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Injection laryngoplasty (IL) has become a mainstay in the treatment of unilateral vocal fold paralysis due to technical ease and avoidance of open surgery. The duration of IL effect depends on the injected material and has not been defined clearly. We aimed to define the effective duration of IL and to investigate the associated factors. Fifty-nine patients who underwent IL for unilateral vocal fold paralysis were included. IL was performed using a cricothyroid membrane approach under local anesthesia. During follow-up, in cases that developed subjective hoarseness with objective glottic insufficiency, a second IL was performed, and loss of IL effect was recorded. The duration of IL was analyzed using Kaplan-Meier estimates, and the associations between duration of effect and various factors such as postinjection voice therapy, injected material, and cause of paralysis were investigated using log-rank test. Of 59 patients, 20 (33.9 %) received a second IL. The median time interval between the first and second IL was 3.3 months (95% CI, 0.4∼27.8 months). The mean duration of effect after IL was 42.5 months (95% CI, 32.1∼52.9 months), and the rate of persisting effect was 63.4% at 1-year after IL (1-year effect rate) and 59.4% at 2 years after IL. The 1-year effect rate was 80.8% in cases with postinjection voice therapy and 57.8% in those without postinjection voice therapy (P = 0.084). Injected material, DM, HTN, patient age and sex, and cause of paralysis had no effect on the 1-year effect rate. The mean duration of IL effect was 42.5 months, and the rate of persisting effect was 63.4% at 1-year after IL. There were no significant factors affecting the duration of effect, although the duration tended to be slightly longer in cases with postinjection voice therapy. Further study with a prospective, randomized design is needed. [ABSTRACT FROM AUTHOR]

Everyday observations indicate that creaky voice has become common in Finland in recent years. Previous studies suggest that this trend is also occurring in other countries. This cross-sectional study investigates the use of creaky voice among Finnish university students from the 1990′s to the 2010′s. Material was obtained from a sound archive. It consisted of 200 samples from normophonic speakers (95 males, 105 females; mean age 23.7 years, SD 3.3 years, range 19–35 years). Normophonia was checked by two speech therapists in a preliminary perceptual analysis. Thereafter, two voice specialists rated the amount of creak and strain. A scale of 0–4 was used (0 = none, 4 = a lot). The inter- and intrarater reliability for the listening evaluations were satisfactory (for creaky phonation, rho = 0.611, P < 0.001 for interrater reliability and rho = 0.540, P < 0.001 for intrarater reliability; for strain, rho = 0.463, P < 0.001 and rho = 0.697, P < 0.001 for inter- and intrarater reliability, respectively). These results revealed a significant increase in the amount of perceived creak in females (from 1.04, SD 0.69 to 1.55, SD 1.06; P < 0.05, Mann-Whitney U test). In males, no significant change was found. However, the frequency of creaky voice use increased in both genders. No male speakers from the 1990′s were rated as using "a lot" of creaky voice, but 2.3% of male speakers from the 2010′s received this rating. Male speakers who were rated "quite a lot" increased from 5.9% in the 1990′s to 18.1% in the 2010′s. Female speakers rated "a lot" increased from 0% to 6%, and female speakers rated "quite a lot" increased from 7% to 25.8% over the studied time periods. Creaky phonation and strain correlated slightly in males (rho = 0.24, P < 0.05) and moderately in females (rho = 0.55, P < 0.001). Age did not correlate with the amount of creaky phonation (rho = 0.005, P > 0.10 for males, rho = -0.011, P > 0.10 for females). It can be concluded that the prevalence of creaky voice has increased among young Finnish speakers, particularly females. [ABSTRACT FROM AUTHOR]

To investigate the effects of auditory training with synthesized voices on intra- and inter-rater agreement of the auditory-perceptual voice analysis of roughness and breathiness. This was an experimental study consisting of four auditory training sessions. The sample consisted of twenty raters, students from a Speech-Language Pathology course, who had previous experience with auditory-perceptual assessment. The raters participated in the four training sessions with a seven-day break in between sessions. Each training consisted of three tasks: 1) Pre-training activity: Participants were asked to rate 20 natural voices, normal and dysphonic, from zero to three, according to the parameters of roughness and breathiness; 2) Training activity: Synthesized voice anchor stimuli were presented, and participants were asked to rate them from zero to three. Four stimuli were related to roughness and four to breathiness. Participants heard 20 voice stimuli and were instructed to pair the natural voice with the synthesized anchor stimulus that most resembled it; and 3) Post-training activity: the 20 voices from the pre-training activity were randomized and participants rated the same voices, without prior knowledge that these were repeated. Statistical analysis of data was performed using the AC 2 test, to assess the extent of agreement between raters, and the Friedman test to compare the training sessions. A 5% significance level was considered. For the auditory-perceptual voice analysis of roughness, intra-rater agreement results ranged from 79% to 86% between the first and fourth auditory training session, with improvement in intra-rater agreement from the fourth session forward (P = 0.005). For the analysis of breathiness, results ranged from 88% to 92% between the first and fourth auditory training sessions, with improvement from the fourth session forward (P = 0.036). Inter-rater agreement results for the auditory-perceptual analysis of roughness ranged from 23% to 34%, and from 48% to 61% for breathiness, with no differences regarding training (P = 0.855). The auditory-perceptual breathiness parameter had a higher AC 2 indicator compared to the roughness parameter, suggesting better agreement. The intra-rater agreement showed improvement starting from the fourth auditory training session for the assessment of roughness and breathiness. The auditory training program did not show a positive inter-rater agreement impact. [ABSTRACT FROM AUTHOR]

To analyze and compare cepstral measurements in singing and non-singing men and women to understand if vocal adaptations of singers reflect greater cepstral measurement results. The study included 91 vocally healthy individuals, consisting of 60 erudite or popular singers (30 males, 30 females) and 31 non-singers (16 males, 15 females). The Cepstral Peak Prominence (CPP) and Cepstral Peak Prominence-Smoothed (CPPS) measures were carried out using the sustained /a/ vowel recorded with a unidirectional condenser microphone associated with a sound card on the computer. The Praat software (version 6.1.16) was used to extract the CPP and CPPS measurements. The intra and intergroup values obtained for each sex were compared using the t-test with a 5% significance level. There was a CPP (P = 0,000) and CPPS (P = 0,000 and P = 0,001) value difference between the sexes in both groups. Cepstral measurements showed no statistically significant difference between singing and non-singing participants (male: P = 0,778 and P = 0,622; female: P = 0,622 and P = 0,460). Men presented higher CPP and CPPS values than women, which may be related to the presence of the physiological posterior glottic cleft in women. The knowledge of the cepstral values of singers shows that singing specificities may not reflect in all vocal evaluations. [ABSTRACT FROM AUTHOR]

This prospective randomized study aimed to investigate whether patients with dysphagia after treatment for head and neck cancer improve their vocal function from doing head lift exercises (Shaker's exercise). Patients were randomized into an intervention group (n = 24) or a control group (n = 26). Patients in the intervention group performed the head lift exercise three times a day for 8 weeks. At baseline and at follow-up after 8 weeks, participants' voices were evaluated perceptually with the Grade-Roughness-Breathiness-Asthenia-Strain (GRBAS) scale. Vocal fry (VF) was also perceptually evaluated and patients filled in the Voice Handicap Index (VHI). Patients in the intervention group were perceptually evaluated as having less roughness and vocal fry in their voices at follow-up compared to the control group. There were no statistically significant changes between baseline and follow-up neither in the intervention nor the control group regarding GRBAS, VF, or VHI. Neither were there any statistically significant differences within the groups when results on the perceptual evaluations at baseline and follow-up were compared. The voices of the participants in the intervention group were slightly better than the voices of the participants in the control group with less roughness and VF at follow-up. However, no improvement in the VHI or the remaining GRBAS variables was found. Therefore, this study can only give cautious support to the head lift exercise as a method for improving the voice of patients with dysphagia after treatment for head and neck cancer. [ABSTRACT FROM AUTHOR]

The breathing technique is a determining factor for the singer's sound quality and consequently crucial for the choral sound. However, very little is known about possible influences of the conductor's preparatory gesture on the way choral singers inhale before the beginning of a piece (respectively every subsequent phrase). The conducting literature does not discriminate between out- and inward preparatory gestures and even describes them as equivalent, but previous studies suggest that singers assign different types of inhalation to different preparatory gestures. It may therefore be assumed that the type of preparatory gesture has a direct influence on the singer's inhalation and tone production, and the aim of this study is hence to examine possible effects of two contrasting preparatory gestures on the singer's inhalation type and the resulting tone quality. In our within-subjects study design, 18 healthy choral singers (9 male/ 9 female) were recruited to participate in a laboratory experiment. The participants were asked to sing a tone suitable for their voice register in response to different video stimuli. These consisted of two conducting-videos, each showing a different preparatory gesture, and two control conditions with an animated bar and an arrow indicating the desired breathing type. The singers reacted to 10 sets of videos, each set consisting of the four stimuli in randomized order. For evaluation of the breathing behavior and vocal output during the different experimental conditions, chest wall kinematics of upper rib cage, abdominal rib cage and abdomen were measured via 3D motion capture and voice samples were recorded. The obtained data were filtered and compared using the repeated measures analysis of variance and post hoc Tukey test for significant results. The level of significance was set at P < 0.05. The results of the study show significant differences in volume of the abdomen between the two different gestures (F 1,17 = 24.04, η2 = 0.59, P = 0.0001), which can be validated by the two control measurements (F 1,17 = 21.12, η2 = 0.55, P = 0.0002). An outward preparatory gesture evoked an abdominal breathing type while an inward-upward movement led to an inhalation with a higher portion of clavicular breathing. Furthermore, significant differences in timbre and loudness of the produced tone could be observed. The maximum sound pressure level of the outward preparatory gesture was significantly higher than in case of the inward-upward movement (F 1,17 = 20.4, η2 = 0.56, P = 0.0004). In contrast to the existing conducting literature, which does not discriminate between out- and inward preparatory gestures, the results of this study show that the conductor's choice of trajectory direction and form of the preparatory gestures elicit spontaneous, gesture-specific reactions in singers' breathing behavior as well as the corresponding loudness and sound quality. [ABSTRACT FROM AUTHOR]

The objective of this study was to verify the immediate effect of the voiced tongue trill technique in ascending and descending glissandos on the voice range profile of choir members. A total of 25 sopranos, mezzo-sopranos, contraltos, tenors, and baritones participated in the study. They were choir members, aged 20 to 45 years, with no voice symptoms, and able to perform the voiced tongue trill technique. Their voice range profile was analyzed before and after performing the ascending and descending technique for 2 and 5 minutes. The maximum fundamental frequency values in the study groups increased after performing the ascending and descending technique for 2 minutes (P = 0.001) and 5 minutes (P = 0.003). The range in Hz increased after 2 minutes (P = 0.010) and 5 minutes (P = 0.050) of the ascending technique and after 2 minutes (P = 0.001) of the descending technique, and the minimum fundamental frequency mean value suffered interference from the type of technique (ascending/descending). The immediate effects of VTTT in glissandos on the VRP of choir members' considering the two factors: condition and time, in ascending and descending glissandos for 2 and 5 minutes increased the maximum frequency and the range in Hz of choristers. Regarding volume levels results, no difference was found in intensity after applying the technique. [ABSTRACT FROM AUTHOR]

Bhramari Pranayama (BP) is a yogic breathing technique that involves producing a vibrating constant pitch sound emulating the buzzing of bumblebee. Since BP deals with breathing and humming in the sustained pitch, it is hypothesized that it can have implications for improving voice quality in individuals. However, there is a dearth of research available to support this assumption. Further, there are no published reports on the effect of BP on voice quality in prospective singers group. Current study was taken up to explore the effect induced by BP in the voice characteristics/quality of prospective singers. The participants included 30 healthy prospective singers in the age range of 18-35 years who were attending music schools within the state of Karnataka, India. BP regimen was demonstrated to all individuals. The voice recordings of the participants were obtained on day 0 and day 30 of BP practice. Acoustic analysis was performed to obtain AVQI and its constituent parameters and voice parameters from the MDVP program. Among the AVQI and its constituent parameters, Cepstral peak prominence-smoothed, Slope LTAS, and Tilt LTAS showed significant differences before and after BP. MDVP showed a significant difference in tremor measures before and after the practice of BP. Results of the present study indicated positive effects of BP on the voice characteristics of the prospective singers and it is reflected in objective acoustic outcome parameters of AVQI and MDVP. This supports the assumption that BP which involves yogic breathing will have beneficial effects on vocal physiology in turn leading to improved voice quality in these individuals. However, it is of future interest to validate these findings on larger samples and populations with different outcome measures. Also, future studies are warranted to verify the efficacy of BP in improving vocal quality and vocal efficiency of individuals with dysphonia. [ABSTRACT FROM AUTHOR]

The aim of this study was to review systematically the literature and to investigate the effects of electrical stimulation in treating dysphonia. This is a systematic review. The publications indexed on the MEDLINE, LILACS, PubMed, Web of Science, and SciELO databases were searched. Original articles with experimental, clinical trial and randomized studies involving a control group and approaching dysphonia treatment with electrical stimulation in humans, regardless of age, gender, or race were included. Those excluded were theses, editorials, comments and opinions, reflexive articles, case studies, experimental studies with animals, models, projects, reports and technical reports, and review articles, as well as articles approaching other alterations, not related to dysphonia. Eleven articles were found and it evaluated the effects of neuromuscular electrical stimulation (NMES) and transcutaneous electrical nerve stimulation on dysphonia caused by vocal fold paralysis, spasmodic dysphonia, behavioral dysphonia, and in patients with vocal fold nodules. The methodological analysis of the articles through the PEDro scale resulted in a mean score of 5.18; the studies were classified as either high quality (N = 3) or fair quality (N = 8). The results indicated that electrical stimulation had a therapeutic effect on various aspects of dysphonia. However, due to the high risk of bias and the heterogeneity of the studies, it is not possible to state the effectiveness of electrical stimulation in treating dysphonia. Using electrical stimulation as an evidence-based conventional rehabilitation therapy in the treatment of dysphonia cannot yet be done. [ABSTRACT FROM AUTHOR]

The aim of our study is to evaluate objective and subjective vocal outcomes in patients undergoing vagus nerve stimulation (VNS) therapy for drug-resistant epilepsy and to assess the vocal outcome in the known laryngeal dysmotility patterns induced by VNS. We enrolled 16 adult patients without cognitive impairment who had undergone VNS implant for drug-resistant epilepsy at least 1 year prior. They were evaluated by flexible fibreoptic laryngeal examination and Voice Handicap Index questionnaire administration; acoustic and perceptual voice analysis was performed both at rest and during VNS activation. All recruited patients were admitted to the study. The VNS implant systematically determined laryngeal motility alterations, which were in turn mirrored by perceptual, subjective, and/or acoustic analysis voice alterations in all patients. Patients with intact vocal fold function at rest performed worse during acoustic voice analysis in terms of jitter during VNS activation and shimmer at rest when compared to other laryngeal patterns (P = 0.027 and P = 0.034, respectively, Kruskal-Wallis test). Furthermore, VNS activation determined an overall worsening of the perceptual and acoustically analysed voice quality: the grade of hoarseness, instability and breathiness parameters of the GRBASI (grade, roughness, breathiness, asthenia, strain, instability) scale and the jitter, shimmer and noise-to-harmonic ratio of the acoustic analysis worsened significantly during VNS activation (P = 0.001, P = 0.021, P = 0.012, P <.001, P = 00.002, P = 0.039, respectively, Wilcoxon test). According to our results, the VNS implant determines a significantly impaired vocal outcome that has a surprisingly mild impact on Voice Handicap Index scores. Such impairment is significantly greater in patients with intact vocal fold function at rest. [ABSTRACT FROM AUTHOR]

The aim of this study was to verify the immediate effect of a flexible resonance tube in water and of lip trill on oropharyngeal geometry and vocal acoustic parameters of singers without vocal symptoms. Twenty-two adult singers participated in the study. They had an average age of 27 (±4.8) years. Participants were split into two groups: a group composed of 12 singers who performed the flexible resonance tube (FRT) exercise and a group of 10 singers who performed the Lip Trill technique (LTT). Acoustic pharyngometry and acoustic analysis of the voice were used to assess oropharyngeal geometry before and after the exercises. After performing the techniques, the vocal tract length was longer in the group that performed the FRT, compared to the one that performed the LTT. In the acoustic evaluation, there was an improvement in the glottal to noise excitation ratio and a decrease in noise in the group of singers who performed the LTT. In the analysis by sex men had a longer oral cavity compared to women and after application of the techniques greater volume of the vocal tract. There was variation in the oropharyngeal geometry with the FRT, while the LTT had a positive effect on the vocal acoustic parameters related to glottal noise. [ABSTRACT FROM AUTHOR]

Acoustic Voice Quality Index (AVQI) has emerged in the recent past as a robust multiparametric voice quality evaluation tool. Two versions of AVQI derived using the program PRAAT have found extensive clinical and research applications. These versions have been validated in several languages around the world. However, no research reports are available on validation of AVQI in the South Indian population. Further, studies comparing the performance of the two versions of AVQI are limited in the literature. This study was designed to validate and compare the two versions of AVQI (AVQIv02.02 and AVQIv03.01) in South Indian languages (Malayalam and Kannada). A retrospective analysis of previously recorded voice samples was carried out on a total of 160 (91 normophonic and 69 dysphonic) voice samples. These samples were perceptually rated on a GRBAS scale by five experienced speech-language pathologists. Standardized Syllable Number (SSN) necessary to derive AVQIv03.01 was computed. Following this, these samples were analyzed to obtain the AVQIv02.02 and AVQIv03.01. The concurrent validity and diagnostic accuracy of these measures were then examined and compared. A moderate agreement was obtained across the judges on perceptual evaluation of voice quality. SSN in Malayalam and Kannada languages were identified to be 29 and 25 syllables respectively. Language differences were not observed on both versions of AVQI. The concurrent validity of AVQIv03.01 (r = 0.788) was superior to that of AVQIv02.02 (r = 0.655). Further, the threshold of differentiating normophonic and dysphonic samples were determined to be >3.45 for AVQIv02.02 and >2.45 for AVQIv03.01. AVQIv03.01 is superior to AVQIv02.02 in terms of its diagnostic accuracy and concurrent validity. Current findings also extend the application of AVQI as a robust tool for the evaluation of voice characteristics to the South Indian population. [ABSTRACT FROM AUTHOR]

ObjectiveThis study evaluates the need of airflow conservation and the effect of glottal resistance on respiratory effort of phonation under different phonation conditions.MethodsA computational model of the pressure-volume-flow relationship of the respiratory system is developed.ResultsSimulations show that increasing the glottal resistance reduces the glottal airflow and allows phonation to be sustained for a longer breath group duration. For a given breath group duration, the reduced airflow also allows phonation to be sustained within a narrow range of lung volumes, thus lowering the overall respiratory effort.ConclusionsThis study shows that for breath group durations and subglottal pressures typical of normal conversational speech, airflow conservation or maintaining "effortless" respiratory support does not provide a stricter requirement on the glottal resistance than that required for initiating phonation. However, the need for airflow conservation and respiratory effort reduction becomes relevant when the target subglottal pressure and breath group duration increase as in prolonged speech or singing or in conditions of weakened pulmonary function. In those conditions, the glottal resistance is expected to increase proportionally with increasing subglottal pressure to conserve airflow consumption and reduce respiratory effort.

Bilateral vocal fold paralysis (BVFP) is a clinical condition that may require emergency intervention that is characterized by airway obstruction. The main aspect to be taken under consideration in treatment is to preserve the vocal functions as much as possible while also ensuring an open airway. This study aims to present the preliminary results of a novel surgical method that we refer to as "posterior glottoplasty," which has been performed on BVFP patients to minimize phonation disorder and achieve a better respiratory function. Five female patients who developed BVFP-related respiratory distress following total thyroidectomy surgery and underwent "posterior glottoplasty" between 2017 and 2019 were included in our study. Preoperative and postoperative aspiration-swallowing, respiration, and phonation functions were separately evaluated in all patients. Five subjects were included in the study. All patients were female and between 31 and 67 years of age (mean 47). The mean duration of dyspnea was 58.4 months (range: 6-120). Mean postoperative follow-up time was 11.6 months (range: 6-18). All patients experienced respiratory relief in the postoperative period. Acoustic voice analysis showed minimal to no phonation loss. Minimal aspiration was observed in the early postoperative period which was supposed to be related to the Botulinum effect and it resolved in 2-4 weeks. The posterior glottoplasty technique aims to increase the posterior (respiratory) glottic space for a better inhalation while keeping the membranous (phonatory) glottic gap to preserve phonation by redirecting the residual or synkinetic muscular vectors. It does not carry major morbidity risks in terms of phonation and aspiration and validates potential spontaneous recovery of the vocal fold paralysis since it preserves the integrity of the cricoarytenoid joints. [ABSTRACT FROM AUTHOR]

Injection laryngoplasty (IL) is performed to reduce the gap between vocal folds induced by unilateral vocal fold paralysis (UVFP). Voice quality after IL may be different due to other factors that influence voice quality. Voice therapy has been reported to improve voice quality after IL in patients with UVFP. This study evaluated the efficacy of voice therapy combined with IL. Patients with UVFP who underwent IL as primary therapy from March 2017 to June 2019 were evaluated. The enrolled patients were divided into two groups, those who did and did not receive voice therapy after IL. Voice quality was evaluated using perceptual, acoustic, and aerodynamic parameters, and voice handicap index-30 scores one month after IL and after completing each treatment. Of 261 patients who underwent IL during the study period, 40 were enrolled, including 21 who did and 19 who did not receive voice therapy. Voice parameters one month after IL did not differ between these two groups. Jitter, shimmer, noise-to-harmonic ratio, and mean flow rate decreased, while maximum phonation time increased after voice therapy (both P < 0.05). In the absence of voice therapy, improved voice parameters were maintained for six months after IL. Total voice handicap index-30 scores decreased, from 35.6 to 19.1 (P < 0.05), in patients who received voice therapy. Voice therapy following IL is beneficial to patients with UVFP. Combined treatment can help to maintain improved voice quality more than six months after IL. [ABSTRACT FROM AUTHOR]

This study examines the acoustic correlates of the vocal expression of emotions in contemporary commercial music (CCM) and classical styles of singing. This information may be useful in improving the training of interpretation in singing. This is an experimental comparative study. Eleven female singers with a minimum of 3 years of professional-level singing training in CCM, classical, or both styles participated. They sang the vowel [ɑ:] at three pitches (A 3 220Hz, E 4 330Hz, and A 4 440Hz) expressing anger, sadness, joy, tenderness, and a neutral voice. Vowel samples were analyzed for fundamental frequency (fo) formant frequencies (F1-F5), sound pressure level (SPL), spectral structure (alpha ratio = SPL 1500-5000 Hz—SPL 50-1500 Hz), harmonics-to-noise ratio (HNR), perturbation (jitter, shimmer), onset and offset duration, sustain time, rate and extent of fo variation in vibrato, and rate and extent of amplitude vibrato. The parameters that were statistically significantly (RM-ANOVA, P ≤ 0.05) related to emotion expression in both genres were SPL, alpha ratio, F1, and HNR. Additionally, for CCM, significance was found in sustain time, jitter, shimmer, F2, and F4. When fo and SPL were set as covariates in the variance analysis, jitter, HNR, and F4 did not show pure dependence on expression. The alpha ratio, F1, F2, shimmer apq5, amplitude vibrato rate, and sustain time of vocalizations had emotion-related variation also independent of fo and SPL in the CCM style, while these parameters were related to fo and SPL in the classical style. The results differed somewhat for the CCM and classical styles. The alpha ratio showed less variation in the classical style, most likely reflecting the demand for a more stable voice source quality. The alpha ratio, F1, F2, shimmer, amplitude vibrato rate, and the sustain time of the vocalizations were related to fo and SPL control in the classical style. The only common independent sound parameter indicating emotional expression for both styles was SPL. The CCM style offers more freedom for expression-related changes in voice quality. [ABSTRACT FROM AUTHOR]

To compare the quality of life of patients with early glottic carcinoma who have been treated using three treatment modalities: endoscopic cordectomy using radiofrequency microdissection electrodes (ECRM), transoral laser cordectomy, and radiotherapy (RT). ECRM, transoral laser cordectomy, and RT can all be used as alternatives to invasive open surgery to treat the early stages of glottic cancer such as stage T1. Patients treated using these different modalities could have different outcomes with respect to voice quality of life. The voice quality of life was measured in patients who underwent ECRM, transoral diode laser excision, or RT for early laryngeal cancer. Post-treatment quality of voice was assessed using the Turkish version of the Voice-Related Quality of Life questionnaire in all patients after 1 year of cancer-free survival. A comparison was then made between the outcomes of the three groups. The total score of the ECRM group, when compared independently to that of the laser and the RT groups, was found to be statistically higher in both cases. However, no statistically significant differences were found between laser and RT groups in terms of any parameters. There was a statistically significant difference between the RT group and the other groups in terms of percentage jitter, percentage shimmer, and fundamental frequency (F0) (P < 0.05). While the RT group had the longest maximum phonation time (P < 0.001), no significant differences were found between the maximum phonation time of the ECRM and the laser groups (P < 0.001). Overall, the worst outcome with respect to voice quality of life is seen with ECRM. Since there were no significant differences in quality of life between the other two treatment modalities, it is recommended to leave the choice between RT and laser surgery up to the patient. [ABSTRACT FROM AUTHOR]

The voice is an important occupational tool for teachers. Voice training programs have been shown to help strengthen the voice health and endurance. However, longitudinal studies on voice trainings are sparse. In this study, long-term effects nearly 2 years after a voice training program have been investigated. The acoustic voice quality (Dysphonia Severity Index [DSI]), the voice self-concept (Fragebogen zur Erfassung des Stimmlichen Selbstkonzepts), and the health-related quality of life (SF-12) of 55 teachers who participated in a prior voice training program of ten 90 minutes sessions were compared to 33 teachers without voice training. The participants were measured at three times: in a pre- and a post-training survey and in a 2-years follow-up survey. The trained teachers increased in DSI over all three surveys while the nontrained teachers decreased in DSI with a significant interaction effect. Also the trained teachers significantly increased the awareness of voice use and their mental health compared to the nontrained group. The positive effects of the voice training, which have been found between pre- and post-training and in comparison with the control group, clearly sustained in long-term 2 years after the end of the training. This finding emphasizes the importance of voice training for teachers as a long-term investment for a voice-related healthy working life. [ABSTRACT FROM AUTHOR]

Obtain aerodynamic vocal measurements of dysphonic female teachers from two groups, before and after a brief and intensive short-term voice therapy using the finger kazoo technique, compare to the respective control groups, and compare between the two study groups. A randomized blind controlled clinical trial. A randomized blind controlled clinical trial. Measurements of maximum phonation time and sound pressure level (dB SPL) were measured before and after intensive short-term vocal therapy in 24 teachers with and without structural laryngeal disorders and 17 controls with and without structural laryngeal disorder. There was significant reduction in the maximum phonation time of /e/ for the group with no structural laryngeal disorder, and a significant reduction of the maximum sound pressure level for the group with structural laryngeal disorder. Based on the observed results, a significant reduction in the maximum phonation time of /e/ for the group with no structural laryngeal disorder, and a significant reduction of the maximum sound pressure level for the group with structural laryngeal disorder, it is possible that finger kazoo reduced the glottal hyperfunction by improving the balance between the respiratory and the glottal vocal production levels during speech. [ABSTRACT FROM AUTHOR]

The objective of this study was to investigate if there are differences in acoustic parameters between diabetic patients and normal controls. A prospective cross-sectional study was performed in 83 diabetic patients and 70 healthy controls. Voice parameters including fundamental frequency (F0), jitter, shimmer, amplitude perturbation quotient, noise-to-harmonic ratio, smoothed amplitude perturbation quotient, and relative average perturbation were analyzed using Computerized Speech Lab with the Multi-Dimensional Voice Program. F0 in female diabetic patients was significantly lower than controls (222.23 ± 27.89 Hz versus 241.08 ± 28.21 Hz, P < 0.01). In female diabetic subgroups with disease duration more than 10 years, poor glycemic control, or neuropathy, the F0 was still significantly lower. Multivariate analysis showed that F0 was significantly associated with diabetes after controlled for age, body mass index, presence of hypertension, and dyslipidemia. (P = 0.022). However, F0 was not able to predict the presence of diabetes as shown by logistic regression analysis (P = 0.243). Voice fundamental frequency is lower in females with diabetes. However, voice fundamental frequency cannot adequately predict the presence of diabetes. [ABSTRACT FROM AUTHOR]

Several perceptual scales have been developed to assess voice quality in dysphonic voices, among which the Grade Roughness Breathiness Asthenia Strain and a Rate of Dysphonia scale is probably the most frequently used. However, this clinical tool has not been properly validated with a normophonic population yet. The aim of the present study was to provide a first set of reference data gathered from a normal population, to serve as a basis of comparison for vocologists and laryngologists working with French-speaking patients. A second goal was to investigate the influence on this normal voice dataset, of variables known to affect perceptual judgments of pathological voice. Sustained vowels and sentences produced by 80 healthy, normophonic French native speakers were perceptually assessed by a panel of 18 raters (nine students, nine experts) using the Grade Roughness Breathiness Asthenia Strain and a Rate of Dysphonia scale. The average overall grade was close to 1 on the (0 to 3) scale, questioning the notion of "normal" voice as opposed to dysphonic voice. Rating reliability as well as perceptual scores were affected by task-, speaker-, and listener-related factors: speech stimuli led to better rating reliability and were judged less severely than voice stimuli; experts were slightly more reliable and less severe than students; older speakers were unanimously considered as more dysphonic. Multiple interactions between these factors were observed, confirming the multidimensional nature of voice quality. [ABSTRACT FROM AUTHOR]

To compare the maximum phonation time of /a/, acoustic glottal source parameters, and physiological measures in patients with dysarthria. Thirteen patients were classified according to dysarthria type and divided into functional profiles (hypofunctional, hyperfunctional, and mixed). Assessments of maximum phonation time of /a/, glottal source parameters, electroglottography, and nasometry were performed. Results were compared between groups using ANOVA and Tukey posthoc tests. The highest fundamental frequency differed significantly between groups, with the hyperfunctional profile showing higher values than the other participant groups. Reductions in the maximum phonation time of /a/ and alterations in acoustic glottal source parameters and electroglottography measures were observed in all groups, with no significant differences between them. The remaining measures did not differ between groups. The maximum phonation times for /a/ were reduced in all participant groups, suggesting air escape during phonation. The presence of alterations in several glottal source parameters in all participant groups is indicative of noise, tremor, and vocal instability. Lastly, the high fundamental frequency in patients with a hyperfunctional profile reinforces the presence of vocal instability. These findings suggest that, although the characteristics observed in the assessments were consistent with expectations of patients with dysarthria, it is difficult to perform a differential diagnosis of this condition based on acoustic and physiological parameters alone. [ABSTRACT FROM AUTHOR]

The pitch-shift reflex (PSR) is the adaptation of the fundamental frequency during phonation and speech and describes the auditory feedback control. Speakers without voice and speech disorders mostly show a compensation of the pitch change in the auditory feedback and adapt their fundamental frequency to the opposite direction. Dysphonic patients often display problems with the auditory perception and control of their voice during therapy. Our study focuses on the auditory and kinesthetic control mechanisms of patients with muscle tension dysphonia (MTD) and speakers without voice and speech problems. Main purpose of the study is the analysis of the functionality of the control mechanisms within phonation and speech between patients with MTD and normal speakers. Sixty-one healthy subjects (17 male, 44 female) and 22 patients with MTD (7 male, 15 female) participated following two paradigms including a sustained phonation (vowel /a/) and speech (['mama]). Within both paradigms the fundamental frequency of the auditory feedback was increased synthetically. For the analysis of the PSR the electroencephalogram, electroglottography, the voice signal, and the high-speed endoscopy data were recorded simultaneously. The PSR in the electroencephalogram was detected via the N100 and the mismatch negativity. Statistical tests were applied for the detection of the PSR in the physiological response within the electroglottography, voice, and high-speed endoscopy signals. The results were compared between both groups. No differences were found between the controls and patients with MTD regarding latency and magnitude of the perception of the pitch shift in both paradigms, but for the magnitude of the behavioral response. Differences also could be found for both groups between the "no pitch" and "pitch" condition of the two paradigms regarding vocal fold dynamics and voice quality. Patients with MTD showed more vibrational irregularities during the PSR than the controls, especially regarding the symmetry of vocal fold dynamics. Patients with MTD seem to have a disturbed interaction between the auditory and kinesthetic feedback inducing the execution of an overriding behavioral response. [ABSTRACT FROM AUTHOR]

This study aims to analyze the effect of telephone transmission on the voice quality perception of subjects with dysphonia and seeks to contribute to the use of perceptual voice analysis in forensic context. The main hypothesis is that the auditory perception of voice quality differs according to the acoustic quality of the speech material. Eight male speakers were simultaneously recorded directly by a digital recorder and over a mobile phone. A perceptual experiment containing 21 speech samples was used. The samples were analyzed via an online adaptation of the Vocal Profile Analysis Scheme (VPAS) into Brazilian Portuguese by a group of six voice-specialized professionals. Data analysis included the relative frequency of the 10 most evaluated VPAS settings in both recording conditions, and the relative frequency of the VPAS groups of features. A multidimensional scaling technique was applied to investigate the perceptual distance between stimuli pairs from both recording conditions. This was followed by a nonparametric multiple linear regression analysis that aimed to comprehend the underlying variables that motivated the spatial arrangement of the stimuli. The telephone transmission effect may have an influence on assessing correctly the supralaryngeal, laryngeal, prosodic, and temporal VPAS settings. The perceptual distance between stimuli pairs were mainly motivated by the rating of velopharyngeal system, respiratory support, laryngeal tension, speech rate, and creaky voice. The auditory perception differences between the stimuli pairs with different acoustic qualities could be related to the mobile phone bandwidth and data compression, and to telephone interaction characteristics. A group of laryngeal, supralaryngeal, temporal, and respiratory settings was mainly related to the dissimilarities reported. In terms of the application of VPAS in forensic context, the protocol was considered a relevant scientific tool that enables standardizing and analysis comparison among different groups of forensic specialists. [ABSTRACT FROM AUTHOR]

This study aims to determine the sensitivity of perceptual and computational correlates of breathy and rough voice quality (VQ) across multiple vowel categories using single-variable matching tasks (SVMTs). Sustained phonations of /a/, /i/, and /u/ from 20 dysphonic talkers (10 with primarily breathy voices and 10 with primarily rough voices) were selected from the University of Florida Dysphonic Voice Database. For primarily breathy voices, perceived breathiness was judged, and for primarily rough voices, perceived roughness was judged by the same group of 10 listeners using an SVMT with five replicates per condition. Measures of pitch strength, cepstral peak, and autocorrelation peak were applied to models of the perceptual data. Intra- and inter-rater reliability were high for both the breathiness and the roughness perceptual tasks. For breathiness judgments, the effect of vowel was small. Averaged over all talkers and listeners, breathiness judgments for /a/, /i/, and /u/ were −11.6, −11.2, and −12.2 dB noise-to-signal ratio, respectively. For roughness judgments, the effect of vowel was larger. The perceived roughness of /a/ was higher than /i/ or /u/ by 3 dB modulation depth. Pitch strength was the most accurate predictor of breathiness matching (r 2 = 0.84–0.94 across vowels), and log-transformed autocorrelation peak was the most accurate predictor of roughness matching (r 2 = 0.59–0.83 across vowels). Breathiness is more consistently represented across vowels for dysphonic voices than roughness. This work represents a critical step in advancing studies of voice quality perception from single vowels to running speech. [ABSTRACT FROM AUTHOR]

This study examines the recognition of emotion in contemporary commercial music (CCM) and classical styles of singing. This information may be useful in improving the training of interpretation in singing. This is an experimental comparative study. Thirteen singers (11 female, 2 male) with a minimum of 3 years' professional-level singing studies (in CCM or classical technique or both) participated. They sang at three pitches (females: a, e1, a1, males: one octave lower) expressing anger, sadness, joy, tenderness, and a neutral state. Twenty-nine listeners listened to 312 short (0.63- to 4.8-second) voice samples, 135 of which were sung using a classical singing technique and 165 of which were sung in a CCM style. The listeners were asked which emotion they heard. Activity and valence were derived from the chosen emotions. The percentage of correct recognitions out of all the answers in the listening test (N = 9048) was 30.2%. The recognition percentage for the CCM-style singing technique was higher (34.5%) than for the classical-style technique (24.5%). Valence and activation were better perceived than the emotions themselves, and activity was better recognized than valence. A higher pitch was more likely to be perceived as joy or anger, and a lower pitch as sorrow. Both valence and activation were better recognized in the female CCM samples than in the other samples. There are statistically significant differences in the recognition of emotions between classical and CCM styles of singing. Furthermore, in the singing voice, pitch affects the perception of emotions, and valence and activity are more easily recognized than emotions. [ABSTRACT FROM AUTHOR]

Summary Objective The aim of this study was to determine nodules using newly developed software with a computer-assisted visual process technique for the calculation of size. The effects of the ratios of nodule base and width were evaluated with voice acoustic analysis. Methods A total of 72 patients with pediatric vocal nodule were evaluated. Nodules were marked with the ImageJ News program on photographs obtained from the video recordings in the videostroboscopic examination and classified according to the Shah et al scale. Segmentation was applied automatically. The ratios were taken as base of nodule/width and base of nodule/vocal cord. In the voice acoustic analysis, basic frequencies (mean F0), jitter (local %), shimmer (local %), and harmonicity (mean harmonics-to-noise [mean HNR]) were evaluated. Results A statistically significant negative correlation was determined between the mean F0 value and the nodule base/width ratio (P = 0.042, r = −0.240). A negative statistically significant relationship was determined between jitter (%) and vocal nodule base/width (P = 0.009, r = −0.305). A statistically significant positive correlation was determined between mean HNR and vocal nodule base/width (P = 0.034, r = 0.324). In discriminant analysis, correct classification of the Shah et al scale degrees of the classifying variables was 73.6%. Conclusion Through collaboration with the biomedical engineering department, the results of this study determined new ratios in patients with pediatric vocal nodule. In voice acoustic analysis, the mean F0 was more affected by the width of the nodule, mean HNR was affected by the length of the base of the nodule, and jitter (%) was affected by the width of the nodule. [ABSTRACT FROM AUTHOR]

Summary Purpose To analyze the effects of auditory-perceptual training with anchor stimuli of natural voices on inter-rater agreement during the assessment of vocal quality. Study design This is a quantitative nature study. Methods An auditory-perceptual training site was developed consisting of Programming Interface A, an auditory training activity, and Programming Interface B, a control activity. Each interface had three stages: pre-training/pre-interval evaluation, training/interval, and post-training/post-interval evaluation. Two experienced evaluators classified 381 voices according to the GRBASI scale (G-grade, R-roughness, B-breathiness, A-asthenia, S-strain, I-instability). Voices were selected that received the same evaluation by both evaluators: 57 voices for evaluation and 56 for training were selected, with varying degrees of deviation across parameters. Fifteen inexperienced evaluators were then selected. In the pre-, post-training, pre-, and postinterval stages, evaluators listened to the voices and classified them via the GRBASI scale. In the stage interval evaluators read a text. In the stage training each parameter was trained separately. Evaluators analyzed the degrees of deviation of the GRBASI parameters based on anchor stimuli, and could only advance after correctly classifying the voices. To quantify inter-rater agreement and provide statistical analyses, the AC1 coefficient, confidence intervals, and percentage variation of agreement were employed. Results Except for the asthenia parameter, decreased agreement was observed in the control condition. Improved agreement was observed with auditory training, but this improvement did not achieve statistical significance. Conclusion Training with natural voice anchors suggest an increased inter-rater agreement during perceptual voice analysis, potentially indicating that new internal references were established. [ABSTRACT FROM AUTHOR]

The human voice qualitatively changes across the lifespan. Although some of these vocal changes may be pathologic, other changes likely reflect natural physiological aging. Normative data for voice characteristics in healthy aging is limited and disparate studies have used a range of different acoustic features, some of which are implicated in pathologic voice changes. We examined the perceptual and acoustic features that predict healthy aging. Participants (N = 150) aged between 50 and 92 years performed a sustained vowel task. Acoustic features were measured using the Multi-Dimensional Voice Program and the Analysis of Dysphonia in Speech and Voice. We used forward and backward variable elimination techniques based on the Bayesian information criterion and linear regression to assess which of these acoustic features predict age and perceptual features. Hearing thresholds were determined using pure-tone audiometry tests at frequencies 250 Hz, 500 Hz, 1000 Hz, 2000 Hz, and 4000 Hz. We further explored potential relationships between these acoustic features and clinical assessments of voice quality using the Consensus Auditory-Perceptual Evaluation of Voice. Chronological age was significantly predicted by greater voice turbulence, variability of cepstral fundamental frequency, low relative to high spectral energy, and cepstral intensity. When controlling for hearing loss, age was significantly predicted by amplitude perturbations and cepstral intensity. Clinical assessments of voice indicated perceptual characteristics of speech were predicted by different acoustic features. For example, breathiness was predicted by the soft phonation index, mean cepstral peak prominence, mean low-high spectral ratio, and mean cepstral intensity. Findings suggest that acoustic features that predict healthy aging are different than those previously reported for the pathologic voice. We propose a model of healthy and pathologic voice development in which voice characteristics are mediated by the inability to monitor vocal productions associated with age-related hearing loss. This normative data of healthy vocal aging may assist in separating voice pathologies from healthy aging. [ABSTRACT FROM AUTHOR]

Summary Voice is an important gender marker in the transition process as a transgender individual accepts a new gender identity. The objectives of this study were to describe and relate aspects of a perceptual-auditory analysis and the fundamental frequency (F0) of male-to-female (MtF) transsexual individuals. A case-control study was carried out with individuals aged 19–52 years who attended the Gender Identity Program of the Hospital de Clínicas of Porto Alegre. Vocal recordings from the MtF transgender and cisgender individuals (vowel /a:/ and six phrases of Consensus Auditory Perceptual Evaluation Voice [CAPE-V]) were edited and randomly coded before storage in a Dropbox folder. The voices (vowel /a:/) were analyzed by consensus on the same day by two judge speech therapists who had more than 10 years of experience in the voice area using the GRBASI perceptual-auditory vocal evaluation scale. Acoustic analysis of the voices was performed using the advanced Multi-Dimensional Voice Program software. The resonance focus and the degrees of masculinity and femininity for each voice recording were determined by listening to the CAPE-V phrases, for the same judges. There were significant differences between the groups regarding a greater frequency of subjects with F0 between 80 and 150 Hz (P = 0.003), and a greater frequency of hypernasal resonant focus (P < 0.001) in the MtF cases and greater frequency of subjects with absence of roughness (P = 0.031) in the control group. The MtF group of individuals showed altered vertical resonant focus, more masculine voices, and lower fundamental frequencies. The control group showed a significant absence of roughness. [ABSTRACT FROM AUTHOR]

Summary Objective In voice assessment, the evaluation of voice quality is a major component in which roughness has received wide acceptance as a major subtype of abnormal voice quality. The aim of the present study was to develop a new multivariate acoustic model for the evaluation of roughness. Method In total, 970 participants with dysphonia and 88 participants with normal voice were included. Concatenated voice samples of continuous speech and sustained vowel [a:] were perceptually judged on roughness severity. Acoustic analyses were conducted on the voiced segments of the continuous speech sample plus sustained vowel as well. A stepwise multiple linear regression analysis was applied to construct an acoustic model of the best acoustic predictors. Concurrent validity, diagnostic accuracy, and cross-validation were verified on the basis of Spearman correlation coefficient (r s ), several estimates of the receiver operating characteristics plus the likelihood ratio, and iterated internal cross-correlations. Results Six experts were included for perceptual analysis based on acceptable rater reliability. Stepwise multiple regression analysis yielded a 12-variable acoustic model. A marked correlation was identified between the model and the perceptual judgment (r s  = 0.731, P  = 0.000). The cross-correlations confirmed a high comparable degree of association. However, the receiver operating characteristics and likelihood ratio results showed the best diagnostic outcome at a threshold of 2.92, with a sensitivity of 51.9% and a specificity of 94.9%. Conclusions Currently, the newly developed roughness model is not recommended for clinical practice. Further research is needed to detect the acoustic complexity of roughness (eg, multiplophonia, irregularity, chaotic structure, glottal fry, etc). [ABSTRACT FROM AUTHOR]