Endoscopic and Phoniatric Evaluation in Singing Students.

OBJECTIVES: In To analyze laryngostroboscopic findings and ENT/phoniatric examination results in a group of singing students and in a control group of non-singing subjects to emphasize the importance of ENT/phoniatric examination and of laryngostroboscopy before taking up singing. METHODS: 56 singing students and 60 healthy euphonic non-singer volunteers were recruited. In each subject a perceptual assessment and a self-assessment (VHI) of the voice were performed. The singing students filled out the Singing-VHI. All subjects underwent flexible fiberoptic endoscopy and laryngostroboscopy. All subjects were evaluated through the Reflux Symptom Index (RSI) and the Reflux Finding Score (RFS). RESULTS: At laryngostroboscopy, 60.7% of students presented pathological findings, versus 20% of controls (P < 0.0001). Incomplete glottic closure (35.7% vs. 13.3%), supraglottic hypertonus (16.1% vs. 5%), organic lesions (bilateral nodules, cysts, sulcus vergeture) (17.9% vs. 3.3%), posterior erythema (16.1% vs. 5%) and laryngeal edema (14.3% vs 3.3%) were more frequent in the students. The most common symptoms in singers were phonasthenia (37.5 % vs 6.7%; P = 0.0001) and mucus sensation (17.9% vs. 5%, P = 0.03). S-VHI showed higher values in students with pathological laryngostroboscopy (P < 0.0001). Finally, average RSI and RFS were higher in students. CONCLUSIONS: Due to the high percentage of organic and functional voice disorders in singing students, it would be desirable that every subject who is going to start singing underwent an ENT/phoniatric investigation with videostrobolaryngoscopy to ascertain vocal folds healthy condition.

Automatic Assessment of Acoustic Parameters of the Singing Voice: Application to Professional Western Operatic and Jazz Singers.

INTRODUCTION: The obvious perceptual differences between various singing styles like Western operatic and jazz rely on specific dissimilarities in vocal technique. The present study focuses on differences in vibrato acoustics and in singer's formant as analyzed by a novel software tool, named BioVoice, based on robust high-resolution and adaptive techniques that have proven its validity on synthetic voice signals. MATERIAL AND METHODS: A total of 48 professional singers were investigated (29 females; 19 males; 29 Western operatic; and 19 jazz). They were asked to sing "a cappella," but with artistic expression, a well-known musical phrase from Gershwin's Porgy and Bess, in their own style: either operatic or jazz. A specific sustained note was extracted for detailed vibrato analysis. Beside rate (s(-1)) and extent (cents), duration (seconds) and regularity were computed. Two new concepts are introduced: vibrato jitter and vibrato shimmer, by analogy with the traditional jitter and shimmer of voice signals. For the singer's formant, on the same sustained tone, the ratio of the acoustic energy in formants 1-2 to the energy in formants 3, 4, and 5 was automatically computed, providing a quality ratio (QR). RESULTS: Vibrato rates did not differ among groups. Extent was significantly larger in operatic singers, particularly females. Vibrato jitter and vibrato shimmer were significantly smaller in operatic singers. Duration of vibrato was also significantly longer in operatic singers. QR was significantly lower in male operatic singers. CONCLUSIONS: Some vibrato characteristics (extent, regularity, and duration) very clearly differentiate the Western operatic singing style from the jazz singing style. The singer's formant is typical of male operatic singers. The new software tool is well suited to provide useful feedback in a pedagogical context.

Is the perception of dysphonia severity language-dependent? A comparison of French and Italian voice assessments.

In this cross-language study, six Italian and six French voice experts evaluated perceptually the speech of 27 Italian and 40 French patients with dysphonia to determine if there were differences based on native language. French and Italian voice specialists agreed substantially in their evaluations of the overall grade of dysphonia and moderately concerning roughness and breathiness. No statistically significant effects were found related to the language of the speakers with the exception of breathiness, a finding that was interpreted as being due to different voice pathologies in the patient groups. It was concluded that the perception of the overall grade of dysphonia and breathiness is not language-dependent, whereas the significant difference in the perception of roughness may be related to a perception/adaption process.

Validation of the Italian version of the singing voice handicap index.

Singers constitute a specific population that is particularly sensitive to vocal disability, which may have a higher impact on their quality of life compared to non-singers. A specific questionnaire, the Singing Voice Handicap Index (SVHI), was created and validated aimed to measure the physical, social, emotional and economic impacts of voice problems on the lives of singers. The aim of this study was to validate the Italian version of the SVHI. The validated English version of the SVHI was translated into Italian and then discussed with several voice care professionals. The Italian version of the SVHI was administered to 214 consecutive singers (91 males and 123 females, mean age: 32.62 ± 10.85). Voice problem complaints were expressed by 97 of the singers, while 117 were healthy and had no voice conditions. All subjects underwent a phoniatric consultation with videolaryngostroboscopy to ascertain the condition of the vocal folds. Internal consistency of the Italian version of the SVHI showed a Cronbach's α of 0.97. The test-retest reliability was assessed by comparing the responses obtained by all subjects in two different administrations of the questionnaire; the difference was not significant (p = ns). The SVHI scores in healthy singers was significantly lower than the one obtained in the group of singers with a vocal fold abnormality (29.26 ± 25.72 and 45.62 ± 27.95, p < 0.001, respectively). The Italian version of the SVHI was successfully validated as an instrument with proper internal consistency and reliability. It is a suitable instrument for the self-evaluation of handicaps related to voice problems in the context of singing.

Fat injections for the treatment of velopharyngeal insufficiency.

The aim of this article was to describe the technical details of a fat injection procedure for the treatment of mild to moderate velopharyngeal insufficiency (VPI). Before surgery, the velopharyngeal gap is assessed by means of flexible nasoendoscopy, and speech intelligibility, hypernasality, and nasal air escape are perceptually evaluated and scored by independent raters; nasal airflow during speech is objectively measured. The lipoaspirate is centrifuged at 1200g for 3 minutes to separate and remove blood, cell debris, and the oily layer. Patients are injected with 3.5 to 8 mL of fat in the posterior and lateral pharyngeal walls and soft palate under general anesthesia. The fat is placed within the superior constrictor muscle on the posterior pharyngeal wall to avoid injection behind the prevertebral fascia and possible intraoperative or postoperative fat displacement in a caudal direction. A 19-gauge malleable, blunt, single-hole cannula is used for fat grafting, and the operative field is exposed by means of a Digman mouth gag. Two Nelaton probes are inserted through the nostrils and retracted from the mouth under moderate tension to favor visualization of the nasopharynx. No donor-site or injection-site morbidity has been observed so far, and the 12 patients (aged 5-48 y) treated so far have not manifested snoring or nasal obstruction at any time after surgery. Improved voice resonance is audible soon after the operation, and no hyponasality can be detected. The patients are discharged the day after surgery. Subsequent fat grafting procedures can be performed to achieve further improvement. Correctly performed fat injections improve voice resonance and reduce nasal air escape in VPI, as demonstrated by nasoendoscopy, speech perceptual evaluation, and the objective measurement of nasal airflow and represent an alternative to velopharyngoplasty for mild to moderate VPI.

Treatment of velopharyngeal insufficiency by pharyngeal and velar fat injections.

The aim of this prospective study was to evaluate the effectiveness of fat injections in the treatment of velopharyngeal insufficiency (VPI). The study involved 10 patients (6 adults aged 19-48 years and 4 children aged 5-13 years) with mild/moderate VPI who were injected with 3.5 to 8 mL of fat in the posterior, lateral pharyngeal walls and soft palate under general anaesthesia. A second fat-grafting procedure was performed in 2 patients to achieve further improvement. Nasoendoscopy revealed a reduction in the closure gap in all patients, and the perceptual evaluation demonstrated improved speech intelligibility and resonance and reduced nasal air leakage in all cases (P < .005). The aerodynamic assessment showed a significant reduction in nasal airflow during phonation (P < .05). Follow-up was 6 to 23 months. In conclusion, fat injections improved voice resonance and reduced nasal air escape in all treated cases and can be a promising alternative to major procedures, such as velopharyngoplasties, for the treatment of mild/moderate VPI.

Assessment of dysphonia due to benign vocal fold lesions by acoustic and aerodynamic indices: a multivariate analysis.

The goal was to identify acoustic and aerodynamic indices that allow the discrimination of a benign organic dysphonic voice from a normal voice. Fifty-three patients affected by dysphonia caused by vocal folds benign lesions, and a control group were subjected to maximum phonation time (MPT) measurements, GRB perceptual evaluations and acoustic/aerodynamic tests. All analyzed variables except the airflow variation coefficient were significantly different between the two groups. The unique significant factors in the discrimination between healthy and dysphonic subjects were the aerodynamic indices of MPT and Glottal efficiency index, and the acoustic index Shimmer. These results show that a combination of three parameters can discriminate a voice deviance and highlight the importance of a multidimensional assessment for objective voice evaluation.

Results of TRT after eighteen months: our experience.

The aim of this study was to evaluate the efficacy of TRT in patients suffering from tinnitus. The tinnitus disorder affects about 10-15% of the population and, in one person out of a hundred, it is a disabling disorder. TRT treatment is based on Jastreboff's neurophysiological model. TRT consists of two parts: counselling, and sound therapy by means of dedicated hearing aids and sound generators. It proved to be useful to reduce the symptoms related to tinnitus. Jastreboff's structured interviews were proposed to a sample of 51 patients with tinnitus belonging to the I-II-III-IV classes according to Jastreboff. These patients were treated for 18 months. Sixty-eight percent of patients reported a reduction in the symptoms related to tinnitus, such as sleep disturbance, problems in concentration, and inability to relax. A percentage (64.7%) of patients thought that their quality of life was improved. Patients who had suffered from tinnitus for less than one year achieved significantly better results than patients who had suffered for a longer period of time. TRT is an effective tool in the treatment of tinnitus.