The clinical voice laboratory: Clinical application of voice research

In the past decade the number of voice laboratories has increased dramatically. Their primary mission is to enhance patient care by the application of knowledge gained from basic research. They also are dedicated to further improvement of diagnostic and therapeutic resources. The strength of the voice laboratory lies in collaboration between the clinician and the scientist.     

Effects of voice therapy on the voice range profiles of dysphonic patients

In a group of chronically dysphonic patients, a voice range profile, or phonetogram, was recorded before and after receiving voice therapy and again 3 months later. The voice range profiles took a wide variety of shapes. Therefore, only measures that did not depend on a smooth contour could be used to describe changes before and after therapy. The main effect of voice therapy was an enlargement on the side of low frequency and low intensity.     

G. Paul Moore lecture: Rational thought: The impact of voice science upon voice care

Recent evolution in scientific knowledge and technology has led to monumental improvement in the standard of care for patients with voice disorders. New concepts in anatomy, physiology, measurement, and analysis have provided voice care professionals with not merely better understanding, but moreover an extensive vocabulary with which to think about voice function and dysfunction. Previously, we had to depend too much upon anecdote and “the art of medicine.” Thanks to scientific advances, we now have the tools we need for rational thought about the human voice. This is the fundamental change responsible for recent great advances in voice care.     

Some physical characteristics of the male falsetto voice

Previous research indicated that, as groups, male (bass/baritone) and female (soprano) professional singers tend to exhibit differing vocal tract and voice source behaviours. The use of an objective measure of voice [xeroradiographic-electrolaryngographic analysis (XEL)] revealed differences between the two voice types, especially at the highest sample pitches (e, 330 Hz for bass/baritones, and e″, 1,320 Hz for sopranos). XEL analysis combines two known techniques, i.e., soft-tissue radiographic imaging (xeroradiography), and an analysis of voice-source vibratory patterning (electrolaryngography). Subsequent to this investigation, interest centered on the male professional falsetto voice over a two-octave range (E 165 Hz to e′ 660 Hz) using a sample (n=9) of professional countertenors. Results suggest that there are characteristic trends in the patterning of the male professional falsetto register, but there is also evidence of within-group variability. The subjects significantly increased the size of the pharyngeal tube area during phonation. ANOVA and Trend Analysis revealed ventricular space as the only measure to expand systematically and consistently as sung pitch increases.     

Respiratory training in voice therapy

Many patients with dysphonia do not need to modify their respiratory patterns. For those that do, a simple four-point program is offered that will usually aid the patient in developing better expiration control. First, the patient is instructed that inspiratory-expiratory respiration is a continuous ongoing movement. Imagery is used to show that there is little or no discernible gap between inspiration-expiration. The patient begins working on expiratory control by prolonging phonation with no instruction given for “taking in” a breath. The patient's task is to prolong a sound with no discernible inspiratory effort before the sound is made. The patient is then asked to match a verbal target model, making no special effort to take in a breath before producing the model. Finally, instruction is given in developing skills to take renewed breaths (catch-up breaths) when saying or singing an utterance     

Effects of singing training on the speaking voice of voice majors

This longitudinal study gathered data with regard to the question: Does singing training have an effect on the speaking voice? Fourteen voice majors (12 females and two males; age range 17 to 20 years) were recorded once a semester for four consecutive semesters, while sustaining vowels and reading the "Rainbow Passage." Acoustic measures included speaking fundamental frequency (SFF) and sound pressure level (SLP). Perturbation measures included jitter, shimmer, and harmonic-to-noise ratio. Temporal measures included sentence, consonant, and diphthong durations. Results revealed that, as the number of semesters increased, the SFF increased while jitter and shimmer slightly decreased. Repeated measure analysis, however, indicated that none of the acoustic, temporal, or perturbation differences were statistically significant. These results confirm earlier cross-sectional studies that compared singers with nonsingers, in that singing training mostly affects the singing voice and rarely the speaking voice.     

The relationship among voice onset, voice quality, and fundamental frequency: a dynamical perspective

In dynamical motor theory, skill acquisition occurs as a modification of preexisting coordination patterns or attractor states. The purpose of this study was to assess how different levels of voice onset, voice quality, and fundamental frequency (F₀) combine to form the attractor states common to voice motor control. Three levels of voice onset (glottal, simultaneous, and breathy), voice quality (modal speech, mixed, and falsetto), and fundamental frequency (low, mid, and high) were manipulated by vocally untrained, female subjects. Percent correct of acquisition trials and self-report of effort were used as measures of stable phonations indicative of an attractor state. Using intensity as a covariate, the results provided support for two of the three predicted triads representing attractor states in female speakers: (1) glottal onset/modal speech quality/low F₀; and (2) breathy onset/falsetto quality/high F₀. The results of this study suggest that certain parameters of voice motor control, such as onset, quality, and F₀, exist as part of a dynamical system that can be identified and manipulated in voice motor acquisition and learning.     

Panel The integration of voice science, voice pathology, medicine, public speaking, acting, and singing

The integration of voice science, voice pathology, medicine, public speaking, acting, and singing has been central to evolution in all fields. The Voice Foundation Symposia have played a seminal and central role in fostering integration among disciplines. The result has been an improvement in the knowledge and practice in each field. And the future promises to be even more informative and exciting.     

Expert consensus in solo voice performance evaluation

Experts were interviewed to identify criteria for evaluation of vocal performance. A scale was then constructed and inter- and intrajudge reliability assessed. Experts listened to 19 different performances, plus 6 presented a second time. Interjudge reliability for one judge was modest, but increased dramatically as the size of the judge panel increased. The most reliable items were overall score and intonation accuracy. Diction was less reliable than other items. Intrajudge reliability was higher for overall score than for any other item. A factor analysis on the test items yielded factors labelled intrinsic quality, execution, and diction. Another factor analysis, using the experts as variables, revealed two underlying evaluative dimensions. It was found that 13 experts were primarily influenced by execution, and that 8 were mainly affected by intrinsic quality. Interjudge and intrajudge reliabilities of these two groups differed.     

Voice field measurements—a new method of examination: the influence of hearing on the human voice

There are various methods to evaluate voice parameters. Original software was used to assess the voice quality by the staff of AUDIO-Fon centr Brno, Czech Republic. A group of hereditary deaf persons was examined. Deaf persons have all of the biological conditions to make voice except for the possibility of acoustic feedback. We examined the voices of 35 persons (20 men and 15 women) with hereditary profound hearing impairments, and we compared voice parameters with the voice of intact persons. To measure we used special software called voice field measurements (VFMs). The program graphically records voice frequency and intensity. VFM is an objective method that enables the assessment of basic physical voice characteristics. It is suitable for the examination of both intact and disturbed voice. The voice of the deaf has a higher basic voice frequency in men as well as in women. This type of voice production, ie, childlike voice, which is fixed only by a motor stereotype, is much more demanding for a mature larynx. Hearing influences both the voice development and speech production. The voice of persons with hearing impairments has a higher basic voice frequency regardless of their sex. This type of voice production, which is fixed only by a motor stereotype, ie, child voice, is much more demanding for a larynx of an adult. Thus, phonation of deaf people is more demanding and their voice production needs greater effort. Deaf people, despite an intact phonic apparatus, cannot produce more than one type of voice. They cannot modulate their voices concerning the frequency and dynamics. They cannot change their voices continually. The voice is limited in both of these parameters (frequency and dynamics). If a deaf person wants to change a voice characteristic, it is possible only by discontinuous changes-"skipping."     

Preparing the singing voice specialist revisited

In review of singing voice specialist preparation, discussion can be chronicled prior to the establishment of Arts Medicine in 1987. Although discussion began in 1984 (and earlier), no formal academic program currently exists to train the singing voice specialist. The need now is greater than ever for a formal program of study to prepare a person who seeks to be a singing voice specialist. The question of adequate preparation continues to be in need of an appropriate answer because no formal training programs or fellowships are available. It is essential to first define the role of singing voice specialists and the populations that they will encounter. To meet the needs of a diverse population, care of the professional voice demands cross-disciplinary training. Knowledge from the fields of music, science, medicine and communication disorders and experience/observation, clinical preparation, and research would provide for optimal preparation. To meet this need, development of a Masters degree program seems highly desirable. The structure of such a program is proposed, along with specific requirements outlined from the music and singing voice pathology components for a Masters Degree in Arts Medicine with a concentration in voice.     

Mechanical and dynamic aspects of voice production as related to voice therapy and phonosurgery

Laryngeal framework surgery can change the position and tensionof the vocal folds safely without direct surgical intervention in the vocal fold proper. Some 23 years of experience with phonosurgery have proved its usefulness in treating dysphonia related to unilateral vocal fold paralysis, vocal fold atrophy, and pitch-related dysphonias. Meanwhile, much information about the mechanism of voice production has been obtained through intraoperative findings of voice and fiberscopic examination of the larynx . Based on such knowledge together with information obtained through model experiments, the human vocal organ was reconsidered mainly from the mechanical view point, and the roles of voice therapy and singing pedagogy were discussed in relation to phonosurgery. The vocal organ may not be an ideal musical organ and is rather vulnerable, but its potential is enormous.     

Aerodynamic and acoustic characteristics of the adult AfricanAmerican voice

Laryngeal aerodynamic and acoustic characteristics of African American voice production were examined from vowel samples produced by ten adult female and ten adult male speakers. The data were compared with that for a control group consisting of ten adult female and ten adult male White speakers, matched for age, height, and weight. All measures were analyzed using Cspeech 4.0. Aerodynamic measurements, extracted from a glottal airflow waveform, included maximum flow declination rate, alternating glottal airflow, minimum glottal airflow, and airflow open quotient. Acoustic measures included fundamental frequency and sound pressure level. No significant mean differences between the African American and White speakers were found, except for maximum-flow declination rate. The White speakers produced significantly higher declination rates than the African American speakers. The factor of sex for the African American speakers was statistically significant for the measures of maximum-flow declination rate, alternating glottal airflow, open quotient, and fundamental frequency, consistent with the functioning of the White speakers. The results suggest that during vowel production, where the vocal tract is in a fairly static position, acoustic and aerodynamic characteristics for African American and White Speakers are comparable.     

The young adult voice

Young adulthood is notable for rapid physical changes and psychosocial instability. Care of the young adult professional voice requires knowledge of the specific anatomic and physiologic changes associated with the mutational voice, as well as the effects of general growth and maturation on the vocal mechanism. The effects of psychological stresses common to young adulthood, such as educational commitments and early career choices, must also be understood. Upper respiratory infection and allergies are common in this age group. Treatment of these conditions must be tailored in the professional voice user because of the potential side effects of some medications and the performance imperatives of the patient. Surgical indications for tonsillectomy in the young voice patient are discussed. There are no special considerations in the evaluation and treatment of laryngeal pathology in the young adult, with the exception of limiting the use of sedative anesthesia. However, conservatism in surgical decision-making is advised. The development of a stable, efficient vocal technique and a mature professional background requires time, patience, and hard work.     

Effects of HearFones on speaking and singing voice quality

HearFones (HF) have been designed to enhance auditory feedback during phonation. This study investigated the effects of HF (1) on sound perceivable by the subject, (2) on voice quality in reading and singing, and (3) on voice production in speech and singing at the same pitch and sound level.

Test 1: Text reading was recorded with two identical microphones in the ears of a subject. One ear was covered with HF, and the other was free. Four subjects attended this test. Tests 2 and 3: A reading sample was recorded from 13 subjects and a song from 12 subjects without and with HF on. Test 4: Six females repeated [pa:p:a] in speaking and singing modes without and with HF on same pitch and sound level.

Long-term average spectra were made (Tests 1–3), and formant frequencies, fundamental frequency, and sound level were measured (Tests 2 and 3). Subglottic pressure was estimated from oral pressure in [p], and simultaneously electroglottography (EGG) was registered during voicing on [a:] (Test 4). Voice quality in speech and singing was evaluated by three professional voice trainers (Tests 2–4).

HF seemed to enhance sound perceivable at the whole range studied (0–8 kHz), with the greatest enhancement (up to ca 25 dB) being at 1–3 kHz and at 4–7 kHz. The subjects tended to decrease loudness with HF (when sound level was not being monitored). In more than half of the cases, voice quality was evaluated “less strained” and “better controlled” with HF. When pitch and loudness were constant, no clear differences were heard but closed quotient of the EGG signal was higher and the signal more skewed, suggesting a better glottal closure and/or diminished activity of the thyroarytenoid muscle.     

Frequency and effects of teachers'' voice problems

This study compared the frequency and effects of voice symptomsin teachers to a group of individuals employed in other occupations. Teachers were more likely to report having a voice problem (15 vs. 6%), having 10 specific voice symptoms, and having 5 symptoms of physical discomfort. They averaged almost 2 symptoms compared with none for nonteachers. Likewise, teachers were more likely to perceive that a voice problem would adversely affect their future career options, had done so in the past, and was limiting their current job performance. Over 20% of teachers but none of the nonteachers had missed any days of work due to a voice problem. These findings suggest that teaching is a high-risk occupation for voice disorders and that this health problem may have significant work-related and economic effects.     

The role of pitch in the discrimination of voice quality

Pitch is an important attribute of a musical sound. With it the melody of a song is established. With it the beauty of a voice is showcased. But how does pitch affect the perception of voice? Is it used to help to distinguish among voices or does it merely exist in the background, affecting the fine details of a voice but not radically altering the voice? The purpose of this paper is to review some of the evidence on the role of pitch in the perception of voice quality; specifically for the discrimination of one voice quality from another. The objective of the discussion is to understand how pitch affects our perception of voice quality and its importance to the perception of musical sound.     

Expanding perspectives in care of the speaking voice

The effective voice clinician has always had to borrow from various disciplines: voice science, otolaryngology, psychology, and speech-language pathology. Such eclecticism requires, however, that the clinician integrate the perspectives of these various disciplines into some kind of theoretical clinical bias. One bias might be that with greater use of instrumentation in voice therapy, the voice clinician must not substitute data collection for attending to the feelings of the patient. By using the clinical input from various disciplines, for example, voice clinicians might develop a useful clinical perspective that vocal hyperfunction is one of the primary causes of many voice disorders. Consequently, from such a clinical view might come a treatment perspective that can clearly define the problem (too much effort while speaking) and offer a rationale for voice remediation.     

Suitability of minidisc (MD) recordingsfor voice perturbation analysis

A new digital recording format, Minidisc (MD), shows promise for high-quality voice recordings. It is available in a portable size and uses magneto-optical recording techniques on a miniature compact disc. The disc can be recorded an unlimited number of times with essentially the same playback life span; however, the digital recording technique uses a data compression algorithm that may interfere with acoustic voice perturbation analysis. This study investigated what effects this compression may have and whether the MD format is viable for use in this application.The MD format was evaluated by traditional synthetic test signals used onrecording devices. In addition, human phonation recorded on Digital Audio Tape (DAT) was used as the input to the MD. The output of the MD was then compared to the original DAT recording. The two signals were analyzed for long- and short-term perturbation measures, and their waveforms were visually inspected. The results indicated that the MD format performed as well as the DAT format in all areas of standard tests, with the exception of signal-to-noise (S/N) ratio. S/N ratio for the MD was approximately 10 dB less than for the DAT under normal operating conditions; however, in comparing perturbation measures on normal human vowels, there were no significant differences between the two formats, i.e., no distortions in voice perturbation were introduced by the MD record/playback process.     

The accent method of voice therapy: Effect of accentuations on FO, SPL, and airflow

The effect of the increased flow rate (ΔU) in response to the Accent Method exercises on fundamental frequency (FO) and sound pressure level (SPL) was studied in three subjects (professionally trained, trained, and untrained in this method). In all the subjects, the rhythmic accentuated exercises produced a variable degree of increase in FO (ΔFO) and SPL (ΔSPL). The professionally trained subject showed greater ΔFO and ΔSPL in response to the ΔU in the fastest tempo, which requires higher skills. Both trained subjects showed a greater correlation between ΔU and both ΔSPL and ΔFO, as well as between ΔFO and ΔSPL, as compared to the untrained subject. The effects of the accentuated exercises on FO and SPL in response to the increased airflow rate (ΔU) thus appear to demonstrate the treating effectiveness of the Accent Method.