Voice

Effect of Dysphonia and Cognitive-Perceptual Listener Strategies on Speech Intelligibility Publication date: Available online 25 April 2019 Source: Journal of Voice Author(s): Connie K. Porcaro, Paul M. Evitts, Nicole King, Cassandra Hood, Erin Campbell, Layla White, Jacqueline Veraguas ABSTRACT There is a high prevalence of dysphonia among professional voice users and the impact of the disordered voice on the speaker is well documented. However, there is minimal research on the impact of the disordered voice on the listener. Considering that professional voice users include teachers and air-traffic controllers, among others, it is imperative to determine the impact of a disordered voice on the listener. To address this, the objectives of the current study included: (1) determine whether there are differences in speech intelligibility between individuals with healthy voices and those with dysphonia; (2) understand whether cognitive-perceptual strategies increase speech intelligibility for dysphonic speakers; and (3) determine the relationship between subjective voice quality ratings and speech intelligibility. Sentence stimuli were recorded from 12 speakers with dysphonia and four age- and gender-matched typical, healthy speakers and presented to 129 healthy listeners divided into one of three strategy groups (ie, control, acknowledgement, and listener strategies). Four expert raters also completed a perceptual voice assessment using the Consensus Assessment Perceptual Evaluation of Voice for each speaker. Results indicated that dysphonic voices were significantly less intelligible than healthy voices (P≤ 0.001) and the use of cognitive-perceptual strategies provided to the listener did not significantly improve speech intelligibility scores (P = 0.602). Using the subjective voice quality ratings, regression analysis found that breathiness was able to predict 41% of the variance associated with number of errors (P = 0.008). Overall results of the study suggest that speakers with dysphonia demonstrate reduced speech intelligibility and that providing the listener with specific strategies may not result in improved intelligibility.

The Effectiveness of Vocal Hygiene Education for Decreasing At-Risk Vocal Behaviors in Vocal Performers Publication date: Available online 25 April 2019 Source: Journal of Voice Author(s): Fran Pomaville, Kristi Tekerlek, Anthony Radford Summary This study examined the knowledge gained and behavioral changes made by vocal performers after attending a vocal hygiene education program. A single-group, pretest-posttest research design was utilized to examine the improvement of voice care knowledge and decrease of phonotraumatic behaviors in vocal performers. Data analysis involved a comparison of pretest and posttest responses from an online questionnaire. A paired sample t test revealed a statistically significant improvement in the participants' knowledge regarding the larynx, voice production, and vocal hygiene. In addition, a behavioral inventory revealed improved hydration habits, decreased caffeine and alcohol intake, and healthier responses to symptoms of throat irritation or vocal fatigue. The findings from this study will contribute to evidence regarding the benefits of having vocal performers attend a vocal hygiene education program in order to increase their knowledge about voice production and care, decrease at-risk vocal behaviors, and improve healthy vocal practices.

Normative Value of SVHI-10. Systematic Review and Meta-Analysis Publication date: Available online 25 April 2019 Source: Journal of Voice Author(s): Maria Sobol, Ewelina M. Sielska-Badurek, Anna Rzepakowska, Ewa Osuch-Wójcikiewicz Summary Objective The study aimed to determine the normative value of SVHI-10. Study Design The study is a systematic review and a meta-analysis. Methods A systematic literature search was performed using PubMed and ScienceDirect to access relevant databases and to locate outcome studies. Eligibility criteria included type of publication, participant characteristics, and report of outcomes. Data analysis was conducted using the meta-analysis method. Results Six articles were included for the final analysis. The normative values for the SVHI-10 for a group of 528 subjects were 8.38 with confidence levels of 7.43–9.34 (age range 16–83). Conclusions Based on the results of the meta-analysis the SVHI-10 can be used as a screening tool for a group of singers. In the future, it would be worthwhile to carry out a subordinate analysis to determine the SVHI-10 range for mild voice disorders or severe voice disorders in singing.

Morphology, Vibratory Function, and Vascular Pattern for Predicting Malignancy in Vocal Fold Leukoplakia Publication date: Available online 19 April 2019 Source: Journal of Voice Author(s): Anna Rzepakowska, Maria Sobol, Ewelina Sielska-Badurek, Kazimierz Niemczyk, Ewa Osuch-Wójcikiewicz Summary Background The study evaluates clinical features of vocal fold (VF) leukoplakia in predicting its benign or malignant nature. Materials 57 patients with 84 lesions were evaluated before undergoing laryngeal microsurgery. The texture, color, thickness and size of the leukoplakia, along with an assessment of the surrounding mucosa vascularization using narrow-band imaging (NBI), and VF vibratory function were analyzed. Receiver-operating characteristic curves were constructed to determine the predictive value of each feature and area under the curve (AUC) was calculated. Results Histopathological examination revealed high-grade dysplasia or invasive cancer in 13 of VF leukoplakia. Seventy-one lesions were nondysplastic or low-grade dysplasia. Nonhomogenous color, irregular texture, and prominent thickness predicted malignancy with statistical significance (P < 0.05). AUC was 0.793, 0.793, and 0.679, respectively. Absence of a mucosal wave on laryngovideostroboscopy was significant for the detection of malignancy (P < 0.001) with an AUC of 0.927. The NBI diagnosis of horizontal vessel loops was significant with the highest AUC of 0.993. Conclusions The comprehensive clinical evaluation of VF leukoplakia with laryngovideostroboscopy and NBI creates the opportunity to differentiate between low- and high-risk malignancy lesions. The perpendicular vascular pattern and the limited or absent mucosal wave appear to be the most powerful indicators of malignancy.

A Very Rare Complication of Hyaluronic Acid Injection for Medialization Laryngoplasty: A Case With Laryngeal Abscess Publication date: Available online 17 April 2019 Source: Journal of Voice Author(s): Necati Enver, Orhan Asya, Ghazi Abuzaid, Ece Gürol Summary Hyaluronic acid injection for medialization laryngoplasty is a safe procedure performed on patients with glottic incompetence. Laryngeal abscess formation as a complication of injection laryngoplasty is a very rare complication, and, as we know from the literature, there has been only one case of laryngeal abscess after injection laryngoplasty in a patient with a type-I laryngeal cleft. We document for the first time a laryngeal abscess resulting from hyaluronic acid injection laryngoplasty for unilateral vocal fold paralysis. Prompt evaluation of the patient was necessary. Our patient was treated with antibiotics and corticosteroids without a need for intubation. One year after injection, the patient's Voice Handicap Index-10 score was still good and within the range of normal values.

Efficacy of Videostroboscopy and High-Speed Videoendoscopy to Obtain Functional Outcomes From Perioperative Ratings in Patients With Vocal Fold Mass Lesions Publication date: Available online 17 April 2019 Source: Journal of Voice Author(s): Maria E. Powell, Dimitar D. Deliyski, Steven M. Zeitels, James A. Burns, Robert E. Hillman, Terri Treman Gerlach, Daryush D. Mehta Summary Objectives A major limitation of comparing the efficacy of videostroboscopy (VS) and high-speed videoendoscopy (HSV) is the lack of an objective reference by which to compare the functional assessment ratings of the two techniques. For patients with vocal fold mass lesions, intraoperative measures of lesion size and depth may serve as this objective reference. This study compared the relationships between the pre- to postoperative change in VS and HSV visual-perceptual ratings to intraoperative measures of lesion size and depth. Design Prospective visual-perceptual study with intraoperative measures of lesion size and depth. Methods VS and HSV samples were obtained preoperatively and postoperatively from 28 patients with vocal fold lesions and from 17 vocally healthy controls. Two experienced clinicians rated amplitude, mucosal wave, vertical phase difference, left-right phase asymmetry, and vocal fold edge on a visual-analog scale using both imaging techniques. The change in perioperative ratings from VS and HSV was compared between groups and correlated to intraoperative measures of lesion size and depth. Results HSV was as reliable as VS for ratings of amplitude and edge, and substantially more reliable for ratings of mucosal wave and left-right phase asymmetry. Both VS and HSV had mild-moderate correlations between change in perioperative ratings and intraoperative measures of lesion area. Change in function could be obtained in more patients and for more parameters using HSV than VS. Group differences were noted for postoperative ratings of amplitude and edge; however, these differences were within one level of the visual-perceptual rating scale. The presence of asynchronicity in VS recordings renders vibratory features either uninterpretable or potentially distorted and thus should not be rated. Conclusions Amplitude and edge are robust vibratory measures for perioperative functional assessment, regardless of imaging modality. HSV is indicated for evaluation of subepithelial lesions or if asynchronicity is present in the VS image sequence.

Acoustic Voice Quality Index and Acoustic Breathiness Index: Analysis With Different Speech Material in the Brazilian Portuguese Publication date: Available online 17 April 2019 Source: Journal of Voice Author(s): Marina Englert, Livia Lima, Mara Behlau Summary Objective To analyze the Acoustic Voice Quality Index (AVQI) and the Acoustic Breathiness Index (ABI) concurrent validity and diagnostic accuracy with different speech materials. Methods Voices of 53 subjects (40 dysphonic; 13 vocally health) were recorded: vowel /a/ + counting numbers 1–20 (42 syllables) + reading text (138 syllables). Numbers and text were edited in order to achieve 3 seconds of voiced segments, such as the vowel /a/ (average of 18.81 and 32.49 syllables; confidence interval of 1.87 and 2.30). The audio files were edited to have 17 syllables for numbers and 32 for text. Three voice specialists perceptually judge the overall voice quality (G) and the breathiness (B). AVQI's and ABI's precision and concurrent validity were assessed. Results The intra- and inter-rater reliability were high. Reading text presented higher concurrent validity (r) than automatic speech and excellent area under the receiver-operating characteristic curve for AVQI (0.963) and ABI (0.929). Counting numbers presented good area under the receiver-operating characteristic curve for AVQI (0.870) and excellent for ABI (0.924). Counting numbers produced higher sensitivity for ABI (95.2%) and reading text higher specificity for both indexes (AVQI = 100%; ABI = 90.90%). Reading text presented higher AVQI and ABI scores than numbers, therefore, reading seems to reveal more vocal deviations; however, perceptual judgment can be similar in both samples. Conclusions Different speech materials may impact acoustic outcomes and certain voice characteristics may not be evident. Reading text offers higher diagnostic accuracy. Clinician and/or researchers must select and standardize the speech sample according to their goals.

Association Between Subglottic Pressure and Pulmonary Function in Individuals With Parkinson's Disease Publication date: Available online 16 April 2019 Source: Journal of Voice Author(s): Adrián Castillo, Javiera Castillo, Alvaro Reyes Summary Introduction In individuals with Parkinson's disease (PD), pulmonary complication such as weakness and rigidity of respiratory muscles and reduced cough airflow may be associated with reduced voice production due to limited pulmonary capacity and reduced airflow needed to vibrate the vocal folds. It is not clear, however, which pulmonary function parameter is determinant in the association with peak subglottic pressure (SGP). Therefore, the purpose of this study was to determine the association between peak SGP and pulmonary function parameters in individuals with PD. Methods Forty-two individuals with diagnosis of idiopathic PD of both genders were recruited in the study. Mean and peak SGP, spirometric indices, maximum inspiratory pressure, maximum expiratory pressure (MEP), and peak cough flow (PCF) during reflex and voluntary cough were measured on all participants. Results The analysis revealed that peak SGP had a moderate but significant linear association with MEP (r = 0.38; P = 0.013), voluntary (r = 0.31; P = 0.051), and reflex PCF (r = 0.40; P = 0.012), but not with maximum inspiratory pressure (r = 0.23; P = 0.145). Higher values in peak SGP were associated with higher values in MEP, voluntary PCF, and reflex PCF. No linear association was detected between peak SGP and spirometric indices. Conclusions Peak SGP has a direct association with voluntary and reflex PCF, and expiratory muscle strength, but not with inspiratory muscle strength. The association with peak SGP is higher for reflex PCF than for voluntary PCF.

Longitudinal Case Study of Transgender Voice Changes Under Testosterone Hormone Therapy Publication date: Available online 13 April 2019 Source: Journal of Voice Author(s): Gabriel J. Cler, Victoria S. McKenna, Kimberly L. Dahl, Cara E. Stepp Abstract The purpose of this study was to comprehensively evaluate voice and speech changes in one healthy 30-year-old transgender male undergoing testosterone therapy for transition. Testing occurred at three timepoints before cross-sex hormone therapy and every 2 weeks thereafter for 1 year. Data collected included measures of acoustics, aerodynamics, and laryngeal structure and function via flexible laryngoscopy. Analysis included acoustic correlates of pitch, loudness, voice quality, and vocal tract length, as well as perceptual measures of voice quality and gender. Speaking fundamental frequency (fo) lowered from 183 Hz to 134 Hz. Phonatory frequency range (ie, minimum and maximum singing range) shifted from a range of D#3–E6 to a range of A2–A5. Perceptual measures of voice quality indicated no negative changes. Naïve listeners reliably rated the participant's speech samples as male after 37 weeks on testosterone. Few studies document in detail the variety of voice changes that occur during cross-sex hormone therapy, focusing instead on fo alone. This study adds to the literature a comprehensive case study of speech and voice changes experienced by one transmasculine participant undergoing testosterone therapy.

The Prevalence of Dysphonia and Dysphagia in Patients with Vitamin D Deficiency Publication date: Available online 12 April 2019 Source: Journal of Voice Author(s): Abdul-Latif Hamdan, Elie Khalifee, Nader Al Souky, Bakr Saridar, Pierre Richard Abi Akl, Anthony Ghanem, Sami Azar Abstract Objective To investigate the prevalence of phonatory and swallowing symptoms in patients with hypovitaminosis D. Methods/Design All patients presenting to the endocrinology clinic and investigated for vitamin D deficiency between January 2018 and April 2018 were asked to participate in this study. Demographic data included age, gender, allergy, and history of smoking. Patients filled Voice handicap Index (VHI-10) and Eating Assessment Tool (EAT-10). Results A total of 136 consecutive subjects presenting to the endocrinology clinic for vitamin D testing were included: 60 with hypovitaminosis D and 76 with no hypovitaminosis D. The mean vitamin D level in the study group and controls was 13.25 ng/mL and 31.91 ng/mL, respectively. There was no significant difference in the mean score of VHI-10, nor in the mean score of EAT-10 in patients with hypovitaminosis D versus those with no hypovitaminosis D (P value >0.05). Conclusion There was no significant difference in the prevalence of phonatory and dysphagia symptoms using VHI-10 and EAT-10 questionnaires between subjects with hypovitaminosis D and those with normal serum vitamin D levels.