Studying vocal fold vibrations in Parkinson's disease with a nonlinear model

A nonlinear model is applied to study pathologic vocal vibratory characteristics and voice treatments of Parkinson's disease. We find that a number of pathologic vocal characteristics commonly observed in Parkinson's disease, including reduced vibratory intensity, incomplete vocal closure, increased phonation threshold pressure, glottal tremor, subharmonics, and chaotic vocal fold vibrations, can be studied with this nonlinear model. We also find that two kinds of clinical voice treatments for Parkinson's disease, including respiratory effort treatment and Lee Silverman voice treatment can be studied with this computer model. Results suggest that respiratory effort treatment, in which subglottal pressure is increased, might aid in enhancing vibratory intensity, improving glottal closure, and avoiding vibratory irregularity. However, the Lee Silverman voice treatment, in which both subglottal pressure and vocal fold adduction are increased, might be better than respiratory effort treatment. Increasing vocal fold thickness would be further helpful to improve these pathologic characteristics. The model studies show consistencies with clinical observations. Computer models may be of value in understanding the dynamic mechanism of disordered voices and studying voice treatment effects in Parkinson's disease.     

Glottal flow through a two-mass model: comparison of Navier-Stokes solutions with simplified models

A new numerical model of the vocal folds is presented based on the well-known two-mass models of the vocal folds. The two-mass model is coupled to a model of glottal airflow based on the incompressible Navier-Stokes equations. Glottal waves are produced using different initial glottal gaps and different subglottal pressures. Fundamental frequency, glottal peak flow, and closed phase of the glottal waves have been compared with values known from the literature. The phonation threshold pressure was determined for different initial glottal gaps. The phonation threshold pressure obtained using the flow model with Navier-Stokes equations corresponds better to values determined in normal phonation than the phonation threshold pressure obtained using the flow model based on the Bernoulli equation. Using the Navier-Stokes equations, an increase of the subglottal pressure causes the fundamental frequency and the glottal peak flow to increase, whereas the fundamental frequency in the Bernoulli-based model does not change with increasing pressure.     

Soft Phonation in the Male Singing Voice: A Preliminary Study

Sustained high notes, diminishing gradually from the loudest to the softest phonation within a maneuver called messa di voce, are examined in two contrasting professional tenor voices. Signals of the sound pressure level, electroglottograph, and mean esophageal pressure are recorded, and similar maneuvers by the same subjects are examined stroboscopically. The lyric voice is found to make a gradual diminuendo while maintaining nearly constant posture of the vocal tract together with a phase of complete closure in the glottal cycle. The robust voice, by contrast, passes abruptly from a production of high subglottal pressure and a high closed quotient to one of low pressure and incomplete closure, and the transition is marked by a sudden opening of the previously constricted laryngeal collar. It is proposed that the mode of soft voice production demonstrated by the robust voice be recognized as a distinct register of the singing voice.     

Vocal loudness and frequency capabilities of the voice

A phonetogram is a graph showing the sound pressure level (SPL) of softest and loudest phonation over the entire fundamental frequency range of a voice. A physiological interpretation of a phonetogram is facilitated if the SPL is measured with a flat frequency curve and if the vowel /a/ is used. It was found that in soft phonation, the SPL is mainly dependent on the amplitude of the fundamental, while in loud phonation, the SPL is mainly determined by overtones. The short-term SPL variation, i.e., the level variation within a tone, was about 5 dB in soft phonation and close to 2 dB in loud phonation. For two normal voices the long-term SPL variation, calculated as the mean standard deviation of SPL for day-to-day variation, was found to be between 2.4 and 3.4 dB in soft and loud phonation. Speakers who raise their loudness of phonation also tend to raise their mean voice fundamental frequency. Measures obtained from speaking at various voice levels were combined so that typical pathways could be introduced into the phonetogram. The average slope of these pathways was 0.3–0.5 st/dB for healthy subjects. Averaged phonetograms for male singers and male nonsingers did not differ significantly, but averaged phonetograms for female singers and female nonsingers did, in that the upper contour was higher for the female singers. Averaged phonetograms for female patients with non-organic dysphonia showed significantly lower SPL values in loudest phonation as compared to healthy female subjects, while no corresponding difference was seen for males in this regard. With respect to the SPL values for softest phonation, male dysphonic patients showed significantly higher SPL values than healthy male subjects, while no corresponding difference was seen in female subjects. The subglottal pressure mirrored these phonetogram differences between healthy and pathological voices. The averaged phonetograms of female patients after voice therapy showed an increased similarity with those of normal voices. For the male patients the averaged phonetogram did not change significantly after therapy.     

Objective Voice Measures in Nonsinging Patients With Unilateral Superior Laryngeal Nerve Paresis

The clinical value of objective voice measures in nonsinging patients with superior laryngeal nerve dysfunction is unknown. In this study, patients with symptomatic unilateral superior nerve paresis were evaluated for maximum phonation time, frequency range of phonation, and mean flow rate. Patients with coexisting pathology, bilateral superior nerve paresis, and those with recurrent laryngeal nerve paresis were excluded from this analysis. A total of 35 nonsinging patients, 14 men and 21 women, with unilateral superior laryngeal nerve paresis were examined between 1999 and 2002. The severity of superior laryngeal nerve paresis ranged from 25% to 85% of normal recruitment with a mean of 70% superior laryngeal nerve recruitment in men and 65% in women by electromyography. In both men and women with superior laryngeal nerve paresis, the maximum phonation time and frequency range of phonation were decreased and the mean air flow rate was increased when compared with normal population values. The jitter percent, shimmer percent, and noise-to-harmonic ratio were also increased in patients when compared with normative data. Selected objective voice measures are abnormal in voice patients with superior laryngeal nerve paresis, which suggests that the measures may be useful as outcomes measures after therapy. More research is encouraged.     

Effects of lung volume on the glottal voice source

According to experience in voice therapy and singing pedagogy, breathing habits can be used to modify phonation, although this relationship has never been experimentally demonstrated. In the present investigation we examine if lung volume affects phonation. Twenty-four untrained subjects phonated at different pitches and degrees of vocal loudness at different lung volumes. Mean subglottal pressure was measured and voice source characteristics were analyzed by inverse filtering. The main results were that with decreasing lung volume, the closed quotient increased, while subglottal pressure, peak-to-peak flow amplitude, and glottal leakage tended to decrease. In addition, some estimates of the amount of the glottal adduction force component were examined. Possible explanations of the findings are discussed.     

Data on subglottal pressure and SPL at varied vocalloudness and pitch in 8- to 11-year-old children

Phonation threshold pressure has been defined as the minimum subglottalpressure to generate phonation. Previous research has indicated that children may habitually employ higher subglottal pressures than adults. In the present investigation sound pressure level (SPL) and subglottal pressures at different pitch levels were measured at and above phonation threshold in nine children. Phonation threshold values were scattered in reasonable agreement with Titzes' prediction, although a discrepancy was noted regarding the frequency dependence in some voices. At normal conversational loudness and loudest level of phonation the children's PS values were between two to four and four to eight times the predicted threshold values, respectively. At normal conversational loudness and habitual pitch subglottal pressures were lower than those previously observed for children, but similar to those found for female adults. The SPL in softest and loudest phonation were somewhat lower as compared to previous phonetogram data for children and for female adults. At normal loudness and habitual pitch the SPL values were similar to those of female adults. For a doubling of P_s mean SPL increased by 10.5 dB on the average.     

Direct measurement of onset and offset phonation threshold pressure in normal subjects

Phonation threshold pressures were directly measured in five normal subjects in a variety of voicing conditions. The effects of fundamental frequency, intensity, closure speed of the vocal folds, and laryngeal airway resistance on phonation threshold pressures were determined. Subglottic air pressures were measured using percutaneous puncture of the cricothyroid membrane. Both onset and offset of phonation were studied to see if a hysteresis effect produced lower offset pressures than onset pressures. Univariate analysis showed that phonation threshold pressure was influenced most strongly by fundamental frequency and intensity. Multiple linear regression showed that these two variables, as well as laryngeal airway resistance, most strongly predicted phonation threshold pressure. Two of the five subjects demonstrated a significant hysteresis effect, but one subject actually had higher offset pressures than onset pressures.     

Effects of prolonged oral reading on F0, SPL, subglottal pressure and amplitude characteristics of glottal flow waveforms

The effects of prolonged (5x45 minute) reading (vocal loading) on fundamental frequency (F0), sound pressure level (SPL), subglottal (intraroral) pressure (p), and two glottal flow waveform parameters (AC amplitude of glottal flow, f, and negative peak amplitude of differentiated flow (d) of normal female and male subjects (N = 80) were studied. Two rest (morning and noon) and three loading (two in the morning and one in the afternoon) samples were recorded and analyzed. The glottal waveforms were obtained by inverse filtering of the acoustic pressure waveforms of speaking voice samples. The analyses were based on measurement and inverse filtering of the first stressed syllable of "paappa" words repeated 3x5 times for normal, as soft as possible, and as loud as possible phonation. In normal phonation the parameter values changed statistically significantly due to loading. In many cases the values obtained in the morning samples changed after the first loading session. This is interpreted as a vocal "warming-up effect." Especially in soft phonation p, d, and f were sensitive indicators of vocal loading. In both normal and soft phonation, the SPL, p, d, and f values tended to rise due to prolonged reading in the morning and afternoon samples, indicating increased effort (normal phonation) and a rise in the phonatory threshold (soft phonation). The lunch break vocal rest ("rest effect") considerably affected the parameter values in many cases.     

Relationship between changes in voice pitch and loudness

Changes in mean fundamental frequency accompanying changes in loudness of phonation are analyzed in 9 professional singers, 9 nonsingers, and 10 male and 10 female patients suffering from vocal functional dysfunction. The subjects read discursive texts with noise in earphones, and some also at voluntarily varied vocal loudness. The healthy subjects phonated as softly and as loudly as possible at various fundamental frequencies throughout their pitch ranges, and the resulting mean phonetograms are compared. Mean pitch was found to increase by about half-semitones per decibel sound level. Grossly, the subject groups gave similar results, although the singers changed voice pitch more than the nonsingers. The voice pitch changes may be explained as passive results of changes of subglottal pressure required for the sound level variation.     

Predicting vocal frequency from selected physiologic measures.

Simultaneous physiologic measures were obtained on four young adult male subjects as they sustained phonation at seven frequencies within their modal-to-falsetto voice range. Data were analyzed using a multiple regression program to determine the contribution of each measure singly and in combination with other measures to the prediction of the resultant voice frequency. Results showed that by far the best predictor was cricothyroid muscle activity for both the pooled data model, and for each individual subject. The contribution of subglottal air pressure and thyroarytenoid muscle activity increased the variance explained by only 4% while the measure of vertical laryngeal position was a significant factor in only one subject's predictive model. Partial models from the pooled data explained from 67% to 73% of the variance; whereas the obtained measures for individual subjects explained from 90% to 94% of the variance.     

Some effects of deafness on the generation of voice

Glottal volume-velocity waveform data were collected from twenty male and female hearing-impaired adolescents by means of a reflectionless tube. The subjects each provided samples of phonation in normal- and soft-voice modes and in a three-syllable word with primary stress on the medial syllable. Analysis of the data, in comparison with characteristics of phonation produced by normally hearing subjects, indicates that deafness affects primarily the time-varying characteristics of the glottal source. Among the hearing-impaired subjects, the following abnormalities were noted; diplophonia and creaky-voice episodes at the onset or middle of phonation, and irregular patterns of change in the frequency and intensity of the glottal waveform. For some subjects, the period-to-period changes of frequency and intensity may be greater than normal. For the hearing-impaired subjects, the shape of the isolated glottal pulse and its spectrum are similar or identical to normal, while striking abnormalities may be seen in the way the glottal pulse changes over time. The effect of deafness is thus that it may prevent a speaker from learning the phonatory consequences of the muscular gestures which maintain and alter vocal-fold tension and subglottal air pressure dynamically in the production of voice.     

Some Phonatory and Resonatory Characteristics of the Rock, Pop, Soul, and Swedish Dance Band Styles of Singing

This investigation aims at describing voice function of four nonclassical styles of singing, Rock, Pop, Soul, and Swedish Dance Band. A male singer, professionally experienced in performing in these genres, sang representative tunes, both with their original lyrics and on the syllable /pae/. In addition, he sang tones in a triad pattern ranging from the pitch Bb2 to the pitch C4 on the syllable /pae/ in pressed and neutral phonation. An expert panel was successful in classifying the samples, thus suggesting that the samples were representative of the various styles. Subglottal pressure was estimated from oral pressure during the occlusion for the consonant [p]. Flow glottograms were obtained from inverse filtering. The four lowest formant frequencies differed between the styles. The mean of the subglottal pressure and the mean of the normalized amplitude quotient (NAQ), that is, the ratio between the flow pulse amplitude and the product of period and maximum flow declination rate, were plotted against the mean of fundamental frequency. In these graphs, Rock and Swedish Dance Band assumed opposite extreme positions with respect to subglottal pressure and mean phonation frequency, whereas the mean NAQ values differed less between the styles.     

An Investigation of a Modal-Falsetto Register Transition Hypothesis Using Helox Gas

This study concerned the effect of the first subglottal formant (F1') on the modal-falsetto register transition in males and females. Phonations using air and a helium-oxygen mixture (helox) were used in a comparative study to tease apart possible acoustic and myoelastic contributions to involuntary register transitions. Recordings of the first subglottal formant and its accompanying bandwidths, and the lower and upper shift point marking the outer boundaries of abrupt register transitions, were obtained via a neck-mounted accelerometer, and analyzed using spectrograms and power spectra on a K-5500 Sona-Graph. The four subjects had their hearing masked bilaterally with speech level noise to increase the likelihood of involuntary register transition via minimized auditory feedback. In three of the four test subjects registration was surmised to be primarily a laryngeal event, as evidenced by the similar frequency dependency of voice breaks in both air and helox. It may be hypothesized that subglottal resonance influenced register transition in the fourth subject, as voice breaks rose with helox-induced phonation; however, this result did not reach statistical significance. Therefore, in this experiment subglottal resonance was not found to have a significant influence on register transition as originally hypothesized.     

A lumped mucosal wave model of the vocal folds revisited: recent extensions and oscillation hysteresis

This paper examines an updated version of a lumped mucosal wave model of the vocal fold oscillation during phonation. Threshold values of the subglottal pressure and the mean (DC) glottal airflow for the oscillation onset are determined. Depending on the nonlinear characteristics of the model, an oscillation hysteresis phenomenon may occur, with different values for the oscillation onset and offset threshold. The threshold values depend on the oscillation frequency, but the occurrence of the hysteresis is independent of it. The results are tested against pressure data collected from a mechanical replica of the vocal folds, and oral airflow data collected from speakers producing intervocalic /h/. In the human speech data, observed differences between voice onset and offset may be attributed to variations in voice pitch, with a very small or inexistent hysteresis phenomenon.     

Examination of air usage during phonation: Correlations among test parameters

Correlations among parameters indicating air usage during phonation were investigated in 60 normal subjects and 1,545 voice patients. The parameters examined were maximum phonation time (MPT), mean air flow rate for maximum sustained phonation (MFRm), mean air flow rate for comfortable phonation (MFRc), and phonation quotient (PQ). In normal subjects, correlations among MPT, MFRm, and PQ were high, but those between MFRc and the others were moderate. In cases of paralysis and hypofunctional dysphonia, all correlations between the four parameters were high. In the cases of polyp, nodule, epithelial hyperplasia, glottic carcinoma, and hyperfunctional dysphonia, the correlation between MPT and MFRc was moderate or not significant. The low correlation between these parameters was associated with the variations in flow rate differences between maximum and comfortable phonations. The results suggest that measurement of all four parameters is not necessary in routine tests and that MPT and MFRc should be measured in most voice patients.     

A comparison of subglottal and intraoral pressure measurements during phonation

Intraoral pressure and subglottal pressure, derived from tracheal puncture, were recorded with the electroglottographic signal for one normal speaking male during phonation. The mean subglottal pressure for vowels was also estimated by interpolating the intraoral pressure from surrounding /p/ occlusions. The pressure measurements were highly correlated (r = 0.98) and there were small pressure value differences (on average <2%). The effects of varying speech rate and mode of phonation on the pressure measurements are discussed. A decrease in pressure from the mean subglottal pressure for the open phase and an increase for the closed phase was found during the glottal vibratory cycles.     

Significance of mechanoreceptors in the subglottal mucosa for subglottal pressure control in singers

According to Wyke and Kirchner (Wyke B, Kirchner J. Neurology of the larynx. In: Hinchcliffe R, Harrison D, eds. Scientific foundation of otolaryngology. London: William Heinemann Medical Books, 1976:546–66) mechanoreceptors in the subglottal mucosa play a significant role in the control of laryngeal muscle activity in response to changes of subglottal pressure during phonation. In singers this pressure is adapted not only to phonatory loudness but also to fundamental frequency. By spraying Xylocaine solution with a needle inserted into the trachea through the anterior gap between the cricoid and thyroid cartilages, the subglottal mucosa was anesthetized in three singers. The effects on subglottal pressure and fundamental frequency of this anesthesia were examined. The pressure effects varied between the subjects, whereas the fundamental frequency accuracy was adversely affected in all three subjects. The implications of these findings are discussed.     

Reflex activation of laryngeal muscles by sudden induced subglottal pressure changes.

In measuring the effect of subglottal pressure changes on fundamental frequency (Fo) of phonation, the effects of changing laryngeal muscle activity must be eliminated. Several investigators have used a strategy in which pulsatile increases of subglottal pressure are induced by pushing on the chest or abdomen of a phonating subject. Fundamental frequency is then correlated with subglottal pressure changes during an interval before laryngeal response is assumed to occur. The present study was undertaken to repeat such an experiment while monitoring electromyographic (EMG) activity of some laryngeal muscles, to discover empirically the latency of the laryngeal response. The results showed a consistent response to each push, with a latency of about 30 ms. Despite this response, analyses of fundamental frequency versus subglottal pressure changes during the interval of constant EMG activity were in general agreement with previously published values. With respect to the nature of the electromyographic response itself, its timing was found to be within the range of latencies appropriate for peripheral feedback, and was also similar to that for an acoustically--or tactually--elicited startle reflex.     

Phonatory control in male singing: A study of the effects of subglottal pressure, fundamental frequency, and mode of phonation on the voice source

This article describes experiments carried out in order to gain a deeper understanding of the mechanisms underlying variation of vocal loudness in singers. Ten singers, two of whom are famous professional opera tenor soloists, phonated at different pitches and different loudnesses. Their voice source characteristics were analyzed by inverse filtering the oral airflow signal. It was found that the main physiological variable underlying loudness variation is subglottal pressure (Ps). The voice source property determining most of the loudness variation is the amplitude of the negative peak of the differentiated flow signal, as predicted by previous research. Increases in this amplitude are achieved by (a) increasing the pulse amplitude of the flow waveform; (b) moving the moment of vocal fold contact earlier in time, closer to the center of the pulse; and (c) skewing the pulses. The last mentioned alternative seems dependent on both Ps and the ratio between the fundamental frequency and the first formant. On the average, the singers doubled Ps when they increased fundamental frequency by one octave, and a doubling of the excess Ps over threshold caused the sound pressure level (SPL) to increase by 8–9 dB for neutral phonation, less if mode of phonation was changed to pressed. A shift of mode of phonation from flow over neutral to pressed was associated with a reduction of the peak glottal permittance i.e., the ratio between peak transglottal airflow to Ps. Flow phonation had the most favorable relationship between Ps and SPL.