Acoustic correlates of Burmese voiced and voiceless sonorants.

Voiceless sonorant consonants are typologically rare segments, appearing in only a few of the world's languages, including Burmese. In this study, Burmese sonorants and their adjacent vowels are investigated in an attempt to (1) determine what acoustic correlates distinguish voiced and voiceless sonorants and (2) determine whether there are multiple realizations of voiceless sonorants and, if so, establish what acoustic correlates distinguish them. In order to pursue these questions, a production study was carried out and target words were analyzed, demonstrating that Burmese voiceless sonorants have a spread glottis period resulting in turbulent airflow 78 % of the time. Findings from linear mixed-effects models showed that voiced and voiceless sonorants are significantly different in terms of duration of the sonorant, F0 of the sonorant, and strength of excitation measured over the following vowel. A linear discriminant analysis was able to predict voicing category with 86.7 % accuracy, with the duration of the spread glottis period being the best indicator of voicelessness, followed by the cues that were significant in the linear mixed-effects models. In cases when the spread glottis period is absent from voiceless sonorants, the sonorant only has correlates that are associated with voicelessness (such as F0 and strength of excitation) but not correlates that are associated with the spread glottis gesture (such as duration and harmonics-to-noise ratio). These results have implications both for our understanding of the acoustics of Burmese sonorants and for our understanding of voiceless sonorants more generally.

[Voice disorders associated with novel coronavirus infection]. / Narusheniya golosa u patsientov posle perenesennoi novoi koronavirusnoi infektsii.

OBJECTIVE: To evaluate the features of voice disorders associated with novel coronavirus infection and to develop the clinical algorithm for diagnostic and treatment these patients. MATERIAL AND METHODS: A prospective observational study was conducted in patients with dysphonia after COVID-19 (n=60). All patients underwent a comprehensive voice assessment before and after the proposed treatment. The follow-up period was 1 month. RESULTS: Functional dysphonia or aphonia with a stable (refractory) or recurrent course was diagnosed in 58 (97%) patients. A tendency to an increase in the value of the latent period of the P300 and MMN in patients with voice disorder was revealed. There was a significant decrease in supraglottic constriction and glottal insufficiency before and after the treatment. The mean VHI-10 decreased from 25.4 before treatment to 15.3 after treatment. The DSI which is based on the set of voice measurements, statistically significant improved from -5.2 to 2.6 in patients as a result of treatment. The average value of MFI-20 improved from 65.4 (8.7) at the beginning of the study to 20.3 (5.3) after treatment. CONCLUSION: In patients with dysphonia or aphonia associated with COVID-19 are indicated a refractory type of dysphonia. This was indicated by the study of AEPs of the brain. The clinical algorithm for treatment and diagnostic patients with voice disorders after COVID-19 has been developed. The treatment of this group of patients should be adjunct by the drug therapy, kinesiotaping method and psychotherapy.

Voice onset time and constriction duration in Warlpiri stops (Australia).

This paper presents a first detailed analysis of the Voice Onset Time (VOT) and Constriction Duration (CD) of stops /p t ʈ c k/ and flap /ɽ/ in the Indigenous Australian language Warlpiri as spoken in Lajamanu Community, in Australia's Northern Territory. The results show that Warlpiri stops are realised as voiceless, long-lag stops word-initially, as well as word-medially, where /p t k/ are also characterised by CDs in excess of 100 ms. This is similar to what has been reported for Kriol, and for the emerging mixed language Light Warlpiri, also spoken in the community, and by some of the participants. The results indicate that Warlpiri does not obligatorily make a word-medial distinction between stops orthographically represented by 'rt' and 'rd', which have previously been argued to be realised as /ʈ/ and /ɽ/, respectively, at least in some varieties of Warlpiri. Finally, the results also suggest that the realisation of word-initial Warlpiri flap /ɽ/ is highly variable, potentially resulting in a near-merger with /É»/.

"Lost Your Superpower"? Graphic Medicine, Voicelessness, and Georgia Webber's Dumb.

Unlike deafness and disability, speech-related disorders-voluntary/involuntary voicelessness, mutism, and their imperatives-have largely remained undertheorized both as scholarship and praxis. Given the primacy and over-privileging of vision, a consideration of the nature of voice/voicelessness is critical and urgent. Framed in metaphysical, metaphorical, and existential terms, Georgia Webber's graphic memoir Dumb (2018), which narrates the protagonist's temporary loss of voice, is perhaps the first graphic medical text that coheres around issues related to voice/voicelessness in its entirety. Taking these cues, the present article, after briefly reviewing the significance of voice in human life and the relationship between voice and identity, provides a close reading of how Webber negotiates her lost acoustical agency in an otherwise abundant soundscape. Intriguingly, Webber also utilizes her voicelessness as a metaphor to reflect on her own marginality in an ableist society. Finally, the essay explores how Dumb projects drawing/comics-making and self-care as recuperative projects that not only help Webber to process her suffering caused by voicelessness but also aid her in reclaiming her lost voice and to acuminate practices of self-preservation.

[Psychogenic Aphonia - Succesfull Multiprofessional Treatment of a 13-Year-Old Girl - A Case Report]. / Psychogene Aphonie ­ erfolgreiche multiprofessionelle Behandlung eines 13-jährigen Mädchens ­ ein Kurzbeitrag aus der Praxis.

Psychogenic Aphonia - Succesfull Multiprofessional Treatment of a 13-Year-Old Girl - A Case Report Psychogenic aphonia is a rather rare disorder with a point prevalence of 0.4 %. It appears more frequently in females than in males. There are only few reports in the scientific literature about children affected by psychogenic aphonia. The diagnostical and therapeutical approach must be multimodal. The case reported here describes a 13 year-old girl with a psychogenic aphonia, the course of her illness und the efforts of treatment until full recovery of voice and speech.

Fully Implanted Brain-Computer Interface in a Locked-In Patient with ALS.

Options for people with severe paralysis who have lost the ability to communicate orally are limited. We describe a method for communication in a patient with late-stage amyotrophic lateral sclerosis (ALS), involving a fully implanted brain-computer interface that consists of subdural electrodes placed over the motor cortex and a transmitter placed subcutaneously in the left side of the thorax. By attempting to move the hand on the side opposite the implanted electrodes, the patient accurately and independently controlled a computer typing program 28 weeks after electrode placement, at the equivalent of two letters per minute. The brain-computer interface offered autonomous communication that supplemented and at times supplanted the patient's eye-tracking device. (Funded by the Government of the Netherlands and the European Union; ClinicalTrials.gov number, NCT02224469 .).

Mechanical regulation of human vocal fold stellate cells.

OBJECTIVE: It is generally accepted that tensile and compressive strains have direct effects on cell morphology and structure, including changes in cytoskeletal structure and organization. Cytoskeletons play the role of mechanoreceptor of the cells. Vocal fold stellate cells (VFSCs) in the human maculae flavae (MFe) are inferred to be involved in the metabolism of extracellular matrices essential for the viscoelasticity of the vocal fold mucosa. Our previous studies have supported the hypothesis that the tension caused by phonation (vocal fold vibration) regulates the behavior of the VFSCs. The microstructure of the intermediate filaments and the expression of their proteins were investigated in VFSCs in the MFe, which had remained unphonated since birth. METHODS: Three adult vocal fold mucosae that had remained unphonated since birth were investigated by immunohistochemistry and electron microscopy. RESULTS: The intermediate filaments of the VFSCs were fewer in number. The expression of their characteristic proteins (vimentin, desmin, and glial fibrillary acidic protein) was also reduced. CONCLUSION: Vocal fold vibration seems to affect VFSC morphology and structure, such as cytoskeletal structure and organization. This supports the hypothesis that vocal fold vibration regulates VFSC behavior in the human MFe. In addition to chemical factors, mechanical factors also appear to modulate VFSC behavior.

Evaluation of Speak for Myself with Patients Who Are Voiceless.

PURPOSE: To describe the creation and initial feasibility study of a new computer application to improve communication with people who cannot communicate by customary means during their hospitalization. DESIGN: This was a mixed-methods, quasi-experimental design. METHODS: This exploratory feasibility study obtained data about the experiences of 20 intensive care patients in three South Florida hospitals who were unable to speak due to mechanical obstruction. FINDINGS: Study participants (20), who ranged in age from 45 to 91 years (M=67.4, SD=12.88) and between -1 to +1 (SD=-0.15) on the Richmond Agitation Sedation Scale, used Speak for Myself from 4 to 16 hours with a mean of 8.86 (SD=2.12). Ninety-five percent of the participants stated that Speak for Myself was helpful for communication. CONCLUSIONS: Speak for Myself was helpful to patients who used it. This was a small study (n=20). It warrants further investigation. CLINICAL RELEVANCE: Patients who are unable to communicate their needs through conventional methods still want to make their preferences and needs known. Speak for Myself is a new application that facilitates ensuring the patient's voice is heard.

Silence in the EHR: infrequent documentation of aphonia in the electronic health record.

BACKGROUND: To begin to deliver patient-centered care, providers need to be aware of when a patient has a communication disability and what communication methods to use with the patient. The aim of the study was to describe if and how patients' communication disabilities are documented within electronic health records (EHR). METHODS: A retrospective manual chart review of all inpatient and outpatient clinical encounter notes within the EHR for patients who had undergone a laryngectomy at Northwestern Memorial Hospital (Chicago, IL) between 2000-2013. We selected patients who had undergone a laryngectomy as the patient population as we were able to easily identify the patients through Common Procedural Terminology (CPT) codes. RESULTS: We identified 81 patient charts with 7484 encounter notes. Of the 81 patient charts, 58 (72%) had at least one encounter note with a communication notation. Excluding speech-language pathology notes, 1164 (16%) of all encounter notes included some notation of the patients' communication abilities. We coded the communication notations into four categories. 1) Descriptions of communication abilities appeared in 663 (9%) of all encounter notes, 2) descriptions of communication methods appeared in 590 (8%) of all encounter notes, and the last two categories 3) medical management and 4) referrals to speech-language pathology services each appeared in 148 (2%) of all encounter notes. While all patients had the same type of communication disability, aphonia, providers used 39 different terms and phrases to describe aphonia. CONCLUSIONS: Patients' communication abilities were infrequently documented in the EHR. When providers did document a patient's communication disability or method, they used inconsistent descriptions, suggesting a lack of standardized language. Further work is needed to determine how to consistently and accurately document patients' communication abilities so staff and providers can quickly recognize how best to communicate with patients with communication disabilities.

A retrospective review of swallow dysfunction in patients with severe traumatic brain injury.

In the acute-care setting, it is difficult for clinicians to determine which patients with severe traumatic brain injury will have long-term oropharyngeal dysphagia (>6 weeks) and which patients will begin oral nutrition quickly. Patients frequently remain in the acute-care setting while physicians determine whether to place a percutaneous endoscopic gastrostomy (PEG) tube. To improve the acute-care clinician's ability to predict long-term oropharyngeal dysphagia and subsequent need for PEG tube placement in patients with severe traumatic brain injury [Glascow Coma Scale (GCS) ≤ 8), a novel prediction model was created utilizing clinical information and acute-care swallowing evaluation findings. Five years of retrospective data were obtained from trauma patients at a Level 1 trauma hospital. Of the 375 patients who survived their hospitalization with a GCS ≤ 8, a total of 269 patients received Ranchos Los Amigos (RLA) scores. Of those patients who were scored for RLA, 219 patients underwent swallowing evaluation. Ninety-six of the 219 patients were discharged from the hospital with a feeding tube, and 123 patients were discharged without one. Logistic regression models examined the association between clinical and patient characteristics and whether a patient with severe traumatic brain injury exhibited long-term oropharyngeal dysphagia. Multivariable logistic regression analysis revealed that increased age, low RLA score, tracheostomy tube placement, and aphonia observed on the initial swallowing evaluation significantly increased the odds of being discharged from the acute-care hospital with a feeding tube. The resultant model could be used clinically to guide decision making and to counsel patients and families.

Management of aphonic patients following total laryngectomy and trachea esophageal puncture.

BACKGROUND: Trachea esophageal puncture (TEP) is performed following total laryngectomy to allow speech and communication. The most common reason for long-term speech failure in this population is hypertonicity of the constrictor muscle. OBJECTIVES: To present our experience with the treatment of aphonic patients after total laryngectomy and TEP and suggest a protocol for treatment. METHODS: Of 50 patients who underwent total laryngectomy and TEP, 6 suffered from aphonia after surgery. All patients underwent radiotherapy with or without chemotherapy. Delay in speech continued for more than 6 months after surgery. The patients received percutaneous lidocaine injection to the neopharynx in different locations around the stoma in order to map the hypertonic segments in the neopharynx. RESULTS: Lidocaine injection immediately enabled free speech in five patients. One patient (patient 6) suffered from aphonia and from severe dysphagia and required a feeding tube. This patient succeeded to pronounce abbreviations after lidocaine injection. Another (patient 4) gained permanent ability to speak following a single lidocaine injection; this patient was not injected with botolinium toxin (BTX). For the other five, lidocaine had a transient effect on speech. These patients received BTX percutaneous injections. After BTX injections four regained free speech within 14 days. The fifth patient (patient 6) gained a conversational voice and his swallowing improved only after additional intensive speech therapy. CONCLUSIONS: Percutaneous lidocaine and BTX injections represent first-line treatment in this population, with good success and minimal complications.

Impact of syllable stress and phonetic context on the distribution of intermittent aphonia.

The occurrence of intermittent aphonia, perceived as sudden interruptions of voicing in connected speech, often reflects high stiffness of the vocal fold mucosa as part of a voice disorder. This retrospective study aimed to investigate the overarching hypothesis that the aphonic instances in voices with intermittent aphonia are not totally randomly appearing, but related to syllable stress and phonetic context. Recordings of 31 dysphonic patients with intermittent aphonia reading a standard text were analyzed perceptually. All vowels of the text were labelled and categorized with regard to syllable stress and character of the phoneme preceding the vowel. The occurrence of aphonic instances within each syllable category was analyzed. Four different hypotheses were formulated and analyzed by the non-parametric Wilcoxon's signed-ranks test. The results showed a significantly higher occurrence of aphonic instances in unstressed syllables as opposed to stressed, in vowels following an unvoiced phoneme as opposed to a voiced, and in vowels following two or more unvoiced phonemes as opposed to one unvoiced phoneme. No significant difference was found between vowels following aspirated stops [p], [t], [k] as opposed to unaspirated stops [b], [d], [g]. The findings support the theory that both physiological and functional aspects may contribute to the phenomenon of intermittent aphonia.

[A single appointment with a speech therapist can release a patient, even from a long-term aphonic status! Three clinical cases]. / Consulter un(e) phoniatre peut "Libérer" d'une "aphonie rebelle"! Trois cas cliniques évoqués.

Those three clinical cases involved aphonic female patients without any laryngeal disorders for their ENTs. 1) The first one had been out of work since 11/2 year because of her aphonia. She was still suffering from it in spite of a weekly speech therapy session and a monthly psychotherapy appointment. 2) The second patient had been aphonic for 3 weeks. Three different ENTs had renewed her prescription of work stoppage, even with normal laryngeal exam. 3) The third had lost her singing voicing ability during a performance in a national festival of songs and had to cancel the followings events. Even if all of them were waiting for a "miracle pill" they recorded their training session and left this single phoniatrician appointment with their restored voicing ability.

Congenital glottic stenosis as a clinical manifestation of FREM1-associated disorders in a neonate with respiratory distress and aphonia.

A female infant born at 38 weeks and 2 days via induced vaginal delivery was admitted to the neonatal intensive care unit for respiratory distress soon after birth. Noted to have aphonia on examination, the patient underwent direct laryngoscopy and was diagnosed with an anterior glottic web and subglottic stenosis. The patient underwent a genetic workup including whole exome sequencing which resulted in a diagnosis of a FREM1-associated disorder. Congenital glottic webs and subglottic stenoses have not been previously described as clinical manifestations of FREM1-associated disorders.

The efficiency of the DoctorVox voice therapy technique in conversion dysphonia and aphonia.

OBJECTIVE: The main purpose of this study was to retrospectively evaluate the efficiency of DoctorVox voice therapy in psychogenic dysphonia or aphonia patients, and to share the mid- to long-term results of the method. METHODS: The study was carried out on patients who underwent DoctorVox voice therapy for psychogenic dysphonia or aphonia between January 2015 and September 2019. The evaluation methods used were: the Voice Handicap Index-10; the grade, roughness, breathiness, asthenia and strain ('GRBAS') scale; and videolaryngostroboscopy recordings. RESULTS: The mean Voice Handicap Index-10 values of the patients were 30.91 ± 2.97 before treatment, 8.14 ± 3.82 after treatment, and 3.36 ± 1.78 in the final follow-up examination. The grade, roughness, breathiness, asthenia and strain scale scores were: 9 ± 0.67 pre-treatment, 0.78 ± 0.80 post-treatment, and 0.57 ± 0.64 at the final follow up. CONCLUSION: DoctorVox voice therapy seems to be an efficient treatment method for psychogenic dysphonia or aphonia; it helps develop phonatory muscle functions, using multidimensional biofeedback mechanisms, and increases the patients' therapy adherence.

Tongue position in Mandarin Chinese voiceless stops.

The current study explores whether Mandarin initial and medial voiceless unaspirated and voiceless aspirated stops differ in their tongue positions and post-vocalic voicing during closure. Ultrasound tongue imaging and acoustic data from five Mandarin speakers revealed (1) no consistent pattern for tongue positions among speakers, and (2) no difference in degree of voicing during closure between the two stop series. These findings suggest that tongue position is not a reliable articulatory correlate for Mandarin laryngeal contrasts. This further suggests that aspiration is not correlated with tongue position differences, unlike the reported correlation between voicing and tongue root advancement.

Ewing's sarcoma of the larynx. Effective treatment with organ preservation.

Extraskeletal Ewing's sarcoma arising in the head and neck region is an extremely rare malignant neoplasm. We describe the unusual case of a tumor originating in the larynx of a 68-year-old male with hoarseness and occasional aphonia. We report successful treatment with sequential chemo- and radiotherapy. Complete regression and larynx preservation with voice function recovery was achieved. To our knowledge, this is the first report of this type of tumor in the larynx with cartilage invasion that documents the effectiveness of radiotherapy as an alternative to surgical management. At present, after 30 months of follow-up, the patient is free of tumor relapse and in very good condition.

[Psychogenic aphonia. A challenging diagnosis?]. / Psychogene Aphonie. Eine schwierige Diagnose?

BACKGROUND: Based on clinical experience in the treatment of psychogenic aphonic patients, the study aimed to analyse the time interval between symptom onset and diagnosis using concrete data and to identify the cause of delayed diagnosis. PATIENTS AND METHODS: The medical records of 14 patients (all female) with psychogenic aphonia first diagnosed at the ENT department of the Saarland University Clinic were evaluated in a retrospective study. RESULTS: The time interval between symptom onset and the diagnosis of psychogenic aphonia ranged from 1 to 32 weeks, with a mean time interval of 9 weeks. In addition to all patients consulting an ENT specialist, additional diagnostic procedures (primarily imaging) were performed in 6 of 14 patients before the correct diagnosis was made. In all, 13 patients had previously undergone some form of therapy, 11 of these receiving antibiotic treatment. CONCLUSIONS: The study confirms that unnecessary instrument-based"over-diagnosis", as well as ineffective treatment attempts lead to significant delays in the diagnosis of psychogenic aphonia and hence delays in the initiation of causal treatment.

Convergence to shortened and lengthened voice onset time in an imitation task.

Convergence to variation in voice onset time (VOT) of English voiceless stops is reported to be selective, with speakers adjusting their VOTs after exposure to stimuli with lengthened, but not shortened, VOT. The current study re-examined this proposed selectivity with an explicit imitation paradigm designed to maximize convergence, using stimuli with more extreme differences, and explored the perceptual salience of the differences in a discrimination task. Participants showed phonetic convergence to both shortened and lengthened VOT, and better discrimination of shortened than lengthened VOT. Results suggest that there is no general constraint against convergence to shortened VOT.