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.     

Voice Analysis of Postlingually Deaf Adults Pre- and Postcochlear Implantation

Objectives

To ascertain whether cochlear implantation (CI), without specific vocal rehabilitation, is associated with changes in perceptual and acoustic vocal parameters in adults with severe to profound postlingual deafness.

Hypothesis

Merely restoring auditory feedback could allow the individual to make necessary adjustments in vocal pattern.

Study Design

Prospective and longitudinal.

Methods

The experimental group composed of 40 postlingually deaf adults (20 males and 20 females) with no previous laryngeal or voice disorders. Participants’ voices were recorded before CI and 6–9 months after CI. To check for chance modifications between two evaluations, a control group of 12 postlingually deaf adults, six male and six female, without CI was also evaluated. All sessions composed of the recording of read sentences from Consensus Auditory-Perceptual Evaluation of Voice and sustained vowel /a/. Auditory and acoustic analyses were then conducted.

Results

We found a statistically significant reduction in overall severity, strain, loudness, and instability in auditory analysis. In vocal acoustic analysis, we found statistically significant reduction fundamental frequency (F0) values (in male participants) and F0 variability (in both genders). The control group showed no statistically significant changes in most vocal parameters assessed, apart from pitch and F0 (in female participants only). On comparing the interval of variation of results between the experimental and control groups, we found no statistically significant difference in vocal parameters between CI recipients and nonrecipients, with the exception of F0 variability in male participants.

Conclusions

The patients in our sample showed changes in overall severity, strain, loudness, and instability values, and reductions in F0 and its variability. On comparing the variation of results between the groups, we were able to prove in our study that implant recipients postlingually deaf adults (experimental group), without specific vocal rehabilitation, differed from nonrecipients (control group) in loudness and F0 variability sustained vowel /a/ in male participants.     

Spectral Amplitude Measures of Adductor Spasmodic Dysphonic Speech

Spectral amplitude measures are sensitive to varying degrees of vocal fold adduction in normal speakers. This study examined the applicability of harmonic amplitude differences to adductor spasmodic dysphonia (ADSD) in comparison with normal controls. Amplitudes of the first and second harmonics (H1, H2) and of harmonics affiliated with the first, second, and third formants (A1, A2, A3) were obtained from spectra of vowels and /i/ excerpted from connected speech. Results indicated that these measures could be made reliably in ADSD. With the exception of H1(*)-H2(*), harmonic amplitude differences (H1(*)-A1, H1(*)-A2, and H1(*)-A3(*)) exhibited significant negative linear relationships (P < 0.05) with clinical judgments of overall severity. The four harmonic amplitude differences significantly differentiated between pre-BT and post-BT productions (P < 0.05). After treatment, measurements from detected significant differences between ADSD and normal controls (P < 0.05), but measurements from /i/ did not. LTAS analysis of ADSD patients' speech samples proved a good fit with harmonic amplitude difference measures. Harmonic amplitude differences also significantly correlated with perceptual judgments of breathiness and roughness (P < 0.05). These findings demonstrate high clinical applicability for harmonic amplitude differences for characterizing phonation in the speech of persons with ADSD, as well as normal speakers, and they suggest promise for future application to other voice pathologies.     

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/.     

Vocal Tract Configurations in Male Alto Register Functions

Purpose

Professional male altos (countertenors) mostly use a register function, which is considered to be derived from falsetto. However, the sound produced differs in professional altos compared with the modal register or falsetto of untrained voices. The aim of this study was to analyze differences of the vocal tract shapes in male alto register functions.

Material and Methods

Dynamic real-time magnetic resonance imaging of eight frames per second was used to analyze the vocal tract profile in seven professional male altos who sang on the vowel /a/, an ascending and descending scale from G3 (196 Hz) to E4 (330 Hz). The scale included their register transition from modal register to stage (counter) falsetto and naïve falsetto.

Results

Register transitions from modal register to stage falsetto were associated with increased lip opening, jaw retraction, elevation and back positioning of the tongue, pharynx narrowing, uvula elevation, drop of larynx height, and tilting of the larynx. Differences between stage and naïve falsetto were found mostly with regard to lip opening and pharynx width.

Conclusions

The differences between the vocal tract configurations might have an impact on the acoustic characteristics observed in professional male alto register functions.     

MRI Anatomical and Morphological Differences in the Vocal Tract Between Dysphonic and Normal Adult Women

Objective

To analyze the vocal tract morphometry of women with vocal nodules (VN) compared with normal subjects by means of magnetic resonance imaging (MRI) at rest position.

Study Design

Prospective study.

Methods

The present research included 20 young adult women, aged 18–40 years: 10 dysphonic patients with VN and 10 normal subjects. All participants were tested using MRI; 12 measurements of the vocal tract were performed: nine in median sagittal section and three in axial section.

Results

The 12 measurements were smaller in the dysphonic group; statistical significance was obtained for three parameters: in the sagittal plane, the laryngeal vestibule area was significantly smaller in the dysphonic group, with P = 0.012∗ (∗ = statistical significance); in the axial section, the distance between the right and left vocal processes of the arytenoids’ cartilages and the distance between the anterior commissure of the glottis and the laryngeal posterior wall were also significantly lower in the dysphonic group, with P = 0.036∗ and 0.010∗, respectively. Significant differences in the vocal tract morphometry of individuals with VN were observed compared with normal subjects, at rest position.

Conclusions

Results obtained from this study suggest that patients with VN may present a constantly increased tension of the laryngeal muscles, even at rest; moreover, reduced anterior-posterior dimension of the larynx may be a morphological characteristic of patients with VN.     

Differences in Self-Rated, Perceived, and Acoustic Voice Qualities Between High- and Low-Fatigue Groups

Objectives

The present study was performed to examine which factors among self-rated scales, perceptual evaluations, and acoustic parameters, calculated from sustained vowels, are reliable indicators of physical and mental fatigues.

Methods

A total of 73 volunteers (male:female, 52:21), aged 19–24 years, were enrolled in this study. We defined the high- and low-fatigue groups using the Chalder Fatigue Scale score. For assessment of self-rated symptoms, each subject was asked to complete Voice Handicap Index (VHI) and Voice Rating Scale (VRS). For perceptual evaluations, three clinicians assessed each subject’s vocal quality on the Grade, Roughness, Breathiness, Asthenia, Strain Scale. For acoustic analysis, each subject was asked to produce sustained vowels /a/, /e/, /i/, /o/, and /u/ for 3 seconds. Then, the habitual fundamental frequency (F₀), jitter, shimmer, F₀ tremor, mean F₀, standard deviation of F₀, maximum F₀, minimum F₀, normalized noise energy, harmonic-to-noise ratio (HNR), signal-to-noise ratio (SNR), amplitude tremor, and ratio within 2–4 kHz were calculated using Dr. Speech software.

Results

In men, VHI, VRS, F₀ tremor, shimmer, HNR, SNR, and amplitude tremor were related to mental fatigue. In women, only VHI was related to physical fatigue, and none of the acoustic parameters was related to the fatigue score. Perceptual evaluations were not related to fatigue in men or women.

Conclusions

These findings suggest that self-rated symptoms and acoustic parameters related to voice quality are indicative of mental fatigue, and these features are prominent in men.     

Investigating the Effects of Caffeine on Phonation

Objective

A core component of vocal hygiene programs is the avoidance of agents that may dry the vocal folds. Clinicians commonly recommend that individuals reduce caffeine intake because of its presumed dehydrating effects on the voice. However, there is little evidence that ingestion of caffeine is detrimental to voice production. The first objective of this study was to evaluate whether caffeine adversely affects voice production. The second objective was to evaluate if caffeine exacerbates the adverse phonatory effects of vocal loading.

Study Design

Prospective, double-blinded, sham-controlled study.

Methods

Sixteen healthy adults participated in two sessions where they consumed caffeine (caffeine concentration = 480 mg) or sham (caffeine concentration = 24 mg) beverages. Voice measures (phonation threshold pressure and perceived phonatory effort) were collected. Subjects then completed a vocal loading challenge and voice measures were obtained again.

Results

There were no significant differences in voice measures between the caffeine and sham conditions. Ingestion of caffeine did not adversely affect voice production (P > 0.05) or exacerbate the detrimental phonatory effects of vocal loading (P > 0.05).

Conclusions

Our findings contribute to emerging knowledge on the effects of caffeine on voice production. Recommendations to completely eliminate caffeine from the diet, as a component of a vocal hygiene program, should be evaluated on an individual basis.     

The Impact of Voice Disorders Among Teachers: Vocal Complaints, Treatment-Seeking Behavior, Knowledge of Vocal Care, and Voice-Related Absenteeism

Objectives

Teachers are at increased risk for developing voice disorders. Occupational risk factors have been extensively examined; however, little attention has been paid to the consequences of the vocal complaints. The objective of this study was to investigate the knowledge that teachers have about vocal care, treatment-seeking behavior, and voice-related absenteeism.

Methods

The study group comprised 994 teachers and 290 controls whose jobs did not involve vocal effort. All participants completed a questionnaire inquiring about vocal complaints, treatment-seeking behavior, voice-related absenteeism, and knowledge about vocal care. Comparisons were made between teachers with and without vocal complaints and with the control group.

Results

Teachers reported significantly more voice problems than the control population (51.2% vs 27.4%) (χ² = 50.45, df = 1, P < 0.001). Female teachers reported significantly higher levels of voice disorders than their male colleagues (38% vs 13.2%, χ² = 22.34, df = 1, P < 0.001). Teachers (25.4%) sought medical care and eventually 20.6% had missed at least 1 day of work because of voice problems. Female teachers were significantly more likely to seek medical help (χ² = 7.24, df = 1, P = 0.007) and to stay at home (χ² = 7.10, df = 1, P = 0.008) in comparison with their male colleagues. Only 13.5% of all teachers received information during their education.

Conclusions

Voice disorders have an impact on teachers' personal and professional life and imply a major financial burden for society. A substantial number of teachers needed medical help and was obligated to stay at home because of voice problems. This study strongly recommends the implementation of vocal education during the training of teacher students to prepare the vocal professional user.     

Features of the energy spectra of photoelectrons at the atomic ionization in a two-color laser field of first and third harmonics

Classical analysis and quantum-mechanical studies of the energy spectra of photoelectrons have been carried out for above-threshold ionization of atoms in a two-color laser field of the first and third (n = 3) harmonics. Numerical computations show that the boundary of direct ionization plateau corresponds to the electron energy E ≈ 3.56 \(U_{p_1 } \), while the boundary of rescattering plateau corresponds to the electron energy E ≈ 16.62 \(U_{p_1 } \) for the two-color field of fundamental frequency and its third harmonic with equal intensities, which is in accordance with the results of classical analysis. The results of classical analysis of the ionization processes in the field of first and nth harmonics of equal intensities show that the length of the direct ionization plateau and the length of the high-energy rescattering plateau decrease with increasing n. The results of numerical analysis of the ionization processes in the field of first and third (n = 3) harmonics correspond to the results of classical analysis carried out by the authors.     

Chronic Refractory Cough as a Sensory Neuropathy: Evidence From a Reinterpretation of Cough Triggers

Objectives/Hypothesis

The aims of this study were to examine cough triggers in individuals with chronic cough (CC), identify sensory symptoms consistent with central reflex sensitization (paresthesia and allotussia), and interpret this information in relation to sensory laryngeal neuropathy.

Study Design

Prospective observational study.

Methods

Patients (n = 53) with CC that was refractory to medical management based on the anatomic diagnostic protocol completed questionnaires regarding cough triggers, anxiety and depression, and factors contributing to laryngeal irritation such as vocal hygiene and laryngopharyngeal reflux.

Results

An abnormal sensation in the laryngeal area (laryngeal paresthesia) was present in 94% of people with refractory CC. Nontussive stimuli including phonation were frequent triggers for cough (allotussia), occurring in 71% of participants. Although tussive stimuli were significantly more potent than nontussive stimuli (P = 0.005), the relative clinical importance was not statistically different (P = 0.072). Most participants with refractory cough had poor vocal hygiene.

Conclusion

The sensory symptom changes that accompany CC suggest central reflex sensitization and include laryngeal paresthesia and allotussia. The results are consistent with cough as a sensory neuropathic disorder.     

Age, sex, and vowel dependencies of acoustic measures related to the voice source

The effects of age, sex, and vocal tract configuration on the glottal excitation signal in speech are only partially understood, yet understanding these effects is important for both recognition and synthesis of speech as well as for medical purposes. In this paper, three acoustic measures related to the voice source are analyzed for five vowels from 3145 CVC utterances spoken by 335 talkers (8-39 years old) from the CID database [Miller et al., Proceedings of ICASSP, 1996, Vol. 2, pp. 849-852]. The measures are: the fundamental frequency (F0), the difference between the "corrected" (denoted by an asterisk) first two spectral harmonic magnitudes, H1* - H2* (related to the open quotient), and the difference between the "corrected" magnitudes of the first spectral harmonic and that of the third formant peak, H1* - A3* (related to source spectral tilt). The correction refers to compensating for the influence of formant frequencies on spectral magnitude estimation. Experimental results show that the three acoustic measures are dependent to varying degrees on age and vowel. Age dependencies are more prominent for male talkers, while vowel dependencies are more prominent for female talkers suggesting a greater vocal tract-source interaction. All talkers show a dependency of F0 on sex and on F3, and of H1* - A3* on vowel type. For low-pitched talkers (F0 < or = 175 Hz), H1* - H2* is positively correlated with F0 while for high-pitched talkers, H1* - H2* is dependent on F1 or vowel height. For high-pitched talkers there were no significant sex dependencies of H1* - H2* and H1* - A3*. The statistical significance of these results is shown.     

Maximum Phonation Time in Healthy Older Adults

Objectives/Hypothesis

Maximum phonation time (MPT), a clinical measurement of the longest time one can phonate a vowel, typically /a/, is a frequently used measure of vocal function, but normative data are lacking for MPT in healthy older adults. The aim of this study was to provide data on MPT in healthy older adults and to determine the effect of advanced age, gender, and repeated measures on MPT.

Study Design

Prospective.

Methods

Sixty-nine healthy older adult volunteers participated (ie, 15, 26, and 28 in the seventh, eighth, and ninth decades of life, respectively). The effects of age, gender, and repeated measures (three trials in a single session) on MPT were assessed. Mean, standard deviation, compound symmetry covariance, analysis of variance, and analysis of covariance were used for statistical analysis.

Results

Neither age group, gender, trial, nor their interactions was statistically significant (P > 0.05). Adults in the seventh, eighth, and ninth decades of life had mean MPTs of 22.27 (standard error [SE] = 1.56), 22.97 (SE = 1.11), and 21.14 (SE = 0.97) seconds, respectively. Females and males had mean MPTs of 20.96 (SE = 0.92) and 23.23 (SE = 0.96) seconds, respectively. Finally, MPTs for trials 1, 2, and 3 were 21.77 (SE = 1.09), 21.67 (SE = 1.12), and 22.80 (SE = 1.27), respectively.

Conclusions

MPTs were longer in this group of older adults than previously reported and did not vary significantly with age or gender. Additionally, across a single short sampling session, measurements were relatively stable across three trials of MPTs.     

Zakharov equations with zeroth harmonic and a new type of modulation instability

It has been shown that the system of Zakharov equations for the amplitudes of the first and zeroth harmonics of the waves on the surface of an ideal liquid describes not only the known type of the modulation instability of the envelope of the main harmonic with respect to harmonic perturbations with small wave vectors κ (Benjamin-Feier modulation instability), but also the modulation instability of a combination of the main and zeroth harmonics at κ values on the order of the wave vector k ₀ of the main harmonic. In contrast to the Benjamin-Feier modulation instability typical for large depths, the described modulation instability does not disappear at k ₀ h < 1.363.     

Localized vibrations ofH andD in Ta and their relation to theH(D) potential

The localized vibrations ofH(D) in and TaH(D) _x have been studied by high resolution inelastic neutron scattering. The frequencies of the fundamentals have been determined with very high accuracy. The corresponding line widths are extremely narrow in contrast to literature data. The slight broadening of the higher fundamental in the phase could be related to the orthorhombic distortion of this phase. For the first time higher harmonics of localizedH(D) vibrations in Ta could be observed. Their frequency shift relative to the harmonic value and the deviation of the fundamental frequencies from the harmonic isotope effect could consistently be described by one anharmonicity parameter for theH(D) potential.     

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.     

Bacterial Cellulose as Laryngeal Medialization Material: An Experimental Study

Hypothesis

The use of a material made of bacterial cellulose with the aim of obtaining vocal fold medialization has not hitherto been fully investigated. Although the material has been tested in other animal models, the evaluation did not include the larynx; hence, situations, such as tissue reaction, material absorption, and extrusion, need to be addressed to evaluate its usefulness as a material for laryngeal reconstruction.

Objective

To evaluate the medialization, tissue response, and healing of rabbit vocal folds, after the implantation of a membrane of bacterial cellulose.

Study Design

Experimental study.

Methods

A total of 32 rabbits were used, two of which were used to check out the adequacy of the implant location. The animals were followed for 4 months and grouped according to follow-up times of 2, 4, and 16 weeks. All test animals received an implant of bacterial cellulose in one vocal fold and the injection of distilled water in the other, both performed by videoendoscopic cervicotomy. At the end of the follow-up, the presence of inflammatory and medial displacement was evaluated.

Results

No statistically significant difference in the inflammatory parameters between the study and control vocal folds or among follow-up times was found. All animals receiving cellulose presented medial displacement of vocal folds, and all retained this material at the implant site up to study endpoint.

Conclusion

Bacterial cellulose is a useful material for laryngeal medialization, showing no signs of rejection or absorption.     

The Role of the Cricothyroid Joint Anatomy in Cricothyroid Approximation Surgery

Objectives/Hypothesis

Cricothyroid approximation (CTA) surgery aims at raising the voice pitch in male-to-female transsexuals. However, 30% of the patients are not satisfied with the result. The purpose of our study was to examine the cricothyroid joint (CTJ) biomechanics and to analyze if (and how) the CTJ anatomy influences the movement of the cricoid and, consequently, the elongation of the vocal fold and the voice pitch after CTA.

Methods

Twenty-four cadaver larynges were examined with high-resolution computerized tomography and MIMICS three-dimensional imaging software (Materialise Interactive Medical Image Control System, Leuven, Belgium). After superimposing the two scans taken in “neutral” and in “CTA” positions, vector geometrical analysis was used to determine the effective rotation axis of the CTJ and to calculate the elongation of the vocal folds after CTA.

Results

Our results showed that the cricoid rotates around an axis, the position of which depends on the anatomical structure of the CTJ. Based on the location of this effective rotation axis, we could distinguish three groups. In group I (N = 13), the rotation axis was located in the lower third; in group II (N = 5), it was located in the middle third; and in group III (N = 6), it was located in the upper third of the cricoid. The elongations of the vocal fold were 12%, 8%, and 3%, in groups I, II, and III, respectively.

Conclusions

The anatomical structure of the CTJ influences directly (1) the position of the effective rotation axis and (2) the elongation of the vocal folds.     

New applications of the Mössbauer effect

Results from a Mössbauer experiment to observe acoustic oscillations induced by pulsed laser excitation in MgO:⁵⁷Fe²⁺ crystal are presented. Time-domain spectra are satsifacorily described by the theory of the frequency modulation of Mössbauer radiation transmitted through a vibrating resonance medium. It is proposed that the D _4Ω/D _2Ω ratio of the fourth and second Fourier harmonics of the modulated radiation be used to measure the amplitude of nuclear oscillations.     

Voice Training and Changing Weight—Are They Reflected in Speaking Fundamental Frequency, Voice Range, and Pitch Breaks of 13-Year-Old Girls? A Longitudinal Study

Objective

Assessment of the voice-change progress of 20 girls (12–13 years) over 1 year by observing changes in speaking fundamental frequency (SFo), voice range, and register pitch breaks in the context of weight, height, voice training, and self-perception.

Study Design

One-year longitudinal collective case study.

Method

Twenty girls were recorded at the beginning and end of a year; nine girls were recorded another three times. SFo, vocal range, and characteristics were analyzed and interactions between these data assessed against weight and height to indicate pubertal development, and to test the hypothesis that changes in weight, height, SFo, and pitch breaks were related. Effects of training and the girls' self-perception of their voice use were also assessed.

Results

Vocal characteristics changed as the girls passed through different weight ranges. During 47.5–52.4 kg (called band 2) and 52.4–57.5 kg (band 3), there was progressive contraction of vocal range and in some girls a slight rise in SFo between recording times 1 and 5. Both high- and low-pitch breaks were present in 45% of girls' voices. Girls in band 4 (<57.5 kg) had an increased vocal range, and pitch breaks in vocal-range areas that indicated the development of adult vocal registers. In this study, voice-trained girls were heavier, had higher SFo, used wider speech-range inflection, had a higher vocal range, and greater voice-use confidence; all girls lost confidence in their voice use over the year.

Conclusions

In this longitudinal study of twenty 13-year-old girls, voice changes in SFo, vocal range, and pitch-break frequency were synchronous with certain weight ranges. Girls with training registered higher maximum phonational frequency and were more confident in their voice use than girls without training.