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Presbyphonia is more common than appreciated by most physicians, and it is associated with undesirable vocal characteristics such as hoarseness, weakness, breathiness, instability, and tremulousness. Hearing impairment in the patient or his or her friends, family, and associates exacerbates the problem, resulting in depression and social withdrawal, further reducing quality of life. Moreover, voice weakness and instability are all too often misinterpreted as reflecting intellectual instability. Expert diagnosis, medical treatment, voice therapy and training, and occasionally surgery usually can maintain or restore vocal stability and "youth."

Objective: The aim of this study was to validate the Acoustic Voice Quality Index 03.01 (AVQIv3) and the Acoustic Breathiness Index (ABI) in the Spanish language. Method: Concatenated voice samples of continuous speech (cs) and sustained vowel (sv) from 136 subjects with dysphonia and 47 vocally healthy subjects were perceptually judged for overall voice quality and breathiness severity. First, to reach a higher level of ecological validity, the proportions of cs and sv were equalized regarding the time length of 3 seconds sv part and voiced cs part, respectively. Second, concurrent validity and diagnostic accuracy were verified. Results: A moderate reliability of overall voice quality and breathiness severity from 5 experts was used. It was found that 33 syllables as standardization of the cs part, which represents 3 seconds of voiced cs, allows the equalization of both speech tasks. A strong correlation was revealed between AVQIv3 and overall voice quality and ABI and perceived breathiness severity. Additionally, the best diagnostic outcome was identified at a threshold of 2.28 and 3.40 for AVQIv3 and ABI, respectively. Conclusions: The AVQIv3 and ABI showed in the Spanish language valid and robust results to quantify abnormal voice qualities regarding overall voice quality and breathiness severity.

Vocal cord palsy (VCP) is one of the most frequent complications following thyroidectomy. We evaluated the outcomes of intraoperative reconstruction of the recurrent laryngeal nerve (RLN). Of 917 patients who underwent thyroid surgery in a single high-volume general surgery ward between 2000 and 2015, 12 (1.3%) were diagnosed with RLN injury and were retrospectively categorized into 2 groups: group A (n = 5), with intraoperative evidence of iatrogenic transection or cancer invasion of the RLN, and group B (n = 7), with postoperative confirmation of VCP. In group A, immediate microsurgical primary repair of the RLN was performed. Postoperative assessment included subjective ratings (aspiration and voice quality improvement) and objective ratings (perceptual voice quality according to the grade, roughness, breathiness, asthenia and strain [GRBAS] scale, and direct laryngoscopy). In group A, roughness, breathiness and strain were significantly lower at 9 months than at 3 months (p < 0.05). Although larger, multicentre studies are needed, the results suggest potentially excellent postoperative phonatory function after immediate RLN reconstruction.

Purpose Over the last 5 decades, many acoustic measures have been created to measure roughness and breathiness. The aim of this study is to present a meta-analysis of correlation coefficients ( r ) between auditory-perceptual judgment of roughness and breathiness and various acoustic measures in both sustained vowels and continuous speech. Method Scientific literature reporting perceptual–acoustic correlations on roughness and breathiness were sought in 28 databases. Weighted average correlation coefficients ( r w ) were calculated when multiple r -values were available for a specific acoustic marker. An r w ≥ .60 was the threshold for an acoustic measure to be considered acceptable. Results From 103 studies of roughness and 107 studies of breathiness that were investigated, only 33 studies and 34 studies, respectively, met the inclusion criteria of the meta-analysis on sustained vowels. Eighty-six acoustic measures were identified for roughness and 85 acoustic measures for breathiness on sustained vowels, in which 43 and 39 measures, respectively, yielded multiple r -values. Finally, only 14 measures for roughness and 12 measures for breathiness produced r w ≥ .60. On continuous speech, 4 measures for roughness and 21 measures for breathiness were identified, yielding 3 and 6 measures, respectively, with multiple r -values in which only 1 and 2, respectively, had r w ≥ .60. Conclusion This meta-analysis showed that only a few acoustic parameters were determined as the best estimators for roughness and breathiness.

The perception of a pair of enhancing cues, pitch and breathiness, and non-enhancing cues, pitch and vowel duration, were compared in a cue-shifting experiment with Hani listeners who have experience with both cue pairs in the same tense-lax contrast. Results show that, when the correlation between the non-enhancing cues was the reverse of their experience, it was equally difficult for Hani listeners to shift attention from pitch to vowel duration as from vowel duration to pitch. For the enhancing cues, difficulty with cue-shifting was asymmetric; shifting from pitch to breathiness was easy, but shifting from breathiness to pitch was difficult. This asymmetry may occur because the perceptual dependence between pitch and breathiness is unidirectional: breathiness is associated with pitch but not vice versa. Thus, listeners experience interference only when shifting attention from breathiness to pitch. The difference between two cue pairs and the direction of asymmetry found for the enhancing cue pair is consistent with earlier results from English listeners who do not have phonemic experience with either pair. Collectively, these results indicate that enhancing cues are perceived differently from non-enhancing cues, even when listeners’ language experience with cue pairs is equated.The perception of a pair of enhancing cues, pitch and breathiness, and non-enhancing cues, pitch and vowel duration, were compared in a cue-shifting experiment with Hani listeners who have experience with both cue pairs in the same tense-lax contrast. Results show that, when the correlation between the non-enhancing cues was the reverse of their experience, it was equally difficult for Hani listeners to shift attention from pitch to vowel duration as from vowel duration to pitch. For the enhancing cues, difficulty with cue-shifting was asymmetric; shifting from pitch to breathiness was easy, but shifting from breathiness to pitch was difficult. This asymmetry may occur because the perceptual dependence between pitch and breathiness is unidirectional: breathiness is associated with pitch but not vice versa. Thus, listeners experience interference only when shifting attention from breathiness to pitch. The difference between two cue pairs and the direction of asymmetry found for the enhancing cue pair is co...

Hoarseness or dysphonia are terms used to describe a change in the quality of the voice. The voice quality can be raspy, breathy, strained, fatigued, rough, tremulous or weak. There may be a change in pitch, restriction of range, voice breaks, decreased projection, or abnormal resonance. It is important to remember that a voice disorder is not a disease in itself but rather a presentation of an underlying pathology. Clinicians' knowledge of paediatric hoarseness is limited as it can be difficult to examine children using fibreoptic laryngoscopy and the child may not comprehend the need for detailed examination. However, paediatric flexible naso-laryngoscopy provides a dynamic view of the laryngeal anatomy and function. Recent advances in diagnostic equipment, pharmacology and therapeutics mean that this problem can be managed more successfully but it still remains a challenge. This article discusses the presentation, aetiology and management of hoarseness in children.

Acoustic analysis-based automatic detection of voice pathologies enables non-invasive, low-cost and objective assessments of the presence of disorders, which might assist in accelerating and improving the diagnosis and clinical treatment given to patients. In this paper, we focus on the automatic assessment of pathological voice quality by identifying the four attributes of Roughness, Breathiness, Asthenia, and Strain based on the GRBAS categorization. The proposed method adopts higher-order local auto-correlation (HLAC) features, which are calculated from the excitation source signal obtained by an automatic topology-generated AR-HMM analysis, and identifies the four attributes using a feed-forward neural network (FFNN)-based classifier. In the experiments, an average F-measure of 87.25% was obtained for a speaker- based identification task, which confirms the feasibility of the proposed method.

Summary Background The perception of pediatric voice quality has been investigated using clinical protocols developed for adult voices and acoustic analyses designed to identify important physical parameters associated with normal and dysphonic pediatric voices. Laboratory investigations of adult dysphonia have included sophisticated methods, including a psychoacoustic approach that involves a single-variable matching task (SVMT), characterized by high inter- and intra-listener reliability, and analyses that include bio-inspired models of auditory perception that have provided valuable information regarding adult voice quality. Objectives To establish the utility of a psychoacoustic approach to the investigation of voice quality perception in the context of pediatric voices? Methods Six listeners judged the breathiness of 20 synthetic vowel stimuli using an SVMT. To support comparisons with previous data, stimuli were modeled after four pediatric speakers and synthesized using Klatt with five parameter settings that influence the perception of breathiness. The population average breathiness judgments were modeled with acoustic measures of loudness ratio, pitch strength, and cepstral peak. Results Listeners reliably judged the perceived breathiness of pediatric voices, as with previous investigations of breathiness in adult dysphonic voices. Breathiness judgments were accurately modeled by loudness ratio (r2 = 0.93), pitch strength (r2 = 0.91), and cepstral peak (r2 = 0.82). Model accuracy was not affected significantly by including stimulus fundamental frequency and was slightly higher for pediatric than for adult voices. Conclusions The SVMT proved robust for pediatric voices spanning a wide range of breathiness. The data indicate that this is a promising approach for future investigation of pediatric voice quality.

Spasmodic dysphonia (SD) or laryngeal dystonia is a focal voice disorder that produces involuntary spasms of the vocal folds, resulting in a strained-strangled voice production. Symptoms of SD come in several varieties. The disorder can be broadly divided into three forms: adductor-type SD, abductor-type SD, and mixed-type SD. The most common adductor-type causes a tight, “strangled-sounding” voice quality, often with abrupt starting and stopping of the voice. The abductor-type causes a breathy, whispering voice. Most cases of SD are primary and develop in adults (adult-onset). There is no cure for SD, and little is known on risk factors that contribute to its development. The diagnosis is mainly based on speech analysis. Injecting botulinum toxin has become the treatment of choice for 30 years. However, the disorder typically remains chronic after onset, and repeated injections therefore are needed.

Summary Twenty-three female Speech Communication Disorders (SCD) graduate students rated the desirability of 25 adjectives used to describe perceived speaker's affect (including attitude, emotion, etc). A three-point weighted scale—desirable = 3, in-between = 2, and undesirable = 1—was used and a “desirability score” was calculated for each of these adjectives. Afterward, students were asked to use these adjectives to describe the perceived communication affect of female speakers with voices characterized by “vocal fry” as well as seven other vocal qualities (rough, breathy, strained, loud, high pitch, low pitch, and soft/weak). Proficiency of the students in identification of each of these eight voice qualities was determined before the survey. A desirability score for each voice quality, with a focus on vocal fry, was calculated by averaging the sum of the weighted counts for each adjective used to describe that vocal quality. Results Ten adjectives were rated as desirable (eg, cool), two were rated as in-between (eg, nonaggressive), and 13 were rated as undesirable (eg, vain). Thirty-two percent used only undesirable adjectives to describe vocal fry; 64% used a mixture of desirable, in-between, and undesirable; and 5% used only desirable adjectives and one in-between adjective. The relative order of the desirability scores of the vocal qualities was low pitch (2.13), high pitch (2.11), loud (1.89), vocal fry (1.82), breathy (1.77), soft/weak (1.68), rough (1.46), and strained (1.08). A vocal quality profile for each adjective was created. Vocal fry was the primary vocal quality associated with the adjectives vain (56%), apathetic/disinterested (48%), sleepy (38%), relaxed/chill (38%), and bored/unengaged (36%). Conclusions SCD graduate student participants rated the desirability of 25 adjectives used to describe the perceived speaker's affect (including attitude, emotion, etc), and a “desirability score” was calculated for each. Afterward, they used these adjectives to describe the perceived communication affect of female speakers with voices characterized by vocal fry. Most participants were undecided, 30% perceived it as undesirable, and only 5% perceived it as desirable. The desirability scoring system and the adjectives used in this study add to the growing literature focusing on how different vocal qualities influence the listener's perception of the speaker's affect.

Objective The Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) was developed to promote a standardised approach to evaluating and documenting auditory perceptual judgments of vocal quality. This tool was originally developed in English language and its Spanish version is still inexistent. The aim of this study was to develop a Spanish adaptation of CAPE-V and to examine the reliability and empirical validity of this Spanish version. Method To adapt the CAPE-V protocol to the Spanish language, we proposed 6 phrases phonetically designed according to the CAPE-V requirements. Prospective instrument validation was performed. The validity of the Spanish version of the CAPE-V was examined in 4 ways: intra-rater reliability, inter-rater reliability and CAPE-V versus GRABS judgments. Results Inter-rater reliability coefficients for the CAPE-V ranged from 0.93 for overall severity to 0.54 for intensity; intra-rater reliability ranged from 0.98 for overall severity to 0.85 for intensity. The comparison of judgments between GRABS and CAPE-V ranged from 0.86 for overall severity to 0.61 for breathiness. Conclusions The present study supports the use of the Spanish version of CAPE-V because of its validity and reliability.

Resumo:OBJETIVO:analisar o poder discriminatório do diagrama de desvio fonatório na avaliação do tipo de voz predominante e da intensidade do desvio vocal em crianças.MÉTODOS:coletou-se a vogal /ε/ sustentada de 93 crianças. A intensidade do desvio e a qualidade vocal foram analisadas por meio da escala analógico-visual. Utilizou-se o diagrama para a análise acústica, com avaliação da distribuição dos sinais vocais de acordo com a área, quadrante, forma e densidade. Realizou-se o teste de igualdade de proporções e o teste Qui-quadrado(x2) para comparar as variáveis, e o teste de Correlação de Spearman para correlacionar as medidas acústicas e perceptivo-auditivas.RESULTADOS: houve correlação entre a classificação de quadrantes e a intensidade do desvio vocal para todos os parâmetros analisados. Houve diferença estatisticamente significante entre a proporção de crianças com rugosidade, soprosidade, tensão e instabilidade em relação à área, ao quadrante e à forma. Não houve diferença estatisticamente significante entre a proporção de crianças com e sem desvio da qualidade vocal em relação a todos os parâmetros analisados, ao considerar a distribuição das vozes nos quadrantes.CONCLUSÃO: o diagrama de desvio fonatório foi capaz de diferenciar a qualidade vocal predominante por meio da distribuição nos quadrantes, embora não tenha discriminado as vozes infantis saudáveis e alteradas. Abstract:PURPOSE:to analyze the discriminating power of the phonatory deviation diagram (PDD) in assessing the predominant voice type and severity of voice deviance in children.METHODS:samples of the sustained vowel /ε/ were collected from 93 children. The severity of voice deviance and vocal quality were assessed with the aid of a visual analog scale. The PDD was used in the acoustic analysis, with an assessment of the distribution of the voice signals according to the area, quadrant, shape, and density in the diagram. The results were obtained from the statistical analysis of the variables using the test for equality of proportions, chi-squared test (Χ(2)), and Spearman's correlation. The level of statistical significance was set at ≤ 5% across analyses.RESULTS:a positive and statistically significant correlation was found between the classification based on the PDD quadrants and the severity of voice deviance for all the parameters analyzed except strain, which showed a negative correlation. Statistically significant differences were also noted in the proportion of children with voice roughness, breathiness, strain, and instability in relation to the area, quadrant, and shape in the PDD. There were no significant differences between the proportion of children with and without voice deviation for the evaluated parameters regarding the distribution of the voice samples in the quadrants.CONCLUSION:the PDD was capable of distinguishing the predominant vocal quality based on the distribution of the signals in the quadrants, although it could not discriminate between healthy and disordered children's voices.

Objective: To evaluate the effects of balloon dilation for idiopathic laryngotracheal stenosis on voice production. Methods: Retrospective review of 10 female patients with idiopathic laryngotracheal stenosis undergoing balloon dilation. Voice outcomes were evaluated by comparing pre- and posttreatment patient-reported, perceptual, aerodynamic, and acoustic parameters. Complete data sets were not available for all subjects; sample size for each parameter is reported with the corresponding result. Results: Total Voice Handicap Index (VHI) decreased significantly (22.9 ± 13.5 to 6.8 ± 6.5; n = 8; p = .015), as did glottal function index (7.2 ± 4.9 to 1.5 ± 2.0; n = 6; p = .022). No changes were observed in the GRBAS (grade, roughness, breathiness, asthenia, strain) scale. Changes in aerodynamic parameters were not statistically significant. Percent jitter decreased (1.32 ± 1.37 to 0.60 ± 0.29; n = 7; P = .078), and fundamental frequency range was preserved (507 ± 325 to 612 ± 281; n = 7; P = .309). Conclusions: Our sample of patients with idiopathic laryngotracheal stenosis had a mild-moderate dysphonia that improved with balloon dilation. Importantly, adverse effects on voice that can occur with open procedures were not observed. Patient perception of dysphonia improved while fundamental frequency range was maintained and aerodynamic parameters remained within or moved toward the normal range. Larger prospective studies are warranted to further evaluate changes in voice production associated with balloon dilation.

Depressor consonants in Xitsonga block high-tone spreading. These voiced obstruents and breathy voice consonants do phonetically lower pitch, but phonological blocking of H-tone spreading is not common. This paper reports new findings in which depressors allow H tone to spread into toneless words in Xitsonga, contrary to what we expect if depressor blocking is a categorical phonological phenomenon. This new pattern calls for a reanalysis of the depressor effect in Xitsonga. Building upon an observation that phonological processes can be triggered only if there are multiple triggers (Lionnet 2013), we propose that the depressor effect in Xitsonga is triggered only when a depressor-initial word has an underlying H tone. Unless these two conditions are met (depressor and the presence of H tone), depressor consonants do not block H-tone spreading.

The aim of this study is to synthesize pathological breathy voice and to make a cepstral peak prominence (CPP) table following breathiness ranks by cepstral analysis to supplement reliability of the perceptual auditory judgment task. KlattGrid synthesizer included in Praat was used. Synthesis parameters consist of two groups, i.e., constants and variables. Constant parameters are pitch, amplitude, flutter, open phase, oral formant and bandwidth. Variable parameters are breathiness (BR), aspiration amplitude (AH), and spectral tilt (TL). Five hundred sixty samples of synthetic breathy vowel /a/ for male were created. Three raters participated in ranking of the breathiness. 217 were proved to be inadequate samples from perceptual judgment and cepstral analysis. Finally, 343 samples were selected. These CPP values and other related parameters from cepstral analysis are classified under four breathiness ranks (B0~B3). The mean and standard deviation of CPP is dB(B0), dB(B1), dB(B2), and dB(B3). The value of CPP decreases toward the severe group of breathiness because there is a lot of noise and a small quantity of harmonics.

Summary Objectives Surgery of Reinke edema requires reduction of the degenerated superficial lamina propria and preservation of the vibratory epithelium. Material and Methods Sixteen patients were included for microdebrider and 10 patients for carbon dioxide (CO 2 ) laser surgery. Vocal analysis was performed before and at 1 and 3 months after surgery. Subjective rating of voice quality was completed by the grade, roughness, breathiness, asthenia, and strain scale. The objective assessment was conducted by Multi-Dimensional Voice Program software. Results We found consistent improvement in all parameters both in CO 2 laser and microdebrider group. The normalization of all parameters were statistically better after microdebrider surgery. The most statistically significant improvements were accounted in reduction in grade of hoarseness, roughness, and asthenia and acoustic analysis. Conclusions Microdebrider is a useful and safe tool for Reinke edema treatment. The oscillatory cutting knife and low suction protect lamina propria resulting in better vibratory function.

Objectives: The objective of this study was to evaluate the role of transnasal fiber-optic injection laryngoplasty in the treatment of glottic insufficiency. Methods: Video recordings of 16 patients who underwent fiber-optic injection laryngoplasty for the treatment of glottic insufficiency were reviewed. Outcome measures included perceptual evaluation using the GRBAS (grading, roughness, breathiness, asthenia, straining) classification, laryngeal videostroboscopy, and frame-by-frame analysis to assess the extent, shape, and duration of glottic closure. Results: Nine patients were ultimately included in this study. Their mean age was 66.2 years, with 7 men and 2 women. The most common symptoms were dysphonia and aspiration, and the most common diagnosis was vocal fold paralysis. Patients underwent transnasal fiber-optic injection laryngoplasty with hyaluronic acid as a filling material (0.2-0.8 mL). The procedure was well tolerated by all patients, with improvement in the phonatory symptoms and aspiration in 66.66% and 50% of patients, respectively. There were significant decreases in the mean scores of all perceptual parameters ( P < .05 for all). All subjects had glottal gap preoperatively that was closed completely in 66.66% and reduced to Conclusions: Transnasal fiber-optic injection laryngoplasty is a safe procedure well tolerated by patients with good results.

The objective of this study was to improve the evaluation of unilateral vocal fold paralyses (uVFP) by means of an area measurement of the glottic plane, which describes the position of the paralysed vocal fold. The area measurements were related to electromyographic findings and clinical outcome (recovery, voice quality). In 56 patients (33 women and 23 men), uVFP were confirmed by endolaryngeal electromyography (EMG) of the paralysed vocal fold and cricothyroid muscles (CT). The EMG response was classified on a 4-point scale (from 0 to 3). Vocal fold position was divided into 'paramedian' and 'intermediate' and additionally quantified by measurement of the glottic area. An 'area quotient' (AQ) was calculated and related to the EMG findings and clinical outcome. Voice qualities were objectified regarding their additive noise (breathiness) and irregularity (roughness) using the 'Göttingen Hoarseness Diagram'. The majority of uVFP was due to iatrogenic lesions. The AQ of classically graduated 'paramedian' and 'intermediate' vocal fold positions was significantly different but did not correlate with objective voice quality values. There were no significant correlations regarding EMG findings, duration or recovery from paralyses. Laryngeal EMG remains the gold standard for verifying uVFP. But EMG did not correlate significantly with AQ or functional outcome of uVFP. The measurement of an AQ is suitable for obtaining continuous data describing the position of paralysed vocal folds beyond the terms 'paramedian' or 'intermediate' and provides the basis for clinical evaluations of diagnostic tools and therapeutic interventions.

Purpose Describe and correlate acoustic and auditory-perceptual vocal measures, vocal complaints and professional characteristics of a group of teachers. Methods Ninety-nine female primary school teachers, aged 20 to 66 years, underwent auditory-perceptual (CAPE-V) and acoustic (Multi-Dimensional Voice Program Advanced) vocal assessments, and answered a questionnaire with questions about personal identification, overall health, occupational activities and vocal complaints. The ANOVA and Pearson’s correlation statistical tests have been applied. Results The teachers worked 6.98 hours a day, on average, and had been working as teachers for 12.91 years, approximately. Most of them reported vocal complaints and were employed in private schools. Auditory perceptual parameters were normal. All measures of jitter, shimmer, voiceless or unvoiced and subharmonic segments were above the normal range, as well as the standard deviation for fundamental frequency and soft phonation index. Perturbation frequency and age, roughness, breathiness and overall degree of voice were positively correlated with age and length of professional practice. There was also a negative correlation between amplitude perturbation and daily use of voice. Conclusion The teachers’ voices were considered as normal by the auditory-perceptual assessment, but noise and instability were detected in the acoustic analysis; there were, particularly, vocal complaints, and alteration of vocal acoustic and auditory-perceptual measures with increasing age and length of professional practice. Objetivo Descrever e correlacionar medidas vocais perceptivo-auditivas e acústicas, queixas vocais e características profissionais de um grupo de professoras. Métodos Noventa e nove mulheres, entre 20 e 66 anos, professoras do ensino fundamental, realizaram análise vocal perceptivo-auditiva (CAPE-V) e acústica (Multi-Dimensional Voice Program Advanced) e responderam a questionário, contendo dados de identificação, saúde geral, ocupacionais e queixas vocais. Foram aplicados os testes estatísticos Correlação de Pearson e ANOVA. Resultados As professoras trabalhavam, em média, 6,98horas por dia e atuavam como docentes há 12,91 anos, aproximadamente. A maioria apresentou queixas vocais e pertencia à rede de ensino particular. Os parâmetros perceptivo-auditivos estiveram normais. Todas as medidas de jitter, shimmer, segmentos surdos ou não sonorizados e sub-harmônicos mostraram-se acima da normalidade, bem como desvio-padrão da frequência fundamental e índice de fonação suave. Observou-se correlação positiva entre perturbação de frequência e idade, rugosidade, soprosidade e grau geral da voz com idade e tempo de atuação profissional. Observou-se correlação negativa entre perturbação da amplitude e uso diário da voz. Conclusão A voz das professoras foi considerada normal pela avaliação perceptivo-auditiva, mas houve detecção de ruído e instabilidade na análise acústica, com predomínio de queixas vocais, bem como alteração de medidas acústicas e perceptivo-auditivas, com o aumento de idade e tempo de profissão.

Patient initials or identifier number Mr. Tsu, Male, 74 y/o ### Relevant clinical history and physical exam Chief complaint: Syncope at bathroom with chest pain and shortness of breathiness. Past history: Type 2 DM with nephropathy (CKD stage 3-4), Hypertension, Polymyositis BP: 170/91mmHg

While the call repertoire and its communicative function is relatively well explored in Japanese macaques (Macaca fuscata), little empirical data is available on the physics and the physiology of this species' vocal production mechanism. Here, a 6 year old female Japanese macaque was trained to phonate under an operant conditioning paradigm. The resulting “coo” calls, and spontaneously uttered “growl” and “chirp” calls, were recorded with sound pressure level (SPL) calibrated microphones and electroglottography (EGG), a non-invasive method for assessing the dynamics of phonation. A total of 448 calls were recorded, complemented by ex vivo recordings on an excised Japanese macaque larynx. In this novel multidimensional investigative paradigm, in vivo and ex vivo data were matched via comparable EGG waveforms. Subsequent analysis suggests that the vocal range (range of fundamental frequency and SPL) was comparable to that of a 7-10 year old human, with the exception of low-intensity chirps, whose production may be facilitated by the species' vocal membranes. In coo calls, redundant control of fundamental frequency in relation to SPL was also comparable to humans. EGG data revealed that growls, coos, and chirps were produced by distinct laryngeal vibratory mechanisms. EGG further suggested changes in the degree of vocal fold adduction in vivo, resulting in spectral variation within the emitted coo calls, ranging from “breathy” (including aerodynamic noise components) to “non-breathy”. This is again analogous to humans, corroborating the notion that phonation in humans and non-human primates is based on universal physical and physiological principles.

The main purpose of the research is to model the cognitive processes that occur when the physician determines the severity of the dysphonia, and to build an IT system that can substitute the subjective severity diagnosis used by a clinician. In this preliminary study the relationship between acoustic parameters and the speech defect severity determined by a clinician is investigated. Being limited in the number of pathological speech samples, it is very important to choose the effective parameters. After a phoneme level segmentation, acoustic parameters were measured at a predetermined fixed points in continuous speech. Parameters were grouped according to the phonetic classes (classes according to the manner of articulation), and the correlation of the grouped parameters with the severity of dysphonia given by the RBH scale was examined, where R stands for roughness, B for breathiness, H for overall hoarseness. The analysis was carried out on a database containing several pathological disease types, the most frequent being recurrent paresis and functional dysphonia. It was found that beyond the initial acoustic parameters such as jitter(ddp), shimmer(dda), Harmonics-to-Noise Ratio (HNR) and mel-frequency cepstral coefficients (mfcc) measured on vowels, it is worth measuring Soft Phonation Index (SPI) and Empirical mode decomposition (EMD) based frequency band ratios on different phonetic classes. These measures were found to correlate with the severity of dysphonia, determined by the clinician (RBH). They provide useful information and could be useful to differentiate different types of dysphonia like functional dysphonia and recurrent paresis.

This study aimed to examine the relationships among patient occupation, laryngeal diagnosis, perceptual dysphonia severity, and patient-perceived voice impairment.Adult patients presenting with a chief complaint of dysphonia over a 20-month period at a tertiary care, interdisciplinary voice center were included in this retrospective cohort study. Patients were categorized by profession: vocal performers, high occupational voice demand, low or no occupational voice demand, and retired. Associations between professional voice demand and clinician rating of dysphonia severity using the "Grade" score from the Grade, Roughness, Breathiness, Asthenia, and Strain scale and patient ratings of voice impairment using the Voice Handicap Index-10 (VHI-10) were tested using standard descriptive statistical methods.One hundred and sixty-three patients with a presenting complaint of dysphonia were evaluated. Significant associations were found on univariate and multivariable analysis among a patient's occupational voice demand, Grade, Roughness, Breathiness, Asthenia, and Strain grade, and VHI-10 score (P = 0.007 and P 0.001, respectively). Patients subject to greater vocal demands as a result of their occupation had a greater perception of impairment, regardless of acoustic-perceptual severity, when compared with those with low or no occupational voice demand. Although voice diagnosis was significantly associated with VHI-10 score on univariate analysis, it failed to reach significance on multivariable analysis. Demographic measures such as gender and age also did not correlate with perceived vocal impairment.Patient-perception of voice impairment is influenced by occupational demand, independent of acoustic-perceptual dysphonia. Performers and people with high occupational voice needs demonstrate a unique sensitivity to subtle voice changes.

Examine the relationship among the severity of patient-perceived voice impairment, perceptual dysphonia severity, occupational voice demand, and voice therapy adherence. Identify clinical predictors of increased risk for therapy nonadherence.A retrospective cohort study of patients presenting with a chief complaint of persistent dysphonia at an interdisciplinary voice center was done. The Voice Handicap Index-10 (VHI-10) and the Voice-Related Quality of Life (V-RQOL) survey scores, clinician rating of dysphonia severity using the Grade score from the Grade, Roughness Breathiness, Asthenia, and Strain scale, occupational voice demand, and patient demographics were tested for associations with therapy adherence, defined as completion of the treatment plan. Classification and Regression Tree (CART) analysis was performed to establish thresholds for nonadherence risk.Of 166 patients evaluated, 111 were recommended for voice therapy. The therapy nonadherence rate was 56%. Occupational voice demand category, VHI-10, and V-RQOL scores were the only factors significantly correlated with therapy adherence (P 0.0001, P = 0.018, and P = 0.008, respectively). CART analysis found that patients with low or no occupational voice demand are significantly more likely to be nonadherent with therapy than those with high occupational voice demand (P 0.001). Furthermore, a VHI-10 score of ≤29 or a V-RQOL score of40 is a significant cutoff point for predicting therapy nonadherence (P 0.011 and P 0.004, respectively).Occupational voice demand and patient perception of impairment are significantly and independently correlated with therapy adherence. A VHI-10 score of ≤9 or a V-RQOL score of40 is a significant cutoff point for predicting nonadherence risk.

Purpose The aim of the study was to address the reported inconsistencies in the relationship between objective acoustic measures and perceptual ratings of vocal quality. Method This tutorial moves away from the more widely examined problems related to obtaining the perceptual ratings and the acoustic measures and centers in less scrutinized issues regarding the procedure to establish the correspondence. Expressions for the most common measure of association between perceptual and acoustic measures (Pearson's r ) are derived using a multiple linear regression model. The particular case where the multiple linear regression involves only roughness and breathiness is discussed to illustrate the issues. Results Most problems reported regarding inconsistent findings in the relationship between given acoustic measures and particular perceptual ratings could be linked to sample properties not directly related to the actual relationship. The influential sample properties are the collinearity between the regressors in the multiple linear regression and their relative variances. Recommendations on how to rule out this possible cause of inconsistency are given, varying in scope from data collection, reporting, manipulation, and results interpretation. Conclusions The problems described can be extended to more general cases than the exemplified roughness and breathiness sample's coverage. Ruling out this possible cause of inconsistency would increase the validity of the results reported.

Lewis-Sumner syndrome (LSS) is a rare disease characterized by asymmetrical and multifocal mononeuropathy commonly located in the upper limbs. Some rare cases affecting cranial nerve have been described, but LSS is unknown to affect especially laryngeal nerves. This paper presents the first case of unilateral vocal fold paresis caused by an LSS in a 59-year-old man complaining of dysphonia, breathy voice, and vocal fatigue. Epidemiology, clinical features, diagnosis, and treatment will be described.

Summary Objective The purpose of this study was to examine whether changes in respiratory patterns occurred in response to volitional changes in glottal configuration. Methods Twelve vocally healthy participants read a passage while wearing the Inductotrace respiratory inductive plethysmograph, which measures the excursions of the rib cage and abdomen. Participants read the passage 5 times in a typical speaking voice ( baseline phase), 10 times in an experimental voice, which was similar to a breathy vocal quality ( experimental phase), and 5 times again in a typical speaking voice ( return phase). Kinematic estimates of lung volume (LV) initiation, LV termination, and LV excursion were collected for each speech breath. Results Participants spoke with larger LV excursions during the experimental phase, characterized by increased LV initiation and decreased LV termination compared with the baseline phase. Conclusion In response to volitional changes in glottal configuration, healthy individuals spoke with increased LV excursion. They both responded to changes (decreasing LV termination) and planned for more efficient future utterances (increasing LV initiation) during the experimental phase. This study demonstrated that respiratory patterns change in response to changes in glottal configuration; future work will examine these patterns in individuals with voice disorders.

Data mining has a great potential in different areas of health informatics. Data mining in health industry can minimize the health cost as well as reduces the risk of life by informing a person at initial stage. An automatic classification system capable of mining pathological data may contribute in health informatics significantly. In this paper, an automatic system to differentiate between pathological and normal data is developed. The developed system mines the pathological data on the basis of an acoustic analysis. The purpose of the acoustic analysis is to estimate the auditory spectrum of a voice sample by using the principle of the human auditory system called as critical bandwidths. The estimated auditory spectrum simulates the behavior of a human ear and acts like an expert clinician who can identify a pathological voice by hearing. The pathological data used for this study is recorded from the people who are suffering from more than 100 different types of voice disorders. Voice of a disordered patient feels noisy, harsh, strain, breathy and unpleasant to ears. During the training phase of the proposed system, it takes labeled normal and pathological data to generate acoustic models by using the Gaussian mixture model. While in deployment phase, an unknown and unlabeled voice sample is given to the system to determine its type, i.e. normal or pathological. The best obtained accuracy of the system is 99.50%.

Objective: To analyze the performance of a phonatory deviation diagram (PDD) in discriminating the presence and severity of voice deviation and the predominant voice quality of synthesized voices. Method: A speech-language pathologist performed the auditory-perceptual analysis of the synthesized voice (n = 871). The PDD distribution of voice signals was analyzed according to area, quadrant, shape, and density. Results: Differences in signal distribution regarding the PDD area and quadrant were detected when differentiating the signals with and without voice deviation and with different predominant voice quality. Differences in signal distribution were found in all PDD parameters as a function of the severity of voice disorder. Conclusion: The PDD area and quadrant can differentiate normal voices from deviant synthesized voices. There are differences in signal distribution in PDD area and quadrant as a function of the severity of voice disorder and the predominant voice quality. However, the PDD area and quadrant do not differentiate the signals as a function of severity of voice disorder and differentiated only the breathy and rough voices from the normal and strained voices. PDD density is able to differentiate only signals with moderate and severe deviation. PDD shape shows differences between signals with different severities of voice deviation.

Summary Objective This study aimed to present vocal extent measure (VEM), demonstrate its changes with phonomicrosurgical treatment in patients with vocal fold polyps (VFPs), and to compare its performance to that of established vocal parameters. Study Design This is an individual cohort study. Methods Microlaryngoscopic ablation was executed in 61 patients with manifestation of VFP (28 male, 33 female; 45 ± 13 years [mean ± SD]). Analysis of treatment outcome was based on pre- and postoperative voice function diagnostics and videolaryngostroboscopy. Examination instruments were: auditory-perceptual voice assessment (roughness, breathiness, and overall hoarseness [RBH]-status), voice range profile (VRP), acoustic-aerodynamic analysis, and patients' self-assessment of voice using the voice handicap index. The VEM, a parameter not yet commonly established in phoniatric diagnostics, was calculated from area and shape of the VRP to be compared with the dysphonia severity index (DSI) concerning diagnostic suitability. Results All polyps were completely excised. Three months postoperatively, mucosal wave propagation had recovered. All subjective and most objective acoustic and aerodynamic parameters showed highly significant improvement. The VHI-9i-score decreased from 15 ± 8 to 6 ± 7 points. The average total vocal range extended by 4 ± 5 semitones, the mean speaking pitch decreased by 1 ± 2 semitones. The DSI increased on average from 2.6 ± 2.1 to 4.0 ± 2.2, VEM from 83 ± 28 to 107 ± 21 ( P s = 0.65; P Conclusion Phonomicrosurgery of VFP is an objectively and subjectively satisfactory therapy for voice improvement. The VEM represents a comprehensible and easy-to-use unidimensional measure for objective VRP evaluation. This positive measure of vocal function seems to be a compelling diagnostic addition for objective quantification of vocal performance.

Objective. Supraglottic laryngectomy is a surgical procedure that preserves laryngeal functions. This technique allows extensions including removal of tongue base or 1 arytenoid. We aimed to compare vocal results of supraglottic laryngectomy and extended procedures.Study Design. Cross-sectional study.Setting. Tertiary care hospital.Subjects and Methods. Thirty-three males who underwent supraglottic laryngectomy were included in the study. Fifteen patients (45.5%) were applied standard supraglottic laryngectomy (standard supraglottic laryngectomy group). In 11 patients (33.3%), unilateral arytenoid cartilage was totally resected by separation at the cricoarytenoid joint (laterally extended group), and the tongue base was removed in 7 patients (anteriorly extended group) (21.2%). Twenty male smokers constituted control group. Acoustic and aerodynamic voice analyses were performed for the assessment of objective results. Grade, roughness, breathiness, asthenia, and strain scale (GRBAS) scores were analyzed for perceptual assessment. Voice Handicap Index-30 was used to evaluate subjective results.Results. The comparison of supraglottic laryngectomy group with the control group revealed that the mean maximum phonation time and fundamental frequency were significantly lower in the supraglottic laryngectomy group (P

Made available in DSpace on 2015-02-02T12:39:27Z (GMT). No. of bitstreams: 0 Previous issue date: 2014-10-01Bitstream added on 2015-02-02T13:08:33Z : No. of bitstreams: 1 S1516-18462014000501606.pdf: 303128 bytes, checksum: 0ecaa3cf2df8b382e5f178d01f9798b7 (MD5) Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) OBJETIVO: caracterizar os aspectos de saúde vocal, o conhecimento dos coristas quanto aos cuidados com a própria voz, e realizar uma análise percepto auditiva da voz falada, em um coro infanto juvenil. MÉTODOS: participaram deste estudo 20 indivíduos, de ambos os gêneros, entre 10 e 18 anos, integrantes de um coro. Foram aplicados dois questionários: um voltado aos pais sobre a saúde geral, tratamento médico e hábitos alimentares de seus filhos e outro para os coristas, que abordou aspectos sobre vivência no canto, conhecimentos sobre a voz, hábitos e saúde vocal. Foi realizada uma triagem vocal individual para análise perceptoauditiva da voz falada por meio de protocolo específico. RESULTADOS: no questionário aplicado aos pais, foi observado que 40% dos coristas apresentaram algum tipo de alergia. Quanto ao questionário respondido pelos coristas, 65% não souberam dizer como a voz é produzida; 100% realizavam aquecimento vocal; 80% não possuíam cuidados com a voz; 35% apresentaram queixa vocal. Na triagem vocal, verificou-se 35% de coristas com voz rouca e soprosa e 5% áspera; o pitch predominantemente agudo (55%); a articulação e a ressonância equilibradas; o tipo respiratório predominante foi o médio (65%); o modo respiratório misto (45%); a coordenação pneumofonoarticulatória presente em 90%; o tempo máximo fonatório aumentado em 65%; e o coeficiente s/z mostrou-se adequado em 65%. CONCLUSÃO: nos aspectos de saúde vocal, foi observado um alto índice de alergia; nos cuidados com a própria voz, a maioria dos coristas não sabe como a voz é produzida; na análise perceptoauditiva,foram encontrados em um grande número de coristas, qualidade vocal roucosoprosa e tempo máximo fonatório aumentado. PURPOSE: to characterize the vocal health, knowledge of choristers in caring for her own voice, and perceptual analysis of the spoken voice, performed by an audiologist in a chorus children and youth. METHODS: the study included 20 individuals of both sexes, between 10 and 18 years, members of a choir, two questionnaires were applied: one facing parents on general health, medical and dietary habits, and another for the choristers facing experience in singing, knowledge of the voice and vocal health habits. Screening was performed for individual vocal perceptual analysis of the spoken voice. RESULTS: in the questionnaire back to the parents, it was observed that 40% of the choristers had some kind of allergy, whereas in the questionnaire aimed to choristers, 65% did not know how the voice is produced; carried out vocal training 100%, 80% did not care voice, 35% had vocal complaints; already screening vocal assessed that 35% expressed hoarse and breathy and rough 5%, the pitch was found predominantly acute (55%); articulation and resonance were balanced, the type was the predominant respiratory medium (65%), whereas the breathing mode mixed (45%), the coordination between breathing in 90%, the maximum phonation time increased by 65% and the coefficient s / z was adequate in 65%. CONCLUSION: the aspects of vocal health was observed a high rate of allergy, care of his own voice most choristers do not know how the voice is produced and auditory perception was found in a large number of choristers hoarse breathy vocal quality and maximum phonation time increased. Universidade Estadual Paulista Universidade Federal de São Paulo Universidade Estadual Paulista

IntroductionVoice modification after swallowing may indicate changes in the transit of the bolus.Objective The aim of this study is to verify the use of perceptual voice analysis to detect oropharyngeal dysphagia. Study Design Case series.Methods Twenty-seven patients with dysphagia as diagnosed by videofluoroscopy and 25 without were evaluated. The sustained vowel /a/ was recorded before this exam and after swallowing different consistencies (pasty, liquid and solid). For the voice evaluation, the GRBAS scale (grade, roughness, breathiness, asthenia and strain) and the parameter "wet voice" were used. Three judges blinded to study group and time of emission performed voice analysis.Results Individuals with dysphagia showed significant decrease in grade of voice and asthenia and increase in strain after swallowing pasty substances, differing from individuals without dysphagia who showed no modification of the parameters after swallowing. The wet voice parameter showed no difference after swallowing in both study groups.Conclusion The decrease in grade and asthenia and increased strain are indicative of a swallowing disorder, indicating increased vocal strain to clean the vocal tract of food. The modification of vocal production after swallowing proved to be a trusted resource for detection of swallowing disorders.

Introduction and objectives The present study aimed to compare elderly and young female voices in habitual and high intensity. The effect of increased intensity on the acoustic and perceptual parameters was assessed. Methods Sound pressure level, frequency, jitter, shimmer, and harmonic to noise ratio were obtained at habitual and high intensity in a group of 30 elderly women and 30 young women. Perceptual assessment was also performed. Results Both groups demonstrated an increase in SPL and F0 from habitual voice to high intensity voice. No differences were found between groups in any acoustic variables on samples recorded with habitual intensity level. No significant differences between groups were found in habitual intensity level for pitch, hoarseness, roughness, and breathiness. Asthenia and instability obtained significant higher values in elderly than young participants, whereas, the elderly demonstrated lower values for perceived tension and loudness than young subjects. Conclusion Acoustic and perceptual measures do not demonstrate evident differences between elderly and young speakers in habitual intensity level. The parameters analyzed may lack the sensitivity necessary to detect differences in subjects with normal voices. Phonation with high intensity highlights differences between groups, especially in perceptual parameters. Therefore, high intensity should be included to compare elderly and young voice.

Background Chronic obstructive pulmonary disease (COPD) is a respiratory condition that can affect voice as respiration is the source for voice production. There are very few studies available on the analysis of voice in individuals with COPD (asthma, chronic bronchitis and emphysema). Purpose of the study The aim of this study was to analyze the acoustic and perceptual characteristics of voice in individuals with COPD. Method The study followed a comparative cross-sectional study design. Sixty-four participants were considered, and they were divided into two groups (group 1: individuals with COPD, n = 32; group 2: normal individuals, n = 32). Acoustic analysis was performed using CSL software. The perceptual analysis was done using CAPE-V. Results The results showed that there was significant difference between the two groups on acoustic measures (lower fundamental frequency, reduced frequency range, increased pitch and amplitude perturbation measures and increased noise measures), and perceptual measures (presence of increased roughness, breathiness, strain). Conclusion We can conclude that COPD has an impact on voice measures as assessed through acoustic and perceptual parameters. These voice deviations may be due to COPD itself or due to the effects of the medication. Clinical implication The findings of this study provide valuable information regarding voice problems in the individuals with COPD so that an appropriate intervention plan can be designed. How to cite this article Shastry A, Balasubramanium RK, Acharya PR. Voice Analysis in Individuals with Chronic Obstructive Pulmonary Disease. Int J Phonosurg Laryngol 2014;4(2):45-49.

Introduction. Hyperkinetic (hyperfunctional) dysphonia is a common pathology. The disorder is often found in vocal professionals faced with high vocal requirements. Objective. The objective of this study was to evaluate the effects of vocal therapy on voice condition characterized by hyperkinetic dysphonia with prenodular lesions and soft nodules. Methods. The study included 100 adult patients and 27 children aged 4-16 years with prenodular lesions and soft nodules. A subjective acoustic analysis using the GIRBAS scale was performed prior to and after vocal therapy. Twenty adult patients and 10 children underwent objective acoustic analysis including several acoustic parameters. Pathological vocal qualities (hoarse, harsh and breathy voice) were also obtained by computer analysis. Results. The subjective acoustic analysis revealed a significant (p

BACKGROUND Voice change is one of the earliest features of Parkinson's disease. However, quantitative studies of vocal fold dynamics which are needed to provide insight into disease biology, aid diagnosis, or track progression, are few. METHODS We therefore quantified arytenoid cartilage movements and glottic area during repeated phonation in 15 patients with Parkinson's disease (symptom duration < 6 years) and 19 controls, with 320-slice computerised tomography (CT). We related these measures to perceptual voice evaluations and spirometry. We hypothesised that Parkinson's disease patients have a smaller inter-arytenoid distance, a preserved or larger glottic area because vocal cord bowing has previously been reported, less variability in loudness, more voice dysdiadochokinesis and breathiness and a shortened phonation time because of arytenoid hypokinesis relative to glottic area. RESULTS Inter-arytenoid distance in Parkinson's disease patients was moderately smaller (Mdn = 0.106, IQR = 0.091-0.116) than in controls (Mdn = 0.132, IQR = 0.116-0.166) (W = 212, P = 0.015, r = -0.42), normalised for anatomical and other inter-subject variance, analysed with two-tailed Wilcoxon's rank sum test. This finding was confirmed in a linear mixed model analysis-Parkinson's disease significantly predicted a reduction in the dependent variable, inter-arytenoid distance (b = -0.87, SEb = 0.39, 95% CI [-1.66, -0.08], t(31) = -2.24, P = 0.032). There was no difference in glottic area. On perceptual voice evaluation, patients had more breathiness and dysdiadochokinesis, a shorter maximum phonation time, and less variability in loudness than controls. There was no difference in spirometry after adjustment for smoking history. CONCLUSIONS As predicted, vocal fold adduction movements are reduced in Parkinson's disease on repeated phonation but glottic area is maintained. Some perceptual characteristics of Parkinsonian speech reflect these changes. We are the first to use 320-slice CT to study laryngeal motion. Our findings indicate how Parkinson's disease affects intrinsic laryngeal muscle position and excursion.

Objective: Type I Gore-tex thyroplasty (GTP) for nonparalytic glottic incompetence (GI) results in significantly improved subjective and perceptual voice outcomes. We endeavored to investigate the longitudinal course of voice outcomes measuring the same patients across time points stratified by diagnostic subgroup. Methods: Seventy-five patients with nonparalytic GI treated with GTP in the past 9 years were retrospectively reviewed and grouped according to their primary diagnoses (atrophy, scar, hypomobility, and paresis). Voice outcome measures, Voice-Related Quality of Life (VRQOL), Glottal Function Index (GFI), and GRBAS (grade, roughness, breathiness, asthenia, and strain) for each individual patient and diagnostic subgroup were grouped by time interval following surgery: 0 to 90 days, 3 to 9 months, 9 to 18 months, 18 to 36 months, 3 to 5 years, and 5 to 10 years. Results: Across all diagnoses, statistically significant improvement in VRQOL was maintained at 3 to 5 years ( P = .03) and GFI at 5 to 10 years ( P = .02). The GRBAS showed statistically significant improvements out to 18 to 36 months ( P = .02). In the subgroup analysis, hypomobility/paresis patients maintained significant improvement voice measures longer than patients with other diagnoses. As a group, scar patients did not show statistically significant postoperative improvement in VRQOL or GFI at any of the tested time points. Conclusions: Gore-tex thyroplasty provides durable improvement in subjective and perceptual voice outcomes for patients with nonparalytic GI. Patients treated for hypomobility/paresis have the most durable vocal outcomes followed by atrophy and lastly, scar.

Background/aim: The aim of this study was to investigate alterations in voice parameters among patients using continuous positive airway pressure (CPAP) for the treatment of obstructive sleep apnea syndrome. Materials and methods: Patients with an indication for CPAP treatment without any voice problems and with normal laryngeal findings were included and voice parameters were evaluated before and 1 and 6 months after CPAP. Videolaryngostroboscopic findings, a self-rated scale (Voice Handicap Index-10, VHI-10), perceptual voice quality assessment (GRBAS: grade, roughness, breathiness, asthenia, strain), and acoustic parameters were compared. Results: Data from 70 subjects (48 men and 22 women) with a mean age of 44.2 ± 6.0 years were evaluated. When compared with the pre-CPAP treatment period, there was a significant increase in the VHI-10 score after 1 month of treatment and in VHI- 10 and total GRBAS scores, jitter percent (P = 0.01), shimmer percent, noise-to-harmonic ratio, and voice turbulence index after 6 months of treatment. Vague negative effects on voice parameters after the first month of CPAP treatment became more evident after 6 months. Conclusion: We demonstrated nonsevere alterations in the voice quality of patients under CPAP treatment. Given that CPAP is a long-term treatment it is important to keep these alterations in mind.

Background Objective acoustic analysis is a key component of multidimensional voice assessment. OperaVOX is an iOS app which has been shown to be comparable to Multi Dimensional Voice Program for most principal measures of vocal function. As a relatively cheap, portable and easily accessible form of acoustic analysis, OperaVOX may be more clinically useful than laboratory-based software in many situations. This study aims to determine whether correlation exists between acoustic measurements obtained using OperaVOX, and perceptual evaluation of voice. Methods Forty-four voices from the multidisciplinary voice clinic were examined. Each voice was assessed blindly by a single experienced voice therapist using the GRBAS scale, and analysed using OperaVOX. The Spearman rank correlation co-efficient was calculated between each element of the GRBAS scale and acoustic measurements obtained by OperaVOX. Results Significant correlations were identified between GRBAS scores and OperaVOX parameters. Grade correlated significantly with jitter (ρ = 0.495, p

In a recent study, we investigated listeners’ ability to judge talker height from CVC syllables spoken by children. The present study extends this research by examining acoustic variables that predict talker height. We analyzed recordings of the sustained vowel /a/ produced by children 5 through 18 years of age, taken from a larger children's speech database. In addition to measures previously found to predict speaker height (GMFF and G0, the geometric mean of the lowest three formant frequencies and fundamental frequency, respectively) we investigated measures related to the glottal source reflecting breathiness and spectral tilt. Multiple regression models incorporating these measures provided accurate estimates of talker height (mean average error of 9.3 cm). Consistent with our previous findings for age, a model specifying the sex of the talker predicts talker height significantly more accurately than a model that excludes sex.In a recent study, we investigated listeners’ ability to judge talker height from CVC syllables spoken by children. The present study extends this research by examining acoustic variables that predict talker height. We analyzed recordings of the sustained vowel /a/ produced by children 5 through 18 years of age, taken from a larger children's speech database. In addition to measures previously found to predict speaker height (GMFF and G0, the geometric mean of the lowest three formant frequencies and fundamental frequency, respectively) we investigated measures related to the glottal source reflecting breathiness and spectral tilt. Multiple regression models incorporating these measures provided accurate estimates of talker height (mean average error of 9.3 cm). Consistent with our previous findings for age, a model specifying the sex of the talker predicts talker height significantly more accurately than a model that excludes sex.

This project investigates the perceived breathiness of nasal segments than non-nasal sonorants like [l] in Hindi. Shared acoustic correlates between nasality and breathiness (like wider F1 bandwidth, appearance of additional poles and zeros in the acoustic spectrum) lead to perceptual consequences that both allow erroneous perception of breathiness as nasality (Ohala and Busa, 1995) or enhanced perception of nasality (Arai, 2006). Breathiness has been observed to co-occur with nasality in French (Styler, 2017) and some Yi languages (Garellek et al., 2016). Effects of breathiness on perception of nasality have also been reported in Hindi (Ohala and Ohala, 1993)—vowels that were produced with a relatively open glottis were perceived to be more nasal than their non-breathy counterparts. Based on these findings, we hypothesized that Hindi speakers use breathiness for enhanced perception of nasality. This was tested using the following acoustic parameters of breathiness: Difference between 1st and 2nd harmonic (H1-H2), Cepstral Peak Prominence (CPP), Spectral tilt and Harmonic to Noise Ratio (HNR). The results demonstrated that the nasals were significantly breathier than the non-nasal sonorants, suggesting that breathiness might be used as a cue to enhance the perception of nasality in Hindi.This project investigates the perceived breathiness of nasal segments than non-nasal sonorants like [l] in Hindi. Shared acoustic correlates between nasality and breathiness (like wider F1 bandwidth, appearance of additional poles and zeros in the acoustic spectrum) lead to perceptual consequences that both allow erroneous perception of breathiness as nasality (Ohala and Busa, 1995) or enhanced perception of nasality (Arai, 2006). Breathiness has been observed to co-occur with nasality in French (Styler, 2017) and some Yi languages (Garellek et al., 2016). Effects of breathiness on perception of nasality have also been reported in Hindi (Ohala and Ohala, 1993)—vowels that were produced with a relatively open glottis were perceived to be more nasal than their non-breathy counterparts. Based on these findings, we hypothesized that Hindi speakers use breathiness for enhanced perception of nasality. This was tested using the following acoustic parameters of breathiness: Difference between 1st and 2nd harmonic...

Patients with unilateral vocal fold paralysis (UVFP) complain of a soft breathy voice that is hard to understand. Thyroplasty Type 1 (TT1), the most common surgical intervention for UVFP, uses an implant to push over the membranous fold. There remains controversy regarding TT1 procedures. Questions include the optimal shape and size for the implant, where to place the implant and whether an arytenoid adduction should be added. Despite several studies, no optimal technique has been found, and the revision rate has reported to be as high as 12%–25%. This study aims to understand the impact of implant location on vocal fold vibration. TT1 procedures were performed on excised canine larynges using silastica implants placed either at the glottis or just below the glottis to medialize the folds. Larynges were then made to phonate at various subglottal pressures (Psg), and measurements were taken of the acoustics, supplied flow rate, and Psg. From these measurements, the glottal efficiency was calculated, and the acoustic signal was analyzed to determine the quality of the sound source. On average, larnges medialized in the subglottis had higher glottal efficiency and cepstral peak prominence than those medialized at the glottis, indicating that lower implant location is preferable.Patients with unilateral vocal fold paralysis (UVFP) complain of a soft breathy voice that is hard to understand. Thyroplasty Type 1 (TT1), the most common surgical intervention for UVFP, uses an implant to push over the membranous fold. There remains controversy regarding TT1 procedures. Questions include the optimal shape and size for the implant, where to place the implant and whether an arytenoid adduction should be added. Despite several studies, no optimal technique has been found, and the revision rate has reported to be as high as 12%–25%. This study aims to understand the impact of implant location on vocal fold vibration. TT1 procedures were performed on excised canine larynges using silastica implants placed either at the glottis or just below the glottis to medialize the folds. Larynges were then made to phonate at various subglottal pressures (Psg), and measurements were taken of the acoustics, supplied flow rate, and Psg. From these measurements, the glottal efficiency was calculated, and th...

Objective: Evaluate the outcome of autologous fat injection (AFI) in the management of unilateral vocal cord palsy (UVCP). Materials and Methods: In this retrospective study, we obtained data of all patients with UVCP of at least 6 months duration who underwent AFI. Preoperative and postoperative grade, roughness, breathiness, asthenia, and strain (GRBAS), voice handicap index (VHI), and multidimensional voice program scores were obtained and compared to evaluate the subjective and objective outcomes of AFI. Results: Sixty patients underwent AFI. There was significant improvement in perceptual voice, as graded by both – patient and observer, using VHI and GRBAS scale. Significant improvement was also seen in Jitter and Soft Phonation Index on voice analysis. Conclusion: AFI is a simple, safe, and cost-effective method with excellent phonatory outcomes for the management of UVCP.