Physiological aspects of a vocal exercise

The physiological aim of vocal exercises is mostly understood in intuitive terms only. This article presents an attempt to document the phonatory behavior induced by a vocal exercise. An elevated vertical position of the larynx is frequently associated with hyperfunctional phonatory habits, presumably because it induces an exaggerated vocal fold adduction. Using the multichannel electroglottograph (MEGG), the laryngeal position was determined in a group of subjects who performed a voice exercise that contained extremely prolonged versions of the consonant /b:/. This exercise is used by the coauthor (N.E.) as part of a standard vocal exercise program. Two of the seven subjects were dysphonic phonastenic patients, and the rest were normal trained or untrained persons. Different attempts to calibrate the MEGG confirmed a linear relationship with larynx height, provided electrode positioning was correct. The results showed that the exercise induced substantial vertical displacements of the larynx. Comparison with larynx height during voicing of other consonants showed that the /b/, in particular, tended to lower the larynx.     

Variations in adductor spasmodic dysphonia:Acoustic evidence

Acoustic analysis was used to gain information about the normal, aswell as the abnormal acoustic events associated with adductor spasmodic dysphonia (ADSD). This analysis was completed to determine whether specific acoustic events could be used to differentiate the voice of individuals with ADSD from those with normal voice. A group comparison between 14 women diagnosed with ADSD and 14 women (age-matched) with no evidence of vocal pathology or vocal dysfunction was completed. Phonatory breaks, aperiodicity, and frequency shifts, acoustic parameters previously identified in ADSD, were found throughout sustained vowel productions. The duration of the phonatory breaks and aperiodic segments was calculated and the amount of frequency shift was determined. The location of each acoustic event was marked relative to the onset of the vowel production. The subjects with ADSD presented with normal phonation and various amounts of each of the three acoustic parameters. Aperiodic segments primarily characterized the phonation of ADSD, followed by frequency shifts and phonatory breaks. The location of each of these acoustic events was within the midportion of the vowel production. The advantages of segmenting the acoustic waveform into these measures and separating the spasmodic events from normal phonation when examining laryngeal motor control of spasmodic dysphonics is discussed     

Effects of laryngeal endoscopy on the vocal performanceof young adult females with normal voices

This study investigated changes in maximum phonation time andacoustic and perceptual measures of voice following topical anesthesia and laryngeal endoscopy with the flexible endoscope. Forty-four females, aged 18–33 years and with normal voices, performed four vocal tasks: (a) 3-second /i/ prolongation, (b) maximum phonation time on /i/, (c) stepwise scale-singing, and (d) reading a standard passage. Subjects performed these tasks prior to anesthesia, after anesthesia, and again during laryngeal endoscopy. Voice samples were analyzed for jitter, shimmer, harmonic-to-noise ratio, speaking fundamental frequency, maximum phonational frequency range, maximum phonation time, harshness, and breathiness. Results demonstrated significant reductions in maximum phonational frequency range following anesthesia and, during laryngeal endoscopy, reductions in maximum phonation time and increases in speaking fundamental frequency, minimum fundamental frequency on scale-singing, and breathiness. Clinicians using laryngeal endoscopy for evaluation and management of vocal dysfunction should, therefore, consider the possible effects of these procedures on vocal functioning.     

Aerodynamic measurements of patients with parkinson''s disease

Patients with Parkinson's disease commonly complain of voice dysfunction. Most of these complaints can be attributed to the known muscular control disorders that occur with Parkinson's disease. However, the manifestations of Parkinson's disease muscular dysfunction on parameters of phonation such as airflow, laryngeal resistance, and subglottal pressure necessary to sustain phonation have not been reported. The purpose of this study was to examine the aerodynamic characteristics of flow, laryngeal resistance, and phonation pressure threshold in a heterogeneous population of patients with Parkinson's disease who had varying voice complaints and to compare the data to similar studies for human subjects who have no voice complaints. The studies used a noninvasive method of detecting flow and acoustic signal from the lips, oral cavity and nose during phonation and used an external flow interruption technique to estimate subglottal pressure and phonation threshold pressure. About one third of the patients could not produce phonation at regular and loud intensities that were comfortable for normal subjects. The mean subglottal pressure (SGP) of patients with Parkinson disease who could produce 3 levels of intensity comparable to normal subjects was significantly higher than the mean SG-Ps for normal subjects for the same intensities of vocal production. The mean flow rates measured from patients with Parkinson's disease at the same 3 intensities of phonation was not significantly greater than in normal subjects. This indicated that the mean laryngeal resistance calculated for patients with Parkinson's disease was notably and significantly greater than mean laryngeal resistance calculated for normal subjects at the same intensity levels. The mean vocal efficiency (VE) for normal subjects was not significantly different than the mean VE for patients with Parkinson's disease, because greater pressure was used to generate similar flow and acoustic energy. These findings correlate with the perception of patients with Parkinson's disease that they are working harder to produce phonation. The observation of notably greater laryngeal resistance and phonation threshold pressure in patients with Parkinson's disease suggests that further studies of the glottic aperture in patients with Parkinson' disease may be useful for understanding how this common motor disorder disturbs phonation.     

Vocal tract changes caused by phonation into a tube: a case study using computer tomography and finite-element modeling

Phonation into a glass tube is a voice training and therapy method that leads to beneficial effects in voice production. It has not been known, however, what changes occur in the vocal tract during and after the phonation into a tube. This pilot study examined the vocal tract shape in a female subject before, during, and after phonation into a tube using computer tomography (CT). Three-dimensional finite-element models (FEMs) of the vocal tract were derived from the CT images and used to study changes in vocal tract input impedance. When phonating on vowel [a:] the data showed tightened velopharyngeal closure and enlarged cross-sectional areas of the oropharyngeal and oral cavities during and after the tube-phonation. FEM calculations revealed an increased input inertance of the vocal tract and an increased acoustic energy radiated out of the vocal tract after the tube-phonation. The results indicate that the phonation into a tube causes changes in the vocal tract which remain also when the tube is removed. These effects may help improving voice production in patients and voice professionals.     

Effects of Inhalatory Abdominal Wall Movement on Vertical Laryngeal Position During Phonation

The configuration of the body resulting from inhalatory behavior is sometimes considered a factor of relevance to voice production in singing and speaking pedagogy and in clinical voice therapy. The present investigation compares two different inhalatory behaviors: (1) with a "paradoxical" inward movement of the abdominal wall, and (2) with an expansion of the abdominal wall, both with regard to the effect on vertical laryngeal position during the subsequent phonation. Seventeen male and 17 female healthy, vocally untrained subjects participated. No instructions were given regarding movements of the rib cage. Inhaled air volume as measured by respiratory inductive plethysmography, was controlled to reach 70% inspiratory capacity. Vertical laryngeal position was recorded by two-channel electroglottography during the subsequent vowel production. A significant effect was found; the abdomen-out condition was associated with a higher laryngeal position than the abdomen-in condition. This result apparently contradicted a hypothesis that an expansion of the abdominal wall would allow the diaphragm to descend deeper in the torso, thereby increasing the tracheal pull, which would result in a lower laryngeal position. In a post-hoc experiment including 6 of the subjects, body posture was studied by digital video recordings, revealing that the two inhalatory modes were clearly associated with postural changes affecting laryngeal position. The "paradoxical" inward movement of the abdominal wall was associated with a recession of the chin toward the neck, such that the larynx appeared in a lower position in the neck, for reasons of a postural change. The results suggest that the laryngeal position can be affected by the inhalatory behavior if no attention is paid to posture, implying that instructions from clinicians and pedagogues regarding breathing behavior must be carefully formulated and adjusted in order to ensure that the intended goals are reached.     

“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.     

Voice of Postradiotherapy Nasopharyngeal Carcinoma Patients: Evidence of Vocal Tract Effect

This study was aimed at identifying acoustic and physiological measures useful for monitoring voice changes in postnasopharyngeal patients with nonlaryngeal malignancies, and providing evidences of vocal tract effect on voice through comparisons between individuals with and without intact vocal tract. Simultaneous acoustic-electroglottographic signals recorded during phonation of vowels /i/ and /a/ sustained at habitual, high, and low pitch levels were compared among 10 postradiotherapy patients with nasopharyngeal carcinoma (NPC), 10 voice patients (VPs) with intact vocal tract, and 10 healthy individuals with normal voice (NORM). Results from a series of discriminant analyses revealed that the NPC group generally exhibited lower signal-to-noise (SNR) and open quotient (OQ) and higher Formant 1 frequency (F(1)) and speed quotient (SQ) than the NORM group. Unlike both VP and NORM groups, the NPC group failed to show a pitch effect on all voice measures, including OQ, SQ, percent jitter, percent shimmer, and SNR, suggesting an effect of radiotherapy and/or vocal tract on laryngeal behaviors. For the vowel /i/, on the other hand, only the NPC and NORM groups showed a pattern of pitch-dependent F(1) raising, a reflection of increased pharyngeal narrowing. These findings suggested that the pitch effect on laryngeal behaviors differed not only between individuals with intact vocal tract and those without but also between those with structural and dynamic changes of vocal tract.     

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.     

Supraglottic contribution to voice quality

Although there has been continuing interest in voice quality, much of this research has focused on the vocal folds rather than the supraglottal structures. This paper reports the use of videoendoscopy for studying supraglottal participation in various singing tasks. In a preliminary study presented last year by the present authors, CT scanning was used to corroborate videoendoscopic observation. Vocal tract activities observed included variation of laryngeal height with pitch, variation of pharyngeal wall dimension with pitch and vowel, and marked supraglottic constriction with certain vocal imitations. In order to gain a better understanding of vocal training, and its effect upon vocal tract physiology, a study was designed using videoendoscopy to observe singers with significant experience and training while performing various vocal tasks. The tasks focused on the following: (1) vocal tract activity associated with pitch changes; (2) the physiology involved in the production of “cover”; (3) the structures involved in the production of vibrato; and (4) the physiology of the singer's “ring.” It would appear that videoendoscopy will become increasingly more valuable to the voice community as our understanding of vocal tract physiology improves.     

A Comparison of Two Methods of Formant Frequency Estimation for High-Pitched Voices

This study sought to compare formant frequencies estimated from natural phonation to those estimated using two methods of artificial laryngeal stimulation: (1) stimulation of the vocal tract using an artificial larynx placed on the neck and (2) stimulation of the vocal tract using an artificial larynx with an attached tube placed in the oral cavity. Twenty males between the ages of 18 and 45 performed the following three tasks on the vowels /a/ and /i/: (1) 4 seconds of sustained vowel, (2) 2 seconds of sustained vowel followed by 2 seconds of artificial phonation via a neck placement, and (3) 4 seconds of sustained vowel, the last two of which were accompanied by artificial phonation via an oral placement. Frequencies for formants 1-4 were measured for each task at second 1 and second 3 using linear predictive coding. These measures were compared across second 1 and second 3, as well as across all three tasks. Neither of the methods of artificial laryngeal stimulation tested in this study yielded formant frequency estimates that consistently agreed with those obtained from natural phonation for both vowels and all formants. However, when estimating mean formant frequency data for samples of large N, each of the methods agreed with mean estimations obtained from natural phonation for specific vowels and formants. The greatest agreement was found for a neck placement of the artificial larynx on the vowel /a/.     

The effect of head position on glottic closure in patients with unilateral vocal fold paralysis

The present study was designed to assess the effect of head position on glottic closure as reflected in airflow rates (open quotient and maximum flow declination rate), in patients with unilateral vocal fold paralysis. Ten patients, 2 males and 8 females ranging in age from 40 to 75, with a mean age of 57.3, served as subjects. Airflow measures were taken during sustained phonation of two vowels (/i/ and /a/) in 3 head positions (center, right, left). Vowels /i/ and /a/ were produced at subject's comfortable pitch and loudness, with random ordering of both vowel order and head orientation. Subjects were trained to focus eye gaze on right and left markers (70-degree angle) and a central marker at eye level directly in front of the subject. Theoretically, if turning the head during phonation alters the laryngeal anatomic relationship by bringing the vocal folds in closer proximity to one another, then airflow rate should lessen. Our results indicate that head position does not improve glottic closure in these patients, which is in contrast to previously published research.(1) Our results question the utility and underlying theoretical construct for the use of head turning as a therapeutic technique for improvement of voice in patients with unilateral vocal fold paralysis.     

Vocal Warm-up Increases Phonation Threshold Pressure in Soprano Singers at High Pitch

Vocal warm-up is thought to optimize singing performance. We compared effects of short-term, submaximal, vocal warm-up exercise with those of vocal rest on the soprano voice (n = 10, ages 19-21 years). Dependent variables were the minimum subglottic air pressure required for vocal fold oscillation to occur (phonation threshold pressure, Pth), and the maximum and minimum phonation fundamental frequency. Warm-up increased Pth for high pitch phonation (p = 0.033), but not for comfortable (p = 0.297) or low (p = 0.087) pitch phonation. No significant difference in the maximum phonation frequency (p = 0.193) or minimum frequency (p = 0.222) was observed. An elevated Pth at controlled high pitch, but an unchanging maximum and minimum frequency production suggests that short-term vocal exercise may increase the viscosity of the vocal fold and thus serve to stabilize the high voice.     

Simultaneous videofluorographic and dual-channel electroglottographic registration of the vertical laryngeal position in various phonatory tasks

Simultaneous tracking of the vertical laryngeal position in various phonatory tasks was performed for 2 subjects (one male, one female) using dual-channel electroglottography (EGG) and videofluorography (videofluoroscopy). The tasks included phonation on [a:] with voluntary repeated (1) heightening and (2) lowering of the laryngeal position; alternation between [a:] and phonation on (3) [b], (4) [m], and (5) the voiced bilabial fricative [beta:]; and (6) production of the corner vowels [a, i, u]. EGG and videofluorography agreed about the direction of changes in the vertical laryngeal position in most cases. Most disagreements were found in the amount of changes. Reasons for the discrepancies, including, for example, changes in the resting position of the larynx and anteroposterior movements of the cartilages, are discussed. It can be concluded that dual-channel EGG is a valuable clinical and pedagogical tool for the analysis of the vertical displacement of larynx in well-specified phonatory tasks. The method should act most reliably on separately phonated vowels. Its applicability for studying laryngeal biomechanics more wholistically, however, is limited.     

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.     

Vocal Fold Polyp in a Professional Brass/Wind Instrumentalist and Singer

Wind instrumentalists, especially brass players, and singers share common factors, including vocal tract shape, function and pressure, vocal fold opening and closure, breath vector of force and air flow rates. To understand the mechanism and function of the vocal folds with a pathological lesion, it is necessary to visualize the differing interactions of the vocal tract during wind and brass instrument playing and in singing. A school band director, singer, wind and brass instrumentalist, was referred by musician colleagues with intermittent dysphonia, aphonia, and inability to sing high notes. Simultaneous videolaryngoscopy, with and without stroboscopy, and external video examination were documented. An hourglass glottis with a sessile, cystic polyp of the left vocal fold were recorded and studied during phonation and the playing of 3 instruments. The techniques of glottic opening, closure, configuration and function varied with the type of instrument and phonatory function. Singing was adversely affected by the vocal fold polyp but no harmful interaction occurred during wind/brass instrument playing. Down-stream loading in singers is at the laryngeal level and in wind/brass instrumentalists is at the embouchure. Preoperative voice therapy, phonomicrosurgery, and postoperative voice rest followed by voice therapy, succeeded in restoring her combined wind/brass instrumental and singing career.     

Laryngeal closure pressure during phonation in humans.

We investigated the laryngeal closure pressure during sustained phonation in five healthy adult men with no pathological lesions in the glottis using a round pressure transducer with a diameter of 10 mm and a thickness of 1 mm. The transducer was placed between the vocal processes through the mouth. Subjects were asked to utter a sustained phonation of the vowel sound /eh/ at varying pitch and intensity in modal register. The laryngeal closure pressure ranged from 0 to 200 cmH2O. At a comfortable pitch and intensity, the pressure was below 50 cmH2O. The pressure was correlated with pitch, but not with intensity.     

A Novel Treatment for Hypophonic Voice: Twang Therapy

A hypophonic voice, characterized perceptually as weak and breathy, is associated with voice disorders such as vocal fold atrophy and unilateral vocal fold paralysis. Although voice therapy programs for hypophonia typically address the vocal folds or the sound source, twang voice quality was examined in this study as an alternative technique for increasing vocal power by altering the epilarynx or the sound filter. OBJECTIVE: This study investigated the effect of twang production on physiologic, acoustic, and perceived voice handicap measures in speakers with hypophonia. DESIGN/METHODS: This prospective pilot study compared the vocal outcomes of six participants with hypophonia at pre- and posttreatment time points. Outcome measures included mean airflow rate, intensity in dB sound pressure level (SPL), maximum phonation time, and self-report of voice handicap. RESULTS: All subjects improved in at least three of the four vocal outcome measures. Wilcoxon signed-rank test of paired differences revealed significant differences between pre- and posttherapy group means for airflow rate, SPL, and Voice Handicap Index scores. CONCLUSION: The twang voice quality as a manipulation of the sound filter offers a clinical complement to traditional voice therapies that primarily address the sound source.     

Fundamental Frequency Change During Offset and Onset of Voicing in Individuals with Parkinson Disease

SUMMARY: After years of treatment with the medication levodopa, most individuals with Parkinson disease (PD) experience fluctuations in response to their medications. Although relatively consistent perceptual voice improvements have been documented to correspond with these fluctuations, consistent quantitative data to support this finding are lacking. This mismatch may have occurred because most of this phonation research has centered on long-term phonatory measures (ie, across speaking samples and prolonged vowel tasks). The current study examined short-term phonatory behavior in individuals with PD, specifically examining fundamental frequency (F0) at the offset and onset of phonation, before and after a voiceless consonant. The F0 analysis at phonatory offset supported the conclusion that individuals with PD have difficulty with the rapid offset of voicing, and that they are stopping vocal fold vibration primarily through vocal fold abduction (without adding tension). The F0 analysis at phonatory onset revealed that all groups use some laryngeal tension at the initiation of voicing. The tension was lowest for the PD participants who were in their OFF medication state, and it was highest for the age-matched control participants and the PD participants in their ON medication states.     

Influence of glottal closure configuration on vocal efficacy in young normal-speaking women

Posterior closure insufficiency of the glottis is often mentioned in connection with permanent voice disorders. Recently published studies have revealed that an incomplete closure of the glottis can be found also in normal-speaking voices, especially in women. However, the effect of glottal closure configuration on vocal efficacy is not sufficiently clarified. The purpose of this study was to determine the effect of glottal closure configuration on singing and speaking voice characteristics. Overall, 520 young female normal-speaking subjects were examined by videostroboscopy for different phonation conditions in the combination of soft, loud, low, and/or high phonation and by voice range profile measurements. According to the videostroboscopic analysis, the subjects were subdivided into four groups: complete closure of the vocal folds already in soft phonation (group 1), closure of the vocal fold with increasing intensity (group 2), persistent closure insufficiencies despite increasing intensity (group 3), and hourglass-shaped closure in subjects with vocal nodules (group 4). Subjects in which the glottal closure could not be evaluated sufficiently were subclassified into group 5 (missing values).

Selected criteria of the singing and speaking voice were evaluated and statistically processed according to the mentioned subclassification. Group 1 reached significantly the highest sound pressure levels (SPL_max) for the singing voice as well as for the shouting voice. Group 3 showed a limited capacity to increase the intensity of the singing and speaking voice. The results gathered in this study objectify the relationship of insufficient glottal closure and reduced vocal capabilities. As long as no conclusive data on long-term consequences of insufficient glottal closure are available, a prophylactic improvement of the laryngeal situation especially in female professional voice users by voice therapy should be recommended.