Vocal Improvement After Voice Therapy in Unilateral Vocal Fold Paralysis

Unilateral vocal fold paralysis (UVFP) is associated with changes in acoustic and aerodynamic voice measurements and can have a significant impact on a patient's quality of life. Few objective data regarding the efficacy of voice therapy for UVFP exist. The aim of this study was to retrospectively analyze voice modifications in a group of patients with UVFP before and after voice therapy. Forty patients with UVFP of different etiology were included in the study. Each subject had voice therapy with an experienced speech/language pathologist twice a week; the mean number of sessions was 12.6. A multidimensional assessment protocol was used; it included videoendoscopy, the maximum phonation time (MPT), the GIRBAS scale, spectrograms and a perturbation analysis, and the Voice Handicap Index (VHI). Pre- and posttreatment data were compared by means of the Wilcoxon and Student's t tests. A complete glottal closure was seen in 8 patients before voice therapy and in 14 afterward. Mean MPT increased significantly. In the perceptual assessment, the difference was significant for five out of six parameters. A significant improvement was found on spectrographic analysis; as for perturbation analysis, the differences in jitter, shimmer, and noise-to-harmonic ratio values were significant. VHI values showed a clear and significant improvement. A significant improvement of voice quality and quality of life after voice therapy is an often reached and reasonable goal in patients with UVFP.     

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.     

Deviant Vocal Fold Vibration as Observed During Videokymography: The Effect on Voice Quality

Videokymographic images of deviant or irregular vocal fold vibration, including diplophonia, the transition from falsetto to modal voice, irregular vibration onset and offset, and phonation following partial laryngectomy were compared with the synchronously recorded acoustic speech signals. A clear relation was shown between videokymographic image sequences and acoustic speech signals, and the effect of irregular or incomplete vocal fold vibration patterns was recognized in the amount of perceived breathiness and roughness and by the harmonics-to-noise ratio in the speech signal. Mechanisms causing roughness are the presence of mucus, phase differences between the left and right vocal fold, and short-term frequency and amplitude modulation. It can be concluded that the use of simultaneously recorded videokymographic image sequences and speech signals contributes to the understanding of the effect of irregular vocal fold vibration on voice quality.     

Computational Simulations of Vocal Fold Vibration: Bernoulli Versus Navier–Stokes

The use of the mechanical energy (ME) equation for fluid flow, an extension of the Bernoulli equation, to predict the aerodynamic loading on a two-dimensional finite element vocal fold model is examined. Three steady, one-dimensional ME flow models, incorporating different methods of flow separation point prediction, were compared. For two models, determination of the flow separation point was based on fixed ratios of the glottal area at separation to the minimum glottal area; for the third model, the separation point determination was based on fluid mechanics boundary layer theory. Results of flow rate, separation point, and intraglottal pressure distribution were compared with those of an unsteady, two-dimensional, finite element Navier-Stokes model. Cases were considered with a rigid glottal profile as well as with a vibrating vocal fold. For small glottal widths, the three ME flow models yielded good predictions of flow rate and intraglottal pressure distribution, but poor predictions of separation location. For larger orifice widths, the ME models were poor predictors of flow rate and intraglottal pressure, but they satisfactorily predicted separation location. For the vibrating vocal fold case, all models resulted in similar predictions of mean intraglottal pressure, maximum orifice area, and vibration frequency, but vastly different predictions of separation location and maximum flow rate.     

Voice and Laryngeal Configuration of Men With Unilateral Vocal Fold Paralysis Before and After Medialization

Aim

To describe the laryngeal configuration and the voice of male patients diagnosed with unilateral vocal fold paralysis (UVFP) before and after medialization.

Methods

A retrospective study involving the collection of data from medical records of 142 patients diagnosed with UVFP from January 2003 to April 2009, submitted to auditory-perceptual assessment of voices and visual perception of laryngeal images before and after medialization.

Results

The study included data from 24 male patients, with an average of 60.7 years, who underwent three surgical medialization techniques (injection of hyaluronic acid, type I thyroplasty, and injection of Teflon). Before treatment, the position of the paralyzed vocal fold was seen to have a significant influence to the passing of the healthy vocal fold beyond the midline and on the overall degree of dysphonia. After treatment, the complete glottic closure; the free margin of the linear vocal fold; paralyzed vocal fold in the median position, reduction of hoarseness, roughness and breathiness (more frequently mild), and asthenia (more frequently normal and mild); tension and instability (more frequency normal); and a decrease in the overall degree of dysphonia were found to be significant.

Conclusion

The position of the paralyzed vocal fold influences the position of the healthy vocal fold in relation to the midline and the overall degree of dysphonia. All three treatments improved the glottic configuration and the voice of patients with UVFP.     

Vocal Fold Vibration and Phonation Start in Aspirated, Unaspirated, and Staccato Onset

Objectives/Hypotheses

Singers learn to produce well-controlled tone onsets by accurate synchronization of glottal adduction and buildup of subglottal pressure. Spectrographic analyses have shown that the higher spectrum partials are present also at the vowel onset in classically trained singers’ performances. Such partials are produced by a sharp discontinuity in the waveform of the transglottal airflow, presumably produced by vocal fold collision.

Study Design

After hearing a prompt series of a triad pattern, six singer subjects sang the same triad pattern on the vowel /i/ (1) preceded by an aspirated /p/, (2) preceded by an unaspirated /p/, and (3) without any preceding consonant in staccato.

Methods

Using high-speed imaging we examined the initiation of vocal fold vibration in aspirated and unaspirated productions of the consonant /p/ as well as in the staccato tones.

Results

The number vibrations failing to produce vocal fold collision were significantly higher in the aspirated /p/ than in the unaspirated /p/ and in the staccato tones. High frequency ripple in the audio waveform was significantly delayed in the aspirated /p/.

Conclusions

Initiation of vocal fold collision and the appearance of high-frequency ripple in the vowel /i/ are slightly delayed in aspirated productions of a preceding consonant /p/.     

Evaluation of Voice Pathology Based on the Estimation of Vocal Fold Biomechanical Parameters

Voice disorders are a source of increasing concern as normal voice quality is a social demand for at least one third of the population in developed countries in cases where voice is an essential resource in professional exercise. In addition, the growing exposure to certain pathogenic factors such as smoking, alcohol abuse, air pollution, and acoustic contamination, and other problems such as gastro-esopharyngeal reflux or allergy as well as aging, aggravate voice disorders. Voice pathologies justify the assignment of larger resources to prevention policies, early detection, and less aggressive treatments. Traditional pathology detection relies on perceptive evaluation methods (GRABS), acoustic analysis, and visual inspection (indirect laryngoscopy, and modern fibro-endo-stroboscopy). This article describes a method for voice pathology detection based on the noninvasive estimation of vocal cord biomechanical parameters derived from voice using specific signal processing methods. Preliminary results using records from patients showing four frequent causes of voice pathology (nodules, polyps, chronic laryngitis, and Reinke's edema) are given. The results show that the alteration (distortion, unbalance, or deviation) of cord biomechanical parameters may serve as an indicator of pathology. Statistical methods based on hierarchical clustering and principal component analysis reveal that combining biomechanical estimates with classic perturbation parameters increases the accuracy of acoustic analysis, improving the detection of voice pathology. This research could open new possibilities for noninvasive screening of vocal fold pathologies and could be used in the implantation of e-health voice care services.