Mild Vocal Fold Paresis: Understanding Clinical Presentation and Electromyographic Findings

The implications of mild vocal fold hypomobility are incompletely understood. This study describes the clinical, electromyographic, and probable etiologic findings in patients who presented with complaints of dysphonia and whose physical examination revealed vocal fold paresis as a factor possibly contributing to their voice complaints. A retrospective chart review of all patients who presented to a tertiary laryngology referral center over a 13-month period, who had a clinical diagnosis of mild vocal fold hypomobility and who underwent laryngeal electromyography, were included in the study. A total of 22 patients completed the medical evaluation of their voice complaint. Of these patients, 19 (86.4%) were found to have evidence of neuropathy on laryngeal electromyography. The clinical picture indicated the following probable origins for the vocal fold paresis: goiter/thyroiditis (7/22 or 31.8%), idiopathic (4/22 or 18.2%), viral neuritis (4/22 or 18.2%), trauma (3/22 or 13.6%), and Lyme's disease (1/22 or 4.5%). This article describes the clinical entity of mild vocal fold hypomobility and associated flexible laryngoscopic, rigid strobovideolaryngoscopic, and laryngeal electromyographic findings.     

蝙蝠喉部发声组织建模及发声机理*

建立蝙蝠发声组织模型对超声机理研究及在智能设备的应用具有重要意义。根据蝙蝠喉部发声组织结构特点,通过有限元方法构建了蝙蝠的3种不同发声组织模型,分析了尺寸、材料力学参数、组织结构和张力4个因素对发声组织特征频率的影响。结果表明,如果用人类声带,按比例缩小构建蝙蝠喉部组织模型,蝙蝠无法发出超声波。构建组织结构含甲状软骨和声带的半鼓状模型和只含声带的条状模型,两种模型的特征频率相近且在合理的参数域内均无法达到超声范围。而含膜条状模型的特征频率可以通过张力进行超声频率的调节,这与文献的实验结果一致。因此,可基于含膜条状模型对蝙蝠喉管发声组织进行建模及其发声机理研究。     

Data on subglottal pressure and SPL at varied vocalloudness and pitch in 8- to 11-year-old children

Phonation threshold pressure has been defined as the minimum subglottalpressure to generate phonation. Previous research has indicated that children may habitually employ higher subglottal pressures than adults. In the present investigation sound pressure level (SPL) and subglottal pressures at different pitch levels were measured at and above phonation threshold in nine children. Phonation threshold values were scattered in reasonable agreement with Titzes' prediction, although a discrepancy was noted regarding the frequency dependence in some voices. At normal conversational loudness and loudest level of phonation the children's PS values were between two to four and four to eight times the predicted threshold values, respectively. At normal conversational loudness and habitual pitch subglottal pressures were lower than those previously observed for children, but similar to those found for female adults. The SPL in softest and loudest phonation were somewhat lower as compared to previous phonetogram data for children and for female adults. At normal loudness and habitual pitch the SPL values were similar to those of female adults. For a doubling of P_s mean SPL increased by 10.5 dB on the average.     

What happens during vocal warm-up?

Most singers prefer to warm up their voices before performing. Although the subjective effect is often considerable, the underlying physiological effects are largely unknown. Because warm-up tends to increase blood flow in muscles, it seems likely that vocal warm-up might induce decreased viscosity in the vocal folds. According to the theory of vocal-fold vibration, such a decrease should lead to a lower phonation threshold pressure. In this investigation the effect of vocal warm-up on the phonation threshold pressure was examined in a group of male and female singers. The effect varied considerably between subjects, presumably because the vocal-fold viscosity was not a dominating factor for the phonation-threshold pressure.     

Endolaryngeal contact pressures

In this work, we present a new method for in vivo endolaryngeal contactpressure measurement with a miniature pressure transducer. Using this methodology, contact pressures can be measured during videoendoscopy at different locations between the artyenoids and also at various locations along the membranous vocal folds. Twenty adults with organic and functional voice disorders and two vocally healthy adults participated as subjects. Endolaryngeal contact pressure measures were made during a series of phonatory tasks varying pitch, loudness, and phonatory onset and offset. Measures were also made during nonphonatory tasks, including throat clearing, coughing, Valsalva maneuvres, and gagging. The most remarkable findings were: (1) interarytenoid contact pressures were considerably greater than intraglottal contact pressures; (2) interarytenoid contact pressures were greater for lower than higher pitches; (3) both interarytenoid and intraglottal contact pressures were remarkably large during hard glottal attack; and (4) overall, the largest endolaryngeal pressures were recorded between the arytenoids, during a thoracic fixation maneuver and during gag reflex.This work was supported in part by Deutsche Forschungsgemeinschaft (He 2869/1-1), by a grant from the “Verein zur Förderung hör-, sprach- und stimmgestörter Patienten an der FU Berlin e.V.” (nonprofit organization), Berlin, Germany, and by Grant No. K08 DC00139 from the National Institute on Deafness and Other Communication Disorders.     

Acoustic Analyses of Developmental Changes and Emotional Expression in the Preverbal Vocalizations of Infants

The nonverbal vocal utterances of seven normally hearing infants were studied within their first year of life with respect to age- and emotion-related changes. Supported by a multiparametric acoustic analysis it was possible to distinguish one inspiratory and eleven expiratory call types. Most of the call types appeared within the first two months; some emerged in the majority of infants not until the 5th (“laugh”) or 7th month (“babble”). Age-related changes in acoustic structure were found in only 4 call types (“discomfort cry,” “short discomfort cry,” “wail,” “moan”). The acoustic changes were characterized mainly by an increase in harmonic-to-noise ratio and homogeneity of the call, a decrease in frequency range and a downward shift of acoustic energy from higher to lower frequencies. Emotion-related differences were found in the acoustic structure of single call types as well as in the frequency of occurrence of different call types. A change from positive to negative emotional state was accompanied by an increase in call duration, frequency range, and peak frequency (frequency with the highest amplitude within the power spectrum). Negative emotions, in addition, were characterized by a significantly higher rate of “crying,” “hic” and “ingressive vocalizations” than positive emotions, while positive emotions showed a significantly higher rate of “babble,” “laugh,” and “raspberry.”     

Clinical applications of electroglottography

Electroglottography (EGG) is a method to monitor the vibrations of the vocal folds by measuring the varying impedance to a weak alternating current through the tissues of the neck. The paper is an attempt to give a state-of-the-art report of how electroglottography is used in the clinic. It is based on a search of the pertinent literature was well as on an inquiry to 17 well known specialists in the field. The EGG techniques are described and limitations to the method are pointed out. Attempts to document voice quality by EGG are recognized and computerized methods to obtain information about vibratory perturbations and/or the vibratory frequency of the vocal folds are described. The author's personal conclusion is that the EGG signal is especially well suited for measurements of the glottal vibratory period. In the clinic such measurements are useful for periodicity analysis, as a basis for recording intonation contours, and to establish the characteristics of the voice fundamental frequency.     

Is There an Effect of Dysphonic Teachers' Voices on Children's Processing of Spoken Language?

There is a vast body of literature on the causes, prevalence, implications, and issues of vocal dysfunction in teachers. However, the educational effect of teacher vocal impairment is largely unknown. The purpose of this study was to investigate the effect of impaired voice quality on children's processing of spoken language. One hundred and seven children (age range, 9.2 to 10.6, mean 9.8, SD 3.76 months) listened to three video passages, one read in a control voice, one in a mild dysphonic voice, and one in a severe dysphonic voice. After each video passage, children were asked to answer six questions, with multiple-choice answers. The results indicated that children's perceptions of speech across the three voice qualities differed, regardless of gender, IQ, and school attended. Performance in the control voice passages was better than performance in the mild and severe dysphonic voice passages. No difference was found between performance in the mild and severe dysphonic voice passages, highlighting that any form of vocal impairment is detrimental to children's speech processing and is therefore likely to have a negative educational effect. These findings, in light of the high rate of vocal dysfunction in teachers, further support the implementation of specific voice care education for those in the teaching profession.     

The effects of time constraints on phonatory stability in normally speaking adult women

Forty normally speaking women sustained /a/ five times in two conditions,untimed and timed. In the untimed condition, phonation began whenever the subject felt ready. The timed task required subjects to begin phonation as quickly as possible after the examiner's signal. Conditions were counterbalanced across subjects. Jitter and shimmer values were obtained on a Kay Elemetrics Computerized Speech Lab (Pine Brook, NJ). Three distinct patterns of change emerged for fitter and shimmer from the untimed to the timed condition, reflecting either decreases, increases, or no change in values. These changes in jitter and shimmer values across conditions are related to a reaction time model of “bias toward accuracy.”