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1.
Voice Handicap Index in singers 总被引:1,自引:0,他引:1
The Voice Handicap Index (VHI) was developed to assess patients' perception of the severity of their voice disorder. The purpose of this study was to determine the degree of handicap expressed by professional and recreational presenters with a voice complaint. Singers (n = 106) and nonsingers (n = 369) with voice symptoms were studied. The results of the VHI for singers indicate that singers score significantly lower (less severe) on the VHI compared to nonsingers. Singers with vocal fold nodules had a lower mean VHI than singers with vocal fold cysts or polyps. Singers who perform classical music had the lowest mean VHI of all types of singers studied. A low VHI in singers may represent a significant handicap and should not be ignored when considering the severity of a singer's voice problem. 相似文献
2.
Background
Spectrum is a fast Fourier transform-generated power spectrum extracted from the speech sample. It is reported to provide a quantitative acoustic index of the degree of glottal abduction and adduction in voices perceived to be breathy or pressed. In the present study, it was hypothesized that there would be abnormal reduction of higher harmonic amplitudes relative to the amplitude of the first harmonics in the subjects with vocal nodules and hence the present study was carried out.Method
One hundred twenty participants were divided into clinical group and control group. They were instructed to phonate /a/ at their most comfortable pitch and loudness. Fourier transformation of the recorded acoustic signal was first performed to create a spectrum. Amplitudes were measured for the first and second harmonics (H1 and H2) as well as the harmonics at the first, second, and third formants (A1, A2, and A3) using the Computerized Speech Science Lab (Kay Pentax, Lincoln, NJ).Results
There was a significant difference between the means of two groups for all the parameters, such as H1-H2, H1-A1, H1-A2, and H1-A3 at P < 0.05. The obtained results are discussed with respect to the underlying pathophysiology.Conclusions
The present study investigated the vowel harmonic amplitude differences in persons with vocal nodules. The results revealed a significant difference between the two groups for the vowel harmonic amplitude differences. This particular measure could be used to track the changes following the vocal treatment. 相似文献3.
Rosiane Yamasaki Mara Behlau Osíris de Oliveira Camponês do Brasil Hélio Yamashita 《Journal of voice》2011,25(6):743-750
Objective
To analyze the vocal tract morphometry of women with vocal nodules (VN) compared with normal subjects by means of magnetic resonance imaging (MRI) at rest position.Study Design
Prospective study.Methods
The present research included 20 young adult women, aged 18–40 years: 10 dysphonic patients with VN and 10 normal subjects. All participants were tested using MRI; 12 measurements of the vocal tract were performed: nine in median sagittal section and three in axial section.Results
The 12 measurements were smaller in the dysphonic group; statistical significance was obtained for three parameters: in the sagittal plane, the laryngeal vestibule area was significantly smaller in the dysphonic group, with P = 0.012∗ (∗ = statistical significance); in the axial section, the distance between the right and left vocal processes of the arytenoids’ cartilages and the distance between the anterior commissure of the glottis and the laryngeal posterior wall were also significantly lower in the dysphonic group, with P = 0.036∗ and 0.010∗, respectively. Significant differences in the vocal tract morphometry of individuals with VN were observed compared with normal subjects, at rest position.Conclusions
Results obtained from this study suggest that patients with VN may present a constantly increased tension of the laryngeal muscles, even at rest; moreover, reduced anterior-posterior dimension of the larynx may be a morphological characteristic of patients with VN. 相似文献4.
Maria McDonnell Johan Sundberg Joakim Westerlund Per-Åke Lindestad Hans Larsson 《Journal of voice》2011,25(5):526-531
Objectives/Hypotheses
Singers learn to produce well-controlled tone onsets by accurate synchronization of glottal adduction and buildup of subglottal pressure. Spectrographic analyses have shown that the higher spectrum partials are present also at the vowel onset in classically trained singers’ performances. Such partials are produced by a sharp discontinuity in the waveform of the transglottal airflow, presumably produced by vocal fold collision.Study Design
After hearing a prompt series of a triad pattern, six singer subjects sang the same triad pattern on the vowel /i/ (1) preceded by an aspirated /p/, (2) preceded by an unaspirated /p/, and (3) without any preceding consonant in staccato.Methods
Using high-speed imaging we examined the initiation of vocal fold vibration in aspirated and unaspirated productions of the consonant /p/ as well as in the staccato tones.Results
The number vibrations failing to produce vocal fold collision were significantly higher in the aspirated /p/ than in the unaspirated /p/ and in the staccato tones. High frequency ripple in the audio waveform was significantly delayed in the aspirated /p/.Conclusions
Initiation of vocal fold collision and the appearance of high-frequency ripple in the vowel /i/ are slightly delayed in aspirated productions of a preceding consonant /p/. 相似文献5.
Comparisons were made between 10 singers and 10 nonsingers with vocal nodules and two control groups of normals, 10 singers and 10 nonsingers, on a wide range of acoustic, aerodynamic, psychoacoustic, and videostroboscopic measures. Results showed significant differences between the normals and those with nodules as well as differences between the singers and nonsingers. The singers with nodules had smaller nodules, less impairment of vibratory function, and less severe vocal symptoms than their nonsinging counterparts. The singing normals were found to be superior to the nonsinging normals on acoustic measures including jitter, shimmer, and signal-to-noise ratio. In addition, the singers, even in the presence of nodules, had superior maximum performance skills than their nonsinging counterparts. 相似文献
6.
Thomas Murry 《Journal of voice》1990,4(4):317-321
The present study determined the accuracy and the effect of repeated trials for singers and nonsingers when matching their vocal fundamental frequency to a preset tone near the midpoint of their modal-loft phonational range. Two measures of accuracy were obtained for nine trials for five singers and five age-matched nonsingers: (a) the difference between the target frequency and the first measureable waveform, and (b) the difference between the target and the average of the first five measureable waveforms. The results indicate that singers are more accurate than nonsingers are in their ability to match the first measureable waveform and the mean of the first five measureable waveforms to targets presented aurally. In addition, singers as a group improved from the first three trials to the final three trials in accuracy for both measures, whereas the nonsingers did not demonstrate a group trend toward improvement. The results suggest that singers as a group may rely on their training or experience to perform a pitch-matching task superiorly to nonsingers. 相似文献
7.
Deborah Feij Andrade Reinhardt Heuer Neil E. Hockstein Eugnia Castro Joseph R. Spiegel Robert Thayer Sataloff 《Journal of voice》2000,14(2):240-246
Hard or abrupt glottal attack (HGA) is one of the vocal behaviors often associated with benign lesion of the vocal folds. This study was designed to determine whether the frequency of HGA was different in hyperfunctional voice patients with and without vocal fold masses. One hundred and forty-seven subjects were studied. All subjects received a complete otolaryngological evaluation including strobovideolaryngoscopy, objective voice measures, and evaluation by a speech-language pathologist. Thirty-two patients were diagnosed with muscle tension dysphonia (19 male, 13 female) without vocal fold masses. Fifty-seven patients were diagnosed with unilateral vocal fold masses (29 male, 28 female), most of which were cysts. Fifty-eight patients were diagnosed with bilateral vocal fold masses (13 male, 45 female). Of the 45 females with bilateral vocal fold masses. 26 had a vocal cyst and reactive nodule and 19 had bilateral vocal fold nodules. The control group was balanced and matched based on sex and on percentage of singers and nonsingers. It consisted of 49 subjects with no vocal fold pathology (20 male, 29 female). The group was composed of professional speakers, singers, and nonprofessional speakers. All voice disordered groups demonstrated higher frequencies of HGA than the control group. Differences were found between the male and female subjects in this study. No differences were found between the various disorders. Differences were also found between the subgroups of bilateral masses, where the bilateral nodules group presented a higher frequency of HGA than the cyst and contralateral reactive nodule. 相似文献
8.
Objective
Traditionally, glottic insufficiency because of scar, atrophy, and sulcus has been treated by injection or medialization laryngoplasty. These procedures do not reestablish the vertical height of the vocal fold margin. We propose soft tissue augmentation laryngoplasty with allograft (sheet Alloderm; LifeCell Corporation, Branchburg, NJ) or autograft (temporalis fascia) via a minithyrotomy or a transoral approach.Study Design
A retrospective case series analysis of 21 patients treated by sheet Alloderm or temporalis fascia for correction of glottic insufficiency.Methods
Twenty-one patients with glottic insufficiency secondary to scar, atrophy, or sulcus were treated. Ten failed prior techniques. Seventeen had minithyrotomy by a small fenestration in the thyroid cartilage. Exploration of scar or lamina propria through the fenestration allowed for the creation of a pocket for Alloderm implantation within the intermediate layer of the lamina propria. Four patients underwent a transoral approach by cordotomy with either Alloderm or temporalis fascia implantation, which also allowed for exploration of scar but required repair using sutures. These implantation approaches allowed for both restoration of the layered structure and augmentation of the middle third of the musculomembranous vocal fold. Preoperative and postoperative videostroboscopic examinations were reviewed with review of clinical outcome.Results
With a median follow-up time of 12 months, patients demonstrated excellent long-term vocal fold augmentation and minimal absorption of the implant in 19 out of 21 patients. There is improved pliability of the vocal fold with good oscillation in scar patients.Conclusion
Minithyrotomy with soft tissue augmentation is a novel approach for soft tissue augmentation of glottic insufficiency. It has the advantage of augmentation of the medial edge of the vocal fold with a soft tissue implant that has long-term viability. Its role should be explored further in patients with atrophy and scar. 相似文献9.
Nele Baudonck Evelien D'haeseleer Ingeborg Dhooge Kristiane Van Lierde 《Journal of voice》2011,25(6):683-691
Objectives
The purpose of this study was to determine the objective vocal quality in 36 prelingually deaf children using cochlear implant (CI) with a mean age of 9 years. An additional purpose was to compare the objective vocal quality of these 36 CI users with 25 age-matched children with prelingual severe hearing loss using conventional hearing aids (HAs) and 25 normal hearing (NH) children.Study Design
The design for this cross-sectional study was a multigroup posttest-only design.Methods
The objective vocal quality was measured by means of the dysphonia severity index (DSI). Moreover, perceptual voice assessment using the GRBASI scale was performed.Results
CI children have a vocal quality by means of the DSI of +1.8, corresponding with a DSI% of 68%, indicating a borderline vocal quality situated 2% above the limit of normality. The voice was perceptually characterized by the presence of a very slight grade of hoarseness, roughness, strained phonation, and higher pitch and intensity levels. No significant objective vocal quality differences were measured between the voices of the CI children, HA users, and NH children.Conclusions
According to the results, one aspect of the vocal approach in children with CI and using HAs must be focused on the improvement of the strained vocal characteristic and the use of a lower pitch and intensity level. 相似文献10.
Flavia Coelho de Souza Henrique Olival-Costa Leonardo da Silva Paulo A. Pontes Carmen Lúcia Penteado Lancellotti 《Journal of voice》2011,25(6):765-769
Hypothesis
The use of a material made of bacterial cellulose with the aim of obtaining vocal fold medialization has not hitherto been fully investigated. Although the material has been tested in other animal models, the evaluation did not include the larynx; hence, situations, such as tissue reaction, material absorption, and extrusion, need to be addressed to evaluate its usefulness as a material for laryngeal reconstruction.Objective
To evaluate the medialization, tissue response, and healing of rabbit vocal folds, after the implantation of a membrane of bacterial cellulose.Study Design
Experimental study.Methods
A total of 32 rabbits were used, two of which were used to check out the adequacy of the implant location. The animals were followed for 4 months and grouped according to follow-up times of 2, 4, and 16 weeks. All test animals received an implant of bacterial cellulose in one vocal fold and the injection of distilled water in the other, both performed by videoendoscopic cervicotomy. At the end of the follow-up, the presence of inflammatory and medial displacement was evaluated.Results
No statistically significant difference in the inflammatory parameters between the study and control vocal folds or among follow-up times was found. All animals receiving cellulose presented medial displacement of vocal folds, and all retained this material at the implant site up to study endpoint.Conclusion
Bacterial cellulose is a useful material for laryngeal medialization, showing no signs of rejection or absorption. 相似文献11.
A vocal health questionnaire was administered to three groups of professional singers and a “friendship-matched” group of nonsingers in Melbourne, Australia. The responses of 79 opera, 57 musical theatre and 31 contemporary (excluding rock) singers and 86 nonsingers were analysed. The questionnaire solicited information regarding biographical data speaking and singing voice-use behaviours, and vocal health over the previous 12 months in terms of experiences of vocal impairment, vocal disability, and handicap. Significant differences between singers and nonsingers in the prevalence and nature of voice problems were reported. Of the singers, 44% reported one or more occurrences of a diagnosed vocal condition compared to 21% of nonsingers and 69% of singers experienced vocal disability compared to only 41% of nonsingers, over the previous 12 months. In contrast, no significant differences were found between the three different styles of singers in their experience of vocal impairment, disability or handicap. 相似文献
12.
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. 相似文献
13.
Thomas R. Blaylock 《Journal of voice》1999,13(1):43-50
This investigation studied the effect of a systematized vocal warm-up procedure on voices with disorders. There were 4 subjects with voice disorders. To optimize vocal function a systematized vocal warm-up system was developed by the author for singers and nonsingers alike. Subjects were asked to practice the vocal warm-up exercises daily, with weekly monitoring in the studio. Data from independent raters and subjects' self-ratings were compared to and corroborated with computer analysis of audio samples. Results indicated significant improvement in subjects' voices that were increasingly maintained over time. 相似文献
14.
Karine Schwarz Carla Aparecida Cielo Nédio Steffen Jéfferson Becker Geraldo Pereira Jotz 《Journal of voice》2011,25(5):611-618
Aim
To describe the laryngeal configuration and the voice of male patients diagnosed with unilateral vocal fold paralysis (UVFP) before and after medialization.Methods
A retrospective study involving the collection of data from medical records of 142 patients diagnosed with UVFP from January 2003 to April 2009, submitted to auditory-perceptual assessment of voices and visual perception of laryngeal images before and after medialization.Results
The study included data from 24 male patients, with an average of 60.7 years, who underwent three surgical medialization techniques (injection of hyaluronic acid, type I thyroplasty, and injection of Teflon). Before treatment, the position of the paralyzed vocal fold was seen to have a significant influence to the passing of the healthy vocal fold beyond the midline and on the overall degree of dysphonia. After treatment, the complete glottic closure; the free margin of the linear vocal fold; paralyzed vocal fold in the median position, reduction of hoarseness, roughness and breathiness (more frequently mild), and asthenia (more frequently normal and mild); tension and instability (more frequency normal); and a decrease in the overall degree of dysphonia were found to be significant.Conclusion
The position of the paralyzed vocal fold influences the position of the healthy vocal fold in relation to the midline and the overall degree of dysphonia. All three treatments improved the glottic configuration and the voice of patients with UVFP. 相似文献15.
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. 相似文献16.
Paulo Sérgio Lins Perazzo Marcos André Sarvat Francisco de Souza Amorim Filho Paulo Augusto de Lima Pontes 《Journal of voice》2011,25(5):626-631
Objectives
To assess the integration of an autologous composite fascia and fat graft implanted into the lamina propria of a porcine vocal fold using two different approaches.Study Design
An experimental prospective study on the porcine larynx was conducted at a tertiary research institution.Methods
An external cervical approach was used to expose the thyroid cartilage of 24 healthy minipigs under general anesthesia. The composite fascia/fat graft was implanted through two distinct approaches, transmuscular and submuscular. Animals were sacrificed at 7, 30, 90, and 180 days for macroscopic and histological study of the larynx. Graft integration and local inflammatory response were studied.Results
The survival rate of the experimental model was 100% and all animals had local inflammatory response to the surgical procedure. Only 41.7% of the grafts placed inside the thyroarytenoid (TA) muscle fibers were identified postmortem, whereas 83.3% of the submuscular grafts remained intact.Conclusions
Graft incorporation was better and there was less inflammation when the architecture of the TA muscle fibers was preserved. Graft extrusion was observed in the most of the cases where it was placed inside the muscle. 相似文献17.
Patricia Gramming 《Journal of voice》1991,5(2)
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. 相似文献
18.
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. 相似文献19.
Elisabeth C. Inwald Michael Döllinger Maria Schuster Ulrich Eysholdt Christopher Bohr 《Journal of voice》2011,25(5):576-590
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. 相似文献20.
Patricia Gramming Johan Sundberg Sten Ternstrm Rolf Leanderson William H. Perkins 《Journal of voice》1988,2(2)
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. 相似文献