Ignacio Cobeta

Acoustic voice analysis in patients with Parkinson's disease treated with dopaminergic drugs

To quantify several acoustic features of the voice in patients with Parkinsons disease (PD), 41 patients and 28 age and sex-matched controls were studied. PD severity was assessed with the Unified PD Rating Scale (UPDRS) and the Hoehn and Yahr staging. The Computerized Speech Lab 4300 program (Kay Elemetrics) was used. Two seconds of a sustained /a/ and a sentence were captured with a microphone and laryngograph equipment. Measures included fundamental frequency (F0), frequency perturbation (jitter), intensity perturbation (shimmer), and harmonic/noise ratio (H/N) of the vowel /a/, and frequency and intensity variability of a sentence, phonational range, dynamic range at the natural frequency, maximum phonational time and s/z ratio. All subjects underwent indirect laryngoscopy and/or laryngeal fibroscopy. When compared with controls, PD patients showed higher jitter, lower H/N ratio, lower frequency and intensity variability of the sentence, and lower phonational range and reported a higher frequency of the presence of low voice-intensity, monopitch, voice arrests, and struggle. These features seem to be unaffected by the duration and severity of the disease.

Acoustic voice analysis in patients with essential tremor

To quantify several acoustic features of the voice in patients with essential tremor (ET), 28 patients and 28 age- and sex-matched controls were studied. ET severity was assessed with the rating scale for tremor of Fahn, Tolosa, and Marín. The Computerized Speech Lab 4300 program (Kay Elemetrics) was used. Two-second samples of a sustained /a/ and a sentence were captured with a microphone and laryngograph equipment. Measures included fundamental frequency (F0), frequency perturbation (jitter, Koike algorithm), intensity perturbation (shimmer, Horii algorithm), and harmonic-to-noise ratio (H/N, Yumoto algorithm) of the vowel /a/, and the frequency and intensity variability of the sentence, phonational range, and dynamic range at the natural frequency, maximum phonational time, and s/z ratio. All subjects underwent indirect laryngoscopy and/or laryngeal fibroscopy. When compared with controls, ET patients showed higher jitter, lower H/N ratio (the last one only with laryngographic signal), of the vowel /a/, lower frequency variability in the microphonic signal, lower intensity variability in the laryngographic signal of the sentence, and significantly lower dynamic range at natural frequency of phonation. ET patients reported higher frequency of the presence of high voice intensity, tremor, and struggle. Several acoustic parameters were influenced by the severity of the disease, including shimmer, jitter, H/N ratio, frequency variability of the sentence, and s/z ratio, although neither of the acoustic analysis values or the phonetometric measurements were affected by the presence of voice tremor or by a successful pharmacological treatment of ET.

Acoustic voice analysis in untreated patients with Parkinson's disease.

To quantify several acoustic features of the voice in patients with Parkinsons disease (PD) not treated with dopaminergic drugs, 22 PD patients and 28 age and sex-matched controls were studied. The Computerized Speech Lab 4300 program (Kay Elemetrics) was used. Two seconds of a sustained /a/ and a sentence were captured with a microphone and laryngograph equipment. Measures included fundamental frequency (F(0)), frequency perturbation (jitter), intensity perturbation (shimmer), and harmonic/noise ratio (HIN) of the vowel /a/, and frequency and intensity variability of a sentence, phonational range, dynamic range at the natural frequency, maximum phonational time and s z ratio. All subjects underwent indirect laryngoscopy and/or laryngeal fibroscopy. When compared to controls, PD patients showed higher jitter and shimmer, lower H N ratio, and lower frequency variability of the sentence in the microphonic signal and reported a higher frequency of presence of low voice intensity, monopitch, harshness, voice arrests, and tremor.

Acoustic analysis of voice in Huntington's disease patients.

BACKGROUND/OBJECTIVES Alterations of voice and speech are frequently observed in Huntingtons disease (HD). The aim of this study was to assess the degree of voice and speech abnormalities in a group of patients with HD and to analyze possible correlations with degree of disease severity. PATIENTS/METHODS An observational study was carried out on diagnosed cases and controls. The voices of 20 patients were analyzed and compared with an age- and sex-matched control group. Variables analyzed included subjective voice exploration, analysis of aerodynamic efficiency, acoustic analysis measures, and laryngeal examination descriptions. Results obtained were correlated with degree of disease severity. RESULTS Changes in the Voice Handicap Index and clinical characteristics of the voice were observed. Maximum phonation time was reduced. Acoustic analysis revealed changes that were analyzed. Uncontrolled adduction-abduction movements were observed by laryngeal examination. All results showed a positive correlation with degree of disease severity assessed by the Unified Huntingtons Disease Rating Scale. CONCLUSIONS HD causes alterations in subjective voice features, aerodynamic and acoustic analysis measures that are correlated with disease severity.

Digital Voice Analysis in Patients With Advanced Parkinson’s Disease Undergoing Deep Brain Stimulation Therapy

INTRODUCTION An acoustic analysis was conducted of the voice of 25 patients with Parkinsons disease (PD) subjected to deep brain stimulation (DBS) to assess the impact of therapy. MATERIALS AND METHODS We examined 25 patients with advanced PD under four different conditions: deprived of medical treatment, under medical treatment, and one week and one month after the implant of the DBS electrodes. At the four time points, the patients produced a sustained /a/ and a standard sentence in Spanish, and microphone and electroglottographic recordings were digitally analyzed using the Computerized Speech Lab program. RESULTS Waveform analysis of the sustained /a/ captured by the microphone indicated a higher fundamental frequency (F(0)) when the patients were under levodopa treatment. The frequency perturbation (jitter) decreased remarkably after the three treatments. Shimmer also fell, but differences were not significant. CONCLUSIONS Nearly all acoustic analysis parameters during phonation of a sustained /a/ improved after DBS, but the factor that was most sensitive to the impact of both surgical and medical therapy was jitter.

The Aging Voice Influence of Respiratory and Laryngeal Changes

Objectives To evaluate the impact on voice quality of 2 pathogenic factors involved in age-related dysphonia: glottal gap and decline in respiratory function. Study Design Cross-sectional prospective. Settings Tertiary referral center. Subjects and Methods A total of 105 healthy patients ≥65 years old were included, with a maximum phonation time ≤15 seconds for men and ≤12 seconds for women. Laryngostroboscopy and spirometry were conducted to assess the glottal gap and respiratory function, and 4 profiles were defined according to their combination: glottal deficit, respiratory deficit, combined deficit, and no deficit. Differences across profiles in phonation times, acoustic parameters, and GRBAS scale and Voice Handicap Index–10 scores were analyzed according to Kruskal-Wallis and Mann-Whitney nonparametric tests. Multiple regression was performed to estimate the influence of each pathogenic factor. Results Respiratory deficit was the most frequent profile (37%). When compared to the other groups, patients with combined deficit had shorter phonation times for men (8.5 seconds; Kruskal-Wallis, P = .009) and women (7.8 seconds; P = .003), worse jitter (8.3%; P = .001), GRBAS scale (5.8; P < .001), and Voice Handicap Index–10 (7.7; P = .002). Conclusion Age-related respiratory and laryngeal changes have a negative impact on vocal quality, especially when both deficits are present.

In-office cup biopsy and laryngeal cytology versus operating room biopsy for the diagnosis of pharyngolaryngeal tumors: Efficacy and cost-effectiveness

In‐office biopsy is an effective technique to diagnose the nature of pharyngolaryngeal lesions.

Refractory chronic cough, or the need to focus on the relationship between the larynx and the esophagus

In this review we question the current way of handling tackle a problem of chronic cough, especially by the excessive number of patients who can not find complete relief from your cough by anatomical diagnosis of universal use. From the field of Otolaryngology new perspectives arise now considering the larynx as a preferential afferent stimuli cough reflex arc. Also the constitution laryngopharyngeal reflux gas and new approaches to non-acid reflux and the local action of pepsin in laryngeal deserving of a joint review, which can illuminate new ways to handle the problem of chronic refractory cough. We believe that the chronic cough syndrome hpersensitivity as more precise label for chronic cough, should place particular emphasis on laryngeal sensory neuropathy as cough and reflux the influence that may have on their maintenance, and thereby causes definitely wide related to the syndrome if the larynx is incorporated, place greater number of afferent nerves of chronic cough, which are sure to cover much of the case of refractory cough remain without a satisfactory solution. The close collaboration between Otolaryngology, Gastroenterology and Pneumology in a patient with refractory chronic cough seems now an unavoidable necessity.

SCREENING AUDITIVO EN NIÑOS CON FACTORES DE RIESGO DE HIPOACUSIA EN EL ÁREA 3 DE MADRID

Resumen La deteccion precoz de la hipoacusia tiene una gran importancia para poder iniciar una rehabilitacion temprana y asi conseguir un desarrollo normal del lenguaje. Por este motivo se han desarrollado programas de screening auditivo neonatal, fundamentalmente en los casos con antecedentes de riesgo de hipoacusia. El objetivo de este trabajo es estudiar la incidencia de la hipoacusia en los ninos con factores de riesgo en el area 3 de Madrid. Se realizo screening auditivo en 138 ninos en un periodo de 3,5 anos, mediante otoemisiones acusticas a los ninos menores de 1 ano y potenciales evocados auditivos a los que superaban esta edad. Los resultados muestran que existe un 4,34% de casos de hipoacusia neurosensorial en ninos con factores de riesgo, y mas concretamente un 2,8% de hipoacusia neurosensorial profunda bilateral; ademas tambien se detecto un 6,5% de hipoacusias transmisivas. El hecho de realizar este programa de screening permitio disminuir la edad de deteccion de la hipoacusia antes de los 6 meses. Estos datos apoyan la necesidad de realizacion de programas de screening auditivo con caracter obligatorio, aunque abogamos por el screening universal para poder abarcar los casos de hipoacusia sin antecedentes de riesgo

Participación laríngea en la tos crónica

Cough lasting more than 8 weeks is considered chronic. If the classic causes of chronic cough have been discarded, vagus nerve sensory disturbances are currently considered the most important etiological cause. Patients with chronic cough of laryngeal origin have associated symptoms such as globus, dysphagia, dysphonia, dyspnoea and/or stridor. These patients are more likely to have paradoxical vocal fold movement. There is a higher cough reflex sensibility and neuropathic laryngeal response, mainly caused by viral infection or reflux. The cough associated with reflux has 2 mechanisms: Exposure to acid in the distal oesophagus (gastroesophageal reflux) and microaspiration of oesophageal contents into the larynx and tracheo-bronchial tree (pharyngo-laryngeal reflux). Laryngeal neuropathy hypersensitivity responds well to speech therapy as a treatment for refractory chronic cough. Because chronic cough is a sign of laryngeal sensory, neuropathy can improve with neuroleptic drugs such as amitriptyline and gabapentin.