Physical Appearance and Voice in Male-To-Female Transsexuals

It has been suggested that sex judgments of male-to-female transsexuals based on the voice may be influenced by the physical appearance of the clients. To explore this hypothesis, a listener experiment was designed in which a panel of 22 laypersons and 22 students in speech-language pathology rated the “femaleness” of fourteen male-to-female transsexuals from video-recorded speech samples in three modes of presentation: auditory-only presentation, visual-only presentation, and audiovisual presentation. Results indicate that appearance and voice are indeed interacting factors. Ratings from the auditory-only presentation were significantly lower than ratings from the audiovisual presentation and ratings from the visual-only presentation were significantly higher than those from the audiovisual presentation. It follows that the success of voice training in male-to-female transsexuals is not solely dependent on vocal characteristics and that speech pathologists should consider incorporating physical appearance as a treatment and outcome variable in the voice training of male-to-female transsexuals.     

Feminine after cricothyroid approximation?

A number of studies have evaluated the effectiveness of a cricothyroid approximation (CA) in creating a more female voice in male-to-female transsexuals (MFTs) from an acoustic perspective. An increase in pitch is of little value, however, unless it accurately indicates listeners' perceptions of gender. The purpose of this study was to further investigate the effectiveness of a CA in feminizing the voice from a perceptual perspective. Video recordings of nine MFTs, nine nontranssexual males (NTMs), and nine nontranssexual females (NTFs) were presented twice to the panel of judges in a randomized order: first auditory only (only hearing a subject's speech) and subsequently audiovisual (hearing and seeing a subject's speech). The panel of judges, 42 students (21 female, 21 male) from different disciplines, rated the participants' voices on a 100-mm visual analog scale with "very male" and "very female" as left and right extremes, respectively. The group of MFT obtained scores that were situated in between those of the NTM and the NTF, both for the auditory only and the audiovisual mode of presentation. Perception of femaleness significantly correlated with average fundamental frequency for both modes of presentation. It can be concluded that a CA approximation is a viable option to raise the voice pitch in MFTs but that this surgery alone may not be sufficient to create a voice that is perceived as a totally female.     

The effect of visual and auditory cues on seat preference in an opera theater

Opera performance conveys both visual and auditory information to an audience, and so opera theaters should be evaluated in both domains. This study investigates the effect of static visual and auditory cues on seat preference in an opera theater. Acoustical parameters were measured and visibility was analyzed for nine seats. Subjective assessments for visual-only, auditory-only, and auditory-visual preferences for these seat positions were made through paired-comparison tests. In the cases of visual-only and auditory-only subjective evaluations, preference judgment tests on a rating scale were also employed. Visual stimuli were based on still photographs, and auditory stimuli were based on binaural impulse responses convolved with a solo tenor recording. For the visual-only experiment, preference is predicted well by measurements taken related to the angle of seats from the theater midline at the center of the stage, the size of the photographed stage view, the visual obstruction, and the distance from the stage. Sound pressure level was the dominant predictor of auditory preference in the auditory-only experiment. In the cross-modal experiments, both auditory and visual preferences were shown to contribute to overall impression, but auditory cues were more influential than the static visual cues. The results show that both a positive visual-only or a positive auditory-only evaluations positively contribute to the assessments of seat quality.     

Perceptual evaluations of voice scatter in unison choir sounds

The preferences of experienced listeners for pitch and formant frequency dispersion in unison choir sounds were explored using synthesized stimuli. Two types of dispersion were investigated: (a) pitch scatter, which arises when voices in an ensemble exhibit small differences in mean fundamental frequency, and (b) spectral smear, defined as such dispersion of formants 3 to 5 as arises from differences in vocal tract length. Each stimulus represented a choir section of five bass, tenor, alto, or soprano voices, producing the vowel [u], [a], or [w]. Subjects chose one dispersion level out of six available, selecting the “maximum tolerable” in a first run and the “preferred” in a second run. The listeners were very different in their tolerance for dispersion. Typical scatter choices were 14 cent standard deviation for “tolerable” and 0 or 5 cent for “preferred.” The smear choices were less consistent; the standard deviations were 12 and 7%, respectively. In all modes of assessment, the largest dispersion was chosen for the vowel [u] on a bass tone. There was a vowel effect on the smear choices. The effects of voice category were not significant.     

Comfortable effort level revisited

The purpose of this study was to measure the variability of frequency and intensity of speech, using multiple voice samples obtained over a period of time at a speaker's “comfortable effort level.” Variability in vocal output within and across several experimental sessions was assessed from measures of speaking fundamental frequency (SFF) and vocal intensity for utterances repeated three times a day over a 3-day period. Three distinct age groups of men and women—young, middle-aged and elderly—repeated the vowel /a/, read a standard passage, and spoke extemporaneously during each experimental session. Results indicated that variability in SFF and intensity were present across experimental sessions, age groups, gender, and speaking samples. Generally, group means indicated that ±1 semitone of variability for SFF and 2 db sound pressure level (SPL) variation in vocal intensity from any one experimental session to the next could be expected; individual variations within any group may reach two semitones and 6 db SPL.     

The importance of the voice in male-to-female transsexualism.

Transsexuality is a complex, permanent transposition involving a paradoxical feeling of belonging to the opposite sex. Furthermore, in the case of male-to-female transsexuals, the unchanged male voice, which is at odds with the female outward appearance, poses a serious obstacle to full social integration of the woman. One way of permanently raising the fundamental frequency, requiring little effort, is modified cricothyroidopexy via miniplates, which has been used in our hospital since 1993 following a technique developed by Isshiki (thyroplasty type IV). Until now, this operation has been performed on 67 female patients. To record the anatomical-morphological and functional data, preoperatively, post-operatively, and a year after the operation, a detailed voice diagnosis was made, laryngoscopy was carried out, X-rays were taken, and computer-assisted tomography was used to examine the larynx. Thus far, the functional results have been good. On average, the fundamental frequency has been raised by about one fourth. Whereas none of the female patients had a female-speaking voice before the operation, after the operation, about 30% of the patients' voices were in the female range, and 32% had at least a neutral-sounding voice.     

Preliminary study of two methods of treatment for laryngeal nodules

To date, a limited number of formal studies have assessed the efficacy of voice therapy for laryngeal nodules. The present study represents a preliminary stage of inquiry in a series of planned studies on this topic. Thirteen women with nodules participated as paid subjects. Some subjects received “confidential voice therapy,” some received “resonant voice therapy,” and some received no therapy (control condition) over a period of 2 weeks. Pre- and post-therapy measures of phonatory effort, auditory-perceptual status of voice, and laryngeal appearance provided evidence of a benefit from therapy. Baseline measures were then repeated 2 weeks after therapy was terminated. The final results indicated that, for auditory-perceptual and phonatory effort measures, the likelihood of benefiting from therapy directly covaried with compliance scores (reflecting the reported extraclinical utilization of the therapy technique), but not with therapy type (confidential vs. resonant voice therapy). At this level, the results point to the importance of assessing not only therapy type but also compliance in future, larger studies. A series of other positive and negative factors in the present research design were identified based on the results. These should be considered in future studies.     

Phonetographic profiles and F0-SPL characteristics of untrained versus trained vocal groups

The phonetogram has been recommended as an international tool for voice analysis. However, the capability of this technique to distinguish between different vocal groups has not been clearly established. The purpose of this study was to examine untrained versus trained vocalists using the phonetogram and the fundamental frequency by intensity (F₀/SPL) information derived through that method. In this study, “musical” or “controlled” ranges of phonation were stressed rather than “physiological” ranges. Results indicated that (a) characteristic phonetographic profiles may be established for untrained versus trained vocalists, and (b) trained vocalists show significantly increased capability in terms of F₀ range and maximum, minimum, and comfortable SPL production. Elicitation of “controlled” phonations may be the key to revealing the underlying vocal capabilities of seemingly different vocal groups.     

Voice Source Characteristics in Mongolian “Throat Singing” Studied with High-Speed Imaging Technique, Acoustic Spectra, and Inverse Filtering

Mongolian “throat singing” can be performed in different modes. In Mongolia, the bass-type is called Kargyraa. The voice source in bass-type throat singing was studied in one male singer. The subject alternated between modal voice and the throat singing mode. Vocal fold vibrations were observed with high-speed photography, using a computerized recording system. The spectral characteristics of the sound signal were analyzed. Kymographic image data were compared to the sound signal and flow inverse filtering data from the same singer were obtained on a separate occasion. It was found that the vocal folds vibrated at the same frequency throughout both modes of singing. During throat singing the ventricular folds vibrated with complete but short closures at half the frequency of the true vocal folds, covering every second vocal fold closure. Kymographic data confirmed the findings. The spectrum contained added subharmonics compared to modal voice. In the inverse filtered signal the amplitude of every second airflow pulse was considerably lowered. The ventricular folds appeared to modulate the sound by reducing the glottal flow of every other vocal fold vibratory cycle.     

G. Paul Moore lecture: Rational thought: The impact of voice science upon voice care

Recent evolution in scientific knowledge and technology has led to monumental improvement in the standard of care for patients with voice disorders. New concepts in anatomy, physiology, measurement, and analysis have provided voice care professionals with not merely better understanding, but moreover an extensive vocabulary with which to think about voice function and dysfunction. Previously, we had to depend too much upon anecdote and “the art of medicine.” Thanks to scientific advances, we now have the tools we need for rational thought about the human voice. This is the fundamental change responsible for recent great advances in voice care.     

A critical view of the yawn-sigh as a voice therapy technique

The purpose of this study was to take a critical look at a voice therapy technique known as the yawn-sigh. The voiced sigh as an approach in voice therapy has had increased use in recent years, particularly with problems of vocal hyperfunction. In this study, the physiology of the yawn-sigh was studied with video nasoendoscopy in eight normal subjects; their taped voices were also studied acoustically for possible fundamental frequency and formant changes in producing selected vowels under normal and sigh conditions. Although each subject was given a model by the examiner of a yawn-sigh, one of the eight subjects could not produce a true yawn-sigh. Endoscopic findings for seven of the eight subjects performing the yawn-sigh demonstrated retracted elevation of the tongue, a lower positioning of the larynx, and a widened pharynx. Acoustic analyses for the seven subjects producing the sigh found a marked lowering of the second and third formants. Implications for using the yawn-sigh in voice therapy are given, such as using a modified “silent” yawn-sigh, as an easy method for producing greater vocal tract relaxation.     

What is “Twang”?

A single female professional vocal artist and pedagogue sang examples of “twang” and neutral voice quality, which a panel of experts classified, in almost complete agreement with the singer's intentions. Subglottal pressure was measured as the oral pressure during the occlusion during the syllable /pae/. This pressure tended to be higher in “twang,” whereas the sound pressure level (SPL) was invariably higher. Voice source properties and formant frequencies were analyzed by inverse filtering. In “twang,” as compared with neutral, the closed quotient was greater, the pulse amplitude and the fundamental were weaker, and the normalized amplitude tended to be lower, whereas formants 1 and 2 were higher and 3 and 5 were lower. The formant differences, which appeared to be the main cause of the SPL differences, were more important than the source differences for the perception of “twanginess.” As resonatory effects occur independently of the voice source, the formant frequencies in “twang” may reflect a vocal strategy that is advantageous from the point of view of vocal hygiene.     

Integration efficiency for speech perception within and across sensory modalities by normal-hearing and hearing-impaired individuals

In face-to-face speech communication, the listener extracts and integrates information from the acoustic and optic speech signals. Integration occurs within the auditory modality (i.e., across the acoustic frequency spectrum) and across sensory modalities (i.e., across the acoustic and optic signals). The difficulties experienced by some hearing-impaired listeners in understanding speech could be attributed to losses in the extraction of speech information, the integration of speech cues, or both. The present study evaluated the ability of normal-hearing and hearing-impaired listeners to integrate speech information within and across sensory modalities in order to determine the degree to which integration efficiency may be a factor in the performance of hearing-impaired listeners. Auditory-visual nonsense syllables consisting of eighteen medial consonants surrounded by the vowel [a] were processed into four nonoverlapping acoustic filter bands between 300 and 6000 Hz. A variety of one, two, three, and four filter-band combinations were presented for identification in auditory-only and auditory-visual conditions: A visual-only condition was also included. Integration efficiency was evaluated using a model of optimal integration. Results showed that normal-hearing and hearing-impaired listeners integrated information across the auditory and visual sensory modalities with a high degree of efficiency, independent of differences in auditory capabilities. However, across-frequency integration for auditory-only input was less efficient for hearing-impaired listeners. These individuals exhibited particular difficulty extracting information from the highest frequency band (4762-6000 Hz) when speech information was presented concurrently in the next lower-frequency band (1890-2381 Hz). Results suggest that integration of speech information within the auditory modality, but not across auditory and visual modalities, affects speech understanding in hearing-impaired listeners.     

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.     

Gender presentation: Perceptual and acoustical analysesof voice

This study investigated the perceptual and acoustical characteristicsof vocal presentation in both the masculine and the feminine modes by the same group of male subjects. Listeners (N = 88) evaluated 22 voice samples by using 18 semantic differential scales and 57 adjectives. The 22 voice samples were provided by I I biologically male speakers, who described themselves as heterosexual crossdressers. Each speaker read a standard passage under controlled conditions. In one reading, they demonstrated their typical masculine voice and in the other they spoke in their feminine voice. Acoustical analyses included mean fundamental frequency, frequency range, overall passage duration, and duration of a sample of stressed vowels. Results indicated that listeners heard significant differences between masculine and feminine presentations across the I I speakers and the 18 semantic differential scales. Masculine-feminine and high-low pitch were the most salient scales in the perceptual judgments. Acoustical analyses indicated wide variation according to speaker and condition. Clinical applications are provided.     

The Effectiveness of Oral Resonance Therapy on the Perception of Femininity of Voice in Male-to-Female Transsexuals

Ten male-to-female transsexuals participated in five sessions of oral resonance voice therapy targeting lip spreading and forward tongue carriage. Acoustic analysis of recordings made pre- and posttherapy found that participant formant frequency values (F1, F2, and F3, from the vowels /a/, /i/, and /mho/), as well as fundamental frequency (F0), underwent a general increase posttherapy. F3 values, in particular, increased significantly posttreatment. Trends in listener ratings of these recordings showed that the majority of participants were perceived to sound more feminine following treatment. Participants' self-ratings of their voices pre- and posttreatment also indicated that participants perceived their voices as sounding more feminine and that they were more satisfied with their voices following treatment. The present study supports the findings of previous studies that have demonstrated that resonance characteristics in male-to-female transsexuals can be changed to more closely approximate those of females through oral resonance therapy. This intervention study also demonstrates that a spontaneous increase in F0 is achieved during the course of therapy. Further, this study provides preliminary evidence to suggest that oral resonance therapy may be effective in increasing femininity of voice in male-to-female transsexual clients.     

Associations of Speaking-Voice Parameters With Personality and Behavior in School-Aged Children

ObjectivesPrevious studies suggest a link between voice disorders and personality traits. However, nearly nothing is known about the relationship between personality and voice parameters in healthy children. The present study investigated associations between children's personality and the intensity and frequency of their speaking voice.Study DesignThis is a cross-sectional analysis.MethodsThe study participants included 871 German children aged from 7 to 14 who had not yet experienced voice change in puberty. Within the framework of the LIFE Child study, all participants were asked to perform a speaking-voice task at four different intensity levels (quietest, conversational, presentation, and shouting voice). Associations of fundamental frequency and voice intensity with children's personality and behavioral strengths and difficulties (assessed using parent-reported questionnaires) were estimated using multiple linear regression analyses.ResultsWith respect to children's personality, the analyses revealed significant positive associations between speaking-voice intensity and extraversion (eg, for the conversational voice, β = 0.16, P < 0.001) as well as significant negative associations between voice intensity and emotional stability (eg, for the shouting voice, β = −0.15, P = 0.004) and conscientiousness (for the shouting voice, β = −0.10, P = 0.033). Regarding behavioral strengths and difficulties, we observed significant positive associations between voice intensity and peer-relationship problems (eg, for the conversational voice, β = 0.14, P = 0.001) and prosocial behavior (for the conversational voice, β = 0.11, P = 0.015). In contrast, no significant association was found between speaking fundamental frequency and personality or behavioral difficulties/strengths.ConclusionsIn children, associations exist between a child's speaking-voice intensity and his or her personality, especially extraversion and emotional stability, and behavioral characteristics.     

“Compensatory falsetto”: Effects on vocal quality

The term “compensatory falsetto”, for the purpose of this investigation, refers to the development of an abnormally high-pitched voice in the presence of laryngeal pathology where more socially acceptable lower pitched voice production is possible. The purpose of this investigation was to compare laryngeal compensations and their effects on objective measures of vocal function during production of compensatory falsetto voice. Eighteen patients with abnormally high-pitched voice in the presence of underlying laryngeal pathology were evaluated in the Department of Otolaryngology at the University of Miami School of Medicine from January 1988 through December 1992 and were diagnosed with “compensatory falsetto”. Vocal fold paralysis (n = 11) was the most common laryngeal pathology. Vibratory characteristics were evaluated through videostrobolaryngoscopic examination. Acoustic and aerodynamic parameters assessed included fundamental frequency, jitter rate, harmonic-to-noise ratio, glottal air flow, and maximum phonation time. Production of a higher-pitched voice appeared to improve glottic closure and decrease the amount of air loss during phonation. A corresponding increase in maximum phonation time and improvement in acoustic characteristics of jitter and harmonic-to-noise ratio was also observed.     

Fragments of a Greek Trilogy: impact on phonation

This study documents the vocal characteristics of an actor before and after a series of eight performances involving extended voice use. The hypothesis was that this type of extended voice use would result in symptoms of vocal abuse and that damage to the actor's voice would be evident in measures made after the performance series. Three pre-performance and three post-performance speech samples were gathered and analyzed using the CSL and Visipitch II. Measurements taken included maximum phonational range; maximum sustained phonation; fundamental frequency during reading; maximum intensity levels; sound pressure levels for soft, moderate, and loud productions of sustained /a/; and perturbation including jitter, shimmer, harmonics-to-noise ratio, and an s/z ratio. Pre- and post-performance samples of the “Rainbow passage” and sustained vowel phonation were rated by a group of blinded listeners that included professional voice trainers and speech pathologists. In addition, sample lines from the performance were played for the listeners to judge whether this technique would result in symptoms of vocal abuse. Eleven out of 12 professional voice trainers rated that this technique would result in symptoms of vocal abuse. The data revealed post-performance improvement in phonational range, maximum intensity levels, perturbation measures, and s/z ratio. Measures of maximum sustained phonation, fundamental frequency, and sound pressure levels remained stable. Videoendoscopy revealed normal function of the larynx and vocal folds.