Aerodynamic and Acoustic Characteristics of Voice in Prader-Willi Syndrome

Prader-Willi syndrome (PWS) is a multisystem disorder caused by DNA abnormalities involving chromosome 15. Major characteristics are infant hypotonia, hypogonadism, mental retardation, a short stature, atypical facial appearance, and the onset of obesity due to insatiable hunger in early childhood. Also, speech and language abnormalities have been reported including voice disorders. These have seldom been studied in detail, however. This paper reports the results of an acoustic and aerodynamic investigation of the voice in 22 individuals with PWS. Two age groups were distinguished, a group of children [chronological age (CA) 6 years, 7 months through 11 years, 7 months; total intelligence quotient (TIQ) 40-88] and a group of adolescents and adults (CA 17 years, 1 month through 29 years, 5 months; TIQ 41-94). Both aerodynamic and acoustic parameters were obtained and compared with normative data from the Belgian Study Group on Voice Disorders. It was found that voice difficulties do commonly occur in individuals with PWS including impairment of frequency levels, voice quality, and poor aerodynamic capabilities.     

Acid reflux and hoarseness

The aim of this study was to investigate the prevalence of acid reflux in patients complaining of hoarseness where no organic disease or functional dysphonia could be found. We also aimed to determine whether anti-reflux treatment improved their symptoms. Patients were not selected on the basis of symptoms of reflux. Fifty patients with hoarseness took part in a prospective study that sought to establish objectively whether acid reflux was present. All patients were given a 6-week course of ranitidine and Gaviscon. Patients were asked to score their voice quality before and after treatment. Although 72% of patients complained of heartburn more than once a week, only 40% proved to have acid reflux. Although subjective improvement after anti-reflux treatment was found in a larger proportion of those with than without proven reflux, the conclusions that can be drawn are limited as there were no satisfactory objective measurements of voice or controls.     

Advantages of endoscopic laser arytenoidectomy using yag laser scalpel

The surgical management of bilateral vocal cord paralysis has been performed through an endoscope in the past. The etiology of bilateral vocal cord paralysis is usually secondary to trauma; to secure an adequate airway, a tracheostomy is performed. Endoscopic laser arytenoidectomy offers a safe method of decannulating patients with maintenance of good voice quality and a rima glottidis of 4–6 mm posteriorly. Several wavelengths are available to carry out this procedure, and this article will focus on Nd:Yag laser scalpel applications. The advantage of this method is the preservation of good voice quality with an option of an external procedure, if the need arises. The laser application offers excellent hemostasis, and decreased edema and scar tissue formation. The results of our study on 10 patients appear encouraging and superior with respect to other available wavelengths.     

Voice Analysis of Postlingually Deaf Adults Pre- and Postcochlear Implantation

Objectives

To ascertain whether cochlear implantation (CI), without specific vocal rehabilitation, is associated with changes in perceptual and acoustic vocal parameters in adults with severe to profound postlingual deafness.

Hypothesis

Merely restoring auditory feedback could allow the individual to make necessary adjustments in vocal pattern.

Study Design

Prospective and longitudinal.

Methods

The experimental group composed of 40 postlingually deaf adults (20 males and 20 females) with no previous laryngeal or voice disorders. Participants’ voices were recorded before CI and 6–9 months after CI. To check for chance modifications between two evaluations, a control group of 12 postlingually deaf adults, six male and six female, without CI was also evaluated. All sessions composed of the recording of read sentences from Consensus Auditory-Perceptual Evaluation of Voice and sustained vowel /a/. Auditory and acoustic analyses were then conducted.

Results

We found a statistically significant reduction in overall severity, strain, loudness, and instability in auditory analysis. In vocal acoustic analysis, we found statistically significant reduction fundamental frequency (F0) values (in male participants) and F0 variability (in both genders). The control group showed no statistically significant changes in most vocal parameters assessed, apart from pitch and F0 (in female participants only). On comparing the interval of variation of results between the experimental and control groups, we found no statistically significant difference in vocal parameters between CI recipients and nonrecipients, with the exception of F0 variability in male participants.

Conclusions

The patients in our sample showed changes in overall severity, strain, loudness, and instability values, and reductions in F0 and its variability. On comparing the variation of results between the groups, we were able to prove in our study that implant recipients postlingually deaf adults (experimental group), without specific vocal rehabilitation, differed from nonrecipients (control group) in loudness and F0 variability sustained vowel /a/ in male participants.     

Differences in Self-Rated, Perceived, and Acoustic Voice Qualities Between High- and Low-Fatigue Groups

Objectives

The present study was performed to examine which factors among self-rated scales, perceptual evaluations, and acoustic parameters, calculated from sustained vowels, are reliable indicators of physical and mental fatigues.

Methods

A total of 73 volunteers (male:female, 52:21), aged 19–24 years, were enrolled in this study. We defined the high- and low-fatigue groups using the Chalder Fatigue Scale score. For assessment of self-rated symptoms, each subject was asked to complete Voice Handicap Index (VHI) and Voice Rating Scale (VRS). For perceptual evaluations, three clinicians assessed each subject’s vocal quality on the Grade, Roughness, Breathiness, Asthenia, Strain Scale. For acoustic analysis, each subject was asked to produce sustained vowels /a/, /e/, /i/, /o/, and /u/ for 3 seconds. Then, the habitual fundamental frequency (F₀), jitter, shimmer, F₀ tremor, mean F₀, standard deviation of F₀, maximum F₀, minimum F₀, normalized noise energy, harmonic-to-noise ratio (HNR), signal-to-noise ratio (SNR), amplitude tremor, and ratio within 2–4 kHz were calculated using Dr. Speech software.

Results

In men, VHI, VRS, F₀ tremor, shimmer, HNR, SNR, and amplitude tremor were related to mental fatigue. In women, only VHI was related to physical fatigue, and none of the acoustic parameters was related to the fatigue score. Perceptual evaluations were not related to fatigue in men or women.

Conclusions

These findings suggest that self-rated symptoms and acoustic parameters related to voice quality are indicative of mental fatigue, and these features are prominent in men.     

Spectral- and Cepstral-Based Measures During Continuous Speech: Capacity to Distinguish Dysphonia and Consistency Within a Speaker

Spectral- and cepstral-based acoustic measures are preferable to time-based measures for accurately representing dysphonic voices during continuous speech. Although these measures show promising relationships to perceptual voice quality ratings, less is known regarding their ability to differentiate normal from dysphonic voice during continuous speech and the consistency of these measures across multiple utterances by the same speaker. The purpose of this study was to determine whether spectral moments of the long-term average spectrum (LTAS) (spectral mean, standard deviation, skewness, and kurtosis) and cepstral peak prominence measures were significantly different for speakers with and without voice disorders when assessed during continuous speech. The consistency of these measures within a speaker across utterances was also addressed. Continuous speech samples from 27 subjects without voice disorders and 27 subjects with mixed voice disorders were acoustically analyzed. In addition, voice samples were perceptually rated for overall severity. Acoustic analyses were performed on three continuous speech stimuli from a reading passage: two full sentences and one constituent phrase. Significant between-group differences were found for both cepstral measures and three LTAS measures (P < 0.001): spectral mean, skewness, and kurtosis. These five measures also showed moderate to strong correlations to overall voice severity. Furthermore, high degrees of within-speaker consistency (correlation coefficients ≥0.89) across utterances with varying length and phonemic content were evidenced for both subject groups.     

Voice Training and Changing Weight—Are They Reflected in Speaking Fundamental Frequency, Voice Range, and Pitch Breaks of 13-Year-Old Girls? A Longitudinal Study

Objective

Assessment of the voice-change progress of 20 girls (12–13 years) over 1 year by observing changes in speaking fundamental frequency (SFo), voice range, and register pitch breaks in the context of weight, height, voice training, and self-perception.

Study Design

One-year longitudinal collective case study.

Method

Twenty girls were recorded at the beginning and end of a year; nine girls were recorded another three times. SFo, vocal range, and characteristics were analyzed and interactions between these data assessed against weight and height to indicate pubertal development, and to test the hypothesis that changes in weight, height, SFo, and pitch breaks were related. Effects of training and the girls' self-perception of their voice use were also assessed.

Results

Vocal characteristics changed as the girls passed through different weight ranges. During 47.5–52.4 kg (called band 2) and 52.4–57.5 kg (band 3), there was progressive contraction of vocal range and in some girls a slight rise in SFo between recording times 1 and 5. Both high- and low-pitch breaks were present in 45% of girls' voices. Girls in band 4 (<57.5 kg) had an increased vocal range, and pitch breaks in vocal-range areas that indicated the development of adult vocal registers. In this study, voice-trained girls were heavier, had higher SFo, used wider speech-range inflection, had a higher vocal range, and greater voice-use confidence; all girls lost confidence in their voice use over the year.

Conclusions

In this longitudinal study of twenty 13-year-old girls, voice changes in SFo, vocal range, and pitch-break frequency were synchronous with certain weight ranges. Girls with training registered higher maximum phonational frequency and were more confident in their voice use than girls without training.     

The Impact of Voice Disorders Among Teachers: Vocal Complaints, Treatment-Seeking Behavior, Knowledge of Vocal Care, and Voice-Related Absenteeism

Objectives

Teachers are at increased risk for developing voice disorders. Occupational risk factors have been extensively examined; however, little attention has been paid to the consequences of the vocal complaints. The objective of this study was to investigate the knowledge that teachers have about vocal care, treatment-seeking behavior, and voice-related absenteeism.

Methods

The study group comprised 994 teachers and 290 controls whose jobs did not involve vocal effort. All participants completed a questionnaire inquiring about vocal complaints, treatment-seeking behavior, voice-related absenteeism, and knowledge about vocal care. Comparisons were made between teachers with and without vocal complaints and with the control group.

Results

Teachers reported significantly more voice problems than the control population (51.2% vs 27.4%) (χ² = 50.45, df = 1, P < 0.001). Female teachers reported significantly higher levels of voice disorders than their male colleagues (38% vs 13.2%, χ² = 22.34, df = 1, P < 0.001). Teachers (25.4%) sought medical care and eventually 20.6% had missed at least 1 day of work because of voice problems. Female teachers were significantly more likely to seek medical help (χ² = 7.24, df = 1, P = 0.007) and to stay at home (χ² = 7.10, df = 1, P = 0.008) in comparison with their male colleagues. Only 13.5% of all teachers received information during their education.

Conclusions

Voice disorders have an impact on teachers' personal and professional life and imply a major financial burden for society. A substantial number of teachers needed medical help and was obligated to stay at home because of voice problems. This study strongly recommends the implementation of vocal education during the training of teacher students to prepare the vocal professional user.