Singing power ratio: Quantitative evaluation of singing voice quality

This paper presents a parameter for objectively evaluating singing voice quality. Power spectrum of vowel sound / a / was analyzed by Fast Fourier Transform. The greatest harmonics peak between 2 and 4 kHz and the greatest harmonics peak between 0 and 2 kHz were identified. Power ratio of these peaks, termed singing power ratio (SPR), was calculated in 37 singers and 20 nonsingers. SPR of sung / a / in singers was significantly greater than in nonsingers. In singers, SPR of sung / a / was significantly greater than that of spoken / a /. By digital signal processing, power spectrum of sung / a / was varied, and the processed sounds were perceptually analyzed. SPR had a significant relationship with perceptual scores of “ringing” quality. SPR provides an important quantitative measurement for evaluating singing voice quality for all voice types, including soprano.     

Combined surgical medialization and nerve-muscle pedicle reinnervation for unilateral vocal fold paralysis: Improved functional results and prevention of long-term deterioration of voice

Including those patients that were the subject of our previous report in 1990 (1) a total of 52 patients with unilateral vocal fold paralysis have been managed by combined surgical medialization and nerve-muscle pedicle reinnervation. The technique has been modified only slightly since 1985, when the first such surgery was performed. Short- and long-term voice results determined by a panel of sophisticated listeners are reported, as well as details of patient selection and complications. Better functional results were noted than were observed with surgical medialization alone, and long-term deterioration of the voice improvement initially achieved was prevented with this technique.     

Clinical applications of electroglottography

Electroglottography (EGG) is a method to monitor the vibrations of the vocal folds by measuring the varying impedance to a weak alternating current through the tissues of the neck. The paper is an attempt to give a state-of-the-art report of how electroglottography is used in the clinic. It is based on a search of the pertinent literature was well as on an inquiry to 17 well known specialists in the field. The EGG techniques are described and limitations to the method are pointed out. Attempts to document voice quality by EGG are recognized and computerized methods to obtain information about vibratory perturbations and/or the vibratory frequency of the vocal folds are described. The author's personal conclusion is that the EGG signal is especially well suited for measurements of the glottal vibratory period. In the clinic such measurements are useful for periodicity analysis, as a basis for recording intonation contours, and to establish the characteristics of the voice fundamental frequency.     

Episodic paroxysmal laryngospasm: Voice and pulmonary function assessment and management

Episodic paroxysmal laryngospasm (EPL) is a sign of laryngeal dysfunction, often without a specific organic etiology, which can masquerade as asthma, vocal fold paralysis, or a functional voice disorder. The intermittent respiratory distress of EPL may precipitate an apparent upper airway obstructive emergency, resulting in unnecessary endotracheal intubation, cardiopulmonary resuscitation, or tracheostomy. During 27 months, seven women and three men, ages 30–76 years, were assessed by a high diagnostic index of suspicion, an intensive history including psychosocial factors, physical examination of the airways, provocative asthma testing, and swallowing studies. Videolaryngoscopy, stroboscopy, and pulmonary flow-volume loop testing were definitive. The classic appearance was paradoxic inspiratory adduction of the anterior vocal folds with a posterior diamond-shaped glottic gap. During an attack of stridor or wheezing, attenuation of the inspiratory flow rate as depicted by the flow-volume loop suggested partial extrathoracic upper airway obstruction. Swallowing evaluation by videolaryngoscopy and videoesophagography may uncover gastroesophageal reflux disease. Hallmarks of management include patient and family education by observation of laryngoscopic videos, a specific speech therapy program, psychotherapy, and medical treatment of associated disorders. Electromyography may become a valuable future adjunct. Unlike laryngeal dystonia, patients with EPL do not benefit from botulinum toxin type A.     

Genetics of Vocal Quality Characteristics in Monozygotic Twins: A Multiparameter Approach

The main purpose of this study was to determine the vocal quality characteristics among the 45 monozygotic cotwins (MT). As the performance of the voice is related to several genetically determined anatomical and physiological factors, the authors hypothesized that the vocal characteristics and the overall vocal quality by means of the Dysphonia Severity Index (DSI) will be identical in MT. An additional objective of this study was to determine whether sex and age influence vocal similarities in MT and to compare the voice characteristics of MT with the normative data of unrelated peers. As more environmental factors influence the aging of the voice, age-related differences were expected. No sex-related differences were expected. Subjective and objective assessment techniques determined the vocal quality. No significant differences were obtained, and most comparisons resulted in significant correlation coefficients. For the acoustic parameters jitter and shimmer only, no significant correlation coefficients could be obtained. It is clear that the perceptual voice characteristics, the laryngeal aerodynamic measurements of maximum phonation time (MPT), the vocal performances, and the overall vocal quality by means of the DSI are similar in MT. These vocal characteristics are not influenced either by the subjects' age or sex and are situated within the normative range of unrelated peers. To what extent other aspects (environment, anxiety, tension, etc) might play a role in the acoustical dimensions regarding frequency and amplitude perturbation, which were in the normal range, is a subject of further research.     

Evaluation of Support in Singing

This study searched for perceptual, acoustic, and physiological correlates of support in singing. Seven trained professional singers (four women and three men) sang repetitions of the syllable [pa:] at varying pitch and sound levels (1) habitually (with support) and (2) simulating singing without support. Estimate of subglottic pressure was obtained from oral pressure during [p]. Vocal fold vibration was registered with dual-channel electroglottography. Acoustic analyses were made on the recorded samples. All samples were also evaluated by the singers and other listeners, who were trained singers, singing students, and voice specialists without singing education (a total of 63 listeners). We rated both the overall voice quality and the amount of support. According to the results, it seemed impossible to observe any auditory differences between supported singing and good singing voice quality. The acoustic and physiological correlates of good voice quality in absolute values seem to be gender and task dependent, whereas the relative optimum seems to be reached at intermediate parameter values.     

Paradoxical vocal fold movement: A case report

We present a case of one patient with respiratory stridor that was resolved by speech therapy. Paradoxical vocal fold movements were observed by flexible fiberoptic videolaryngoscopy in this patient during episodes of wheezing and dyspnea. Otherwise, normal vocal fold movement was observed in normal conditions of breathing (out of the crisis) and during phonation. Many different terms have been used to describe this entity in the literature, and it is crucial that clinicians recognize the subtle signs of functional stridor. Paradoxical vocal fold motion has to be considered as an important cause of respiratory disease. Its recognition and treatment are discussed in this report.     

Expanding perspectives in care of the speaking voice

The effective voice clinician has always had to borrow from various disciplines: voice science, otolaryngology, psychology, and speech-language pathology. Such eclecticism requires, however, that the clinician integrate the perspectives of these various disciplines into some kind of theoretical clinical bias. One bias might be that with greater use of instrumentation in voice therapy, the voice clinician must not substitute data collection for attending to the feelings of the patient. By using the clinical input from various disciplines, for example, voice clinicians might develop a useful clinical perspective that vocal hyperfunction is one of the primary causes of many voice disorders. Consequently, from such a clinical view might come a treatment perspective that can clearly define the problem (too much effort while speaking) and offer a rationale for voice remediation.     

Respiratory function in singers: Medical assessment, diagnoses, and treatments

A healthy voice depends upon healthy respiration. An understanding of respiratory function is essential in evaluating disorders that affect the voice. This review addresses the assessment of respiratory complaints by history, physical examination, laboratory testing, and endoscopic procedures. Allergy testing and pulmonary function testing are covered in detail. Special problems that confront the professional voice user, such as the need to optimize respiratory function even in mild disease states, exposure to environmental irritants, and the athletic demands of performance, are related specifically to respiratory function. The discussion of diagnosis and treatment of common ailments such as allergic rhinitis and bronchitis is directed toward treatment of the active singer.     

Pediatric abdominal masses: diagnostic accuracy of diffusion weighted MRI

Purpose

To retrospectively identify apparent diffusion coefficient (ADC) values of pediatric abdominal mass lesions, to determine whether measured ADC of the lesions and signal intensity on diffusion-weighted (DW) images allow discrimination between benign and malignant mass lesions.

Materials and Methods

Approval for this retrospective study was obtained from the institutional review board. Children with abdominal mass lesions, who were examined by DW magnetic resonance imaging (MRI) were included in this study. DW MR images were obtained in the axial plane by using a non breath-hold single-shot spin-echo sequence on a 1.5-T MR scanner. ADCs were calculated for each lesion. ADC values were compared with Mann–Whitney U test. Receiver operating characteristic curve analysis was performed to determine cut-off values for ADC. The results of visual assessment on b800 images and ADC map images were compared with chi-square test.

Results

Thirty-one abdominal mass lesions (16 benign, 15 malignant) in 26 patients (15 girls, 11 boys, ranging from 2 days to 17 years with 6.9 years mean) underwent MRI. Benign lesions had significantly higher ADC values than malignant ones (P<.001). The mean ADCs of malignant lesions were 0.84±1.7×10⁻³ mm²/s, while the mean ADCs of the benign ones were 2.28±1.00×10⁻³ mm²/s. With respect to cutoff values of ADC: 1.11×10⁻³ mm²/s, sensitivity and negative predictive values were 100%, specificity was 78.6% and positive predictive value was 83.3%. For b800 and ADC map images, there were statistically significant differences on visual assessment. All malignant lesions had variable degrees of high signal intensity whereas eight of the 16 benign ones had low signal intensities on b800 images (P<.001). On ADC map images, all malignant lesions were hypointense and most of the benign ones (n=11, 68.7%) were hyperintense (P<.001).

Conclusion

DW imaging can be used for reliable discrimination of benign and malignant pediatric abdominal mass lesions based on considerable differences in the ADC values and signal intensity changes.