Frank Rosanowski

Clinically evaluated procedure for the reconstruction of vocal fold vibrations from endoscopic digital high-speed videos

Investigation of voice disorders requires the examination of vocal fold vibrations. State of the art is the recording of endoscopic high-speed movies which capture vocal fold vibrations in real-time. It enables investigating the interrelation between disturbances of vocal fold vibrations and voice disorders. However, the lack of clinical studies and of a standardized procedure to reconstruct vocal fold vibrations from high-speed videos constrain the clinical acceptance of the high-speed technique. An image processing approach is presented that extracts the vibrating vocal fold edges from digital high-speed movies. The initial segmentation is principally based on a seeded region-growing algorithm. Even in movies with low image quality the algorithm segments successfully the glottal area by an introduced two-dimensional threshold matrix. Following segmentation, the vocal fold edges are reconstructed from the computed time-varying glottal area. The performance of the procedure was objectively evaluated within a study comprising 372 high-speed recordings. The accuracy of vocal fold reconstruction exceeds manual segmentation results obtained by clinical experts. The algorithm reaches an information flow-rate of up to 98 images per second. The robustness and high accuracy of the procedure makes it suitable for the application in clinical routine. It enables an objective and highly accurate description of vocal fold vibrations which is essential to realize extensive clinical studies which focus on the classification of voice disorders.

PEAKS - A system for the automatic evaluation of voice and speech disorders

We present a novel system for the automatic evaluation of speech and voice disorders. The system can be accessed via the internet platform-independently. The patient reads a text or names pictures. His or her speech is then analyzed by automatic speech recognition and prosodic analysis. For patients who had their larynx removed due to cancer and for children with cleft lip and palate we show that we can achieve significant correlations between the automatic analysis and the judgment of human experts in a leave-one-out experiment (p<.001). A correlation of .90 for the evaluation of the laryngectomees and .87 for the evaluation of the childrens data was obtained. This is comparable to human inter-rater correlations.

Quality of Life in Laryngectomees after Prosthetic Voice Restoration

Background: In oncology, the paradigms for evaluating the results of treatment have shifted over the last few years. Preserving or restoring the quality of life has become an equally important aim of medical treatment as complete excision of the tumor and the duration of patient survival. Following laryngectomy, adequate speech restoration is one major aim of therapy. Different replacement strategies of voice production such as tracheoesophageal speech, esophageal speech, or electrolarynx are in use. The reporting department is able to restore speech in more than 90% of the patients; the majority uses tracheoesophageal speech with Provox® voice prosthesis. The purpose of the study was to assess the quality of life in laryngectomees after successful voice restoration with Provox voice prosthesis. Patients and Methods: In a cross-sectional study 25 laryngectomees whose voice had been restored by tracheoesophageal puncture and Provox voice prosthesis were examined for quality of life. The Short Form 36-Item Health Survey (SF-36) was used as an international and highly standardized test. Results: In comparison with a standardized healthy German male population, the patients showed more limited physical functioning as well as more restricted physical and emotional role functions. However, the laryngectomees did not attain lower scores for bodily pain. According to the patients’ statements their social functioning, vitality, and their mental health were not excessively limited; mental health and vitality were even better than in patients with heart or renal failure and hepatitis C. General health was fairly similar to a standard population. Conclusions: After laryngectomy, patients have deficits in physical and emotional well-being. Concepts of therapy should increasingly focus on how to deal with physical limitations and the patient’s apperception. Successfully restored voice minimizes social, mental and vitality limitations. The SF-36 is a suitable instrument for quality of life assessment in order to define disease-dependent and individual limitations of quality of life in laryngectomees and should lead to individual interventions.

Voice Handicap of Laryngectomees with Tracheoesophageal Speech

The evaluation of diagnostics and therapies includes more and more subjective, i.e. emotional and social aspects. Focussing on the handicap experienced by dysphonic patients, the Voice Handicap Index (VHI) has previously been found to be of significant clinical and scientific value for different voices. In this study the VHI questionnaire was applied to demonstrate the voice handicap of 20 male laryngectomees using tracheoesophageal voice (Provox®), aged 65.5 ± 8.7 years. Their VHI was 45.5 ± 24.1, which was significantly higher than the score of patients with functional voice disorders, but differed only slightly from patients with organic laryngeal dysphonia. Focussing on individual data, VHI scores ranged from values similar to persons without voice disorder to maximum handicap of 101. Comparing the VHI scores with the laryngectomees’ gradual self-perception of voice disorder severity, no consistent relationship was found. Considering the large interindividual differences, the VHI may serve as a valuable instrument for the assessment of individual interventional needs rather than for the identification of a general laryngectomees’ handicap.

Intelligibility of laryngectomees’ substitute speech: automatic speech recognition and subjective rating

Substitute speech after laryngectomy is characterized by restricted aero-acoustic properties in comparison with laryngeal speech and has therefore lower intelligibility. Until now, an objective means to determine and quantify the intelligibility has not existed, although the intelligibility can serve as a global outcome parameter of voice restoration after laryngectomy. An automatic speech recognition system was applied on recordings of a standard text read by 18 German male laryngectomees with tracheoesophageal substitute speech. The system was trained with normal laryngeal speakers and not adapted to severely disturbed voices. Substitute speech was compared to laryngeal speech of a control group. Subjective evaluation of intelligibility was performed by a panel of five experts and compared to automatic speech evaluation. Substitute speech showed lower syllables/s and lower word accuracy than laryngeal speech. Automatic speech recognition for substitute speech yielded word accuracy between 10.0 and 50% (28.7±12.1%) with sufficient discrimination. It complied with experts’ subjective evaluations of intelligibility. The multi-rater kappa of the experts alone did not differ from the multi-rater kappa of experts and the recognizer. Automatic speech recognition serves as a good means to objectify and quantify global speech outcome of laryngectomees. For clinical use, the speech recognition system will be adapted to disturbed voices and can also be applied in other languages.

Voice-related quality of life in organic and functional voice disorders

The voice-related quality of life (V-RQOL) questionnaire was proposed as a disease specific measure of patients’ subjective burden elicited by a voice disorder. The purpose of this study was to investigate the influence of gender and aetiology (benign organic versus functional) on V-RQOL results. Fifty-two German-speaking patients completed the questionnaire without prior information about their individual diagnosis. Results allow for the conclusion that women score lower indicating a poorer voice status. Differences between patients diagnosed with an organic or a functional voice disorder revealed no universal difference. This has to be investigated in future, especially against the degree of the voice disorder, the individual personality, health belief and social background.

Glissando: laryngeal motorics and acoustics

The objective of this study was to investigate the laryngeal mechanisms and the acoustical signal during a glissando. In particular, glottal length, maximum glottal area, and vibratory amplitudes during a glissando maneuver of a healthy male adult were measured. An endoscopic high-speed system combined with a laser projection device was used to obtain quantitative data both in the time and spatial domains. Simultaneously to the endoscopic investigation, the acoustic signal was recorded. Fundamental frequency and sound pressure level derived from the acoustic recordings were compared to vocal fold length and glottis area derived from the high-speed recordings. Results were used for interpretation of the phonation mechanism during glissando by means of laryngeal and acoustic parameters. The transition between the chest register and the falsetto register was identified by the absence of vocal fold contact. A rather early onset of the falsetto register was observed at 160 Hz. Although fundamental frequency of the vocal folds increased linearly even at the transition point, sound pressure level dropped down. These data represent the first ever quantitative description and interpretation of the glissando based on both voice properties and laryngeal motorics. In the presented example of an untrained singer, the falsetto sets in at comparatively low frequencies. Although the chest-falsetto transition is rather smooth for laryngeal motorics and voice pitch, a sudden drop of voice intensity was observed.

Stimmbezogene Lebensqualität: Struktur, Gültigkeit und Bedingungsfaktoren des deutschen Fragebogens

In this study, structure and validity of the German version of the Voice-Related Quality of Life (V-RQOL) questionnaire and its correlation to age, gender, and type of dysphonia (organic vs. functional) were assessed. Correlations of the V-RQOL result on the one hand and emotional and physical complaints on the other hand were investigated. Data were collected in 62 adult patients with dysphonia of benign origin and the following results were found: the German version of the V-RQOL questionnaire describes voice-related quality of life in one single value. Age, gender and type of dysphonia do not influence its result. Dysphonic patients present with an increased number of emotional and physical complaints when compared with normative values derived from the literature. However, not all of these complaints correlate with voice-related quality of life at a significant level.In this study, structure and validity of the German version of the Voice-Related Quality of Life (V-RQOL) questionnaire and its correlation to age, gender, and type of dysphonia (organic vs. functional) were assessed. Correlations of the V-RQOL result on the one hand and emotional and physical complaints on the other hand were investigated. Data were collected in 62 adult patients with dysphonia of benign origin and the following results were found: the German version of the V-RQOL questionnaire describes voice-related quality of life in one single value. Age, gender and type of dysphonia do not influence its result. Dysphonic patients present with an increased number of emotional and physical complaints when compared with normative values derived from the literature. However, not all of these complaints correlate with voice-related quality of life at a significant level.

Graduierung des Voice-Handicap-Index

ZusammenfassungHintergrundDer Voice-Handicap-Index (VHI) gilt heute als Goldstandard zur Messung der subjektiven Betroffenheit durch eine Dysphonie. Ziel der Studie war es darzustellen, wie das VHI-Ergebnis zu bewerten bzw. zu graduieren ist. Dazu wurde das VHI-Ergebnis dem Außenkriterium gesundheitsbezogene Lebensqualität gegenübergestellt und zusätzlich von den VHI-Ergebnissen stimmgesunder Personen abgegrenzt.Probanden/Methoden101 Patienten (61 Frauen, 40 Männer) zwischen 19 und 86 Jahren (48,4±14,6) mit einer Dysphonie benigner Ursache (62% organische, 38% funktionelle Dysphonie; Frauen: 62% vs. 38%, Männer: 63% vs. 37%) nahmen an der Studie teil. Erhebungsinstrumente waren der VHI-Fragebogen in einer deutschen Version sowie der kommerziell erhältliche SF-36-Fragebogen zur gesundheitsbezogenen Lebensqualität.ErgebnisseVon den beiden Summenskalen des SF-36 waren nur die Werte der „körperlichen Gesundheit“ gleichzeitig signifikant vermindert und korrelierten signifikant mit dem VHI-Summenwert. Diese Summenskala wurde also als Bewertungsmaßstab des VHI benutzt. Nach der Abgrenzung des VHI-Ergebnisses von dem stimmgesunder Probanden resultiert eine vierstufige Graduierung des VHI.FazitVHI-Gesamtwerte sind „sicher unauffällig“ bei einem VHI-Gesamtwert von 0–11 entsprechend einem „Betroffenheitsgrad 0“. „Eher unauffällig“ sind Werte von 12–28 entsprechend einem „Betroffenheitsgrad 1“, „eher auffällig“ sind Werte von 29–56 entsprechend einem „Betroffenheitsgrad 2“ und „sicher auffällig“ sind Werte von 57–120 entsprechend einem „Betroffenheitsgrad 3“.AbstractBackgroundThe Voice Handicap Index (VHI) questionnaire is currently regarded as the gold standard for the measurement of subjective suffering caused by dysphonia. The object of this study was to show how to weight or grade the result yielded by the VHI. To this end, the result obtained with the VHI was graded against the external criterion of health-related quality of life and also compared with the VHI results obtained in persons not affected by dysphonia.Patients and methodsA total of 101 patients (61 women, 40 men) aged between 19 and 86 (48.4±14.6) years and suffering from benign dysphonia (organic in 62%, functional in 38%: 62% and 38%, respectively in the women, 63% and 37%, respectively, in the men) took part in the study. The instruments used were a German version of the VHI and the SF-36 Health Survey on health-related quality of life, which is commercially available.ResultsThere are two subscales to the SF-36, but only the values for physical health were significantly reduced and correlated significantly with the results on the VHI scale. This subscale was therefore used as the external standard for grading of the VHI results. Following the separation of the VHI results recorded in the nondysphonic test subjects a four-point grading of the VHI results emerged.ConclusionsVHI values of 0–11 are classified as grade 0 suffering (almost certainly not noticeable), while values of 12–28 reflect grade 1 (more likely unnoticeable than conspicuous) suffering; values of 29–56 reflect grade 2 suffering (more probably noticeable than not), and values of 57–120 suggest a classification of certainly noticeable and are graded as grade 3 suffering.

Anxiety, Depression, and Quality of Life in Mothers of Children with Cleft Lip/Palate

Multidisciplinary care for patients with cleft lip and palate (CLP) includes the surgical correction of the facial disfigurement and the rehabilitation of functional deficits to optimize the communicational competence of the affected patient. Although the well-being of the mother of a CLP child is an important protective factor for the child, up to now literature has paid only little attention to this topic. In this study, 50 mothers of CLP children aged 1–10 years were examined using the 36-item Short-Form Health Survey and the Hospital Anxiety and Depression Scale (HADS) to screen for quality of life, anxiety and depression. Surprisingly, the data obtained indicate no group-specific alterations of these items when compared with normal controls. In cases with a deteriorated quality of life, the results of the HADS were pathologic as well. In general, mothers of CLP children aged more than 12 months do not require psychological screening. In individual cases, screening for relevant emotional aspects may be restricted to using the HADS.