Effect of Wendler glottoplasty on voice and quality of life of transgender women

ObjectiveTo investigate the effect of Wendler glottoplasty on voice feminization, voice quality and voice-related quality of life.MethodsProspective interventional cohort of transgender women submitted to Wendler glottoplasty. Acoustic analysis of the voice included assessment of fundamental frequency, maximum phonation time formant frequencies (F1 and F2), frequency range, jitter and shimmer. Voice quality was blindly assessed through GRBAS scale. Voice-related quality of life was measured using the Trans Woman Voice Questionnaire and the self-perceived femininity of the voice.ResultsA total of 7 patients were included. The mean age was 35.4 years, and the mean postoperative follow-up time was 13.7 months. There was a mean increase of 47.9 ± 46.6 Hz (p = 0.023) in sustained/e/F0 and a mean increase of 24.6 ± 27.5 Hz (p = 0.029) in speaking F0 after glottoplasty. There was no statistical significance in the pre- and postoperative comparison of maximum phonation time, formant frequencies, frequency range, jitter, shimmer, and grade, roughness, breathiness, asthenia, and strain scale. Trans Woman Voice Questionnaire decreased following surgery from 98.3 ± 9.2 to 54.1 ± 25.0 (p = 0.007) and mean self-perceived femininity of the voice increased from 2.8 ± 1.8 to 7.7 ± 2.4 (p = 0.008). One patient (14%) presented a postoperative granuloma and there was 1 (14%) premature suture dehiscence.ConclusionGlottoplasty is safe and effective for feminizing the voice of transgender women. There was an increase in fundamental frequency, without aggravating other acoustic parameters or voice quality. Voice-related quality of life improved after surgery.     

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.     

The evaluation of voice in elderly patients

Results of voice analysis in 96 elderly patients are presented. The objective of the study was to evaluate dysphonia and its morphologic conditions. Videolaryngostroboscopic (VLSS) examination distinguished between oedematic and atrophic form of senile dysphonia. Morphologic evaluation of the vocal fold mucosa with the use of light microscopy (LM) and transmission electron microscopy (TEM) confirmed the clinical diagnosis. Evaluation of aerodynamic factors of the larynx function, particularly MPT and VVI, suggested hyperfunctional and hypofunctional modes of the voice formation in patients with the larynx oedema and in patients with atrophic changes, respectively.     

Spectral correlates of glottal voice source waveform characteristics

The relationships between the waveform and the spectrum of the pulsating transglottal airflow during vowel phonation are analyzed in singers and nonsingers. The waveform, called the flow glottogram, is analyzed by means of inverse filtering, and the spectrum is determined either directly, by submitting the flow glottogram to spectrum analysis, or indirectly, by measuring spectral changes accompanying phonatory changes under conditions of constant vowel articulation. The peak-to-peak amplitude of the flow glottogram pulses shows a strong relationship with the amplitude of the source spectrum fundamental and varies considerably during phonation, presumably depending on the degree of glottal ab/adduction. The negative peak amplitude of the differentiated flow glottogram shows a high correlation with the sound pressure level of the vowel.     

Aspects of voice quality quantification

The present work is directed towards providing a complement to the current use of sustained sounds as the basis for the physical measurement of voice quality parameters. For many clinical observations, there is a clear lack of correspondence between the measurement results, for example of shimmer, jitter and harmonic to noise ratio, and the perceived quality of the speaking voice. Our work is motivated by the need to overcome this familiar problem. It has four main objectives: to use running speech as the basis for one set of measurements in the clinical protocol; to link physical measures based on the use of this data with both production and perception; to employ voice production data as the foundation for auditorily significant criteria; the presentation of quantitative comparisons using sustained sound and running speech data, derived for a range of pathological voice conditions, within the same clinical session. Our pilot observations are based on the use of clinical acoustic and laryngographic data from patients of 4 different clinical centres.     

The laryngeal vestibule and voice quality

Most of the literature on voice quality focuses on the vocal folds while six other gestures involving the laryngeal entry and epilaryngeal structures are largely ignored. Whole organ tracer series histograms of the larynx are examined and suggestions are made as to which muscles and/or forces might cause these gestures. An examination of photographs of the larynx indicates that the latter must be described in three dimensions: medio-lateral, antero-posterior, and vestibule cross-sectional area. The article is aimed at laryngologists in general, not surgeons in particular, and has implications for laryngology (being a putative model of diagnostic procedures), physiology (what forces create epilaryngeal configurations?), neuroscience (does the motor cortex control single muscles or whole gestures?), speech pathology (what is the ragbag called "hypertenseness"?), linguistics (how is one to describe lower pharynx phenomena?) and paralinguistics (what is the extrasystemic laryngeal component of voice quality?).     

The laryngeal vestibule and voice quality

Summary Most of the literature on voice quality focuses on the vocal folds while six other gestures involving the laryngeal entry and epilaryngeal structures are largely ignored. Whole organ tracer series histograms of the larynx are examined and suggestions are made as to which muscles and/or forces might cause these gestures. An examination of photographs of the larynx indicates that the latter must be described in three dimensions: (1) medio-lateral, (2) antero-posterior, and (3) vestibule cross-sectional area. The article is aimed at laryngologists in general, not surgeons in particular, and has implications for laryngology (being a putative model of diagnostic procedures), physiology (what forces create epilaryngeal configurations?), neuroscience (does the motor cortex control single muscles or whole gestures?), speech pathology (what is the ragbag called hypertenseness?), linguistics (how is one to describe lower pharynx phenomena?) and paralinguistics (what is the extrasystemic laryngeal component of voice quality?).     

音质障碍测量与治疗的个案研究

目的通过嗓音音质治疗的个案研究,验证音质参数在嗓音测量中的临床评估与监控作用。方法测试者为1名音质障碍患儿,男性,2000年6月出生,采用“喉功能检测仪”对嗓音音质进行实时评估;嗓音治疗为期3个月,每周两次,将音质评估(Jitter,Shimmer,NNE等)贯穿于整个矫治过程中,并采用单一被试法进行统计分析;结果嗓音治疗前后的数据比较发现:Jitter,Shimmer,NNE均存在显著性差异(P<0.05);而嗓音F0无明显差异(P>0.05)。结论①音质评估在嗓音治疗过程中起着非常重要的作用,其中Jitter,Shimmer,NNE被证明是衡量嗓音音质的3个有效参数;②患儿接受的嗓音矫治方法是有效的。     

Listener experience and perception of voice quality

Five speech-language clinicians and 5 naive listeners rated the similarity of pairs of normal and dysphonic voices. Multidimensional scaling was used to determine the voice characteristics that were perceptually important for each voice set and listener group. Solution spaces were compared to determine if clinical experience affects perceptual strategies. Naive and expert listeners attended to different aspects of voice quality when judging the similarity of voices, for both normal and pathological voices. All naive listeners used similar perceptual strategies; however, individual clinicians differed substantially in the parameters they considered important when judging similarity. These differences were large enough to suggest that care must be taken when using data averaged across clinicians, because averaging obscures important aspects of an individual's perceptual behavior.     

食管发音对无喉患者生存质量的影响

目的探讨无喉患者术后躯体康复对生存质量（qualjty of life）的影响。方法对49例喉全切除术后进行食管发音训练成功的患者，分别在训练前和食管发音后3个月，用头颈肿瘤行为状态量表（performance status scale for head and neck cancer patients，PSS—HN），癌症治疗功能评估调查问卷（functional assessment of cancer therapy-head and neck，FACT—H＆N）进行生存质量评估。结果喉全切除严重影响患者的生存质量，在食管发音训练前PSS—HN量表和FACT—H＆N问卷的评分为131．4和90．6分，均低于标准（分别300分和144分），差异有统计学意义（t值分别为53．673、67．44，P值均〈0．001）。在运用食管发音后PSS—HN量表、FACT—H＆N问卷的评分均比训练前提高，分别为240．4和103．7分，与训练前比较差异有统计学意义（t值分别为18．209、21．389，P值均〈0．001）。结论无喉患者可以通过术后躯体的康复及食管发音训练来提高其生存质量。     

Outcome measurements and quality of life in voice disorders

Although outcome research in the area of voice is truly in its beginning stages, the clinician who treats voice disorders should be aware of its potential usefulness. It is possible to identify a patient's perception of severity using one of several voice-specific outcome measures. Using these measures may also direct treatment in a more specific manner. For example, although a patient may have a vocal fold polyp or cyst, a low Voice Handicap Index may indicate that immediate surgery is unnecessary. A more conservative treatment approach or observation only may be appropriate. In this way, medical resources and time can be used most appropriately. Certainly one must never compromise treatment when significant disease is suspected. In the absence of significant disease, however, the patient's perceived severity and need to recover vocal function may determine treatment.     

Individual differences in voice quality perception.

Sixteen listeners (10 expert, 6 naive) judged the dissimilarity of pairs of voices drawn from pathological and normal populations. Separate nonmetric multidimensional scaling solutions were calculated for each listener and voice set. The correlations between individual listeners' dissimilarity ratings were low. However, scaling solutions indicated that each subject judged the voices in a reliable, meaningful way. Listeners differed more from one another in their judgments of the pathological voices (which varied widely on a number of acoustic parameters) than they did for the normal voices (which formed a much more homogeneous set acoustically). The acoustic features listeners used to judge dissimilarity were predictable from the characteristics of the stimulus sets: only parameters that showed substantial variability were perceptually salient across listeners. These results are consistent with prototype models of voice perception. They suggest that traditional means of assessing listener reliability in voice perception tasks may not be appropriate, and highlight the importance of using explicit comparisons between stimuli when studying voice quality perception.     

An evaluation of residue features as correlates of voice disorders

Two experiments were conducted to assess the correlations of residue features with some perceptual properties of voice disorders. First, 90 samples of the vowel /a/ produced by patients with various vocal pathologies were analyzed to obtain the residue features, and severity judgments of these vowel samples were obtained. The results of linear multiple regression analysis indicated that the features were highly correlated with the severity ratings. Second, an attempt was made to correlate the residue features with voice qualities. The features were calculated for the vowel /a/ produced by patients with vocal nodules, vocal fold paralysis, and vocal polyps and by normal talkers. Each vowel sample was rated on ten scales of voice quality. The results revealed high correlations among the quality scales so that discrete subject groups could not be formed. Thus, residue features may be useful in assessing the degree of vocal impairment, but their use as correlates of voice quality must await further research.     

年龄和性别因素对老年嗓音的影响

目的:探讨年龄及性别因素对正常嗓音造成的影响,为病理嗓音的诊断与疗效评估奠定基础。方法:随机选择18~40岁、60~90岁两年龄段的男、女性各33例,采用"喉功能检测仪"和"电声门图仪"进行嗓音声学测试,测试的嗓音参数主要包括:基频(F0)、基频微扰(Jitter)、振幅微扰(Shimmer)、噪声能量(NNE)、声门接触率(CQ),获得的数据采用SPSS13.0进行统计分析。结果:年龄与性别因素均对嗓音造成显著性影响,而且年龄与性别存在交互作用。其中对年龄或性别因素敏感的声学参数是F0、Jitter、NNE和CQ。结论:老年嗓音随着年龄增长存在特征性的改变,老年男女性的嗓音也存在不同的改变特征,老化嗓音通过发声训练可以得到改进。     

老年期嗓音的生理特征及保健

老年期全身各器官系统发生退行性变化,可影响发声器官的组织结构及生理功能,引起嗓音衰老。该文概述了老年人喉部组织结构、声门外观形态及嗓音生理特征的改变,并阐明老年期嗓音保健的相关措施,有助于区别老年期喉生理性与病理性改变,进行适当合理的老年嗓音功能保护,从而提高老年人群的生活质量。