Association between birth control pills and voice quality

OBJECTIVES/HYPOTHESIS: The objective was to extend our knowledge of the effect of birth control pills on voice quality in women based on various acoustic measures. STUDY DESIGN: A longitudinal comparative study of 14 healthy young women over a 36- to 45-day period. METHODS: Voices of seven women who used birth control pills and seven women who did not were recorded repeatedly approximately 20 times. Voice samples were analyzed acoustically, using an extended set of frequency perturbation parameters (jitter, relative average perturbation, pitch period perturbation quotient), amplitude perturbation parameters (shimmer, amplitude average perturbation quotient), and noise indices (noise-to-harmonics ratio, voice turbulence index). RESULTS: Voice quality and stability were found to be better among the women who used birth control pills. Lower values were found for all acoustic measures with the exception of voice turbulence index. Results also provided preliminary indication for vocal changes associated with the days preceding ovulation. CONCLUSION: In contrast to the traditional view of oral contraceptives as a risk factor for voice quality, and in keeping with the authors' previous work, the data in the present study showed that not only did oral contraceptives have no adverse effect on voice quality but, in effect, most acoustic measures showed improved voice quality among women who used the birth control pill. The differences in the noise indices between groups may also shed light on the nature of the effect of sex hormones on vocal fold activity. It was suggested that hormonal fluctuations may have more of an effect on vocal fold regulation of vibration than on glottal adduction.     

Acoustic discrimination of pathological voice: sustained vowels versus continuous speech.

We investigated the ability of acoustic measures to discriminate between normal and pathological talkers. Two groups of measures were compared: (a) those extracted from sustained vowels and (b) those based on continuous speech samples. Nine acoustic measures, which include fundamental frequency and amplitude perturbation measures, long term average spectral measures, and glottal noise measures were extracted from both sustained vowel and continuous speech samples. Our experiments were performed on a published database of 53 normal talkers and 175 talkers with a pathological voice. The classification performance of the nine acoustic measures was quantified using linear discriminant analysis and receiver operating characteristic (ROC) curve analysis. When individual measures were considered in isolation, classification was more accurate for measures extracted from sustained vowels than for those based on continuous speech samples. Classification accuracy improved when combinations of acoustic parameters were considered. For such combinations of measures, classification results were comparable for measures extracted from continuous speech samples and for those based on sustained vowels.     

Response of the female vocal quality and resonance in professional voice users taking oral contraceptive pills: a multiparameter approach

OBJECTIVE/HYPOTHESIS: The purpose of this study was to analyze the vocal quality and resonance (nasality and nasalance values) during the menstrual cycle in professional voice users using oral contraceptive pills (OCPs). Although professional voice users are more sensitive and aware of their vocal quality, no changes of voice and resonance characteristics were expected because OCPs create a stable hormonal balance throughout the menstrual cycle. STUDY DESIGN: The authors conducted a comparative study of 24 healthy, young professional voice users using OCPs. One assessment was performed between the 10th and 17th day of pill intake, when hormonal levels reached a steady state. The second assessment was performed during the first 3 days of menses, when no pills were taken and hormonal levels were minimized. METHODS: Subjective (perceptual evaluation of voice and nasality) and objective (aerodynamic, voice range, acoustic, Dysphonia Severity Index [DSI], nasometer) assessment techniques were used. RESULTS:: The Mann-Whitney U test showed no significant difference between the perceptual evaluation of the voice and the nasality in the two assessments. The paired Student t test showed no significant difference regarding the maximum phonation time, the vocal performance, the acoustic parameters, and the DSI. CONCLUSIONS: These findings indicate that OCPs do not have an impact on the objective and subjective voice and resonance parameters in young professional voice users. This information is specifically relevant to professional voice users who are more aware of vocal quality changes and ear, nose and throat specialists/voice therapists who treat professional voice users with voice problems/disorders. Further research regarding the impact of increased vocal load during the premenstrual or menstrual phase in professional voice users using OCPs should be considered.     

Validez de las medidas del pico cepstral para la valoración objetiva de la disfonía en sujetos de habla hispana

Introduction and objectivesPerceptual rating of overall voice quality and other more specific perceptual dimensions is difficult, as such judgments depend on the listener's subjectivity. Thus, finding objective, valid, and accessible clinical measures to include in comprehensive voice evaluation protocols is a priority.The purposes of this study were to 1) determine the diagnostic accuracy of a single acoustic measure, smoothed cepstral peak prominence (CPPS), to predict voice disorder status from sustained vowels and connected speech samples using the software Praat; 2) to determine the relationship between measures of CPPS and perceptual ratings of vocal quality; and 3) describe the normative values of CPPS.MethodMeasures of CPPS were obtained from connected speech and sustained vowel recordings of 72 Spanish-speaking subjects with voice disorders and 52 nondysphonic Spanish-speaking subjects with no vocal disorders using freely downloadable Praat software. IBM SPSS Statistics software version 23 was used to complete the statistical analyses.Resultsresults revealed a 70% sensitivity rate, a specificity rate of 85%. Estimated severity for sustained vowels and connected speech were strongly correlated and significantly associated with listener ratings of dysphonia severity.ConclusionsA single acoustic measure of CPPS was highly predictive of voice disorder status using Praat software. Clinicians may consider using CPPS to complement clinical voice evaluation and screening protocols.     

内收型痉挛性发音障碍的语音特征

目的 探讨内收型痉挛性发音障碍的语音特征.方法 采用嗓音和语音的声信号和三维语图分析及主观评价的方法对1O例内收型痉挛性发音障碍患者(女7例,男3例)的语音特征与10例健康志愿者(男5例,女5例)进行对比.结果 内收型痉挛性发音障碍主要表现为音质、音韵及语音的流畅性改变,在朗读文章时出现紧张性发音困难,语音颤抖,频率及响度瞬间起伏,嗓音挤卡、中断,语音延长,失去正常韵律.10例患者中表现为轻度障碍者(异常音节数<25%)1例,中度障碍(异常音节数占25%～49%)6例,重度(异常音节数占50%～74%)1例,极重度(异常音节数≥75%)2例.10例患者朗读时间中位数为49 S,声信号中间断出现无音区,无音比率中位数为42%;而健康对照组朗读时间中位数为30 S,无声音中断.在三维语图中不同的患者在各自症状音节中可以看到嗓音起始时间延长,元音共振峰不规则、断裂甚至消失,症状音节的辅音缺失,或塞擦音的擦音成分延长等.结论 内收型痉挛性发音障碍语音特征为音质、音韵及语音的流畅性改变,在症状音节的三维语图中可以看到相应的元音或辅音音素的特征性改变.     

The Acoustic Voice Quality Index: Toward improved treatment outcomes assessment in voice disorders

Voice practitioners require an objective index of dysphonia severity as a means to reliably track treatment outcomes. To ensure ecological validity however, such a measure should survey both sustained vowels and continuous speech. In an earlier study, a multivariate acoustic model referred to as the Acoustic Voice Quality Index (AVQI), consisting of a weighted combination of 6 time-, frequency- and quefrency-domain metrics, was developed to measure dysphonia severity in both speaking tasks. In the current investigation, the generalizability and clinical utility of the AVQI are evaluated by first assessing its external cross-validity and then determining its sensitivity to change in dysphonia severity following surgical and/or behavioral voice treatment. The results, based upon a new set of normal and disordered voices compared favorably with outcomes reported earlier, indicating acceptable external validity. Furthermore, the AVQI was sensitive to treatment-related changes, validating its role as a potentially robust and objective voice treatment outcomes measure.Learning outcomes: Readers will be able to: (1) explain methodological issues surrounding the development of voice treatment outcomes measures (such as external cross-validity and responsiveness to change), (2) appreciate the relevance of measuring dysphonia severity in both sustained vowels and connected speech, (3) describe the method of obtaining the Acoustic Voice Quality Index (AVQI), (4) appreciate differences among a variety of estimates of diagnostic accuracy, and (5) discuss the AVQI as a clinically valid treatment outcomes measure.     

京剧嗓音的声学分析及音域特征

OBJECTIVE: To get the objective acoustic parameters of the voice of Beijing Opera actors and set a foundation for the training and protection of the special professional voice. METHODS: Seventy-three (age 16-57 years) professional actors and students were asked to produce sustained comfortable vowels /a/ and /i/, and to sing two pieces of songs which were in the category of Xipi and Erhuang respectively. Dr. Speech for windows version 3.0 was used to get the acoustic parameters of the vowels and the songs. RESULTS: F0 of the vowels /a/ and /i/ of different Hangdangs were Chou (272.6 +/- 42.0) Hz (mean +/- s), (304.2 +/- 22.1) Hz; Xiaosheng (499.3 +/- 34.0) Hz, (485.4 +/- 18.7) Hz; Laosheng (335.6 +/- 60.0) Hz, (317.9 +/- 45.1) Hz; Hualian (319.0 +/- 61.3) Hz, (340.1 +/- 68.8) Hz; Laodan (427.6 +/- 47.2) Hz, (437.7 +/- 45.8) Hz; Huadan (535.8 +/- 48.8) Hz, (561.6 +/- 29.2) Hz; Qingyi (548.0 +/- 69.5) Hz, (543.5 +/- 79.3) Hz; these and other acoustic parameters of vowels such as Jitter, Shimmer and NNE were all within the normal range given by the software. The vocal range of Beijing Opera actors was from 1.7 to 2.8 oct, and most of the highest and the lowest pitches were higher than that of tenor or soprano. CONCLUSIONS: These findings may help to provide insight regarding the acoustic characteristics of the voice of Beijing Opera actors.     

金嗓散结丸治疗声带小结的疗效观察

目的探讨口服中成药（金嗓散结丸）治疗声带小结患者的动态喉镜及嗓音声学分析指标变化。方法采用Xion动态喉镜及嗓音声学分析软件对48例女性声带小结患者治疗前1天及治疗后2周、1个月、2个月进行动态喉镜观察及声学分析,同期选取48例动态喉镜检查声带外观及运动均正常的成人女性作为对照组进行对比。结果声带小结患者治疗前基频微扰（jitter）、振幅微扰（shimmer）均高于对照组,嗓音障碍指数（DSI）低于对照组,差异均具有统计学意义（P〈0.01）;治疗2周后动态喉镜观察声带小结无明显缩小,而患者的各项声学参数值与治疗前相比均有一定程度降低,但差异无统计学意义（P〉0.05）;治疗1个月后与治疗前比较,动态喉镜观察声带小结明显缩小甚至消失,各声学参数值差异均有统计学意义（P〈0.05）;且与正常对照组相比,各声学参数值差异仍具有统计学意义（P〈0.05）;治疗2个月后与对照组相比,各声学参数值差异无统计学意义（P〉0.05）。结论中成药治疗声带小结有较好疗效,且安全方便,无不良反应,值得临床推广使用;基频微扰、振幅微扰及DSI声学参数可以作为中成药治疗声带小结疗效评价的客观敏感指标。     

Acoustic and perceptual parameters relating to connected speech are more reliable measures of hoarseness than parameters relating to sustained vowels

This report investigates the correlations between acoustic parameters and the perception of hoarseness by trained listeners. Both sustained vowels and connected speech were examined. Fourteen acoustic parameters from samples of sustained vowels and 2 from connected speech were measured. The results show that jitter, shimmer and cepstral peak prominence (CPP) are correlated with the perception of hoarseness in sustained vowels. CPP is strongly correlated with the perception of hoarseness in connected speech. Some evidence is seen that perception of hoarseness in connected speech is more valid than the perception of hoarseness in sustained vowels. It is concluded that CPP for connected speech is a more valid objective measure of hoarseness than jitter, shimmer or CPP for sustained vowels and that perception of hoarseness may be most accurate in connected speech, rather than isolated vowels.     

Acoustic correlates of pathologic voice types

Listeners classified 49 samples of vowels /a/ and /i/ on the basis of four voice types: hoarse, breathy, strained, and normal. The vowels were analyzed acoustically for mean harmonic/noise differences in four spectral regions, average fundamental frequency, natural logarithm of fundamental frequency, and jitter. Discriminant analysis showed that classifications of voice type were made with 80% accuracy using three acoustic parameters: (a) mean harmonic/noise difference factor (1-3.5 kHz), (b) natural log of fundamental frequency, and (c) vowel type. The significance of these particular acoustic parameters for the perception and classification of voice types is discussed.     

Spectral noise level measurements used to track voice improvement in one patient

In this report we present one example of the utilization of an acoustic measurement to aid in describing voice roughness objectively in a clinical context. Vowel spectral noise level (SNL) and fundamental voice frequency (F₀) measurements were acquired for five sustained vowels produced by one patient having bilateral vocal fold nodules. The measurements were obtained at specific time intervals while the patient underwent voice therapy. Clinically observed changes over the course of therapy included an improvement in perceived voice quality, a general reduction in vowel SNL, and an increase in vowel F₀. These observations were accompanied by visually detected laryngeal tissue changes. The results suggest that acoustic SNL measurements can be employed clinically to verify and support perceptual judgements of voice quality.     

Effects of environmental tobacco smoke on objective measures of voice production.

OBJECTIVE: The effects of passive smoking on the voice and laryngeal structures of 20 female passive smokers and 20 age-matched nonsmokers were examined. METHODS: The voice evaluation consisted of acoustic, aerodynamic, and videostroboscopic analyses. RESULTS: Three passive smokers displayed mild edema or erythema. Passive smokers had higher mean flow rates and shorter mean maximum phonation times during sustained vowels at comfortable, low-, and high-pitch levels. However, means were only outside normal limits and significantly different from nonsmokers at high pitch. Variables such as the number of years and hours per day subjects were exposed to environmental tobacco smoke were considered. CONCLUSION: The majority of the variables indicated that vocal fold structure and function were not adversely altered by exposure to passive smoke. Differences between these results and clinical observations are highlighted.     

Assessing the quality of the speaking voice after therapy of T1 and T2 vocal cord cancers]

All studies which analysed voice quality after T1 and T2 glottic cancer employed sustained vowels for evaluation. Sustained vowels can often be produced more clearly than expected in a severe degree of hoarseness in running speech. In this investigation voice quality was analysed by measuring the signal-to-noise-ratio (SNRc) in running speech. For evaluation these data were correlated to the scores from an auditive evaluation and from a clinical examination of the larynx considering functional parameters. 39 patients were examined after different therapies (primary radiation, chordectomy, frontolateral partial resection). The grading of the three different methods for characterisation of the voice quality correlated well. Therefore the SNRc is presumed to be a valuable additional method to the psychoacoustic voice evaluation. Comparison of voice quality after different therapies provided no significant difference between radiotherapy and chordectomy. The functional results after frontolateral partial resection were significantly less satisfying as expected.     

Changing the vocal characteristics of a postoperative transsexual patient: a longitudinal study

The vocal characteristics of a 63-year-old individual who underwent male-to-female sex reassignment surgery were evaluated. Treatment was designed to alter inappropriate male voice characteristics. Speech goals were to (1) encourage use of successively higher pitch levels, and (2) modify tongue carriage to change resonance. After 11 months of therapy, average fundamental frequency for /i, a, u/ vowels changed from 110 to 205 Hz. Also, second formant frequency values changed remarkably for each of these vowels, with the greatest frequency change being 291 Hz for /i/. These acoustic differences could account for the perception of femininity in her posttreatment voice. Maintenance of these acoustic features was found five years posttreatment.     

Acoustical analysis of Spanish vowels produced by laryngectomized subjects.

The purpose of this study was to describe the acoustic characteristics of Spanish vowels in subjects who had undergone a total laryngectomy and to compare the results with those obtained in a control group of subjects who spoke normally. Our results are discussed in relation to those obtained in previous studies with English-speaking laryngectomized patients. The comparison between English and Spanish, which diFfer widely in the size of their vowel inventories, will help us to determine specific or universal vowel production characteristics in these patients. Our second objective was to relate the acoustic properties of these vowels to the perceptual data obtained in our previous work (J. L. Miralles & T. Cervera, 1995). In that study, results indicated that vowels produced by alaryngeal speakers were well perceived in word context. Vowels were produced in CVCV word context by two groups of patients who had undergone laryngectomy: tracheoesophageal speakers (TES) and esophageal speakers. In addition a control group of normal talkers was included. Audio recordings of 24 Spanish words produced by each speaker were analyzed using CSL (Kay Elemetrics). Results showed that F1, F2, and vowel duration of alaryngeal speakers differ significantly from normal values. In general, laryngectomized patients produce vowels with higher formant frequencies and longer durations than the group of laryngeal subjects. Thus, the data indicate modifications either in the frequency or temporal domain, following the same tendency found in previous studies with English-speaking laryngectomized speakers.     

An initial study of voice characteristics of children using two different sound coding strategies in comparison to normal hearing children

Objective: To compare some perceptual and acoustic characteristics of the voices of children who use the advanced combination encoder (ACE) or fine structure processing (FSP) speech coding strategies, and to investigate whether these characteristics differ from children with normal hearing. Design: Acoustic analysis of the sustained vowel /a/ was performed using the multi-dimensional voice program (MDVP). Analyses of sequential and spontaneous speech were performed using the real time pitch. Perceptual analyses of these samples were performed using visual-analogic scales of pre-selected parameters. Study sample: Seventy-six children from three years to five years and 11 months of age participated. Twenty-eight were users of ACE, 23 were users of FSP, and 25 were children with normal hearing. Results: Although both groups with CI presented with some deviated vocal features, the users of ACE presented with voice quality more like children with normal hearing than the users of FSP. Conclusions: Sound processing of ACE appeared to provide better conditions for auditory monitoring of the voice, and consequently, for better control of the voice production. However, these findings need to be further investigated due to the lack of comparative studies published to understand exactly which attributes of sound processing are responsible for differences in performance.     

正常青少年嗓音的元音发音特性

目的探讨青少年所发元音的声学特性,为临床嗓音测试及评估提供参考标准。方法采集103例8～20岁儿童及青少年分别发/e/、/a：/、/i：/三个元音的嗓音资料,按不同年龄段分组,用praat嗓音分析软件进行语音分析,对取得的数据进行统计学分析。结果男女性从8～11岁开始进入变声期,元音基频随着年龄的增长而呈逐步下降,男性下降速度大于女性。基频值在性别和各年龄段间存在明显差异。各元音的F1/F2、基频微扰、振幅微扰、谐噪比在同一年龄组男女性之间比较无明显差异。结论青少年的嗓音各参数变化范围大,应根据年龄、声样、性别而使用不同的参考值。     

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。     

Acoustic characteristics of different target vowels during the laryngeal telescopy

Objective

The aim of this study was to investigate the acoustic characteristics of target vowels phonated in normal voice persons while performing laryngeal telescopy. The acoustic characteristics are compared to show the extent of possible difference to speculate their impact on phonation function.

Methods

Thirty-four male subjects aged 20–39 years with normal voice were included in this study. The target vowels were /i/ and /?/. Recording of voice samples was done under natural phonation and during laryngeal telescopy. The acoustic analysis included the parameters of fundamental frequency, jitter, shimmer and noise-to-harmonic ratio.

Results

The sound of a target vowel /?/ was perceived identical in more than 90% of the subjects by the examiner and speech language pathologist during the telescopy. Both /i/ and /?/ sounds showed significant difference when compared with the results under natural phonation. There was no significant difference between /i/ and /?/ during the telescopy.

Conclusion

The present study showed that change in target vowels during laryngeal telescopy makes no significant difference in the acoustic characteristics. The results may lead to the speculation that the phonation mechanism was not affected significantly by different vowels during the telescopy. This study may suggest that in the principle of comfortable phonation, introduction of the target vowels /i/ and /?/ is practical.     

Effects of uvulopalatopharyngoplasty with Harmonic Scalpel on speech and voice

The aim of this study was to evaluate changes in acoustic features of speech and voice after uvulopalatopharyngoplasty (UPPP) with the Harmonic Scalpel (HS), using the multidimensional voice program (MDVP) in conjunction with other tests. Before and 6 months after surgery, phonetically balanced sentences and sustained vowels a, e, i were carried out and digitalized with MDVP in all the patients, as an evaluation of nasal resonance (trough the Glatzel and the Gutzmann tests), speech articulation and voice handicap index (VHI). These parameters were estimated: average of fundamental frequency, Jitter, Shimmer, noise-to-harmonics ratio, voice turbulence index, soft phonation index, degree of voiceless, degree of voice breaks and peak amplitude variation. Six months after surgery, improvements in all the acoustic parameters, in nasalance and VHI were achieved. In our experiences UPPP, with the HS, improves speech and voice in patients affected by snoring and/or obstructive sleep apnea syndrome.