Journal of Voice最新文献

Objectives: Altered respiratory kinematics are thought to contribute to primary muscle tension dysphonia (pMTD) symptoms such as vocal effort, fatigue, and discomfort. Although speech-language pathologists (SLPs) often comment on respiratory patterns during voice evaluations, it remains unclear which visual-perceptual cues they rely on for clinical decision-making and how accurate these patterns are for identifying patients with pMTD. As such, this study aimed to (1) identify the respiratory patterns SLPs perceive in pMTD and (2) evaluate their diagnostic accuracy in distinguishing pMTD from vocally healthy controls.

Methods: Forty-six participants (21 pMTD, 25 controls) performed voice tasks varying in intensity and articulatory complexity, while six synchronized cameras captured perilaryngeal-respiratory movements. Five blinded, fellowship-trained SLPs rated breathing normality, severity (0-10), presence of pMTD (Y/N), and confidence (0-10). Open-ended responses were analyzed using natural language processing (NLP) and reflexive content analysis (RCA).

Results: NLP analysis identified five visual-perceptual respiratory features: abdominal, anterior neck tension, clavicular, thoracic, and suboptimal breathing-none of which reliably distinguished pMTD from vocally healthy controls (average diagnostic accuracy = 60%; d' ≤ 1.04). RCA methods yielded three categories: Observable Features of Movement and Breathing, Perceived Patient Experiences, and Interpreting and Evaluating Data.

Conclusion: Observable respiratory patterns were inconsistently linked to diagnostic accuracy. Visual observation alone appears insufficient for reliably identifying pMTD, underscoring the need for multimodal physiological approaches to improve diagnostic specificity.

While binary discrimination between healthy and pathological voices provides initial screening capability, clinical utility requires accurate multi-class classification to distinguish between different pathology types. This paper presents a novel Auditory Feature Extraction (AFE) approach, inspired by auditory perception mechanisms, for a robust multi-class pathological voice recognition (PVR) system. The proposed approach uses a Gammachirp FilterBank (GCFB) to accurately simulate the spectral behavior of the cochlea. This FilterBank is considered an efficient auditory filter model and contains 128 Gammachirp auditory filters with center frequencies equally distributed according to the Equivalent Rectangular Bandwidth-rate scale. The GCFB output undergoes decimation, cubic-root amplitude compression, and then Discrete Cosine Transform to finally generate the AFE coefficients. We evaluated the performance of the proposed AFE approach for PVR using Hidden Markov Model Toolkit on two widely recognized datasets: the Saarbruecken Voice Database (SVD) and the Massachusetts Eye and Ear Infirmary (MEEI) dataset. Our AFE outperforms state-of-the-art approaches as revealed by assessment results compared to Human Factor Cepstral Coefficients (HFCC), Frequency Domain Linear Prediction (FDLP), and Mel-Frequency Cepstral Coefficients (MFCC). AFE approach achieves 99.75% balanced accuracy in binary voice classification (95.6%, 94.8%, and 93.85% for HFCC, FDLP, and MFCC, respectively) and 94.38% balanced accuracy in multi-class pathologic voice classification (72.93%, 69.66%, and 60.03% for HFCC, FDLP, and MFCC, respectively) on the SVD dataset, while accomplishing 100% balanced accuracy on the MEEI database. These findings suggest the AFE approach provides a robust and highly discriminative feature set that could lead to an improved voice pathology classification, then a better clinical screening of voice disorders.

Background: Transmasculine patients generally benefit from medical treatment using hormonal therapy for their transition process. However, up to 20% of transgender men report dissatisfaction with their voice pitch after hormonal therapy. Voice therapy is usually the next appropriate step. Surgical and procedural interventions are a last resort when the pitch remains too elevated for transmasculine patients; however, their effectiveness for voice masculinization is not well characterized.

Objectives: To review surgical and procedural options for voice masculinization in the literature.

Methods: Two independent reviewers completed a scoping review of literature studying surgical and procedural interventions for voice masculinization. Because of the limited studies available, databases were also searched for surgical and procedural outcomes for puberphonia. Initial fundamental frequency, initial nonprocedural treatment, clinical symptoms, intervention, outcomes, and complications were gathered from included studies.

Results: The search for surgical and procedural interventions for voice masculinization yielded 34 articles, and 4 articles were included in the study. Regarding puberphonia, 21 articles were screened, and 8 articles were included in the study. Surgical and procedural treatments for voice masculinization included type III laryngoplasty (3 articles) and direct vocal fold injection with testosterone (1 article). For the 12 transmasculine patients, voice deepening ranged from -3 to -67 Hz with an average of -43.75 Hz. Additional treatments described for puberphonia included modifications in the type III laryngoplasty, injection laryngoplasty, and Botox injection. Voice deepening for the 44 puberphonia patients ranged from -12.25 to -175 Hz with an average of -68.61 Hz. Only 6 of the 56 puberphonia patients had complications, all of which were transient.

Conclusion: Conservative measures often succeed in achieving voice masculinization. Our review describes the best results in voice deepening with type III laryngoplasty. Although less effective at voice deepening, less invasive methods like injection laryngoplasty with testosterone or hyaluronic acid also appear promising.

Objective: Human voice arises from the glottal source being shaped and modified by the resonances of the vocal tract (VT). Reconstructing this interaction from mummified or surgically altered anatomy poses a significant challenge. In this study, we aimed to recreate the phonatory potential of King Henri IV of France (1553-1610) through a functional three-dimensional (3D) reconstruction of his preserved head and neck, providing insights into vowel production in altered vocal anatomy.

Methods: The embalmed head and neck of King Henri IV provided a unique opportunity to model historical phonation. Using high-resolution computed tomography imaging, all craniofacial and cervical structures were manually segmented in ITK-SNAP 4.0 by two independent operators following validated protocols. Mesh refinement was performed in Mesh Mixer® without altering anatomical integrity. Digital reconstruction and anatomical repositioning (including mandibular closure, vertebral alignment, and articulation correction) were achieved in Fusion 360® and reviewed by a multidisciplinary panel. Acoustic simulations were conducted on both digital and 3D-printed models to assess vowel-like sound production.

Results: The physical reconstruction of King Henri IV's head and VT enabled the generation of distinct vowel-like sounds. Initial digital simulations produced vowels comparable to /u/ (F1 = 446 Hz, F2 = 1055 Hz, F3 = 2360 Hz), /a/ (F1 = 582 Hz, F2 = 1556 Hz, F3 = 2557 Hz), /i/ (F1 = 340 Hz, F2 = 2144 Hz, F3 = 2841 Hz), and /œ/ (F1 = 540 Hz, F2 = 1530 Hz, F3 = 2545). The 3D-printed model reproduced /a/ (F1 = 588 Hz, F2 = 1109 Hz, F3 = 2585 Hz) and /u/ (F1 = 427 Hz, F2 = 880 Hz, F3 = 2452 Hz) with realistic resonance patterns producing a comparative vowel chart.

Conclusion: This study demonstrates that combining advanced imaging, digital modeling, and 3D printing can restore plausible phonatory behavior from preserved or altered anatomy. Such interdisciplinary methodology has potential translational applications in phonatory modeling, surgical voice rehabilitation, and laryngeal function research.

Objective: To review the current literature linking laryngopharyngeal reflux disease (LPRD) with microbiome impairments.

Methods: Two independent investigators conducted a systematic literature search for studies reporting microbiome findings in LPRD patients through PubMed, Scopus, and Cochrane Library databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and the Population, Intervention, Comparison, Outcome, Timing, and Setting (PICOTS) framework were followed. A methodological bias analysis was conducted with the Tool to Assess the Risk of Bias in Cohort Studies.

Results: Of the 585 identified papers, eight studies met the inclusion criteria, including 245 patients with suspected or confirmed LPRD. Two studies using objective diagnostic approaches confirmed that LPRD is associated with significantly reduced alpha and beta diversities compared to controls. Streptococcus and Actinomyces emerged as key taxa consistently differentiating LPRD patients from controls across multiple studies. However, significant methodological heterogeneity was observed in LPRD diagnosis, microbiome assessment methods, and control group definitions.

Conclusion: Preliminary literature suggests that patients with suspected or confirmed LPRD exhibit salivary microbiome alterations characterized by reduced diversity and selective microbial shifts. Future high-quality methodological studies are needed to elucidate the mechanistic relationship and clinical consequences of LPRD-related dysbiosis.

Objective: Traditional Iranian singing involves demanding vocal techniques that increase the risk of muscle tension dysphonia (MTD). This study compared the immediate effects of Semi-Occluded Vocal Tract (SOVT) exercises and Vocal Facilitating Techniques (VFTs) on the vocal function of traditional Iranian singers diagnosed with MTD.

Study design: Single-session randomized clinical trial.

Method: Twenty-six Persian-speaking singers with MTD (mean age = 32.31 ± 5.51 years) were randomly assigned to SOVT (n = 13) or VFT (n = 13) groups. Each participant completed a single 1-hour intervention session including four techniques. Acoustic measures included the Acoustic Voice Quality Index (AVQI) and Acoustic Breathiness Index (ABI), and auditory-perceptual evaluation used the Persian version of the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V). Pre- and post-intervention data were compared using mixed-design repeated-measures ANOVA.

Results: Both groups demonstrated significant improvements in AVQI, ABI, and overall dysphonia severity after intervention (P < 0.05). Between-group comparisons revealed that the SOVT group achieved significantly greater reductions in ABI (P < 0.001), indicating superior improvement in breathiness, while changes in AVQI and dysphonia severity did not differ significantly between groups.

Conclusion: Both SOVT and VFT approaches led to immediate improvements in vocal quality among traditional Iranian singers with MTD. While SOVT exercises showed a greater reduction in breathiness, both methods were effective overall. These findings support the clinical utility of both techniques and highlight the potential of SOVT for addressing breathiness. Further research is needed to explore long-term outcomes and integrated treatment strategies tailored to professional voice users.

Objectives: To quantify characteristics of laryngeal electromyography with the laryngeal motor conduction study (LMCS) for evaluating laryngeal nerve injury.

Methods: This study included 809 patients with unilateral vocal fold paralysis. Quantitative parameters were measured on abnormal spontaneous activity, motor unit potential (MUP), recruitment patterns, and synkinesis of the affected thyroarytenoid (TA), posterior cricoid (PCA), and cricothyroid (CT) muscles. The proportion of recorded compound muscle action potential in LMCS was calculated to further divide muscles into LMCS+ and LMCS- groups, between which cut-off values for recruitment patterns were determined.

Results: In laryngeal muscles, amplitudes of fibrillation potentials were 90-100 μV and durations were 2.2-2.4 milliseconds, which were of 80-90 μV and durations of 4.8-5.0 milliseconds in positive sharp waves. Amplitudes of abnormal MUP showed increased amplitude compared to the normal, with prolonged durations of 6.16 ± 1.02 milliseconds, 6.57 ± 1.32 milliseconds, and 6.19 ± 1.19 milliseconds (P < 0.01). The amplitude and turns of abnormal recruitment were significantly smaller than those of normal laryngeal muscles (P < 0.01), with turns in the mixed and simple pattern being 30% and 20-25% of the full interference pattern, respectively. In mixed patterns, the LMCS- group exhibited smaller amplitudes, with cut-off values at 298.50 μV, 355.00 μV and 379.50 μV for TA, PCA and CT muscles.

Conclusions: Amplitude and duration are critical parameters for identifying abnormal spontaneous activity and MUP in laryngeal muscles, with duration being of higher specificity. Combined with LMCS-derived cut-off values for amplitude, the reduced turns can help distinguish recruitment patterns to assess the degree of laryngeal nerve injury.

Background: Subjective assessment of voice and speech disorders, often based on hoarseness or breathiness, suffers from limited interrater reliability. Objective, composite metrics-such as the acoustic voice quality index (AVQI) and the acoustic breathiness index (ABI)-offer more consistent and reproducible alternatives for diagnosis and monitoring, although they show some sensitivity to recording conditions.

Aim: The aim of this study is to analyze the contributions and dependencies of individual acoustic parameters to composite metrics. Building on this, the influence of room acoustics on objective measures and their parameters is systematically investigated.

Methods: Using close-microphone recordings with negligible reverberation, the contribution of individual parameters to the composite measures was determined through variance and value range analyses. In 35 speech and language therapy (SLT) rooms, acoustic parameters such as reverberation time, impulse response, and background noise were measured. Their influence on objective measures from real voice samples was analyzed using mixed linear regression.

Results: Variance analyses show that, in particular, smoothed cepstral peak prominence (CPPS) substantially contributes to the predictive power of the composite measures and has a dominant influence on the investigated voice quality metrics. The results also demonstrate a strong impact of room acoustics on measurement accuracy - especially for mildly pathological voices and for reverberant speech recordings. Reverberation time and clarity measures were found to be crucial influencing factors and predictors.

Conclusions: The investigated voice quality measures are largely determined by CPPS. However, CPPS is heavily influenced by room acoustic properties, which can cause unreliable prediction with indices such as AVQI and ABI. Despite these limitations, CPPS remains a strong predictor of perceptual grading and breathiness. For reliable use of objective voice quality metrics in clinical settings, standardization or optimization of recording conditions, or development of more robust analytical methods, is essential. These findings support the refinement of objective voice diagnostics and promote evidence-based approaches in SLT.

Objectives: Tonsillar hypertrophy can alter the vocal tract; however, the potential effects of partial and total tonsillectomy on pediatric voice characteristics have been relatively understudied compared to their impact on sleep-related problems and the management of tonsillitis. This study aimed to compare the effects of partial and total tonsillectomy on voice characteristics in pediatric patients over the first three postoperative months.

Methods: Forty-four children (4-12 years) undergoing total (n = 22) and partial (n = 22) tonsillectomy were evaluated preoperatively and at 1 and 3 months postoperatively. Voice outcomes were assessed using both subjective (Pediatric Voice Handicap Index [pVHI]) and objective measures, including Multi-Dimensional Voice Program parameters, cepstral analyses, and formant frequency evaluations.

Results: Both groups demonstrated a significant reduction in pVHI scores (P < 0.001) and mean fundamental frequency (F0) values (P = 0.037 for total, P = 0.006 for partial tonsillectomy), while jitter, shimmer, noise-to-harmonic ratio, and cepstral measures showed no significant postoperative changes. Formant frequency shifts, particularly in F1 and F2 of /i/, were more pronounced after total tonsillectomy, indicating subtle resonance alterations.

Conclusion: Tonsillectomy influences vocal output by reducing vocal tract resistance and lowering F0, even without direct vocal fold involvement. Preoperative counseling is recommended, particularly for children or parents concerned about potential resonance changes, as total tonsillectomy may cause subtle alterations in vocal tract resonance despite the absence of direct vocal fold involvement.

Introduction: There is evidence to suggest physiological impacts of seasonal allergic rhinitis (SAR) on the singing voice. Yet there is limited evidence surrounding the subsequent impact on perceived singing vocal quality from the perspective of singers.

Objectives: To investigate the impacts of SAR on the perceived vocal quality of adult choral/choir singers in Australia.

Study design: Quantitative cohort study design.

Methods: An anonymous online questionnaire was administered to professional and amateur singers in choral or choir contexts, with participant recruitment realized through active snowballing.

Results: A total of 32 participants completed the surveys: five (16%) professional singers, three (9%) teachers or instructors, three (9%) music students and 21 (66%) amateur choir/singing group singers. Twenty-six participants were identified as having SAR. Participants with SAR reported a greater frequency of negative vocal experiences impacting personal vocal performance and reported more severe challenges presented in their ability to sing than those without SAR symptoms. No significant difference was exhibited between male and female participants. Of the 26 participants with SAR, 13 (50%) reported using medication to treat symptoms. No difference was exhibited between participants who medicate for SAR and those who do not.

Conclusions: This study indicates a correlation between SAR-related vocal pathologies and the perceived impact on vocal performance and quality of life. Further research is needed to consider the impact of medication on a singer's vocal performance and ability to sing.