Objective Vocal Quality in Children Using Cochlear Implants: A Multiparameter Approach

Objectives

The purpose of this study was to determine the objective vocal quality in 36 prelingually deaf children using cochlear implant (CI) with a mean age of 9 years. An additional purpose was to compare the objective vocal quality of these 36 CI users with 25 age-matched children with prelingual severe hearing loss using conventional hearing aids (HAs) and 25 normal hearing (NH) children.

Study Design

The design for this cross-sectional study was a multigroup posttest-only design.

Methods

The objective vocal quality was measured by means of the dysphonia severity index (DSI). Moreover, perceptual voice assessment using the GRBASI scale was performed.

Results

CI children have a vocal quality by means of the DSI of +1.8, corresponding with a DSI% of 68%, indicating a borderline vocal quality situated 2% above the limit of normality. The voice was perceptually characterized by the presence of a very slight grade of hoarseness, roughness, strained phonation, and higher pitch and intensity levels. No significant objective vocal quality differences were measured between the voices of the CI children, HA users, and NH children.

Conclusions

According to the results, one aspect of the vocal approach in children with CI and using HAs must be focused on the improvement of the strained vocal characteristic and the use of a lower pitch and intensity level.     

Behavioral Characteristics of Children With Vocal Fold Nodules

Vocal fold nodules (VNs) in children are benign, bilateral lesions occurring on the mid-membranous vocal folds. Repetitive phonotraumatic behavior leading to chronic vocal fold injury and repair is frequently cited as the primary etiology; however, specific behavioral characteristics may predispose some children toward intense and potentially phonotraumatic voice use, thereby contributing secondarily to VN formation. The purpose of this case-control study was to determine whether children with VNs possess unique behavioral characteristics that may predispose them to VN development. Parents of 26 children with VNs (20 boys, 6 girls, mean age=7.2 years, SD=2.5 years), and 29 vocally normal, medical controls (22 boys, 7 girls, mean age=6.7 years, SD=2.4), completed the Childhood Behavior Checklist (CBCL/4-18, Achenbach, 1991), a standardized parent-rating scale with strong psychometric properties. No significant between-group differences were detected on any of the behavior problem syndrome scales. Group differences approached significance for the individual items "screams a lot" and "teases a lot" (VN group > Controls). The VN group scored significantly higher than the controls on the "Social Scale," a compilation of positive ratings of the child's social activity, frequency of contacts with friends, behavior with others, and behavior by themselves. Observed outcomes were consistent with previous characterizations of children with VN as "outgoing" or "extroverted" but were not consistent with other claims that this population may be at risk for "aggressive," "attentional," or "impulsive" behavior problems.     

Characteristics of Phonatory Function in Singers and Nonsingers With Vocal Fold Nodules

Purpose

The goals of this study were to determine if there were significant differences between singers and nonsingers in the morphology of vocal nodules and the associated impact on vocal function.

Method

Participants were 10 professionally trained singers with nodules, eight nonsingers with nodules, and 10 individuals with healthy normal voice (controls). Surface electromyography (sEMG) from three anterior neck locations and acoustic rise times for vowels /a/ and /i/ were measured in all the participants. In individuals with nodules, dB SPL/cm H₂O, glottal airflow, and nodule location and size were also measured.

Results

There were no significant differences between singers and nonsingers with nodules in terms of airflow, dB SPL/cm H₂O, nodule size, or nodule location. In nonsingers with nodules, airflow and nodule size were significantly correlated, but were not significantly correlated in singers. Vowel rise times and sEMG during vocal tasks did not differentiate among nodule and control groups. Sternocleidomastoid sEMG during initiation of the vowel /a/ was statistically significantly stronger in nonsingers with nodules relative to singers with nodules and controls.

Conclusions

Nodule morphology did not differ between singers and nonsingers, although some behavioral aspects of phonation differed between the groups.     

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.     

Boot Camp: A Novel Intensive Approach to Voice Therapy

It is well known in the disciplines of neurobiology, exercise physiology, motor learning, and psychotherapy that desirable learning and behavior changes occur primarily from practice that involves high-intensity overload, variability, and specificity of training. We propose a novel treatment approach called intensive short-term voice therapy that uses these practice parameters for recalcitrant dysphonia. Intensive short-term voice therapy involves multiple sessions with a variety of clinicians, incorporating multiple simultaneous therapeutic approaches. The intensive short-term voice therapy approach is characterized by voice therapy for 1–4 successive days each with an average of 5 hours of therapy and five clinicians. This form of intensive voice therapy provides rigorous practice, involving not only overload but also opportunities for specificity and individuality thereby facilitating better transfer of learned skills. This article discusses the conceptual, theoretical, and practical foundations of this novel therapy approach.     

Comparison of Telomere Length of Vocal Folds With Different Tissues: A Physiological Measurement of Vocal Senescence

The objective of this article is to determine telomere length, a measure of biological age, in true vocal fold (TVF), false vocal fold (FVF), and five other tissue types, to ascertain whether there is tissue-specific telomere shortening. The study design is that of a prospective, basic science study. Tissue samples were obtained from the TVF, FVF, skin from the back of hand, skin from thigh, aorta, blood, and bone marrow from 12 patients ages 54 to 76 years. Genomic DNA was isolated from each sample, and telomere lengths were calculated with real-time polymerase chain reaction. In our small age group, age was not significantly associated with telomere length across tissue types, nor were there any linear correlations within tissue types and age. Controlling for age, significant differences were found between the following tissues: aorta and blood (P < 0.000), aorta and bone marrow (P = 0.033), aorta and FVF (P = 0.015), aorta and hand skin (P = 0.004), blood and thigh skin (P = 0.012), and blood and TVF (P = 0.048). A significant linear correlation between telomere length and tissue type without considering donor age was established between bone marrow and hand skin (P < 0.05, R2 = 0.766), thigh skin and hand skin (P < 0.01, R2 = 0.926), TVF and blood (P < 0.01, R2 = 0.836), and thigh skin and TVF (P < 0.05, R2 = 0.624). Our findings indicate that surrogate tissue for measurement of telomere length of TVF includes FVF, bone marrow, skin, and aorta. These findings have implications for understanding vocal fold aging at the cellular level.     

Vocal Range and Intensity in Actors: A Studio Versus Stage Comparison

A voice range profile (VRP) was obtained from each of eight professional actors and compared with two speech range profiles (SRPs). One speech profile was obtained during the dramatic reading of a scene in the laboratory and the other during a performance on stage in a professional theater. The objective was to determine the pitch and loudness ranges used by the actors in speech relative to the VRP. The principal question of interest was whether the actors stayed within the center of the VRP, or whether they tended to drift toward the boundaries of intensity and frequency. A second question was whether the performance within the laboratory accurately reflects that of a stage performance. The results suggest that some subjects tend to exceed the center of the VRP during the stage performance. It is hypothesized that these actors may stress their vocal mechanism during performance and are more likely candidates for vocal injury.     

Source Characteristics of Aged Voice Assessed from Long-Term Average Spectra

This study is the first to investigate age-related changes in the source characteristics of dynamic speech using long-term average spectral analysis (LTAS). A total of 80 speakers divided equally by age and gender participated. All participants were healthy, active community members. From the first paragraph of the Rainbow Passage, spectral energy measurements were completed for all speakers at 50 frequency levels across the LTAS. In comparison with young women, elderly women demonstrated: (1) significantly higher spectral amplitude levels at the frequencies of 320, 6080, 6240, 6400, 6560, and 6720 Hz; (2) significantly lower levels at the frequencies of 3040 and 3200 Hz; and (3) a tendency toward higher levels at 160 Hz. These findings suggest that both young and elderly women demonstrate spectral features associated with breathy voice quality, while differing in the specific spectral regions in which breathiness is indicated. Elderly men demonstrated significantly higher spectral amplitude levels than young men at 160 Hz, as well as significantly lower levels at 1600 Hz. Findings for men provide acoustic support for previous laryngoscopic findings of an age-related increase in the incidence of glottal gaps.