Reliability in Perceptual Analysis of Voice Quality

This study focuses on speaking voice quality in male teachers (n = 35) and male actors (n = 36), who represent untrained and trained voice users, because we wanted to investigate normal and supranormal voices. In this study, both substantial and methodologic aspects were considered. It includes a method for perceptual voice evaluation, and a basic issue was rater reliability. A listening group of 10 listeners, 7 experienced speech-language therapists, and 3 speech-language therapist students evaluated the voices by 15 vocal characteristics using VA scales. Two sets of voice signals were investigated: text reading (2 loudness levels) and sustained vowel (3 levels). The results indicated a high interrater reliability for most perceptual characteristics. Connected speech was evaluated more reliably, especially at the normal level, but both types of voice signals were evaluated reliably, although the reliability for connected speech was somewhat higher than for vowels. Experienced listeners tended to be more consistent in their ratings than did the student raters. Some vocal characteristics achieved acceptable reliability even with a smaller panel of listeners. The perceptual characteristics grouped in 4 factors reflected perceptual dimensions.     

Vocal Cord Medialization by Transcutaneous Injection of Calcium Hydroxylapatite

Transcutaneous vocal cord augmentation has increasingly become the method of choice when treating causes of vocal cord insufficiency. Many substances have accompanied this technique, but they all have problems. One newer substance is calcium hydroxylapatite (CaHA). CaHA may produce fewer problems and offer a longer-lasting treatment. Twenty-one patients were treated in the Pacific Voice Clinic with trancutaneous injection of CaHA for vocal cord paralysis (n = 19) and vocal scarring (n = 2). Maximum phonation time (MPT) was the measure of vocal performance. An improvement was seen in 20 patients with the MPT, who improved from 4.6 seconds before treatment to 10.8 seconds at posttreatment of 3 months (n = 15). This improvement was maintained at 6 months (MPT = 12 seconds, n = 12). Follow-up was incomplete because of the terminal nature of some diagnoses and the large geographical area covered by the clinic. Three subjects had submucosal injection of CaHA (two resolving spontaneously). Two other patients had extrusion of the material. With short-term and medial-term follow-up on a small group of patients, encouraging results were seen with transcutaneous injection of CaHA for vocal cord augmentation.     

Preliminary Results of a New Temporary Vocal Fold Injection Material

Temporary vocal fold injection is a valuable procedure for vocal fold paralysis or paresis of uncertain permanency and as a trial augmentation to decide the value of vocal fold augmentation. A new material made from glycerin, carboxymethylcellulose, and water has recently been developed for temporary vocal fold augmentation. Eleven patients underwent vocal fold injection for the treatment of glottal incompetence with this material. The duration of effectiveness of this injection material was 2 to 3 months depending on the injection amount. This new material satisfies several requirements for an ideal temporary vocal fold injection material in terms of injectability, convenience, duration of effectiveness, and safety. The authors conclude that this new material is a good option for temporary vocal fold augmentation.     

Recurrent Laryngeal Nerve Electrophysiologic Monitoring in Thyroid Surgery: The Standard of Care?

Reports in the literature suggest that the rate of transient and permanent vocal fold immobility (VFI) after thyroid surgery is 4% to 7% and 1% to 4%. The intraoperative use of nerve integrity monitors has been advocated to reduce the incidence of VFI during thyroid surgery. The purpose of this study was to compare postoperative VFI after unmonitored and monitored thyroid surgical procedures. The charts of 136 consecutive patients who underwent thyroid surgery from 1998 to 2003 were retrospectively surveyed. Fifty-four patients had total thyroidectomies, bringing the total recurrent laryngeal nerves (RLNs) dissected to 190. Three of 190 (1.6%) and 7 of 190 (3.7%) RLNs dissected had permanent and transient vocal fold dysfunction. Overall, 107 RLNs were unmonitored compared with 83 RLNs that were monitored. Unmonitored and monitored RLNs had a 4 of 83 (4.8%) versus 3 of 107 (2.8%) rate of transient VFI (P > 0.05). Unmonitored and monitored RLNs had a 1 of 107 (0.9%) versus 2 of 83 (2.4%) rate of permanent VFD (P > 0.05). Electrophysiologic RLN monitoring was not demonstrated in this study to reduce the incidence of transient or permanent VFI after thyroid surgery. Electrophysiologic RLN integrity does not always translate into clinical postoperative vocal fold mobility. Electrophysiologic RLN monitoring may support that the RLN was not severed in the patient with postoperative VFI.     

Glottic Characteristics and Voice Complaint in the Elderly

This study evaluated the relationship between voice complaint and deviant vocal fold status with special regard to presbylarynx, in patients aged more than 60 years, with pharyngeal-laryngeal complaint. The material consisted of clinical histories and images obtained by laryngoscopies from protocols from the Larynx Institute-INLAR, Sao Paulo, Brazil, of 210 patients, 88 men and 122 women, aged more than 60 years, who had sought otorhinolaryngologic treatment. Indicative glottic characteristics of the presbylarynx, such as vocal fold bowing, prominence of vocal processes, and spindle-shaped glottic chink, were analyzed. The increase in mass, leukoplakia, and other vocal fold alterations, distinct from these two, grouped as miscellaneous, as well as the presence or absence of voice complaint were also analyzed. Vocal fold bowing, prominence of vocal processes, and spindle-shaped glottic chink showed a strong correlation among each other. The presence of presbylarynx was accompanied by less voice complaint than the presence of vocal fold mucosa alterations, which in turn are more common where an absence of presbylarynx exists.     

Changes in the Prevalence of Vocal Symptoms Among Teachers During a Twelve-Year Period

Vocal symptoms and voice disorders among teachers were studied in 1988 using a questionnaire designed to obtain information on six vocal symptoms that had appeared during the past 2 years. Twelve percent of the 478 respondents reported vocal symptoms occurring weekly or more often. The study was repeated using the same questionnaire in 2001. The results of this second study (n=241) indicate that vocal symptoms had increased considerably. Twenty-nine percent of the teachers reported symptoms occurring weekly or more often, and 20% reported two symptoms or more occurring at least once a week, which is significantly more than in 1988. Accordingly, voice disorders are probably a growing problem among teachers. Several factors may explain these increases. In 2001, the teachers complained more often about increases in the size of their classes. Factors that disturbed normal work routines, such as noisy or misbehaving pupils, had also increased significantly. A growing number of misbehaving pupils probably cause increased background noise and stress and, thus, increase the vocal symptoms in teachers.     

Evolution of Vocal Fold Nodules from Childhood to Adolescence

SUMMARY: Bilateral (quasi) symmetrical lesions of the anterior third of the vocal folds, commonly called vocal fold nodules (VFNs) are the most frequent vocal fold lesions in childhood caused by vocal abuse and hyperfunction. This study evaluates their long-term genesis with or without surgery and voice therapy. A group of 91 postmutational adolescents (mean age, 16 years), in whom VFNs were diagnosed in childhood, were questioned to analyze the evolution of their complaints. Thirty four of them could be clinically reexamined by means of the European Laryngological Society-protocol, including a complete laryngological investigation and voice assessment. A total of 21% of the questioned group (n=91) had voice complaints persisting into postpubescence with a statistically significant difference (P 相似文献   

Analysis of Voice and Quantitative Measurement of Glottal Gap After Thyroplasty Type I in the Treatment of Unilateral Vocal Paralysis

Thyroplasty type I is one of several surgical treatments in which improving the voice of unilateral vocal fold paralysis is the ultimate objective. The goal of the surgery is the medialization of the paralyzed vocal fold. The purpose of this study is to evaluate the effectiveness of thyroplasty type I through acoustical analysis, aerodynamic measures, and quantitative videostroboscopic measurements. We report on 20 patients with unilateral vocal cord paralysis who underwent thyroplasty type I. We performed preoperative and postoperative video image analysis (normalized glottal gap area) and computer-assisted voice analysis (fundamental frequency, jitter, shimmer, noise-to-harmonic ratio, mean phonation time, mean flow rate, mean subglottic pressure) in all patients. The glottal gap was significantly reduced after thyroplasty type I. Postoperative voice quality was characterized by an improved pitch and amplitude pertubation (jitter and shimmer), phonation time (mean phonation time), and subglottic pressure (mean subglottic pressure). Thyroplasty type I is an effective method for regaining glottal closure and vocal function.     

Laryngeal Gestures During Stop Production Using High-Speed Digital Images

On acoustic and fiberscopic studies of stop consonants, voice onset time and glottal width have been shown to be greatest in heavily aspirated stops, next greater for slightly aspirated stops, and least for unaspirated stops. Integrated activity of the thyroarytenoid and posterior cricoarytenoid muscles has been reported to be involved in differentiating aspirate characteristics of the stops. However, the fine movement of mucosal edges of vocal folds during the production of stops has not been well documented. In recent years, a new method for high-speed digital recording of laryngeal dynamics has made this possible. In the current study, the movements of vocal fold edges were documented during the period of stop production using a fiberscopic system of high-speed digital images. By observing the glottal width and the visual vibratory movements of vocal folds before voice onset, the heavily aspirated stop was characterized as being more prominent and dynamic than the slightly aspirated and unaspirated stops.     

Hyaluronic Acid: Its Role in Voice

The extracellular matrix (ECM), once regarded simply as a structural scaffold, is now recognized as an important modulator of cellular behavior and function. One component that plays a prominent role in this process is hyaluronic acid (HA)--a molecule found in many different tissues. Research into the roles of HA indicates that it plays a key role in tissue viscosity, shock absorption, and space filling. Specifically, research into the role of HA in laryngology indicates that it has profound effects on the structure and viscosity of vocal folds. This article provides an introduction to the structure and biological functions of HA and its importance in voice. In addition, an overview of the pharmaceutical applications of HA is discussed.