Journal of Voice最新文献

Objective: Hoarseness is often observed in patients with acute central nervous system (CNS) impairment. However, the vocal function is not routinely assessed. The purpose of this prospective study was to reveal the severity of dysphagia and dysphonia simultaneously during a bed side swallowing assessment in patients with CNS disorders.

Study design: Prospective observational cohort study.

Methods: The bed side evaluation of swallowing and vocal function was performed in 24 patients (aged 22-96 years; 14 male, 10 female) who were admitted to the Center for Neurology and Medical Science of out institute. They were suspected to have aspiration by a routine screening examination and required a bed side swallowing endoscopic assessment. The swallowing functions were evaluated by videoendoscopic swallowing test and Food Intake Level Scale (FILS). Vocal function was evaluated by bed side stroboscopic examinations with the measurement of vocal fold vibratory amplitude (VFVA) and Bowing Index (BI). Grade Roughness Breathiness Asthenia and Strain scale, aerodynamic and acoustic analyses were also completed. In addition, grip strength, tongue pressure measurements, geriatric nutritional risk index (GNRI), and the respiratory function tests were evaluated.

Results: Swallowing and vocal function were impaired in all patients. An overall FILS average was level 4-6 that required alternative nutrition. Vocal fold atrophy was observed in 19 patients with reduced values in both VFVA and BI. Inspiratory function and muscle strength were decreased compared to the average of the healthy elderly, and the overall average of nutrition fell into the category of moderate nutritional impairment.

Conclusions: The current study revealed that both swallowing and vocal function were impaired in the patients under acute treatment of CNS disorders. It was suggested that several factors can affect swallowing and vocal disorder in CNS disorder patients, including vocal fold atrophy, poor respiratory function, reduced muscle strength, and poor nutritional status, which should be kept in mind during the treatment or rehabilitation for CNS disorders.

Objectives/hypothesis: The goal of this study was to investigate the relationship between respiratory discomfort and voice measures, including perceived vocal effort and selected acoustic parameters. A secondary aim was to examine whether threat appraisal-measured as susceptibility to experience fear of suffocation-modulated these relationships. We hypothesized that greater dyspnea would predict worse voice outcomes, especially in speakers with greater fear susceptibility.

Study design: Repeated measures study.

Methods: Fifty-eight healthy females were submitted to various levels of respiratory discomfort through rounds of breath-holding while they rated their perceived dyspnea. Participants performed a phonation task-in a comfortable and a loud voice-immediately after each breath hold and rated their perceived vocal effort and fear of suffocation. Smoothed cepstral peak prominence (CPPS), harmonics-to-noise ratio (HNR), mean fundamental frequency (mean F₀), relative level of high-frequency noise (Hfno), and amplitude difference between the first two harmonics (H₁-H₂) were extracted. Linear mixed models and repeated measures correlations were generated to assess the relationships between dyspnea, fear susceptibility, and voice measures.

Results: In the vocal effort models for comfortable and loud phonation, dyspnea was a significant predictor (P < 0.0001) and interacted significantly with fear susceptibility (P < 0.0001). In the comfortable condition, dyspnea was also found to be a significant predictor for CPPS (P = 0.0014) and mean F₀ (P = 0.0003) and interacted significantly with fear susceptibility in the CPPS model (P = 0.0051). Post hoc analyses showed that perceived vocal effort increased as dyspnea intensified, especially in participants with greater fear susceptibility. The direction of CPPS fluctuations with increasing dyspnea varied based on level of fear susceptibility, although correlations were weak.

Conclusions: The relationships between respiratory discomfort and voice were influenced by fear, suggesting that sensory and affective mechanisms interact when impacting voice production and vocal effort perception. Future studies could investigate whether similar interactions may impact laryngeal function in voice and upper airway disorders.

Objectives: The objective of the current study was to examine the acoustic, aerodynamic, and glottographic effects of Clear reading compared with Habitual reading.

Methods: Participants were five female and four male college students. They were native speakers of American English and had normal voice, speech, and hearing. Participants were instructed to read six sentences in four different conditions: (1) Habitual reading with a Glottal Enterprises mask off the face, (2) Habitual reading with the mask on the face, (3) Clear reading mask-off, and (4) Clear reading mask-on. Praat was used for acoustic analysis. The Glottal Enterprises system was used for airflow and oral air pressure recordings. A Kay Laryngograph was used to acquire the electroglottographic (EGG) signal. The airflow, air pressure, and EGG signals were analyzed using BGSigplot, implemented in MATLAB.

Results: The following measures increased significantly in clear reading compared with Habitual reading: (1) duration of sentences, stressed vowels, unvoiced fricatives, voice onset time for stop consonants, and stop gap in the second /p/ in the words papa, piper, and pepper; (2) fundamental frequency for vowels /ʊ/ and /ɛ/ for females; (3) intensity of stressed vowels and release of stop consonants; (4) oral air pressure in the phoneme /p/; and (5) airflow measures (average airflow, total air volume, and peak flow) in the words pass, cushion, papa, put, and pepper. The following measures did not change significantly in clear reading compared with Habitual reading: (1) fundamental frequency in male subjects; (2) glottal airflow measures, including closed quotient, open quotient (OQ), and skewing quotient; and (3) EGG measures, including EGG width, height, and contact and OQ.

Conclusions: Differences observed between Habitual and Clear readings suggest that clear speech predominantly involves changes in subglottal pressure and oral cavity kinematics rather than modifications in vocal fold adduction and vibratory dynamics.

Purpose: Professional voice users utilize systematic hydration to preserve the quality of their voice. However, the existing literature provides limited research on the systemic hydration of voice quality from a thermal and multi-dimensional perspective, particularly in speech-language pathologists (SLPs). Thus, using thermal and multidimensional measures, the current study inspected the effectiveness of systemic hydration in SLPs' voice quality.

Method: The study involved 20 vocally healthy female SLPs allocated to vocal loading (control group), who read passage loudly for 1 hour, and systemic hydration (experimental group), who consumed water during the vocal loading task. Pre evaluation and post evaluation of multidimensional voice measures: thermal (front view of throat), acoustic (fundamental frequency, perturbation [frequency and amplitude], and noise-related measures), aerodynamic (maximum phonation time: MPT and s/z ratio), and self-perceptual [perceived phonatory effort (PPE), perceived vocal tiredness (PVT)] measures were collected for two groups.

Results: Pre-post comparison in the vocal loading group had a significant increase in thermal (FVT), acoustic [STD of F0, vF0, jitter, shimmer, amplitude perturbation quotient (APQ), and noise-to-harmonic ratio (NHR)], self-perceptual (PPE and PVT), and decreased aerodynamic measures MPT. However, no significant differences were noted in the systemic hydration group's thermal and multidimensional voice outcome measures. Between-group post test comparisons, the systemic hydration group showed a significant decrease in thermal front view of the throat (FVT), acoustic [jitter, NHR], and an increase in aerodynamic (MPT) compared with the vocal loading group.

Conclusion: The voice quality was decreased in the vocal loading group, while the systemic hydration group remained stable, as depicted on multidimensional voice measures. This study confirms the positive benefits of systemic hydration on voice quality and recommends its incorporation into clinical practice for SLPs.

Objective: Reference data from vocally healthy German-speaking adults of the speaking voice for pitch and loudness in four intensity levels in the speech range profile using Vox Phonetography were collected with the aim of establishing cutoff values for clinical diagnostics.

Methods: Sixty vocally healthy adults (30 female and 30 male), who were nonsmokers and between 18 and 83 years, were investigated in three groups (18-44, 45-60, and >60 years). The commercial plug-in Vox Phonetography of the software Praat was used to collect speech range profile (SRP) data. An SRP of continuous speech material was recorded for each participant using the soft-(level-I), habitual-(level-II), loud speaking voice (level-III), and shouting voice (level-IV). A t test was used to compare SF0 and SPL differences between genders at each intensity level, while repeated-measures analysis of variance (ANOVA) analyzed these differences across intensity levels. One-way ANOVA with Bonferroni post hoc tested age effects on SF0 and SPL, and 95% confidence intervals (CI) determined cutoff values. Backward multiple linear regression assessed gender and age effects on slope SRP parameters, with ANOVA and Tukey-HSD post hoc for age group differences. Cutoff values for slope SRP parameters were established using 95% CI, considering potential age and gender effects.

Results: Various cutoff values of pitch ranges for males and females of the four intensity levels were detected. Pitch decreased significantly from the middle age at intensity levels I and II for females (P < 0.01), and increased at older age at intensity level II for males (P < 0.05). Loudness increased significantly with older age at intensity level I for males (P < 0.05), but no significant age differences in females were evaluated at all intensity levels. The slope measures of the SRP showed no differences between males and females, but a significant age-related effect with cutoff values was established.

Conclusions: The SRP data are appropriate as reference data for the clinical measurement of the speaking voice in German using Vox Phonetography under consideration of age, gender, and vocal status. Further SRP parameters for combining the four intensity levels by slope were successfully analyzed.

Objective: This study investigated the effectiveness of "Edge Therapy" (ET) for improving glottal closure in singers with primary muscle tension dysphonia (MTD-1).

Study design: Double-blind randomized clinical trial.

Methods: Forty adult male singers with MTD-1 were recruited using convenience sampling method from a university otolaryngology clinic. The participants were randomly assigned to either laryngeal manual therapy (LMT) plus sham therapy (control group, CG), or LMT plus ET (Edge Therapy Group, ETG). All participants received eight treatment sessions and were evaluated before, immediately after, and at 2-week follow-up using videolaryngostroboscopy, acoustic voice analysis, auditory-perceptual ratings, and the Persian Singing Voice Handicap Index (SVHI). Data from 31 participants (14 CG and 17 ETG) were available for analysis using repeated measures analysis of variance and the Friedman test, respectively, based on data normality.

Results: Although no significant differences were found between the groups for acoustic measures (F0, jitter, shimmer, and harmonics-to-noise ratio), auditory-perceptual ratings improved more in the ETG, with 94% of participants scoring 6 or higher compared with 72% in the CG (P < 0.001). Glottal closure also improved significantly in both groups, with greater improvements in the ETG. MTD type shifted toward reduced supraglottic involvement in both groups. SVHI scores decreased significantly post treatment and at follow-up, with more prominent improvements in the ETG (P < 0.001).

Conclusion: Both LMT and ET were effective in improving vocal quality, laryngeal function, and reducing self-perceived vocal handicap in singers with MTD-1. The addition of ET to LMT provided superior benefits, particularly in perceptual measures and glottal closure.

Objective: The use of face masks during COVID-19 causes communication difficulties. Determining the effects of face masks can provide precautions against possible voice problems. The aim of the study is to determine the difference between vocal fatigue and anxiety levels depending on the use of masks in basic and basic-professional activities.

Materials and methods: This study was conducted in a descriptive and cross-sectional design. Data were collected between March and May 2021. The study included 476 people aged 18-65 years. Participants were divided into two groups according to the purpose of mask use; "wearing masks only for essential activities" group (EA) and "wearing masks for essential-professional activities" group (EPA). Vocal Fatigue Inventory (VFI), Beck Anxiety Inventory (BAI), and Self-Assessment Questions were used in the study. All scales and subjective evaluation questions were transferred to Google Forms. The link was sent to participants living in Turkey with a letter of consent.

Results: VFI-Factor 1, VFI-Factor 2, VFI-Factor 3, VFI Total, and BAI scores differed statistically significantly between the groups. VFI and BAI scores of the EPA group were found to be higher. There was a correlation between all factors of VFI and BAI scores. According to the results of regression analysis, it was found that the purpose of mask use and BAI score increased the VFI score. When the EPA group was masked, their results on respiratory control abilities, auditory perception, and speech intelligibility were shown to be lower.

Conclusion: Regardless of the purpose of use, face masks have been found to reduce speech intelligibility, auditory feedback, and the ability to maintain breath control while speaking. The findings of our study suggest that longer mask use may increase the VFI score.

Background: With the advancement of vocal arts, Chinese National Singing and Western Classical Singing (Bel Canto) encounter challenges in cross-cultural adaptation. Investigating formant tuning strategies and the singer's formant is crucial for scientifically characterizing the vocal production techniques in Chinese singing styles.

Method: Eight singers-Chinese National Singing tenors, Chinese National Singing sopranos, Bel Canto tenors, and Bel Canto sopranos-were recruited. The fundamental frequency (F0), intensity, formants, and long-term average spectrum (LTAS) were analyzed using a series of designed tasks to examine the phonation and articulation characteristics of these two singing genres in the context of cross-cultural adaptation.

Results: A positive correlation between F0 and intensity was generally observed, though variations existed across vowels and singers. Both linear and non-linear relationships were found between F0 and formants. The first formant (F1) was proportional to F0, with greater variability for female singers in the vowel /a/. LTAS analysis revealed that the tenors exhibited the singer's formant in sung vowels and songs, whereas the sopranos did not exhibit this feature when singing vowels but did so in specific songs. Moreover, the primary and secondary spectral peaks in Bel Canto were less influenced by songs compared to Chinese National Singing.

Conclusions: (i) Intensity can provide an objective basis for differentiating subjective differences between singing genres, and individual differences are evident in how singers handle the relationship between F0 and intensity. (ii) Vowel modification and vowel migration in sopranos reflect consistency and variability across linguistic and cultural contexts. (iii) The presence and characteristics of the singer's formant are influenced by sexes, singing genres, and songs. Differences in the degree of spectral influence between the two singing genres suggest that Bel Canto emphasizes yi qiang xing zi (ie, phonation drives articulation), while Chinese National Singing emphasizes yi zi xing qiang (ie, articulation drives phonation).

Background and objective: Imams are under-researched professional voice users who are exposed to significant vocal demands. This study is the first to examine the prevalence of voice impairments among Palestinian imams, addressing a critical gap in the literature and contributing to the global understanding of challenges faced by vocally intensive professions. It focuses on the functional, physical, and emotional dimensions of voice-related quality of life.

Setting and design: A cross-sectional study using the validated Arabic version of the Voice Handicap Index-10 (VHI-10).

Subjects and methods: Ninety participants, comprising 45 imams and 45 controls with less vocally demanding professions, were evaluated using the VHI-10. Statistical analyses, including t tests and regression analysis, were performed to identify patterns and predictors of voice handicap.

Results: Seventy-five percent of imams exceeded the clinical VHI-10 cutoff, indicating a high prevalence of voice handicap. The Physical dimension showed the greatest effect, while the Emotional dimension had the least. A significant correlation was observed, with years of professional experience predicting lower Total VHI-10 scores (B = -0.41, R² = 0.95, P < 0.001), whereas education level had no significant effect (P > 0.05). Analyses of variance revealed significant effects of professional experience on the Physical subscale (P < 0.001), but not on the Emotional subscale (P > 0.05).

Conclusion: Palestinian imams face significant voice handicap, primarily driven by physical strain. Professional experience appears to mitigate its severity. These findings underline the need for culturally tailored, evidence-based interventions for this population, including vocal training and voice hygiene programs.

Background: The World Professional Association for Transgender Health (2022) recommend voice and communication therapy within their standards of care for transgender and gender-diverse individuals; however, there is currently limited data to address the efficacy of interventions for this population beyond changes to fundamental frequencies. This systematic review will explore (1) the efficacy of voice and communication therapy for supporting trans and gender-diverse individuals in decreasing gender incongruence and will (2) consider the most effective modes and models of intervention for attaining this goal.

Study design: Systematic review.

Methods: A systematic literature search was undertaken through the online databases Scopus, Cochrane Library, PsycInfo, and PubMed, based upon a population, intervention, comparison, outcomes search strategy, with an additional paper being included from manual citation searches. For inclusion, studies were required to address purely non-surgical interventions and, to appropriately align with a contemporary understanding of therapeutic efficacy, to include patient self-rating outcome measures alongside acoustic measures.

Results: Eight pertinent studies were included from the searches. The results of all eight studies indicated changes in acoustic measures, listener perceptions, and self-perceptions following therapeutic intervention for participants of varying ages and backgrounds.

Conclusions: Voice and communication interventions appear to improve quality of life, vocal function, and social participation in transgender and non-binary individuals and support movements of acoustic and perceptual measures to more closely reflect an individual's gender. Further, much larger studies are required to (1) compare modes and models of intervention and to (2) assess the efficacy of therapeutic intervention for wider transgender populations.