Vocal Acoustics and Aerodynamics During Scripted Reading Compared to Spontaneous Speech.

BACKGROUND: Examination of vocal acoustics and phonatory aerodynamics during connected speech provide a more ecologically valid approach to voice assessment than single phoneme measures. The purpose of the current investigation was to determine if differences exist in vocal acoustics and aerodynamics between reading and spontaneous speech tasks in patients with common voice disorders. METHODS: The Emory University Institutional Review Board approved this retrospective study. The voice records of 100 patients (74 females and 26 males) diagnosed with benign voice disorders and referred for voice evaluation at the Emory Voice Center between November 2018 and March 2019 were analyzed. These consisted of reading a scripted passage (the Rainbow Passage) and spontaneous speech (describing how to make a peanut butter and jelly sandwich). Data collected included gender, voice diagnosis, mean fundamental frequency (F0), mean airflow during voicing, and mean inspiratory airflow (MIA). RESULTS: Univariate analysis assessed normality of the data. Variables with normal distribution utilized paired t test. Non-normal data were log transformed. Mean F0 was not significant for complete case analysis (P = 0.053) but gender based stratified analysis, for females (mean difference = 4.68 Hz; 95% CI = 0.359, 9.0012; P = 0.03). Gender-related statistical differences were also found in MIA in women (P = 0.0001), and P = 0.0003 for MIA in men. The direction and range of change between scripted reading and the spontaneous speech tasks in all metrics varied widely. No consistent patterns were noted in gender, age and diagnosis across the parameters studied. However, clinically salient findings in the range of MIA were noted in a small subgroup of participants. CONCLUSIONS: This study suggests that multiple testing stimuli for phonatory aerodynamic and acoustic outcomes measurement may be appropriate for use depending on the need and vocal challenges of the individual patient. Clinically, both structured reading and spontaneous speech provide valuable insight into the vocal capabilities of the patient.

Revisiting Sustained Phonation Time of /s/, /z/, and /α/.

PURPOSE: Research studies of maximum phonation time, have questioned its validity and value as a tool to assess laryngeal competence. This study proposes a fresh look at phonation time, from a different perspective. The interrelationships of the durations between semiocclusion vs. open vocal tract (/s/-/z/ vs. /α/) and voiced vs voiceless (/z/-/α/ vs. /s/) sound are examined to determine whether this approach might provide additional clinical insight into the respiratory phonatory efficiency of patients. METHODS: Comfortable sustained phonation time of /s/, /z/ and /α/ was collected as part of the voice evaluation of patients referred by laryngologists for voice therapy. Inclusionary criteria: male and female subjects 19 years of age or older. Exclusionary criteria: autoimmune disorders, malignancies, major pulmonary/respiratory disorders. RESULTS: A total of 218 patients (150 females and 68 males) mean age of 53.6 met all the criteria. Means, standard deviations and t test were conducted to determine whether significant differences existed. t test results indicate significance between s/z P = 0.002 and z/α P = 0.004 for females but only slight significance in s/α P = 0.03 for males. Close analysis of individual results observed four (4) different conditions or effects of fricative/semiocclusion and voicing: the close durations of the /s/ and /z/ relative to the /α/; the /z/ and /α/ are close in duration relative to the /s/; the spread of more than 5 seconds between /s/, /z/ and /α/ relative to the others; and similar duration of /s/, /z/, and /α/. CONCLUSION: Significant differences exist in the durations of comfortable phonation time of sustained /s/ and /z/ and /α/ thought to be related to effects of semiocclusion, fricative consonants, and voicing. Phonation time should be seen not only in terms of duration, but the interplay of the phonemic qualities of the sounds as they relate of laryngeal efficiency.

Airflow Patterns of Running Speech in Patients With Voice Disorders.

OBJECTIVE: Aerodynamic measures of voice have historically been acquired using sustained phonation tasks. This study seeks to determine whether there are differences in airflow during sustained phonation (MFs), in running speech (MFrs), or during phonation in running speech (MFvrs). We also seek to determine whether these patterns are diagnostically significant. METHODS: Data were collected on 40 subjects (15 men, 25 women), ages 20-79, with a mean age of 53 in this prospective study. All participants received a comprehensive videostroboscopic evaluation and were deemed appropriate for voice evaluation and trial therapy. The Phonatory Aerodynamic System 6600 was used for data collection. The Comfortable Sustained Phonation and Running Speech protocols were used for data acquisition. Patient diagnoses were divided into five subgroups: benign lesions, vocal fold paralysis or paresis, muscle tension dysphonia, edema or laryngitis, and chronic cough. Statistical methods such as analysis of variance and Tukey tests assessed pairwise differences in the airflow rate. Pairwise Tukey multiple comparisons of means testing using a 95% family-wise confidence level were completed to determine the interrelationships of the pairs. RESULTS: Differences were found among airflow measures (P value = 0.0152), pairwise comparisons of MFs-MFvrs pair (P value = 0.012), and diagnosis. No significance was found in MFs-MFrs (P = 0.051) or MFvrs-MFrs (P = 0.94) pairs. Mean flow rates were higher than the norms in MFs. The overall range of mean airflow was similar to those of published norms. CONCLUSION: Assumptions about mean airflow of connected speech should not be made based on sustained phonation tasks alone. No salient diagnostic characteristics were found by diagnosis.

Aerodynamic Patterns in Patients With Voice Disorders: A Retrospective Study.

OBJECTIVE: A recently published retrospective chart review of aerodynamic profiles of women with primary muscle tension dysphonia by Gillespie et al (2013) identified various relationships between mean airflow rate (MFR) and estimated subglottal pressure (est-Psub). The current retrospective study expanded the diagnostic categories to include all voice disorders referred for voice therapy. Three research questions were proposed: (1) Are there differences in the MFR and the est-Psub compared with the normal control group? (2) Within the disordered population, are there different variations in the pairing of MFR and est-Psub? (3) If these variations exist, are they diagnosis specific? METHODS: A retrospective chart review of patients seen for acoustic and aerodynamic voice assessment at the Emory Voice Center between January 1, 2013 and December 31, 2014, were examined for aerodynamic measures of est-Psub and MFR; of these, 192 met the inclusion criteria. Simple t test, two-step cluster analysis, and analysis of variance, as well as Tukey multiple comparisons, were performed using R and SPSS. RESULTS: Mean est-Psub was significantly greater in the group with voice disorder than in the control group (P value < 0.001). However, no statistical significance was found when comparing the MFR with the control group (P value <0.59). Nine possible pairings of MFR and est-Psub were found. Sufficient evidence was not found to detect significant differences in these pairings across diagnostic groups. CONCLUSION: With regard to the rate and interrelationships of MFR and est-Psub, the findings of this study are similar to those of Gillespie et al, that is, MFR and est-Psub are not determinate of diagnosis.

The Effect of Head Position and/or Stance on the Self-perception of Phonatory Effort.

BACKGROUND: Vocal fatigue is a common but poorly defined complaint of patients presenting with voice disorders. Definitions of vocal fatigue generally include increased self-perceived phonatory effort resulting from references to vocal loading or prolonged voice use resulting in deterioration of function. The present study looks at the role of posture, specifically head position and stance, in self-perceived phonatory effort. METHODS: Forty-six healthy adults, 13 males and 33 females (mean age was 27.5), with no history of vocal problems/disorders within the past year were recruited. Subjects were asked to sustain the vowel /a/ at a comfortable pitch and loudness for 5-10 seconds in each of six positions: sitting and standing in the manner habitual for each subject, two exaggerated positions of the head (head back and head forward), and two exaggerated positions in standing (standing with knees locked and with knees soft). Each position was repeated three times in randomized order, resulting in 18 trials for each subject. After each repetition of the sustained /a/, subjects were asked to rate their experience of vocal effort using a 100-mm visual analog scale (0-40 least effort, 40-60 habitual effort, and 60-100 increased effort). RESULTS: Repeated measures analysis of variance revealed significant difference in the self-perceived phonatory effort levels across positions (P value < 0.001). The exaggerated forward and back head positions in both sitting and standing positions showed the greatest significance on the Tukey post hoc tests (P < 0.000). CONCLUSIONS: Based on the findings, posture may play a more important role in vocal fatigue than previously thought.

The vocal load of Reform Jewish cantors in the USA.

OBJECTIVE: Jewish cantors comprise a subset of vocal professionals that is not well understood by vocal health professionals. This study aimed to document the vocal demands, vocal training, reported incidence of voice problems, and treatment-seeking behavior of Reform Jewish cantors. METHODS: The study used a prospective observational design to anonymously query Reform Jewish cantors using a 35-item multiple-choice survey distributed online. Demographic information, medical history, vocal music training, cantorial duties, history of voice problems, and treatment-seeking behavior were addressed. RESULTS: Results indicated that many of the commonly associated risk factors for developing voice disorders were present in this population, including high vocal demands, reduced vocal downtime, allergies, and acid reflux. Greater than 65% of the respondents reported having had a voice problem that interfered with their ability to perform their duties at some time during their careers. CONCLUSION: Reform Jewish cantors are a population of occupational voice users who may be currently unidentified and underserved by vocal health professionals. The results of the survey suggest that Reform Jewish cantors are occupational voice users and are at high risk for developing voice disorders.

Analysis of voice change during cellular phone use: a blinded controlled study.

It is a growing belief that cellular phone use may be hazardous to the voice. This study aims to assess voice production in different conversational scenarios to identify any changes in vocal production that may be specific to cellular phone use. Twenty healthy participants were randomized to seven conversational scenarios: quiet conditions face to face; quiet conditions over a landline; quiet conditions using a cellular phone (QCP); quiet conditions using cellular phone with earpiece (QCPE); noisy conditions face to face (NFF); noisy conditions using cellular phone (NCP); and noisy conditions using cellular phone with earpiece (NCPE). In each condition, participants performed spontaneous speech, a standardized reading passage, and sustained voicing. Sound pressure levels (dB SPL) and fundamental frequencies (F(0)[Hz]) were measured. Subjects completed a 100-mm visual analog scale measuring vocal effort after each speaking scenario. Statistical analysis was performed using analysis of variance (ANOVA). There was a significant difference in dB SPL and F(0) between all quiet conditions relative to all noisy conditions (P<0.001). There was no difference in cellular phone use relative to any other conversational condition in mean dB SPL, respective of ambient noise. Vocal effort was rated greater for noisy conditions compared with quiet conditions. Cellular phone use does not lead to a significant change in voice production relative to other speaking conditions. Voice problems associated with cellular phone use may simply be a function of the increased amount of voice use and increased vocal loudness (Lombard effect) associated with speaking in noisy situations rather than a variable inherent to the phone.

Assessing the effectiveness of botulinum toxin injections for adductor spasmodic dysphonia: clinician and patient perception.

To determine the effectiveness of Botox treatment for adductor spasmodic dysphonia (ADSD), the clinician and patient judge changes in voice symptoms and the effect on quality of life. Currently, there is no standard protocol for determining the effectiveness of Botox injections in treating ADSD. Therefore, clinicians use a variety of perceptual scales and patient-based self-assessments to determine patients' impressions of severity and changes after treatments. The purpose of this study was to assess clinician-patient agreement of the effects of Botox on voice quality and quality of life in ADSD. Retrospective chart review of 199 randomly selected patients since 2004. Results indicated a weak correlation between the patient's assessment of voice impairment (EIS) and patient's quality of life impairment (Voice-Related Quality of Life [V-RQOL]) in the mild-moderate dysphonia severity group and the moderate-to-severe dysphonia group. There was a weak correlation between the patient's assessment of voice impairment EIS and the clinician's perceptual judgment of voice impairment (Consensus Auditory Perceptual Evaluation of Voice [CAPE-V]) only in the moderate to severe dysphonia group. There was a weak correlation between the patient's quality of life impairment (V-RQOL) and the clinician's perceptual judgment of voice impairment (CAPE-V) only in the severe to profound dysphonia group. The poor relationship among commonly used outcome measures leads us to question how best to assess the effectiveness of Botox in ADSD. Clinicians are required to document treatment outcomes, making it important to use scales that are valid, reliable, and sensitive to change. Future research directions include examining relationships between measures both before and after Botox injections, examining the specific factors that determine quality of life changes, and further research on specific parameters of the CAPE-V as well as comparing perceptual and quality of life scales with acoustic and aerodynamic measures in this population would be beneficial in the move toward more effective ways of measuring change.

Performer's attitudes toward seeking health care for voice issues: understanding the barriers.

Contemporary commercial music (CCM) performers rely heavily on their voice, yet may not be aware of the importance of proactive voice care. This investigation intends to identify perceptions and barriers to seeking voice care among CCM artists. This cross-sectional observational study used a 10-item Likert-based response questionnaire to assess current perceptions regarding voice care in a population of randomly selected participants of professional CCM conference. Subjects (n=78) were queried regarding their likelihood to seek medical care for minor medical problems and specifically problems with their voice. Additional questions investigated anxiety about seeking voice care from a physician specialist, speech language pathologist, or voice coach; apprehension regarding findings of laryngeal examination, laryngeal imaging procedures; and the effect of medical insurance on the likelihood of seeking medical care. Eighty-two percent of subjects reported that their voice was a critical part of their profession; 41% stated that they were not likely to seek medical care for problems with their voice; and only 19% were reluctant to seek care for general medical problems (P<0.001). Anxiety about seeking a clinician regarding their voice was not a deterrent. Most importantly, 39% of subjects do not seek medical attention for their voice problems due to medical insurance coverage. The CCM artists are less likely to seek medical care for voice problems compared with general medical problems. Availability of medical insurance may be a factor. Availability of affordable voice care and education about the importance of voice care is needed in this population of vocal performers.

Electrotherapy and the human voice: a literature review of the historical origins and contemporary applications.

SUMMARY: The present article surveys the literature on the electrotherapy treatment for voice disorders from the mid-18th century to World War I (1914--1918) and the post 1970s reappearance of such therapies. The reappearance of electrotherapy as treatment for voice disorders in the past 20 years has been heralded as a major breakthrough. In light of our reading of the scientific literature of the 19th century, it can be shown to repeat many of the presuppositions of electrotherapists of that time. The current resurgence of interest and research in electrical stimulation of the larynx is buoyed by technological innovations analogous to those in the 19th century. Although the current state of research has enhanced our understanding of vocal fold physiology, it does not necessarily provide a new therapeutic approach as a survey of the most recent literature shows.