Journal of Voice最新文献

The purpose of this study was to examine the relationship between airflow vibrato (primarily extent) and pitch, loudness, and adduction, as well as the differences between vibrato production and straight tone singing. A single professional mezzo soprano was the participant. A Glottal Enterprises aerodynamic system was used to record wide-band airflow. Results indicated that airflow vibrato extent tended to increase with pitch and loudness and decrease with greater adduction. The standard deviation of the airflow signal (including both the vibrato conditions and straight tone conditions) tended to increase with increase in the standard deviation of the fundamental frequency signal. Straight tone productions have small airflow variations that appear random, but acoustically contain the fundamental frequency and at least 10 additional harmonics of the intended sung pitch. Average airflow was higher for vibrato productions than for straight tones by about 17%.

Introduction: Pediatric dysphonia is common, with a prevalence as high as 38% in school-aged children. Previous studies have shown the benefits of therapy in treating pediatric dysphonia; however, much of the literature that discusses these benefits address older school-aged children (6-18 years) and not those who are younger. The objective of this study is to examine the efficacy of voice therapy for preschool-aged patients, between ages 2 and 5 years old.

Methods: An IRB-approved retrospective review was conducted of pediatric patients (age range 2-5 years) seen at multi-disciplinary voice clinics within Boston Children's Hospital, Department of Otolaryngology, between January 2015 and March 2023. Data including dates of presentation, demographics, co-morbidities, presenting symptoms, number of therapy sessions, Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) ratings, and Pediatric Voice Handicap Index (pVHI) scores were collected and analyzed.

Results: 77 patients who were recommended voice therapy for dysphonia were reviewed. 51 (66.2%) were male and 26 (33.8%) were female. The mean age at first evaluation was 4.49 years old. Each patient underwent, on average, 5.29 sessions (SD = 2.16) and 1.87 months (SD = 2.79) of therapy. Patients experienced a 36.4% decrease in their CAPE-V Overall Severity score from pretherapy to post therapy. Patients diagnosed with vocal cord nodules experienced greater decrease in CAPE-V ratings than those with other etiologies for hoarseness (-18.18, P = 0.016). Age, schooling status, number of siblings, history of speech delay, and other medical co-morbidities had no significant effect on patients' overall CAPE-V ratings. pVHI parental rating of severity decreased 43.9% from pretherapy to post therapy. Total pVHI scores also decreased after treatment.

Conclusion: Voice therapy in younger preschool age children can be efficacious and result in improved vocal quality.

Aim: This study aimed to (i) culturally adapt and linguistically translate the Evaluation of the Ability to Sing Easily (EASE) in Tamil (EASE-T), (ii) validate EASE-T in Tamil-speaking Carnatic singers, and (iii) compare the scores of EASE-T with the original EASE (English) and EASE-K (Kannada).

Method: The original EASE (English) consisting of twenty-two statements in the three subscales-vocal fatigue, pathological risk factors, and vocal concerns, was adapted and translated to Tamil by professional translators. After incorporating the modifications, EASE preliminary version was given to eight Carnatic singers and four speech language pathologists for content validation. Two hundred and thirty-six healthy Tamil-speaking Carnatic singers (175 female and 59 male) ranging in age from 18 to 60 years validated the final version of the EASE-T (22 statements) after completing a vocal loading task.

Results and discussion: The Cronbach's alpha revealed good internal consistency for all subscales of EASE-T. Spearman's correlation coefficient showed a moderate-to-strong positive correlation between all subscales. No significant gender differences were observed. However, significant differences between the age groups of 18 to 30 years and 46 to 60 years were obtained. The comparison of the raw scores of the EASE-T with the original EASE, and EASE-K revealed some differences for both subscales. The adapted EASE-T has the potential for clinical and research applications in tracking subtle vocal changes, especially in response to vocal loading in Carnatic singers. This valid tool can aid voice professionals in early self-detection of vocal strain and could serve as a basis for seeking timely help, thereby supporting singers in maintaining vocal health and longevity in their careers.

Objective: The lip trill (an oscillatory semioccluded vocal tract (SOVT) exercise) is commonly used by singers and speakers to improve voice production skills. The specific objective of this study was to investigate the relationships between aerodynamic and acoustic signals during lip trills.

Methods: One trained female singer performed lip trill with and without voicing and a lip trill followed immediately by a /bap:/ syllable string. The audio, airflow, electroglottography (EGG), and oral air pressure signals were obtained. EGG was used to compute EGGW25, EGG height (EGGH), and fundamental frequency (f_o).

Results: This participant's EGGW25 reduced from over 0.5 during vowel production to 0.2 during lip trill. Oral air pressure during voiced lip trill never reached atmospheric pressure and was higher during unvoiced than voiced lip trill production. EGGW25, EGGH, and f_o changed regularly within a lip trill cycle: EGGW25 and EGGH decreased with lip opening, and f_o increased by as much as three semitones above the target frequency.

Discussion and conclusion: The results indicate that lip trill greatly reduced the glottal EGGW25, an indication of less glottal adduction. During the lip trill, the EGGW25 and EGGH decreased as the lips separated, contrary to what was expected, indicating a complex relationship among transglottal pressures, adduction, and airflow. Conversely, fundamental frequency increased during lip separation as expected, albeit to a greater magnitude than anticipated. Unvoiced lip trill reported higher oral air pressures presumably due to the lack of glottal resistance.

Objectives: This study aims to comprehensively analyze global research trends and developments in laryngeal dystonia (LD), providing valuable insights into the current state of LD research and highlighting emerging areas for future investigation, with particular focus on the role of novel technologies and interdisciplinary collaborations.

Methods: We conducted a bibliometric analysis of 497 studies on LD retrieved from PubMed, CINAHL, Embase, Scopus, and Web of Science, spanning from 1971 to 2023. Utilizing R, VOSviewer, and Citespace, we examined the characteristics and trends of the accumulated scientific literature, aiming to offer comprehensive insights and directions for future research.

Results: The analysis revealed substantial growth in publications, with significant contributions from 1555 authors across 120 journals. The United States, Japan, and Canada were the leading contributors. Notably, 44.5% of the studies appeared in four core journals, including the Journal of Voice. Research was largely supported by 372 grants, predominantly from the National Institutes of Health (USA). Emerging research areas include treatments for LD, assessment tools, and innovative fields such as artificial intelligence (AI), cortical silent periods (CSP), and deep brain stimulation (DBS).

Conclusions: Despite the growing research interest in LD, substantial breakthroughs remain scarce. Collaborative international efforts are essential to drive innovative advancements in LD research, particularly by leveraging new technologies such as AI, to sustain and accelerate development in this evolving field.

Objective: This study aimed to determine (1) how cepstral peak prominence (CPP) and the amplitude difference between the first two spectral harmonics (H₁-H₂) change as a function of using pressed and breathy voice production in vocally healthy individuals and (2) whether CPP and H₁-H₂ can discriminate breathy and pressed phonation from typical phonation.

Method: Acoustic voice recordings were obtained from 50 vocally healthy individuals. Speech tasks included five repetitions of three sustained vowels (/ɑ, i, u/) and one all-voiced sentence ("We were away a year ago") using three voice production conditions (typical, breathy, and pressed). For each production, we calculated average smoothed CPP and H₁-H₂. Mixed ANOVA models and post hoc pairwise comparisons were used to determine how the acoustic measures differed across phonation conditions and whether those differences varied by sex. Multinomial logistic regression models were used to determine whether measures could differentiate the phonation types, controlling for pitch and intensity.

Results: In connected speech, pressed phonation demonstrated higher CPP and lower H₁-H₂ compared with typical phonation, whereas breathy phonation had lower CPP and higher H₁-H₂. Female participants also exhibited higher CPP and lower H₁-H₂ during pressed phonation compared with typical phonation on all sustained vowels. Male participants did not have significant differences in either measure between typical and pressed phonation in any sustained vowel but did have lower CPP/higher H₁-H₂ during breathy phonation. CPP and H₁-H₂ each significantly differentiated pressed from typical phonation in most speech tasks, but neither differentiated pressed from typical phonation in sustained /i/ tasks. CPP differentiated breathy from typical phonation when controlling for intensity.

Conclusion: CPP and H₁-H₂ respond to changes in phonation patterns. The results indicate within-person changes in each measure could indicate a change in vocal function. In particular, pressed phonation resulted in increased CPP in all speech tasks for females and in connected speech for males, suggesting that CPP increasing too much could be associated with vocal hyperfunction.

Objective: Professional operatic singing is vocally demanding, making the maintenance of professional vocal health a paramount concern for the opera chorister. Occupational environment has been shown to affect vocal health for other vocally dependent professions. Hence, the objective of the current study was to explore what occupational environment factors affect the professional vocal health of Swedish opera choristers.

Methods: In total, 12 focus group interviews with a total of 47 opera choristers at the three main opera houses in Sweden were conducted. The singers were grouped according to sex and age (≤45 and ≥46 years), discussions were aided by an interview guide. The interviews were recorded, transcribed verbatim, and analyzed using systematic text condensation, a thematic qualitative analysis.

Results: Five main themes were identified: (1) varying vocal demand, (2) adequate recovery, (3) instrument care, (4) psychosocial work environment, and (5) management measures. An underlying core prerequisite emerged highlighting the importance of the opera house management to understand the vocal as well as the psychological and emotional demands of the opera chorister profession.

Conclusion: Our findings support the supposition that occupational environment affects the professional vocal health of opera choristers. We suggest that if management can provide both adequate vocal recovery and succeed in alleviating psychosocial factors, this would improve vocal health and strengthen the singers' ability to handle the intrinsically high occupational demands of the profession. Further research is needed to understand how the findings may be implemented in the work place.

Objective: Much of what is known about semi-occluded vocal tract (SOVT) exercise is based on modeling and theoretical constructs. This exploratory study aimed to address the need for direct kinematic data from laryngeal imaging to investigate the impact of SOVT exercise on the vibratory characteristics of the vocal folds.

Method: A small sample of two participants, with no history of voice disorder, underwent transnasal, flexible fiberoptic endoscopy connected to a custom-built high-speed videoendoscopy (HSV) system. Participants were asked to perform the following tasks: a sustained vowel (/i/), sustained straw phonation, another repetition of the /i/ vowel, and straw phonation into a small cup of water. Physiologic measures during the phonation tasks, derived from the HSV playback, were analyzed and compared to the SOVT tasks.

Results: Glottal attack time trended toward longer, positive values during SOVT exercises, indicating "breathier" onsets, compared to sustained phonation preSOVT. This trend was more pronounced for straw phonation into a cup of water than for straw phonation alone. The results for glottal contact closed-quotient were more variable. Both participants had some degree of supraglottic squeezing during phonation, which was not present during SOVT production.

Conclusion: Although a small sample was investigated, this study reports clinically significant findings, providing some of the first insight into vocal fold vibratory physiology during SOVT production, as measured by direct laryngeal imaging. Additionally, this study offers descriptions of objective measures of manual HSV analysis to a literature base in need of validation of such measures.

Aim: To investigate the auditory perception of vocal deviation by dysphonic and nondysphonic women and to correlate the accuracy rate with acoustic measurements.

Methods: In total, 24 dysphonic women allocated to an experimental group (EG) and 10 nondysphonic women allocated to the control group (CG) participated in this study. The volunteers filled in the vocal screening form the vocal symptom scale (VoiSS) self-assessment protocol and made voice recordings during the emission of the vowel /Ɛ/, whose degree of deviation was examined through perceptual-auditory and acoustic evaluation; all the participants underwent audiometry. Three experiments were conducted for the perception tests. The first experiment consisted of randomly presenting 38 stimuli in isolation, 10 of which were healthy voices and 28 with different degrees of deviation, so that each participant could classify them as normal or altered. In the second experiment, the participants heard only breathy and healthy voices with different degrees of deviation and had to discriminate the presence or absence of breathiness. The third experiment was similar to the second experiment but with a rough voice.

Results: Women in the EG had a lower hit rate (52.2%) in identifying dysphonic voices than women in the CG (69.6%) (P < 0.001). The women in the EG had a lower accuracy rate in identifying predominantly rough (62.7%) and breathy (62%) voices, compared with the accuracy rate of the women in the CG (73% and 75.6%, respectively) (P value < 0.001). There was a moderate negative correlation between the hit rate of nondysphonic women and the shimmer values.

Conclusions: Dysphonia can interfere with the identification of dysphonic voices. Dysphonic women had a lower accuracy rate in identifying dysphonia and roughness and breathiness parameters than nondysphonic women.

Objective: To determine practice patterns for the management of vocal fold hemorrhage (VFH).

Study design: Cross-sectional survey.

Methods: American Broncho-Esophagological Association (ABEA) members were queried regarding VFH management paradigms. Clinical scenarios involving uncomplicated VFH and VFH with associated mucosal pathology were posed. Participants were asked about their threshold for procedural intervention and experience with the evolution of uncomplicated VFH to VF scar and hemorrhagic polyps.

Results: Fifty-six responses were obtained by in- or post-training physicians, all of whom indicated laryngology as their principal focus. The majority of respondents had been in practice for less than 15 years (71.4%) and worked in an academic setting (96.4%). Most recommended voice rest for both uncomplicated VFH (96.4%) and VFH with associated mucosal pathology (85.7%) for an average of 7.3 ± 2.2 and 7.0 ± 6.4 days, respectively. For both clinical scenarios, roughly one-quarter of respondents prescribed steroids. Voice therapy was more likely to be recommended for VFH with associated mucosal pathology (69.6%) compared to uncomplicated VFH (26.8%). The majority would intervene procedurally on a VF varix/ectasia following one (33.9%) or two (55.4%) episodes of associated hemorrhage, typically with an angiolytic laser in the operating room (55.4%) vs. office (41.1%) setting. Respondents indicated that a minority of uncomplicated VFH cases evolve to become VF scar (average 9.4% ± 8.2%) or hemorrhagic polyps (18.3% ± 12.8%).

Conclusion: Most surveyed ABEA members advise one week of voice rest for VFH, voice therapy for VFH with associated mucosal pathology, and angiolytic laser treatment for VF varices/ectasias following recurrent hemorrhage episodes.

Level of evidence: V.