Acoustic Analyses of Sustained and Running Voices From Patients With Laryngeal Pathologies

In this paper, we investigated the acoustic characteristics of sustained and running vowels from normal subjects and patients with laryngeal pathologies. Perturbation methods (including jitter and shimmer), signal-to-noise ratio (SNR), and nonlinear dynamic methods (such as correlation dimension and second-order entropy) were used to analyze sustained and running vowels. We found that the sustained vowels and running voices from normal subjects and patients with laryngeal pathologies had low-dimensional dynamic characteristics. For sustained vowels, the analyses of jitter, shimmer, correlation dimension, and second-order entropy revealed significant differences between normal and pathological voices. For running voices, jitter and shimmer did not statistically discriminate between normal and pathological voices, but a significant difference was found for SNR, correlation dimension, and second-order entropy. The results suggest that nonlinear dynamic analysis and traditional SNR analysis may be valuable for the analysis of sustained and running vowels; perturbation analysis may be applicable for the analysis of sustained vowels but should be applied with caution for running voice analysis.     

Effects of head extension and tongue protrusion on voice perturbation measures

Head extension with protruded tongue is the position for video-laryngoscopy and simultaneous glottographic recordings including photoglottographic signals. This study investigated the effect of head extension and tongue protrusion on the measures of fundamental frequency, frequency perturbation (jitter), and amplitude perturbation (shimmer). Acoustic signals recorded during sustained vowels were obtained from 49 women and 66 men with no speech or voice disorders in different head-tongue positions. Head extension was associated with increased fundamental frequency and decreased shimmer. In men, head extension did not appear to affect jitter. When the tongue was protruded, head extension tended to lower jitter. For both genders, tongue protrusion was associated with decreased fundamental frequency with head extension. In the men, tongue protrusion tended to increase shimmer when the head was in the neutral position. In the women, tongue protrusion was associated with increased jitter and increased shimmer and was most evident in the head-neutral position. These findings supported a physical linkage hypothesis of the relationship between vocal tract configuration and vocal fold vibration, suggesting that head-tongue position must be taken into account when comparing voice measures.     

Measures of vocal function during changes in vocal effort level

The purpose of this article is to present the results of a controlled study of the day-to-day variabilities of three acoustic parameters (jitter, shimmer, and normalized noise energy), and two electroglottographic parameters (contact quotient and contact quotient perturbation) for vowels produced at three vocal efforts (low, normal, high). Data were obtained with use of a sophisticated bilinear interpolation pitch detection method. A repeated measures design required subjects to produce the vowels // and /a/ five times a day over 3 days at each vocal effort level. The jitter, shimmer, and normalized noise energy values from acoustic measures and contact quotient and contact quotient perturbation values varied significantly among the three vocal effort levels. The clinical implication of this finding is that vocal effort must be controlled in order to obtain consistent clinical measures. Furthermore, day-to-day variability must be taken into account if representative measures are to be obtained for clinical use.     

Relationship between subjective voice complaints and acoustic parameters in female teachers'' voices

The aim of the study was to identify the acoustic correlates of female teachers' subjective voice complaints by recording their voices in their working environment. The subjects made recordings during lessons (N = 10) and breaks (N = 11). The subjects were divided into 2 groups: those with few voice complaints (FC group) and those with many voice complaints (MC group). The speech sample made in the breaks was maximally sustained /a/, from which fundamental frequency (F0), jitter, and shimmer were analyzed. The classroom samples were analyzed for F0, sound pressure level (SPL), and F0 time (the active vibration time of the vocal folds). Additionally, an index for assessing voice loading is presented. The results revealed a tendency of the MC group to have higher F0 and lower SPL and perturbation values than the FC group. The index values correlated moderately with the subjective vocal complaints.     

The effects of excessive vocalization on acoustic and videostroboscopic measures of vocal fold condition

Although dysphonia is a recognized consequence of acute vocal abuse, associated changes in vocal fold appearance and function are not well understood. To document these presumed effects of vocal abuse, audio recordings of sustained vowel production were obtained from 42 drill sergeants daily during the first 6 days of a vocally demanding training exercise. Acoustic analysis showed abnormal levels of jitter and shimmer on Day 1 in 16 of the 42 subjects. Considering only the 26 subjects who showed normal voice acoustics on Day 1, the median levels of jitter and shimmer varied little over the course of training, and significant increases in jitter and shimmer were not seen during the study period. However, the distributions for both jitter and shimmer became more positively skewed and showed a greater number of positive outliers over the course of training. This trend was attributed to 11 subjects who showed two or more instances of abnormal voice acoustics over Days 2 through 6. Laryngeal videostroboscopic recordings of sustained vowel production also were obtained prior to and following training. Perceptual ratings of these recordings by 2 observers revealed significant increases in vocal fold edema, erythema, and edge irregularity, and decreases in vocal fold mucosal wave and amplitude of excursion following the 5-day training period. In general, there was considerable intersubject variability in the extent of acoustic and videostroboscopic effects over the course of training. Of the two types of data, videostroboscopy appears to provide a more sensitive indication of the effects of excessive vocalization.     

Vocal Problems Among Teachers: Evaluation of a Preventive Voice Program

Vocal education programs for teachers may prevent the emergence of vocal disorders; however, only a few studies have tried to evaluate the effectiveness of these preventive programs, particularly in the long term. Two hundred and sixty-four subjects, mostly kindergarten and primary school female teachers, participated in a course on voice care, including a theoretical seminar (120 minutes) and a short voice group therapy (180 minutes, small groups of 20 subjects). For 3 months, they had to either attend the vocal ergonomics norms and, as psychological reinforcement, they had to make out a daily report of vocal abuse, or to follow the given exercises for a more efficient vocal technique, reporting on whether the time scheduled was respected or not. The effectiveness of the course was assessed in a group of 21 female teachers through a randomized controlled study. Evaluation comprehended stroboscopy, perceptual and electro-acoustical voice analysis, Voice Handicap Index, and a course benefit questionnaire. A group of 20 teachers matched for age, working years, hoarseness grade, and vocal demand served as a control group. At 3 months evaluation, participants demonstrated amelioration in the global dysphonia rates (P=0.0003), jitter (P=0.0001), shimmer (P=0.0001), MPT (P=0.0001), and VHI (P=0.0001). Twelve months after the course, the positive effects remained, although they were slightly reduced. In conclusion, a course inclusive of two lectures, a short group voice therapy, home-controlled voice exercises, and hygiene, represents a feasible and cost-effective primary prevention of voice disorders in a homogeneous and well-motivated population of teachers.     

Chaos in voice, from modeling to measurement.

Chaos has been observed in turbulence, chemical reactions, nonlinear circuits, the solar system, biological populations, and seems to be an essential aspect of most physical systems. Chaos may also be central to the interpretation of irregularity in voice disorders. This presentation will summarize the results from a series of our recent studies. These studies have demonstrated the prescence of chaos in computer models of vocal folds, experiments with excised larynges, and human voices. Methods based on nonlinear dynamics can be used to quantify chaos and irregularity in vocal fold vibration. Studies have suggested that disordered voices from laryngeal pathologies such as laryngeal paralysis, vocal polyps, and vocal nodules might exhibit chaotic behaviors. Conventional parameters, such as jitter and shimmer, may be unreliable for analysis of periodic and chaotic voice signals. Nonlinear dynamic methods, however, have differentiated between normal and pathological phonations and can describe the aperiodic or chaotic voice. Chaos theory and nonlinear dynamics can enchance our understanding and therefore our assessment of pathological phonation.     

Vowel amplitude variation associated with the heart cycle

Modulation of the acoustic amplitude of a sustained vowel across the cardiac (ECG) cycle was examined by signal-averaging techniques. Ten normal men prolonged [a] at a comfortable Fo maintained within three SPL ranges: 60-68, 70-78, and 80-88 dB. Peak-to-peak amplitude variation associated with the heart cycle averaged 8.5% (s.d. = 5.4) re: mean, varying from about 14% at low SPLs to approximately 3% at high SPLs. The amplitude modulation was estimated to account for 11.8% of the measured short-term amplitude perturbation (shimmer), ranging from about 5% to almost 22% for individual samples. The mean deterministic shimmer (Sd) was 0.036 dB (s.d. = 0.019), with a trend toward decreasing Sd with increasing SPL. Additionally, fundamental frequency variation across the heart cycle within these phonations was comparable to that observed by Orlikoff and Baken [J. Acoust. Soc. Am. 85, 888-893 (1989)], and was shown to be uninfluenced by vocal SPL, although deterministic jitter (Jd) did decrease with vocal intensity. The results are discussed in terms of how the phonovascular relationship may affect the reliability and interpretation of acoustic shimmer measures.     

Perturbation-free measurement of the harmonics-to-noise ratio in voice signals using pitch synchronous harmonic analysis.

The measurement of the harmonics-to-noise ratio (HNR) in speech signals gives an indication of the aperiodicity of the speech waveform. This may be due to the presence of jitter, shimmer, additive noise, waveshape change, or some unknown combination of these factors. In order to estimate the HNR as a measure of the additive noise component only, the contaminating effects of the other contributory components must first be removed. A pitch synchronous harmonic analysis is proposed to overcome this problem. The procedure takes advantage of the time scale compression-frequency expansion property of the Fourier series in order to eliminate jitter and shimmer. Successive spectra are added by harmonic number as opposed to frequency location, and perturbation is removed due to the fact that the relative heights of the harmonic components remain the same for scaled signals. The technique is examined on synthetically generated voice signals. A discussion of the results is given in terms of human voice signals, characterization of jitter, vocal tract filtering effects, perturbation mechanisms, nonlinear dynamics, and the possibility of developing the method for use with inverse filtering strategies.     

Determination of largest lyapunov exponents of vocal signal: Application to unilateral laryngeal paralysis

It has been shown that voice signal abnormalities, particularly in unilateral laryngeal paralysis (ULP), are not always randomly distributed and that "statistical" indexes of regularity, such as jitter and shimmer, may be unreliable in these cases. The techniques of nonlinear dynamics, particularly phase portraits, have been used to demonstrate that some of the abnormalities observed were the consequence of nonlinearity of glottic function. From a theoretical point of view, determination of Lyapunov exponents allows quantification of the complexity of the phase portraits. The authors studied vocal signals recorded in 12 normal subjects and 26 patients with ULP and calculated the largest Lyapunov exponent (LLE). In normal subjects, LLE mean value was 0.380 (SD = 0.182). In patients with ULP, LLE mean value was 0.570 (SD = 0.337). The difference is significant at P = 0.031. Determination of LLE was compared to more "classical" indexes such as jitter and oral airflow during phonation. A principal component analysis showed that information contained in LLE was not redundant but complementary to the other parameters.     

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

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

Acoustic Measures and Self-reports of Vocal Fatigue by Female Teachers

This study investigated the relation of symptoms of vocal fatigue to acoustic variables reflecting type of voice production and the effects of vocal loading. Seventy-nine female primary school teachers volunteered as subjects. Before and after a working day, (1) a 1-minute text reading sample was recorded at habitual loudness and loudly (as in large classroom), (2) a prolonged phonation on [a:] was recorded at habitual speaking pitch and loudness, and (3) a questionnaire about voice quality, ease, or difficulty of phonation and tiredness of throat was completed. The samples were analyzed for average fundamental frequency (F0), sound pressure level (SPL), and phonation type reflecting alpha ratio (SPL [1-5 kHz]-SPL [50 Hz-1 kHz]). The vowel samples were additionally analyzed for perturbation (jitter and shimmer). After a working day, F0, SPL, and alpha ratio were higher, jitter and shimmer values were lower, and more tiredness of throat was reported. The average levels of the acoustic parameters did not correlate with the symptoms. Increase in jitter and mean F0 in loud reading correlated with tiredness of throat. The results seem to suggest that, at least among experienced vocal professionals, voice production type had little relevance from the point of view of vocal fatigue reported. Differences in the acoustic parameters after a vocally loading working day mainly seem to reflect increased muscle activity as a consequence of vocal loading.     

Subjective and Objective Evaluation of Voice Quality in Patients With Asthma

OBJECTIVES: To evaluate the voice quality in patients with mild-to-moderate asthma by subjective and objective methods. STUDY DESIGN: Comparative, controlled, cross-sectional study. METHODS: Patients with mild-to-moderate asthma (n=40) and age- and sex-matched healthy controls (n=40) were included. Acoustic analyses were performed by the Multi-Dimensional Voice Program (MDVP; Kay Elemetrics Corporation, Lincoln Park, NJ) and the movements of the vocal cords were examined by videolaryngostroboscopy (VLS). In addition, the duration of illness, maximum phonation time, "s/z" values, and vital capacity were evaluated. Voice Handicap Index (VHI) and GRB scales were used for subjective evaluations. RESULTS: Maximum phonation time values were significantly shorter both in male and female asthma patients compared with controls (P<0.0001). Also, average shimmer values in MDVP were higher for both sexes in the patient group compared with controls (P=0.002 and P=0.04, respectively). There was a significant difference between female patients and sex-matched controls with regard to mean noise-to-harmonic ratio values (P=0.006). Female patients with asthma had higher average jitter values compared with sex-matched controls (P<0.0001). A significant difference was noted between asthma and control groups with regard to GRB scale (P<0.0001, P<0.001, and P<0.0001, respectively). The VHI score was above the normal limit in 16 (40%), and VLS findings were abnormal in 39 (97.5%) asthmatics. CONCLUSION: In asthmatic patients, maximum phonation time, frequency, and amplitude perturbation parameters were impaired, but the vital capacity and the duration of illness did not correlate with these findings.     

Vocal Parameters of Aerobic Instructors with and without Voice Problems

Aerobic instructors frequently experience vocal fatigue and are at risk for the development of vocal fold pathology. Six female aerobic instructors, three with self-reported voice problems and three without, served as subjects. Measures of vocal function (perturbation and EGG) were obtained before and after a 30-minute exercise session. Results showed that the group with self-reported voice problems had greater amounts of jitter, lower harmonic-to-noise ratios, and less periodicity in sustained vowels overall, but no significant differences in measures of perturbation and EGG were found before and immediately after instruction. Measures of vocal parameters showed that subjects with self-reported voice problems projected with relatively greater vocal intensity and phonated for a greater percentage of time across beginning, middle, and ending periods of aerobic instruction than subjects with no reported voice problems.     

Effects of simulated source of tremor on acoustic and airflow voice measures

To test the effects of different sources of tremor on the voice, tremor was simulated by external rhythmic perturbation of structures at the subglottal, glottal, and supraglottal levels in 10 healthy subjects. The acoustic and airflow signals simultaneously recorded during sustained phonation in the normal and the 3 simulated tremor conditions were analyzed and compared. Voice measures included: fundamental frequency, 2 short-term perturbation measures (jitter and shimmer), and 3 long-term tremor measures (prominence ratios of the spectral peaks of the acoustic frequency contour, acoustic amplitude contour, and airflow contour). Measures of fundamental frequency and percent shimmer were not significantly affected by the simulated tremors. Measures of percent jitter and the amplitudes of the long-term frequency and amplitude modulations were most prominently increased when respiratory drive was perturbed by simulated tremor. Spectral analysis of the acoustic amplitude contour was most useful in distinguishing the 3 sites of simulated tremor.     

Time-shift, trial, and gender effects on vocal perturbation measures

Three jitter and three shimmer measures were examined for: (1) the stability of the measured values with respect to shifts in sample site (starting point of window in the token) and (2) the effects of trial and gender. The perturbation measures and their coefficients of variation for windows starting from five different but adjacent cycles showed a dependence on sample size. Their variability with regard to shifts in sample site decreased asymptotically with increasing size. The data suggested no statistically significant trial effect except for APQ and no statistically significant gender effect except for absolute jitter. It is speculated that relatively long smoothing windows for shimmer (such as the one used for APQ) would allow the effects of slow vocal modulations (e.g., tremor) to accentuate, especially for lower pitch speakers.     

Comparisons of jitter, shimmer, and signal-to-noise ratio from directly digitized versus taped voice samples

The purpose of this study was to compare jitter, shimmer, and signal-to-noise ratio (SNR) measures obtained from tape-recorded samples with the same measures made on directly digitized voice samples, with use of the CSpeech acoustic analysis program. Subjects included 30 young women who phonated the vowel /a/ at a comfortable pitch and loudness level. Voice samples were simultaneously recorded and digitized, and the resulting perturbation measures for the two conditions were compared. Results indicated that there were small but statistically significant differences between percent jitter, percent shimmer, and SNR calculated from taped samples compared with the same measures calculated from directly digitized samples. It was concluded that direct digitization for clinical measures of vocal perturbation was most desirable, but that taped samples could be used, if necessary, with some caution.     

Perceptual and Acoustic Assessment of Voice Pathology and the Efficacy of Endolaryngeal Phonomicrosurgery

Values for acoustic voice measurements were obtained from 88 normal individuals and 98 pathological cases of mass lesions of vocal fold and 50 cases of unilateral vocal fold paralysis. Overall, all items reflecting perturbations of pitch and amplitude as well as glottal noise were significantly higher in the groups of patients compared with the normal group. The measurement of normalized noise energy (NNE) was found to be an optimum parameter for discrimination of normal/abnormal voices. The voices of patients with vocal fold nodules and vocal fold polyps were analyzed before endolaryngeal phonomicrosurgery (EPM) and 2 weeks after. Statistically significant (p < 0.01) improvement was achieved both in perceptual and acoustic analysis. EPM resulted in a significant decrease of mean jitter, shimmer, and NNE. Clinically, these measures provided documentable and measurable evidence of vocal function and were helpful for comparing patients with normal speakers. They also were useful for a thorough documentation of patient's voice pathology and for evaluation of the presurgical and postsurgical voice status.     

The Effect of Oral Contraceptives on Voice: Preliminary Observations

Most studies investigating the effect of sex hormones on the larynx and vocal folds focused on the voice quality of women either around menopause or during the menstrual cycle. To our knowledge, however, there have been no studies that investigated the effect of oral contraceptives on the female voice. In the present study five women who ingest oral contraceptives (pill group) and five women who do not (natural group) were recorded producing the vowels /i/ and /a/ repeatedly over a period of 40 days. Acoustic analyses were performed on these recordings including F0, amplitude, jitter, shimmer, and harmonic-to-noise ratio (HNR). Results indicated that jitter and shimmer values of the pill group were significantly lower than those of the natural group. No group differences were found for F0, amplitude, or HNR. In addition, the pill group demonstrated significantly smaller variance for all variables tested. The results suggest that oral contraceptives might increase voice stability associated with smaller hormonal changes. Thus the present study provides preliminary evidence of the effect of oral contraceptives on the female voice.