Effects of laryngeal endoscopy on the vocal performanceof young adult females with normal voices

This study investigated changes in maximum phonation time andacoustic and perceptual measures of voice following topical anesthesia and laryngeal endoscopy with the flexible endoscope. Forty-four females, aged 18–33 years and with normal voices, performed four vocal tasks: (a) 3-second /i/ prolongation, (b) maximum phonation time on /i/, (c) stepwise scale-singing, and (d) reading a standard passage. Subjects performed these tasks prior to anesthesia, after anesthesia, and again during laryngeal endoscopy. Voice samples were analyzed for jitter, shimmer, harmonic-to-noise ratio, speaking fundamental frequency, maximum phonational frequency range, maximum phonation time, harshness, and breathiness. Results demonstrated significant reductions in maximum phonational frequency range following anesthesia and, during laryngeal endoscopy, reductions in maximum phonation time and increases in speaking fundamental frequency, minimum fundamental frequency on scale-singing, and breathiness. Clinicians using laryngeal endoscopy for evaluation and management of vocal dysfunction should, therefore, consider the possible effects of these procedures on vocal functioning.     

Changes in sustained production tasks among women with bilateral vocal nodules before and after voice therapy

The purpose of the current study was to determine how maximum phonationduration (MPD) of five notes (C4, D4, E4, F4, 134) sustained on /o/, sustained vowels (/i/, //, /a/, /u/), and s/z ratio (sustained /s/ and /z/ changed during voice therapy for vocal nodules. Voices of adult females before treatment and after resolution of vocal nodules were analyzed via the PM Pitch Analyzer. Treatment included tension reduction, abuse identification and elimination, laryngeal strengthening, and home exercises. Results indicate there was no significant difference in maximum phonation duration or S/Z ratio before and after treatment. Results revealed that females with vocal nodules demonstrate measurements before therapy similar to measures considered to be normal in persons without vocal nodules. Application of findings to clinical practice is discussed.     

Acoustic voice analysis in patients with essential tremor

To quantify several acoustic features of the voice in patients with essentialtremor (ET), 28 patients and 28 age- and sex-matched controls were studied. ET severity was assessed with the rating scale for tremor of Fahn, Tolosa, and Marín. The Computerized Speech Lab 4300 program (Kay Elemetrics) was used. Two-second samples of a sustained /a/ and a sentence were captured with a microphone and laryngograph equipment. Measures included fundamental frequency (F₀), frequency perturbation (fitter, Koike algorithm), intensity perturbation (shimmer, Horii algorithm), and harmonic-to-noise ratio (H/N, Yumoto algorithm) of the vowel /a/, and the frequency and intensity variability of the sentence, phonational range, and 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, ET patients showed higher jitter, lower H/N ratio (the last one only with laryngographic signal), of the vowel /a/, lower frequency variability in the microphonc signal, lower intensity variability in the laryngographic signal of the sentence, and significantly lower dynamic range at natural frequency of phonation. ET patients reported higher frequency of the presence of high voice intensity, tremor, and struggle. Several acoustic parameters were influenced by the severity of the disease, including shimmer, jitter, H/N ratio, frequency variability of the sentence, and s/z ratio, although neither of the acoustic analysis values or the phonetometric measurements were affected by the presence of voice tremor or by a successful pharmacological treatment of ET.     

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.     

“Compensatory falsetto”: Effects on vocal quality

The term “compensatory falsetto”, for the purpose of this investigation, refers to the development of an abnormally high-pitched voice in the presence of laryngeal pathology where more socially acceptable lower pitched voice production is possible. The purpose of this investigation was to compare laryngeal compensations and their effects on objective measures of vocal function during production of compensatory falsetto voice. Eighteen patients with abnormally high-pitched voice in the presence of underlying laryngeal pathology were evaluated in the Department of Otolaryngology at the University of Miami School of Medicine from January 1988 through December 1992 and were diagnosed with “compensatory falsetto”. Vocal fold paralysis (n = 11) was the most common laryngeal pathology. Vibratory characteristics were evaluated through videostrobolaryngoscopic examination. Acoustic and aerodynamic parameters assessed included fundamental frequency, jitter rate, harmonic-to-noise ratio, glottal air flow, and maximum phonation time. Production of a higher-pitched voice appeared to improve glottic closure and decrease the amount of air loss during phonation. A corresponding increase in maximum phonation time and improvement in acoustic characteristics of jitter and harmonic-to-noise ratio was also observed.     

Laryngostroboscopic, Acoustic, and Environmental Characteristics of High-Risk Vocal Performers

Vocal performance often requires excessively high vocal demand. In particular “high-risk” performers, a group of individuals who use their voices at their maximum effort level, are often exposed to unique vocal abuse characteristics which include high environmental and performance demands and inconsistencies of cast performance. Three categories of high-risk performers were studied: musical theater, choral ensemble, and street theater. Musical theater performers produce a Broadway, West End “belting” style voice. Street theater performers use a high-energy pitch varying dialogue in order to imitate a desired character voice. Choral ensemble performance requires group cohesion and blending of four-part harmony. The melodies require sustained vocal durations within each of the respective registers. For each of these studied groups vocal tasks of sustained production of /i/ and /a/ were subjected to analysis. Acoustic measures included fundamental frequency, standard deviation of fundamental frequency, jitter percent, shimmer percent, and noise-to-harmonic ratio. Laryngostroboscopic parameters were assessed during sustained /i/. Environmental acoustic sound field measurements were made using an A weighting and linear weighting sound pressure level. These weightings were used to describe noise levels and vocal output, respectively, within the performance environments. Results of the analysis suggest that high-risk performers are a unique performance type defined by distinctive, acoustic, laryngostroboscopic, and environmental characteristics.     

Model-based classification of nonstationary vocal fold vibrations

Classification of vocal fold vibrations is an essential task of the objective assessment of voice disorders. For historical reasons, the conventional clinical examination of vocal fold vibrations is done during stationary, sustained phonation. However, the conclusions drawn from a stationary phonation are restricted to the observed steady-state vocal fold vibrations and cannot be generalized to voice mechanisms during running speech. This study addresses the approach of classifying real-time recordings of vocal fold oscillations during a nonstationary phonation paradigm in the form of a pitch raise. The classification is based on asymmetry measures derived from a time-dependent biomechanical two-mass model of the vocal folds which is adapted to observed vocal fold motion curves with an optimization procedure. After verification of the algorithm performance the method was applied to clinical problems. Recordings of ten subjects with normal voice and ten dysphonic subjects have been evaluated during stationary as well as nonstationary phonation. In the case of nonstationary phonation the model-based classification into "normal" and "dysphonic" succeeds in all cases, while it fails in the case of sustained phonation. The nonstationary vocal fold vibrations contain additional information about vocal fold irregularities, which are needed for an objective interpretation and classification of voice disorders.     

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.     

Reliability in Perceptual Analysis of Voice Quality

This study focuses on speaking voice quality in male teachers (n = 35) and male actors (n = 36), who represent untrained and trained voice users, because we wanted to investigate normal and supranormal voices. In this study, both substantial and methodologic aspects were considered. It includes a method for perceptual voice evaluation, and a basic issue was rater reliability. A listening group of 10 listeners, 7 experienced speech-language therapists, and 3 speech-language therapist students evaluated the voices by 15 vocal characteristics using VA scales. Two sets of voice signals were investigated: text reading (2 loudness levels) and sustained vowel (3 levels). The results indicated a high interrater reliability for most perceptual characteristics. Connected speech was evaluated more reliably, especially at the normal level, but both types of voice signals were evaluated reliably, although the reliability for connected speech was somewhat higher than for vowels. Experienced listeners tended to be more consistent in their ratings than did the student raters. Some vocal characteristics achieved acceptable reliability even with a smaller panel of listeners. The perceptual characteristics grouped in 4 factors reflected perceptual dimensions.     

The Effect of Hemodialysis on Voice: An Acoustic Analysis

Because respiration is part of the well-coordinated process necessary for phonation, this study was conducted with the purpose of analyzing the effect of chronic hemodialysis on voice characteristics of patients with chronic renal failure. A total of 57 patients were recruited for the study, including 31 males and 26 females ranging in age from 16 to 85 years. Patients underwent evaluation of their voice directly before and after hemodialysis using the Kay Elemetric VISI Pitch (Model 330; Kay Elemetric Corporation, Lincoln Park, New Jersey). The vocal acoustic parameters studied include habitual pitch, pitch range, relative average perturbation, shimmer, noise-to-harmonic ratio, voice turbulence index, maximum phonation time, and voice energy. The data were analyzed using the paired t-test for the total sample and the nonparametric test for the female and male subgroups. The total sample analysis showed a statistically significant increase in the habitual pitch after the hemodialyis (p < 0.05), with a borderline increase in the pitch range and maximum phonation time (p < 0.10). In the female group, there was a statistically significant increase in the habitual pitch and a borderline increase in the relative average perturbation. In the male group, there was a significant increase in the habitual pitch with a borderline increase in maximum phonation time. Discussion of the after-mentioned results is presented.     

Voice Perceptions and Quality of Life of Transgender People

Despite the plethora of research documenting that the voice and quality of life (QoL) are related, the exact nature of this relationship is vague. Studies have not addressed people who consider their voice to influence their life and identity, but would not be considered to have a voice “disorder” (e.g., transgender individuals). Individuals seeking vocal feminization may or may not have vocal pathology and often have concerns not addressed on the standard psychosocial measures of voice impact. Recent development of a voice-related QoL measure specific to the needs of transgender care (Transgender Self-Evaluation Questionnaire [TSEQ]) affords opportunity to explore relationships between self-perceived QoL and perceptions of femininity and likability associated with transgender voice. Twenty male-to-female transgender individuals living as a female 100% of the time completed the TSEQ and contributed a speech sample describing Norman Rockwell’s “The Waiting Room” picture. Twenty-five undergraduate listeners rated voice femininity and voice likability after audio-only presentation of each speech sample. Speakers also self-rated their voices on these parameters. For male-to-female transgender clients, QoL is moderately correlated with how others perceive their voice. QoL ratings correlate more strongly with speaker’s self-rated perception of voice compared with others’ perceptions, more so for likability than femininity. This study complements previous research reports that subjective measures from clients and listeners may be valuable for evaluating the effectiveness of treatment in terms of how treatment influences voice-related QoL issues for transgender people.     

Vocal Improvement After Voice Therapy in Unilateral Vocal Fold Paralysis

Unilateral vocal fold paralysis (UVFP) is associated with changes in acoustic and aerodynamic voice measurements and can have a significant impact on a patient's quality of life. Few objective data regarding the efficacy of voice therapy for UVFP exist. The aim of this study was to retrospectively analyze voice modifications in a group of patients with UVFP before and after voice therapy. Forty patients with UVFP of different etiology were included in the study. Each subject had voice therapy with an experienced speech/language pathologist twice a week; the mean number of sessions was 12.6. A multidimensional assessment protocol was used; it included videoendoscopy, the maximum phonation time (MPT), the GIRBAS scale, spectrograms and a perturbation analysis, and the Voice Handicap Index (VHI). Pre- and posttreatment data were compared by means of the Wilcoxon and Student's t tests. A complete glottal closure was seen in 8 patients before voice therapy and in 14 afterward. Mean MPT increased significantly. In the perceptual assessment, the difference was significant for five out of six parameters. A significant improvement was found on spectrographic analysis; as for perturbation analysis, the differences in jitter, shimmer, and noise-to-harmonic ratio values were significant. VHI values showed a clear and significant improvement. A significant improvement of voice quality and quality of life after voice therapy is an often reached and reasonable goal in patients with UVFP.     

Effect of Pregnancy on the Speaking Voice

The study aims to investigate the vocal symptoms and acoustic changes in pregnant women pre- and postpartum in comparison to the controls. A total of 25 pregnant women who presented for delivery were enrolled in this study. Twenty-one nonpregnant women were matched as controls. Vocal symptoms such as hoarseness, vocal fatigue, and aphonia were assessed. Acoustic analysis included fundamental frequency (F₀), habitual pitch, relative average perturbation (RAP), shimmer, noise-to-harmony ratio (NHR), and maximum phonation time (MPT). There were no significant differences in the incidence of vocal symptoms in pregnant women versus controls. However, vocal fatigue was more prevalent in the pregnant group. With respect to the acoustic parameters, there was a significant decrease in the MPT at term. The rest of the variables were comparable. Postpartum, the MPT significantly increased and there was an increase in F₀ and a significant decrease in the voice turbulence index (VTI). Pregnant women have more vocal fatigue and a reduction in MPT compared to the controls. Immediately after delivery, there is a significant increase in MPT.     

Deviant Vocal Fold Vibration as Observed During Videokymography: The Effect on Voice Quality

Videokymographic images of deviant or irregular vocal fold vibration, including diplophonia, the transition from falsetto to modal voice, irregular vibration onset and offset, and phonation following partial laryngectomy were compared with the synchronously recorded acoustic speech signals. A clear relation was shown between videokymographic image sequences and acoustic speech signals, and the effect of irregular or incomplete vocal fold vibration patterns was recognized in the amount of perceived breathiness and roughness and by the harmonics-to-noise ratio in the speech signal. Mechanisms causing roughness are the presence of mucus, phase differences between the left and right vocal fold, and short-term frequency and amplitude modulation. It can be concluded that the use of simultaneously recorded videokymographic image sequences and speech signals contributes to the understanding of the effect of irregular vocal fold vibration on voice quality.     

Nonlinear dynamics of the voice: Signal analysis and biomechanical modeling

Irregularities in voiced speech are often observed as a consequence of vocal fold lesions, paralyses, and other pathological conditions. Many of these instabilities are related to the intrinsic nonlinearities in the vibrations of the vocal folds. In this paper, bifurcations in voice signals are analyzed using narrow-band spectrograms. We study sustained phonation of patients with laryngeal paralysis and data from an excised larynx experiment. These spectrograms are compared with computer simulations of an asymmetric 2-mass model of the vocal folds. (c) 1995 American Institute of Physics.     

Loud Speech in Realistic Environmental Noise: Phonetogram Data, Perceptual Voice Quality, Subjective Ratings, and Gender Differences in Healthy Speakers

A new method for cancelling background noise from running speech was used to study voice production during realistic environmental noise exposure. Normal subjects, 12 women and 11 men, read a text in five conditions: quiet, soft continuous noise (75 dBA to 70 dBA), day-care babble (74 dBA), disco (87 dBA), and loud continuous noise (78 dBA to 85 dBA). The noise was presented over loudspeakers and then removed from the recordings in an off-line processing operation. The voice signals were analyzed acoustically with an automatic phonetograph and perceptually by four expert listeners. Subjective data were collected after each vocal loading task. The perceptual parameters press, instability, and roughness increased significantly as an effect of speaking loudly over noise, whereas vocal fry decreased. Having to make oneself heard over noise resulted in higher SPL and F0, as expected, and in higher phonation time. The total reading time was slightly longer in continuous noise than in intermittent noise. The women had 4 dB lower voice SPL overall and increased their phonation time more in noise than did the men. Subjectively, women reported less success making themselves heard and higher effort. The results support the contention that female voices are more vulnerable to vocal loading in background noise.     

Multiparametric Evaluation of Dysphonic Severity

SUMMARY: In recent years, the multiparametric approach for evaluating perceptual rating of voice quality has been advocated. This study evaluates the accuracy of predicting perceived overall severity of voice quality with a minimal set of aerodynamic, voice range profile (phonetogram), and acoustic perturbation measures. One hundred and twelve dysphonic persons (93 women and 19 men) with laryngeal pathologies and 41 normal controls (35 women and six men) with normal voices participated in this study. Perceptual severity judgement was carried out by four listeners rating the G (overall grade) parameter of the GRBAS scale. The minimal set of instrumental measures was selected based on the ability of the measure to discriminate between dysphonic and normal voices, and to attain at least a moderate correlation with perceived overall severity. Results indicated that perceived overall severity was best described by maximum phonation time of sustained /a/, peak intraoral pressure of the consonant-vowel /pi/ strings production, voice range profile area, and acoustic jitter. Direct-entry discriminant function analysis revealed that these four voice measures in combination correctly predicted 67.3% of perceived overall severity levels.     

Relationship Between Weight, Speaking Fundamental Frequency, and the Appearance of Phonational Gaps in the Adolescent Male Changing Voice

This 12-month prospective longitudinal study used acoustic analysis to identify phonational gaps in the vocal range of adolescent boys undergoing voice change and to investigate the relationship between the appearance of phonational gaps, weight gain, and changes in speaking fundamental frequency (SF0). Eighteen pubescent boys were recorded producing three descending and three ascending glides over their physiological voice range using the vowel "ah." Recordings were digitized over the range 0-16 kHz and then analyzed to determine both the frequency range and appearance and frequency characteristics of the phonational gaps. Data were plotted against changes in weight and SF0 both as an indicator of pubertal development and to test the hypothesis that changes in weight and SF0 were related to the appearance of phonational gaps. Results indicated that minimum F0 decreased significantly over the time period and phonational gaps increased significantly, but there were no significant changes in maximum F0 or range. Individual data indicated the initial appearance of a lower-frequency gap followed by a higher-frequency gap before the long-term establishment of a midrange gap. At time 5, all boys in the weight range 42.7-44.9 kg had either low- or high-range gaps. The SF0 for this group varied from 117 to 216 Hz. All boys heavier than 54.8 kg had highly variable phonational gaps. SF0 range for this group was 99.5-151 Hz. Transitory low- then high-frequency phonational gaps appeared before the establishment of a midrange phonational gap. In this study, these phonational gaps were associated with certain weight ranges and rapid weight gain, with changes to boys' speaking voices, and with loss of ability to use the mid- and falsetto vocal range.     

Short-Term Effects of Endotracheal Intubation on Voice

The objective of this study was to examine the vocal symptoms and acoustic changes perceived in the short period after endotracheal intubation, and to find the association between these changes and the endotracheal tube parameters. A total of 35 subjects were included. They were examined preoperatively, and 2 and 24 hours postoperatively. The vocal symptoms of hoarseness, vocal fatigue, loss of voice, throat clearing, globus pharyngeus, throat pain, and the acoustic variables mainly average fundamental frequency, relative average perturbation, shimmer, noise to harmony ratio, voice turbulence index, habitual pitch, and maximum phonation time (MPT) were assessed as such and in relation to the following endotracheal tube parameters: duration of anesthesia, number of intubation attempts, size of the tube, cuff volume, cuff mean pressure, and the emergence. The association between anesthesia parameters with incidence of vocal complaints and changes in acoustic parameters were examined using logistic and linear regression. Vocal fatigue was associated significantly with the increase in cuff volume and the number of intubation attempts. Throat clearing was associated significantly with the increase in cuff mean pressure. Only the increase in habitual pitch was associated significantly with the increase in cuff volume. The acute short-term effect of endotracheal intubation on voice is significant. The most important endotracheal tube parameters that affect the vocal changes are the cuff mean pressure and volume. The laryngeal contribution to these vocal changes seems to be minimal. All vocal symptoms increased significantly except for globus pharyngeus at 2 hours postoperatively. The acoustic parameters did not change significantly except for a decrease in MPT. At 24 hours postoperatively, all vocal symptoms subsided with no significant difference to baseline value. The habitual pitch increased significantly, and the rest of the parameters remained comparable to baseline value.     

Phonational profiles of female professional singers and nonsingers

Measures of the SFF, vocal intensity, phonational range, and habitualpitch level are reported for 39 professional singer and 39 nonsinger females, who were divided into three age groups (young, middle, and old age), with the professionals further divided into sopranos and altos. Each read the “Rainbow Passage” and spoke extemporaneously, from which measures of the SFF and vocal intensity were calculated; phonational range and habitual pitch levels were also determined. No significant differences were noted between the reading and speaking tasks. The SFF and intensity levels were significantly higher for the professionals in comparison to the nonsingers, but only for certain age groups. Moreover, whereas the nonsinger SFF levels varied significantly as a function of age, those for the professional singers did not. Although trends occurred, no significant differences were found for the mean phonational range or habitual pitch levels when the professionals and nonsingers were compared.