Journal of Voice最新文献

Maximum phonation time (MPT) is commonly used as an indication of phonatory function. However, MPT varies considerably depending on several factors, for instance, laryngeal valving, ie, the completeness of glottal closure. This parameter is closely related to phonation type, which can vary along the continuum between weak and firm glottal adduction, resulting in an abundant and reduced glottal airflow, respectively, ie, Breathy and Pressed phonation. This investigation analyzes the effects of both phonation type and flow rate on MPT, hypothesizing that Pressed and Breathy phonations produce extremes of MPT variation. Audio and lung volume were recorded in 14 singers experienced in performing different singing genres. They sustained the vowel /a/ as long as they could, after a maximum inhalation, a task repeated in Breathy, Flow, Neutral, and Pressed phonations. Real-time visual feedback of sound level and fundamental frequency was provided by means of the FonaDyn software, helping participants to keep these parameters constant across different degrees of vocal fold adduction. The relationship between flow rate, phonation, and MPT was analyzed using multilevel Bayesian models. Such models offer a better quantification of uncertainty, full probability distributions, and the ability to integrate the results of previous experiments into current analyses as compared to equivalent frequentist models. The results suggested that MPT varies with both flow rate and phonation type: the former is a stronger standalone predictor of MPT than the latter. The implication of such a finding is that, when access to flow data is not available, MPT is still a useful metric, provided that control for phonation type is considered. Indeed, much of the variation of published MPT data may reflect phonation type differences. Thus, future investigations should control for phonation type when MPT data are compared.

Objective: Diagnosing laryngopharyngeal reflux (LPR) is challenging due to the overlap of its symptoms with those of other conditions. The Reflux Symptom Score-12 (RSS-12) is a condensed version of the RSS questionnaire to facilitate LPR assessment in clinical practice. This study aimed to validate the German version of the RSS-12 (G-RSS-12) and evaluate its reliability, clinical validity, and responsiveness.

Study design: A prospective, controlled, cross-sectional study.

Methods: This single-center study included 73 patients with LPR symptoms and 50 healthy controls. The participants underwent clinical examination, neck sonography, and 24-hour pH monitoring to confirm LPR. Participants completed the G-RSS-12 and the German version of the Reflux Symptom Index (G-RSI). Thirty-seven patients with confirmed LPR underwent 12-week treatment with pantoprazole 20 mg twice a day. Responsiveness to treatment and the G-RSS-12 cutoff for determining the presence or absence of LPR were examined.

Results: The G-RSS-12 demonstrated high internal consistency (Cronbach's α = 0.809, N = 123) and excellent test-retest reliability (ICC = 0.98, N = 37). Construct validity was supported by significant differences in scores between patients and controls (P < 0.001). G-RSS-12 showed high criterion validity, correlating strongly with the G-RSI (rho = 0.895, P < 0.001, N = 123). Responsiveness was evident, with significant improvements in scores after treatment (P < 0.001, N = 37). A G-RSS-12 cutoff value of 12 indicated LPR with high sensitivity (97.30%) and specificity (91.70%).

Conclusions: G-RSS-12 demonstrated superior discriminative properties compared with G-RSI. G-RSS-12 proved to be a highly reliable, valid, and responsive tool for assessing LPR symptoms and monitoring treatment outcomes in German-speaking populations.

Objective: Adductor laryngeal dystonia (AdLD) is a task-specific focal dystonia characterized by involuntary vocal fold hyperadduction and impaired voice quality. While reduced cortical inhibition is a hallmark of AdLD, its relationship to acoustic measures of voice dysfunction remains unclear. This study investigated whether intracortical inhibition, as measured by the cortical silent period (cSP) from the laryngeal motor cortex (LMC), is associated with cepstral peak prominence (CPP), a quantitative acoustic marker of voice harmonic periodicity.

Methods: Thirty-two participants (17 AdLD, 15 controls) underwent transcranial magnetic stimulation with fine-wire electromyography targeting the LMC to measure cSP. Acoustic recordings of sustained vowels and connected speech were used to derive CPP. Linear models were used to assess the relationship between cSP, CPP, and perceptual voice severity (Consensus auditory-perceptual evaluation of voice overall severity ratings).

Results: Participants with AdLD exhibited significantly shorter cSP durations and lower CPP values than controls (P < 0.05). Across all participants, longer cSP durations were significantly associated with higher CPP values (β = 0.075, P = 0.03), indicating that greater cortical inhibition is associated with better harmonic periodicity in the voice. However, cSP did not independently predict perceptual voice severity after adjusting for age and CPP.

Conclusion: These findings link impaired cortical inhibition in the LMC to less harmonic periodicity in AdLD, supporting a mechanistic role for disinhibition in dysphonic voice production. While cSP did not improve the prediction of perceptual severity, it may serve as a physiological correlate of acoustic dysphonia and a potential biomarker for future neuromodulatory interventions.

Objectives: This study investigated the effects of four common semioccluded vocal tract exercises (SOVTEs)-tongue trill, lip trill, straw phonation, and water resistance therapy (WRT)-in primary muscle tension dysphonia (MTD).

Study design: Double-blind randomized controlled trial.

Methods: The participants who included 30 females with primary MTD were randomly assigned to one of four experimental SOVTE groups and a vocal hygiene (control) group. Each participant underwent four voice therapy sessions, conducted twice weekly. Aerodynamic, acoustic, auditory-perceptual, and self-assessments were performed before and after the interventions.

Results: Within-group comparisons indicated a significant improvement in maximum phonation time (MPT) following lip trill, straw phonation, and WRT (P < 0.05). No significant changes were observed for acoustic measures in SOVTE groups (P > 0.05). The overall severity of dysphonia significantly decreased after tongue trill and straw phonation. Frequency and severity of vocal tract discomfort (VTD) and the voice handicap index (VHI) showed significant improvements after straw phonation and WRT (p< 0.05). In the control group, only acoustic measures and VHI changed significantly (P < 0.05). Between-group comparisons revealed significant improvement only in the MPT and VTD. Post hoc analyses demonstrated that MPT improvement was significantly greater in the straw phonation compared with other groups (P < 0.05; η² ≥ 0.14). Additionally, significant differences were observed between trills, tongue trill and WRT, and WRT and vocal hygiene for the VTD (P > 0.05; η² ≥ 0.14).

Conclusion: All SOVTEs were effective in primary MTD. Although certain SOVTEs demonstrated significant improvements in MPT and VTD, no single exercise was identified as the most beneficial. Future studies with larger sample size and objective measures are recommended.

Objectives: A systematic investigation of the posterior glottal gaps, opening and closing vibratory patterns, and mucosal wave amplitude in children with nodules compared to vocally healthy controls.

Methods: High-speed videoendoscopy (HSV) recordings were obtained from 20 children with vocal fold nodules (10 boys, 10 girls). Sustained phonation on vowel /i:/ was elicited. The posterior glottal gap, the mucosal wave amplitude, and the opening and closing phase anterior-posterior (AP) vibratory patterns along the entire vocal folds (VFs) and at the nodule location were rated by two raters, using a custom visualization tool. Similarly, data obtained from vocally healthy adults and children from a previous study were used as control. Between groups, differences were assessed using Pearson's chi-square, followed by post hoc Mann-Whitney U tests.

Results: Posterior glottal gaps were more frequent in girls with nodules, compared with specific vocally healthy control groups, particularly adult men (P < 0.001), who showed fewer and smaller gaps. Opening patterns initiating posteriorly were common across pediatric groups; however, boys with nodules exhibited mostly opening patterns initiating at the ends (P < 0.001). Children with nodules, especially girls, demonstrated mostly the middle progressing toward both ends or simultaneous closure, while control girls (P < 0.05) and women (P < 0.01) mostly showed an anterior-to-posterior pattern. The male groups showed less differences. In the vibratory patterns at the nodule location, no statistically significant influence of sex was visible. Opening at the nodule most frequently occurred later relative to other locations, while simultaneous closing was the most frequent closing pattern.

Conclusion: This study identified sex- and pathology-related differences in pediatric VF vibration, particularly in glottal gap configuration, AP vibratory coordination, and mucosal wave amplitude. The findings offer valuable benchmarks for visual-perceptual assessment and highlight the diagnostic potential of HSV in differentiating healthy pediatric voice production from pathology.

Musicians are a high-risk population susceptible to various occupation-related health issues. Conservatorium singing students' risk of vocal injury increases as more time is spent practising and performing. Singers are particularly vulnerable to the negative effects of social and recreational voice use. Conservatorium singing students have demonstrated little awareness on vocal health and well-being. Understanding the barriers to good vocal health will allow for targeted strategies to minimize the development and continuation of negative vocal health habits. The aim of this study is to investigate students' current vocal health behaviors. A qualitative design was used. Vocal teachers, voice students, and independent accredited practising speech pathologists who specialized in voice participated in iterative semi-structured interviews. Data were transcribed verbatim, analyzed thematically, and interpreted through the Capability, Opportunity, Motivation, Behavior (COM-B) Model for Behavior Change. Students' limited knowledge in vocal anatomy and physiology hindered their engagement in vocal hygiene practices and articulate their concerns. This contributed to hesitation in seeking professional help and passive vocal health behaviors. Voice teachers were committed to student well-being but struggled to make vocal health concepts accessible in their teaching. Both voice teachers and students reported that more formal support is needed within conservatoria to aid students in accessing relevant health professionals. This study provided the foundation for a collaborative, multidisciplinary approach to vocal health education from health professionals and vocal teachers. Results will inform the design of a vocal health education program for conservatorium singers to provide students with the skills to manage their vocal health.

Background: This study aims to evaluate the outcomes of Wendler glottoplasty combined with postoperative voice therapy in transgender women, focusing on improvements in voice acoustics and quality of life after surgery.

Study design: Retrospective observational study.

Methods: This retrospective study reviewed medical records of 138 transgender women who underwent Wendler glottoplasty between January 2020 and January 2024, performed by a single surgeon. Among them, 52.2% (n = 72) underwent concurrent chondrolaryngoplasty. Speech samples, dysphonia assessment, trans woman voice questionnaire (TWVQ), and a visual analog scale (VAS) for neck aesthetic satisfaction were collected preoperatively and one year postoperatively. All patients completed at least 12 postoperative voice therapy sessions. Statistical analysis used paired t tests and effect-size calculations to assess changes across key parameters.

Results: Significant improvements were observed in both vocal and aesthetic parameters. The mean fundamental frequency (F₀, sustained /e/) increased from 138.73 Hz to 207.82 Hz (Δ = +69.09 Hz or +7.00 semitones (ST); P < 0.0001; 95% confidence interval [CI], 64.18-74.00 Hz; Cohen's d = 5.27), while the mean speaking F₀ rose from 140.38 Hz to 209.24 Hz (Δ = +68.86 Hz or +6.91 ST; P < 0.0001; 95% CI, 65.12-72.60 Hz; Cohen's d = 4.96). Quality of life also improved significantly, with TWVQ decreasing from 99.06 to 56.18 (P = 0.008; 95% CI, 37.54-47.22; Cohen's d = 3.05). Among those who underwent chondrolaryngoplasty, aesthetic satisfaction markedly increased: the mean preoperative VAS score (0-10 scale) rose from 1.03 ± 0.71 to 9.83 ± 0.18 at 12 months postoperatively (P < 0.0001, Wilcoxon test).

Conclusion: Wendler glottoplasty combined with voice therapy significantly enhances fundamental and speaking frequencies in transgender women, while concurrent chondrolaryngoplasty contributes to substantial improvement in aesthetic satisfaction with the neck contour.

Objectives: (1) To determine whether acoustic glottal stop production (GSP) measures from two sentence-embedded glottal stops (GS) differed between patients with unilateral vocal fold paresis/paralysis (pUVFP) and normal controls (NCs), and if so, their diagnostic accuracy; (2) to examine context specificity by correlating within-speaker GSP measures from sentence-embedded GS with repeated [i] and [isi] tokens; and (3) to test whether GSP measures differed depending on speaker perception as pUVFP or NC.

Method: Sixty-two pUVFP and eight NCs produced "We eat eggs every Easter," containing two potential GS: GS1 (we eat) and GS2 (every Easter). Averages were calculated for four GSP measures (offset and onset intensity differences and slopes) obtained by 2 assessors using a customized Praat script. Group comparisons were analyzed using Mann-Whitney U tests, and diagnostic accuracy by receiver operating characteristics and Youden's Index for combined and separate contexts. Pearson product-moment coefficients were used to assess within-speaker correlations across contexts. Kruskal-Wallis tests assessed differences between GSP measures based on perceptual classifications of the sentence.

Results: Intensity differences were significantly smaller and slopes shallower (P < 0.05) between pUVFP and NCs for both environments combined and for GS2 individually. Diagnostic accuracy was perfect for GS2 measures, but poor for GS1. Significant within-speaker correlations (P < 0.05) were found for GSP measures from most contexts. Significantly greater intensity differences and steeper slopes (P < 0.05) were found from sentences that both listeners perceived as produced by an NC compared to those produced by a pUVFP.

Conclusion: Acoustic GSP measures, regardless of phonetic context, show generalizability in distinguishing between pUVFP and NCs. However, repeated [i] may be more valid because acoustic GSP measures are significantly correlated with measures from other contexts; better diagnostic accuracy, and include one more variable, the number of voicing cessations, already shown to be important in recovery.