: experimental and modelling studies.
        J Phon. 1986; 14 (Available at): 373-382https://doi.org/10.1016/S0095-4470(19)30711-9
        • Kapsner-Smith Mara R
        • Hunter Eric J
        • Kimberly K
        • et al.
        A randomized controlled trial of two semi-occluded vocal tract voice therapy protocols.
        J Speech, Lang, Hear Res. 2015; 58: 535-549https://doi.org/10.1044/2015_JSLHR-S-13-0231
      2. Risdal M, Aly A, Chong AJ, et al. On the link between glottal vibration and sonority. LabPhon15: Speech Dynamics and Phonological Representation. 2016. Accessed June 10, 2022.

        • Chong AJ
        • Risdal M
        • Aly A
        • et al.
        Effects of consonantal constrictions on voice quality.
        J Acoust Soc Am. 2020; 148: EL65-EL71https://doi.org/10.1121/10.0001585
        • Mittal VK
        • Yegnanarayana B
        • Bhaskararao P.
        Study of the effects of vocal tract constriction on glottal vibration.
        J Acoust Soc Am. 2014; 136: 1932-1941https://doi.org/10.1121/1.4894789
        • Parker SG.
        Quantifying the Sonority Hierarchy.
        Doctoral Dissertations Available from Proquest, 2002AAI3056268
        • Parker S.
        Sound level protrusions as physical correlates of sonority.
        J Phon. 2008; 36 (Available at): 55-90https://doi.org/10.1016/j.wocn.2007.09.003
        • Ogawa M
        • Hosokawa K
        • Yoshida M
        • et al.
        Immediate effects of humming on computed electroglottographic parameters in patients with muscle tension dysphonia.
        J Voice. 2014; 28 (Available at): 733-741https://doi.org/10.1016/j.jvoice.2014.02.004
        • Andrade PA
        • Wood G
        • Ratcliffe P
        • et al.
        Electroglottographic study of seven semi-occluded exercises: LaxVox, straw, lip-trill, tongue-trill, humming, hand-over-mouth, and tongue-trill combined with hand-over-mouth.
        J Voice. 2014; 28 (Available at): 589-595https://doi.org/10.1016/j.jvoice.2013.11.004
        • Vlot C
        • Ogawa M
        • Hosokawa K
        • et al.
        Investigation of the immediate effects of humming on vocal fold vibration irregularity using electroglottography and high-speed laryngoscopy in patients with organic voice disorders.
        J Voice. 2017; 31 (Available at): 48-56https://doi.org/10.1016/j.jvoice.2016.03.010
        • Ogawa M
        • Hosokawa K
        • Yoshida M
        • et al.
        Immediate effectiveness of humming on the supraglottic compression in subjects with muscle tension dysphonia.
        Folia Phoniatr Logop. 2013; 65 (Available at): 123-128https://doi.org/10.1159/000353539
        • Drechsel JS
        • Thomson SL.
        Influence of supraglottal structures on the glottal jet exiting a two-layer synthetic, self-oscillating vocal fold model.
        J Acoust Soc Am. 2008; 123: 4434-4445https://doi.org/10.1121/1.2897040
        • Bailly L
        • Pelorson X
        • Henrich N
        • et al.
        Influence of a constriction in the near field of the vocal folds: physical modeling and experimental validation.
        J Acoust Soc Am. 2008; 124: 3296-3308https://doi.org/10.1121/1.2977740
        • Zheng X
        • Bielamowicz S
        • Luo H
        • et al.
        A computational study of the effect of false vocal folds on glottal flow and vocal fold vibration during phonation.
        Ann Biomed Eng. 2009; 37: 625-642https://doi.org/10.1007/s10439-008-9630-9
        • Woodson GE
        • Zwirner P
        • Murry T
        • et al.
        Use of flexible fiberoptic laryngoscopy to assess patients with spasmodic dysphonia.
        J Voice. 1991; 5 (Available at): 85-91https://doi.org/10.1016/S0892-1997(05)80168-7
        • Lucie B
        • Bernardoni NH
        • Frank M
        • et al.
        Ventricular-fold dynamics in human phonation.
        J Speech, Lang, Hear Res. 2014; 57: 1219-1242https://doi.org/10.1044/2014_JSLHR-S-12-0418
        • Conte A
        • Defazio G
        • Hallett M
        • et al.
        The role of sensory information in the pathophysiology of focal dystonias.
        Nat Rev Neurol. 2019; 15: 224-233https://doi.org/10.1038/s41582-019-0137-9
        • Khosravani S
        • Mahnan A
        • Yeh I
        • et al.
        Laryngeal vibration as a non-invasive neuromodulation therapy for spasmodic dysphonia.
        Sci Rep. 2019; 9: 17955https://doi.org/10.1038/s41598-019-54396-4