Glottic Characteristics and Voice Complaint in the Elderly

This study evaluated the relationship between voice complaint and deviant vocal fold status with special regard to presbylarynx, in patients aged more than 60 years, with pharyngeal-laryngeal complaint. The material consisted of clinical histories and images obtained by laryngoscopies from protocols from the Larynx Institute-INLAR, Sao Paulo, Brazil, of 210 patients, 88 men and 122 women, aged more than 60 years, who had sought otorhinolaryngologic treatment. Indicative glottic characteristics of the presbylarynx, such as vocal fold bowing, prominence of vocal processes, and spindle-shaped glottic chink, were analyzed. The increase in mass, leukoplakia, and other vocal fold alterations, distinct from these two, grouped as miscellaneous, as well as the presence or absence of voice complaint were also analyzed. Vocal fold bowing, prominence of vocal processes, and spindle-shaped glottic chink showed a strong correlation among each other. The presence of presbylarynx was accompanied by less voice complaint than the presence of vocal fold mucosa alterations, which in turn are more common where an absence of presbylarynx exists.     

Communicative Suitability of Voice Following Radiotherapy for T1 Glottic Carcinoma: Testing the Reliability of a Rating Instrument

The objective of the study was to determine whether a communicative suitability rating instrument could be used in a meaningful way to assess functionality of voice following radiotherapy for T1 glottic cancer. Seventeen naive listeners judged the suitability of voice of a patient group with T1 glottic carcinoma (n = 20) just before treatment, a group of patients (n = 40) after radiotherapy, and a matched control group (n = 20) of normal speakers. Listeners rated suitability on a 10-point scale for 10 speaking situations, which supposedly make different demands. In order to validate scores on communicative suitability, ratings were related to perceptual voice quality evaluations and videolaryngostroboscopic evaluations. Results indicate that the concept of measuring listener judgments of communicative suitability of voice is basically sound. Raters are reliable and can discriminate between groups of normal and pathological voices. Patients with T1 glottic carcinoma (assessed before the start of treatment) have on average the least suitable voices. Following radiotherapy suitability is, on average, improved, but does not approach the suitability of normal voices. Ratings on communicative suitability were clearly related to perceptual voice quality aspects and videolaryngostroboscopic evaluations. A subset of three communicative suitability rating scales is recommended as part of the protocol for evaluating voice outcome after radiotherapy for early glottic cancer, besides perceptual evaluation of voice quality by trained and naive raters, videolaryngostroboscopy, acoustical analyses, and self-ratings of vocal performance.     

Objective Voice Quality Analysis Before and After Onset of Unilateral Vocal Fold Paralysis

This study was designed to investigate objective voice quality measurements in unilateral vocal fold paralysis (UVFP) by eliminating intersubject variability. To our knowledge this is the first report objectively analyzing paralytic dysphonia as compared to the same voice before onset of UVFP. The voices of two male subjects were prospectively recorded before and after the onset of iatrogenic UVFP (thoracic surgery).The following acoustic measurements of the vowel /a/ were performed using the CSL and MDVP (Kay Elemetrics): jitter, shimmer, harmonics-to-noise ratio, cepstral peak prominence, the relative energy levels of the first harmonic, the first formant and the third formant, the spectral slope in the low-frequency zone (0-1 kHz and 0-2 kHz), and the relative level of energy above 6 kHz. Distribution of spectral energy was analyzed from a long-term average spectrum of 40 seconds of text. Laryngeal aerodynamic measurements were obtained for one patient before and after onset of paralysis using the Aerophone II (Kay Elemetrics). Pitch and amplitude perturbation increased secondary to UVFP, while the harmonics-to-noise ratio and the cepstral peak prominence decreased. A relative increase in the mid-frequency and high-frequency ranges and a decrease in the low-frequency spectral slope were observed. Mean airflow rate and intraoral pressure increased, and glottal resistance and vocal efficiency decreased secondary to UVFP. The findings of this self-paired study confirm some but not all the results of previous studies. Measures involving the fundamental and the formants did not corroborate previous findings. Further investigation with vocal tract modeling is warranted.     

Acoustic Analysis of Voice Quality with or without False Vocal Fold Displacement After Cordectomy

Conventional cordectomy by means of a laryngofissure is one of the therapeutic options for treatment of early glottic cancer. To improve the poor voice quality related to this kind of operation, many authors have developed different techniques to repair the mucosal defect. We analyzed voice quality acoustically and compared it after cordectomy alone and after cordectomy with the reconstruction of the vocal cord in a group of 14 patients affected by T1 glottic carcinoma. All the patients underwent postoperative speech therapy. Three patients who underwent cordectomy with reconstruction showed the presence of diplophonia, while two patients without reconstruction showed the presence of bitonality. The differences of the acoustic parameters (jitter, shimmer, harmonic-to-noise ratio) between the two groups of patients were not statistically significant. Reconstruction of the vocal cord does not seem to improve voice quality after cordectomy even in combination with postoperative speech therapy.     

Dimensionality in Voice Quality

This study concerns speaking voice quality in a group of male teachers (n = 35) and male actors (n = 36), as the purpose was to investigate normal and supranormal voices. The goal was the development of a method of valid perceptual evaluation for normal to supranormal and resonant voices. The voices (text reading at two loudness levels) had been evaluated by 10 listeners, for 15 vocal characteristics using VA scales. In this investigation, the results of an exploratory factor analysis of the vocal characteristics used in this method are presented, reflecting four dimensions of major importance for normal and supranormal voices. Special emphasis is placed on the effects on voice quality of a change in the loudness variable, as two loudness levels are studied. Furthermore, the vocal characteristics Sonority and Ringing voice quality are paid special attention, as the essence of the term "resonant voice" was a basic issue throughout a doctoral dissertation where this study was included.