The Influence of Auditory Feedback and Vocal Rehabilitation on Prelingual Hearing-Impaired Individuals Post Cochlear Implant.

OBJECTIVE: To verify changes in the perceptual and acoustic vocal parameters in prelingual hearing-impaired adults with cochlear implants after vocal rehabilitation. HYPOTHESIS: Auditory feedback restoration alone after cochlear implant is not enough for vocal adjustments. A targeted and specific voice therapy intervention is required. STUDY DESIGN: Prospective and pre-post repeated measures design. METHODS: Twenty literate adults with severe to profound prelingual bilateral sensorineural hearing loss participated in the study; individuals were implanted late and were fluent users of oral language. Ages ranged from 17 to 48 years. All individuals presented normal results in laryngoscopy, and hearing thresholds with the cochlear implant were over 40 dB HL. Individuals were randomly distributed into two groups: Group 1 (treatment group) and Group 2 (control group), both with ten patients each, five men and five women, matching mean age and hearing deprivation time before the cochlear implantation. Patients from Group 1 underwent a protocol of vocal therapy including 12 individual sessions with the same clinician. Group 2 only underwent vocal recordings. The vocal recordings occurred before and after the participation in the therapy protocol for Group 1 and after the same period, 3 months later, without any intervention, for Group 2. The recording sessions used the Consensus Auditory-Perceptual Evaluation of Voice protocol sentence reading and emission of sustained vowel /a/. Auditory-perceptual evaluation of voices was performed by three judges, and the acoustical analysis used the Praat program. RESULTS: Statistically significant reductions in the overall vocal degree, vocal instability, and degree of resonance change were observed after vocal rehabilitation in Group 1. Statistically, individuals from Group 1 did not differ in regard to the modification of acoustic parameters. Group 2 did not present significant changes in any of the analyzed parameters. CONCLUSIONS: The cochlear implanted adults submitted to vocal rehabilitation presented changes in the auditory-perceptual parameters, with reduction of the overall voice severity, vocal instability, and degree of resonance after vocal intervention. There were no changes in the acoustic parameters in the implanted prelingual hearing-impaired adult subjects.

Perceptual identification and acoustic measures of the resonant voice based on "Lessac's Y-Buzz"--a preliminary study with actors.

This study aimed to verify whether the resonant voice based on Lessac's Y-Buzz can be perceived by listeners as resonant and different from habitual voice and to compare them to determine whether this sound exploration improves the vocal production. Nine newly graduated actors, six men and three women without voice complaints, were the subjects. They received a session of Lessac's Y-Buzz training from the primary investigator. Before training, they were asked to sustain the vowel /i/ at comfortable frequency and habitual loudness. After training, they were requested to sustain the Y-Buzz they had learned at a comfortable frequency and habitual loudness. Three speech-language pathologists (SLP) trained in voice developed an auditory-perceptive analysis. The pre- and posttraining voice samples were randomly spliced together, edited, and presented in pairs to perceptual judges who were asked to identify the most resonant of the pair. The voice samples were also acoustically compared through the Hoarseness Diagram and acoustic measures using the VoxMetria Software (CTS, version 2.0s, Brazil). The Y-Buzz trials were identified as resonant voice in 74% of the comparisons. The acoustic measures showed a statistically significant decrease of irregularity (P = 0.002) and shimmer (P = 0.38). The Hoarseness Diagram demonstrated how the resonant voice moved toward the normality for irregularity and noise components. The results showed that the resonant voice based on the Y-Buzz can be identified as resonant and different from normal voicing in the same subject, and it apparently implies a better vocal production demonstrating a significant decrease of shimmer and irregularity through the Hoarseness Diagram evaluation.