Ahmed Geneid

Vocal Tract and Glottal Function During and After Vocal Exercising With Resonance Tube and Straw

OBJECTIVE The present study aimed to investigate the vocal tract and glottal function during and after phonation into a tube and a stirring straw. METHODS A male classically trained singer was assessed. Computerized tomography (CT) was performed when the subject produced [a:] at comfortable speaking pitch, phonated into the resonance tube and when repeating [a:] after the exercise. Similar procedure was performed with a narrow straw after 15 minutes silence. Anatomic distances and area measures were obtained from CT midsagittal and transversal images. Acoustic, perceptual, electroglottographic (EGG), and subglottic pressure measures were also obtained. RESULTS During and after phonation into the tube or straw, the velum closed the nasal passage better, the larynx position lowered, and hypopharynx area widened. Moreover, the ratio between the inlet of the lower pharynx and the outlet of the epilaryngeal tube became larger during and after tube/straw phonation. Acoustic results revealed a stronger spectral prominence in the singer/speakers formant cluster region after exercising. Listening test demonstrated better voice quality after straw/tube than before. Contact quotient derived from EGG decreased during both tube and straw and remained lower after exercising. Subglottic pressure increased during straw and remained somewhat higher after it. CONCLUSION CT and acoustic results indicated that vocal exercises with increased vocal tract impedance lead to increased vocal efficiency and economy. One of the major changes was the more prominent singers/speakers formant cluster. Vocal tract and glottal modifications were more prominent during and after straw exercising compared with tube phonation.

Pilot study on acute voice and throat symptoms related to exposure to organic dust: preliminary findings from a provocation test.

The aim of this pilot research was to investigate acute voice and throat symptoms related to organic dust exposure among nine subjects with suspected occupational rhinitis or asthma. Subjective voice and throat symptoms were recorded before and after an occupational exposure test. In addition, the study included perceptual assessment of subjects’ voice samples recorded before and after the exposure tests. The results showed a number of (statistically) significant voice and throat changes in symptoms based on subjects’ own assessments. These symptoms included a hoarse, husky, or tense voice, requiring an extra effort when speaking and difficulty in starting phonation (P < 0.05). Other significant symptoms included feeling of shortness of breath or the need to gasp for air and feeling that the voice is weak or that it does not resonate (P < 0.01). Such changes were not, however, detected by voice clinicians in the listening test of subjects’ voice samples recorded before and after the exposure. These results suggest that the larynx reacts to organic dust with symptoms that are felt by the patient rather than heard by the voice clinician. The voice disorder in such cases is a diagnosis based on symptoms expressed by subjects.

EGG and Acoustic Analyses of Different Voice Samples: Comparison between Perceptual Evaluation and Voice Activity and Participation Profile

Objective: This study investigated whether different electroglottographic (EGG) parameters may be used to estimate voice quality and loading related to it, and whether voice quality is related to self-estimation of voice problems and laryngeal status. The effect of sample type was also considered. Methods: EGG and acoustic signals of a sustained vowel [a:] (90 dB6 cm) and text reading during noise exposure were recorded from 93 female kindergarten teachers. Analyses were made from the sustained vowel and vowel [a:] from a stressed word. Contact quotient (CQ) was calculated. Maximum velocity of increase in contact area inferred from derivative (MDEGG) was examined. Fundamental frequency was calculated from the EGG signal. From the acoustic signal sound pressure level (SPL) was computed and pressedness in voice quality was evaluated perceptually. Self-evaluation was made with Voice Activity and Participation Profile (VAPP). Indirect laryngoscopy was also performed. Results: Pressedness in voice correlated with EGG results only for the sustained vowel, and better with MDEGG than CQ values. VAPP and laryngeal evaluation did not correlate with the acoustic or EGG parameters or with perception. Conclusions: MDEGG is worth testing as an indicator of impact stress. Sustained vowel at a controlled SPL is more suitable for voice quality evaluation than a long stressed vowel from connected speech.

Vocal Fatigue Symptoms and Laryngeal Status in Relation to Vocal Activity Limitation and Participation Restriction

OBJECTIVES The study aims to investigate the vocal fatigue symptoms and laryngeal status in relation to vocal activity limitations and vocal participation restrictions. STUDY DESIGN This is a case-control study. METHODS Two hundred six teachers were divided into two groups based on the frequency of their self-reported vocal symptoms being more or less than the mean of reported frequency. The study compared odds for activity limitation and participation restriction in relation to frequency of vocal symptoms, number of vocal symptoms recurring weekly, and organic laryngeal changes. Activity limitation and participation restriction were studied using the Voice Activity and Participation Profile questionnaire. RESULTS Increased odds were found for teachers with frequent vocal symptoms and especially those with one or more vocal symptom recurring weekly. Odds were found to be 2.6-8.5 times more likely in teachers with more frequent vocal symptoms. The odds increased dramatically with increase of the number of vocal symptoms recurring weekly. Laryngeal organic changes were found to increase the odds but insignificantly. CONCLUSIONS Teachers with frequent vocal symptoms, especially those with vocal symptoms recurring weekly, have increased odds ratio for vocal activity limitation and vocal participation restrictions. High scores or frequent occurrence of self-reported vocal fatigue symptoms must be taken seriously in the evaluation of vocal working ability.

Hearing Impairment and Emotion Identification from Auditory and Visual Stimuli

In the present pilot study, the researchers investigated how people with impaired hearing identify emotions from auditory and visual stimuli, with people with normal hearing acting as their controls. Two separate experiments were conducted. The viewpoint was in the communication and social function of emotion perception. Professional actors of both genders produced emotional nonsense samples without linguistic content, samples in the Finnish language, and prolonged vowel samples. In Experiment 1, nine Cochlear implant users and nine controls participated in the listening test. In Experiment 2, nine users of a variety of hearing aids and nine controls participated in the perception test. The results of both experiments showed a statistically significant difference between the two testing groups, people with hearing impairment and people with normal hearing, in the emotion identification and valence perception from both auditory and visual stimuli. The results suggest that hearing aids and cochlear implants do not transfer well enough the nuances within emotions conveyed by the voice. The results also suggest difficulties in the visual perception among people with hearing impairment. This warrants further studies with larger samples.

The influence of water resistance therapy on vocal fold vibration: a high-speed digital imaging study.

Abstract Purpose: This study investigated the influence of tube phonation into water on vocal fold vibration. Method: Eight participants were analyzed via high-speed digital imaging while phonating into a silicon tube with the free end submerged into water. Two test sequences were studied: (1) phonation pre, during, and post tube submerged 5 cm into water; and (2) phonation into tube submerged 5 cm, 10 cm, and 18 cm into water. Several glottal area parameters were calculated using phonovibrograms. Results: The results showed individual differences. However, certain trends were possible to identify based on similar results found for the majority of participants. Amplitude-to-length ratio, harmonic-to-noise ratio, and spectral flatness (derived from glottal area) decreased for all tube immersion depths, while glottal closing quotient increased for 10 cm immersion and contact quotient for 18 cm immersion. Closed quotient decreased during phonation into the tube at 5 cm depth, and jitter decreased during and after it. Conclusion: Results suggest that the depth of tube submersion appears to have an effect on phonation. Shallow immersion seems to promote smoother and more stable phonation, while deeper immersion may involve increased respiratory and glottal effort to compensate for the increased supraglottal resistance. This disparity, which is dependent upon the degree of flow resistance, should be considered when choosing treatment exercises for patients with various diagnoses, namely hyperfunctional or hypofunctional dysphonia.

Long-Term Follow-Up of Patients with Spasmodic Dysphonia and Improved Voice despite Discontinuation of Treatment

Objective: To evaluate voice function in patients with adductor spasmodic dysphonia (AdSD) who discontinued botulinum toxin (BTX) treatment because they felt that their voice had improved sufficiently. Patients and Methods: Twenty-eight patients quit treatment in 2004, of whom 20 fulfilled the inclusion criteria for the study, with 3 subsequently excluded because of return of symptoms, leaving 17 patients (11 males, 6 females) included in this follow-up study. A questionnaire concerning current voice function and the Voice Handicap Index were completed. Audio-perceptual voice assessments were done by 3 listeners. The inter- and intrarater reliabilities were r > 0.80. Results: All patients had a subjectively good stable voice, but with differences in their audio-perceptual voice assessment scores. Based on the pre-/posttreatment auditory scores on the overall degree of AdSD, patients were divided into 2 subgroups showing more and less improvement, with 10 and 7 patients, respectively. The subgroup with more improvement had shorter duration from the onset of symptoms until the start of BTX treatment, and included 7 males compared to only 4 males in the subgroup with less improvement. Conclusion: It seems plausible that the symptoms of spasmodic dysphonia may decrease over time. Early intervention and male gender seem to be important factors for long-term reduction of the voice symptoms of AdSD.

Detecting inaudible vocal organ changes through glottal inverse filtering

The aim of this study was to investigate if there were objective quantities extracted from the speech pressure waveforms that underlay inaudible changes in the symptoms of the vocal organ. This was done through analyzing 180 voice samples obtained from nine subjects (five females and four males) before and after exposure to a placebo substance (lactose) and an organic dust substance. Acoustical analysis of the voice samples was achieved by using glottal inverse filtering. Results showed that the values of primary open quotient and primary speed quotient changed significantly (P<0.05) as did the amplitude quotient (P<0.01). Exposure to lactose resulted in significant changes of secondary open quotient (P<0.05) but opposite to effects found for exposure to organic dust. Modeling of the vocal tract into cross-sectional planes revealed that the immediate plane above the vocal folds correlates inversely with the feeling that voice is tense, or feeling the need to make an effort when speaking in addition having a feeling of shortness of breath or the need to gasp for air. Such results may point to acoustically detected subclinical changes in the vocal organ that the subject him/herself feels while they remain perceptually undetected by others.

Management of recurrent tonsillitis in children

OBJECTIVE To compare azithromycin (AZT) and benzathine penicillin (BP) in the treatment of recurrent tonsillitis in children. METHODS The study comprised of 350 children with recurrent streptococcal tonsillitis, 284 of whom completed the study and 162 children received conventional surgical treatment. The rest of the children, 122, were divided randomly into two equal main groups. Group A children received a single intramuscular BP (600,000IU for children≤27kg and 1,200,000IU for ≥27kg) every two weeks for six months. Group B children received single oral AZT (250mg for children≤25kg and 500mg for ≥25kg) once weekly for six months. RESULTS Both groups showed marked significant reduction in recurrent tonsillitis that is comparable to results of tonsillectomy. There were no statistical differences between group A and B regarding the recurrence of infections and drug safety after six-month follow-up. Group B showed better compliance. CONCLUSION AZT proved to be good alternative to BP in the management of recurrent tonsillitis with results similar to those obtained after tonsillectomy.

Parameterization of a computational physical model for glottal flow using inverse filtering and high-speed videoendoscopy

Abstract High-speed videoendoscopy, glottal inverse filtering, and physical modeling can be used to obtain complementary information about speech production. In this study, the three methodologies are combined to pursue a better understanding of the relationship between the glottal air flow and glottal area. Simultaneously acquired high-speed video and glottal inverse filtering data from three male and three female speakers were used. Significant correlations were found between the quasi-open and quasi-speed quotients of the glottal area (extracted from the high-speed videos) and glottal flow (estimated using glottal inverse filtering), but only the quasi-open quotient relationship could be represented as a linear model. A simple physical glottal flow model with three different glottal geometries was optimized to match the data. The results indicate that glottal flow skewing can be modeled using an inertial vocal/subglottal tract load and that estimated inertia within the glottis is sensitive to the quality of the data. Parameter optimisation also appears to favour combining the simplest glottal geometry with viscous losses and the more complex glottal geometries with entrance/exit effects in the glottis.