Danièle Robert

Objective Evaluation of Dysphonia: Preliminary Results of a Device Allowing Simultaneous Acoustic and Aerodynamic Measurements

Voice quality analysis was performed in 88 normal speakers and 157 dysphonic speakers using a device that allows simultaneous study of acoustic and aerodynamic parameters during pronunciation of a sustained /a/. We compared the results with those of voice quality grading by a jury. The Mann-Whitney test showed significant differences between the grades of dysphonia for all the parameters chosen. Comparison of results (using discriminant factorial analysis) with perceptual evaluation by a jury showed concordance in 66.1%. Based on these preliminary results, the authors conclude that their protocol overlooks some relevant voice parameters like middle-term variations. Further study will be undertaken to take into account this type of variations.

Quantitative voice analysis in the assessment of bulbar involvement in amyotrophic lateral sclerosis.

Bulbar and pseudobulbar symptoms are diagnostic criteria of amyotrophic lateral sclerosis (ALS). One of the earliest symptoms of bulbar involvement is voice deterioration. Until now voice assessment in ALS patients has been done mainly by perceptual analysis. The objective parameters, including acoustic measures, one aerodynamic measure and the maximal phonation time, have been measured only in a few small series of patients. The first purpose of this prospective study was to determine which vocal parameters discriminate ALS patients with bulbar involvement from control patients. The second was to identify sensitive parameters for early detection of voice deterioration due to bulbar involvement in pre-symptomatic ALS patients. The voices of 63 female ALS patients, including 40 with bulbar symptoms (sALS patients) and 23 without bulbar symptoms (aALS patients), were studied using an objective voice analysis system that allows simultaneous analysis of acoustic and aerodynamic parameters. Measurements were compared with those obtained in 40 normal female subjects (control patients). Five of eight acoustic parameters were significantly different among the three groups: jitter, coefficient of variation for frequency, shimmer, number of harmonics, and maximum phonatory frequency range. Three aerodynamic parameters, phonatory airflow, cycle-to-cycle variation for phonatory airflow, and coefficient of variation for phonatory airflow were significantly different between sALS patients and control patients. No aerodynamic parameter allowed discrimination between aALS patients and control patients. This study shows that acoustic parameters are more sensitive than aerodynamic parameters for early detection of bulbar involvement. Nevertheless, the measurements used can predict bulbar involvement in 73% of those in the sALS group, but only in 52% of those in the aALS group.

Acoustic and aerodynamic measurements of voice production after near-total laryngectomy with epiglottoplasty.

Objective voice analysis based on simultaneous aerodynamic and acoustic measurements is not common and there have been no reports dealing specifically with aerodynamic features of laryngeal performance after partial laryngectomy. The present study describes objective voice analysis after near-total laryngectomy using the Tucker technique (NTLT). We performed and compared acoustic and aerodynamic measurements in patients who underwent NTLT (n = 21) and normal controls (n = 10). Acoustic indexes of instability of frequency and intensity (jitter and shimmer) were always higher in patients. Oral airflow and estimated subglottic pressure (ESPG) were significantly greater in patients than in controls (400 vs. 169 cm3/s and 23 vs. 6.2 hPa, respectively). Poor closure of the glottis after surgery leads to a significant increase in glottal leakage in comparison with controls. Higher ESGP values observed in patients are probably related to two factors. The first involves compensation for glottal leakage in order to achieve sufficient air pressure to initiate vibration of the mucosa. The second factor is the poor vibratory quality of the residual mucosa, which may require higher pressure levels than the more compliant normal cord to initiate vibration. Our findings confirm the adverse effects of NTLT on the aerodynamic efficiency of the larynx due to glottal leakage and poor compliance of postoperative mucosa. Aerodynamic measurements could provide the basis for standardized objective evaluation of postoperative voice quality.

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

Abstract 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.