Manfred Pützer

Correlates of Varying Vocal Fold Adduction Deficiencies in Perception and Production: Methodological and Practical Considerations

In this study the voice characteristics of normal male and female speakers are compared to those of two groups of patients with unilateral vocal fold paralysis. In order to enhance phonation, the patients in the first group compensate for the adduction deficiency which results from paralysis. The patients in the second group do not use compensatory strategies. Sustained vowels [i:, a:, u:] were produced by the speakers and scored for roughness, breathiness and hoarseness (RBH) by 8 raters. Although interrater agreement for RBH scores is only moderate on average, these percepts make consistent distinctions between the three speaker groups. Consistent but different distinctions are made between the three speaker groups for male and female speakers. The results show that male and female speakers should not be pooled in experimental studies of the pathological voice. Our results also indicate that female patients with a compensated unilateral vocal fold paralysis cannot be clinically evaluated solely on the basis of perception, because their voices cannot be distinguished from normal, healthy female speakers, despite their physiological impairment. The group distinctions made on the basis of RBH scores are supported by differences in the acoustic parameters which are derived by automatic analysis of the sustained vowels. Despite identical group distinctions for RBH scores and acoustic parameters, the acoustic basis of the percepts is not straightforward. Different acoustic predictors of the percepts were found for male compared to female speakers. Additionally, interrater differences point towards the presence of perceptual trading relations.

Multiparametrische Stimmqualitätserfassung männlicher und weiblicher Normalstimmen

Die vorliegende Studie hat die Definition von Stimmprofilen zur männlichen und weiblichen Normalstimme zum Gegenstand. Für die Stimmqualitätserfassung, die mit Hilfe zweier kommerziell erhältlicher Stimmanalyseprogramme (MDVP und EGG-Programm von Kay Elemetrics) mit akustischer bzw. elektrophysiologischer Untersuchungsausrichtung angegangen wird, wurden Vokalproduktionen von 300 stimmgesunden erwachsenen Personen (150 männliche und 150 weibliche) analysiert. In einem ersten Schritt wird für die beiden Programme getrennt auf der Grundlage der Analysen ein geschlechtsdifferenziertes mittleres Stimmprofil präsentiert. Hierbei belegen die signifikant unterschiedlichen Mittelwerte der Analyseparameter die Notwendigkeit einer separaten Bearbeitung der männlichen und weiblichen Signale. In einem zweiten Schritt werden mit Hilfe der MDVP-Parameter zwei durch Clusterverfahren gewonnene numerisch bedeutsame Untergruppen für beide Geschlechter dargelegt. Für eine Profildifferenzierung erweisen sich die MDVP-Parameter geeigneter als diejenigen des EGG-Programms, weil diese keine weitere Differenzierung liefern. Eine abschliessende Betrachtung der Relevanz der Analyseparameter beider Programme für normalstimmliche Profildifferenzierungen durch eine Faktorenanalyse unterstreicht ebenfalls den Vorzug, den die MDVP-Parameter gegenüber den EGG-Parametern geniessen.

Bilateral high-frequency electrical impulses to the thalamus reduce voice tremor: acoustic and electroglottographic analysis. A case report

An 81-year-old female patient suffering from disabling Holmes’ tremor affecting both upper extremities, the head and additionally the vocal apparatus underwent bilateral thalamic ventralis intermedius nucleus (v.i.m.) stimulation. With the stimulation ON, the patient experienced complete suppression of the limb and head tremor and thorough voice normalization. Acoustic and electroglottographic (EGG) analysis showed a tendency towards hyperfunctional phonation with the stimulation ON as well as OFF, but a less disturbed vocal cord vibration pattern with the stimulation ON in comparison with a group of normal female speakers. This example shows that long-term monitoring of the vocal apparatus under deep brain stimulation therapy (DBS) of movement disorders must be planned in order to modify the stimulation parameters, if necessary, or to initiate logopaedic treatment.

Improvement of upper limb ataxia and intention tremor allowing cessation of thalamic electrostimulation after four years

A 34-year-old female patient suffering from multiple sclerosis was treated with thalamic electrostimulation for right dominant brachial ataxia and intention tremor. At the end of the fourth year, the energy of the battery of the impulse generator was depleted. However, the patient was able to use her hands without major impairment with the stimulator OFF, due to a stable reduction of the degree of ataxia and intention tremor. The opposite thalamus received an electrode that was never activated because of a permanent thalamotomy effect. Thus, it can be concluded that restoration of function by means of deep brain stimulation might have been beneficial towards achieving a reorganization and stabilization of subcortico-cortical and cerebellar circuitry, supporting the process of self-repair in this patient with a less aggressive course of multiple sclerosis. However, scientific proof has yet to be found. This exceptional observation emphasizes the need for longterm studies.

Instrumental Dimensioning of Normal and Pathological Phonation Using Acoustic Measurements.

The present study deals with the dimensions of normal and pathological phonation. Separation of normal voices from pathological voices is tested under different aspects. Using a new parametrization of voice‐quality properties in the acoustic signal, the vowel productions of 534 speakers (267 M, 267 F) without any reported voice pathology and the productions of 534 gender‐matched pathological speakers were considered. In a first step, a gender‐specific separation of the two groups is supported by a number of significantly different parameter means. In a second step, a clustering technique differentiates three subgroups within each group and gender on the basis of the acoustic parameters. Further, a statistical examination of the correct assignment in the database (DB‐classification) as “normal” or “pathological” shows that the two groups overlap to some extent. The overlap of speaker assignment indicates a phonation continuum through the multidimensional space extending from normal to pathological voices. The validity of a categorical distinction of normal and pathological phonation in the sense of an individual or group‐orientated labelling of voice quality as “normal” or “pathological”, respectively, is discussed.

Auswirkungen der Elektrostimulation subkortikaler Hirnstrukturen auf das glottale Schwingungsverhalten bei Patienten mit Morbus Parkinson und multipler Sklerose

Die vorliegenden Studie hat die Auswirkungen neurostimulatorischer Eingriffe auf die glottale Phonation bei 3 Patienten mit Morbus Parkinson und 3 Patienten mit multipler Sklerose zum Gegenstand. Unter Verwendung zweier Stimmanalyseprogramme (MDVP von Kay Elemetrics und EGG-Programm von Marasek) mit akustischer bzw. elektrophysiologischer Untersuchungsausrichtung wurden Vokalproduktionen der Patienten analysiert, die unter Stimulation bzw. Nichtstimulation aufgezeichnet wurden. In einem ersten Schritt können durch signifikant unterschiedliche Mittelwerte der Analyseparameter die intrasubjektiven Stimulationsauswirkungen nachgewiesen werden. Sie sind in verschiedener Ausprägung vor allem bei den Patienten mit M. Parkinson vorhanden. In einem zweiten Schritt erfolgt der geschlechtsgebundene Vergleich der individuellen Patientendaten unter den Bedingungen der Stimulation bzw. Nichtstimulation mit den Referenzdaten einer umfangreichen Kontrollgruppe stimmgesunder erwachsener Personen (150 männliche und 150 weibliche). Diese intersubjektiv referentielle Bewertung erweist sich im Vergleich zur intrasubjektiven Betrachtung auf Grund unterschiedlicher Ergebnisse bei den meisten Patienten als sinnvoll. Die pathologiebezogenen Tendenzen unter Stimulationseinwirkung bestehen bei den Personen mit M. Parkinson in einer relativen Verschlechterung des glottalen Schwingungsablaufs, während bei den Personen mit multipler Sklerose eine hyperfunktionelle Komponente bei der Phonation deutlich wird, auf Grund derer eine longitudinale Betrachtung des Phonationsverhaltens nach Elektrodenimplantation unter chronischer Stimulation für notwendig erachtet werden kann.

Funktionelle MRT der Sprache

Speech is a multifactorial term. In relationship with our central organ, speech is a communication medium which in a complex manner includes the production and perception of verbal information. Even within this limitation, imaging exploration of the neuronal basis of verbal communication offers an extensive investigative field which can only be presented in this article as highlights. The main focus is on the technical hurdles of investigations into speech production using functional magnetic resonance imaging (fMRI) and solution options will be presented. The difficulties contained in this aspect are that spoken words can only be poorly assessed in the noise level of the measurements and that the movements of the mouth necessary for speech motoric can lead to technical imaging artefacts. Investigation techniques and designs will be discussed which allow a representation of speech-relevant brain centers despite these problems.Zusammenfassung„Sprache“ ist ein vielschichtiger Begriff. In Bezug zu unserem Zentralorgan ist sie ein Kommunikationsmittel, das in komplexer Weise die Produktion und Perzeption verbaler Information beinhaltet. Auch in dieser Einschränkung bietet die bildgebende Erforschung der neuronalen Grundlagen verbaler Kommunikation ein ausgedehntes Untersuchungsfeld, das in diesem Artikel nur schlaglichtartig präsentiert werden kann. Es werden in erster Linie technische Hürden einer Untersuchung der Sprachproduktion mittels funktioneller Magnetresonanztomographie (fMRT) und Lösungsmöglichkeiten angeführt. Solche Schwierigkeiten sind darin zu finden, dass gesprochene Worte im Lärmpegel der Messung schlecht begutachtet werden können und dass die zur Sprechmotorik nötige Bewegung im Mundbereich zu technischen Bildartefakten führen kann. Hier werden Untersuchungstechniken und -designs besprochen, die trotzdem eine Darstellung sprachrelevanter Gehirnzentren ermöglichen.AbstractSpeech is a multifactorial term. In relationship with our central organ, speech is a communication medium which in a complex manner includes the production and perception of verbal information. Even within this limitation, imaging exploration of the neuronal basis of verbal communication offers an extensive investigative field which can only be presented in this article as highlights. The main focus is on the technical hurdles of investigations into speech production using functional magnetic resonance imaging (fMRI) and solution options will be presented. The difficulties contained in this aspect are that spoken words can only be poorly assessed in the noise level of the measurements and that the movements of the mouth necessary for speech motoric can lead to technical imaging artefacts. Investigation techniques and designs will be discussed which allow a representation of speech-relevant brain centers despite these problems.

Evaluation of Phonatory Behavior and Voice Quality in Patients with Multiple Sclerosis Treated with Deep Brain Stimulation

OBJECTIVES The effect of deep brain stimulation (DBS) on phonatory behavior and voice quality in eight patients with multiple sclerosis (MS) was examined instrumentally and perceptually. The acoustic signals of vowel productions obtained from patients (produced with and without stimulation) and from a group of 16 healthy control speakers were analyzed to prove statistically the changes of phonatory behavior and voice quality. STUDY DESIGN This is a randomized study. METHODS Firstly, a new parametrization was used to determine phonatory behavior. Secondly, a perceptual evaluation of voice quality of the same speech material was performed. RESULTS With stimulation, phonation has a greater tendency to be strained. The results of perceptual evaluation support this strained phonation behavior under stimulation, resulting in a smaller degree of breathiness ratings of all raters. Without stimulation, an impaired and partly disturbed adduction of the vocal folds can be shown. These findings are also supported in the perceptual experiment providing a higher degree of hoarseness ratings of all raters for these signals. CONCLUSIONS High-frequency electrical impulses to the thalamus in patients with MS influence the phonatory behavior of their vocal folds. The results suggest the need for long-term monitoring of phonatory behavior during DBS to initiate adequate treatments without delay.

Stimmprofile zur Normalstimme auf der Grundlage akustischer und elektroglottografischer Analysen

OBJECTIVE The present study deals with the dimensions of normal phonation. It is generally accepted that there exists a wide range of normal voices. MATERIAL AND METHODS Using complementarily orientated electroglottografic and acoustic parametrisations of phonation quality, sustained vowel productions of 267 male and 267 female speakers without any reported voice pathology were analysed. A clustering technique serves to differentiate gender specific subgroups of normal phonation on the basis of these analysis results. RESULTS Firstly, 3 subgroups within each gender on the basis of the EGG, and 3 subgroups on the basis of the acoustic parameters are presented. Secondly, this subgroup definition allows one to present voice profiles of normal speakers by combining the parameter means of the electroglottografically determined subgroups with those of the acoustically determined subgroups. CONCLUSIONS The present voice profiles can be used as a reference and are aimed at providing a firmer basis for the classification of different normal and pathological phonation types as well as for the evaluation of shifts in individual phonation behaviour due to therapy or spontaneous recovery.

Funktionelle MRT der Sprache@@@Functional MRI of speech

Speech is a multifactorial term. In relationship with our central organ, speech is a communication medium which in a complex manner includes the production and perception of verbal information. Even within this limitation, imaging exploration of the neuronal basis of verbal communication offers an extensive investigative field which can only be presented in this article as highlights. The main focus is on the technical hurdles of investigations into speech production using functional magnetic resonance imaging (fMRI) and solution options will be presented. The difficulties contained in this aspect are that spoken words can only be poorly assessed in the noise level of the measurements and that the movements of the mouth necessary for speech motoric can lead to technical imaging artefacts. Investigation techniques and designs will be discussed which allow a representation of speech-relevant brain centers despite these problems.Zusammenfassung„Sprache“ ist ein vielschichtiger Begriff. In Bezug zu unserem Zentralorgan ist sie ein Kommunikationsmittel, das in komplexer Weise die Produktion und Perzeption verbaler Information beinhaltet. Auch in dieser Einschränkung bietet die bildgebende Erforschung der neuronalen Grundlagen verbaler Kommunikation ein ausgedehntes Untersuchungsfeld, das in diesem Artikel nur schlaglichtartig präsentiert werden kann. Es werden in erster Linie technische Hürden einer Untersuchung der Sprachproduktion mittels funktioneller Magnetresonanztomographie (fMRT) und Lösungsmöglichkeiten angeführt. Solche Schwierigkeiten sind darin zu finden, dass gesprochene Worte im Lärmpegel der Messung schlecht begutachtet werden können und dass die zur Sprechmotorik nötige Bewegung im Mundbereich zu technischen Bildartefakten führen kann. Hier werden Untersuchungstechniken und -designs besprochen, die trotzdem eine Darstellung sprachrelevanter Gehirnzentren ermöglichen.AbstractSpeech is a multifactorial term. In relationship with our central organ, speech is a communication medium which in a complex manner includes the production and perception of verbal information. Even within this limitation, imaging exploration of the neuronal basis of verbal communication offers an extensive investigative field which can only be presented in this article as highlights. The main focus is on the technical hurdles of investigations into speech production using functional magnetic resonance imaging (fMRI) and solution options will be presented. The difficulties contained in this aspect are that spoken words can only be poorly assessed in the noise level of the measurements and that the movements of the mouth necessary for speech motoric can lead to technical imaging artefacts. Investigation techniques and designs will be discussed which allow a representation of speech-relevant brain centers despite these problems.