Dictamen médico legal de un análisis de voz, ¿cómo hacerlo? / Medical legal opinion of a voice analysis, how to do it?

La acústica forense es una disciplina de la criminalística que ha alcanzado una ma-durez analítica que obliga a que el perito en análisis de voz se especialice en adquirir conocimientos en fonética, tecnologías de sonido, habla, voz, lenguaje, patologías del habla y la voz, así como procesamiento de la señal sonora. Cuando un dictamen deba ser realizado por un profesional de la salud completamente ajeno a la técnica legal, se tropieza con una falta de protocolos, métodos y procedimientos de trabajo que le permitan entregar un informe técnico, válido y validado para la realización de una entrevista y su posterior análisis comparativo de voces, lo que promueve la necesidad de elaborar una ruta o guía metodológica a través de medios académicos físicos o electrónicos para el desarrollo de este conocimiento y su difusión profesional y científica

Forensic acoustics is a criminalistics discipline that has reached an analytical maturity that requires the expert in voice analysis to specialize in acquiring knowledge in pho-netics, sound technologies, speech, voice, language, speech, and voice pathologies, as well as sound signal processing. When an opinion must be made by a health profes-sional completely unrelated to the legal technique, he encounters a lack of protocols, methods, and work procedures that allow him to deliver a technical, valid, and vali-dated report for conducting an interview and its subsequent comparative analysis of voices, which promotes the need to develop a methodological route or guide through physical or electronic academic means for the development of this knowledge and its professional and scientific dissemination

Voice analysis of early glottic carcinoma treated by carbon dioxide laser / 临床耳鼻咽喉头颈外科杂志

Objective@#The aim of this study is to investigate the effect of CO2 laser cordectomy on the voice of early glottic carcinoma. @*Method@#A retrospective analysis of 40 patients who underwent CO2 laser treatment early glottis preoperative clinical data of postoperative laryngeal cancer patients, patients with postoperative recurrence rate, survival rate, and the postoperative complications of patients with preoperative and postoperative laryngoscopy, voice disorders index（voice handicap index, VHI） simplified Chinese version（VHI 13） rating scale, affecting the stability sound quality postoperatively in patients with laryngeal cancer were discussed. @*Result@#All patients underwent voice reexamination 8-97 months after surgery, and the survival rate was 100%, no local recurrence and no obvious postoperative complications. Compared with the healthy control group, there were statistically significant differences in the four indicators F0（fundamental frequency）, Jitter（fundamental frequency perturbation）, Shimmer（amplitude perturbation） and MPT（maximum pronunciation time）, suggesting that CO2 laser surgery resulted in significant changes in acoustic parameters. Jitter and Shimmer indexes in the pre involved combined group were statistically significant different from those in the non involved combined group, suggesting that the sound quality of the pre involved combined group was worse in the postoperative stability period. The VHI score indicated that most patients with early glottic cancer were in severe voice disorder before operation and most were in moderate voice disorder after operation. Compared with the healthy control group, the VHI score and total score of the healthy control group were lower in terms of physiology, psychology and emotion. Compared with the healthy control group, the VHI score and physiology of the early glottic laryngeal cancer patients were lower in the early glottic laryngeal cancer patients before and after surgery, and they were statistically significant. @*Conclusion@#CO2 laser surgery for early glottic cancer, the overall survival rate of patients, low recurrence rate, fewer complications, CO2 laser surgery led to significant changes in acoustic parameters, postoperative sound quality and whether the involvement of pre-associated factors; The total score of VHI and physiological score of early glottic carcinoma patients after CO2 laser operation were better than those before operation.

Voice analysis of early glottic carcinoma treated by carbon dioxide laser / 临床耳鼻咽喉头颈外科杂志

The aim of this study is to investigate the effect of CO2 laser cordectomy on the voice of early glottic carcinoma. A retrospective analysis of 40 patients who underwent CO2 laser treatment early glottis preoperative clinical data of postoperative laryngeal cancer patients, patients with postoperative recurrence rate, survival rate, and the postoperative complications of patients with preoperative and postoperative laryngoscopy, voice disorders index（voice handicap index, VHI） simplified Chinese version（VHI 13） rating scale, affecting the stability sound quality postoperatively in patients with laryngeal cancer were discussed. All patients underwent voice reexamination 8-97 months after surgery, and the survival rate was 100%, no local recurrence and no obvious postoperative complications. Compared with the healthy control group, there were statistically significant differences in the four indicators F0（fundamental frequency）, Jitter（fundamental frequency perturbation）, Shimmer（amplitude perturbation） and MPT（maximum pronunciation time）, suggesting that CO2 laser surgery resulted in significant changes in acoustic parameters. Jitter and Shimmer indexes in the pre involved combined group were statistically significant different from those in the non involved combined group, suggesting that the sound quality of the pre involved combined group was worse in the postoperative stability period. The VHI score indicated that most patients with early glottic cancer were in severe voice disorder before operation and most were in moderate voice disorder after operation. Compared with the healthy control group, the VHI score and total score of the healthy control group were lower in terms of physiology, psychology and emotion. Compared with the healthy control group, the VHI score and physiology of the early glottic laryngeal cancer patients were lower in the early glottic laryngeal cancer patients before and after surgery, and they were statistically significant. CO2 laser surgery for early glottic cancer, the overall survival rate of patients, low recurrence rate, fewer complications, CO2 laser surgery led to significant changes in acoustic parameters, postoperative sound quality and whether the involvement of pre-associated factors; The total score of VHI and physiological score of early glottic carcinoma patients after CO2 laser operation were better than those before operation.

Aplicaciones clínicas del análisis acústico de la voz / Clinical applications of acoustic voice analysis

El análisis acústico de la voz es un método de evaluación vocal objetivo y no invasivo, utilizado con fines diagnósticos, terapéuticos e investigativos. Utiliza registros acústicos obtenidos directamente de la voz del paciente mediante el uso de un micrófono profesional. Existe una gran variedad de programas y métodos de graficación disponibles, que favorecen la versatilidad y especificidad del proceso. Esta revisión muestra los métodos de graficación de la voz más utilizados.

The acoustic voice analysis is an objective and non invasive vocal assessment method, used for voice diagnosis, therapy and research. It uses acoustic records obtained from the patient's voice using professional microphones. There is a variety of softwares and graphing programs available that allows process versatility and specificity. This review presents the most utilized methods of voice graphing.

Differentiation of Adductor-Type Spasmodic Dysphonia from Muscle Tension Dysphonia Using Spectrogram

BACKGROUND AND OBJECTIVES: Adductor type spasmodic dysphonia (ADSD) is neurogenic disorder and focal laryngeal dystonia, while muscle tension dysphonia (MTD) is caused by functional voice disorder. Both ADSD and MTD may be associated with excessive supraglottic contraction and compensation, resulting in a strained voice quality with spastic voice breaks. The aim of this study was to determine the utility of spectrogram analysis in the differentiation of ADSD from MTD. MATERIALS AND METHODS: From 2015 through 2017, 17 patients of ADSD and 20 of MTD, underwent acoustic recording and phonatory function studies, were enrolled. Jitter (frequency perturbation), Shimmer (amplitude perturbation) were obtained using MDVP (Multi-dimensional Voice Program) and GRBAS scale was used for perceptual evaluation. The two speech therapist evaluated a wide band (11,250 Hz) spectrogram by blind test using 4 scales (0–3 point) for four spectral findings, abrupt voice breaks, irregular wide spaced vertical striations, well defined formants and high frequency spectral noise. RESULTS: Jitter, Shimmer and GRBAS were not found different between two groups with no significant correlation (p>0.05). Abrupt voice breaks and irregular wide spaced vertical striations of ADSD were significantly higher than those of MTD with strong correlation (p < 0.01). High frequency spectral noise of MTD were higher than those of ADSD with strong correlation (p < 0.01). Well defined formants were not found different between two groups. CONCLUSION: The wide band spectrograms provided visual perceptual information can differentiate ADSD from MTD. Spectrogram analysis is a useful diagnostic tool for differentiating ADSD from MTD where perceptual analysis and clinical evaluation alone are insufficient.

Analysis of Acoustic Parameters to Objectively Reflect the Change of Voice Quality before and after Surgery in Benign Vocal Fold Mucosal Disorders / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The aim of this study was to compare between preoperative and postoperative voices by subjective auditory perceptual evaluation and objective acoustic analysis. The study also analyzed the acoustic parameters that best reflected the auditory perceptual characteristics in laryngeal microsurgery. SUBJECTS AND METHOD: The records of 49 patients who had been diagnosed as benign vocal fold mucosal diseases and had undergone laryngeal microsurgery were retrospectively analyzed. Preoperative and postoperative voices were assessed by auditory perceptual evaluation using the GRBAS Scale and acoustic analysis using Multi-Dimensional Voice Program (MDVP) and Analysis of Dysphonia in Speech and Voice (ADSV). Correlation between auditory perceptual characteristics and acoustic parameters was analyzed. RESULTS: Auditory perceptual evaluation showed that the patients' voices were improved after the operation. Several acoustic parameters of MDVP related to short-term and long-term variability showed significant improvement. Also, there were significant differences in several cepstral/spectral parameters of ADSV after operation. In the correlation analysis, the overall grade (G) of the GRBAS Scale showed highest correlation with the cepstral spectral index of dysphonia (CSID) (r=-0.700). The roughness (R) of GRBAS Scale was correlated with the smoothed amplitude perturbation quotient of long-term variability of MDVP (r=0.468), breathiness (B) with cepstral peak prominence (r=-0.703) and strain (S) with CSID (r=0.650) (p<0.01). CONCLUSION: Our results showed that the acoustic parameters were related to the long-term variability of MDVP, and the parameters of cepstrum/spectrum were useful for the objective assessment of voice quality in patients who received laryngeal microsurgery. These parameters were also useful for the quantification of voice quality and abnormality of phonation.

Objective Voice Parameters in Colombian School Workers with Healthy Voices / Parámetros objetivos de la voz de trabajadores escolares colombianos con voces saludables / Parâmetros de voz objetivas de funcionários da escola colombianos com vozes saudáveis

Objectives: To characterize the objective voice parameters among school workers, and to identify associated factors of three objective voice parameters, namely fundamental frequency, sound pressure level and maximum phonation time. Materials and methods: We conducted a cross-sectional study among 116 Colombian teachers and 20 Colombian non-teachers. After signing the informed consent form, participants filled out a questionnaire. Then, a voice sample was recorded and evaluated perceptually by a speech therapist and by objective voice analysis with PRAAT software. Short-term environmental measurements of sound level, temperature, humidity, and reverberation time were conducted during visits at the workplaces, such as classrooms and offices. Linear regression analysis was used to determine associations between individual and work-related factors and objective voice parameters. Results: Compared with men, women had higher fundamental frequency (201 Hz for teachers and 209 for non-teachers vs. 120 Hz for teachers and 127 for non-teachers) and sound pressure level (82 dB vs. 80 dB), and shorter maximum phonation time (around 14 seconds vs. around 16 seconds). Female teachers younger than 50 years of age evidenced a significant tendency to speak with lower fundamental frequency and shorter MPT compared with female teachers older than 50 years of age. Female teachers had significantly higher fundamental frequency (66 Hz), higher sound pressure level (2 dB) and short phonation time (2 seconds) than male teachers. Conclusion: Female teachers younger than 50 years of age had significantly lower F0 and shorter MPT compared with those older than 50 years of age. The multivariate analysis showed that gender was a much more important determinant of variations in F0, SPL and MPT than age and teaching occupation. Objectively measured temperature also contributed to the changes on SPL among school workers.

Objetivos: Caracterizar los parámetros objetivos de la voz en trabajadores escolares e identificar los factores asociados de tres parámetros objetivos de la voz (frecuencia fundamental, presión sonora y tiempo máximo de fonación). Materiales y métodos: Estudio transversal en el que participaron 116 profesores y 20 no profesores colombianos. Después de firmar el consentimiento informado, los participantes diligenciaron un cuestionario. Posteriormente, grabaron una muestra de voz, la cual fue analizada, perceptualmente, por una fonoaudióloga y, objetivamente, con el software PRAAT. Se realizaron mediciones ambientales de niveles de ruido, temperatura, humedad y tiempos de reverberación durante las visitas a los lugares de trabajo, tales como salones y oficinas. Análisis de los factores individuales y ocupacionales asociados con los parámetros de la voz fueron realizados por medio de regresiones lineales. Resultados: Comparadas con sus pares masculinos, las trabajadoras escolares registraron frecuencia fundamental más aguda (201 Hz para las profesoras y 209 para las no-profesoras frente a 120 Hz para los profesores y 127 para los no-profesores) e intensidad más alta (82 dB frente 80 dB), y tiempo máximo de fonación más corto (14 segundos aproximadamente frente a 16 segundos aproximadamente). Las profesoras menores de 50 años evidenciaron una tendencia significativa a producir una frecuencia fundamental más baja y un TMF más corto, comparadas con las profesoras mayores de 50 años. Las profesoras registraron frecuencia fundamental significativamente más alta (66 Hz), intensidad más alta (2 dB) y tiempo máximo de fonación más corto (2 segundos) comparadas con los profesores. Conclusión: Las profesoras menores de 50 años registraron frecuencia fundamental más baja y TMF más corto compradas con las profesoras mayores de 50 años. El análisis multivariado mostró que género fue una variable mucho más importante para determinar la variación en F0, SPL y TMF que edad u ocupación. La temperatura dentro de los lugares de trabajo (medida objetivamente) también contribuye a los cambios en intensidad de la voz entre los trabajadores escolares.

Objetivos: Caracterizar os parâmetros objetivos da voz em trabalhadores escolares, e identificar os fatores associados de três parâmetros objetivos da voz (frequência fundamental, pressão sonora e tempo máximo de fonação). Métodos: Estudo transversal no que participaram 116 professores e 20 professores não colombianos. Depois de assinar o consentimento informado, os participantes preencheram um questionário. Posteriormente, gravaram uma amostra de voz, a qual foi analisada perceptualmente por uma fonoaudióloga; e objetivamente utilizando o software PRAAT. Realizaram-se medições ambientais de níveis de barulho, temperatura, humidade e tempos de reverberação durante as visitas aos lugares de trabalho, tais como salas e escritórios. Análise dos fatores individuais e ocupacionais, associados com os parâmetros da voz, foi realizada através e regressões lineares. Resultados: comparadas com os seus pares masculinos, as trabalhadoras escolares registraram frequência fundamental mais aguda (201 Hz para as professoras e 209 para as não-professoras vs. 120 Hz para os professores e 127 para os não-professores) e intensidade maior (82 dB vs. 80 dB), e tempo máximo de fonação menor (14 segundos aproximadamente). As professoras menores de 50 anos evidenciaram uma tendência significativa a produzir uma frequência fundamental mais baixa e um MF mais curto comparadas com as professoras maiores de 50 anos. As professoras registraram frequência fundamental significativamente maior (66Hz), intensidade maior (2 dB) e tempo máximo de fonação mais curto (2 segundos) comparadas com os professores. Conclusão: as professoras menores de 50 anos registraram frequência fundamental mais baixa e TMF mais curto compradas com as professoras maiores de 50 anos. A análise multivariada mostrou que gênero foi uma variável muito mais importante para determinar a variação em F0, SPL e TMF que idade ou ocupação. A temperatura dentro dos lugares de trabalho (mesurada objetivamente) também contribui às mudanças em intensidade da voz entre os trabalhadores escolares.

Relationship between Chest Volume and Pleural Resonance Features in Young Male Adults / 听力学及言语疾病杂志

Objective To investigate the relationship between pleural resonance features and the chest volume and vital capacity in young male adults .Methods A total of 60 healthy young male adults were included in this study .Energy distribution of pleural resonance was measured with the multi-channel voice analysis system when they pronounced /a:/.The frequency spectrums were 0~999 Hz (FR1 ) ,1 000~1 999 Hz (FR2 ) ,2 000~2 999 Hz (FR3 ) ,3 000~4 000 Hz (FR4 ) .Fast 3D reconstruction of chest was detected by multi slice spiral CT to calcu‐late the chest volume .The vital capacity was evaluated by aerodynamics system .SPSS 18 .0 software was used to analyze the data .Results The vital capacity in healthy young male adults was 4 .31 ± 0 .63 L ,the chest volume was 5 .69 ± 0 .52 L .The frequency spectrum of FR1 was 53 .38% ± 2 .14% ,FR2 was 30 .72% ± 1 .59% ,FR3 was 10 . 53% ± 2 .75% ,FR4 was 5 .35% ± 2 .32% ,respectively .There was a highly positive correlation between the chest volume and FR1 (r=0 .854) ,moderately positive correlation between the volume and FR2 (r=0 .740) ,moderately negative correlation between the volume and FR3 (r= -0 .587) ,moderately negative correlation between the volume and FR4 (r= -0 .565);There was a highly positive correlation between the vital capacity and FR1 (r=0 .744) ,mod‐erately positive correlation between the volume and FR2 (r=0 .699) ,moderately negative correlation between thevolume and FR3 (r= -0 .632) ,weakly negative correlation between the volume and FR4 (r= -0 .429) .Conclusion There was a high correlation between the chest volume and pleural resonance ,high correlation between vital capacity and pleural resonance in young male adults ,which may be a influencing factor of pronunciation effect .

Análisis acústico de la voz normal y patológica utilizando dos sistemas diferentes: ANAGRAF y PRAAT / Acoustic analysis of normal and pathological voices using two different systems: ANAGRAF and PRAAT

La necesidad de una evaluación instrumental y objetiva de la calidad de voz se refleja en el creciente número de métodos de análisis acústicos desarrollados para el diagnóstico clínico y la investigación. En el trabajo que se informa se realizaron análisis acústicos utilizando dos programas diferentes: PRAAT y ANAGRAF. Ambos sistemas son programas informáticos de uso común en Latinoamérica, en contextos clínicos y de investigación, para detectar y caracterizar el habla, la voz y los desórdenes vocales. El propósito fue comparar los resultados obtenidos con un conjunto de mediciones acústicas, muchas de las cuales se definen de manera similar en ambos programas y analizar si se puede distinguir clínicamente entre la normalidad y la patología en sus diferentes niveles de severidad. Un total de 776 muestras de voz correspondientes a 4 repeticiones de la vocal /a/ de 194 hablantes de español en Buenos Aires se midieron utilizando los parámetros disponibles como lo son: la frecuencia fundamental, jitter, shimmery harmonic-to-noise ratio. Los resultados muestran valores similares de frecuencia fundamental (F0) para ambos programas. Sin embargo, los valores de jitter, shimmery harmonic-to-noise ratio (HNR) fueron significativamente menores medidos con PRAAT y resultaron superiores utilizando ANAGRAF. La confiabilidad de los valores obtenidos con ambos programas se redujo significativamente con el aumento de las irregularidades en la señal. Por lo tanto, parece importante establecer normas para las voces normales y patológicas con el fin de guiar o dar un paso más en la validez y confiabilidad de las prácticas profesionales.

The need for instrumental objective assessment of voice quality is reflected in the increasing number of acoustic analysis methods developed for clinical diagnosis and as research outcome in the area. Acoustics measures of vocal productions received much attention in the literature and a variety of commercial packages are available. Those systems packages are presented as objective tools with apparently standardized, well-designed measurement protocols and acceptably low incidence of technical problems. The fact of using the same labels for similar measurement output like mean jitter or mean shimmer induce to think that results from different programs are comparable. However, there is no standardization of technique methodology and considerable variability is observed about which acoustic parameters must be measured. Furthermore, product documentation often makes it difficult to know how a particular system actually produces its measurements. Little formal information is available about the actual comparability of measures from different analysis packages. In this study, acoustic analysis was performed using two different programs: PRAAT and ANAGRAF. Both systems are computer programs commonly used in Latin America, in clinical and research to detect and characterize speech and voice disorders. PRAAT, was designed by Boersma and Weenink (2009) and ANAGRAF is a national software designed by Gurlekian (1997). The purpose of this work was to compare the results obtained by a set of acoustic parameters, many of which are defined similarly in both programs, and analyze whether it can distinguish clinically between normal and pathological voices within different severity levels. A total of 776 voice samples corresponding to 4 repetitions of the vowel /a/ of 194 speakers of Spanish in Buenos Aires were measured using the available parameters such as: the fundamental frequency, jitter, shimmer, and noise-to harmonic ratio. The Lilliefords Test, with a significance level of 5%, was used to verify the normal distribution of the results of each measurement. The parameters with normal distribution had their means compared to the standard measurements proposed by the program using the t test (significance level of 5%). General results separated by sex are reported. The findings of analyzed voice samples are showed by definitions for mean, standard deviation, and thresholds of normal for each parameter, which helps the clinician to immediately assess the findings for a particular patient. The test-retest reliability in each pair of measures was calculated. For both programs the results show similar values of fundamental frequency (F0). However, the values of jitter, shimmer and harmonic-to-noise ratio (HNR) were significantly lower measured by PRAAT, and higher using ANAGRAF in relation which the default results proposed by each system. The empirical evidence shows that if followed the default values and thresholds of each system, the diagnostic accuracy might be questioned by considering both cases as false positives or false negatives. Results demonstrate that the reliability of the values obtained by both programs was significantly reduced with the increase of irregularities in the signal. Parameters related with shimmer were more reliable than parameters related with jitter. For the normal data, r Pearson correlations ranged from .72 (ANAGRAF) to .87 (PRAAT) for measures of jitter, with lower correlations among measures of shimmer .27 (ANAGRAF) to .80 (PRAAT) and noise measures .55 (ANAGRAF) to .87 (PRAAT). The large differences found between the measurements from the systems imply that the accuracy of the measurements are questionable, especially for severely pathological samples. Therefore, it seems important to establish normal and pathological voice standards norms for Spanish in Buenos Aires to take a step in the validity and reliability of the professional practices. Future research be aimed at establishing differences between vowels in addition to sex and system used.

Cáncer glótico temprano: influencia del tratamiento primario en la funcionalidad de la voz / Early glottic cancer: influence of primary treatment on the performance voice

Objetivo: Describir en pacientes con cáncer glótico temprano tratado con cirugía y radioterapia, la calidad y funcionalidad de la voz. Diseño: Estudio de serie de casos. Materiales y métodos: Los parámetros objetivos de la voz fueron evaluados con análisis acústico. La funcionalidad de la voz fue evaluada con el índice de incapacidad vocal (VHI). El análisis estadístico fue realizado con SPSS 11.5 y SuperSMITHWeibull. Resultados: 12 sujetos que recibieron tratamiento para cáncer glótico temprano fueron incluidos en la muestra. El seguimiento clínico fue de 53.1 meses en promedio. El control de la enfermedad se observó en 100% de los casos, sin recaídas. El análisis acústico evaluó lafrecuencia fundamental de la voz, que fue normal en 63,6% de los casos; adicionalmente las medidas del Jitter y Shimmer fueron anormales en todos los pacientes. El valor del índice de incapacidad mostró una disfuncionalidad leve en 58,4% de los casos y normal en 41,6% de los casos. Conclusionese importancia clínica: El manejo del cáncer glótico temprano con cirugía y radioterapia resultó en una alteración de los parámetros objetivos de la voz en todos los sujetos; sin embargo, en nuestra muestra los pacientes refieren poca o ninguna disfuncionalidad en la vida diaria.

Objective: To describe on an adult population with early glottic cancer, treated with surgery and radiotherapy, the voice quality and functional outcome. Design: Case series study. Materials andMethods: Voice parameters were assessed using acoustic analysis. Voice functional outcome was evaluated with the voice handicap index (VHI). Statistical analysis was performed using the statistical software SPSS 11.5 and SuperSMITHWeibull. Results: 12 subjects that received treatment for early glottic cancer were included in the sample. The subjects were followed up during an average of 53.1 months. Effective control of disease without relapse was observed in 100% of the cases. The acoustic analysis assessed the fundamental frequency which was normal in 63,63% of the cases. Moreover, the mean of the Jitter and Shimmer was abnormal in the whole sample. The voice handicap index revealed a mild impairment in 58,4% of subjects, and was normal in 41,6% of cases. Conclusion and clinical significance: The management of early glottic cancer with surgery and radiotherapy resulted in alterations of objective voice parameters in the whole sample, however the patients report mild or none voice dysfunction on their daily life.

Manejo del sulcus vocalis con injerto de fascia temporal / Sulcus vocalis management with fascia temporal graft

El sulcus vocalis es una lesión en la cual el epitelio del pliegue vocal tiende a invaginarse y adherirse al ligamento y/o músculo resultando en disfonía. Existen múltiples tratamientos descritos ninguno con resultados ideales. Este es un estudio descriptivo-prospectivo en el Hospital Militar Central en pacientes operados por sulcus vocalis tipos II y III e implantados con fascia autóloga entre junio de 2006 y diciembre de 2008. De 17 pacientes operados cumplieron los criterios de inclusión 11. Edad promedio 32 años. 9 presentaron mejoría del análisis acústico de la voz con una tendencia a la mejoría en todas las variables, particularmente en el Shimmer y la frecuencia fundamental. En la estroboscopia, 10 pacientes presentaron recuperación de la onda mucosa y en 5 del cierre glótico. Ningún paciente presentó reacciones adversas al procedimiento. Del presente estudio se puede considerar que el manejo del sulcus vocalis con injerto autólogo de fascia temporal es un procedimiento seguro que en la mayoría de los casos representa una mejoría subjetiva y objetiva de la calidad de voz. Es necesario aumentar el tamaño de la muestra para obtener resultados de mayor poder estadístico y definir los criterios de éxito.

Sulcus vocalis is an injury in which the epithelium of the vocal fold tends to invaginate and attach to the ligament and / or muscle resulting in dysphonia. There are multiple treatments as described but none has ideal results. This is a descriptive – prospective study carried out at the Hospital Militar Central in patients that had been operated on due to sulcus vocalis of the type II and III and who have been given implants with autologous fascia between June, 2006 and December, 2008. Out of 17 patients that were operated on, 11 complied with the inclusion criteria. The average age was 32 years old. 9 of them exhibited an improvement on the acoustic analysis of the voice with a tendency to improvement in all variables, especially in Shimmer and the basic frequency. 10 patients exhibited a recovery of the mucous wave in the stroboscope analysis and 5 in the glottal closure. Not one patient showed adverse reactions to the procedure. It can be considered from this study that managing sulcus vocalis with a temporalis fascia autologous graft is a safe procedure that represents a subjective and an objective improvement of the quality of the voice. It is necessary to increase the size of the simple in order to obtain results with a greater statistical power and be able to define the criteria for success.

Acoustic characteristics of patients undergoing short-term endotracheal intubation with or without thyroidectomy who had no nerve injury / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: We carried out an acoustic analysis to investigate the phonatory characteristics of patients undergoing short-term endotracheal intubation with or without thyroidectomy, and who had no nerve injury. MATERIALS AND METHODS: The patients were divided into two groups, one undergoing thyroidectomy (39 cases) and the other not undergoing thyroidectomy (25 cases). All patients of the thyroidectomy group had undergone thyroidectomy using general anesthesia with endotracheal intubation. All patients of the other group had undergone chronic ear surgery with the same anesthetic method and duration. For the evaluation of voice, preoperative and postoperative acoustic analyses were done. RESULTS: On the acoustic analysis of thyroidectomy group, jitter, shimmer and the vocal range were significantly increased at one day after thyroidectomy. But one month after thyroidectomy, these changes return to statistically insignificant increments, except for shimmer and the vocal range. These acoustical changes were not related to the extent of surgery between total thyroidectomy and hemithyroidectomy. In comparison with acoustical changes after short-term endotracheal intubation, the change of jitter and shimmer of thyroidectomy group did differ significantly. CONCLUSION: Voice alteration after thyroidectomy without nerve injury may be associated with the disturbance of the prelaryngeal musculature. This voice changes emphasize the importance of the extralaryngeal skeleton for pitch control and early intensive speech therapy, especially in patients who need their voice professionally.

The Clinical Application of Voice Analysis in Identifying the Presence of Laryngopharyngeal Reflux in Patients with Pharyngeal Neurosis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Pharyngeal neurosis is a common problem in the otolaryngology clinic. Laryngopharyngeal reflux is suggested as one of the etiologic factors in pharyngeal neurosis. The purpose of this study was to find usefulness of voice analysis in diagnosis of pharyngeal neurosis and correlation between voice analysis and 24-hour ambulatory double-probe pH monitoring. MATERIALS AND METHODS: 42 patients with pharyngeal neurosis underwent fiberoptic laryngoscopy, voice analysis, and 24-hour ambulatory double-probe monitoring. The authors used a computerized acoustic analysis pr-ogram (CSL-MDVP) to measure fundamental frequency, jitter, shimmer, and noise to harmonics ratio. RESULTS: There was a significant difference between the positive group and negative group during 24-hour ambulatory pH monitoring regarding jitter and shimmer. Correlation results were good between voice analysis and 24-hour ambulatory double-probe pH monitoring, poor between fiberoptic laryngoscopy and 24-hour ambulatory double-probe pH monitoring. CONCLUSION: This study showed that when abnormal results in voice analysis were found in patients of pharyngeal neurosis, the probability that 24-hour ambulatory double-probe pH monitoring would be abnormal was high.

Voice Comparison between Strap Muscle Retraction and Cutting Technique in Thyroidectomy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: A voice analysis was carried out before and after thyroid surgeries without laryngeal nerve injury, between strap muscle retraction and cutting group in thyroid surgery. The study was done by means of questionaires, acoustics and aerodynamic analysis. MATERIALS AND METHODS: A total of fourty-two patients of whom thirty-eight are females and four are males were analyzed; hemithyroidectomy (19 cases) and total thyroidectomy (23 cases). Twenty-seven patients had undergone thyroidectomy via retraction of strap muscle and 15 patients had undergone thyroidectomy via cutting of strap muscle. For evaluation of voice, questionaires for changes of voice, acoustics (fundamental frequency, jitter, shimmer, noise to harmonic ratio, voice intensity, vocal range), and aerodynamic (maximal phonation time, mean flow rate and subglottal pressure) analyses were done. RESULTS: The subjective voice symptoms after thyroidectomy were disturbances of high pitch, loud voice and singing voice, and easy fatigue at phonation. These voice symptoms were related to the extent of surgery. Vocal range was the only diminished parameter in acoustic and aerodynamic analyses after thyroidectomy. There were significant differences in jitter on acoustic and aerodynamic analyses between the strap muscle retraction group and the cutting group. CONCLUSION:Voice alteration after thyroidectomy without laryngeal nerve injury may be associated with the disturbance of the extralaryngeal skeleton- laryngotracheal fixation with impairment of vertical movement or by temporal malfunction of the strap muscles. These voice problems were related to the extent of surgery and cutting of strap muscles.

Possible Etiology and Voice Analysis of Reinke's Edema / 대한이비인후과학회지

BACKGROUND: Reinkes edema is characterized by swelling of the vocal folds, and its etiology and pathogenesis have not yet been established. OBJECTS AND METHODS: We reviewed medical records of 25 patients (14 male and 11 female) who had undergone operation from 1996 to 1998. Post-operative voice lab and skin prick tests were done after 3 months when patients visited hospital. Telephone questionnaires were carried out about smoking and laryngopharyngeal reflux. RESULTS: In the smoking pattern, most patients (18/25) smoked more than 10 packs a year. Twelve patients (48%) complained of laryngopharyngeal reflux symptoms and 4 patients were positive for the skin prick test, Pre- and post-operative voice lab results showed that shimmer and phonation time changed significantly in women patients. Jitter, shimmer, phonation time, mean flow rate, vocal efficiency and subglottic pressure changed significantly in men patients. CONCLUSION: Smoking and laryngopharyngeal reflux may play an important role in developing Reinkes edema and phonatory quality will be improved after proper surgical procedure.

Videostrobokymographic Analysis of Reinke's Edema / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Videostrobokymography (VSK) has been recently developed in our institute. VSK can select multiple regions of interest and analyze vibratory patterns of vocal folds using video data recorded by the conventional videostroboscopy. But the efficacy of VSK in clinical application needs to be proven. MATERIALS AND METHODS: We compared the preoperative and postoperative VSK patterns of Reinke's edema in 15 cases with some other parameters. RESULTS: Most of the patients showed improvement of voice quality by self-assessment, however, the fundamental frequency and subglottic pressure did not return to the normal range after operation. Preoperative videostroboscopy for Reinke's edema patients revealed greatly irregular patterns of mucosal wave so that kymogram could be obtained only in 3 of the 8 preoperative examinations. However, postoperative vibration of the vocal folds returned to the regular pattern on VSK. CONCLUSION: VSK could serve as one of the effective tools to document the vocal fold vibration objectively in various kinds of benign mucosal diseases of the vocal folds.

Voice Analysis in Reinke's Edema / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Reinke's edema is defined as swelling confined to the space underneath the epithelial layer known as Reinke's space. Patients suffering from Reinke's edema are known to have abnormally low fundamental frequency and high subglottic pressure. We compared the preoperative and postoperative voice results of Reinke's edema to evaluate quantitative changes of vocal function. MATERIALS AND METHODS: The voice analyses of 15 patients, who were diagnosed with Reinke's edema from 1997 January to 1998 September in Seoul National University Hospital, and 15 normal controls were undertaken with Multi-dimensional voice program (MDVP) and Aerophone II of Kay system. Eight preoperative patients, 13 postoperative patients, and 6 preoperative and postoperative patients were analyzed with respect to fundamental frequency (F0), pitch perturbation quotient (PPQ), amplitude perturbation quotient (APQ), noise-to-harmonic ratio (NHR), subglottic pressure (Psg), mean vocal efficiency, mean flow rate (MFR), maximum phonation time (MPT), and contact quotient (CQ). Using videostrobokymography, vibratory patterns of vocal folds were analyzed. RESULTS: The fundamental frequency was lower than the normal preoperative and postoperative values. The PPQ, APQ, and NHR were decreased to the normal value after operation. The subglottic pressure, although elevated preoperatively and decreased postoperatively, remained high. The mean vocal efficiency was increased to average value of normal controls after operation. The MFR, MPT, and CQ were not correlated with the course of Reinke's edema. The vocal folds vibration returned to regular pattern after operation on videostrobokymography. CONCLUSION: The fundamental frequency and subglottic pressure are not normalized after operation, and the PPQ, APQ, and NHR are good parameters of postoperative voice results. The voice therapy might help to correct the vocal habit of voice abuse and prevent recurrence after operation.