Jihad Nassar

Relationship between acoustic parameters and body mass analysis in young males.

PURPOSE To analyze the correlation between acoustic parameters and body height, weight, and mass composition in young males. MATERIAL A total of 40 male subjects were included in this study. Each subject underwent acoustic analysis using the Kay Elemetric VISI Pitch (Model 3300, KayPentax, Lincoln Park, NJ) and complete body mass analysis. Pearson correlation was calculated to estimate the strength of the relationship between acoustic parameters and each of the weight analysis variables. RESULTS The mean age of the male subjects was 24 years with a range between 18 and 40 years. The average weight and height were almost 80 and 180cm, with standard deviation (SD) of 7.42 and 10.46, respectively. The fat weight ranged between 3 and 25kg, with the main concentration being in the extremities, 61.84%±17.4 and less concentrated in the trunk, 16.20% ± 7.6. The mean fundamental frequency was 120.13Hz with an SD of 19.16Hz. The mean Habitual Pitch was 114.16Hz with an SD of 16.55Hz. There was no significant correlation between the acoustic parameters and any of the body composition variables, in particular fat weight and distribution. There was a weak correlation between Shimmer, trunk fat (r value=0.328, P=0.039), and muscle mass (r value=0.326, P=0.038). CONCLUSION The body mass composition and distribution do not correlate significantly with the fundamental frequency and the Habitual pitch.

Glottal contact quotient in Mediterranean tongue trill

OBJECTIVE To determine the effect of a Mediterranean tongue trill (Zalghouta) on estimated glottal closed quotient (CQ). MATERIAL AND METHOD A total of 10 female subjects participated in this study. Vocal fold CQ was measured for both sustained vowel [a] and the tongue trill named Zlaghouta using electroglottography. Frequencies and means (±standard deviation) were used to describe categorical and continuous variables, respectively. The Wilcoxon signed nonparametric test was used to determine any significant changes in CQ means pretrill and during trill. RESULTS There was a significant decrease in the mean CQ during the Mediterranean tongue trill (Zalghouta) versus the sustained vowel [a] (P value of 0.002) by 15.98. When stratified by training status there was a significant decrease for the trained group (P value of 0.031) and a nonsignificant decrease for the untrained group (P value of 0.125). CONCLUSION Zalghouta induces a decrease in the vocal fold contact time. The potential benefits of the Mediterranean tongue trill in vocal therapy need consideration.

Cricothyroid joint abnormalities in patients with rheumatoid arthritis.

The objective of this study was to assess structural and functional abnormalities of the cricothyroid joint (CTJ) in patients with advanced rheumatoid arthritis (RA). A total of 19 subjects--11 patients with advanced RA and eight normal controls--were considered. All subjects underwent laryngeal endoscopy, acoustic analysis, and high-resolution computerized tomography (HRCT). Vocal symptoms, such as hoarseness, loss of range, vocal fatigue, and dyspnea were inquired and acoustic parameters, mainly pitch range, fundamental frequency, habitual pitch, perturbation parameters, and noise-to-harmonic ratio (NHR) and voice turbulence index were measured. Frequencies and means were calculated for categorical and continuous variables. Cases and controls were compared with respect to acoustic analysis, HRCT findings and laryngeal symptoms using nonparametric tests, Mann-Whitney U test for continuous variables and Fishers exact test for categorical variables. Almost half of the patients with RA had loss range and two-thirds had vocal fatigue. Thirty-six percent experienced hoarseness compared with 25% in the control group. 9.1% had decrease in vocal fold mobility and 27% had moderate/severe edema of the vocal folds/arytenoids compared with none in the control group. HRCT showed narrowing in the CTJ in 81.8% and ankylosis in 9.1% compared with none in the control group. 45.5% had an increase in the CTJ density compared with 12.5% in the control group. Acoustic analysis revealed significant decrease in pitch range and maximum phonation time (MPT) and significant increase in perturbation parameters. CTJ is commonly affected in patients with RA. Functional disabilities are crucial especially in professional voice users. Proper awareness is important for early detection and intervention.

Vocal characteristics in patients with type 2 diabetes mellitus

The objective of this study is to report the vocal characteristics of patients with type 2 diabetes mellitus in relation to disease duration, glycemic control, and neuropathy. This is a prospective study. The setting is institutional setting. A total of 82 patients were recruited for this study, and a healthy control group matched according to age and gender was recruited. Subjects underwent acoustic analysis and perceptual evaluation using the GRABS classification where G stands for grading, R for roughness, A for asthenia, B for breathiness, and S for straining using a scale of 0–3 where o stands for normal and three for severe deviation from normal. There was no significant difference in any of the acoustic variables between diabetic patients and control. There was no significant difference in the mean score of any of the perceptual evaluation parameters between diabetic patients and control, despite the fact that the mean scores were all higher in the diseased group except for roughness. When looking at subgroups, we see that diabetic patients with poor glycemic control and with neuropathy had significantly higher mean score for the G overall grade of the voice compared to controls with P values of 0.005 and 0.009, respectively. What is also worth noting is that diabetic patients with poor glycemic control had more straining compared to controls, P value 0.043. Patients with type 2 diabetes mellitus and poor glycemic control or neuropathy have a significant difference in the grade of their voice compared to controls.

Vocal Changes in Patients With Prostate Cancer Following Androgen Ablation

OBJECTIVE To compare the prevalence of vocal symptoms and parameters in patients with prostate cancer treated with androgen deprivation therapy (ADT). MATERIALS AND METHODS Thirty-two male patients aged 60-83 years were recruited for this study. The subjects were divided into two groups: one group consisted of 18 patients with prostate cancer treated with ADT using gonadotropin-releasing hormone agonists and the other group consisted of 14 controls matched according to age. Demographic data included age, history of smoking, reflux, and duration of therapy. The reported phonatory symptoms were hoarseness, inability to project the voice, and vocal fatigue. Patients also underwent acoustic analysis, and the following acoustic variables were measured: fundamental frequency, relative average perturbation, shimmer, noise-to-harmonic ratio, and voice turbulence index. RESULTS Compared with the control group, there was no statistical difference in any of the phonatory symptoms. The habitual pitch was significantly higher in the prostate cancer group compared with the controls (131.76 vs 114.11 Hz), with a P value of 0.021. There was also a significant increase in all the perturbation parameters, namely, relative average perturbation and shimmer, with a significant difference with respect to the latter (P value=0.014). There was also a significant increase in the noise-to-harmonic ratio (P value=0.014). CONCLUSION The administration of ADT for patients with prostate cancer can affect the habitual pitch. However, there are no noticeable vocal changes reported by the patients.

Prevalence of arytenoid asymmetry in relation to vocal symptoms.

OBJECTIVES (1) To assess the prevalence of arytenoid asymmetry during adduction, and (2) to correlate arytenoid asymmetry with vocal symptoms. MATERIALS AND METHOD The medical records and video recordings of 116 patients who presented to the voice clinic were reviewed for the presence of arytenoid asymmetry, as regards sharpening of the aryepiglottic fold angle and altered positioning of the cuneiform and corniculate cartilages. RESULTS There were 61 males and 55 females, with a mean age of 39 years and a standard deviation of 15 years. Almost one-third had a history of reflux, 25 per cent had a history of smoking and 9.6 per cent had a history of allergy. Hoarseness was the most common symptom, occurring in 42.2 per cent of patients, followed by vocal fatigue (25 per cent) and inability to project the voice. The most common type of asymmetry was corniculate asymmetry, present in 27.6 per cent of the cases and accounting for 74.39 per cent of cases. This was followed by cuneiform cartilage asymmetry, present in 15.5 per cent of cases. There was no correlation between arytenoid asymmetry and vocal symptoms, except for vocal fatigue (p = 0.038). CONCLUSION The prevalence of arytenoid asymmetry during adduction is common. The presence of vocal symptoms such as hoarseness, breathiness, inability to project the voice and straining does not generally seem to correlate with the prevalence of arytenoid asymmetry. However, subjects with vocal fatigue are more likely to have cuneiform asymmetry.

Frame by Frame Analysis of Glottic Closure in Fasting Subjects

Objective : The purpose of the study is to examine vocal fold closure in fasting subjects using frame by frame analysis. Subjects and Methods : Twenty-two male subjects were recruited for this study. All subjects were evaluated while fasting and non fasting. Frame by frame analysis of at least three glottic cycles was performed and reported as a mean closed quotient. The degree of phonatory effort and vocal fatigue was also reported. Results : The mean closed quotient for all subjects while non fasting was 0.427 ± 0.098 and while fasting 0.441 ± 0.073, with no significant difference between the two (p value 0.417). There was a significant increase in the phonatory effort while fasting (0.23 non fasting vs. 0.77 fasting, p value 0.036). Conclusion: There is no change in the mean closed quotient in male subjects while fasting. However, most subjects exhibit a significant increase in

FORMANT CHARACTERISTICS OF ENGLISH-SPEAKING LEBANESE MEN.

OBJECTIVE To report the formant characteristics of English-speaking Lebanese men during steady prolongation of vowels /a/ and /i/. DESIGN Cross-sectional study involving volunteer participants. PARTICIPANTS Fifty healthy English-speaking males with a mean age of 32 ± 4.027 years and a range of 42 years (18-60). MATERIALS AND METHODS A total of 50 healthy males between the age of 18 and 60 were recruited for the study. Each subject was asked to phonate a sustained /a/ and /i/ sound at a comfortable pitch and intensity level. Measures were made in real-time and formant frequencies across F1, F2, F3 and F4 were determined using the Real-time Spectrogram VP 3950 (Kay Elemetrics, New Jersey). MAIN OUTCOME MEASURES The formant frequencies across F1, F2, F3 and F4 were recorded. RESULTS For the vowel /a/, the mean values of F1, F2, F3 and F4 were 622.86 ± 61.293 Hz, 1264 ± 78.602 Hz, 2610.90 ± 206.359 Hz and 3483.56 ± 206.833 Hz, respectively. For the vowel /i/, the corresponding values were 378.88 ± 51.825 Hz, 2210.34 ± 124.077 Hz, 2847 ± 168.770 Hz and 3576.82 ± 242.760 Hz, respectively. CONCLUSION Formant characteristics vary among cultures and ethnic groups.

Electroglottography in Fasting Subjects

OBJECTIVE To make a comparative analysis on the closed quotient (CQ) of the sustained vowel /e/ while fasting and nonfasting. STUDY DESIGN Cross-sectional study. METHODS A total of 20 male subjects were enrolled. The mean age was 30.45 ± 8.79 years with a range of 20-48 years. The mean weight while nonfasting was 79.66 ± 12.91 kg and while fasting was 78.51 ± 12.70 kg. Demographic data included age, history of smoking, and weight. All subjects were evaluated while fasting and nonfasting. All subjects underwent laryngeal electroglottography while phonating the vowel /e/ at a comfortable pitch and loudness. The mean CQ, range, and standard deviations were computed while fasting and nonfasting. The degree of phonatory effort and vocal fatigue was also reported on a scale of 0-3. RESULTS The difference in weight while fasting and nonfasting was statistically significant (P=0.001). There was no significant difference between the mean CQ while fasting versus nonfasting (44.49 ± 1.15 and 44.30 ± 1.41, P=0.94). The difference in the mean grade of phonatory effort was borderline significant (P=0.059) with 40% of the subjects having an increase in effort. With respect to vocal fatigue, there was an increase in the average while fasting by 0.25, which was statistically nonsignificant (P=0.109). CONCLUSIONS The mean CQ during sustained /e/ is not affected by fasting. The presence of increased vocal effort and vocal fatigue could be secondary either to dehydration or respiratory muscle fatigue accompanying the weight loss.

Vocal characteristics in patients with thyroiditis

OBJECTIVE The aim of the present study was to describe the vocal characteristics of patients with thyroiditis in a clinical setting. MATERIALS AND METHODS A total of 17 consecutive patients with the diagnosis of thyroiditis presenting to the endocrinology clinic were invited to participate in the study. A group of 29 healthy subjects were used as controls. They underwent acoustic analysis and a perceptual evaluation using the GRABS classification. The mean score of each parameter was computed, and the distribution of severity of each perceptual parameter were listed. RESULTS There was no significant difference in any of the acoustic parameters between the patients and the controls, and there was no significant difference in the mean score of all the perceptual parameters between the patients and the controls. Even when examining the distribution of the severity of evaluation, there was no significant difference between the patients and the controls, as well. CONCLUSION Patients with thyroiditis do not have abnormal perceptual vocal evaluation or acoustic findings compared with controls.