Outcome of laryngeal and velopharyngeal biofeedback treatment in children and young adults: A pilot study

A relatively new management strategy for the treatment of voice disorders is the use of laryngeal (LB) and velopharyngeal biofeedback (VB). The main purpose of the present pilot study is to document the outcome of vocal and velopharyngeal performances after a well-defined LB and VB treatment. Four subjects were studied pretreatment (1 week before LB or VB treatment) and posttreatment (1 week after the LB or VB treatment). To measure and compare the effect of LB and VB, objective and subjective assessment techniques were used. Perceptual voice assessment included a perceptual rating of the voice using the GRBAS scale. Furthermore, the vocal quality in this population is modeled by means of the Dysphonia Severity Index. For the objective assessment of nasal resonance, the Nasometer and the Glatzel test were used. A perceptual evaluation of speech, the Gutzmann test, and the tests from Bzoch were used as subjective assessment techniques. Both patients selected for LB and VB treatment showed improvement of their performances. The resulting improvement, as measured by means of an objective approach, is in agreement with the perceived (auditory) improvement of voice and resonance. The use of LB and VB treatment in patients, especially in some subjects who are not responding to traditional voice or velopharyngeal therapy, must be encouraged.     

Consistency of the preoperative and intraoperative diagnosis of benign vocal fold lesions

The purpose of this retrospective study was to compare the preoperative and intraoperative diagnosis of benign vocal fold lesions for consistency. The diagnosis was made in 221 consecutive patients with benign vocal fold lesions for which a microlaryngoscopy was carried out in a general ENT-clinic. The preoperative diagnosis was obtained by both white halogen and stroboscopic light. The intraoperative diagnosis was obtained by direct microscopic visualization and palpation of the vocal folds. In 36% of the patients, the preoperative diagnosis was changed intraoperatively. In 31% of the patients, a lesion was missed at the preoperative examination and a lesion was diagnosed only during microlaryngoscopy. Bilateral lesions were found in 53% of the patients preoperatively, and in 82% of the patients intraoperatively. Specially intracordal lesions constituted a diagnostic pitfall. Because the preoperative and intraoperative diagnosis often differed, both the patients and the ENT-surgeon must keep an open mind about what may need to be done at surgery.     

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.     

Harmonics-to-Noise Ratio: An Index of Vocal Aging

Distinguishing between vocal changes that occur with normal aging and those that are associated with disease is an important goal of research in voice. Several acoustic measures have been used in an attempt to illuminate the integrity of the vocal mechanism, including harmonics-to-noise ratio (HNR), jitter, and fundamental frequency (F₀). HNR is a measure that quantifies the amount of additive noise in the voice signal; jitter reflects the periodicity of vocal fold vibration. In this study, measures of HNR, jitter and F₀ were used to compare vocal function in three groups of normally speaking women: young adults, middle-aged adults, and elderly adults. Significant differences in HNR emerged between the elderly women and the other two groups. F₀ differences were also apparent between the elderly group and the two younger groups; there were no significant differences in jitter between the three groups. HNR was found to be a more sensitive index of vocal function than jitter. The significant lowering of HNR evident in the elderly speakers may be attributable in part to medications taken by the majority of these elderly subjects.     

Phonetogram Changes for Trained Singers Over a Nine-Month Period of Vocal Training

Professional vocalists encounter demands requiring voluntary control of phonation, while utilizing a considerable range of frequency and intensity. These quantifiable acoustic events can be measured and represented in a phonetogram. Previous research has compared the phonetograms of trained and untrained voices and found significant differences between these groups. This study was designed to assess the effects of vocal training for singers over a period of nine months. Phonetogram contour changes were examined, with the primary focus on expansion of frequency range and/or intensity control. Twenty-one first-year, master's level, vocal music students, who were engaged in an intensive vocal performance curriculum, participated in this study. Following nine months of vocal training, significant differences were revealed in the subjects' mean frequency range and minimum vocal intensity across frequency levels. There was no significant difference for the mean maximum vocal intensity across frequency levels following vocal training.     

Fibronectin: An Interesting Vocal Fold Protein

A great deal of information is accruing regarding the function of the extracellular matrix. Once thought to be simply a structural entity to surround cells, it is now known to do much more. Fibronectin in particular has received specific attention. Fibronectin is a ubiquitous glycoprotein found most abundantly in the extracellular matrix of regenerating, healing, and embryonic tissue. Vast evidence supports the fact that fibronectin participates in many diverse functions throughout the body that are relevant to vocal fold biology. This article introduces the structure of fibronectin and its isoforms and provides an introduction to some of the many functions it plays. It also reviews the evidence about fibronectin's place in vocal folds and vocal fold pathology. It discusses fibronectin's presence in vocal nodules, vocal polyps, vocal scarring, and Reinke's edema, and reviews the data on its role in mucosal wave impairment. Lastly, it discusses preliminary microarray data that show gene expression for fibronectin to be upregulated in true vocal folds when compared to false vocal folds.     

Dynamic glottal pressures in an excised hemilarynx model

During phonation, air pressures act upon the vocal folds to help maintain their oscillation. The air pressures vary dynamically along the medial surface of the vocal folds, although no live human or excised studies have shown how those pressure profiles vary in time. The purpose of this study was to examine time-dependent glottal pressure profiles using a canine hemilarynx approach. The larynx tissue was cut in the midsaggital plane from the top to about 5 mm below the vocal folds. The right half was replaced with a Plexiglas pane with imbedded pressure taps. Simultaneous recordings were made of glottal pressure signals, subglottal pressure, particle velocity, and average airflow at various levels of adduction. The data indicate that the pressures in the glottis (on the Plexiglas) vary both vertically and longitudinally throughout the phonatory cycle. Pressures vary most widely near the location of maximum vibratory amplitude, and can include negative pressures during a portion of the cycle. Pressures anterior and posterior to the maximum amplitude location may have less variation and may remain positive throughout the cycle, giving rise to a new concept called dynamic bidirectional pressure gradients in the glottis. This is an important concept that may relate strongly to tissue health as well as basic oscillatory mechanics.     

The frequency of hard glottal attacks in patients with muscle tension dysphonia, unilateral benign masses and bilateral benign masses

Hard or abrupt glottal attack (HGA) is one of the vocal behaviors often associated with benign lesion of the vocal folds. This study was designed to determine whether the frequency of HGA was different in hyperfunctional voice patients with and without vocal fold masses. One hundred and forty-seven subjects were studied. All subjects received a complete otolaryngological evaluation including strobovideolaryngoscopy, objective voice measures, and evaluation by a speech-language pathologist. Thirty-two patients were diagnosed with muscle tension dysphonia (19 male, 13 female) without vocal fold masses. Fifty-seven patients were diagnosed with unilateral vocal fold masses (29 male, 28 female), most of which were cysts. Fifty-eight patients were diagnosed with bilateral vocal fold masses (13 male, 45 female). Of the 45 females with bilateral vocal fold masses. 26 had a vocal cyst and reactive nodule and 19 had bilateral vocal fold nodules. The control group was balanced and matched based on sex and on percentage of singers and nonsingers. It consisted of 49 subjects with no vocal fold pathology (20 male, 29 female). The group was composed of professional speakers, singers, and nonprofessional speakers. All voice disordered groups demonstrated higher frequencies of HGA than the control group. Differences were found between the male and female subjects in this study. No differences were found between the various disorders. Differences were also found between the subgroups of bilateral masses, where the bilateral nodules group presented a higher frequency of HGA than the cyst and contralateral reactive nodule.     

Effects of a vocally fatiguing task and systemic hydration on phonation threshold pressure

Phonation threshold pressure (PTP), effort for speaking, and vibratory closure pattern were assessed in 4 women with normal untrained voices after 2 hours of loud reading. PTP generally increased after this vocally fatiguing task at conversational pitch and 10%, 50%, and especially 80% of the pitch range. Increased systemic hydration by drinking water appeared to attenuate and/or delay the elevation of PTP for 3 subjects, at least at the highest pitch tested. Effort for speaking increased consistently throughout the loud reading task and subsequently decreased after 15 minutes of vocal silence. Upon videostroboscopic examination of the larynx, 3 subjects demonstrated spindle-shaped vibratory closure patterns on occasion after loud reading. The results provide preliminary support for increasing water consumption to reduce or delay some vocal-function changes after prolonged loud phonation in untrained speakers.     

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.