Vocal Range and Intensity in Actors: A Studio Versus Stage Comparison

A voice range profile (VRP) was obtained from each of eight professional actors and compared with two speech range profiles (SRPs). One speech profile was obtained during the dramatic reading of a scene in the laboratory and the other during a performance on stage in a professional theater. The objective was to determine the pitch and loudness ranges used by the actors in speech relative to the VRP. The principal question of interest was whether the actors stayed within the center of the VRP, or whether they tended to drift toward the boundaries of intensity and frequency. A second question was whether the performance within the laboratory accurately reflects that of a stage performance. The results suggest that some subjects tend to exceed the center of the VRP during the stage performance. It is hypothesized that these actors may stress their vocal mechanism during performance and are more likely candidates for vocal injury.     

Pitch-raising surgery in male-to-female transsexuals

Several surgical methods for pitch raising have been described such as cricothyroid approximation, anterior commissure advancement, scarification, and injection of triamcinolone into the vocal folds. These procedures have different disadvantages and risks. A new method for pitch raising via endolaryngeal shortening of the vocal folds is presented. Long-term results of the first 10 patients are presented. In 1 person, who smoked immediately after surgery, coughed, and did not observe voice rest, there was a dehiscent suture. In 9 transsexuals after surgery the voice range was reduced for the lower frequencies, and a permanent 9.2-semitone increase of the mean, spontaneous fundamental frequency was obtained.     

Reliability of Speaking and Maximum Voice Range Measures in Screening for Dysphonia

Speech range profile (SRP) is a graphical display of frequency-intensity occurring interactions during functional speech activity. Few studies have suggested the potential clinical applications of SRP. However, these studies are limited to qualitative case comparisons and vocally healthy participants. The present study aimed to examine the effects of voice disorders on speaking and maximum voice ranges in a group of vocally untrained women. It also aimed to examine whether voice limit measures derived from SRP were as sensitive as those derived from voice range profile (VRP) in distinguishing dysphonic from healthy voices. Ninety dysphonic women with laryngeal pathologies and 35 women with normal voices, who served as controls, participated in this study. Each subject recorded a VRP for her physiological vocal limits. In addition, each subject read aloud the "North Wind and the Sun" passage to record SRP. All the recordings were captured and analyzed by Soundswell's computerized real-time phonetogram Phog 1.0 (Hitech Development AB, T?by, Sweden). The SRPs and the VRPs were compared between the two groups of subjects. Univariate analysis results demonstrated that individual SRP measures were less sensitive than the corresponding VRP measures in discriminating dysphonic from normal voices. However, stepwise logistic regression analyses revealed that the combination of only two SRP measures was almost as effective as a combination of three VRP measures in predicting the presence of dysphonia (overall prediction accuracy: 93.6% for SRP vs 96.0% for VRP). These results suggest that in a busy clinic where quick voice screening results are desirable, SRP can be an acceptable alternate procedure to VRP.     

The effect of uvulopalatopharyngoplasty on the nasality of voice

We prospectively studied the effect of uvulopalatopharyngoplasty (UPPP) on several speech and vocal parameters in 15 patients. Preoperative, 1-month postoperative, and 6-month postoperative assessments were made. Specific parameters included maximum phonation time, mean speaking fundamental frequency, mean frequency perturbation, intensity, and nasalance. Psychoacoustic analysis included pitch, quality, rate, resonance, and loudness. The primary outcome measure was the nasality of voice. At the 1-month postoperative assessment, one patient exhibited mild hypernasality by psychoacoustic analysis and a mildly elevated measured nasalance. At 6 months, both the psychoacoustic hypernasality and the measure nasalance had normalized. Consequently, no subjects exhibited hypernasality at the final assessment. Although abnormalities by psychoacoustic analysis were exhibited by 3 subjects at the 6-month postoperative assessment, none could be attributed to the surgery, but rather to concurrent illnesses. This study adds further data and support that UPPP done in standard fashion does not result in significant changes in voice either by measured parameters or by clinical assessment. Although this study does not obviate the need for preoperative counseling of patients about the potential effect of UPPP on voice, they can be counseled that the risk of hypernasality after UPPP is low.     

Vocal aging and the impact on daily life: a longitudinal study

Longitudinal studies on vocal aging are scarce, and information on the impact of age-related voice changes on daily life is lacking. This longitudinal study reports on age-related voice changes and the impact on daily life over a time period of 5 years on 11 healthy male speakers, age ranging from 50 to 81 years. All males completed a questionnaire on vocal performance in daily life, and perceptual and acoustical analyses of vocal quality and analyses of maximum performance tasks of vocal function (voice range profile) were performed. Results showed a significant deterioration of the acoustic voice signal as well as increased ratings on vocal roughness judged by experts after the time period of 5 years. An increase of self-reported voice instability and the tendency to avoid social parties supported these findings. Smoking males had a lower speaking fundamental frequency compared with nonsmoking males, and this seemed reversible for males who stop smoking. This study suggests a normal gradual vocal aging process with clear consequences in daily life, which should be taken into consideration in clinical practice as well as in studies concerning communication in social life.     

Acute and Subacute Awake Injection Laryngoplasty for Thoracic Surgery Patients

SUMMARY: The rehabilitation of glottic incompetence by injection laryngoplasty is important in the management of thoracic surgery patients with vocal cord paralysis. This group of patients presents special considerations that favor injection under local anesthesia. The objective of this study is to characterize our experience with this minimally invasive approach in both the acute and subacute settings. The study was conducted using a retrospective chart review. From a database of 108 patients who received awake percutaneous injection laryngoplasty over a 3-year period, 15 cases were identified that underwent augmentation shortly following thoracic surgery. These records were reviewed for patient demographics, clinical characteristics, complications, and short-term outcomes. Fifteen patients were identified (12 male, 3 female); the age range for the group was 18-91 years (median=55 years). All the patients reported vocal improvement following injection; all 15 also were improved by perceptual assessment. Five of six dysphagic patients improved following injection. One patient's injection was aborted due to vocal fold edema; no significant bleeding or airway embarrassment was observed. No procedures were terminated because of patient discomfort. Awake percutaneous injection laryngoplasty for vocal paralysis can be performed safely in the postoperative thoracic surgery patient. Swallowing and voice complaints were almost universally improved following treatment. For patients who cannot tolerate or choose not to have open thyroplasty or vocal fold injection under general anesthesia, this procedure may offer a safe and effective alternative.     

Acoustic Changes in Student Actors' Voices After 12 Months of Training

This study was to evaluate acoustic changes in student actors' voices after 12 months of actor training. The design used was a longitudinal study. Eighteen students enrolled in an Australian tertiary 3-year acting program (nine male and nine female) were assessed at the beginning of their acting course and again 12 months later using a questionnaire, interview, maximum phonation time (MPT), reading, spontaneous speaking, sustained phonation tasks, and a pitch range task. Samples were analyzed for MPT, fundamental frequency across tasks, pitch range for speaking and reading, singing pitch range, noise-to-harmonic ratio, shimmer, and jitter. After training, measures of shimmer significantly increased for both male and female participants. Female participants' pitch range significantly increased after training, with a significantly lower mean frequency for their lowest pitch. The finding of limited or negative changes for some measures indicate that further investigation is required into the long-term effects of actor voice training and which parameters of voicing are most targeted and valued in training. Particular investigation into the relationship between training targets and outcomes could more reliably inform acting programs about changes in teaching methodologies. Further research into the relationship between specific training techniques, physiological changes, and vocal changes may also provide information on implementing more evidence-based training methods.     

Voice characteristics, effects of voice therapy, and long-term follow-up of contact granuloma patients

This study evaluates the laryngoscopic findings and voice characteristics of male contact granuloma patients before and after voice therapy and at a follow-up about 9 years later. Pre- and posttherapy recordings as well as follow-up recordings were made for 19 granuloma patients. Pretherapy revealed the most salient perceptual voice characteristics were low pitch, monotony, and a high degree of vocal fry and hyperfunction. Interjudge reliability for these traits was high. Immediately following therapy the healed patients (n = 10) had a decrease in hyperfunction, vocal fry, and monotony, while the unhealed patients (n = 9) had an increase in hyperfunction and vocal fry decreased only marginally. Monotony decreased significantly in this group. As regards the acoustic analyses, no significant differences were found in mean fundamental frequency (F₀) or perturbation. At the follow-up assessment 4 patients had granuloma while 15 had normal laryngeal status. Perceptually their voice characteristics resembled those pretherapy independently of the laryngeal findings. The results suggest that reduced hyperfunction and decreased vocal fry may create better circumstances for the healing process at the posterior glottis.     

Tracking outcomes after phonosurgery for sulcus vocalis: a case report

Outcomes data after a surgical or behavioral intervention should be tracked until stability is reached. Often it is unclear how long patients should be followed and at what point an outcome can be considered stable. These issues have implications for treatment decision making, efficacy measurement, and the design of research studies. Vocal function data were collected 24 hours before and at 1, 6, and 12 months after phonosurgery for sulcus vocalis. One data series was collected daily during the first month after surgery, providing a unique opportunity to study voice changes in the immediate postoperative period. The different vocal function indices (acoustic, perceptual, videostroboscopic, aerodynamic, psychosocial) demonstrated a general pattern of improvement after intervention; however, they appeared to reach stability at different times. This report reinforces the value of following patients until complete outcome stability.     

Voice Therapy Outcome—A Randomized Clinical Trial Comparing Individual Voice Therapy,Therapy in Group,and Controls Without Therapy

ObjectiveA stumbling-block in voice therapy is how the patient will be able to apply the new voice technique in everyday life. Possibly this generalization process could be facilitated by giving voice therapy in group because of the natural forum for training voice-to-speech early in communication between the patients in a group setting. The aim of the study was to compare treatment results from individual voice therapy and voice therapy in group, at several time points and in comparison to patients with no voice therapy.MethodsA randomized treatment study was performed with 77 consecutive patients diagnosed with a functional voice disorder. Thirty-one patients were randomized to individual and group therapy, respectively, and 15 patients to no therapy. The assessments included standardized voice recording and registration of voice range profile (VRP), answering Voice handicap index (VHI) and visual analogue scales for self-hoarseness and self-vocal fatigue, and perceptual voice evaluation by speech-language pathologist. The assessments were performed before, direct after therapy, and three months later in all groups. The 2 therapy groups were also assessed 12 months after therapy.ResultsAll VHI scores as well as the self-ratings of hoarseness and vocal fatigue, and the perceptual evaluation of voice quality and maximum VRP improved significantly in both therapy groups 3 months after treatment and at 12 months follow-up. There were no significant changes in the control group, with the exception of decreased self-rated hoarseness and increased maximum VRP. Comparisons between treatment groups showed significant larger improvement after group therapy for VHI physical subscale at 12 months, as well as significant lower VHI total score at all measurement sessions and lower subscale scores at 12 months. There were no differences between treatment groups in self-hoarseness or self-vocal fatigue and no difference in perceptual voice quality or VRP. Comparison between controls and treatment groups showed significant larger change in treatment groups from baseline to three months in VHI total and to end of therapy in functional subscale. Treatment groups also showed significant lower scores than controls at each measurement session, for VHI total and physical subscale as well as lower degree of perceptual aberration of voice quality and vocal fatigue, at three months follow-up.ConclusionsThis study shows long-term improvement from behavioral voice therapy, particularly in a group setting. The results indicate the importance of early transfer-to-speech and late posttherapy test to capture whether the goal of voice therapy was fulfilled or not for the patients.     

Acoustic impedance of an artificially lengthened and constricted vocal tract

Voice training techniques often make use of exercises involving partial occlusion of the vocal tract, typically at the anterior part of the oral cavity or at the lips. In this study two techniques are investigated: a bilabial fricative and a small diameter hard-walled tube placed between the lips. Because the input acoustic impedance of the vocal tract is known to affect both the shaping of the glottal flow pulse and the vibrational pattern of the vocal folds, a study of the input impedance is an essential step in understanding the benefits of these two techniques. The input acoustic impedance of the vocal tract was investigated theoretically for cases of a vowel, bilabial occlusion (fully closed lips), a bilabial fricative, and artificially lengthening the tract with small diameter tubes. The results indicate that the tubes increase the input impedance in the range of the fundamental frequency of phonation by lowering the first formant frequency to nearly that of the bilabial occlusion (the lower bound on the first formant) while still allowing a continuous airflow. The bilabial fricative also has the effect of lowering the first formant frequency and increasing the low-frequency impedance, but not as effectively as the extension tubes.     

Voice quality after carbon dioxide laser and conventional surgery for T1A glottic carcinoma

The different types of small vocal fold tumor therapy allow the preservation of respiration and deglutition; the quality of phonation is the most important criterion for the patient. The aim of the study is to compare vocal function after treatment of T1a tumors by conventional and laser cordectomy. Fifty-seven male patients were included in the study: 27 underwent conventional cordectomy using an external approach, and 30 underwent an endoscopic microscopic laser cordectomy. Videolaryngoscopy was performed for each subject, and the maximal phonation time was measured. Spectrograms were recorded, and a perturbation analysis was performed if a clear harmonic structure was visible. Voices were perceptually rated by two experienced phoniatricians using the GRBAS scale. Even though a slightly better voice was found after conventional surgery throughout the data, no statistically significant difference was measured in the two groups. The data on voice outcome per se do not indicate the selection of one surgical approach over another.     

Performance Anxiety: Loss of the Spoken Edge

The study aimed to assess whether a specific training program in vocal and physical skills could reduce the level of perceived performance anxiety. Eighteen undergraduate performing arts students were divided into two even groups. The experimental group experienced 10 two-hour sessions in a specialized vocal and physical skills training program. The control group received the same number of sessions in text analysis by the same teacher. Ten weeks after the training period, both groups were videotaped delivering a short speech of general interest. The videotaped material was assessed by four judges, using a visual analog scale (VAS). Perceptual variables considered were eight vocal and physical features: physical ease, physical presence, effective gesture use, effective eye contact, correct breath use, suitable pace, vocal variety, speech clarity, and one performance feature: perceived performance anxiety. Results indicated that the particular vocal and physical skills training program used showed positive results in effectively reducing the level of perceived performance anxiety. The experimental group scored significantly higher on each of the eight vocal and physical features and significantly lower on the perceived anxiety feature than the control group. This research has implications for those affected by performance anxiety in vocal presentation.     

Unilateral recurrent laryngeal nerve paralysis:The importance of “preoperative” voice therapy

This preliminary retrospective study of 19 female patients and 22male patients with unilateral recurrent nerve lesions demonstrated the promise of objective measurements in predicting the need for surgery, the efficacy of voice therapy in ameliorating vocal symptoms, and the effects of therapy in conjunction with surgery. Sixty-eight percent (68%) of the female patients and 64% of the male patients did not elect to have surgery. Outcome satisfaction of nonsurgical and surgical patients appeared to be similar. The data from this study support the importance of preoperative therapy for patients with unilateral vocal fold paralysis.     

Correlation of VHI-10 to Voice Laboratory Measurements Across Five Common Voice Disorders

ObjectiveTo correlate change in Voice Handicap Index (VHI)-10 scores with corresponding voice laboratory measures across five voice disorders.Study DesignRetrospective study.MethodsOne hundred fifty patients aged >18 years with primary diagnosis of vocal fold lesions, primary muscle tension dysphonia-1, atrophy, unilateral vocal fold paralysis (UVFP), and scar. For each group, participants with the largest change in VHI-10 between two periods (T_A and T_B) were selected. The dates of the VHI-10 values were linked to corresponding acoustic/aerodynamic and audio-perceptual measures. Change in voice laboratory values were analyzed for correlation with each other and with VHI-10.ResultsVHI-10 scores were greater for patients with UVFP than other disorders. The only disorder-specific correlation between voice laboratory measure and VHI-10 was average phonatory airflow in speech for patients with UVFP. Average airflow in repeated phonemes was strongly correlated with average airflow in speech (r = 0.75). Acoustic measures did not significantly change between time points.ConclusionsThe lack of correlations between the VHI-10 change scores and voice laboratory measures may be due to differing constructs of each measure; namely, handicap versus physiological function. Presuming corroboration between these measures may be faulty. Average airflow in speech may be the most ecologically valid measure for patients with UVFP. Although aerodynamic measures changed between the time points, acoustic measures did not. Correlations to VHI-10 and change between time points may be found with other acoustic measures.     

Performance effects on the voices of 10 choral tenors: Acoustic and perceptual findings

Trained choral tenors performed a series of vocal tasks before and after a “live” performance. Acoustic (perturbation, harmonic-to-noise ratio, pitch and amplitude ranges) and perceptual analyses (auditory and proprioceptive/kinesthetic) were undertaken to detect changes from pre- to postperformance. Individuality of response to the performance was revealed, with the majority of subjects showing vocal deterioration after performance. The most sensitive vocal tasks were the comfortably pitched notes, high soft notes, and the bottom notes in scale singing. The most sensitive acoustic measure in detecting change from pre- to postperformance was harmonic-to-noise ratio. In contrast to the demonstrated acoustic changes, no significant differences in perceptual ratings were evident after the performance. Perceptual ratings did not reflect the acoustic analysis results. The present study highlights the need to establish further normative data for the singing voice and to consider individual differences in vocal characteristics in future studies of the singing voice.     

Quantitative assessment of voice quality following laser surgery for reinke''s edema

Although laser surgery has been widely advocated for use in the treatment of vocal fold papilloma because it does not incur bleeding, it has been questioned for use in treating Reinke's edema due to the possibility of heat dispersion to normal surrounding tissue and of scarring. We present a series of 8 cases in which laser surgery was the method of treatment for bilateral Reinke's edema. In each case, voice therapy was selected as the initial treatment; laser surgery was performed following voice therapy. Prior to and following surgery, videostroboscopic examinations were performed on the subjects. Only 4 subjects were available for assessment at the 1-month postoperative period. From the audio track of the videotape, the speaking fundamental frequency, perturbation measures for the vowel /i/, and noise-to-harmonic ratio of a completely voiced sentence were obtained. From the videostroboscopic recordings, the symmetry of the vocal folds, the presence or absence of the mucosal wave and the glottic closure pattern, prior to and after surgery, were judged independently by 3 examiners. The fundamental frequencies approximated the normal male and female ranges for those subjects seen 1 month after surgery. In addition, the noise-to-harmonic ratio and the relative average perturbation improved. Stroboscopy revealed irregularities in the symmetry of vocal folds, mucosal wave, and glottic closure 1 month after surgery.     

Normative Voice Range Profiles of Male and Female Professional Voice Users

Normative voice range profiles (VRP) are calculated for a group of male and female teachers, based on 43 and 46 recordings, respectively. All individuals had healthy voices. These normative VRPs contain 95% prediction intervals for both frequency and intensity. They are based on a series of mathematical transformations of the original individual VRPs in order to maintain in the normative VRPs the typical oval VRP shape, including the dip between modal and falsetto register. The normative VRPs presented are directly applicable in the clinical practice of otolaryngologists and speech-language pathologists.     

Acoustic and Perceptual Analyses of Brazilian Male Actors' and Nonactors' Voices: Long-term Average Spectrum and the “Actor's Formant”

SUMMARY: This study investigates the possible differences between actors' and nonactors' vocal projection strategies using acoustic and perceptual analyses. A total of 11 male actors and 10 male nonactors volunteered as subjects, reading an extended text sample in habitual, moderate, and loud levels. The samples were analyzed for sound pressure level (SPL), alpha ratio (difference between the average SPL of the 1-5kHz region and the average SPL of the 50Hz-1kHz region), fundamental frequency (F0), and long-term average spectrum (LTAS). Through LTAS, the mean frequency of the first formant (F1) range, the mean frequency of the "actor's formant," the level differences between the F1 frequency region and the F0 region (L1-L0), and the level differences between the strongest peak at 0-1kHz and that at 3-4kHz were measured. Eight voice specialists evaluated perceptually the degree of projection, loudness, and tension in the samples. The actors had a greater alpha ratio, stronger level of the "actor's formant" range, and a higher degree of perceived projection and loudness in all loudness levels. SPL, however, did not differ significantly between the actors and nonactors, and no differences were found in the mean formant frequencies ranges. The alpha ratio and the relative level of the "actor's formant" range seemed to be related to the degree of perceived loudness. From the physiological point of view, a more favorable glottal setting, providing a higher glottal closing speed, may be characteristic of these actors' projected voices. So, the projected voices, in this group of actors, were more related to the glottic source than to the resonance of the vocal tract.     

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.