Maria Södersten

Glottal closure, transglottal airflow, and voice quality in healthy middle-aged women

Seventeen healthy women, 45 to 61 years old, were examined using videofiberstroboscopy during phonation at three loudness levels. Two phoniatricians evaluated glottal closure using category and ratio scales. Transglottal airflow was studied by inverse filtering of the oral airflow signal recorded in a flow mask (Glottal Enterprises System) during the spoken phrase /ba:pa:pa:pa:p/ at three loudness levels. Subglottal pressure was estimated from the intraoral pressure during p occlusion. Running speech and the repeated /pa:/ syllables were perceptually evaluated by three speech pathologists regarding breathiness, hypo-, and hyperfunction, using continuous scales. Incomplete glottal closure was found in 35 of 46 phonations (76%). The degree of glottal closure increased significantly with raised loudness. Half of the women closed the glottis completely during loud phonation. Posterior glottal chink (PGC) was the most common gap configuration and was found in 28 of 46 phonations (61%). One third of the PGCs were in the cartilaginous glottis (PGCc) only. Two thirds extended into the membranous portion (PGCm); most of these occurred during soft phonation. Peak flow, peak-to-peak (AC) flow, and the maximum rate of change for the flow in the closing phase increased significantly with raised loudness. Minimum flow decreased significantly from normal to loud voice. Breathiness decreased with increased loudness. The results suggest that the incomplete closure patterns PGCc and PGCm during soft phonation ought primarily to be regarded as normal for Swedish women in this age group.

Observations of the Relationship Between Noise Exposure and Preschool Teacher Voice Usage in Day-Care Center Environments

Although the relationship between noise exposure and vocal behavior (the Lombard effect) is well established, actual vocal behavior in the workplace is still relatively unexamined. The first purpose of this study was to investigate correlations between noise level and both voice level and voice average fundamental frequency (F₀) for a population of preschool teachers in their normal workplace. The second purpose was to study the vocal behavior of each teacher to investigate whether individual vocal behaviors or certain patterns could be identified. Voice and noise data were obtained for female preschool teachers (n=13) in their workplace, using wearable measurement equipment. Correlations between noise level and voice level, and between voice level and F₀, were calculated for each participant and ranged from 0.07 to 0.87 for voice level and from 0.11 to 0.78 for F₀. The large spread of the correlation coefficients indicates that the teachers react individually to the noise exposure. For example, some teachers increase their voice-to-noise level ratio when the noise is reduced, whereas others do not.

Prevalence of Voice Symptoms and Risk Factors in Teacher Students

Teacher students seem to have low awareness of the vocal demands in their future professions, and students with vocal symptoms are at risk for developing voice disorders during their professional careers. The purpose of the present study was to determine the prevalence of voice problems in teacher students at the very beginning of their education at the university. Of 1636 students approached in the first couple of days, 1250 (76%) answered two questionnaires about voice symptoms, Screen6 and Swedish Voice Handicap Index (Sw-VHI), and one questionnaire about potential risk factors. A majority of the students were women, and their mean age was 23 years (range, 18-52 years). The results showed that 208 of 1250 students (17%) had voice problems, defined as at least two symptoms weekly or more often in Screen6. The proportion of women was larger in the group with voice problems than in the group without voice problems. Significant risk factors for voice problems were vocal fold problems in childhood and adulthood, frequent throat infections, airborne allergy, smoking, hearing problems, previous work as teacher or leader, voice demanding hobbies, and previous speech therapy or voice training. There was a clear association between the number of potential vocal risk factors and the number of voice symptoms. There was also a strong association between the scores of the two questionnaires, the Sw-VHI and the Screen6. Students with voice problems according to Screen6 scored 23.1 (mean Sw-VHI) compared with 7.8 for students without voice problems.

Phonetograms as a tool in the voice clinic: Changes across voice therapy for patients with vocal fatigue

This study discusses phonetogram recordings as a tool in the voice clinic. It reports experiences during recordings and changes in measures across voice therapy for women with vocal fatigue. Phonetogram data are discussed along with subglottal pressure measurements and subjective evaluations of voice function and quality. Assessments were made pre-, mid-, and post behaviorally based voice therapy. Measures: maximum voice range profile (VRPmax), subglottal pressure, patients and speech and language pathologists (SLP) ratings of voice function and quality, and voice handicap index (VHI). Results: Patients and SLPs often agreed in direction of voice change across therapy. Subglottal pressure did not change systematically across therapy. VHI had decreased and VRPmax increased after therapy, although not to normal values. Increased VRPmax for individuals was mainly due to extended capacity in the low intensities; high intensities did not change noticeably. Changes tended to occur after the mid-therapy session, suggesting that the therapy should not be shortened. The results and the experiences from the assessments are discussed in terms of the use of phonetograms as a tool in the voice clinic and for voice therapy outcome evaluation.

Voice characteristics in women with congenital adrenal hyperplasia due to 21-hydroxylase deficiency.

Objective  Congenital adrenal hyperplasia (CAH) is an autosomal recessive inherited disorder resulting in lack of cortisol and often aldosterone and overproduction of androgens. Raised levels of androgens can lead to increased mass in the laryngeal tissues, which may lower the fundamental frequency (F0) of the voice.

Cancellation of Simulated Environmental Noise as a Tool for Measuring Vocal Performance During Noise Exposure

It can be difficult for the voice clinician to observe or measure how a patient uses his voice in a noisy environment. We consider here a novel method for obtaining this information in the laboratory. Worksite noise and filtered white noise were reproduced over high-fidelity loudspeakers. In this noise, 11 subjects read an instructional text of 1.5 to 2 minutes duration, as if addressing a group of people. Using channel estimation techniques, the site noise was suppressed from the recording, and the voice signal alone was recovered. The attainable noise rejection is limited only by the precision of the experimental setup, which includes the need for the subject to remain still so as not to perturb the estimated acoustic channel. This feasibility study, with 7 female and 4 male subjects, showed that small displacements of the speakers body, even breathing, impose a practical limit on the attainable noise rejection. The noise rejection was typically 30 dB and maximally 40 dB down over the entire voice spectrum. Recordings thus processed were clean enough to permit voice analysis with the long-time average spectrum and the computerized phonetogram. The effects of site noise on voice sound pressure level, fundamental frequency, long-term average spectrum centroid, phonetogram area, and phonation time were much as expected, but with some interesting differences between females and males.

Effects of Tactile Biofeedback by a Portable Voice Accumulator on Voice Sound Level in Speakers with Parkinson's Disease

OBJECTIVES To study the effects of biofeedback on voice sound level (SL) in subjects with reduced voice SL, secondary to Parkinson disease (PD), using a portable voice accumulator. STUDY DESIGN Prospective intervention study. METHODS Voice SL, phonation time, and level of background noise were registered with a portable voice accumulator during three consecutive registration periods. Six subjects with reduced voice SL secondary to PD participated. Biofeedback, in the form of a vibration signal when voice SL went below an individually set threshold level, was administered during the second registration period only. Mean voice SL was calculated for registration periods with and without feedback. Data on phonation time and level of background noise was also collected. Field registrations with the portable voice accumulator were also compared with registrations made in a recording studio. In addition, subjects were asked about subjective experiences of using the portable voice accumulator for up to 15 days. RESULTS There was a statistically significant increase in voice SL during the period when biofeedback of voice SL was administered. Subjects reported that using the portable voice accumulator was a positive experience. Several participants wished to continue using the device. In general, subjects handled the device independently with no major problems and did not report any negative experiences. CONCLUSIONS Although this study was a first trial including six subjects with reduced voice SL secondary to PD, the findings indicate that biofeedback of voice SL administered via a portable voice accumulator may be a useful treatment tool for this group of patients and that further studies are needed.

Voice and speech range profiles and Voice Handicap Index for males — methodological issues and data

Abstract Reference data for speech range profiles (SRP), voice range profiles (VRP), and Voice Handicap Index (VHI) are presented for Swedish males (n = 30). For comparisons, individual data for four male contact granuloma patients are also reported. For the vocally healthy group mean values were: speaking fundamental frequency 123 Hz (SD 12.1), speaking equivalent level, Leq, 72.2 dB (SD 2.1), SRP area 142 ST*dB (SD 24.1), and VRP area 1,706 ST*dB (SD 340). Mean VHI was 5 (SD 4.8). Test-retest recordings of VRP and SRP for three subjects suggested good reliability. SRP and VRP values for three of the patients fell more than 2 SD outside the reference values. Protocols and results are discussed and standardized recording and analyses procedures are suggested.

Effects of voice training in normal-speaking women: Videostroboscopic, perceptual, and acoustic characteristics

Several aspects of normal voices were investigated in eight female speakers (20-31 years) before and after voice training. The subjects were recorded on audio-tape during running speech and sustained-vowels and examined with video-fiberstroboscopy. Glottal closure pattern was evaluated by voice clinicians who analysed video-sequences using a 6-point rating scale. Audio-perceptual analyses of running speech and vowels were performed by experienced listeners who rated each of seven deviant voice quality parameters on a continuous scale. Acoustic analyses of fundamental frequency and of the relative level of the fundamental vs. the first formant were performed. Among the results, the posterior glottal chinks decreased somewhat in size after voice training, but were still observed in most subjects. For running speech, the degree of perceived breathiness, hypofunction, and vocal fry decreased while sonority increased significantly. Mean sound pressure level was raised by about 2 dB. and the mean fundamental fr...

The Flow and Pressure Relationships in Different Tubes Commonly Used for Semi-occluded Vocal Tract Exercises

This experimental study investigated the back pressure (P(back)) versus flow (U) relationship for 10 different tubes commonly used for semi-occluded vocal tract exercises, that is, eight straws of different lengths and diameters, a resonance tube, and a silicone tube similar to a Lax Vox tube. All tubes were assessed with the free end in air. The resonance tube and silicone tube were further assessed with the free end under water at the depths from 1 to 7 cm in steps of 1 cm. The results showed that relative changes in the diameter of straws affect P(back) considerably more compared with the same amount of relative change in length. Additionally, once tubes are submerged into water, P(back) needs to overcome the pressure generated by the water depth before flow can start. Under this condition, only a small increase in P(back) was observed as the flow was increased. Therefore, the wider tubes submerged into water produced an almost constant P(back) determined by the water depth, whereas the thinner straws in air produced relatively large changes to P(back) as flow was changed. These differences may be taken advantage of when customizing exercises for different users and diagnoses and optimizing the therapy outcome.