Can Voice Parameters Provide Cutoff Values to Predict Dysphagia in Individuals with Multiple Sclerosis?

In dysphagia assessment, along with well-defined measurements and signs, voice parameters can potentially support clinical decision as a marker, but more evidence is needed. This study aims to determine the voice parameters that can predict the risk of dysphagia and to determine optimal cutoff values in individuals with multiple sclerosis (IwMS). Seventy-six adults participated in the study, including 39 IwMS and 37 healthy individuals (HI). The study used the Dysphagia in Multiple Sclerosis Questionnaire (DYMUS), Gugging Swallowing Screen (GUSS), and Voice Handicap Index (VHI-10) and recorded voice samples using Praat programme. Voice recordings were taken pre- and post-swallowing. The voice parameters analysed are fundamental frequency (F0), standard deviation F0 (SD F0), jitter (local), shimmer (local), and harmonic-to-noise ratio (HNR). Roc analysis was performed to examine the diagnostic accuracy performance of the risk for dysphagia/penetration. The parameters of IwMS pre-swallowing differed significantly from those of HI on the VHI-10, DYMUS, GUSS scores, and jitter (local), shimmer (local), and HNR. IwMS but not HI exhibited significant differences in shimmer (local) and HNR between the pre- and post-swallowing measurements. In IwMS, GUSS revealed significant differences in shimmer (local) pre- and post-swallowing between the groups with and without dysphagia/penetration. In the ROC analysis results, the area under the curve (AUC) for shimmer (local) pre-swallowing was 73.1% (cutoff = 1.69); post-swallowing, it was 78.6% (cutoff = 1.57). In conclusion, IwMS can be associated with differences in shimmer (local) and HNR parameters, low quality of life-related to voice, and dysphagia/penetration risk. The AUC values for shimmer (local) in IwMS pre- and post-swallowing may help to strengthen diagnostic decisions of dysphagia risk.

The Relationship Between Voice Parameters and Speech Intelligibility: A Scoping Review.

OBJECTIVE: To synthesize existing evidence of the relationship between voice parameters and speech intelligibility. METHODS: Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Review (PRISMA-ScR) guidelines, 13 databases were searched and a manual search was conducted. A narrative synthesis of methodological quality, study characteristics, participant demographics, voice parameter categorization, and their relationship to speech intelligibility was conducted. A Grading of Recommendations Assessment, Development, and Evaluation (GRADE) assessment was also performed. RESULTS: A total of 5593 studies were retrieved, and 30 eligible studies were included in the final scoping review. The studies were given scores of 10-25 (average 16.93) out of 34 in the methodological quality assessment. Research that analyzed voice parameters related to speech intelligibility, encompassing perceptual, acoustic, and aerodynamic parameters, was included. Validated and nonvalidated perceptual voice assessments showed divergent results regarding the relationship between perceptual parameters and speech intelligibility. The relationship between acoustic parameters and speech intelligibility was found to be complex and the results were inconsistent. The limited research on aerodynamic parameters did not reach a consensus on their relationship with speech intelligibility. Studies in which listeners were not speech-language pathologists (SLPs) far outnumbered those with SLP listeners, and research conducted in English contexts significantly exceeded that in non-English contexts. The GRADE evaluation indicated that the quality of evidence varied from low to moderate. DISCUSSION: The results for the relationship between voice parameters and intelligibility showed significant heterogeneity. Future research should consider age-related voice changes and include diverse age groups. To enhance validity and comparability, it will be necessary to report effect sizes, tool validity, inter-rater reliability, and calibration procedures. Voice assessments should account for the validation status of tools because of their potential impact on the outcomes. The linguistic context may also influence the results.

Effects of trace element dietary supplements on voice parameters and some physiological and psychological parameters related to stress.

Trace elements, often used as dietary supplements, are widely accessible without prescription at pharmacies. Pronutri has pioneered Nutripuncture®, a methodology that utilizes orally consumed trace elements to elicit a physiological response akin to that of acupuncture. Pronutri has empirically observed that the user's voice becomes deeper following an exclusive ingestion procedure. Given that alterations in vocal characteristics are often linked to stress, the Pronutri researchers postulated that the pills have the capacity to promptly alleviate stress upon ingestion. Nevertheless, there is a lack of scientific substantiation about the impact of these supplements on voice (or stress) indicators. The aim of this research was to determine whether there is a consistent impact of trace element ingestion on vocal characteristics, namely the fundamental frequency of the voice, as well as other physiological and psychological stress measurements. In order to achieve this objective, we have devised a unique methodology to examine this hypothesis. This involves conducting a monocentric crossover, randomized, triple-blind, placebo-controlled trial with a sample size of 43 healthy individuals. This study demonstrates that compared to placebo tablets, consuming 10 metal traces containing tablets at once is enough to cause noticeable changes in the vocal spectrum in the direction of an improvement of the voice timbre "richness", and a decrease in the occurrence of spontaneous electrodermal activity, suggesting a stress reduction. However, there were no significant changes observed in the other parameters that were tested. These parameters include vocal measures such as voice frequency F0, standard deviation from this frequency, jitter, and shimmer. Additionally, physiological measures such as respiratory rate, oxygenation and heart rate variability parameters, as well as psychological measures such as self-assessment analogic scales of anxiety, stress, muscle tension, and nervous tension, did not show any significant changes. Ultimately, our research revealed that the ingestion of 10 trace elements pills may promptly elicit a targeted impact on both vocal spectrum and electrodermal activity. Despite the limited impact, these findings warrant more research to explore the long-term effects of trace elements on voice and stress reduction.

A Comparative Study of Voice Characteristics in Children With Cochlear Implants and Typically Hearing Children: Insights From an Indian Context.

Purpose The aim of the study was to evaluate speech outcomes in children with cochlear implants compared to normally hearing children in terms of fundamental frequency, shimmer, and jitter. The study also aims to assess the intelligibility of speech in children with cochlear implants using a speech intelligibility rating scale. Methods This was a hospital-based comparative study conducted at JIPMER, a major tertiary referral center. A total of 25 prelingually deaf children with profound deafness, who underwent cochlear implantation at the institute, were recruited from the outpatient department of the Department of Otorhinolaryngology. Twenty-five children under seven years of age who underwent cochlear implantation and received a minimum of 36 speech therapy sessions were included in the study. Subjects with incomplete electrode array insertion and any neurological maldevelopment were excluded. Age- and gender-matched controls comprising 25 individuals were selected from the Ophthalmology Outpatient Department at JIPMER. Study procedure The study commenced in January 2019. Test subjects were asked to visit the Audiology and Speech and Language Pathology Department at JIPMER. Voice recordings were conducted in a soundproof room using a microphone, with the mouthpiece held at a distance of 10-15 cm from the patient. The patient was instructed to say "a" three times. Their voice was recorded and analyzed using Praat software (Version 6.1.15, developed by Paul Boersma and David Weenink, Phonetic Sciences, University of Amsterdam). Data were analyzed using IBM SPSS Statistics for Windows, Version 19 (Released 2010; IBM Corp., Armonk, New York) (Department of Biostatistics, Vanderbilt University, Nashville, Tennessee, USA), and the results were derived. Results The mean fundamental frequency for Group 1 (CI) was 266.03 ± 57.46 Hz, compared to 312.97 ± 22.15 Hz for Group 2 (NH). There was a statistically significant difference between the values of both groups, indicating that cochlear implantation positively impacted the fundamental frequency of speech. The study revealed a significant change in the fundamental frequency when children were implanted at an early age and received effective speech therapy post-implantation. This change was assessed after one year post-implant. Perturbation measures such as shimmer and jitter were lower in the cochlear implant group but were not statistically significant. Conclusion Children with congenital bilateral severe to profound sensorineural hearing loss tend to have higher values of the fundamental frequency of speech. However, when implanted at an early age, they showed a significant difference in the fundamental frequency of speech (p < 0.001). Speech perturbation was lower in the post-cochlear implant group, with a statistically significant difference in the values of shimmer alone. The study concludes that children with cochlear implants can achieve normal voice parameters with early intervention and training. However, the variability range is much higher than in typically hearing individuals.

Analysis of Voice Quality After Thyroid Surgery.

OBJECTIVES: Voice changes are a common complication after a thyroidectomy, which is a surgical procedure involving partial or total removal of the thyroid gland. The main objective of this work is to examine the possible voice disorders after thyroid surgery. More precisely, it is an investigation of partial and total thyroidectomy, as well as the effects that cancerous and noncancerous thyroid glands can have regarding postsurgical vocal and their association with age and gender. METHODS: Patients were evaluated using acoustic voice parameters, including harmonics-to-noise ratio (HNR), fundamental frequency (F0), jitter, speaker phonation frequency (SPF) range, cepstral peak prominence (CPP), maximum phonational frequency range (MPFR), and shimmer at the preoperative stage and postoperatively at the 1 day, and first-month stages. RESULTS: Results demonstrated a significant change in F0 parameters, SPF range, and CPP feature 1 month after surgery, depending on the type of thyroidectomy and thyroid pathology. No significant changes were observed in the HNR, shimmer, and jitter features. Age was associated with the CPP parameter in the entire sample. In contrast, the MPFR parameter was also related to the type of thyroidectomy in the entire sample. However, maximum F0 was significantly associated with the type of thyroidectomy, specifically in the female sample. CONCLUSIONS: Results indicated that a thyroidectomy can have a negative impact on voice quality. The age and type of thyroidectomy performed are not responsible for this change. Potentially this change can be due to factors such as nerve damage or the subjects' experience, such as job, anxiety, and their physical condition, as well as treatments they may have undergone before thyroidectomy. Further efforts are needed to fully understand the background of voice changes after thyroidectomy.

Acoustical and Perceptual Analysis of Voice in Individuals with Parkinson's Disease.

Parkinson's disease is a neurodegenerative disorder that affects motor efficiency which is also required for voice production. Voice is part of the identity of a person, any abnormality in voice quality hampers the quality of communication, and quality of life. This study aimed to analyse the voice of individuals with Parkinson's disease objectively through acoustic analysis, and subjectively through perceptual analysis. Quasi-experimental study conducted in a tertiary health care centre. The study comprised two groups: 12 individuals with Parkinson's disease (11 males and 1 female, mean age: 72.41 years), and 12 healthy controls (10 males and 2 females, mean age: 53.83 years). The voice samples of all the participants were recorded and analyzed using the MDVP software of CSL 4500. The voice samples were analyzed for eleven acoustical parameters, and the perceptual analysis was carried out using the GRBAS scale by two experienced Speech Language Pathologists. Mann-Whitney U test was performed to compare the two groups of participants, and Cronbach's alpha test was performed to find the inter-judge reliability between the perceptual ratings of two listeners. Acoustical comparison showed significant variations in seven parameters (jitter, shimmer, PPQ, APQ, Fatr Hz, Fftr, ATRI), and the perceptual analysis between two listeners showed a fair amount of reliability.

Ambulatory Phonation Monitoring in Prelingual and Postlingual Deaf Patients after Cochlear Implantation.

INTRODUCTION: Hearing loss is known to play a fundamental role in voice production due to a lack of auditory feedback. In this study, we evaluated both fundamental frequency (F0) and loudness of voice on adult deaf patients subjected to cochlear implantation, and we analyzed these results according to the prelingual or postlingual onset of the deafness. METHODS: The study population, balanced in terms of sex, consisted of 32 adults who had undergone cochlear implantation due to severe or profound bilateral hearing loss (16 with prelingual deafness and 16 with postlingual deafness) and their outcomes were compared with a control group of 32 normal hearing (NH) subjects. All subjects were asked to utter the sustained vowel /a/ for at least 5 s and then to read an Italian phonetically balanced text. Voice recordings were performed by means of an ambulatory phonation monitoring (APM 3200). Measurements were performed without cochlear implant (CI), then with CI switched on, both in quiet condition and with background noise. RESULTS: Compared to NH subjects, deaf individuals were overall characterized by higher F0 and loudness values, especially in the vowel task than the reading. In the sustained vowel task, no patients demonstrated significant voice changes after switching on the CI; contrarily, in the reading task, the use of the CI reduced both loudness and F0 up to values comparable to NH subjects, although only in males. There was no significant difference in speech parameters between prelingual and postlingual deafness, although overall lower values were evident in case of postlingual deafness. The use of the CI showed a significant reduction of F0 in males with postlingual deafness and of loudness, both for patients with prelingual and postlingual deafness. Finally, there was a positive correlation between postoperative hearing thresholds and overall speech loudness, highlighting how subjects with better hearing outcomes after CI positioning generally speak with a lower loudness and therefore a reduced vocal effort and load. DISCUSSION/CONCLUSION: We found similar speech performances between prelingual and postlingual deafness, both in the vowel /a/ phonation and in the reading, providing a further suggestion that prelingual adult patients may benefit from cochlear implantation in phonation as well, in addition to the known excellent hearing outcomes. Overall, these results highlight the ability of the CI to adjust in everyday speech certain phonatory aspects such as F0 and loudness by restoring the auditory feedback.

Acoustic analysis of an articulation assessment and training system / 中华物理医学与康复杂志

Objective:To compare the differences in important parameters between the articulation assessment and training system of intelligently extracted speech with those from the Praat acoustic software and those manually extracted.Methods:The speech of thirty-two normal subjects was captured using the intelligent articulation assessment and training system and using Praat acoustic software. The former analyzed the mean fundamental frequencies (mF0s), the first formant peaks (F1s) and the second formant peak (F2s) of the sustained vowels /a/, /i/ and /u/. The speech parameters collected by the traditional Praat software were extracted and analyzed by professionals. The two tools′ consistency in terms of these important acoustic parameters was analyzed.Results:The results with all 32 subjects when retested returned ICC values above 0.9 with all three vowels with the exception of mF0 for /u/ (ICC=0.75), indicating excellent retest reliability for the articulation assessment and training system. The ICC values also indicated excellent consistency between the two kinds of software in analyzing mF0, F1 and F2 of the three vowels. The mF0, F1, F2, FCR, VAI, tongue spacing, VSA, and mandibular spacing of all three vowels were mostly distributed within the 95% confidence interval of the data points in Bland-Altman plots, indicating the high accuracy of both acoustic analysis systems in speech measurement. The mean fundamental frequency values of the male long vowels /a/, /i/ and /u/ were all significantly lower than for the female long versions.Conclusions:The retest reliability of the articulation assessment and training system was good, and the results of the articulation check in the natural state were in good consistency compared to the Praat check and were interchangeable in the articulation check.

Vocal Fatigue in School Teachers and It's Relation to the Acoustic analysis of Voice.

Voice disorders are thought to be one of the major occupational hazards of school teaching. There is a need to study the prevalence of vocal fatigue in school teachers as it is unknown in Indian population and its awareness is at a very basic level. We aim to investigate percentage of school teachers reporting vocal fatigue and to find if there is any relationship between vocal fatigue and acoustic voice parameters. A total of 100 subjects (50-males and 50-females) in the age range of 25-35 years participated in the study. Voice Sample was obtained from the subject using a digital tape recorder and was analyzed in Visi pitch and Dr.Speech softwares. The sample was taken twice in a day, that is, before teaching and after teaching. The mean values obtained on all the questions of the vocal fatigue questionnaire show a significant increase in mean values on all the questions at post teaching ratings. Results revealed a statistically significant difference in pre and post teaching values of F0 and shimmer in males. In females, statistical significant difference was obtained in Noise to Harmonic Ratio in /u/ production. No significant correlation between acoustic parameters and overall vocal fatigue was found except for Noise to Harmonic ratio in females for /u/.

Correlation Between a Self-Voice Assessment and Objective-Voice Evaluation Outcomes in Speech Language Pathology Students.

AIM: The aims of this study is to explore the correlation between the Voice Disorder Index (VDI) score and acoustic and phonatory respiratory voice parameters in speech language pathology (SLP) students with and without self-perceived voice disorders. METHODS: The Voice Disorder Index (VDI) and the Lingwaves 3 "Voice Protocol" were administered to each participant in order to assess his/her self-perceived severity of his/her voice problem, as well as, acoustic and phonatory respiratory measurements. The correlation coefficients were used to evaluate and quantify the degree of a linear relationship between VDI scores and acoustic and phonatory respiratory voice measures in students with and without self-perceived voice disorders. RESULTS: Relatively strong, strong and strong positive correlations were revealed when comparing the VDI physical subscale with the Dysphonia Severity Index (r(11) = 0.56, P = 0.048), mean loudness when reading in English (r(11) = 0.70, P = 0.008) and mean loudness when reading in Greek (r(11) =0.69, P = 0.009) respectively. CONCLUSIONS: SLP students may be more aware of the impact of their laryngeal discomfort and voice output characteristics on their daily activities that can predict certain acoustic parameters than the emotional and functional impact on their daily activities.

[Detection of speech pathology based on parameters of analysis of dysphonia in speech and voice].

Objective:To analysis speech pathology based on dysphonia in speech and voice（ADSV）. Methods:The acoustic signals of continuous vowels and continuous speech of one-hundred and thirteen individuals were collected, including 93 vocal cord polyps cases, 20 glottis laryngeal carcinoma cases and 47 volunteers without speech sound disorders. Cepstral peak prominence（CPP）, CPP standard deviation（CPP SD）, L/H spectral ratio（L/H ratio）, L/H ratio standard deviation（L/H ratio SD） and cepstral/spectral index of dysphonia（CSID） were analyzed by ADSV to explore the role of these parameters in the recognition of speech pathology. Results:In the acoustic signal of continuous vowels, CPP and L/H ratio in normal group were higher than those in pathological voice group（P<0.001）, while CPP SD and CSID were lower than those in pathological voice group（P<0.001）, CPP and CSID areas under ROC curve were 0.95 and 0.99, respectively, which were important acoustic parameters for diagnosing pathological voice. In continuous speech acoustic signals, CPP, CPP SD and L/H ratio in the normal group were all higher than those in the speech disorders group（P<0.001）, and the area under the curve of CPP SD was 0.90, which showed high accuracy in diagnosing pathological voice. The ADSV voice analysis parameters CPP, CPP SD, CSID, and L/H ratio also showed significant differences between the vocal cord polyp group and the glottic laryngeal cancer group. The results of the discriminant analysis model show that the use of ADSV voice parameters can distinguish vocal cord polyps and laryngeal cancers. Conclusion:The ADSV voice analysis parameters can not only distinguish the voice signals of the normal group and the pathological group, but also distinguish different types of pathological voices. It has high sensitivity and specificity in diagnosing pathological voices.

Quality of Voice in Patients With Partial Deafness Before and After Cochlear Implantation.

Partial deafness is a condition characterised by normal hearing thresholds in low frequencies and increased hearing thresholds (nearly deafness) for high frequencies. Typical hearing aids are rather of a very limited use in this condition as they do not improve understanding of speech. Patients with partial deafness can be presently treated with cochlear implants, which had not been used before due to the risk of damage of hearing remains by electrode introduced into cochlea. The purpose of our study was an objective and subjective assessment of voice quality in partial deafness patients before and after cochlear implantation. The subjects in this study were 25 post-lingual, bilaterally partially deaf patients, 13 females and 12 males. The reference group composed of 55 normal hearing individuals (28 females and 27 males). The acoustic analysis was performed with a multidimensional voice analysis MDVP (Multi Dimension Voice Program), and the subjective assessment was done with GRBAS scale. Initial analysis of voice changes in partial deafness patients was performed versus normal hearing individuals, then voice parameters were measured and perceptual voice assessment was done before and 9 months after cochlear implantation. Measurements of acoustic voice parameters in partially deaf patients showed changes in most of frequency, amplitude, noise and subharmonic components versus normal hearing control group. The most significant, statistically important changes were observed in fundamental frequency variation (vF0), absolute jitter (Jita), jitter percent (Jitt), amplitude perturbation quotient (APQ), smoothed amplitude perturbation quotient (sAPQ), relative average perturbation (RAP), peak amplitude variation (vAm), relative amplitude modulation (Shim), percent shimmer (%Shim), pitch perturbation quotient (PPQ), smoothed pitched perturbation quotient (sPPQ), degree of subharmonics (DSH), degree of voiceless (DUV), number of subharmonic segments (NSH), noise-to-harmonic ratio (NHR), voice turbulence index (VTI). All patients in the study group were subjects to cochlear implantation. After 9 months objective and subjective assessment of patients` voices were performed again. Statistically important changes were identified in average fundamental frequency variability (vF0), relative amplitude modulation index (ShdB), noise-to-harmonic ratio (NHR), number of subharmonics NSH, degree of subharmonics (DSH) and the degree of voiceless (DUV). Comparison of the objective voice parameters changes after cochlear implantation with subjective, perceptual voice quality assessments leads to observation, that improvement of subjective voice quality after cochlear implantation takes place parallelly with improvement of certain objective acoustic voice parameters and some correlations exist. We found, that G correlates with vF0 and Shim, R correlates with DSH and NSH, B correlates with NSH and NHR, A correlates with DUV. We did not prove correlation of S with any of the objective parameters in our research group. Our study proved, that acoustic and perceptual features of voice in partially deaf adults are different than in normally hearing people and cochlear implantation in partial deafness patients is an effective tool to improve hearing and leads to improvement of the acoustic structure of the voice.Partial deafness is a condition characterised by normal hearing thresholds in low frequencies and increased hearing thresholds (nearly deafness) for high frequencies. Typical hearing aids are rather of a very limited use in this condition as they do not improve understanding of speech. Patients with partial deafness can be presently treated with cochlear implants, which had not been used before due to the risk of damage of hearing remains by electrode introduced into cochlea. The purpose of our study was an objective and subjective assessment of voice quality in partial deafness patients before and after cochlear implantation. The subjects in this study were 25 post-lingual, bilaterally partially deaf patients, 13 females and 12 males. The reference group composed of 55 normal hearing individuals (28 females and 27 males). The acoustic analysis was performed with a multidimensional voice analysis MDVP (Multi Dimension Voice Program), and the subjective assessment was done with GRBAS scale. Initial analysis of voice changes in partial deafness patients was performed versus normal hearing individuals, then voice parameters were measured and perceptual voice assessment was done before and 9 months after cochlear implantation. Measurements of acoustic voice parameters in partially deaf patients showed changes in most of frequency, amplitude, noise and subharmonic components versus normal hearing control group. The most significant, statistically important changes were observed in fundamental frequency variation (vF0), absolute jitter (Jita), jitter percent (Jitt), amplitude perturbation quotient (APQ), smoothed amplitude perturbation quotient (sAPQ), relative average perturbation (RAP), peak amplitude variation (vAm), relative amplitude modulation (Shim), percent shimmer (%Shim), pitch perturbation quotient (PPQ), smoothed pitched perturbation quotient (sPPQ), degree of subharmonics (DSH), degree of voiceless (DUV), number of subharmonic segments (NSH), noise-to-harmonic ratio (NHR), voice turbulence index (VTI). All patients in the study group were subjects to cochlear implantation. After 9 months objective and subjective assessment of patients` voices were performed again. Statistically important changes were identified in average fundamental frequency variability (vF0), relative amplitude modulation index (ShdB), noise-to-harmonic ratio (NHR), number of subharmonics NSH, degree of subharmonics (DSH) and the degree of voiceless (DUV). Comparison of the objective voice parameters changes after cochlear implantation with subjective, perceptual voice quality assessments leads to observation, that improvement of subjective voice quality after cochlear implantation takes place parallelly with improvement of certain objective acoustic voice parameters and some correlations exist. We found, that G correlates with vF0 and Shim, R correlates with DSH and NSH, B correlates with NSH and NHR, A correlates with DUV. We did not prove correlation of S with any of the objective parameters in our research group. Our study proved, that acoustic and perceptual features of voice in partially deaf adults are different than in normally hearing people and cochlear implantation in partial deafness patients is an effective tool to improve hearing and leads to improvement of the acoustic structure of the voice.

Changes in Acoustic Aspects of Vocal Function in Children After Adenotonsillectomy.

BACKGROUND: Adenotonsillectomy is one of the most common pediatric surgical procedures. Postoperative voice changes are a very common concern among patient's parents. Therefore, the aim of this study is to analyze acoustic voice parameters after adenotonsillectomy, tonsillectomy, and adenoidectomy in pediatric patients in a tertiary referral academic center. PATIENTS AND METHODS: All pediatric patients undergoing an adenotonsillectomy, tonsillectomy or adenoidectomy in a single center from 2002 to 2018 were included in the study. Change of fundamental frequency, jitter, shimmer, and harmonic-noise ratio at first, seventh and 30th postoperative day compared to preoperative values were the primary outcome parameters. Statistical analysis was performed using repeated measures analysis of variance model. RESULTS: A total of 1258 patients were included in the study. The mean age of patients at the time of surgery was 8.3 years (range 3.0-18.0 years). Around 698 were male (55.5%) and 560 female (44.5%). The values of fundamental frequency increased significantly after the first and seventh postoperative day (P = 0.001 both) but normalized 1 month after surgery (P = 0.962). At the first postoperative month, values of jitter and shimmer decreased significantly (P = 0.005 and P = 0.002, respectively). Measurements of harmonic-noise ratio revealed a significant increase 30 days after surgery (P = 0.004). CONCLUSION: Statistically significant differences in objective voice parameters within the first postoperative month after tonsillectomy, adenoidectomy, and adenotonsillectomy were observed. The fundamental frequency returned to normal 1 month after surgery. These findings can contribute in soothing the concerns of parents regarding postoperative voice changes.

Voice parameters for difficult mask ventilation evaluation: an observational study.

BACKGROUND: Mask ventilation (MV) is an essential component of airway management. Difficult mask ventilation (DMV) is a major cause for perioperative hypoxic brain injury; however, predicting DMV remains a challenge. This study aimed to determine the potential value of voice parameters as novel predictors of DMV in patients scheduled for general anesthesia. METHODS: We included 1,160 adult patients scheduled for elective surgery under general anesthesia. The clinical variables usually reported as predictors of DMV were collected before surgery. Voice sample of phonemes ([a], [o], [e], [i], [u], [ü], [ci], [qi], [chi], [le], [ke], and [en]) were recorded and their formants (f1-f4) and bandwidths (bw1-bw4) were extracted. The definition of DMV was the inability of an unassisted anesthesiologist to ensure adequate ventilation during MV under general anesthesia. Univariate and multivariate logistic regression analyses were used to explore the association between voice parameters and DMV. The predictive value of the voice parameters was evaluated by assessment of area under the curve (AUC) of receiver operating characteristic (ROC) curves of a stepwise forward model. RESULTS: The prevalence of DMV was 218/1,160 (18.8%). The AUC of the stepwise forward model (including o_f4, e_bw2, i_f3, u_pitch, u_f1, u_f4, ü_bw4, ci_f1, qi_f1, qi_f4, qi_bw4, chi_f1, chi_bw2, chi_bw4, le_pitch, le_bw3, ke_bw2, en_pitch, and en_f2, en_bw4) attained a value of 0.779. The sensitivity and specificity of the model were 75.0% and 71.0%, respectively. CONCLUSIONS: Voice parameters may be considered as alternative predictors of DMV, but additional studies are needed to confirm the initial findings.

Voice Parameter Changes in Professional Musician-Singers Singing with and without an Instrument: The Effect of Body Posture.

BACKGROUND AND AIM: The impact of body posture on vocal emission is well known. Postural changes may increase muscular resistance in tracts of the phono-articulatory apparatus and lead to voice disorders. This work aimed to assess whether and to which extent body posture during singing and playing a musical instrument impacts voice performance in professional musicians. SUBJECTS AND METHODS: Voice signals were recorded from 17 professional musicians (pianists and guitarists) while they were singing and while they were singing and playing a musical instrument simultaneously. Metrics were extracted from their voice spectrogram using the Multi-Dimensional Voice Program (MDVP) and included jitter, shift in fundamental voice frequency (sF0), shimmer, change in peak amplitude, noise to harmonic ratio, Voice Turbulence Index, Soft Phonation Index (SPI), Frequency Tremor Intensity Index, Amplitude Tremor Intensity Index, and maximum phonatory time (MPT). Statistical analysis was performed using two-tailed t tests, one-way ANOVA, and χ2 tests. Subjects' body posture was visually assessed following the recommendations of the Italian Society of Audiology and Phoniatrics. Thirty-seven voice signals were collected, 17 during singing and 20 during singing and playing a musical instrument. RESULTS: Data showed that playing an instrument while singing led to an impairment of the "singer formant" and to a decrease in jitter, sF0, shimmer, SPI, and MPT. However, statistical analysis showed that none of the MDVP metrics changed significantly when subjects played an instrument compared to when they did not. Shoulder and back position affected voice features as measured by the MDVP metrics, while head and neck position did not. In particular, playing the guitar decreased the amplitude of the "singer formant" and increased noise, causing a typical "raucous rock voice." CONCLUSIONS: Voice features may be affected by the use of the instrument the musicians play while they sing. Body posture selected by the musician while playing the instrument may affect expiration and phonation.

Comparison of Voice Outcomes between Medialization Thyroplasty and Arytenoid Adduction with or without Injection Laryngoplasty in Unilateral Vocal Fold Paralysis Patients

BACKGROUND AND OBJECTIVES: In unilateral vocal fold paralysis (VFP), medialization thyroplasty (MT), arytenoid adduction (AA) and injection layrngoplasty (IL) are the most common procedures to correct phonatory problems. There is no consensus that which procedure is superior to the other for correcting the glottal insufficiency. The purpose of this study was to compare the phonatory parameters between MT, AA and AA with IL (AA+IL) in patients with unilateral VFP. MATERIALS AND METHODS: This retrospective study enrolled patients from 2005 to 2016. Total 72 patients (49 male, 23 female, mean age 54.5 years) were classified into three groups ; MT (n=28), AA (n=12), and AA+IL (n=32). GRBAS scales, maximum phonation time (MPT), jitter, shimmer, noise to harmonic ratio (NHR), and voice handicap index (VHI)-10 and VHI-30 were preoperatively and postoperatively collected and compared between the three groups. RESULTS: Age, gender and cause of VFP were not significantly different between the three groups. In MT and AA groups, MPT, VHI, G (overall grade) and B (breathiness) were significantly improved. In AA+IL group, jitter, shimmer, NHR, MPT, VHI, G and B were significantly improved. In analysis of differences (pre-postoperative values), Δ jitter (p < 0.001), Δ shimmer (p=0.031), and Δ NHR (p=0.002) were significantly different and AA+IL group showed the greatest improvement. CONCLUSION: Analysis of voice parameters showed that all the three procedures for patients with unilateral VFP are effective in the improvement of voice ; especially in MPT, VHI-10, G and B scales. Compared to the others, AA+IL provided the better acoustic values including jitter, shimmer and NHR.

Combined Use of Standard and Throat Microphones for Measurement of Acoustic Voice Parameters and Voice Categorization.

OBJECTIVE: The aim of the present study was to evaluate the reliability of the measurements of acoustic voice parameters obtained simultaneously using oral and contact (throat) microphones and to investigate utility of combined use of these microphones for voice categorization. MATERIALS AND METHODS: Voice samples of sustained vowel /a/ obtained from 157 subjects (105 healthy and 52 pathological voices) were recorded in a soundproof booth simultaneously through two microphones: oral AKG Perception 220 microphone (AKG Acoustics, Vienna, Austria) and contact (throat) Triumph PC microphone (Clearer Communications, Inc, Burnaby, Canada) placed on the lamina of thyroid cartilage. Acoustic voice signal data were measured for fundamental frequency, percent of jitter and shimmer, normalized noise energy, signal-to-noise ratio, and harmonic-to-noise ratio using Dr. Speech software (Tiger Electronics, Seattle, WA). RESULTS: The correlations of acoustic voice parameters in vocal performance were statistically significant and strong (r = 0.71-1.0) for the entire functional measurements obtained for the two microphones. When classifying into healthy-pathological voice classes, the oral-shimmer revealed the correct classification rate (CCR) of 75.2% and the throat-jitter revealed CCR of 70.7%. However, combination of both throat and oral microphones allowed identifying a set of three voice parameters: throat-signal-to-noise ratio, oral-shimmer, and oral-normalized noise energy, which provided the CCR of 80.3%. CONCLUSIONS: The measurements of acoustic voice parameters using a combination of oral and throat microphones showed to be reliable in clinical settings and demonstrated high CCRs when distinguishing the healthy and pathological voice patient groups. Our study validates the suitability of the throat microphone signal for the task of automatic voice analysis for the purpose of voice screening.

Change of Voice Quality before and after Treatment of Short-Term Therapy with Proton Pump Inhibitor in Laryngopharyngeal Reflux / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The aim of this study was to verify that voice analysis could be an alternate tool for the evaluation of proton pump inhibitor treatment of laryngopharyngeal reflux (LPR). SUBJECTS AND METHOD: Twenty-two patients with LPR symptoms underwent laryngoscopy, stroboscopy and their reflux finding index (RFI) were evaluated. Subjective reflux symptom scores (RSS) and voice handicap index (VHI) were completed at the baseline. All patients underwent voice analysis. Thereafter, patients had short-term proton pump inhibitor therapy for 6 weeks. The RFI, RSS, VHI and voice analysis were repeated during the last week of the treatment. RESULTS: RFI was improved and both RSS and VHI were improved after the treatment. RSS and VHI were significantly correlated. In voice analysis, shimmer significantly improved and harmony to noise ratio (HNR) also improved. CONCLUSION: Voice analysis can be indicators of treatment results of laryngopharyngeal reflux disease.

Acoustic and phonatory characterization of the Fado voice.

Fado is a Portuguese musical genre, instrumentally accompanied by a Portuguese and an acoustic guitar. Fado singers' voice is perceptually characterized by a low pitch, hoarse, and strained voice. The present research study sketches the acoustic and phonatory profile of the Fado singers' voice. Fifteen Fado singers produced spoken and sung phonatory tasks. For the spoken voice measures, the maximum phonation time and s/z ratio of Fado singers were near the inefficient physiological threshold. Fundamental frequency was higher than that found in nonsingers and lower than that found in Western Classical singers. Jitter and shimmer mean values were higher compared with nonsingers. Harmonic-to-noise ratio (HNR) was similar to the mean values for nonsingers. For the sung voice, jitter was higher compared with Country, Musical Theater, Soul, Jazz, and Western Classical singers and lower than Pop singers. Shimmer mean values were lower than Country, Musical Theater, Pop, Soul, and Jazz singers and higher than Western Classical singers. HNR was similar for Western Classical singers. Maximum phonational frequency range of Fado singers indicated that male and female subjects had a lower range compared with Western Classical singers. Additionally, Fado singers produced vibrato, but singer's formant was rarely produced. These sung voice characteristics could be related with life habits, less/lack of singing training, or could be just a Fado voice characteristic.

The Effect on Voice by Strap Muscle Cutting in Thyroidectomy / 대한내분비외과학회지

PURPOSE: Voice change after thyroidectomy has generally been the result of damage to the recurrent or superior laryngeal nerve. But many patients complain voice alteration without laryngeal nerve injury after thyroidectomy. The purpose of this study is to investigate whether strap muscle division results in any subjective or objective functional sequelae in voice, through long-term follow-up prospectively. METHODS: Twenty-two female patients who had undergone thyroid surgery between July 1998 and December 1999, were studied. The patients who were planned for neck dissection, who had benign laryngeal disease or vocal cord paresis, and whose vocal cord paresis were developed after thyroid surgery, were excluded from this study. Twelve patients had undergone thyroidectomy via retraction of strap muscle and ten patients had undergone thyroidectomy via cutting of strap muscle. For evaluation of voice, questionnaires for changes of voice, acoustics (fundamental frequency, jitter, shimmer, signal to noise ratio, noise to harmonic ratio, voice range), and aerodynamic (maximal phonation time) analyses were done. RESULTS: The subjective voice symptoms after thyroidectomy were disturbances of high pitch, singing, loud voice, and easy fatigue at phonation. There were no significant differences in voice parameters on acoustic and aerodynamic analyses between the strap muscle retraction group and the cutting group through long-term follow-up. CONCLUSION: We conclude that strap muscle division does not result in any subjective or objective functional problems in voice. We suggest that surgical division and reconstruction of these muscles should be employed routinely when operating on large, toxic or neoplastic glands.