Journal of Voice最新文献

Objective: The aim of this study was to compare the voice characteristics of obese and non-obese individuals using auditory-perceptual evaluation, self-assessment tools, traditional acoustic parameters, and multiparametric acoustic measures, and to examine the relationship between body mass index (BMI) and voice parameters in individuals with obesity (IwO).

Material and methods: This prospective cross-sectional comparative study included 86 participants (43 obese, 43 non-obese). Assessments comprised maximum phonation time (MPT), auditory-perceptual evaluation with the Grade, Roughness, Breathiness, Asthenia, and Strain (GRBAS) scale, acoustic analysis including fundamental frequency (F0), jitter, shimmer, harmonics-to-noise ratio (HNR), acoustic voice quality index (AVQI), acoustic breathiness index (ABI), and dysphonia severity index (DSI) using PRAAT software, as well as self-assessment tools including the voice-related quality of life (V-RQOL) scale and the vocal fatigue index (VFI).

Results: IwO showed significantly shorter MPT and lower HNR, as well as higher AVQI and ABI scores and lower DSI values compared with non-obese individuals (P < 0.005). In the study group, V-RQOL scores were lower, and VFI scores were higher (P < 0.001). GRBAS ratings revealed higher scores for GRBS in IwO (P < 0.05). In addition, BMI demonstrated moderate and significant correlations with several parameters, including GRB, MPT, F0, AVQI, ABI, DSI, V-RQOL, and VFI (P < 0.05).

Conclusions: Voice was adversely affected in IwO, and correlations with BMI showed that increasing obesity severity was linked to greater deterioration in voice parameters. Using multiparametric acoustic tools alongside traditional measures may enable a more comprehensive evaluation in this population.

Objective: The purpose of this scoping review was to determine the inclusion and exclusion criteria typically used for human participants when conducting occupational vocal function research.

Methods: A scoping review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines searching PubMed/MEDLINE (Ovid), APA PsychInfo, and Web of Science with a cover period between January 1, 2018 and September 15, 2023. Studies performed on human participants and published in English were included in this study. In addition, studies were required to use human participants (all ages and sexes) who were occupational voice users. Articles using the following study designs were included: experimental (randomized controlled trials, quasi-experimental) and nonexperimental (observational, cross-sectional). Review articles, case reports, editorials, meta-analysis, and opinion pieces were excluded from review, as well as studies that included participants with head and neck cancer.

Results: A total of 71 studies were included in this scoping review. Data extraction and analysis revealed that variables of sex and vocal health were consistently accounted for in research; however, inclusion/exclusion variables such as gender, hydration, and medication use were rarely included.

Conclusion: This scoping review highlights the need to consider more expansive inclusion/exclusion criteria as relates to factors that could impact objective measures of vocal function. Moreover, developing consistent inclusion and exclusion criteria across studies may help clinicians generalize findings to clinical populations.

Objectives: Altered respiratory kinematics are thought to contribute to primary muscle tension dysphonia (pMTD) symptoms such as vocal effort, fatigue, and discomfort. Although speech-language pathologists (SLPs) often comment on respiratory patterns during voice evaluations, it remains unclear which visual-perceptual cues they rely on for clinical decision-making and how accurate these patterns are for identifying patients with pMTD. As such, this study aimed to (1) identify the respiratory patterns SLPs perceive in pMTD and (2) evaluate their diagnostic accuracy in distinguishing pMTD from vocally healthy controls.

Methods: Forty-six participants (21 pMTD, 25 controls) performed voice tasks varying in intensity and articulatory complexity, while six synchronized cameras captured perilaryngeal-respiratory movements. Five blinded, fellowship-trained SLPs rated breathing normality, severity (0-10), presence of pMTD (Y/N), and confidence (0-10). Open-ended responses were analyzed using natural language processing (NLP) and reflexive content analysis (RCA).

Results: NLP analysis identified five visual-perceptual respiratory features: abdominal, anterior neck tension, clavicular, thoracic, and suboptimal breathing-none of which reliably distinguished pMTD from vocally healthy controls (average diagnostic accuracy = 60%; d' ≤ 1.04). RCA methods yielded three categories: Observable Features of Movement and Breathing, Perceived Patient Experiences, and Interpreting and Evaluating Data.

Conclusion: Observable respiratory patterns were inconsistently linked to diagnostic accuracy. Visual observation alone appears insufficient for reliably identifying pMTD, underscoring the need for multimodal physiological approaches to improve diagnostic specificity.

While binary discrimination between healthy and pathological voices provides initial screening capability, clinical utility requires accurate multi-class classification to distinguish between different pathology types. This paper presents a novel Auditory Feature Extraction (AFE) approach, inspired by auditory perception mechanisms, for a robust multi-class pathological voice recognition (PVR) system. The proposed approach uses a Gammachirp FilterBank (GCFB) to accurately simulate the spectral behavior of the cochlea. This FilterBank is considered an efficient auditory filter model and contains 128 Gammachirp auditory filters with center frequencies equally distributed according to the Equivalent Rectangular Bandwidth-rate scale. The GCFB output undergoes decimation, cubic-root amplitude compression, and then Discrete Cosine Transform to finally generate the AFE coefficients. We evaluated the performance of the proposed AFE approach for PVR using Hidden Markov Model Toolkit on two widely recognized datasets: the Saarbruecken Voice Database (SVD) and the Massachusetts Eye and Ear Infirmary (MEEI) dataset. Our AFE outperforms state-of-the-art approaches as revealed by assessment results compared to Human Factor Cepstral Coefficients (HFCC), Frequency Domain Linear Prediction (FDLP), and Mel-Frequency Cepstral Coefficients (MFCC). AFE approach achieves 99.75% balanced accuracy in binary voice classification (95.6%, 94.8%, and 93.85% for HFCC, FDLP, and MFCC, respectively) and 94.38% balanced accuracy in multi-class pathologic voice classification (72.93%, 69.66%, and 60.03% for HFCC, FDLP, and MFCC, respectively) on the SVD dataset, while accomplishing 100% balanced accuracy on the MEEI database. These findings suggest the AFE approach provides a robust and highly discriminative feature set that could lead to an improved voice pathology classification, then a better clinical screening of voice disorders.

Background: Transmasculine patients generally benefit from medical treatment using hormonal therapy for their transition process. However, up to 20% of transgender men report dissatisfaction with their voice pitch after hormonal therapy. Voice therapy is usually the next appropriate step. Surgical and procedural interventions are a last resort when the pitch remains too elevated for transmasculine patients; however, their effectiveness for voice masculinization is not well characterized.

Objectives: To review surgical and procedural options for voice masculinization in the literature.

Methods: Two independent reviewers completed a scoping review of literature studying surgical and procedural interventions for voice masculinization. Because of the limited studies available, databases were also searched for surgical and procedural outcomes for puberphonia. Initial fundamental frequency, initial nonprocedural treatment, clinical symptoms, intervention, outcomes, and complications were gathered from included studies.

Results: The search for surgical and procedural interventions for voice masculinization yielded 34 articles, and 4 articles were included in the study. Regarding puberphonia, 21 articles were screened, and 8 articles were included in the study. Surgical and procedural treatments for voice masculinization included type III laryngoplasty (3 articles) and direct vocal fold injection with testosterone (1 article). For the 12 transmasculine patients, voice deepening ranged from -3 to -67 Hz with an average of -43.75 Hz. Additional treatments described for puberphonia included modifications in the type III laryngoplasty, injection laryngoplasty, and Botox injection. Voice deepening for the 44 puberphonia patients ranged from -12.25 to -175 Hz with an average of -68.61 Hz. Only 6 of the 56 puberphonia patients had complications, all of which were transient.

Conclusion: Conservative measures often succeed in achieving voice masculinization. Our review describes the best results in voice deepening with type III laryngoplasty. Although less effective at voice deepening, less invasive methods like injection laryngoplasty with testosterone or hyaluronic acid also appear promising.

Objective: Human voice arises from the glottal source being shaped and modified by the resonances of the vocal tract (VT). Reconstructing this interaction from mummified or surgically altered anatomy poses a significant challenge. In this study, we aimed to recreate the phonatory potential of King Henri IV of France (1553-1610) through a functional three-dimensional (3D) reconstruction of his preserved head and neck, providing insights into vowel production in altered vocal anatomy.

Methods: The embalmed head and neck of King Henri IV provided a unique opportunity to model historical phonation. Using high-resolution computed tomography imaging, all craniofacial and cervical structures were manually segmented in ITK-SNAP 4.0 by two independent operators following validated protocols. Mesh refinement was performed in Mesh Mixer® without altering anatomical integrity. Digital reconstruction and anatomical repositioning (including mandibular closure, vertebral alignment, and articulation correction) were achieved in Fusion 360® and reviewed by a multidisciplinary panel. Acoustic simulations were conducted on both digital and 3D-printed models to assess vowel-like sound production.

Results: The physical reconstruction of King Henri IV's head and VT enabled the generation of distinct vowel-like sounds. Initial digital simulations produced vowels comparable to /u/ (F1 = 446 Hz, F2 = 1055 Hz, F3 = 2360 Hz), /a/ (F1 = 582 Hz, F2 = 1556 Hz, F3 = 2557 Hz), /i/ (F1 = 340 Hz, F2 = 2144 Hz, F3 = 2841 Hz), and /œ/ (F1 = 540 Hz, F2 = 1530 Hz, F3 = 2545). The 3D-printed model reproduced /a/ (F1 = 588 Hz, F2 = 1109 Hz, F3 = 2585 Hz) and /u/ (F1 = 427 Hz, F2 = 880 Hz, F3 = 2452 Hz) with realistic resonance patterns producing a comparative vowel chart.

Conclusion: This study demonstrates that combining advanced imaging, digital modeling, and 3D printing can restore plausible phonatory behavior from preserved or altered anatomy. Such interdisciplinary methodology has potential translational applications in phonatory modeling, surgical voice rehabilitation, and laryngeal function research.

Objective: To review the current literature linking laryngopharyngeal reflux disease (LPRD) with microbiome impairments.

Methods: Two independent investigators conducted a systematic literature search for studies reporting microbiome findings in LPRD patients through PubMed, Scopus, and Cochrane Library databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and the Population, Intervention, Comparison, Outcome, Timing, and Setting (PICOTS) framework were followed. A methodological bias analysis was conducted with the Tool to Assess the Risk of Bias in Cohort Studies.

Results: Of the 585 identified papers, eight studies met the inclusion criteria, including 245 patients with suspected or confirmed LPRD. Two studies using objective diagnostic approaches confirmed that LPRD is associated with significantly reduced alpha and beta diversities compared to controls. Streptococcus and Actinomyces emerged as key taxa consistently differentiating LPRD patients from controls across multiple studies. However, significant methodological heterogeneity was observed in LPRD diagnosis, microbiome assessment methods, and control group definitions.

Conclusion: Preliminary literature suggests that patients with suspected or confirmed LPRD exhibit salivary microbiome alterations characterized by reduced diversity and selective microbial shifts. Future high-quality methodological studies are needed to elucidate the mechanistic relationship and clinical consequences of LPRD-related dysbiosis.

Objective: Traditional Iranian singing involves demanding vocal techniques that increase the risk of muscle tension dysphonia (MTD). This study compared the immediate effects of Semi-Occluded Vocal Tract (SOVT) exercises and Vocal Facilitating Techniques (VFTs) on the vocal function of traditional Iranian singers diagnosed with MTD.

Study design: Single-session randomized clinical trial.

Method: Twenty-six Persian-speaking singers with MTD (mean age = 32.31 ± 5.51 years) were randomly assigned to SOVT (n = 13) or VFT (n = 13) groups. Each participant completed a single 1-hour intervention session including four techniques. Acoustic measures included the Acoustic Voice Quality Index (AVQI) and Acoustic Breathiness Index (ABI), and auditory-perceptual evaluation used the Persian version of the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V). Pre- and post-intervention data were compared using mixed-design repeated-measures ANOVA.

Results: Both groups demonstrated significant improvements in AVQI, ABI, and overall dysphonia severity after intervention (P < 0.05). Between-group comparisons revealed that the SOVT group achieved significantly greater reductions in ABI (P < 0.001), indicating superior improvement in breathiness, while changes in AVQI and dysphonia severity did not differ significantly between groups.

Conclusion: Both SOVT and VFT approaches led to immediate improvements in vocal quality among traditional Iranian singers with MTD. While SOVT exercises showed a greater reduction in breathiness, both methods were effective overall. These findings support the clinical utility of both techniques and highlight the potential of SOVT for addressing breathiness. Further research is needed to explore long-term outcomes and integrated treatment strategies tailored to professional voice users.

Objectives: To quantify characteristics of laryngeal electromyography with the laryngeal motor conduction study (LMCS) for evaluating laryngeal nerve injury.

Methods: This study included 809 patients with unilateral vocal fold paralysis. Quantitative parameters were measured on abnormal spontaneous activity, motor unit potential (MUP), recruitment patterns, and synkinesis of the affected thyroarytenoid (TA), posterior cricoid (PCA), and cricothyroid (CT) muscles. The proportion of recorded compound muscle action potential in LMCS was calculated to further divide muscles into LMCS+ and LMCS- groups, between which cut-off values for recruitment patterns were determined.

Results: In laryngeal muscles, amplitudes of fibrillation potentials were 90-100 μV and durations were 2.2-2.4 milliseconds, which were of 80-90 μV and durations of 4.8-5.0 milliseconds in positive sharp waves. Amplitudes of abnormal MUP showed increased amplitude compared to the normal, with prolonged durations of 6.16 ± 1.02 milliseconds, 6.57 ± 1.32 milliseconds, and 6.19 ± 1.19 milliseconds (P < 0.01). The amplitude and turns of abnormal recruitment were significantly smaller than those of normal laryngeal muscles (P < 0.01), with turns in the mixed and simple pattern being 30% and 20-25% of the full interference pattern, respectively. In mixed patterns, the LMCS- group exhibited smaller amplitudes, with cut-off values at 298.50 μV, 355.00 μV and 379.50 μV for TA, PCA and CT muscles.

Conclusions: Amplitude and duration are critical parameters for identifying abnormal spontaneous activity and MUP in laryngeal muscles, with duration being of higher specificity. Combined with LMCS-derived cut-off values for amplitude, the reduced turns can help distinguish recruitment patterns to assess the degree of laryngeal nerve injury.

Background: Subjective assessment of voice and speech disorders, often based on hoarseness or breathiness, suffers from limited interrater reliability. Objective, composite metrics-such as the acoustic voice quality index (AVQI) and the acoustic breathiness index (ABI)-offer more consistent and reproducible alternatives for diagnosis and monitoring, although they show some sensitivity to recording conditions.

Aim: The aim of this study is to analyze the contributions and dependencies of individual acoustic parameters to composite metrics. Building on this, the influence of room acoustics on objective measures and their parameters is systematically investigated.

Methods: Using close-microphone recordings with negligible reverberation, the contribution of individual parameters to the composite measures was determined through variance and value range analyses. In 35 speech and language therapy (SLT) rooms, acoustic parameters such as reverberation time, impulse response, and background noise were measured. Their influence on objective measures from real voice samples was analyzed using mixed linear regression.

Results: Variance analyses show that, in particular, smoothed cepstral peak prominence (CPPS) substantially contributes to the predictive power of the composite measures and has a dominant influence on the investigated voice quality metrics. The results also demonstrate a strong impact of room acoustics on measurement accuracy - especially for mildly pathological voices and for reverberant speech recordings. Reverberation time and clarity measures were found to be crucial influencing factors and predictors.

Conclusions: The investigated voice quality measures are largely determined by CPPS. However, CPPS is heavily influenced by room acoustic properties, which can cause unreliable prediction with indices such as AVQI and ABI. Despite these limitations, CPPS remains a strong predictor of perceptual grading and breathiness. For reliable use of objective voice quality metrics in clinical settings, standardization or optimization of recording conditions, or development of more robust analytical methods, is essential. These findings support the refinement of objective voice diagnostics and promote evidence-based approaches in SLT.