Effectiveness of the Computed Analysis of Electroglottographic Signals in Muscle Tension Dysphonia

Objective: To investigate the usefulness of electroglottography (EGG) parameters in the diagnosis and estimation of efficacy of voice therapy for muscle tension dysphonia (MTD). Patients and Methods: Nineteen MTD participants, an equivalent number of dysphonic ('organic') patients with vocal fold lesions and as many normal speakers were enrolled. Acoustic (Ac) and EGG signals during sustained phonation were recorded simultaneously. The period and amplitude perturbation quotient of both signals, the closed quotient (CQ) of EGG signals (mean CQ) and its standard deviation (CQSD) were calculated, and subsequently compared among the three groups. These parameters in the MTD group were compared before and after voice therapy. Results: The perturbation measures of both signals in the MTD group were either as high as or significantly higher than those in the organic group or the control group, respectively. Both the Ac and EGG parameters after therapy significantly decreased. The CQSD, but not mean CQ, also decreased after therapy. Conclusion: EGG parameters related to the regularity of vocal fold vibration, but not to the degree of vocal fold contact (mean CQ), are useful for the diagnosis and estimation of voice therapy outcome in MTD.     

歌唱艺术嗓音声学参数分析

目的探讨我国歌唱艺术嗓音声学参数特点。方法采用电脑多媒体技术,使用泰亿格公司生产的Dr.Speech软件采样分析,对166名18~22岁音乐学院的各专业学员自然舒适状态下发长元音/a:/进行声学参数的检测和分析,并以嗓音健康普通人群做对照。结果Jitter值男、女通俗组和民族组与对照组相比无显著性差异(P>0.05);Shimmer值的差异存在于各组(P<0.05);NNE值男美声组高于通俗组、民族组和对照组,有显著性差异(比为P<0.05),而女民族组高于通俗组、美声组和对照组,有显著性差异(P<0.05)。结论歌唱艺术嗓音声学参数有其自身特点,在正常范围内参数的差异有无意义,或对嗓音质量的评估有无价值,有待进一步探讨。     

Laryngeal effects of nasal allergen provocation in singers with allergic rhinitis

In spite of our recent insight into nasobronchial interaction mechanisms in allergic airway disease, the association between allergic rhinitis and voice complaints remains obscure. To evaluate the effects of nasal allergen provocation and seasonal grass pollen exposure on subjective and objective laryngeal parameters in singers with and without allergic rhinitis, an observational case control study was conducted. Prior to the pollen season, six grass pollen allergic and six non-allergic semiprofessional singers were exposed to nebulized sham solution and grass pollen extract (HAL°) in rising concentrations. After 3 min, 60?min and 24?h, nasal and laryngeal complaints were evaluated by the use of a visual analog scale (VAS). Laryngeal parameters like voice appearance (video stroboscopic images), voice range profile and subjective (GRBAS) and objective (jitter, shimmer, H/N, DSI) voice quality were evaluated before provocation, after 60?min and 24?h. During the pollen season, the allergic singers were re-evaluated. Results showed that in allergic singers both nasal (TNS of 4.0?±?2.4 vs. 0.0?±?0.0, p?<?0.05) and laryngeal complaints (TLS of 1.4?±?1.1 vs. 0.0?±?0.2, p?<?0.05) were induced at 3?min after the provocation. The induced laryngeal complaints were the feeling of laryngeal irritation, secretions and globus. No change in voice quality or stroboscopy score was measured. During the pollen season, laryngeal complaints were present (TLS of 2.4?±?2.4) in allergic singers, without evidence for objective voice and laryngeal changes. In conclusion, we here demonstrate the rapid induction of laryngeal complaints in allergic singers by nasal allergen provocation and during the pollen season. There was no subject reported or investigator measured change in voice quality. No change in stroboscopy score was measured.     

Onset of voicing in stuttered and fluent utterances

Electroglottographic (EGG) and acoustic waveforms of the first few glottal pulses of voicing were monitored and voice onset time (VOT) measured during an adaptation task performed by stutterers and controls. The fluent utterances of stutterers resembled those of control subjects. After dysfluencies, however, the EGG signal increased gradually, lending physiological support to the technique of "easy onset" of voicing. EGG waveforms also served to help differentiate mild from severe stutterers. Idiosyncratic ritualized laryngeal behavior, sometimes including physiological tremor, was evident in the EGG record.     

电声门图参数与声嘶的心理听觉评价的相关关系研究

目的 研究电声门图参数与声嘶程度心理听觉评价之间的关系。方法 对134例受试者进行电声门图(EGG)检查,按心理听觉评估结果,根据GRBAS分级,将36例正常人及98例病理嗓音患者分成四组,对各组的电声门图参数及其与声嘶程度的关系进行统计学处理。结果 各组EGG参数均有显著性差异,标准化噪声能量(NNE)与接触率(CQ)是判别声嘶程度最有意义的两个参数,5个参数(jittter,shimmer,NNE,CQ,CQP)均与声嘶程度心理听觉评价有良好的相关关系,且频率微扰与粗糙声(R),NNE、CQ与气息声(B)相关性较好。结论 电声门图作为一种反映声带振动模式的方法,它和心理听觉评价声嘶的分级和程度有显著相关性,两者皆为临床应用提供诊断依据,但前者更为客观精确。     

声带小结者嗓音分析和电声门图参数变化的比较

目的比较分析声带小结者嗓音参数和电声门图（EGG）参数的变化，评价这些参数在该病的诊断和疗效观察中的意义。方法采用Dr．SpeechScienceforWindows软件对42例未经手术的声带小给患者作嗓音分析和EGG检测，对其主要声学参数变化进行比较，并对声带小结的EGG波形作了观察。结果在声带小结的诊断中，两种方法中的声学参数基音频率微扰（jitter）和基音振幅微扰（shimmer）均是有价值的，二者可以相互替代。EGG的标准声门噪声能量（NNE）特异性高，嗓音分析中的NNE则敏感性高。结论EGG中声门波的特征结合嗓音分析及EGG的jitter和shimmer值对声带小结的诊断和疗效观察有较大的意义。     

Vocal shadowing in singers and nonsingers

Five nonsingers and five singers vocally matched the pitches of frequency modulated tones. Subject responses to the shadowing task were analyzed in terms of accuracy, and in terms of duration and speed characteristics of pitch changes. In addition, each frequency change was categorized according to hit, overshoot, undershoot, or oscillate patterns. Singers were found to effect pitch changes in significantly less time than the nonsingers. This finding was attributed to more direct patterns (hits) and faster maximum speeds obtained by the singers. Both groups demonstrated a direct relationship between the size of the pitch change and each of the duration and speed parameters examined. Similarly, for both groups, pitch lowering was faster than pitch raising. Faster speeds and more direct paths in effecting pitch changes were viewed as evidence of greater vocal proficiency in singers as compared to nonsingers. Implications of the data for mechanical and physiological aspects of voice frequency control are discussed.     

The use of a screening questionnaire to determine the incidence of allergic rhinitis in singers with dysphonia

OBJECTIVES: To report the incidence of allergic rhinitis in singers with nonspecific laryngeal examination findings and to correlate the incidence of allergic rhinitis with their vocal symptoms when present. DESIGN: A retrospective review of all the medical records of singers with nonspecific laryngeal findings who presented to a specialty voice center for either vocal training or therapy between June 2002 and September 2005. SETTING: Specialty voice center. PARTICIPANTS: Forty-five singers with nonspecific laryngeal findings who presented to a specialty voice center for either vocal training or therapy. MAIN OUTCOME MEASURES: A standardized validated questionnaire for evaluation of allergic rhinitis was filled out by all the subjects. A score above 0 was considered positive. RESULTS: The total prevalence of allergic rhinitis was 87% (39 of 45 subjects). The singers with vocal symptoms were approximately 15% more likely to have allergic rhinitis than those with no vocal symptoms (92% vs 84%). Singers with more than 2 vocal symptoms had a 25% higher likelihood of having allergic rhinitis. CONCLUSIONS: The incidence of allergic rhinitis in singers is extremely high. Hidden respiratory allergies may affect the professional voice. Proper awareness and a multidisciplinary approach are indispensable for proper diagnosis and treatment.     

A proposal to adapt the voice handicap index to the singing voice

OBJECTIVES: The voice handicap index by Jacobson et al doesn't render the difficulties experienced by singers. The aim of this study is to adapt the V.H.I. to the singing voice and evaluate it's reliability and coherence. In order to obtain this first scale, we went through three stages. MATERIAL ET METHOD: The first consisted in the modification of the existing items and the creation of new ones. The second was to measure the stability by a test - retest and the coherence of the adapted and the new items. This was done on groups of dysodic singers and professional voice users. The third stage consisted in evaluating the reliability and the coherence of 31 items on a homogeneous population of 132 classical singers with and without vocal impairment. The subjects were divided in three groups. The first group was composed of 95 normophonic singers, the second included 37 dysphonic singers and the third group was the control group, composed of 20 non singers without vocal complaints. RESULTS: The statistical results show a good stability of the test - retest (ICC=0.949; Rho: 0.912; Bland et Altman [-010.19, +13.23]). The internal coherence of each sub scale (Cronbach's alpha) is good (>0.70). The correlations between the three sub scales are moderate between the functional and the emotional sub scale: 0.58; between the emotional and the physical: 0.64; and between the functional and the physical: 0.78). Each sub scale is measuring a specific dimension; still they are homogeneous between one another. Four variables have a significative influence on the results: the pathology (p<0.001), being a professional singer (p<0.001), the repetition (p=0.003), being a chorister (p=0.002). CONCLUSION: The VH.I adapted to the singers, appears to be reliable, valid and adapted to the population of dysodic classical singers.     

声带小结患者发音矫治前后电声门图参数变化

目的 比较分析声带小结患者发音矫治前后电声门图参数变化，评价发音矫治对声带小结的疗效。方法 对48例声带小结（软性小结）患者发音矫治（3～6个月）前后分别进行电声门图检测，并对其主要参数进行比较分析。结果 发音矫治后平均基频、接触率较矫治前有显菩性升高（P〈0．05），基频微扰、振幅微扰、噪声能量较矫治前有显著性下降（P〈0．05）。结论 发音骄治前后电声门圈参数变化结果提示，发音矫治对声带小结具有一定的治疗效果。     

Laryngeal modeling: Theoretical,in vitro,in vivo

Because the larynx is situated anatomically in an area which is difficult to measure and visualize, theoretical, in vitro, and in vivo models are used in laryngeal research. Vocal fold vibration was studied in anesthetized dogs, while electrically stimulating independently the superior and recurrent laryngeal nerves under conditions of constant airflow. Photoglottographic (PGG), electroglottographic (EGG), and subglottic pressure signals were obtained while stroboscopically photographing the larynx. Specific points along PGG, EGG, and subglottic pressure waveforms were correlated with laryngeal events which occurred during vibration. The canine larynx, in an experimentally produced phonatory mode, vibrates in a two mass (upper and lower margin) system and appears comparable to modal human voice production. The recorded glottogrophic waveforms from experimentally produced phonation in the canine are similar to signals recorded from humans. However, observed differences can be related to anatomic differences.     

Validation of the Italian version of the Singing Voice Handicap Index

Singers constitute a specific population that is particularly sensitive to vocal disability, which may have a higher impact on their quality of life compared to non-singers. A specific questionnaire, the Singing Voice Handicap Index (SVHI), was created and validated aimed to measure the physical, social, emotional and economic impacts of voice problems on the lives of singers. The aim of this study was to validate the Italian version of the SVHI. The validated English version of the SVHI was translated into Italian and then discussed with several voice care professionals. The Italian version of the SVHI was administered to 214 consecutive singers (91 males and 123 females, mean age: 32.62 ± 10.85). Voice problem complaints were expressed by 97 of the singers, while 117 were healthy and had no voice conditions. All subjects underwent a phoniatric consultation with videolaryngostroboscopy to ascertain the condition of the vocal folds. Internal consistency of the Italian version of the SVHI showed a Cronbach’s α of 0.97. The test–retest reliability was assessed by comparing the responses obtained by all subjects in two different administrations of the questionnaire; the difference was not significant (p = ns). The SVHI scores in healthy singers was significantly lower than the one obtained in the group of singers with a vocal fold abnormality (29.26 ± 25.72 and 45.62 ± 27.95, p < 0.001, respectively). The Italian version of the SVHI was successfully validated as an instrument with proper internal consistency and reliability. It is a suitable instrument for the self-evaluation of handicaps related to voice problems in the context of singing.     

Synchronizing videostroboscopic images of human laryngeal vibration with physiological signals.

PURPOSE: This report describes a new system that permits the precise correlation of videostroboscopic images with corresponding physiological measures, such as glottography and subglottic pressure. METHOD: A healthy volunteer had unilateral vocal cord paralysis induced by infiltrating local anesthesia into the recurrent and superior laryngeal nerve. Vocal-fold vibrations were monitored by photoglottography (PGG) and electroglottography (EGG). Analog signals from the EGG and PGG were synchronized with the video and correlated. RESULTS: The method described permits images to be sampled throughout sustained phonation. This technique allows study of events during glottic vibration. Results obtained have been in close agreement with previous studies that correlate the vocal-fold morphology to glottographic signal using other methods. This technique is inexpensive in comparison with high-speed filming. The main disadvantage of this method is related to the limitations of stroboscopy.     

A comparative acoustic study of the speaking and singing voice during the adolescent's break of the voice

The observation of the vocal evolution of adolescent singers has shown it takes place in two stages, the singing voice changing after the speaking voice. The same pattern has been encountered and made more explicit with a study of 50 non-singer adolescents. It thus appears that the average pitch of the speaking voice deepening by one octave is not by itself the sign that the break of the voice has ended. This study also shows the individual nature of adolescent vocal evolution and its length (up to two years in one out of four cases).     

Outcome of vocal hygiene in singers

PURPOSE OF REVIEW: In this article, we illustrate the evolution of studies that contribute to a better understanding of vocal care for professional voice users and singers in particular. RECENT FINDINGS: Research on vocal hygiene is specific, focusing on concrete solutions. It has commonly been believed that hydration and vocal rest are beneficial; recent research proves this supposition. An exhaustive medical diagnosis and careful therapy is stressed to detect and treat any micro-organic lesions caused by reflux, infection, allergy and environmental circumstances, which can harm a singer's voice. The use of medication is reviewed and side effects are evaluated. SUMMARY: Vocal coaches, speech therapists and otolaryngologists need to focus more specifically on the management of vocal care. Accurate medical diagnosis and specific guidelines for singers must be provided as higher voice demands imply more profound and structured voice care. In the past, vocal hygiene had a negative connotation; a more positive and supporting approach to voice care, with more attention to the singer, is recommended.     

Uvulopalatopharyngoplasty changes fundamental frequency of the voice--a prospective study

The aim of the study was to find whether a muscle-sparing uvulopalatopharyngoplasty (UPPP) and tonsillectomy cause a measurable change in the voice. The fundamental frequency and the first two formants of five sustained vowels were measured before and nine (six to 15) months following operation. The operation consisted of tonsillectomy and UPPP with preservation of the musculature of the soft palate. All patients received a pre- and post-operative 12-canal polysomnography (level-I sleep study). No patient showed signs of any post-operative velopharyngeal insufficiency. Acoustic analysis showed a significant raising of the fundamental frequency of up to 10 Hz. There was also a lowering of the second formant in two of the five vowels. This was correlated with the volume of the excised tissue. The minimal changes will probably have no significance for those who place no special reliance on their voice, but the possible post-operative changes should be made clear to singers and those relying on their voice for professional reasons.     

Stimm?rztliche Betreuung und Behandlung von S?ngern

ENT/phoniatrics specialists are frequently the primary reference persons for patients who have problems with the professional use of their voice. Singers show the highest risk factors for voice disorders among all professional voice users. The treatment and care of singers requires specific knowledge and competence of the physician, as well as a treatment setting adapted to the needs of this special group of patients, whose existence depends on the use of their voice. To some extent, evidence based concepts can be taken into account when treating professional singers. In cases for which no concepts have yet been developed and evaluated, recourse to clinical experience is necessary. In the present paper, current concepts for the treatment of singers are discussed on the basis of scientific publications and on long-standing experience of consultations in musician's medicine and ENT, under the aspects of diagnosis, therapy as well as prevention, taking into account the most frequent voice problems in professional singers.     

Voice onset time for female trained and untrained singers during speech and singing

The purpose of this study was to examine the voice onset times of female trained and untrained singers during spoken and sung tasks. Thirty females were digitally recorded speaking and singing short phrases containing the English stop consonants /p/ and /b/ in the word-initial position. Voice onset time was measured for each phoneme and statistically analyzed. Mixed-ANOVAs revealed significantly longer voice onset time durations during speech for /p/ as compared to sung productions. No significant differences between the trained singers and untrained singers were observed. In addition, no task differences occurred for the /b/ productions. The results indicated that the type of phonatory task influences VOT for voiceless stops in females. LEARNING OUTCOMES: As a result of this activity, the reader will be able to (1) understand articulatory and phonatory differences between spoken and sung productions; (2) understand the articulatory and phonatory timing differences between trained singers and untrained singers during spoken and sung productions.