The Voice Performance After Septoplasty With Surgical Efficacy Demonstrated Through Acoustic Rhinometry and Rhinomanometry

ObjectiveTo demonstrate the surgical efficacy of septoplasty using acoustic rhinometry (AR) and anterior rhinomanometry (ARM) and to evaluate the effect of septoplasty on voice performance through subjective voice analysis methods.Materials and MethodsThis prospective study enrolled a total of 62 patients who underwent septoplasty with the diagnosis of deviated nasal septum. Thirteen patients with no postoperative improvement versus preoperative period as shown by AR and/or ARM tests and three patients with postoperative complications and four patients who were lost to follow-up were excluded. As a result, a total of 42 patients were included in the study. Objective tests including AR, ARM, acoustic voice analysis and spectrographic analysis were performed before the surgery and at 1 month and 3 months after the surgery. Subjective measures included the Nasal Obstruction Symptom Evaluation questionnaire to evaluate surgical success and Voice Handicap Index-30 tool for assessment of voice performance postoperatively, both completed by all study patients.ResultsAmong acoustic voice analysis parameters, F0, jitter, Harmonics-to-Noise Ratio values as well as formant frequency (F1-F2-F3-F4) values did not show significant differences postoperatively in comparison to the preoperative period (P > 0.05). Only the shimmer value was statistically significantly reduced at 1 month (P < 0.05) and 3 months postoperatively (P < 0.05) versus baseline. Statistically significant reductions in Voice Handicap Index-30 scores were observed at postoperative 1 month (P < 0.001) and 3 months (P < 0.001) compared to the preoperative period and between postoperative 1 month and 3 months (P < 0.05).ConclusionIn this study, first operative success of septoplasty was demonstrated through objective tests and then objective voice analyses were performed to better evaluate the overall effect of septoplasty on voice performance. Shimmer value was found to be improved in the early and late postoperative periods.     

Predicting Mutational Change in the Speaking Voice of Boys

SUMMARY: The authors investigated whether acoustic speaking voice analyses can be used to predict the beginning of mutation in 21 male members of a professional boys' choir. Over a period of 3 years before mutation, children were examined every 3 months by ear, nose, and throat (ENT) and phoniatric specialists. At the same time, the voice was evaluated acoustically using analysis features of the Goettingen Hoarseness Diagram (GHD). Irregularity component and noise component, jitter, shimmer, mean waveform correlation coefficient, and fundamental frequency were determined from recordings of the speaking voice. Significant changes of acoustic features appeared 7 and 5 months before mutation onset, which indicates that vocal function is already restricted 6 months before mutation onset. This acoustic voice analysis is therefore suitable to support the care of the professional singing voice.     

Acoustic characteristics of children''s voice

Four acoustic measures were taken from voice recordings of 121 children between the ages of 64 and 134 months. Acoustic parameters were measured on a sustained neutral /a/ vowel, produced imitatively at normal pitch and loudness. Samples were analyzed for fundamental frequency, jitter, shimmer, and signal-to-noise ratio (SNR). Data are presented to characterize effects of age, sex, height, and weight on these acoustic parameters. Results indicate statistically significant relationships between frequency and sex, with higher frequencies for girls. Also significant is a positive relationship between shimmer and height and a negative relationship between SNR and height.     

Kinesio Taping Application in Dysphonic Singers

IntroductionKinesio Taping (KT) application in speech therapy has been studied in a few works about dysphonia, facial nerve palsy, sialorrhea, atypical deglutition, postsurgical recovery after thyroidectomy and laryngectomy. The aim of this study was the evaluation of the possible role of KT in supporting speech therapy in singers complaining of dysphonia using singing voice handicap index (SVHI), fundamental frequency (F0), shimmer, jitter and harmonic to noise ratio (mean H/N).Materials and methodsWe enrolled consecutive singers and singing students complaining of dysphonia and voice problems. Control group (DG1) was composed of 15 individuals who underwent traditional speech therapy only, while Case group (DG2), also composed of 15 subjects, underwent traditional speech therapy associated with KT application. A computerized voice analysis was conducted using PRAAT software observing F0, jitter, shimmer and mean H/N before (t1), at mid (t2) and after (t3) the treatment. Moreover, each patient filled in the SVHI before (t1) and after (t3) the complete speech therapy treatment.ResultsThe mean F0 and H/N measured before, during and after the logopedic treatment, showed a notable increase over time (P value <0.001) both for DG1 and DG2. However, no significant difference was found comparing the two groups. Jitter and Shimmer after treatment were clearly seen to be lower than before in both groups (P value <0.001), and followed a significantly different trend over time (P value <0.001). Moreover, unlike F0 and mean H/N, these parameters underwent a significantly greater decrease in DG2 compared to DG1. Lastly, SVHI improved at t₃ and although these reductions were clear in both groups, it was greater in DG2 than in DG1.Discussion and ConclusionsOur findings are encouraging and suggest the possibility of using KT in case of vocal pathologies in singers. It is imperative to underline that the tape does not replace speech therapy, but could possibly enhance the effects of the treatment.     

Effects of singing training on the speaking voice of voice majors

This longitudinal study gathered data with regard to the question: Does singing training have an effect on the speaking voice? Fourteen voice majors (12 females and two males; age range 17 to 20 years) were recorded once a semester for four consecutive semesters, while sustaining vowels and reading the "Rainbow Passage." Acoustic measures included speaking fundamental frequency (SFF) and sound pressure level (SLP). Perturbation measures included jitter, shimmer, and harmonic-to-noise ratio. Temporal measures included sentence, consonant, and diphthong durations. Results revealed that, as the number of semesters increased, the SFF increased while jitter and shimmer slightly decreased. Repeated measure analysis, however, indicated that none of the acoustic, temporal, or perturbation differences were statistically significant. These results confirm earlier cross-sectional studies that compared singers with nonsingers, in that singing training mostly affects the singing voice and rarely the speaking voice.     

Effects of simulated source of tremor on acoustic and airflow voice measures

To test the effects of different sources of tremor on the voice, tremor was simulated by external rhythmic perturbation of structures at the subglottal, glottal, and supraglottal levels in 10 healthy subjects. The acoustic and airflow signals simultaneously recorded during sustained phonation in the normal and the 3 simulated tremor conditions were analyzed and compared. Voice measures included: fundamental frequency, 2 short-term perturbation measures (jitter and shimmer), and 3 long-term tremor measures (prominence ratios of the spectral peaks of the acoustic frequency contour, acoustic amplitude contour, and airflow contour). Measures of fundamental frequency and percent shimmer were not significantly affected by the simulated tremors. Measures of percent jitter and the amplitudes of the long-term frequency and amplitude modulations were most prominently increased when respiratory drive was perturbed by simulated tremor. Spectral analysis of the acoustic amplitude contour was most useful in distinguishing the 3 sites of simulated tremor.     

The Influence of Auditory Feedback and Vocal Rehabilitation on Prelingual Hearing-Impaired Individuals Post Cochlear Implant

ObjectiveTo verify changes in the perceptual and acoustic vocal parameters in prelingual hearing-impaired adults with cochlear implants after vocal rehabilitation.HypothesisAuditory feedback restoration alone after cochlear implant is not enough for vocal adjustments. A targeted and specific voice therapy intervention is required.Study DesignProspective and pre–post repeated measures design.MethodsTwenty literate adults with severe to profound prelingual bilateral sensorineural hearing loss participated in the study; individuals were implanted late and were fluent users of oral language. Ages ranged from 17 to 48 years. All individuals presented normal results in laryngoscopy, and hearing thresholds with the cochlear implant were over 40 dB HL. Individuals were randomly distributed into two groups: Group 1 (treatment group) and Group 2 (control group), both with ten patients each, five men and five women, matching mean age and hearing deprivation time before the cochlear implantation. Patients from Group 1 underwent a protocol of vocal therapy including 12 individual sessions with the same clinician. Group 2 only underwent vocal recordings. The vocal recordings occurred before and after the participation in the therapy protocol for Group 1 and after the same period, 3 months later, without any intervention, for Group 2. The recording sessions used the Consensus Auditory-Perceptual Evaluation of Voice protocol sentence reading and emission of sustained vowel /a/. Auditory-perceptual evaluation of voices was performed by three judges, and the acoustical analysis used the Praat program.ResultsStatistically significant reductions in the overall vocal degree, vocal instability, and degree of resonance change were observed after vocal rehabilitation in Group 1. Statistically, individuals from Group 1 did not differ in regard to the modification of acoustic parameters. Group 2 did not present significant changes in any of the analyzed parameters.ConclusionsThe cochlear implanted adults submitted to vocal rehabilitation presented changes in the auditory-perceptual parameters, with reduction of the overall voice severity, vocal instability, and degree of resonance after vocal intervention. There were no changes in the acoustic parameters in the implanted prelingual hearing-impaired adult subjects.     

The effects of excessive vocalization on acoustic and videostroboscopic measures of vocal fold condition

Although dysphonia is a recognized consequence of acute vocal abuse, associated changes in vocal fold appearance and function are not well understood. To document these presumed effects of vocal abuse, audio recordings of sustained vowel production were obtained from 42 drill sergeants daily during the first 6 days of a vocally demanding training exercise. Acoustic analysis showed abnormal levels of jitter and shimmer on Day 1 in 16 of the 42 subjects. Considering only the 26 subjects who showed normal voice acoustics on Day 1, the median levels of jitter and shimmer varied little over the course of training, and significant increases in jitter and shimmer were not seen during the study period. However, the distributions for both jitter and shimmer became more positively skewed and showed a greater number of positive outliers over the course of training. This trend was attributed to 11 subjects who showed two or more instances of abnormal voice acoustics over Days 2 through 6. Laryngeal videostroboscopic recordings of sustained vowel production also were obtained prior to and following training. Perceptual ratings of these recordings by 2 observers revealed significant increases in vocal fold edema, erythema, and edge irregularity, and decreases in vocal fold mucosal wave and amplitude of excursion following the 5-day training period. In general, there was considerable intersubject variability in the extent of acoustic and videostroboscopic effects over the course of training. Of the two types of data, videostroboscopy appears to provide a more sensitive indication of the effects of excessive vocalization.     

Influence of Data Acquisition Environment on Accuracy of Acoustic Voice Quality Measurements

Accuracy of acoustic voice analysis is influenced by the quality of recording. Lately, articles have suggested that soundcards perform equivalently to specialized professional-grade data acquisition (DA) systems. The purpose of this study was to investigate the influence of DA environment (DA system and microphone) on acoustic voice quality measurement (VQM) while balancing for gender, age, intersubject and intrasubject variability, and analysis software. More specifically, the relative performance of different hardware environments and the relationship between their technical characteristics and VQM performance was investigated. The discretization error and the effective dynamic range of the different DA environments were measured. We used 3 software systems to record and measure separately 2000 acoustic samples of sustained phonation for fundamental frequency, jitter, and shimmer. Analyses of variance (ANOVA) were performed with these parameters as the dependent variables. The results of the study suggested that professional-grade DA hardware is strongly recommended to provide accurate and valid voice assessment. The fundamental frequency measurement differences across DA environments were highly correlated to the discretization error (r=1.00), whereas jitter and shimmer were highly correlated to the effective dynamic range of the DA environments (r=-0.68 and r=-0.86, respectively).     

Acoustic Analyses of Sustained and Running Voices From Patients With Laryngeal Pathologies

In this paper, we investigated the acoustic characteristics of sustained and running vowels from normal subjects and patients with laryngeal pathologies. Perturbation methods (including jitter and shimmer), signal-to-noise ratio (SNR), and nonlinear dynamic methods (such as correlation dimension and second-order entropy) were used to analyze sustained and running vowels. We found that the sustained vowels and running voices from normal subjects and patients with laryngeal pathologies had low-dimensional dynamic characteristics. For sustained vowels, the analyses of jitter, shimmer, correlation dimension, and second-order entropy revealed significant differences between normal and pathological voices. For running voices, jitter and shimmer did not statistically discriminate between normal and pathological voices, but a significant difference was found for SNR, correlation dimension, and second-order entropy. The results suggest that nonlinear dynamic analysis and traditional SNR analysis may be valuable for the analysis of sustained and running vowels; perturbation analysis may be applicable for the analysis of sustained vowels but should be applied with caution for running voice analysis.     

Acoustic Measures and Self-reports of Vocal Fatigue by Female Teachers

This study investigated the relation of symptoms of vocal fatigue to acoustic variables reflecting type of voice production and the effects of vocal loading. Seventy-nine female primary school teachers volunteered as subjects. Before and after a working day, (1) a 1-minute text reading sample was recorded at habitual loudness and loudly (as in large classroom), (2) a prolonged phonation on [a:] was recorded at habitual speaking pitch and loudness, and (3) a questionnaire about voice quality, ease, or difficulty of phonation and tiredness of throat was completed. The samples were analyzed for average fundamental frequency (F0), sound pressure level (SPL), and phonation type reflecting alpha ratio (SPL [1-5 kHz]-SPL [50 Hz-1 kHz]). The vowel samples were additionally analyzed for perturbation (jitter and shimmer). After a working day, F0, SPL, and alpha ratio were higher, jitter and shimmer values were lower, and more tiredness of throat was reported. The average levels of the acoustic parameters did not correlate with the symptoms. Increase in jitter and mean F0 in loud reading correlated with tiredness of throat. The results seem to suggest that, at least among experienced vocal professionals, voice production type had little relevance from the point of view of vocal fatigue reported. Differences in the acoustic parameters after a vocally loading working day mainly seem to reflect increased muscle activity as a consequence of vocal loading.     

Objective acoustic voice-quality parameters in the computer phonetogram

A phonetogram is a plot of the dynamic range of the voice as a function of fundamental frequency. Traditionally, the phonetogram only records the sound-pressure level (SPL) of the threshold of phonation and the upper limit in SPL the voice can reach with sustained phonation as a function of the fundamental frequency (F₀). In this study, the phonetogram is extended by including acoustic voice-quality parameters. Three additional parameters are tested: jitter, shimmer, and crest factor. For each individual voice, the variation in the three parameters is evaluated over the entire phonetogram area. By averaging individual phonetograms, standard or norm phonetograms are obtained revealing general patterns in voice-quality variation. These patterns reflect the complex relations between F₀, SPL, and the acoustic voice-quality parameters just mentioned. Jitter and shimmer distributions over the phonetogram show that large variations in perturbation values can be expected when production conditions are altered. Highest perturbation values are found for the low F₀ and low SPL phonations. For all voices, a gradual decrease of the crest factor is found with increasing F₀, reflecting the degrading of spectral complexity with F₀. The crest-factor parameter can also be used to mark those areas in the phonetogram where the fundamental dominates the waveform and where flow control is the main SPL regulating mechanism in voice production. The strong quality variations within the phonetogram stress the need for accurate control of F₀ and SPL in objective voice-quality measurement.     

Acoustic characteristics of rough voice: Subharmonics

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

Perceptual and Acoustic Characteristics of Voice Changes in Reflux Laryngitis Patients

The aim of the study was to outline the multidimensional perceptual, subjective, and instrumental acoustic voice changes in the group of reflux laryngitis (RL) patients. Data of multidimensional voice assessment of 108 RL patients and 90 healthy persons of the control group were subjected to comparative analysis. A slight hoarseness according to the GRB (G-grade, R- rough, B-breathy) scale was prevailing in the RL patients group. Statistically significant difference (P < 0.001) between RL patients group and the control group was found of all voice parameters measured, with the patients having worse results--increased mean jitter, shimmer, normalized noise energy, voice handicap index (VHI), and decreased parameters of phonetogram. The results of the study demonstrated that multidimensional voice assessment documented deteriorated voice quality and restricted phonation capabilities in the tested group of RL patients.     

Work-Related Communicative Profile of Voice Teachers: Effects of Classroom Noise on Voice and Hearing Abilities

PurposeVocal instructors during their normal workday are exposed to high noise levels that can affect their voice and hearing health. The goal of this study was to evaluate the voice and hearing status of voice instructors before and after lessons and relate these evaluations with voice and noise dosimetry taken during lessons.MethodsEight voice instructors volunteered to participate in the study. The protocol included (1) questionnaires, (2) pre/post assessment of voice quality and hearing status, and (3) voice and noise dosimetry during lessons. Acoustic measurements were taken of the unoccupied classrooms.ResultsIn six of eight classrooms, the measured noise level was higher than the safety recommendations set by National Institute for Occupational Safety and Health. The background noise level and the reverberation time in the classrooms were in compliance with the national standard recommendations. We did not find a clear pattern comparing pre- and post-measurements of voice quality consistent among genders. In all subjects, the Sound Pressure Levels mean increased, and the standard deviation of fundamental frequency decreased indicating association to vocal fatigue. Previous studies link these changes to increasing vocal fatigue. The audiometric results revealed seven out of eight instructors have sensorineural hearing loss.ConclusionsThe interaction of the acoustic space and noise levels can contribute to the development of hearing and voice disorders for voice instructors. If supported by larger sample size, the results of this pilot study could justify the need for a hearing and voice conservation program for music faculty.     

Towards the Objective Speech Assessment of Smoking Status based on Voice Features: A Review of the Literature

Background and ObjectiveIn smoking cessation clinical research and practice, objective validation of self-reported smoking status is crucial for ensuring the reliability of the primary outcome, that is, smoking abstinence. Speech signals convey important information about a speaker, such as age, gender, body size, emotional state, and health state. We investigated (1) if smoking could measurably alter voice features, (2) if smoking cessation could lead to changes in voice, and therefore (3) if the voice-based smoking status assessment has the potential to be used as an objective smoking cessation validation method.MethodsA systematic review of the scientific literature was conducted to compile studies on smoking status assessment based on voice features. We searched nine scientific databases for original studies involving the effects of smoking on voice features, the effects of smoking cessation on voice features.ResultsA total of 34 studies were identified for review. We found that fundamental frequency, jitter, shimmer, harmonics to noise ratio, and other voice features are affected by smoking and could be used to assess smoking status.ConclusionSpeech assessment of smoking status based on voice features has potential as a smoking status validation method, as it is simple, reliable, and less time-consuming. Furthermore, this study provides recommendations for future research on the objective speech assessment of smoking status based on voice features.     

Comparisons of jitter, shimmer, and signal-to-noise ratio from directly digitized versus taped voice samples

The purpose of this study was to compare jitter, shimmer, and signal-to-noise ratio (SNR) measures obtained from tape-recorded samples with the same measures made on directly digitized voice samples, with use of the CSpeech acoustic analysis program. Subjects included 30 young women who phonated the vowel /a/ at a comfortable pitch and loudness level. Voice samples were simultaneously recorded and digitized, and the resulting perturbation measures for the two conditions were compared. Results indicated that there were small but statistically significant differences between percent jitter, percent shimmer, and SNR calculated from taped samples compared with the same measures calculated from directly digitized samples. It was concluded that direct digitization for clinical measures of vocal perturbation was most desirable, but that taped samples could be used, if necessary, with some caution.     

Acoustic voice analysis in patients with essential tremor

To quantify several acoustic features of the voice in patients with essentialtremor (ET), 28 patients and 28 age- and sex-matched controls were studied. ET severity was assessed with the rating scale for tremor of Fahn, Tolosa, and Marín. The Computerized Speech Lab 4300 program (Kay Elemetrics) was used. Two-second samples of a sustained /a/ and a sentence were captured with a microphone and laryngograph equipment. Measures included fundamental frequency (F₀), frequency perturbation (fitter, Koike algorithm), intensity perturbation (shimmer, Horii algorithm), and harmonic-to-noise ratio (H/N, Yumoto algorithm) of the vowel /a/, and the frequency and intensity variability of the sentence, phonational range, and dynamic range at the natural frequency, maximum phonational time, and s/z ratio. All subjects underwent indirect laryngoscopy and/or laryngeal fibroscopy. When compared with controls, ET patients showed higher jitter, lower H/N ratio (the last one only with laryngographic signal), of the vowel /a/, lower frequency variability in the microphonc signal, lower intensity variability in the laryngographic signal of the sentence, and significantly lower dynamic range at natural frequency of phonation. ET patients reported higher frequency of the presence of high voice intensity, tremor, and struggle. Several acoustic parameters were influenced by the severity of the disease, including shimmer, jitter, H/N ratio, frequency variability of the sentence, and s/z ratio, although neither of the acoustic analysis values or the phonetometric measurements were affected by the presence of voice tremor or by a successful pharmacological treatment of ET.     

Effects of head extension and tongue protrusion on voice perturbation measures

Head extension with protruded tongue is the position for video-laryngoscopy and simultaneous glottographic recordings including photoglottographic signals. This study investigated the effect of head extension and tongue protrusion on the measures of fundamental frequency, frequency perturbation (jitter), and amplitude perturbation (shimmer). Acoustic signals recorded during sustained vowels were obtained from 49 women and 66 men with no speech or voice disorders in different head-tongue positions. Head extension was associated with increased fundamental frequency and decreased shimmer. In men, head extension did not appear to affect jitter. When the tongue was protruded, head extension tended to lower jitter. For both genders, tongue protrusion was associated with decreased fundamental frequency with head extension. In the men, tongue protrusion tended to increase shimmer when the head was in the neutral position. In the women, tongue protrusion was associated with increased jitter and increased shimmer and was most evident in the head-neutral position. These findings supported a physical linkage hypothesis of the relationship between vocal tract configuration and vocal fold vibration, suggesting that head-tongue position must be taken into account when comparing voice measures.