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1.
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2.
Objective
A core component of vocal hygiene programs is the avoidance of agents that may dry the vocal folds. Clinicians commonly recommend that individuals reduce caffeine intake because of its presumed dehydrating effects on the voice. However, there is little evidence that ingestion of caffeine is detrimental to voice production. The first objective of this study was to evaluate whether caffeine adversely affects voice production. The second objective was to evaluate if caffeine exacerbates the adverse phonatory effects of vocal loading.Study Design
Prospective, double-blinded, sham-controlled study.Methods
Sixteen healthy adults participated in two sessions where they consumed caffeine (caffeine concentration = 480 mg) or sham (caffeine concentration = 24 mg) beverages. Voice measures (phonation threshold pressure and perceived phonatory effort) were collected. Subjects then completed a vocal loading challenge and voice measures were obtained again.Results
There were no significant differences in voice measures between the caffeine and sham conditions. Ingestion of caffeine did not adversely affect voice production (P > 0.05) or exacerbate the detrimental phonatory effects of vocal loading (P > 0.05).Conclusions
Our findings contribute to emerging knowledge on the effects of caffeine on voice production. Recommendations to completely eliminate caffeine from the diet, as a component of a vocal hygiene program, should be evaluated on an individual basis. 相似文献3.
Maysa Tibério Ubrig Maria Valéria S. Goffi-Gomez Raimar Weber Márcia H. Moreira Menezes Nair Kátia Nemr Domingos Hiroshi Tsuji Robinson Koji Tsuji 《Journal of voice》2011,25(6):692-699
Objectives
To ascertain whether cochlear implantation (CI), without specific vocal rehabilitation, is associated with changes in perceptual and acoustic vocal parameters in adults with severe to profound postlingual deafness.Hypothesis
Merely restoring auditory feedback could allow the individual to make necessary adjustments in vocal pattern.Study Design
Prospective and longitudinal.Methods
The experimental group composed of 40 postlingually deaf adults (20 males and 20 females) with no previous laryngeal or voice disorders. Participants’ voices were recorded before CI and 6–9 months after CI. To check for chance modifications between two evaluations, a control group of 12 postlingually deaf adults, six male and six female, without CI was also evaluated. All sessions composed of the recording of read sentences from Consensus Auditory-Perceptual Evaluation of Voice and sustained vowel /a/. Auditory and acoustic analyses were then conducted.Results
We found a statistically significant reduction in overall severity, strain, loudness, and instability in auditory analysis. In vocal acoustic analysis, we found statistically significant reduction fundamental frequency (F0) values (in male participants) and F0 variability (in both genders). The control group showed no statistically significant changes in most vocal parameters assessed, apart from pitch and F0 (in female participants only). On comparing the interval of variation of results between the experimental and control groups, we found no statistically significant difference in vocal parameters between CI recipients and nonrecipients, with the exception of F0 variability in male participants.Conclusions
The patients in our sample showed changes in overall severity, strain, loudness, and instability values, and reductions in F0 and its variability. On comparing the variation of results between the groups, we were able to prove in our study that implant recipients postlingually deaf adults (experimental group), without specific vocal rehabilitation, differed from nonrecipients (control group) in loudness and F0 variability sustained vowel /a/ in male participants. 相似文献4.
Claudio Storck Raphael Gehrer Claude Fischer Markus Wolfensberger Flurin Honegger Gerhard Friedrich Markus Gugatschka 《Journal of voice》2011,25(5):632-637
Objectives/Hypothesis
Cricothyroid approximation (CTA) surgery aims at raising the voice pitch in male-to-female transsexuals. However, 30% of the patients are not satisfied with the result. The purpose of our study was to examine the cricothyroid joint (CTJ) biomechanics and to analyze if (and how) the CTJ anatomy influences the movement of the cricoid and, consequently, the elongation of the vocal fold and the voice pitch after CTA.Methods
Twenty-four cadaver larynges were examined with high-resolution computerized tomography and MIMICS three-dimensional imaging software (Materialise Interactive Medical Image Control System, Leuven, Belgium). After superimposing the two scans taken in “neutral” and in “CTA” positions, vector geometrical analysis was used to determine the effective rotation axis of the CTJ and to calculate the elongation of the vocal folds after CTA.Results
Our results showed that the cricoid rotates around an axis, the position of which depends on the anatomical structure of the CTJ. Based on the location of this effective rotation axis, we could distinguish three groups. In group I (N = 13), the rotation axis was located in the lower third; in group II (N = 5), it was located in the middle third; and in group III (N = 6), it was located in the upper third of the cricoid. The elongations of the vocal fold were 12%, 8%, and 3%, in groups I, II, and III, respectively.Conclusions
The anatomical structure of the CTJ influences directly (1) the position of the effective rotation axis and (2) the elongation of the vocal folds. 相似文献5.
Evelyne Van Houtte Sofie Claeys Floris Wuyts Kristiane Van Lierde 《Journal of voice》2011,25(5):570-575
Objectives
Teachers are at increased risk for developing voice disorders. Occupational risk factors have been extensively examined; however, little attention has been paid to the consequences of the vocal complaints. The objective of this study was to investigate the knowledge that teachers have about vocal care, treatment-seeking behavior, and voice-related absenteeism.Methods
The study group comprised 994 teachers and 290 controls whose jobs did not involve vocal effort. All participants completed a questionnaire inquiring about vocal complaints, treatment-seeking behavior, voice-related absenteeism, and knowledge about vocal care. Comparisons were made between teachers with and without vocal complaints and with the control group.Results
Teachers reported significantly more voice problems than the control population (51.2% vs 27.4%) (χ2 = 50.45, df = 1, P < 0.001). Female teachers reported significantly higher levels of voice disorders than their male colleagues (38% vs 13.2%, χ2 = 22.34, df = 1, P < 0.001). Teachers (25.4%) sought medical care and eventually 20.6% had missed at least 1 day of work because of voice problems. Female teachers were significantly more likely to seek medical help (χ2 = 7.24, df = 1, P = 0.007) and to stay at home (χ2 = 7.10, df = 1, P = 0.008) in comparison with their male colleagues. Only 13.5% of all teachers received information during their education.Conclusions
Voice disorders have an impact on teachers' personal and professional life and imply a major financial burden for society. A substantial number of teachers needed medical help and was obligated to stay at home because of voice problems. This study strongly recommends the implementation of vocal education during the training of teacher students to prepare the vocal professional user. 相似文献6.
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7.
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8.
Kristiane M. Van Lierde Sophia De Ley Gregory Clement Marc De Bodt Paul Van Cauwenberge 《Journal of voice》2004,18(4):467-474
A relatively new management strategy for the treatment of voice disorders is the use of laryngeal manual therapy. The main purpose of the present pilot study is to document the outcome of vocal quality after a well-defined laryngeal manual therapy (LMT) program. Four Dutch professional voice users with a persistent moderate or severe muscle tension dysphonia were studied pretreatment (1 week before LMT) and posttreatment (1 week) after completion of manual therapy (25 sessions). These subjects had received several months of traditional voice therapy, without any success. To measure and compare, the effect of LMT objective and subjective assessment techniques were used. Perceptual voice assessment included a perceptual rating of the voice using the GRBAS scale. Furthermore, the vocal quality in this population was modeled by means of the Dysphonia Severity Index (DSI). All of the subjects selected for LMT showed improvement in perceptual vocal quality and DSI values. As the DSI is a weighted variable including aerodynamic and acoustic measures, small improvements (closer to 5) are very indicative of vocal quality improvement.1 The use of LMT in professional voice users with persistent moderate-to-severe muscle tension dysphonia, especially in some subjects who have not responded to traditional voice therapy, is supported by this pilot study. 相似文献
9.
10.
《Journal of voice》2019,33(6):948.e23-948.e29
PurposeThe Dysphonia Severity Index (DSI) is an objective multiparameter index of voice quality that measures and describes overall voice quality. Some studies have suggested that the reliability of devices for DSI measurement should be examined. We explored the feasibility of DSI measurements using the Dr. Speech (DRS) device, verified its effectiveness for clinical voice measurements and intradevice reliability, and examined the correlation between the DSI and self-evaluations of voice problems.MethodsSeventy adult participants (including individuals with voice problems and healthy adults) underwent objective and subjective voice assessments. These data were then used to establish a DSIDRS model and test the intradevice (DRS device and Praat software) reliability. The clinical validation of the DSIDRS was conducted by measuring the DSI of six other participants and comparing the observed and predicted perceived voice quality as expressed by the G score (of the GRBAS scale). Moreover, the relationship between the DSI measurements and participants’ self-evaluations of voice problems was investigated by analyzing the correlation between the DSI and the Voice Handicap Index (VHI).ResultsThe DSIDRS discriminated 80% of participants’ voice quality ratings. There were strong correlations between the DSI and variables measured by the DRS device and Praat software. Furthermore, there was no significant correlation between the DSIDRS and VHI.ConclusionThe DRS device can perform DSI measurements. Objective voice measurements and perceptual voice ratings reflected different aspects of vocal function and its effects. These factors should be considered in clinical practice settings. 相似文献
11.
The main purpose of the present study was to examine the vocal quality and to investigate the effects of gender on vocal quality in 28 children with a unilateral or bilateral cleft palate. In this study, the vocal quality was determined using videolaryngostroboscopic and perceptual evaluations, aerodynamic, voice range, acoustic, and dysphonia severity index (DSI) measurements. The DSI is based on the weighted combination of four voice measurements and ranges from +5 to -5 for, respectively, normal and severely dysphonic voices. Additional objectives were to compare the vocal quality characteristics of children with cleft palate with the available normative data and to investigate the impact of the cleft type on vocal quality. Gender-related vocal quality differences were found. The male cleft palate children showed an overall vocal quality of +0.62 with the presence of a perceptual slight grade of hoarseness and roughness. The female vocal quality had a DSI value of +2.4 reflecting a perceptually normal voice. Irrespective of the type of cleft, all subjects demonstrated a significantly lower DSI-value in comparison with the available normative data. The results of the present study have provided valuable insights into the vocal quality characteristics of cleft palate children. 相似文献
12.
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13.
Cara E. Stepp James T. Heaton Tara K. Stadelman-Cohen Maia N. Braden Marie E. Jetté Robert E. Hillman 《Journal of voice》2011,25(6):714-724
Purpose
The goals of this study were to determine if there were significant differences between singers and nonsingers in the morphology of vocal nodules and the associated impact on vocal function.Method
Participants were 10 professionally trained singers with nodules, eight nonsingers with nodules, and 10 individuals with healthy normal voice (controls). Surface electromyography (sEMG) from three anterior neck locations and acoustic rise times for vowels /a/ and /i/ were measured in all the participants. In individuals with nodules, dB SPL/cm H2O, glottal airflow, and nodule location and size were also measured.Results
There were no significant differences between singers and nonsingers with nodules in terms of airflow, dB SPL/cm H2O, nodule size, or nodule location. In nonsingers with nodules, airflow and nodule size were significantly correlated, but were not significantly correlated in singers. Vowel rise times and sEMG during vocal tasks did not differentiate among nodule and control groups. Sternocleidomastoid sEMG during initiation of the vowel /a/ was statistically significantly stronger in nonsingers with nodules relative to singers with nodules and controls.Conclusions
Nodule morphology did not differ between singers and nonsingers, although some behavioral aspects of phonation differed between the groups. 相似文献14.
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15.
Objective
To investigate the common stereotype that homosexual males show pitch patterns that mirror those of heterosexual females.Study Design
Static group comparison.Method
Comparison of speaking fundamental frequency and pitch variation of 30 homosexual males, 56 heterosexual age-matched males, and 54 age-matched heterosexual females as demonstrated in a sample of read speech.Results
In the homosexual males, average fundamental frequency and pitch variation were significantly higher than in the heterosexual males but also significantly lower than in the heterosexual females.Conclusions
Results do not confirm the stereotype that gay male speech mirrors the patterns of women’s speech with respect to pitch characteristics. It would seem that the pitch patterns of gay male speakers constitute an example of sociophonetic variation. 相似文献16.
Michael S. Benninger 《Journal of voice》2011,25(6):653-656
Objective
The purpose of this study was to evaluate the levels of evidence in the voice literature.Study Design
Retrospective literature review.Methods
Retrospective review of all original articles published between January 2004 and December 2009 from four general otolaryngology journals and one subspecialty voice journal. All abstracts related to voice were evaluated and rated as to evidence-based medicine rating, graded levels A–D and 1a–5. Articles were also stratified by time over two consecutive 3-year intervals to assess changes over the time period.Results
Of the 6052 articles published, 950 (15.6%) were related to voice. Six hundred seventy-three articles (10.2%) were clinical articles, and 277 (4.6%) were basic science. Only 1% of the clinical articles were level A, 17% were level B, 73% were level C, and 9% were level D. No noticeable changes occurred in the levels of evidence over the interval of the first 3 years of the study in comparison to the last 3 years, although there was an increase in the number of basic science articles from 24.4% to 32.4%.Conclusion
Despite strong recent interest in improving the quality of the evidence in the literature, the voice literature remains primarily level C and D with no appreciable change over the past 6 years. 相似文献17.
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18.
Kristiane M. Van Lierde Bart Vinck Sofia De Ley Gregory Clement Paul Van Cauwenberge 《Journal of voice》2005,19(4):511-518
The main purpose of this study was to determine the vocal quality characteristics among the 45 monozygotic cotwins (MT). As the performance of the voice is related to several genetically determined anatomical and physiological factors, the authors hypothesized that the vocal characteristics and the overall vocal quality by means of the Dysphonia Severity Index (DSI) will be identical in MT. An additional objective of this study was to determine whether sex and age influence vocal similarities in MT and to compare the voice characteristics of MT with the normative data of unrelated peers. As more environmental factors influence the aging of the voice, age-related differences were expected. No sex-related differences were expected. Subjective and objective assessment techniques determined the vocal quality. No significant differences were obtained, and most comparisons resulted in significant correlation coefficients. For the acoustic parameters jitter and shimmer only, no significant correlation coefficients could be obtained. It is clear that the perceptual voice characteristics, the laryngeal aerodynamic measurements of maximum phonation time (MPT), the vocal performances, and the overall vocal quality by means of the DSI are similar in MT. These vocal characteristics are not influenced either by the subjects' age or sex and are situated within the normative range of unrelated peers. To what extent other aspects (environment, anxiety, tension, etc) might play a role in the acoustical dimensions regarding frequency and amplitude perturbation, which were in the normal range, is a subject of further research. 相似文献
19.
Leonie A. Menke Theo C.J. Sas Sophie H.L. van Koningsbrugge Maria A.J. de Ridder Gladys R.J. Zandwijken Bart Boersma Philippe H. Dejonckere Sabine M.P.F. de Muinck Keizer-Schrama Barto J. Otten Jan M. Wit 《Journal of voice》2011,25(5):602-610
Objectives/Hypothesis
Oxandrolone (Ox) increases height gain but may also cause voice deepening in growth hormone (GH)-treated girls with Turner syndrome (TS). We assessed the effect of Ox on objective and subjective speaking voice frequency in GH-treated girls with TS.Study Design
A multicenter, randomized, placebo (Pl)-controlled, double-blind study was conducted.Methods
One hundred thirty-three patients were included and treated with GH (1.33 mg/m2/d) from baseline, combined with Pl or Ox in a low (0.03 mg/kg/d) or conventional (0.06 mg/kg/d) dose from the age of 8 years and estrogens from the age of 12 years. Yearly from starting Ox/Pl until 6 months after discontinuing GH + Ox/Pl, voices were recorded and questionnaires were completed.Results
At start, mean (±standard deviation [SD]) voice frequency SD score (SDS) was high for age (1.0 ± 1.2, P < 0.001) but normal for height. Compared with GH + Pl, voices tended to lower on GH + Ox 0.03 (P = 0.09) and significantly lowered on GH + Ox 0.06 (P = 0.007). At the last measurement, voice frequency SDS was still relatively high in GH + Pl group (0.6 ± 0.7, P = 0.002) but similar to healthy girls in both GH + Ox groups. Voice frequency became lower than −2 SDS in one patient (3%) on GH + Ox 0.03 and three patients (11%) on GH + Ox 0.06. The percentage of patients reporting subjective voice deepening was similar between the dosage groups.Conclusions
Untreated girls with TS have relatively high-pitched voices. The addition of Ox to GH decreases voice frequency in a dose-dependent way. Although most voice frequencies remain within the normal range, they may occasionally become lower than −2 SDS, especially on GH + Ox 0.06 mg/kg/d. 相似文献20.
Rosiane Yamasaki Mara Behlau Osíris de Oliveira Camponês do Brasil Hélio Yamashita 《Journal of voice》2011,25(6):743-750