Laryngostroboscopic Evaluation After Supracricoid Partial Laryngectomy

BACKGROUND: Supracricoid partial laryngectomy (SCPL) results in laryngeal preservation in more than 95% of patients with T2 glottic carcinoma. Postsurgical glottic function is characterized by an absence of vocal cords, and phonation quality is a key post-SCPL quality-of-life factor. OBJECTIVE: This investigation was designed to enhance post-SCPL vocal function, study anatomic function of the post-SCPL larynx, and correlate anatomic findings with perceptual and instrumented measurements of voice. METHOD: Twenty-five patients were included. All had undergone SCPL with cricoepiglottopexy for T2 glottic carcinoma. All patients were evaluated by laryngostroboscopic examination, voice sample recording, and instrumented voice analysis with the aim of gaining further insight into postoperative larynx function. Laryngostroboscopic parameters such as laryngeal occlusion, epiglottic length, arytenoid movement, and vibratory area were assessed. The perceptual evaluation was based on the GRBAS scale. Acoustic and aerodynamic parameters were recorded, including fundamental frequency (F0), intensity, jitter, shimmer, signal-to-noise ratio (SNR), oral airflow (OAF), maximum phonation time (MPT), and estimated subglottic pressure (ESGP). Nonparametric tests were used to compare laryngostroboscopic parameters with instrumented measurements and perceptual evaluations of voice quality. RESULTS: Correlations were established among occlusion, epiglottic length, and general grade of dysphonia. Oral air flow (P = 0.006) was found to be correlated with occlusion. Voice roughness was correlated with the presence of a clearly identifiable vibratory area (P = 0.003), whereas these vibratory areas were correlated with shimmer (P = 0.041), OAF (P = 0.001), and SNR (P = 0.001). The number of preserved arytenoids was not identified as a voice quality factor (P = 0.423). CONCLUSION: This study highlighted correlations between the laryngostroboscopic examination results and the perceptive and instrumented measurements of voice. Glottis occlusion and epiglottis length were found to be key factors for postoperative voice quality. These results should help to advance technical development on surgical techniques to enhance voice results.     

The Singing Power Ratio as an Objective Measure of Singing Voice Quality in Untrained Talented and Nontalented Singers

A growing body of contemporary research has investigated differences between trained and untrained singing voices. However, few studies have separated untrained singers into those who do and do not express abilities related to singing talent, including accurate pitch control and production of a pleasant timbre (voice quality). This investigation studied measures of the singing power ratio (SPR), which is a quantitative measure of the resonant quality of the singing voice. SPR reflects the amplification or suppression in the vocal tract of the harmonics produced by the sound source. This measure was acquired from the voices of untrained talented and nontalented singers as a means to objectively investigate voice quality differences. Measures of SPR were acquired from vocal samples with fast Fourier transform (FFT) power spectra to analyze the amplitude level of the partials in the acoustic spectrum. Long-term average spectra (LTAS) were also analyzed. Results indicated significant differences in SPR between groups, which suggest that vocal tract resonance, and its effect on perceived vocal timbre or quality, may be an important variable related to the perception of singing talent. LTAS confirmed group differences in the tuning of vocal tract harmonics.     

Evaluation of Support in Singing

This study searched for perceptual, acoustic, and physiological correlates of support in singing. Seven trained professional singers (four women and three men) sang repetitions of the syllable [pa:] at varying pitch and sound levels (1) habitually (with support) and (2) simulating singing without support. Estimate of subglottic pressure was obtained from oral pressure during [p]. Vocal fold vibration was registered with dual-channel electroglottography. Acoustic analyses were made on the recorded samples. All samples were also evaluated by the singers and other listeners, who were trained singers, singing students, and voice specialists without singing education (a total of 63 listeners). We rated both the overall voice quality and the amount of support. According to the results, it seemed impossible to observe any auditory differences between supported singing and good singing voice quality. The acoustic and physiological correlates of good voice quality in absolute values seem to be gender and task dependent, whereas the relative optimum seems to be reached at intermediate parameter values.     

Vowel Intelligibility in Classical Singing

Vowel intelligibility during singing is an important aspect of communication during performance. The intelligibility of isolated vowels sung by Western classically trained singers has been found to be relatively low, in fact, decreasing as pitch rises, and it is lower for women than for men. The lack of contextual cues significantly deteriorates vowel intelligibility. It was postulated in this study that the reduced intelligibility of isolated sung vowels may be partly from the vowels used by the singers in their daily vocalises. More specifically, if classically trained singers sang only a few American English vowels during their vocalises, their intelligibility for American English vowels would be less than for those classically trained singers who usually vocalize on most American English vowels. In this study, there were 21 subjects (15 women, 6 men), all Western classically trained performers as well as teachers of classical singing. They sang 11 words containing 11 different American English vowels, singing on two pitches a musical fifth apart. Subjects were divided into two groups, those who normally vocalize on 4, 5, or 6 vowels, and those who sing all 11 vowels during their daily vocalises. The sung words were cropped to isolate the vowels, and listening tapes were created. Two listening groups, four singing teachers and five speech-language pathologists, were asked to identify the vowels intended by the singers. Results suggest that singing fewer vowels during daily vocalises does not decrease intelligibility compared with singing the 11 American English vowels. Also, in general, vowel intelligibility was lower with the higher pitch, and vowels sung by the women were less intelligible than those sung by the men. Identification accuracy was about the same for the singing teacher listeners and the speech-language pathologist listeners except for the lower pitch, where the singing teachers were more accurate.     

Documentation of progress in voice therapy: perceptual, acoustic, and laryngostroboscopic findings pretherapy and posttherapy

The effect of voice therapy in a group of chronically dysphonic patients with diverse diagnoses was studied according to the normal clinical procedure. The results were evaluated by perceptual rating, acoustic analysis, and the assessment of laryngostroboscopic recordings. Although the group effects for the differences between posttherapy and pretherapy data were clearly significant, the effects of voice therapy for the individual patients were divergent. For each of the three evaluation methods, a significant improvement was found for about 40% to 50% of the patients. The diversity of the therapy outcome among the patients could not be explained by the pretherapy status nor by age, gender, or diagnosis groups. In general, the perceptual ratings and the acoustic parameters from the baseline data were clearly correlated. However, these characterizations of the voice were only moderately correlated with the visual evaluation of the vocal fold vibrations. Relations among the three evaluation tools for the changes caused by voice therapy were very weak. The low correlation among the three methods suggests that a multidimensional evaluation of the voice is necessary to give a complete picture of the therapy outcome.     

Long-Term Horizontal Vocal Directivity of Opera Singers: Effects of Singing Projection and Acoustic Environment

Vocal directivity refers to how directional the sound is that comes from a singer's mouth, that is, whether the sound is focused into a narrow stream of sound projecting in front of the singers or whether it is spread out all around the singer. This study investigates the long-term vocal directivity and acoustic power of professional opera singers and how these vary among subjects, among singing projections, and among vastly different acoustic environments. The vocal sound of eight professional opera singers (six females and two males) was measured in anechoic and reverberant rooms and in a recital hall. Subjects sang in four different ways: (1) paying great attention to intonation; (2) singing as in performance, with all the emotional connection intended by the composer; (3) imagining a large auditorium; and (4) imagining a small theatre. The same song was sung by all singers in all conditions. A head and torso simulator (HATS), radiating sound from its mouth, was used for comparison in all situations. Results show that individual singers have quite consistent long-term average directivity, even across conditions. Directivity varies substantially among singers. Singers are more directional than the standard HATS (which is a physical model of a talking person). The singer's formant region of the spectrum exhibits greater directivity than the lower-frequency range, and results indicate that singers control directivity (at least, incidentally) for different singing conditions as they adjust the spectral emphasis of their voices through their formants.     

Pitch Matching Accuracy of Trained Singers, Untrained Subjects with Talented Singing Voices, and Untrained Subjects with Nontalented Singing Voices in Conditions of Varying Feedback

At a physiological level, the act of singing involves control and coordination of several systems involved in the production of sound, including respiration, phonation, resonance, and afferent systems used to monitor production. The ability to produce a melodious singing voice (eg, in tune with accurate pitch) is dependent on control over these motor and sensory systems. To test this position, trained singers and untrained subjects with and without expressed singing talent were asked to match pitches of target pure tones. The ability to match pitch reflected the ability to accurately integrate sensory perception with motor planning and execution. Pitch-matching accuracy was measured at the onset of phonation (prephonatory set) before external feedback could be utilized to adjust the voiced source, during phonation when external auditory feedback could be utilized, and during phonation when external auditory feedback was masked. Results revealed trained singers and untrained subjects with singing talent were no different in their pitch-matching abilities when measured before or after external feedback could be utilized. The untrained subjects with singing talent were also significantly more accurate than the trained singers when external auditory feedback was masked. Both groups were significantly more accurate than the untrained subjects without singing talent.     

Effects of Professional Singing Education on Vocal Vibrato—A Longitudinal Study

Vocal vibrato is regarded as one of the essential characteristics of voice quality in classical singing. Professional singers seem to develop vibrato automatically, without actively striving to acquire it. In this longitudinal investigation, the vocal vibrato of 22 singing students was examined at the beginning of and after 3 years of professional singing education. Subjects sang an ascending-descending triad pattern in slow tempo on vowel [a:] at a comfortable pitch level twice at soft (piano) and twice at medium (mezzoforte) loudness. The top note of the triad pattern was sustained for approximately 5s. The mean and the standard deviation (SD) of the vibrato rate were measured for this note. Results revealed that after 3 years of training, voices with vibrato slower than 5.2 Hz were found to have a faster vibrato, and voices with vibrato faster than 5.8 Hz were found to have a slower vibrato. Standard deviation of vibrato rate was higher in soft than in medium loudness, particularly before the education. Also high values of SD of vibrato rate, exceeding 0.65 Hz, had decreased after the education. These findings confirm that vibrato characteristics can be affected by singing education.     

The Relationship Between Perceptual Evaluation and Objective Multiparametric Evaluation of Dysphonia Severity

SUMMARY: The purpose of this study was to investigate the usefulness of the Dysphonia Severity Index (DSI) as an objective multiparametric measurement in assessing dysphonia. The DSI was compared with the score on Grade of the GRBAS scale. Investigated was also whether the DSI is related to severity of dysphonia, which was represented by different diagnosis groups. Furthermore, it was investigated whether the DSI can differentiate between a group of patients and a control group. A total of 294 patients with different voice pathologies were included. A control group consisted of 118 volunteers without any voice complaints. The voices of all participants were perceptually evaluated on Grade, and the DSI was measured. The groups of patients with voice complaints have a lower DSI and higher scores on Grade than the control group. The DSI was significantly lower when the score on Grade was higher. The DSI discriminates between patients with nonorganic voice disorders, vocal fold mass lesions, and vocal fold paresis/paralysis. To determine whether the DSI discriminates between patients and controls, the sensitivity and specificity for different DSI cutoff points were calculated. With a DSI cutoff of 3.0, maximum sensitivity (0.72) and specificity (0.75) were found. We conclude that the DSI is a useful instrument to objectively measure the severity of dysphonia.     

Are Real-Time Displays of Benefit in the Singing Studio? An Exploratory Study

This article reports on an exploratory research project to evaluate the usefulness or otherwise of real-time visual feedback in the singing studio. The primary purpose of the work was not to optimize the technology for this application, but to work alongside teachers and students to study the impact of real-time visual feedback technology use on the students' learning experiences. An action research methodology was used to explore the benefit of real-time displays over an extended period. The experimental phase of the work was guided by a Liaison Panel of teachers and academics in the areas of singing, pedagogy, voice science, speech therapy, and linguistic science. Qualitative data were collected from eight students working with two professional singing teachers. The teachers and students acted as co-researchers under the action research paradigm. Teachers and students alike kept journals of their teaching and learning experiences. Singing lessons were observed regularly by the research team, coded for teacher and student behaviors, and all co-researchers were interviewed at the mid- and endpoint of the project. The use of technology had a positive impact on the learning process, and this is evidenced through case study data.     

Long-Term-Average Spectrum Characteristics of Country Singers During Speaking and Singing

Five premier male country singers involved in our previous studies spoke and sang the words of both the national anthem and a country song of their choice. Long-term-average spectra were made of the spoken and sung material of each singer. The spectral characteristics of county singers' speech and singing were similar. A prominent peak in the upper part of the spectrum, previously described as the "speaker's formant," was found in the county singers' speech and singing. The singer's formant, a strong spectral peak near 2.8 kHz, an important part of the spectrum of classically trained singers, was not found in the spectra of the country singers. The results support the conclusion that the resonance characteristics in speech and singing are similar in country singing and that county singing is not characterized by a singer's formant.     

Efficacy of Singing Bowls in Childhood Asthma—A Pilot and Feasibility Study

The potential use of sound and vibration for diagnostic and therapeutic purposes remains largely under-explored and under-estimated. Sound and vibrational energy has great positive impact on the mind and body. It could be particularly useful for psychosomatic diseases as a complementary therapy. Singing bowls, the spiritual ancient therapy has been claimed to aid in mind relaxation and painful and inflammatory conditions. Childhood asthma is an inflammatory airway disease and a psychosomatic disorder. The psychological management in it is often neglected leading to under-treatment or a relapse. Hence, we hypothesized that sound therapy with singing bowls might be useful as complementary therapy in management of childhood asthma. We aimed to study the effect of singing bowl session on child’s asthma severity and control and on the psychological well-being. Children <18 years of age and suffering from childhood asthma were recruited after informed written consent of parents. At the baseline, demographic and clinical details were noted. Anthropometric parameters, PEFR readings, asthma severity, parental and child’s subjective feeling of well-being, asthma control score, and pediatric symptom checklist score (based on age) were determined. The child was given 15 min of singing bowl session as per the set protocol. The subjective and objective evaluation of asthma control and psychological assessment was repeated at 1 month and 3 months follow-up and compared with the baseline results for clinical significance. Eighteen children formed the study group with a mean age of 9.13 ± 2.15 years (range 2–15.25 years). 4 children had psychological issues on initial screening. There was a significant improvement in asthma severity, subjective feeling of well-being and asthma control score at 3 months (p < 0.05). Singing bowl therapy could be a useful, low-cost complementary therapy in childhood asthmatics.     

Pitch-Synchronous Changes in the Anterior Cricothyroid Space During Singing

Pitch-synchronous changes in the anterior cricothyroid (CT) space were registered with ultrasonography (USG) for ten healthy subjects (5 males, 5 females) during the production of musical fifths throughout the whole voice range. One of the males and one of the females were trained amateur singers, the other subjects were choir singers. The average decrease in CT space per a musical fifth was 1.3-2.4 mm for the males and 1.0-1.8 mm for the females; the average decrease was smaller in the middle of the pitch range for both genders. The results suggest that (1) USG can be used for detection of pitch-synchronous changes in the CT space; (2) these changes are dependent on pitch range; and (3) more trained singers tend to have somewhat smaller changes than less trained subjects at certain frequencies. The results seem to indicate that F0 control mechanism varies according to pitch range and register, and possibly according to individual structure and vocal technique related differences.     

Strobovideolaryngoscopic Findings in Singing Teachers

Professional voice users often present to otolaryngologists and laryngologists with specific voice complaints. The contributions of pathologic lesions to the patients' vocal complaints are not always clear on examination, and often, premorbid examinations of the larynx are not available for review. This study examines the incidence of laryngeal pathology among singing teachers. At a national convention of singing teachers, volunteers were recruited for a "free strobovideolaryngoscopic examination." All volunteers completed a detailed questionnaire of their vocal and medical history and underwent strobovideolaryngoscopic examination. Strobovideolaryngoscopic examinations were completed in 20 volunteers, 7 of whom had voice complaints and 13 of whom perceived their voices to be normal. Vocal fold masses were common among the asymptomatic singing teachers. Evidence of reflux laryngitis was a common finding among both symptomatic and asymptomatic singing teachers. Asymmetries in vocal fold hypomobility were more common among those with voice complaints than was the presence of vocal fold masses in the population studied.     

Evaluating the Influence of Warmup on Singing Voice Quality Using Acoustic Measures

Vocal warmup is generally accepted as vital for singing performance. However, only a limited number of studies have evaluated this effect quantitatively. In this study, we evaluated the effect of vocal warmup on voice production, among young female singers, using a set of acoustic parameters. Warmup reduced frequency-perturbation (p < 0.001) and amplitude-perturbation values (p < 0.05). In addition, warmup increased singer's formant amplitude (p < 0.05) and improved noise-to-harmonic ratio (p < 0.05). Tone-matching accuracy, however, was not affected by warmup. The effect of vocal warmup on frequency-perturbation parameters was more evident among mezzo-soprano singers than it was among soprano singers. It was also more evident in the low pitch-range than in the higher pitch-ranges (p < 0.05). The results of this study provide valid support for the advantageous effect of vocal warmup on voice quality and present acoustic analysis as a valuable and sensitive tool for quantifying this effect.