Speech in adults treated for unilateral cleft lip and palate as rated by naïve listeners, speech-language pathologists, and patients.

Speech may be affected in patients with cleft lip and palate (CLP). Professional listeners, naïve listeners, and patients may perceive speech differently. The aim of the study was to assess speech among adults treated for unilateral CLP (UCLP) as rated by naïve listeners, speech-language pathologists (SLPs), and self-assessment and to evaluate how well these ratings correlate. All patients with complete UCLP treated at the Uppsala University Hospital, Uppsala, Sweden, in 1960-1987 were invited. A total of 73 of 109 patients (67%) participated, with a mean of 35 years since the initiation of treatment. The noncleft control group consisted of 55 volunteers. All participants answered questionnaires for self-rating of speech, and their speech was audio-recorded digitally. Fourteen naïve listeners and four SLPs rated the speech individually from blinded recordings. There were more speech abnormalities among patients compared to controls according to the ratings of naïve listeners and SLPs. In controls and patients, there were positive correlations between the speech ratings by naïve listeners and SLPs r = 0.44 to 0.71, p < 0.001, Spearman). The patients were less satisfied and rated to have more speech abnormalities than controls (p < 0.001). Although adults treated for UCLP considered their speech as fairly good, they were less satisfied than noncleft controls. The agreement between ratings by naïve listeners and SLPs were good, while the agreement between these ratings and self-assessment varied widely. When assessing speech in adults treated for UCLP, differences in perception of speech abnormalities by professionals, laymen, and patients should be considered.

Voice Quality in Adults Treated for Unilateral Cleft Lip and Palate: Long-Term Follow-Up After One- or Two-Stage Palate Repair.

OBJECTIVES: The aim of the current study was to assess voice quality among adults treated for unilateral cleft lip and palate (UCLP), after one- or two-stage palate closure, and compare it to a noncleft control group. STUDY DESIGN: Cross-sectional study of patients with UCLP with long-term follow-up and noncleft controls. PARTICIPANTS: Patients with UCLP born between 1960 and 1987, treated at Uppsala University Hospital, Sweden, were examined (n = 73) at a mean of 35 years after primary surgery. Forty-seven (64%) patients had been treated with 1-stage palate closure and 26 with 2-stage closure (36%). The noncleft control group consisted of 63 age-matched volunteers. MAIN OUTCOME MEASURES: Ratings of perceptual voice characteristics from blinded voice recordings with Swedish Voice Evaluation Approach method. Acoustic voice analysis including pitch and spectral measures. RESULTS: Among the patients, the mean values for the 12 evaluated variables on a visual analog scale (0 = no abnormality, 100 = maximal abnormality) ranged between 0.1 and 17, and the mean for all was 6 mm. Voice variables were similar between patients and controls, except the total mean of all the perceptual voice variables, as well as "vocal fry"; both slightly lower among patients ( P = .018 and P = .009). There was no difference in any variable between patients treated with 1-stage and 2-stage palate closure. No clear relationship was found between velopharyngeal insufficiency and dysphonia. CONCLUSIONS: The voice characteristics among adults treated for UCLP in childhood are not different from those of individuals without cleft.

Voice Quality in Adults Treated for Unilateral Cleft Lip and Palate: Long-term Follow-up After 1- or 2-Stage Palate Repair.

OBJECTIVES: The aim of the current study was to assess voice quality among adults treated for unilateral cleft lip and palate (UCLP), after 1- or 2-stage palate closure, and compare it to a noncleft control group. STUDY DESIGN: Cross-sectional study in UCLP patients with long-term follow-up and noncleft controls. PARTICIPANTS: UCLP patients born 1960-1987, treated at Uppsala University Hospital, Sweden, were examined (n = 73) at a mean of 35 years after primary surgery. Forty-seven patients (64%) had been treated with 1-stage palate closure and 26 with 2-stage closure (36%). The noncleft control group consisted of 63 age-matched volunteers. MAIN OUTCOME MEASURE(S): Ratings of perceptual voice characteristics from blinded voice recordings with Swedish Voice Evaluation Approach (SVEA) method. Acoustic voice analysis including pitch and spectral measures. RESULTS: Among the patients, the mean values for the 12 evaluated variables on a VAS scale (0 = no abnormality, 100 = maximal abnormality) ranged between 1 and 22 and the mean for all was 6 mm. Voice variables were similar between patients and controls except the total mean of all the perceptual voice variables, as well as "vocal fry"-both slightly lower among patients ( P = .018 and P = .009). There was no difference in any variable between patients treated with 1-stage and 2-stage palate closure. No clear relationship was found between VPI and dysphonia. CONCLUSION: The voice characteristics among adults treated for UCLP in childhood are not different from those of individuals without cleft.

Speech in Adults Treated for Unilateral Cleft Lip and Palate: Long-Term Follow-Up After One- or Two-Stage Palate Repair.

OBJECTIVE: To evaluate speech in adults treated for unilateral cleft lip and palate with one-stage or two-stage palate closure and compare the speech of the patients with that of a noncleft control group. DESIGN: Cross-sectional study with long-term follow-up. PARTICIPANTS/SETTING: All unilateral cleft lip and palate patients born from 1960 to 1987 and treated at Uppsala University Hospital, Sweden, were invited (n = 109). Participation rate was 67% (n = 73) at a mean of 35 years after primary surgery. Forty-seven had been treated according to one-stage palate closure and 26 according to two-stage palate closure. Pharyngeal flap surgery had been performed in 11 of the 73 patients (15%). The noncleft control group consisted of 63 age-matched volunteers. MAIN OUTCOME MEASURE(S): Speech-language pathologists rated perceptual speech characteristics from blinded audio recordings. RESULTS: Among patients, seven (10%) presented with hypernasality, 12 (16%) had audible nasal emission and/or nasal turbulence, five (7%) had consonant production errors, one (2%) had glottal reinforcements/substitutions, and one (2%) had reduced intelligibility. Controls had no audible signs of velopharyngeal insufficiency and no quantifiable problems with the other speech production variables. No significant differences were identified between patients treated with one-stage and two-stage palate closure for any of the variables. CONCLUSIONS: The prevalence of speech outcome indicative of velopharyngeal insufficiency among adult patients treated for unilateral cleft lip and palate was low but higher compared with individuals without cleft. Whether palatal closure is performed in one or two stages does not seem to affect the speech outcome at a mean age of 35 years.

Freddie Mercury-acoustic analysis of speaking fundamental frequency, vibrato, and subharmonics.

Freddie Mercury was one of the twentieth century's best-known singers of commercial contemporary music. This study presents an acoustical analysis of his voice production and singing style, based on perceptual and quantitative analysis of publicly available sound recordings. Analysis of six interviews revealed a median speaking fundamental frequency of 117.3 Hz, which is typically found for a baritone voice. Analysis of voice tracks isolated from full band recordings suggested that the singing voice range was 37 semitones within the pitch range of F#2 (about 92.2 Hz) to G5 (about 784 Hz). Evidence for higher phonations up to a fundamental frequency of 1,347 Hz was not deemed reliable. Analysis of 240 sustained notes from 21 a-cappella recordings revealed a surprisingly high mean fundamental frequency modulation rate (vibrato) of 7.0 Hz, reaching the range of vocal tremor. Quantitative analysis utilizing a newly introduced parameter to assess the regularity of vocal vibrato corroborated its perceptually irregular nature, suggesting that vibrato (ir)regularity is a distinctive feature of the singing voice. Imitation of subharmonic phonation samples by a professional rock singer, documented by endoscopic high-speed video at 4,132 frames per second, revealed a 3:1 frequency locked vibratory pattern of vocal folds and ventricular folds.

Long-Term Follow-Up of Patients with Spasmodic Dysphonia and Improved Voice despite Discontinuation of Treatment.

OBJECTIVE: To evaluate voice function in patients with adductor spasmodic dysphonia (AdSD) who discontinued botulinum toxin (BTX) treatment because they felt that their voice had improved sufficiently. PATIENTS AND METHODS: Twenty-eight patients quit treatment in 2004, of whom 20 fulfilled the inclusion criteria for the study, with 3 subsequently excluded because of return of symptoms, leaving 17 patients (11 males, 6 females) included in this follow-up study. A questionnaire concerning current voice function and the Voice Handicap Index were completed. Audio-perceptual voice assessments were done by 3 listeners. The inter- and intrarater reliabilities were r > 0.80. RESULTS: All patients had a subjectively good stable voice, but with differences in their audio-perceptual voice assessment scores. Based on the pre-/posttreatment auditory scores on the overall degree of AdSD, patients were divided into 2 subgroups showing more and less improvement, with 10 and 7 patients, respectively. The subgroup with more improvement had shorter duration from the onset of symptoms until the start of BTX treatment, and included 7 males compared to only 4 males in the subgroup with less improvement. CONCLUSION: It seems plausible that the symptoms of spasmodic dysphonia may decrease over time. Early intervention and male gender seem to be important factors for long-term reduction of the voice symptoms of AdSD.

Resonance tube phonation in water: High-speed imaging, electroglottographic and oral pressure observations of vocal fold vibrations--a pilot study.

Phonation into glass tubes ('resonance tubes'), keeping the free end of the tube in water, has been a frequently used voice therapy method in Finland and more recently also in other countries. The purpose of this exploratory study was to investigate what effects tube phonation with and without water has on the larynx. Two participants were included in the study. The methods used were high-speed imaging, electroglottographic observations of vocal fold vibrations, and measurements of oral pressure during tube phonation. Results showed that the fluctuation in the back pressure during tube phonation in water altered the vocal fold vibrations. In the high-speed imaging, effects were found in the open quotient and amplitude variation of the glottal opening. The open quotient increased with increasing water depth (from 2 cm to 6 cm). A modulation effect by the water bubbles on the vocal fold vibrations was seen both in the high-speed glottal area tracings and in the electroglottography signal. A second experiment revealed that the increased average oral pressure was largely determined by the water depth. The increased open quotient can possibly be explained by an increased abduction of the vocal folds and/or a reduced transglottal pressure. The back pressure of the bubbles also modulates glottal vibrations with a possible 'massage' effect on the vocal folds. This effect and the well-defined average pressure increase due to the known water depth are different from those of other methods using a semi-occluded vocal tract.

Vocal fold vibration and phonation start in aspirated, unaspirated, and staccato onset.

OBJECTIVES/HYPOTHESES: Singers learn to produce well-controlled tone onsets by accurate synchronization of glottal adduction and buildup of subglottal pressure. Spectrographic analyses have shown that the higher spectrum partials are present also at the vowel onset in classically trained singers' performances. Such partials are produced by a sharp discontinuity in the waveform of the transglottal airflow, presumably produced by vocal fold collision. STUDY DESIGN: After hearing a prompt series of a triad pattern, six singer subjects sang the same triad pattern on the vowel /i/ (1) preceded by an aspirated /p/, (2) preceded by an unaspirated /p/, and (3) without any preceding consonant in staccato. METHODS: Using high-speed imaging we examined the initiation of vocal fold vibration in aspirated and unaspirated productions of the consonant /p/ as well as in the staccato tones. RESULTS: The number vibrations failing to produce vocal fold collision were significantly higher in the aspirated /p/ than in the unaspirated /p/ and in the staccato tones. High frequency ripple in the audio waveform was significantly delayed in the aspirated /p/. CONCLUSIONS: Initiation of vocal fold collision and the appearance of high-frequency ripple in the vowel /i/ are slightly delayed in aspirated productions of a preceding consonant /p/.

High-speed registration of phonation-related glottal area variation during artificial lengthening of the vocal tract.

Vocal exercises that increase the vocal tract impedance are widely used in voice training and therapy. The present study applies a versatile methodology to investigate phonation during varying artificial extension of the vocal tract. Two males and one female phonated into a hard-walled plastic tube (phi 2 cm), whose physical length was randomly pair-wise changed between 30 cm, 60 cm and 100 cm. High-speed image (1900 f/sec) sequences of the vocal folds were obtained via a rigid endoscope. Acoustic and electroglottographic signals (EGG) were recorded. Oral pressure during shuttering of the tube was used to give an estimate of subglottic pressure (Psub). The only trend observed was that with the two longer tubes compared to the shortest one, fundamental frequency was lower, open time of the glottis shorter, and Psub higher. The results may partly reflect increased vocal tract impedance as such and partly the increased vocal effort to compensate for it. In other parameters there were individual differences in tube length-related changes, suggesting complexity of the coupling between supraglottic space and the glottis.

Laryngeal adduction asymmetries in normal speaking subjects.

To investigate the prevalence of asymmetries at vocal fold adduction, 109 vocally healthy subjects between 22 and 80 years of age were examined. All subjects were examined with a rigid endoscope and video recorded. The recordings were analysed off line by two laryngologists. Seventy percent of the subjects displayed some kind of asymmetry. There was no difference between the sexes. Side differences in antero-posterior position of the corniculate or cuneiform tubercles were the most frequent asymmetries, occurring in 66% of the total material and in 92% of the asymmetrical cases. Asymmetries appeared more common and more marked in older subjects and possibly more frequent in singers than in non-singers. Laryngeal adduction asymmetries are probably of little importance for voice function.

Ventricular fold vibration in voice production: a high-speed imaging study with kymographic, acoustic and perceptual analyses of a voice patient and a vocally healthy subject.

Co-vibrations of the ventricular folds are a common finding in the clinical setting. It is not always obvious how much of the perceived voice change can be attributed to the presence of such vibrations. The aim of the present study was to describe laryngeal vibrations as observed by high-speed imaging in cases where ventricular fold vibrations had been observed. The findings at kymographic display of the recordings were correlated to perceptual measures and spectrographic observations. Two subjects, a 65-year-old man with chronic laryngitis and one vocally healthy man, were examined during pressed and breathy sustained phonation. Perceived roughness in the voice quality correlated to irregularities in true vocal fold vibrations as well as to irregular ventricular fold vibrations with large amplitude combined with sufficient closure. In none of the recorded sections did ventricular fold vibrations occur without simultaneous true vocal fold vibrations. Regular vibrations of the ventricular folds of the same frequency as those of the true vocal folds and with a reciprocal pattern did not contribute to any roughness in the perceived voice.