Journal of Voice最新文献

Objective: The aim of this study was to evaluate the temporal changes in perceptual, acoustic, and cepstral voice parameters following expansion sphincter pharyngoplasty (ESP) in patients with moderate-severe obstructive sleep apnea syndrome (OSAS).

Method: In this prospective, nonrandomized clinical study, ESP was performed on 27 adult patients with moderate-severe OSAS. Voice assessments were conducted preoperatively, at 1 week postoperatively, and at 3 months postoperatively using the Turkish Voice Handicap Index-10, Grade, Roughness, Breathiness, Asthenia, Strain (GRBAS) scale, acoustic parameters (fundamental frequency, jitter %, shimmer %, and noise-to-harmonic ratio [NHR]), formant frequencies (F1-F4), and cepstral measurements (cepstral peak prominence [CPP], smoothed cepstral peak prominence [CPPS]) during sustained /a/ phonation and connected speech. Statistical analyses were performed using the Friedman test and Analysis of Variance (ANOVA).

Results: Regarding perceptual evaluation, although Friedman tests indicated statistical variance in Grade (P = 0.016) and Roughness (P = 0.005), conservative post hoc analyses revealed no statistically significant pairwise differences, suggesting perceptual stability. Objective acoustic analysis demonstrated a significant increase in Shimmer (P = 0.020) and a decrease in NHR (P = 0.011) by the third postoperative month. Cepstral analysis revealed a significant decrease in sustained /a/ CPP (P = 0.007) and CPPS (P = 0.010), reflecting reduced signal periodicity, while connected speech CPP showed significant variance (P = 0.020).

Conclusion: ESP characterizes as a functionally safe and resonance-sparing intervention. Although the procedure induces subclinical acoustic perturbations manifesting as reduced signal periodicity, it maintains perceptual stability and does not compromise functional communication. Preoperative counseling regarding these subtle acoustic changes is recommended, particularly for professional voice users.

Introduction: The spatial characteristics of voice radiation represent an important yet still insufficiently explored dimension of vocal performance and pedagogy. While previous studies have focused on spectral and glottal correlates of vocal modes, less attention has been given to how these modes shape the directional distribution of sound energy in space. Building on prior work on complete vocal technique (CVT), this study explores how the perceptual parameters of metal and density may influence voice directivity patterns across vocal modes and stylistic contexts.

Methods: A double-case study was conducted involving two professional singers (M1-AMAB, F1-AFAB) performing sustained phonation across four CVT vocal modes, each modified in terms of metal (neutral, reduced, and full) and density (reduced, full) for Neutral, Overdrive, and Edge. A total of 1088 samples were recorded using a hemispherical microphone array in an anechoic chamber. Directional sound radiation was analyzed across absolute and relative domains and evaluated using front-back ratios, spectral tilt, and directivity indices. Factor analysis was employed to reduce spatial dimensionality and explore consistent radiation patterns. Correlations were tested between radiation factor scores and directivity and acoustic.

Results: Across the two singers, we observed singer-specific differences in spatial radiation patterns that appeared to relate to variations in metal and density. Full metallic and full density for Overdrive and Edge conditions tended to show more forward-focused radiation, particularly in the 2-5-kHz band. Classical productions showed a tendency toward broader radiation patterns in the 0-2-kHz band, whereas contemporary conditions appeared more directional. Factor scores suggested the presence of structured directional components, and correlations with directivity parameters indicated recurring tendencies across metal levels and, in some cases, density. In these two singers, differences in radiation could not be attributed solely to sound pressure level or fundamental frequency, which may point to the contribution of coordinated vocal tract shaping.

Conclusion: In this double-case study, variations in metal-and to some extent density in Overdrive and Edge-were associated with singer-specific changes in three-dimensional radiation, beyond what could be explained by pitch and loudness alone. These preliminary observations suggest that spatial acoustics may provide a useful extension of the CVT framework and may hold relevance for pedagogical and technological relevance of controlling vocal directivity. The study introduces novel parameters for quantifying radiation and proposes their integration into applied settings such as voice training, performance acoustics, and immersive audio systems.

The study investigates the impact of a preventive vocal health program on the voice quality of male radio-broadcasters to identify effective strategies for mitigating vocal pathologies among professionals with high vocal demands. A pre-post within-subjects design was performed. Thirty participants without vocal pathology underwent assessments, including standardized voice evaluations and knowledge tests. A 7-week program tailored to radio-broadcasters' needs, led by licensed Speech-Language Pathologists, was implemented. The training program utilized a holistic approach to voice use, considering hygienic, symptomatologic, and physiologic voice exercises. The results indicate significant improvements post intervention in acoustic measures (Jitter, from 1.80 to 0.83, P < 0.001; Shimmer, from 3.81 to 2.81, P < 0.001; noise-to-harmonics ratio, from 0.16 to 0.13, P < 0.001) and fundamental frequency (F0, 137.72 to 118.95, P < 0.001; d = 1.09), alongside enhanced subjective voice quality. The program demonstrates the effectiveness of population-specific preventative interventions for broadcasters, highlighting the importance of education and proactive measures in preserving vocal health and potentially reducing long-term risks among professional voice users, even in the absence of pathology. This study underscores the relevance of such programs not only in Chile but also in other professional voice user populations globally, as there was an improvement in healthy voice use even among participants who did not have pathology, suggesting a potential for long-term risk reduction in healthy users.

Aim: This study analyzed deviancies in vocal fold vibratory kinematics across anterior, middle, and posterior regions due to bilateral vocal nodules using videostrobokymography (VSK).

Method: This cross-sectional study utilized videostroboscopic recordings obtained from the clinical voice database of a quaternary care hospital. Purposive sampling included 70 stroboscopy videos of confirmed clinical diagnosis of bilateral vocal fold nodules. All had a sustained /i/ phonation, with at least three glottal cycles and an adequate illumination for (i) preprocessing (angle correction and image stabilization), (ii) videostrobokymograms extraction (anterior, middle, and posterior regions along the glottal axis), and (iii) estimation of quantitative parameters such as open quotient (OQ), Normalized Amplitude Mean, Normalized Amplitude Difference, Amplitude Asymmetry, Lateral Phase Difference, and Asymmetry Index. Kolmogorov-Smirnov test for normality, intraclass correlation coefficient (ICC), and Bland-Altman analysis for inter-rater reliability, and Kruskal-Wallis pairwise comparison tests showed statistical inferences.

Results and discussion: Of the 70 recordings analyzed, most participants were female (87.14%) with predominantly soft nodules (91.42%). Significant differences (P < 0.05) were observed in OQ, Normalized Amplitude Mean, and Normalized Amplitude Difference across posterior and other regions of the vocal folds, with higher values in the posterior region. Other parameters showed no such region-specific differences. The ICC and Bland-Altman analysis revealed good agreement between the raters (with ICC > 0.90, P < 0.05).

Conclusion: VSK parameters such as OQ, Nw Amplitude Mean, and Nw Amplitude Difference show regional differences in bilateral vocal fold nodules. The current study also highlights the applicability of VSK in understanding the biomechanical dynamics of nodular lesions on phonatory function and vocal health.

Objective: Assessing the vocal difficulty of a composition is a challenging task. The purpose of this study is to manually evaluate 150 Western classical (WC) operatic arias in the G. Schirmer Opera Anthology series using previously established tessituragram analysis methods to generate objective measurements of the vocal difficulty found in each aria.

Methods: The melodic line of each aria in the G. Schirmer Arias for Bass, Baritone, Tenor, Mezzo-Soprano, and Soprano Volume 1 anthologies was subdivided by a universal rhythmic subdivision uniquely determined for each aria to generate equal duration weighting of the vocal pitches. The total time, time dose, rest time, cycle dose, and melodic directionality of each aria were determined using basic calculations. Quartile analysis applied to the subdivided pitches of each aria revealed musical tessitura and compositional range. Musical passaggio figures were determined by summing the percent of time in each aria where the melodic line contains pitches in generalized vocal passaggio areas. Finally, the aggregate averages of each anthology were determined using basic calculations.

Results: Arias in the Soprano anthology have the shortest total time (178.2 seconds), and arias in the Baritone anthology have the shortest time on pitch (126.3 seconds) on average. Tenor arias have the longest average time on pitch (144.2 seconds). The average cycle dose is highest in the Soprano anthology (71593.5 vibrations) and lowest in the Baritone anthology (29221.6 vibrations). Bass, Mezzo, and Soprano arias have the widest musical range, spanning 20 semitones, while Baritone and Tenor arias have the smallest musical tessitura, averaging 5 semitones. Tenor arias have a higher %p rating than those written for Bass, Baritone, Mezzo, or Soprano.

Conclusions: A teacher of singing might use the metrics in this report to better understand the inherent challenges of WC arias.

Objectives/hypothesis: The goal of this study was to determine if coexisting emotional disturbance affects Voice Handicap Index-10 (VHI-10) scores in patients with primary muscle tension dysphonia (pMTD). We hypothesize that those with emotional disturbances will have a higher perceived voice handicap, and therefore higher VHI-10 scores.

Study design: Retrospective chart review.

Methods: We reviewed the medical charts of patients diagnosed with pMTD at initial voice evaluation in 2019. We included patients in the emotional disturbances group if they self-reported depression, anxiety, or acute stress; were diagnosed with a depressive episode, major depressive disorder, anxiety disorder, or severe acute stress episode; or received a score ≥5 on the Patient Health Questionnaire-9 depression screener, indicating at least mild levels of depression. We used univariable and multivariable linear regression models to analyze the severity of VHI-10 scores, prevalence of abnormal VHI-10 scores, and compare International Classification of Diseases, Tenth Revision diagnoses and VHI-10 scores between groups.

Results: Three-hundred twenty-nine patients met the selection criteria. One-hundred nineteen patients had an emotional disturbance, and 210 patients did not. There was no significant association between higher VHI-10 scores and patients with emotional disturbances. Patients with a diagnosis of depressive episode had higher VHI-10 scores, with an average of 15.7, compared to the rest of the sample, with an average of 11.7 (P = 0.01). No association was found between higher VHI-10 scores and diagnosis of anxiety, though anxiety was the most common comorbidity with depression. An increase in age was also found to correlate with an increase in VHI-10 score, and identifying as Hispanic or Latino was correlated with lower VHI-10 scores.

Conclusions: Patients with coexisting emotional disturbance and pMTD do not have significantly higher perceived voice handicap than patients with pMTD and no emotional disturbance. Patients with pMTD and a history of depressive episode had greater perceived voice handicap.

Behavioral voice therapy and voice training often rely on auditory perceptual prompts and oral sensations to communicate the intended voice production and voice quality. Due to the subjective nature, voice quality perception and sensations vary depending on listeners' experience and do not always allow precise communication of treatment plans and training goals in clinical voice care or voice training. A possible alternative is to describe voices using the underlying anatomical and physiological configurations that are used to produce them. This approach may provide a common, objective framework that allows precise communication of the target voice production and voice quality. The goal of this study is to evaluate how accurately laryngeal and epilaryngeal configurations can be perceived by listening to the voice in the framework of the Estill Voice Model. The results show that with training focused on both physiology and auditory perception of the voice, listeners are able to perceive laryngeal and epilaryngeal configurations with an accuracy much higher than the chance level. However, our results also show that some physiological combinations are more challenging to perceive than others, which implies either anatomical or physiological constraints or conflicting/redundant acoustic consequences.

Voice disorders are multidimensional phenomena involving anatomical and physiological features alongside emotional, behavioral, and psychological aspects. Although the literature acknowledges the relevance of psychological factors in voice disorders, the structured incorporation of psychological approaches into voice therapy remains limited. This article addresses that gap by presenting a preliminary framework for integrating acceptance and commitment therapy (ACT) principles into voice therapy. ACT is a well-established psychological approach with demonstrated adaptability across various professions and contexts. The six core processes of ACT are briefly outlined and contextualized, followed by practical suggestions and clinical examples illustrating their potential application in routine voice therapy. ACT is presented as a flexible, accessible, and theoretically coherent approach that may enhance the personalization and effectiveness of voice therapy. While these suggestions are grounded in conceptual reasoning and extensive clinical experience, further research is needed to systematically examine their application and outcomes. Moreover, training models for speech-language pathologists should be developed to provide clinicians with the tools and confidence to apply ACT principles as part of their professional scope. While this article is not intended to serve as a comprehensive manual for therapy, it offers an initial conceptual framework. This preliminary contribution aims to encourage clinicians and researchers to expand the therapeutic framework of voice therapy by incorporating psychological flexibility, acceptance, and values-based action.

Objectives: Flexible nasendoscopy (FNE) is a commonly undertaken procedure in Otolaryngology, enabling a dynamic evaluation of the structure and function of the upper aerodigestive tract. Despite FNE being performed routinely in clinical practice, studies investigating the associated complications are lacking. The aim of this prospective case series is to evaluate patient experience and complications associated with FNE.

Methods: This prospective consecutive case series evaluates the experience of 143 patients undergoing assessment for laryngeal pathology. A questionnaire was given to 181 consecutive patients prior to their outpatient appointment. The forms offered the patients the opportunity to evaluate apprehension prior to FNE, perceived pain during FNE, and decisional regret following FNE, by means of visual analog scale scores. Patient-reported complications were categorized into eight domains and collected prospectively. Responses were collected and the data analyzed using GraphPad Prism Version 10.4.1 (532).

Results: Out of 181 patients, 143 (79%) answered the questionnaire. Mean apprehension score was 24.8%, mean pain score 18% and mean decisional regret score 3.7%. Eighty-eight patients (62%) experienced no complications associated with FNE. Fifty-five patients experienced between 1 and 4 complications each. Forty patients (28%) experienced gag reflex activation, 24 patients (16.8%) experienced cough, and 10 (7%) reported sore throat as a result of FNE. One patient experienced epistaxis, and no patients had vasovagal syncope. Ten patients (7%) required a topical anaesthetic to tolerate the procedure, 2 patients (1.4%) required alternative examination with a rigid nasendoscope, and for 1 patient, the procedure was abandoned due to equipment malfunction.

Conclusions: FNE is a safe, commonly performed procedure. The rate of individual complications in this prospective case series is low. This study's findings have the potential to enhance the process of informed consent by enabling clinicians to refine their practice in offering a clearer understanding of the incidence of common complications of FNE.

Level of evidence: Uncontrolled prospective case series of consecutive patients: Level IV.