Quantitative evaluation of the voice range profile in patients with voice disorder

In 1953, Calvet first displayed the fundamental frequency (pitch) and sound pressure level (intensity) of a voice on a two-dimensional plane and created a voice range profile. This profile has been used to evaluate clinically various vocal disorders, although such evaluations to date have been subjective without quantitative assessment. In the present study, a quantitative system was developed to evaluate the voice range profile utilizing a personal computer. The area of the voice range profile was defined as the voice volume. This volume was analyzed in 137 males and 175 females who were treated for various dysphonias at Kyushu University between 1984 and 1990. Ten normal subjects served as controls. The voice volume in cases with voice disorders significantly decreased irrespective of the disease and sex. Furthermore, cases having better improvement after treatment showed a tendency for the voice volume to increase. These findings illustrated the voice volume as a useful clinical test for evaluating voice control in cases with vocal disorders.     

Acoustic interpretation of the voice range profile (phonetogram).

The voice range profile (VRP) is a display of vocal intensity range versus fundamental frequency (F0). Past measurements have shown that the intensity range is reduced at the extremes of the F0 range, that there is a gradual upward tilt of the high- and low-intensity boundaries with increasing F0, and that a ripple exists at the boundaries. The intensity ripple, which results from tuning of source harmonics to the formants, is more noticeable at the upper boundary than the lower boundary because higher harmonics are not energized as effectively near phonation threshold as at maximum lung pressure. The gradual tilt of the intensity boundaries results from more effective transmission and radiation of acoustic energy at higher fundamental frequencies. This depends on the spectral distribution of the source power, however, At low F0, a smaller spectral slope (more harmonic energy) produces greater intensity. At high F0, on the other hand, a shift of energy toward the fundamental results in greater intensity. This dependence of intensity on spectral distribution of source power seems to explain the reduced intensity range at higher F0. An unrelated problem of reduced intensity range at low F0 stems from the inherent difficulty of keeping F0 from rising when subglottal pressure is increased.     

Effects of age,sex, and disorder on voice range profile characteristics of 230 children

In this study, the effect of age, sex, and disorder on the vocal performance of 230 children 6 to 11 years of age was investigated by means of the voice range profile (VRP). Ninety-four control children and 136 children with disorders were studied. The VRPs were quantitatively described by frequency and intensity characteristics, as well as by morphological characteristics. Significant differences between healthy children and children with disorders were found. Age has a different effect in girls than in boys regarding vocal performance. Most of the characteristics for the healthy girls change gradually over the period from 6 to 11 years. For the healthy boys, however, two age groups can be identified: one below and one above 8 years of age. It is hypothesized that the androgen dehydroepiandrosterone (DHEA) and its sulfate may play a role in this phenomenon.     

嗓音训练治疗声门闭合不全所致功能性嗓音障碍的疗效分析

目的探讨嗓音训练对声门闭合不全的功能性嗓音障碍患者的疗效。方法对24例声门闭合不全的功能性嗓音障碍患者进行8周的嗓音训练,训练内容包括健康宣教、肌肉放松、喉部按摩、暖嗓、呼吸训练、嗓音训练和共鸣训练,训练前后对患者进行电子喉镜检查、GRBAS评估、嗓音障碍指数量表（VHI）评估、计算机嗓音声学分析,比较训练前后评估结果。结果24例患者训练后电子喉镜检查16例患者声门闭合良好（66.67%,16/24）,6例声门裂隙变小（25.00%,6/24）,2例声门裂隙无明显变化（8.33%,2/24）;GRBAS评分中总嘶哑度G(0.61±0.66)明显低于训练前(1.91±0.87)（P<0.05）,粗糙声Ｒ(0.51±0.58)明显低于训练前(1.41±0.52)（P<0.05）;VHI评分总分(29.21±21.02)分明显低于训练前的(52.35±23.45)分（P<0.05）;计算机嗓音声学分析最长发声时间（15.24±3.64）s比训练前（9.02±3.45）s明显延长（P<0.05）,基频微扰、最高基频、最低音强、嗓音障碍严重指数训练后分别为（0.21±0.08）%、（420.11±44.21）Hz、（54.21±3.20）dB、（1.62±0.82）比训练前的（0.92±0.12）%、（375.21±49.21）Hz、（56.81±3.42）dB、（0.21±1.02）有改善（P<0.05）。结论嗓音训练能改善声门闭合不全的功能性嗓音障碍患者的声门闭合及嗓音质量。     

Videolaryngostroboscopy and voice evaluation in patients with rheumatoid arthritis

Arthritis may affect the larynx and produce symptoms such as hoarseness and vocal fatigue.ObjectiveThis paper aimed to evaluate the laryngeal manifestations of rheumatoid arthritis.MethodsThis is prospective study assessed 27 patients with rheumatoid arthritis with the aid of videolaryngostroboscopy, auditory-perceptual analysis of the speech using the GIRBAS scale, acoustic analysis and the Voice Handicap Index questionnaire.ResultsNineteen patients had laryngeal complaints, the main ones being intermittent dysphonia and sensation of a foreign body in the throat. The most frequent laryngoscopical finding was overlapping arytenoids. Three patients had low pitch, nine patients had mild dysphonia and roughness. Median acoustic measures were: F0, 198.39 Hz; Jitter, 0.815; Shimmer, 4.915; and NHR, 0.144. Regarding the Voice Handicap Index, the median score was zero in all domains. There was a statistically significant correlation between voice complaints and the domains of this index. Functional classes were significantly correlated to: overlapping arytenoids (p = 0.001), PPQ (p = 0.0257), Shimmer (p = 0.0295), APQ (p = 0.0195), and the VHI physical (p = 0.0227) and total domains (p = 0.0425).ConclusionLaryngeal complaints were reported by 70.4% of the patients and laryngoscopical alterations were observed in 48% of the subjects. Voice acoustic evaluation and self-perception were altered.     

Electromyographic biofeedback training with patients exhibiting a hyperfunctional voice disorder

Baseline EMG measures of general laryngeal area muscle tension while speaking and during silence were taken from a group of 21 normal subjects and 7 subjects diagnosed through indirect laryngoscopy as having vocal nodules. In an attempt to reduce their baseline scores, the vocal nodule patients underwent 8 EMG biofeedback training sessions followed by a 2-week follow-up session. Sophisticated listeners then judged the qualities of the voices produced during the baseline and follow-up sessions. Measures of sound pressure levels for the speech samples were also taken to determine their effects on EMG scores. Results of the statistical analyses revealed that significant differences in general laryngeal area muscle tension while speaking and in silence exist between normal and pathological subjects; and that subjects with vocal nodules could significantly reduce these tension levels with EMG biofeedback training. A positive correlation was then found between the EMG measures and the judgments of voice qualities. No correlations were found between EMG measures and sound pressure levels.     

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.     

Approach to the patient with a voice disorder.

The author's approach to patients with voice disorders emphasizes the value of a multidisciplinary voice team, including an otolaryngologist, a speech pathologist, and a neurologist.     

Quantitative videofluoroscopy: a new evaluation tool for tracheoesophageal voice production

OBJECTIVE: To develop a quantitative videofluoroscopy protocol using well-defined visual parameters and quantitative measures for the evaluation of anatomical and morphologic characteristics of the neoglottis in relation to perceptual evaluation of tracheoesophageal voice quality. DESIGN: A patient survey. SETTING: The Netherlands Cancer Institute, Amsterdam. PATIENTS: Thirty-nine individuals with laryngectomies, 30 with standard total laryngectomy and 9 with a partial or total pharynx reconstruction. INTERVENTIONS: Videofluoroscopy, speech recordings. MAIN OUTCOME MEASURES: Well-defined visual parameters and quantitative measures based on videofluoroscopy images should improve the evaluation of neoglottic characteristics in relation to voice quality. RESULTS: Quantitative measures were significantly related to visual assessment outcomes. Tonicity (P=.02) and presence of a neoglottic bar during phonation (P=.03) were significantly related to voice quality, as were several quantitative measures, especially the minimal distance between the neoglottic bar and anterior esophageal wall at rest (P<.001) and during phonation (P=.02), and the index for the relative increase of the maximal subneoglottic distance from rest to phonation (P=.01). CONCLUSIONS: This new quantitative videofluoroscopy protocol is a useful tool for the study of the anatomy and morphology of the neoglottis. With this protocol, characteristics relevant to tracheoesophageal voice quality can be defined. The quantitative measures are promising for a more standardized evaluation of the neoglottis in individuals who have undergone laryngectomy.     

儿童复发性呼吸道乳头状瘤病肿瘤范围的量化评估

目的:探讨儿童复发性呼吸道乳头状瘤病(JO-RRP)肿瘤范围的量化评估方法的临床应用。方法:根据肿瘤范围大小分为3级分值(1分,2分及3分),评估68例JO-RRP患儿共238次手术,内镜下观察患儿22个呼吸和消化道的解剖亚区的肿瘤范围,计算积分;量化反映JO-RRP的分布特点及病情演变。结果:本组患儿肿瘤范围的积分在2~20分,7~14分占64.3%。全部患儿均有喉部受累,其中声带和室带是最常见的受累部位,鼻、咽、硬腭、气管、支气管、双肺和食管等受累较少见;随着手术治疗次数增多,肿瘤范围积分有下降趋势,与JO-RRP的临床特点相符。结论:以肿瘤范围为依据的量化评估法客观准确地反映了JO-RRP病变程度和临床疗效,是个科学而方便的方法,临床应用价值高,值得推广。     

Quantitative evaluation of thermosensitivity in patients with mandibular fractures]

AIM: The temperature and pain thresholds of 30 patients with mandibular fractures were evaluated with a specially developed measuring device in a prospective study to examine neurosensory disturbances of the inferior alveolar nerve (IAN). PATIENTS AND METHODS: Measurements in 30 patients with 45 mandibular fractures were done before, immediately after, and over the course of half a year after operation. Outcomes of the thermosensitivity measurement (TSM) were compared to the results of the two point discrimination (2-PD) test, sharp/blunt test (SBT), and questioning the patients about their subjective feelings (SF). RESULTS: Post-traumatically, neurosensory testing revealed up to 2.8 degrees C (mean) increased thresholds as compared with the intact side. By contrast, post operative diagnostics clearly revealed up to 8.1 degrees C (mean) increased thresholds. Compared with the clinical sensory tests, the post-therapeutic (3-6 months postoperative) measurements with the TSM device proved a resensitization and threshold decrease by up to 3 degrees C. We found more exact and reproducible results of the TSM in comparison to those of the 2-PD and SBT for the evaluation of sensory disturbances of the IAN. Close agreements between the results of the TSM and the SF could be detected. CONCLUSION: Because of its sensitivity and accuracy in the quantitative detection of temperature and pain thresholds, the TSM is particularly suitable for evaluating neurosensory deficits and monitoring their progression.     

喉癌与声带息肉患者嗓音的计算机定量评估

目的比较喉癌及声带息肉患者主要嗓音参数在不同检测方法中的变化,探讨喉癌与声带息肉对发声功能的影响。方法采用Dr．SpeechScienceforWindows（4．0）软件对正常成人、喉癌患者、声带息肉患者作嗓音声学分析和电声门图检测,并比较其主要参数的变化,分析各自嗓音质量评估的特点。结果①在喉癌和声带息肉患者中,两种嗓音检测方法的嗓音参数,基频微扰、振幅微扰、声门噪声能量均是有价值的,两者的基频微扰、振幅微扰、声门噪声能量可以互相替代,两种方法各参数间比较无统计学差异;②正常成人、喉癌患者、声带息肉患者平均基频之间无统计学意义,基频微扰、振幅微扰、声门噪声能量数值由低到高排列依次为正常成人组、声带息肉组、喉癌组,两两比较均有显著性差异（P〈O.05）;③嗓音质量由好到差排列为正常成人组、声带息肉组、喉癌组。结论计算机声学分析的各项参数可作为嗓音定量评价的客观指标,判断嗓音损害程度。     

Quantitative detection of substitute voice generator during phonation in patients undergoing laryngectomy

OBJECTIVE: To evaluate the vibration pattern of the substitute voice generator of patients who have undergone laryngectomy. For automatic quantification of the oscillations of the pharyngoesophageal (PE) segments, image processing of digital high-speed video sequences is applied. DESIGN: Physiologic analysis. SETTING: An acute care hospital. PATIENTS: Endoscopic recordings were taken of 10 men who underwent laryngectomy (mean +/- SD age, 61.5 +/- 5.2 years) during sustained phonation of a vowel using a 90 degree endoscope coupled to a high-speed camera. MAIN OUTCOME MEASURES: An image-processing algorithm was developed to automatically define the pseudoglottis in each recording and track its movements. RESULTS: The clinical assessment of the high-speed technique for the endoscopic examination of the substitute voice generator yields the following results. The forms and oscillation characteristics of the pseudoglottides varied considerably: 3 pseudoglottides were circular, 6 were split shaped, and 1 was triangle shaped. A quasi-periodic opening and closing were observed and automatically detected by the described algorithm in each recording independently from quality of the recording and from morphologic and oscillation characteristics of the PE segment. The frequencies of the extracted oscillations of the pseudoglottides correspond to the structure of the acoustic signals. CONCLUSIONS: Automatic image processing of PE segments derived from high-speed endoscopic recordings enables the detection and quantification of the substitute voice generator's oscillations in high temporal resolution. These data directly prove that the detected pseudoglottis is the source of the substitute voice. Close relations between substitute voice and functional properties of the PE segment exist. In the future, these data will be interpreted by applying biomechanical models of the PE segment. Presumably, results may help to optimize surgical and adaptive procedures for specific substitute voice restoration.     

Clinical profile of hoarseness of voice

A study comprising of 110 cases of hoarseness was carried out in the department of otolaryngology—HNS, M.G.I.M.S., Sewagram between Jan. 1998 and Sept. 1999. Age of patients ranged between 6 to 71 years. Male to female ratio was 2∶1. Labourers constituted the single largest group of patients (36.36%). Rural to urban ratio was 3∶1. Duration of hoarseness ranged from 1 day to 5 years. Acute laryngitis was the commonest cause of hoarseness.     

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。     

Acoustic evaluation of voice in children with cleft palate

The study presents some problems related to objective methods of evaluation of nasalization due to a cleft palate. A group of 30 children 3-11 years old were referred for evaluation of nasalization through acoustics. The primary factor of children speech disability with cleft palate is velopharyngeal valving malfunction which results in hypernasal voice quality. The hypernasality is one of the most important features of cleft palate speech and its objective evaluation after surgical operation is recommended to assessment of velopharyngeal insufficiency and therapy efficiency prognosis. Some problems in clinical application of acoustical methods of speech nasality evaluation are discussed.     

Development and validation of the protocol for the evaluation of voice in patients with hearing impairment (PEV-SHI)

IntroductionThe voice of individuals with hearing impairment has been widely described, and can be compromised in all levels of the phonatory system.ObjectiveTo develop and validate an instrument for evaluating the voice of this population.MethodsThe instrument underwent the validation steps suggested by the Scientific Advisory Committee of the Medical Outcomes Trust. The study sample consisted of seventy-eight Brazilian people with cochlear implants (experimental group) and 78 individuals with normal hearing (control group), divided in groups by age range — children from 3 to 5 years; children from 6 to 10 years and adults from 18 to 46 years. The study sample participated in a voice recording of the sustained vowel /a/, connected speech and spontaneous conversation, in which three voice specialists rated using the proposed instrument. It consists of visual-analog scales of suprasegmental aspects, respiratory-phonatory coordination, resonance, phonation, additional parameters and general vocal perception.ResultsEvaluation by an expert committee and a pilot test established content validity. Reliability measures showed excellent test-retest reproducibility for the majority of the parameters. Analysis with the ROC curve showed that perceptual evaluation with the sustained vowel did not strongly differentiate individuals with cochlear implants from those with normal hearing, and the parameter “speech rate” did not differentiate the groups at all. For the connected speech and spontaneous conversation, the majority of the parameters differentiated the experimental group from the control group with an area under the curve ≥0.7. The cutoff values with maximum specificity and sensitivity were 30.5 for mild, 49.0 for moderate and 69.5 for intense deviation.ConclusionsThe protocol for the evaluation of voice in subjects with hearing impairment, PEV-SHI, is a reliable and useful tool for assessing the particularities of the voice of individuals with hearing impairment treated with cochlear implants and can be used in research and clinical settings to standardize evaluation and facilitate information exchange among services.