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.     

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.     

Phonatory Impairment in Parkinson''s Disease: Evidence from Nonlinear Dynamic Analysis and Perturbation Analysis

Many persons with Parkinson's disease (PD) will eventually experience vocal impairment as their condition advances. Using standard perturbation analyses (parameters like jitter and shimmer) to measure fluctuations in phonatory signal may inhibit researchers from recognizing severely disordered patterns that seem to be present in the voices of some PD patients. Nonlinear dynamic analysis can quantify these aperiodic patterns, which indicate severe pathology that is usually characterized perceptually by hoarseness. Here, sustained vowel phonations of a heterogeneous group of PD subjects (20 women and 21 men) were compared with those of a control group (22 women and 18 men) based on results of nonlinear dynamic analyses (D(2)) and perturbation analyses. Results showed PD subjects as a whole to have significantly higher D(2) values than control subjects (P = 0.016), which indicates increased signal complexity in PD vocal pathology. Differences in the comparison of these two groups were significant in jitter (P = 0.014) but nonsignificant in shimmer (P = 0.695). Furthermore, the performance on these three measures was affected by subject sex. Nonlinear dynamic analysis showed significantly higher D(2) in the female PD group than in the female control group (P = 0.001), but jitter and shimmer did not show such a difference. The male PD group had statistically higher jitter than the male control group (P = 0.036), but these groups did not differ in D(2) or shimmer. Overall, nonlinear dynamic analysis may be a valuable method for the diagnosis of Parkinsonian laryngeal pathology.     

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.     

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.     

A Comparative Study of Acoustic Voice Measurements by Means of Dr. Speech and Computerized Speech Lab

In this study, the calculations and results of acoustic voice analysis as calculated by two different analysis systems (Doctor Speech (DRS), Tiger Electronics, Neu-Anspach, Germany, and Computerized Speech Lab (CSL), Kay Elemetrics Corporation, Lincoln Park, NJ) are compared. A group of 120 normal voices was selected for analysis of the objective parameters: fundamental frequency (F(0)), variation of F(0) (F(0)SD), jitter, shimmer, and harmonics-to-noise ratio (HNR). The subject group was a random selection of normal voices of adults. The aim of this comparison was to find determined differences and similarities in data measurements between both systems to make data transfer possible. A significant correlation was found for F(0), HNR, and shimmer relative. The correlation for jitter (relative and absolute) and F(0)SD was weak. DRS and CSL are not comparable in absolute figures, but their judgment against normative data is identical. Further research is necessary to explore the affect on pathological voices or child voices.     

Comparison of nonlinear dynamic methods and perturbation methods for voice analysis

Nonlinear dynamic methods and perturbation methods are compared in terms of the effects of signal length, sampling rate, and noise. Results of theoretical and experimental studies quantitatively show that measurements representing frequency and amplitude perturbations are not applicable to chaotic signals because of difficulties in pitch tracking and sensitivity to initial state differences. Perturbation analyses are only reliable when applied to nearly periodic voice samples of sufficiently long signal lengths that were obtained at high sampling rates and low noise levels. In contrast, nonlinear dynamic methods, such as correlation dimension, allow the quantification of chaotic time series. Additionally, the correlation dimension method presents a more stable analysis of nearly periodic voice samples for shorter signal lengths, lower sampling rates, and higher noise levels. The correlation dimension method avoids some of the methodological issues associated with perturbation methods, and may potentially improve the ability for real time analysis as well as reduce costs in experimental designs for objectively assessing voice disorders.     

Multiparametric Analysis of Vocal Fold Vibrations in Healthy and Disordered Voices in High-Speed Imaging

Objectives

The aim of this study was to look for visual subjective and objective parameters of vocal fold dynamics being capable of differentiating healthy from pathologic voices in daily clinical practice applying endoscopic high-speed digital imaging (HSI).

Study Design and Methods

Four hundred ninety-six datasets containing 80 healthy and 416 pathologic subjects (232 functional dysphonia (FD), 13 bilateral, and 171 unilateral vocal fold nerve paralysis) were analyzed retrospectively. Videos at 4000 Hz (256 × 256 pixel) were recorded during sustained phonation. Subjective parameters were visually evaluated and complemented by an analysis of objective parameters. Visual subjective parameters were mucosal wave, glottal closure type, glottal closure insufficiency (GI), asymmetries of the vocal folds, and phonovibrogram (PVG) symmetry. After image segmentation, objective parameters were computed: closed quotient, perturbation measures (PMs) of glottal area, and left-right asymmetry values.

Results

HSI evaluation enabled to distinguish healthy from pathologic voices. For visual subjective parameters, GI, symmetrical behavior, and PVG symmetry exhibited statistical significant differences. For 95% of the data, objective parameters could be computed. Among objective parameters, closed quotient, jitter, shimmer, harmonic-to-noise ratio, and signal-to-noise ratio for the glottal area function differentiated statistically significant normal from pathologic voices. Applying linear discriminant analysis by combining visual subjective and objective parameters, accurate classifications were made for 63.2% of the female and 87.5% of the male group for the three-class problem (healthy, FD, and unilateral vocal fold nerve paralysis).

Conclusion

Actual acoustically applied PMs can be transferred to clinical beneficial HSI analysis. Combining visual subjective and objective basic parameters succeeds in differentiating pathologic from healthy voices. The presented evaluation can easily be included into everyday clinical practice. However, further research is needed to broaden our understanding of the variability within and across healthy and pathologic vocal fold vibrations for diagnosing voice disorders and therapy control.     

Analysis of Voice and Quantitative Measurement of Glottal Gap After Thyroplasty Type I in the Treatment of Unilateral Vocal Paralysis

Thyroplasty type I is one of several surgical treatments in which improving the voice of unilateral vocal fold paralysis is the ultimate objective. The goal of the surgery is the medialization of the paralyzed vocal fold. The purpose of this study is to evaluate the effectiveness of thyroplasty type I through acoustical analysis, aerodynamic measures, and quantitative videostroboscopic measurements. We report on 20 patients with unilateral vocal cord paralysis who underwent thyroplasty type I. We performed preoperative and postoperative video image analysis (normalized glottal gap area) and computer-assisted voice analysis (fundamental frequency, jitter, shimmer, noise-to-harmonic ratio, mean phonation time, mean flow rate, mean subglottic pressure) in all patients. The glottal gap was significantly reduced after thyroplasty type I. Postoperative voice quality was characterized by an improved pitch and amplitude pertubation (jitter and shimmer), phonation time (mean phonation time), and subglottic pressure (mean subglottic pressure). Thyroplasty type I is an effective method for regaining glottal closure and vocal function.     

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.     

The effects of vowels on voice perturbation measures

This study examines voice perturbation parameters of the sustained [a] in English and of the eight vowels in Turkish to discover whether any difference exists between these languages, and whether a correlation exists between voice perturbation parameters and articulatory and acoustic properties of the Turkish vowels. Eight Turkish vowels uttered by 26 healthy nonsmoker volunteer males who are native Turkish speakers were compared with a voice database that includes samples of normal and disordered voices belonging to American English speakers. Fundamental frequencies, the first and second formants, and perturbation parameters, such as jitter percent, pitch perturbation quotient, shimmer percent, and amplitude perturbation quotient of the sustained vowels, were measured. Also, the first and second formants of the sustained [a] in English were measured, and other parameters have been obtained from the database. When the voice perturbation parameters in Turkish and English were compared, statistically significant differences were not found. However, when Turkish vowels compared with each other, statistically significant differences were found among perturbation values. Categorical comparisons of the Turkish vowels like high-low, rounded-unrounded, and front-back revealed significant differences in perturbation values. In correlation analysis, a weak linear inverse relation between jitter percent and the first formant (r=-0.260, p<0.05) was found.     

Heartbeat-related fundamental frequency and amplitude variation in healthy young and elderly male voices

Modulation of the acoustic amplitude and fundamental frequency of a sustained vowel across the heart cycle was examined via signal-averaging. Ten normal young and ten normal elderly men prolonged phonations of the vowel /a/. Consistent with previous studies, the young men's maximal heart-beat-related frequency and amplitude variations averaged 1.0% and 8.4% of their respective means. Such modulation was estimated to account for 6.6% of the absolute jitter and 11.3% of the shimmer measured in these voice samples. The extent of this systematic variation was significantly greater in the older voices, averaging 2.4% of the mean frequency and 15.4% of the mean amplitude and was estimated to account for approximately 12.9% and 15.8% of their mean absolute jitter and shimmer, respectively. This age-related difference is thought to be a manifestation of involutional changes in laryngeal vascular and soft tissues and in ventilatory biomechanics.     

Acoustic characteristics of rough voice: Subharmonics

This study investigates the relationship between rough voice and the presence of Subharmonics, which correspond to smaller yet distinct peaks located between two consecutive harmonic peaks in the power spectrum. Spectrum analysis was undertaken in 389 pathologic voices, of which 20 had subharmonics. Although all 20 voices had roughness perceptually, 8 had normal jitter and/or shimmer. The degree of roughness had a significant inverse relationship with the frequency of subharmonics. By digital signal processing, sound samples with various types of subharmonics were synthesized and perceptually analyzed. Power and frequency of subharmonics in the synthesized sound also had significant relationships with the degree of roughness. Rough voice is acoustically characterized not only by jitter and shimmer but also by the presence of subharmonics in the power spectrum. Subharmonics are important acoustic properties for objective evaluation of rough voices.     

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 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.     

Objective Voice Quality Analysis Before and After Onset of Unilateral Vocal Fold Paralysis

This study was designed to investigate objective voice quality measurements in unilateral vocal fold paralysis (UVFP) by eliminating intersubject variability. To our knowledge this is the first report objectively analyzing paralytic dysphonia as compared to the same voice before onset of UVFP. The voices of two male subjects were prospectively recorded before and after the onset of iatrogenic UVFP (thoracic surgery).The following acoustic measurements of the vowel /a/ were performed using the CSL and MDVP (Kay Elemetrics): jitter, shimmer, harmonics-to-noise ratio, cepstral peak prominence, the relative energy levels of the first harmonic, the first formant and the third formant, the spectral slope in the low-frequency zone (0-1 kHz and 0-2 kHz), and the relative level of energy above 6 kHz. Distribution of spectral energy was analyzed from a long-term average spectrum of 40 seconds of text. Laryngeal aerodynamic measurements were obtained for one patient before and after onset of paralysis using the Aerophone II (Kay Elemetrics). Pitch and amplitude perturbation increased secondary to UVFP, while the harmonics-to-noise ratio and the cepstral peak prominence decreased. A relative increase in the mid-frequency and high-frequency ranges and a decrease in the low-frequency spectral slope were observed. Mean airflow rate and intraoral pressure increased, and glottal resistance and vocal efficiency decreased secondary to UVFP. The findings of this self-paired study confirm some but not all the results of previous studies. Measures involving the fundamental and the formants did not corroborate previous findings. Further investigation with vocal tract modeling is warranted.     

Polyps and paralysis phonation classification with nonlinear dynamics model

In order to provide the basis for parameter selection of vocal diseases classification,a nonlinear dynamic modeling method is proposed.A biomechanical model of vocal cords with polyp or paralysis,which couples to glottal airflow to produce laryngeal sound source,is introduced.And then the fundamental frequency and its perturbation parameters are solved.Poincare section and bifurcation diagram are applied to nonlinear analysis of model vibration.By changing the pathological parameters or subglottal pressure,the changes of fundamental frequency and Lyapunov exponents are analyzed.The simulation results show that,vocal cord paralysis reduces the fundamental frequency,and the chaos occurs only within a certain pressure range;while vocal cord with a polyp don't reduce the fundamental frequency,chaos distributes throughout the entire range of pressure.Therefore this study is helpful for classification of polyp and paralysis by the acoustic diagnoses.     

息肉与麻痹喉声源分类中非线性动力学发声系统模型研究

提出一种非线性动力学建模仿真发声系统,分类息肉和麻痹喉声源的方法,为声带疾病分类时参数选择提供了依据。首先介绍息肉和麻痹声带力学模型,耦合声门气流产生喉声源,求取喉声源频率(基频)、基频微扰;提出用庞加莱截面,分岔图对模型振动进行非线性分析;改变声带病理参数及声门下压,分析频率参数和混沌参数李雅普诺夫指数的变化。仿真实验结果表明,声带麻痹减小了发声基频,且只在一定压力范围内出现混沌振荡;息肉声带的混沌则分布在整个压力范围内。根据最大李雅普诺夫指数随声门下压变化的差异性分布,有助于识别并分类声带息肉和声带麻痹。     

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.     

A pitch-synchronous analysis of hoarseness in running speech

A method of pitch-synchronous acoustic analysis of hoarseness requiring a voice sample of only four fundamental periods is presented. This method calculates a noise-to-signal (N/S) ratio, which indicates the depth of valleys between harmonic peaks in the power spectrum. The spectrum is calculated pitch synchronously from a Fourier transform of the signal, windowed through a continuously variable Hanning window spanning exactly four fundamental periods. A two-stage procedure is used to determine the exact duration of the four fundamental periods. An initial estimate is obtained using autocorrelation in the time domain. A more precise estimate is obtained in the frequency domain by minimizing the errors between the preliminary calculated power spectrum and the predicted spectrum spread of a windowed harmonic signal. Analysis of synthesized voices showed that the N/S ratio is sensitive to additive noise, jitter, and shimmer, and is insensitive to slow (8 Hz) modulation in fundamental frequency and amplitude. An analysis of pre- and postoperative voices of six patients with benign laryngeal disease showed that the N/S ratio for vowel /u/ in running speech consistently improved after surgery for all subjects, in agreement with their successful therapeutic results.