Journal of Voice最新文献

Voice is a highly salient and complex signal that people use to categorize another's gender. For transmasculine individuals seeking to align their gender expression with their gender identity, vocal presentation is a major concern. Voice-gender incongruence, where one's voice does not match their gender identity, can lead to vocal strain, fatigue, emotional distress, and increased risk of suicidality. Testosterone therapy, which uses exogenous testosterone to masculinize or androgynize the voice and other secondary sexual characteristics in individuals assigned female at birth, is one method to address this issue. However, many individuals remain dissatisfied with their voice post therapy, indicating that hormonal voice modification is a complex process not fully understood. In the present study, we use unmodified voice samples from 30 transmasculine individuals undergoing testosterone therapy and utilized multivariate analysis to determine the relative and combined effects of four acoustic parameters on two measures of gender perception. The results show that transmasculine individuals' speech is perceived as equally "masculine" as that of cisgender males, with both groups being statistically categorized as male at similar rates. Although mean fundamental frequency and formant-estimated vocal tract length together account for a significant portion of the variance in gender perceptions, a substantial amount of variance in gender perception remains unexplained. Understanding the acoustic and sociolinguistic factors that contribute to masculine voice presentation can lead to more informed and individualized care for transmasculine individuals experiencing voice-gender incongruence and considering testosterone therapy. For this population, addressing voice-gender incongruence has important implications for life satisfaction, quality of life, and self-esteem.

Aim: This study aimed (i) to extract videostrobokymograms (VSK) and measure the objective metrics of vocal fold vibration from stroboscopic footage with unsteady laryngeal positions using a customized approach that utilized the Lucas-Kanade optical flow method-alongside other preprocessing methods and kymogram extraction techniques and (ii) to juxtapose the readings of Electroglottography (EGG) with the extracted VSK metrics.

Method: Sixty-three tokens of videostroboscopy and EGG were obtained from 21 phononormals. The videostroboscopic samples were then subjected to pre-processing for optimization. From the preprocessed samples, VSK were extracted at three lines of interest, ie, anterior, middle, and posterior region of the vocal folds, using a customized approach. Further, closed quotient was computed from the extracted VSK (VSK CQ) and contact quotient from the EGG waveform (EGG CQ). Wilcoxon signed-rank test and Bland-Altman plot analysis were performed to compare and determine the agreements between VSK and EGG values.

Results and discussion: VSK obtained in this study were visually similar to the VSK reported in the literature. Mean and SD of EGG CQ was (0.45 ± 0.01), and VSK CQ was (0.46 ± 0.02). The values of VSK CQ differed from the anterior to the posterior portion of the vocal folds, demonstrating variations in movement along its length. Wilcoxon signed-rank test revealed no statistically significant differences between the VSK and EGG measurements. Bland-Altman plot analysis used to compare the agreements between two measurements suggested that VSK values were in agreements with the EGG measurements.

Conclusion: The present work offers preliminary evidence that quantifiable objective measures can be calculated even from videostroboscopic footage with unsteady laryngeal positions by tailoring the VSK technique. However, assessing the clinical value of this approach is mandatory.

Objectives: This study aimed to evaluate the efficacy of injection laryngoplasty (IL) in improving voice quality in patients with unilateral vocal fold paralysis (UVFP), as measured by acoustic parameters.

Methods: A cohort of 177 patients with UVFP underwent preIL and postIL assessment using maximum phonation time (MPT), Acoustic Voice Quality Index (AVQI), and Acoustic Breathiness Index (ABI), in conjunction with auditory-perceptual (A-P) ratings and the Voice Handicap Index-10 (VHI-10).

Results: Significant improvements were observed across all acoustic and perceptual measures following IL. MPT, AVQI, and ABI, as analyzed using Praat, provided comprehensive quantification of voice recovery. All three measures showed high diagnostic accuracy, with area under the curve values of ≥ 0.73. Receiver-operating characteristic analysis identified effective cutoff values for MPT, AVQI, and ABI, confirming their predictive value for voice recovery.

Conclusion: The findings of this study support the integration of MPT, AVQI, and ABI in clinical practice for a more precise assessment of IL outcomes in patients with UVFP. Future research should involve larger sample sizes to investigate cause-specific recovery rates and the role of postIL voice therapy.

Objectives: To assess the prevalence, lifetime prevalence of voice disorders, and its association with psychosocial work factors and psychological distress among secondary school teachers.

Study design: Cross-sectional study.

Methods: Secondary data from the CLUSTer study were analyzed, which included sociodemographics, psychosocial work factors (Job Content Questionnaire-22), psychological distress (Depression Anxiety and Stress Scale-21), and outcome measure of voice (Voice Handicap Index-10).

Results: A total of 1216 teachers were included in this study. Majority of them were females (81.0%), of Malays ethnicity (63.9%), and were married (83.3%). Almost one-third of the participants experienced high occupational stress. Less than one-third of them were having depression (27.9%) and stress (21.8%). More than half had anxiety (53.9%). The prevalence of voice disorders was 11.2% [95% confidence interval (CI): 8.9, 14.1], and the lifetime prevalence of voice disorders was 52.4% (95% CI: 48.8, 56.0). Participants with depression (aOR = 2.50, 95% CI: 1.48, 4.22), anxiety (aOR = 2.08, 95% CI: 1.05, 4.13), and stress (aOR = 1.94, 95% CI: 1.11, 3.40) were associated with voice disorders. Psychosocial work factors such as occupational stress, supervisor support, and coworker support were not associated with voice disorders.

Conclusion: Psychological distress is associated with the prevalence of voice disorders among secondary school teachers. These findings can be utilized in developing, designing, and implementing interventions or programs to reduce voice disorders for school teachers.

Objectives: Vocal fatigue is a common hyperfunctional voice condition, particularly among speech-language pathologists (SLPs), due to their high vocal demands. This study compared the immediate effects of semi-occluded vocal tract (SOVT) exercises and vocal facilitating techniques (VFTs) on the vocal function of SLPs with vocal fatigue, emphasizing multidimensional voice assessments.

Study design: Single-blind randomized clinical trial.

Methods: Twenty-six SLPs and senior speech therapy students with vocal fatigue were randomly assigned to SOVT or VFT groups. Participants performed four techniques for approximately 40 minutes. Vocal outcomes, including single-dimension (jitter, shimmer, harmonic-to-noise ratio [HNR], and Cepstral Peak Prominence Smoothed [CPPS]) and multiparametric (Acoustic Voice Quality Index [AVQI], Acoustic Breathiness Index [ABI]) acoustic measures, as well as maximum performance task and auditory-perceptual parameters, were evaluated before and immediately after treatment. Within-group and between-group comparisons were conducted.

Results: SOVT exercises significantly improved single-dimension acoustic parameters, including jitter, shimmer, and HNR and auditory-perceptual dysphonia severity within the group (P < 0.05). Between-group analysis showed a greater reduction in jitter and auditory-perceptual severity in the SOVT group compared with the VFT group (P < 0.05). However, multiparametric acoustic indices, including AVQI and ABI, showed no significant changes in either group, suggesting that longer interventions may be necessary to impact connected speech.

Conclusions: SOVT exercises showed immediate improvements in acoustic and auditory-perceptual measures for SLPs with vocal fatigue, making them a promising short-term intervention. However, while sustained vowel analysis revealed significant changes, connected speech analysis did not show similar improvements, highlighting the importance of assessing real-world vocal function. In contrast, VFT techniques likely require longer durations to yield significant effects. Future research should explore extended treatments with multiparametric measures to better understand their efficacy for professional voice users.

Objectives: This study aims to validate and assess the reliability of the Arabic version of the Newcastle Laryngeal Hypersensitivity Questionnaire (LHQ) as a self-reported questionnaire for patients with laryngeal hypersensitivity syndrome (LHS).

Study design: A prospective, observational, cross-sectional study was conducted in the ear, nose and throat Department of Kafr Elsheikh University Hospitals.

Methods: The preliminary Arabic version of the LHQ (LHQ-Ar) was created using a rigorous forward and backward translation method. Native Arabic-speaking patients visiting outpatient pulmonology, speech pathology, and ear, nose and throat clinics in this tertiary referral center were invited to participate. Participants were divided into two groups: group 1, comprising patients with LHS, and group 2, consisting of healthy controls. All participants completed the LHQ-Ar questionnaire twice, with a two-week interval, to assess test-retest reliability. Additionally, LHS patients completed the Arabic Voice Handicap Index-10 to examine correlations with LHQ-Ar scores. The LHQ-Ar underwent rigorous testing for internal consistency, reliability, validity, sensitivity, and specificity to establish it as a validated patient questionnaire.

Results: The KMO test (KMO = 0.955) and Bartlett's test (P < 0.001) confirmed the sample's adequacy. The analysis identified only one factor with an eigenvalue greater than one, which explained 63.4% of the total variance. Items 13 (0.372) and 14 (0.306), which had commonalities below 0.5, were excluded. The final model, consisting of 12 items, accounted for 68.7% of the variance. Cronbach's alpha coefficients ranged from 0.933 to 0.988 for individual items and 0.995 for the total score, indicating excellent internal consistency.

Conclusion: The Arabic version of the Newcastle LHQ (LHQ-Ar) proves to be a reliable and valid tool for assessing LHS in Arabic-speaking populations. The LHQ-Ar shows strong internal consistency, test-retest reliability, and good sensitivity and specificity in predicting LHS, thus making it a valuable instrument for clinical use and research in Arabic-speaking patients.

Objective: This study investigates the effects of dehydration induced by dry air breathing and the nebulization of various osmotic agents on vocal parameters, including perceptual, acoustic, and electroglottographic measures.

Methods: Thirty normophonic females (age x̅ = 26, SD = 1.67) participated over three consecutive days. On the first day, the baseline data were meticulously collected before the participants underwent a 22-minute session of transoral dry air breathing. Immediately after this desiccation protocol, measurements were taken to establish the initial effects. Subsequently, one of three osmotic agents was randomly selected for each participant. These agents included hypotonic distilled water, 0.9% isotonic saline, and 3% hypertonic saline. Each participant then underwent a 10-minute nebulization session with 5 mL of the assigned osmotic agent. The process was repeated on the second and third days. Each day, the participants again experienced the 22-minute transoral dry air breathing session. The evaluations were performed by Borg CR-10 (perceived vocal effort), electroglottography (EGG), voice onset time (VOT), nasalance score (NS), and cepstral peak prominence analyses with CAPE-V sentences (s).

Results: No statistically significant differences were found in the EGG parameters between the preliminary recordings, post transoral medical-grade dry air protocol, and after each of task-hypotonic, task-isotonic, and task-hypertonic. Following the transoral medical-grade dry air protocol, both /s1/-CPP and /s5/-CPP values decreased compared with the preliminary recordings. Only /s1/-CPP values increased after the 0.9% isotonic saline nebulization. NS from preliminary measurements was higher for both oronasal and nasal texts compared with scores after the dry air protocol and nebulization. Voiceless plosive VOT values decreased solely after the 0.9% isotonic saline nebulization. Participants' Borg CR-10 scores increased after transoral medical-grade dry air protocol and decreased after nebulization with distilled water and 0.9% isotonic saline.

Conclusions: Isotonic saline and distilled water nebulization protocols demonstrated a trend toward mitigating the adverse effects of the transoral medical-grade dry air inhalation protocol on vocal parameters.

Vocal training is a crucial component in developing a singer's vocal capabilities. It enhances the vocal quality and improves the overall vocal health. Through consistent practice and well-structured exercises, singers can achieve high control, clarity, and expressiveness. In this research, we aim to investigate the impact of a structured vocal training program on older choristers. This research includes 18 older choral singers (with ages above 50 years), randomly assigned to either the study group or control group. Data were gathered through pretest and post test assessments of vocal function using perceptual voice analysis, self-assessments, and acoustic evaluation. The vocal training program was exclusively performed for the study group. Additionally, participant feedback and program effectiveness were collected through structured interviews. Respondents in the study group indicated substantial improvements in perceptual roughness, vocal clarity, jitter, shimmer, and pitch accuracy following the training session. However, assessments of subjective breathiness and effort, as well as phonational frequency range, revealed no significant differences. The participants also reported that the training program had a favorable impact on their voices. Overall, the findings suggest that structured vocal training can significantly enhance certain aspects of vocal performance in choristers. This research highlights the potential benefits of vocal training programs for improving vocal health and performance quality for older choristers.

Purpose: Voice pathology detection is a rapidly evolving field of scientific research focused on the identification and diagnosis of voice disorders. Early detection and diagnosis of these disorders is critical, as it increases the likelihood of effective treatment and reduces the burden on medical professionals.

Methods: The objective of this scientific paper is to develop a comprehensive model that utilizes various deep learning techniques to improve the detection of voice pathology. To achieve this, the paper employs several techniques to extract a set of sensitive features from the original voice signal by analyzing the time-frequency characteristics of the signal. In this regard, as a means of extracting these features, a state-of-the-art approach combining Gammatonegram features with Scalogram Teager_Kaiser Energy Operator (TKEO) features is proposed, and the proposed feature extraction scheme is named Combine Gammatonegram with (TKEO) Scalogram (CGT Scalogram). In this study, ResNet deep learning is used to recognize healthy voices from pathological voices. To evaluate the performance of the proposed model, it is trained and tested using the Saarbrucken voice database.

Results: In the end, the proposed system yielded impressive results with an accuracy of 96%, a precision of 96.3%, and a recall of 96.1% for binary classification and an accuracy of 94.4%, a precision of 94.5%, and a recall of 94% for multi-class.

Conclusion: The results of the experiments demonstrate the effectiveness of the feature selection technique in maximizing the prediction accuracy in both binary and multi-class classifications.

Objectives: This retrospective, observational analytic, cross-sectional research study aimed to establish cut-off scores for categorizing the severity of voice qualities on a 100-unit visual analog scale (VAS). The study investigated the VAS cut-off ranges corresponding to auditory-perceptual ratings of normal, mild, moderate, and severe severities from the GRBAS scale for overall severity, breathiness, roughness, and strain.

Methods: The study utilized voice samples and ratings from the Perceptual Voice Qualities Database (PVQD). The database contains 296 audio samples, including sustained vowels and sentences, rated by 19 experienced voice clinicians. The raters used a 100-point VAS and the GRBAS scale to evaluate voice qualities. Receiver operator curves (ROC) were calculated to determine cut-off scores for each severity category, balancing a 90% sensitivity with a 10% allowable false-positive categorization.

Results: Cut-off ranges were established for overall severity, breathiness, and roughness, demonstrating similar values across severities. The ranges were: Overall severity: normal (0-15), mild (16-39), moderate (40-69), severe (70-100). Breathiness: normal (0-14), mild (15-34), moderate (35-68), severe (69-100). Roughness: normal (0-13), mild (14-37), moderate (38-65), severe (66-100). For strain, only the normal range (0-15) could be determined with statistical significance.

Conclusions: This study provided clinically relevant cut-off values for severity categories on a VAS, enhancing communication with patients and facilitating the use of both sensitive and specific categorical measures in voice evaluation. The findings contribute to a more standardized and objective assessment of voice quality.