Laryngeal pathological findings following trauma to cricoarytenoid joint

Abnormal vocal cord mobility may result from trauma to the cricoarytenoid joint. A rabbit model of this kind of trauma was established in order to investigate pathological changes of the traumatized joint. Two types of pathological changes in the cricoarytenoid joint (acute inflammatory reaction in the early stage and fibrosis in the later stage) were noted. The above phenomena might be the mechanism of vocal cord dysfunction caused by trauma to the cricoarytenoid joint. The recovery of vocal cord function may depend on whether or not there is fibrosis of the cricoarytenoid joint. It is almost impossible to regain normal vocal cord function as soon as fibrosis of the joint occurs. Therefore, it is important to treat the patients effectively and immediately in the early stage of trauma for recovery.     

Phonetographic profiles and F0-SPL characteristics of untrained versus trained vocal groups

The phonetogram has been recommended as an international tool for voice analysis. However, the capability of this technique to distinguish between different vocal groups has not been clearly established. The purpose of this study was to examine untrained versus trained vocalists using the phonetogram and the fundamental frequency by intensity (F₀/SPL) information derived through that method. In this study, “musical” or “controlled” ranges of phonation were stressed rather than “physiological” ranges. Results indicated that (a) characteristic phonetographic profiles may be established for untrained versus trained vocalists, and (b) trained vocalists show significantly increased capability in terms of F₀ range and maximum, minimum, and comfortable SPL production. Elicitation of “controlled” phonations may be the key to revealing the underlying vocal capabilities of seemingly different vocal groups.     

G. Paul Moore Lecture—1993: New voices for old

Otolaryngology and voice science have entered the era of “phonosurgery.” Several techniques allow voice professionals to intervene to restore or modify the voice in patients with immobile vocal folds and other problems related to voice production. It is necessary and appropriate that physicians and speech and language pathologists critically examine what has been accomplished and what may yet be possible for further voice improvement.     

Glottal configuration associated withfundamental frequency and vocal register

Simultaneous measurements of mean airflow rate, vocal intensityand fundamental frequency were made during flexible video endoscopic recording of the vowel /i/ sustained in two vocal registers, modal and falsetto. The glottal closure patterns of four males and four females were evaluated by visually inspecting the video images. Acoustic signals were recorded and analyzed to verify the frequency and intensity criteria. Aerodynamic analysis of mean airflow rate was done via Rothenberg mask and commercial software. Incomplete glottic closure was common in both males and females. The degree of closure was significantly higher for modal samples than for falsetto samples with frequency and intensity held constant. The shape of the glottal closure did not vary with changes in the mode of phonation. As expected, the mean airflow rate increased with decreased glottal closure. The results suggest that incomplete glottic closure should be considered as a normal glottal configuration in high frequency modal and falsetto phonation. Moreover, hourglass and spindle glottal configurations may also be found in both the modal and falsetto registers of normal subjects. These results also confirm the positive relationships between degree of glottal gap and mean airflow rate. Thus, mean airflow rate may be regarded as a criterion for judging degree of glottal closure.     

Changes in glottal configuration in women after loud talking

The purpose of this investigation was to examine changes in glottal configuration in women under a variety of pitch and loudness conditions after an interval of loud reading. Twelve young adult women with normal laryngeal structures were photographed under stroboscopic light and sustained the vowel /i/ for a minimum of 3 s, at three pitch levels and three loudness levels, before and after a 15-min interval of loud reading. Results indicate that female speakers tend to alter glottic configurations across phonatory conditions after loud reading, particularly during high-pitch phonation. Specifically, five subjects tended to increase glottal closure, one tended to increase glottal opening, two tended to maintain the identical configuration, and four demonstrated no consistent pattern of response.     

Vocal fundamental frequency measures as a reflection of tumor response to chemotherapy in patients with advanced laryngeal cancer

The fundamental frequency (F₀) characteristics of 19 male patients with advanced laryngeal cancer, treated with cisplatin-based chemotherapy as part of a Larynx Preservation Protocol (LPP), were measured before each of three cycles of chemotherapy received before definitive radiotherapy (RT). In these select patients, for whom chemotherapy resulted in 50% decrease in the tumor bulk, it was found that mean F₀ was essentially unaffected by the disease and did not change over the course of chemotherapy, although the cycle of their treatment could be differentiated by both speaking F₀ variability (pitch sigma) and F₀ perturbation (fitter). Although these measures failed to distinguish between those patients showing a complete response (CR) (no measurable disease) versus a partial (PR) (residual) tumor response at the primary disease site, the significant changes observed in both groups indicate that frequency variation measures could prove valuable in the documentation of tumor response to nonsurgical therapeutic intervention if the voice is directly affected. Additional assessment of 15 age- and disease-matched patients who showed minimal or no primary response to the chemotherapy showed no significant change in any of the frequency measures after one chemotherapy cycle, suggesting that vocal improvement seen in the successful chemotherapy patients was not due to postbiopsy healing or other systemic influence unassociated with tumor reduction.     

Intervention with young voice users: A clinical perspective

This diverse group is described in relation to life stage, short- and long-range performance objectives, and lifestyle factors pertinent to vocal health. Physical, behavioral, cognitive, and psychosocial issues relevant to assessment and intervention will be addressed. The possible dissonance between a clinician's developmental perspective and a client's immediate pragmatic concerns is discussed. In addition, the specific challenges of dealing with adolescents (e.g., the influence of the peer group, the emergence of autonomy, the redefinition of relationships with significant adults, and the vulnerability of the mechanism) are related to clinical problem solving.     

Intonation Drift in A Capella Soprano, Alto, Tenor, Bass Quartet Singing With Key Modulation

OBJECTIVES/HYPOTHESIS: When a soprano, alto, tenor, bass (SATB) quartet sings unaccompanied, or a capella, the members of the group will tend to make use of non-equal-tempered intonation to govern their tuning. If the music they are performing visits different keys and they do maintain non-equal-tempered tuning, then the pitch center will have to shift from its starting point, which is a necessary consequence of the physics behind the use of a non-equal-tempered tuning system. The implication of this shift for tuning in a capella singing is that it is not possible both to maintain accurate non-equal-tempered tuning and to stay in pitch throughout music that modulates in key. METHODS: To test this notion, a set of four-part exercises were written by the author that visit several different key chords in sequential progression. In each case, the starting and finishing chords were either identical or exactly an octave apart. Mean fundamental frequency values for each note were measured using four electrolaryngographs (one per singer), and the f0 data were normalized and plotted with respect to equal-tempered tuning to enable any overall tuning shift to be observed. RESULTS: The results indicate that singers do (1) tend to non-equal-tempered tuning and (b) do consequentially shift their intonation with modulation. CONCLUSIONS: These data indicate that pitch drift is potentially a necessary part of staying in-tune. Further work is required to identify items in the choral repertoire for which this effect is likely and then to inform the choral conducting and singing communities appropriately.     

Fundamental Frequency Change During Offset and Onset of Voicing in Individuals with Parkinson Disease

SUMMARY: After years of treatment with the medication levodopa, most individuals with Parkinson disease (PD) experience fluctuations in response to their medications. Although relatively consistent perceptual voice improvements have been documented to correspond with these fluctuations, consistent quantitative data to support this finding are lacking. This mismatch may have occurred because most of this phonation research has centered on long-term phonatory measures (ie, across speaking samples and prolonged vowel tasks). The current study examined short-term phonatory behavior in individuals with PD, specifically examining fundamental frequency (F0) at the offset and onset of phonation, before and after a voiceless consonant. The F0 analysis at phonatory offset supported the conclusion that individuals with PD have difficulty with the rapid offset of voicing, and that they are stopping vocal fold vibration primarily through vocal fold abduction (without adding tension). The F0 analysis at phonatory onset revealed that all groups use some laryngeal tension at the initiation of voicing. The tension was lowest for the PD participants who were in their OFF medication state, and it was highest for the age-matched control participants and the PD participants in their ON medication states.     

Acute and Subacute Awake Injection Laryngoplasty for Thoracic Surgery Patients

SUMMARY: The rehabilitation of glottic incompetence by injection laryngoplasty is important in the management of thoracic surgery patients with vocal cord paralysis. This group of patients presents special considerations that favor injection under local anesthesia. The objective of this study is to characterize our experience with this minimally invasive approach in both the acute and subacute settings. The study was conducted using a retrospective chart review. From a database of 108 patients who received awake percutaneous injection laryngoplasty over a 3-year period, 15 cases were identified that underwent augmentation shortly following thoracic surgery. These records were reviewed for patient demographics, clinical characteristics, complications, and short-term outcomes. Fifteen patients were identified (12 male, 3 female); the age range for the group was 18-91 years (median=55 years). All the patients reported vocal improvement following injection; all 15 also were improved by perceptual assessment. Five of six dysphagic patients improved following injection. One patient's injection was aborted due to vocal fold edema; no significant bleeding or airway embarrassment was observed. No procedures were terminated because of patient discomfort. Awake percutaneous injection laryngoplasty for vocal paralysis can be performed safely in the postoperative thoracic surgery patient. Swallowing and voice complaints were almost universally improved following treatment. For patients who cannot tolerate or choose not to have open thyroplasty or vocal fold injection under general anesthesia, this procedure may offer a safe and effective alternative.