Analysis of the relationship between emotion intensity and electrophysiology parameters during a voice examination of opera singers.

OBJECTIVES: Emotions and stress affect voice production. There are only a few reports in the literature on how changes in the autonomic nervous system affect voice production. The aim of this study was to examine emotions and measure stress reactions during a voice examination procedure, particularly changes in the muscles surrounding the larynx. MATERIAL AND METHODS: The study material included 50 healthy volunteers (26 voice workers - opera singers, 24 control subjects), all without vocal complaints. All subjects had good voice quality in a perceptual assessment. The research procedure consisted of 4 parts: an ear, nose, and throat (ENT)­phoniatric examination, surface electromyography, recording physiological indicators (heart rate and skin resistance) using a wearable wristband, and a psychological profile based on questionnaires. RESULTS: The results of the study demonstrated that there was a relationship between positive and negative emotions and stress reactions related to the voice examination procedure, as well as to the tone of the vocal tract muscles. There were significant correlations between measures describing the intensity of experienced emotions and vocal tract muscle maximum amplitude of the cricothyroid (CT) and sternocleidomastoid (SCM) muscles during phonation and non-phonation tasks. Subjects experiencing eustress (favorable stress response) had increased amplitude of submandibular and CT at rest and phonation. Subjects with high levels of negative emotions, revealed positive correlations with SCMmax during the glissando. The perception of positive and negative emotions caused different responses not only in the vocal tract but also in the vegetative system. Correlations were found between emotions and physiological parameters, most markedly in heart rate variability. A higher incidence of extreme emotions was observed in the professional group. CONCLUSIONS: The activity of the vocal tract muscles depends on the type and intensity of the emotions and stress reactions. The perception of positive and negative emotions causes different responses in the vegetative system and the vocal tract. Int J Occup Med Environ Health. 2024;37(1):84-97.

Direct subthalamic nucleus stimulation influences speech and voice quality in Parkinson's disease patients.

BACKGROUND: DBS of the subthalamic nucleus (STN) considerably ameliorates cardinal motor symptoms in PD. Reported STN-DBS effects on secondary dysarthric (speech) and dysphonic symptoms (voice), as originating from vocal tract motor dysfunctions, are however inconsistent with rather deleterious outcomes based on post-surgical assessments. OBJECTIVE: To parametrically and intra-operatively investigate the effects of deep brain stimulation (DBS) on perceptual and acoustic speech and voice quality in Parkinson's disease (PD) patients. METHODS: We performed an assessment of instantaneous intra-operative speech and voice quality changes in PD patients (n = 38) elicited by direct STN stimulations with variations of central stimulation features (depth, laterality, and intensity), separately for each hemisphere. RESULTS: First, perceptual assessments across several raters revealed that certain speech and voice symptoms could be improved with STN-DBS, but this seems largely restricted to right STN-DBS. Second, computer-based acoustic analyses of speech and voice features revealed that both left and right STN-DBS could improve dysarthric speech symptoms, but only right STN-DBS can considerably improve dysphonic symptoms, with left STN-DBS being restricted to only affect voice intensity features. Third, several subareas according to stimulation depth and laterality could be identified in the motoric STN proper and close to the associative STN with optimal (and partly suboptimal) stimulation outcomes. Fourth, low-to-medium stimulation intensities showed the most optimal and balanced effects compared to high intensities. CONCLUSIONS: STN-DBS can considerably improve both speech and voice quality based on a carefully arranged stimulation regimen along central stimulation features.

Singing in different performance spaces: The effect of room acoustics on singers' perception.

Classical singers' performances vary across different acoustic environments. The changes in the delivery are influenced by the singer's perception of the venue's acoustics. This study investigated these relationships using nine professional or semi-professional classical singers. Participants performed Giordani's "Caro mio ben" aria in five venues, and the acoustic parameters reverberance (T30 and EDT), clarity (C80), early vocal support (STv), and tonal color (EDTf) were measured. From a factor analysis of the subjective analysis three major factors emerged that, we propose, would represent three generalized percepts of Room Supportiveness, Room Noiselessness, and Room Timbre. These percepts correlated significantly with objective acoustic parameters traditionally linked to vocal support, reverberation, and timbre. Room Supportiveness and Room Noiselessness significantly contributed to the singers' likability of the acoustic environment, while Room Timbre did not. This indicates that singers' perceptual preference for a performance space may be influenced by factors affecting both auditory feedback and vocal function. These findings underscore the need for performing space designers to consider the unique needs of all stakeholders, including listeners and performers. The study contributes to the bridging of the gap between subjective perceptions and objective measurements, providing valuable insights for acoustic design considerations.

An experimental model of the pharyngoesophageal segment in tracheoesophageal phonation.

Tracheoesophageal (TE) speech is an important method of speech rehabilitation for those who undergo a total laryngectomy. Despite the many advantages over other methods, there is still room for improvement in terms of the overall quality of the TE voice as well as its success rate. These points could be greatly assisted by an improved knowledge on the mechanics of TE speech. Here, an experimental model of the pharyngoesophageal segment (PES), based on the idea of a collapsible tube, is proposed. To implement the model, considerable simplifications had to be made, most notably in the use of a thin flexible tube to represent the PES. The model was used to assess the minimum amount of tonicity required for the onset of phonation in terms of the flow rate and longitudinal tension. Additionally, comparisons with a mathematical model [Tourinho, da Silva, dos Santos, Thomaz, and Vieira, J. Acoust. Soc. Am. 149, 1979-1988 (2021)] have been made, yielding similar trends for sufficiently large flow rates. The measurements also suggest that the phonation frequency is most affected by the tonicity of the PES, which highlights the question of which physiological mechanism is responsible for the control of the fundamental frequency of phonation.

Normative Voice Range Profile of the Young Female Voice.

OBJECTIVES: Normative data are important in the clinical setting of Speech and Language Pathology. The purpose of this study was to develop a normative reference dataset of voice range profiles from young females. STUDY DESIGN: Descriptive study including a prospective collection of voice range profile data. METHODS: Voice range profile recordings from 39 females with healthy voices aged 18 to 28 years were conducted. Seven voice range profile variables were analyzed: minimum and maximum fundamental frequency and intensity, semitone and intensity ranges, and voice range profile area. Descriptive statistical methods were applied. RESULTS: An age-specific voice range profile normative dataset was established. The mean values and standard deviations were as follows: semitone range 34.7 ± 3.9 ST, minimum fundamental frequency 143.6 ± 21.7 hertz, maximum fundamental frequency 1063.5 ± 160 hertz, intensity range 65.6 ± 5.0 dB, minimum intensity 43.2 ± 2.5 dB SPL, maximum SPL 108.9 ± 5.1 dB SPL, and voice range profile area 1346 ± 222 cells. CONCLUSION: A normative dataset usable for optimization of future voice assessments has been established. It may especially benefit evaluation and treatment planning for younger females suffering from vocal fold nodules.

The effect of type 1 diabetes mellitus on voice in pediatric patients.

PURPOSE: The aim of this prospective case-control study was to determine the effect on the voice of type 1 diabetes mellitus (T1DM) in paediatric patients. MATERIALS AND METHODS: The study included patients aged 6-18 years followed up for at least 1 year because of T1DM, and a control group of age and gender-matched healthy volunteers. Following an Ear, Nose, and Throat (ENT) examination, all subjects underwent flexible endoscopic laryngeal examination. Fasting venous blood samples were taken in the morning for the examination of fasting blood glucose (FBG), HgbA1C, and kidney, liver, and thyroid function tests. Data were recorded from the patient files of age, gender, comorbidities, and the development of diabetes-related complications. Voice recordings were taken and the Voice Handicap Index (VHI)-10 form was completed. The patients and control group were compared in respect of the parameters of fundamental frequency, jitter, shimmer, and acoustic voice quality index (AVQI). RESULTS: Evaluation was made of 64 children and adolescents as 32 in the patient group (Group 1) and 32 healthy control subjects (Group 2). Group 1 comprised 17 females and 15 males with a mean age of 12.75 ± 3.23 years. Group 2 comprised 17 females and 15 males with a mean age of 12.75 ± 3.33 years. In Group 1, mean disease duration was 5.21 ± 3.17 years (range, 1-13 years), the FBG value was mean 216.6 ± 122.3 mg/dl, mean HgbA1c was 10.7 ± 2.8, as ≤ 7 in 4 patients, 7-9 in 4, and > 9 in 24. Maximum phonation time (MPT) was determined as 10.66 ± 3.6 secs in Group 1 and 12.11 ± 4.43 in Group 2. VHI was determined as 2.33 ± 3 in Group 1 and 2.31 ± 2.77 in Group 2. No statistically significant difference was determined between the groups was determined in respect of acoustic analysis, perturbation parameters, AVQI and body mass index. CONCLUSIONS: This study is the first to have investigated the effects of T1DM on the voice in paediatric patients. The study results showed that the AVQI value was higher in the patient group but not to a statistically significant level. Therefore, there is a need for further studies with larger samples. The current study can be of guidance for further studies in this field.

Effects of Cognitive Stress on Voice Acoustics in Individuals With Hyperfunctional Voice Disorders.

PURPOSE: Autonomic nervous system dysfunction has been implicated in the development and persistence of hyperfunctional voice disorders (HVDs). The purpose of this study was to determine the effects of cognitive stress, which is known to arouse the autonomic nervous system, on voice acoustics in female speakers with and without HVDs. METHOD: Adult female speakers-66 with HVDs, 66 without-were recorded while speaking with and without a cognitive stressor. Root-mean-square (RMS) of amplitude, fundamental frequency (f o), low-to-high spectral energy ratio (L/H ratio), cepstral peak prominence (CPP), and relative f o (RFF) were measured for each speaker and cognitive stress condition. Mixed-model analyses of variance and post hoc t tests were conducted to determine if cognitive stress affected voice acoustics and whether voice changes were greater for those with HVDs. RESULTS: All measures differed significantly under cognitive stress for speakers with and without HVDs. RMS and CPP increased whereas f o, CPP, and RFF decreased under cognitive stress. Changes in these measures were not greater in those with HVDs. CONCLUSION: Cognitive stress and presumed autonomic arousal affect voice similarly in female speakers with and without HVDs.

Interactions Between Breathy and Rough Voice Qualities and Their Contributions to Overall Dysphonia Severity.

PURPOSE: Dysphonic voices typically present multiple voice quality dimensions. This study investigated potential interactions between perceived breathiness and roughness and their contributions to overall dysphonia severity. METHOD: Synthetic stimuli based on four talkers were created to systematically map out potential interactions. For each talker, a stimulus matrix composed of 49 stimuli (seven breathiness steps × seven roughness steps) was created by varying aspiration noise and open quotient to manipulate breathiness and superimposing amplitude modulation of varying depths to simulate roughness. One-dimensional matching (1DMA) and magnitude estimation (1DME) tasks were used to measure perceived breathiness, roughness, their potential interactions, and overall dysphonia severity. Additional 1DME tasks were used to assess a set of natural stimuli that varied along both breathiness and roughness. RESULTS: For the synthetic stimuli, the 1DMA task indicated little interaction between the two voice qualities. For the 1DME task, breathiness magnitude was influenced by roughness step to a greater extent than roughness magnitude was influenced by breathiness step. The additive contributions of breathiness and roughness to overall severity gradually diminished with increasing breathiness and roughness steps, possibly reflecting a ceiling effect in the 1DME task. For the natural stimuli, little consistent interaction was observed between breathiness and roughness. CONCLUSIONS: The matching task revealed minimal interaction between perceived breathiness and roughness, whereas the magnitude estimation task revealed some interaction between the two qualities and their cumulative contributions to overall dysphonia severity. Task differences are discussed in terms of differences in response bias and the role of perceptual anchors. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.21313701.

Reducing the GAP between science and clinic: lessons from academia and professional practice - part A: perceptual-auditory judgment of vocal quality, acoustic vocal signal analysis and voice self-assessment. / Reduzindo o GAP entre a ciência e a clínica: lições da academia e da prática profissional ­ parte A: julgamento perceptivo-auditivo da qualidade vocal, análise acústica do sinal vocal e autoavaliação em voz.

During the XXVIII Brazilian Congress of SBFa, 24 specialists met and, from a leading position on scientific research as a tool for connecting laboratory and clinic, five fronts of knowledge of the voice specialty were discussed as following: Perceptual-auditory judgment of vocal quality; 2. Acoustic analysis of the vocal signal; 3. Voice self-assessment; 4. Traditional techniques of therapy; 5. Modern techniques of electrostimulation and photobiomodulation (PBMT) in voice. Part "a" of this publication was associated with the consolidation of the analyses of the first three aspects. The trend in the perceptual-auditory judgment of vocal quality was related to the use of standard protocols. The acoustic evaluation of the vocal signal is accessible and can be done descriptively or by extraction of parameters, thus preferring multiparametric measures. Finally, the analysis of the individual himself closes this triad of voice documentation, which will be the basis for the conclusion of the evaluation, reference for monitoring progress, and evaluation of treatment results.

No XXVIII Congresso Brasileiro da SBFa, 24 especialistas reuniram-se e, a partir de um posicionamento condutor sobre pesquisa científica como ferramenta de conexão entre laboratório e clínica, cinco frentes de conhecimento da especialidade de voz foram discutidas: 1. Julgamento perceptivo-auditivo da qualidade vocal; 2. Análise acústica do sinal vocal; 3. Autoavaliação em voz; 4. Técnicas tradicionais de terapia; 5. Técnicas modernas de eletroestimulação e fotobiomodulação em voz. A parte "a" desta publicação é a consolidação das análises dos três primeiros aspectos. A tendência no julgamento perceptivo-auditivo da qualidade vocal é o uso de protocolos padrão. A avaliação acústica do sinal vocal é acessível e pode ser feita de modo descritivo ou por extração de parâmetros, preferindo-se medidas multiparamétricas. Finalmente, a análise do próprio indivíduo fecha essa tríade de documentação fonoaudiológica, que será base para a conclusão da avaliação, referência para monitoramento do progresso e avaliação de resultado de tratamento.

O uso da voz nos rituais indígenas Pankararu / The use of voice in Pankararu indigenous rituals / El uso de la voz en los rituales indígenas Pankararu

Introdução: a voz é essencial para preservação e manutenção da cultura de grupos sociais. O povo Pankararu, vincula sua língua-mãe aos rituais religiosos. A principal forma de transmitir a tradição oral é através dos cantos nos rituais dos Praiás. Objetivo: resgatar o uso de voz pelos cantadores Pankararu no ritual dos Praiás, à luz do saber tradicional e científico. Método: estudo qualitativo, do tipo história de vida, autobiográfica, no qual foram acessadas memórias individuais e coletivas da comunidade Pankararu, considerando a caracterização do povo, do ambiente e o uso de voz nos rituais. Resultados: os cantadores utilizam a voz de maneira intensa e contínua, sem hidratação, e fumam cachimbo durante o ritual. O local onde cantam é um terreiro, espaço aberto, exposto às intempéries da natureza, com presença de poeira. Para cuidar da voz, baseiam-se no saber tradicional, apresentando uma visão distinta do conhecimento científico, no qual a voz representa sua cultura e identidade. Nesta perspectiva, hábitos descritos pela literatura como deletérios, são considerados saudáveis, demonstrando uma concepção singular de saúde. Conclusão: o conhecimento científico, paralelamente ao tradicional, poderá contribuir para estabelecimento de cuidados que visem à saúde vocal dos Pankararus.  Poderei oferecer ao meu povo, o qual apresenta demandas de saúde, conhecimentos científicos proporcionando uma melhor qualidade de voz e vida.

Introduction: The voice is essential for the preservation and maintenance of the culture of social groups. The Pankararu people link their mother language to religious rituals. The main way of transmitting the oral tradition is through singing in the rituals of Praiás. Objective: To rescue the use of voice by Pankararu singers in the Praiás ritual, considering the traditional and scientific knowledges. Method: Qualitative study, history life, autobiography design, which individual and collective memories of the Pankararu community were accessed, considering the characterization of the people, environment, and voice use in the rituals. Results: The singers use their voices intensely and continuously, without hydration, and smoking pipes during the ritual. The "terreiro" is the place where they sing, an open space, exposed to wuthering and dust. They are based on traditional knowledge for taking care of their voices, in a different view of scientific knowledge, in which voice represents their culture and identity. In this perspective, habits described in the literature as harmful are considered healthy, demonstrating a unique conception of health. Conclusion: Scientific knowledge, in parallel with the traditional one, can contribute to establish care aimed at the vocal health of the Pankararus. I will be able to offer to my people, who have health demands, scientific knowledge providing a better quality of voice and life.

Introducción: la voz es fundamental para la preservación y mantenimiento de la cultura de los grupos sociales. La gente de Pankararu, vincula su lengua materna a los rituales religiosos. La principal forma de transmitir la tradición oral es a través del canto en los rituales de Praiás. Objetivo: rescatar el uso de la voz de los cantantes de Pankararu en el ritual Praiás, a la luz de los conocimientos tradicionales y científicos. Método: estudio cualitativo, del tipo de historia de vida; Se accedió a las memorias individuales y colectivas de la comunidad Pankararu, considerando la caracterización de las personas, el entorno y el uso de la voz en los rituales. Resultados: los cantantes utilizan sus voces de forma intensa y continua, sin hidratarse, pipas de humo durante el ritual. El lugar donde canta el terreiro, un espacio abierto, expuesto a la intemperie de la naturaleza, con presencia de polvo. Para cuidar la voz, se basan en los conocimientos tradicionales, presentan una visión diferente del conocimiento científico, donde la voz representa la cultura y la identidad. En esta perspectiva, los hábitos descritos en la literatura como nocivos, se consideran saludables, demostrando una concepción única de la salud. Conclusión: El conocimiento científico, además del conocimiento tradicional, puede contribuir al establecimiento de cuidados dirigidos a la salud vocal de los Pankararus. Podré ofrecer a mi gente, que tiene demandas de salud, conocimientos científicos que brinden una mejor calidad de vida.

Effects of Laryngeal Vibratory Asymmetry and Neuromuscular Compensation on Voice Quality.

INTRODUCTION: Vibratory asymmetry and neuromuscular compensation are often seen in laryngeal neuromuscular pathology. However, the ramifications of these findings on voice quality are unclear. This study investigated the effects of varying levels of vibratory asymmetry and neuromuscular compensation on cepstral peak prominence (CPP), an analog of voice quality. STUDY DESIGN: In vivo canine phonation model. METHODS: Varying degrees of vocal fold vibratory asymmetry were achieved by stimulating one recurrent laryngeal nerve (RLN) over 11 levels from threshold to maximal muscle activation. For each of these levels, phonation was induced at systematically varied combinations of neuromuscular compensation: three levels each of contralateral RLN stimulation (80%, 90%, and 100% of maximal), superior laryngeal nerve (SLN) activation (0%, 50%, and 100% of maximal), and airflow levels (500, 700, and 900 mL/s). Vocal fold symmetry was determined by assessing the opening phase of the vibratory cycle in high-speed video recordings. Voice quality was estimated acoustically by calculating CPP for each voice sample. RESULTS: Eight hundred twenty-two phonatory conditions with varying degrees of vibratory asymmetry were evaluated. CPP was highest at vibratory symmetry. Increasing levels of asymmetry resulted in significant decreases in CPP. CPP increased significantly with increasing contralateral RLN activation. CPP was significantly higher at 50% SLN activation than 0% or 100% SLN activation. CONCLUSION: Voice quality, as approximated by CPP, is best at vibratory symmetry and deteriorates with increasing degrees of asymmetry. Voice quality may be improved with neuromuscular compensation by increased adduction of the contralateral vocal fold or increased vocal fold tension at mid-levels of SLN activation. LEVEL OF EVIDENCE: NA, Basic Science Laryngoscope, 132:130-134, 2022.

Dermatoglifia e condição vocal de professores universitários / Dermatoglyphy and vocal condition of professors

RESUMO Objetivo Investigar a associação entre o perfil dermatoglífico e a condição vocal dos professores de uma instituição pública de ensino superior. Métodos Participaram do estudo 49 docentes. Foram utilizados os seguintes instrumentos de coleta: questionário sociodemográfico e Índice de Triagem para Distúrbios da Voz (ITDV). As impressões digitais foram coletadas por meio do scanner Watson Mini da Integrated Biometric e a análise realizada por meio do protocolo de Cummins e Midlo. Os resultados foram expostos em frequência absoluta. Foi realizado o teste Qui-Quadrado, com nível de significância de 5%, para verificação da associação dos sintomas vocais do ITDV com o perfil dermatoglífico. Resultados houve prevalência do gênero feminino entre os docentes universitários estudados. Quanto à classificação do perfil dermatoglífico, a maioria apresentou perfil anaeróbico. Observou-se associação estatisticamente significativa apenas entre perfil dermatoglífico e carga horária semanal. Conclusão a maioria dos sujeitos de perfil anaeróbico teve maior frequência de sintomas vocais. Observou-se associação estatisticamente significativa entre carga horária semanal e perfil dermatoglífico.

ABSTRACT Purpose To investigate the association between the dermatoglyphic profile and the vocal condition of teachers at a public higher education institution. Methods 49 professors participated in the study. After signing the Informed Consent Form, the following instruments were used: sociodemographic questionnaire and Voice Disorder Screening Index (ITDV). Fingerprints were collected using the Integrated Biometric Watson Mini scanner and analysis performed using the Cummins and Midlo protocol. The results were presented in absolute frequency. The Chi-Square Test was performed, with a significance level of 5%, to verify the association of ITDV vocal symptoms with a dermatoglyphic profile. This study was approved by the Research Ethics Committee of a public higher education institution under protocol number 3,372.226. Results There was a prevalence of females among the university professors studied. As for the classification of the dermatoglyphic profile , most had an anaerobic profile. There was a statistically significant association only between dermatoglyphic profile and weekly workload. Conclusion Most subjects with an anaerobic profile had more frequency of vocal symptoms. There was a statistically significant association between weekly working hours and dermatoglyphic profile.

The Normative Study of Acoustic and Aerodynamic Characteristics of Voice among Healthy Adult Turkish Speaker Population.

Phonatory Aerodynamic System (PAS Model 6600) is an evaluation instrument that assesses the effectiveness of surgical interventions, treatments, and therapy for voice disorders. It can be used for the assessment of voice disorders by supporting other perceptual and instrumental methods. It is important to establish normative data, because the use of appropriate norms is necessary for diagnostic and descriptive accuracy. Therefore, this study is aimed primarily at establishing adult normative databases for phonatory aerodynamic measures obtained with the KayPENTAX PAS Model 6600 among healthy adult Turkish speakers and then examining the effect of age, gender, and age-gender interaction variables on these measures. The contribution of the study is considered so important since it will generate normative data for all measurements-except the mean pitch-by the five protocols of PAS for the first time. Two hundred and six healthy Turkish speakers with normal voice (106 women and 100 men) were included in the study and stratified into three age groups. Forty-five phonatory aerodynamic measures across five PAS protocols (vital capacity, maximum sustained phonation, comfortable sustained phonation, variation in sound pressure level, and voicing efficiency) were collected. Age, gender, and age-gender interaction variables were analyzed for 45 PAS parameters. Significant gender and age effect was found for 30 and 19 variables, respectively. Gender-age interaction together was observed for only 6 parameters. Significant differences were not found for the remaining 10 parameters. Significant age and gender effects were observed for 35 phonatory and aerodynamic measures which are essential part of the objective clinical assessment of voice. Consequently, normative data used as reference in voice assessment should be generated according to age and gender differences.

Enlarging the spectrum of cluster headache: Extracranial autonomic involvement revealed by voice analysis.

BACKGROUND: People with cluster headache (CH) are frequently burdened by misdiagnosis or diagnostic delay. The peculiar somatic and behavioral changes characterizing patients with CH are not useful to improve diagnostic accuracy. In our clinical experience, we noticed a typical voice quality with low and croaking tone in patients with CH. In this cross-sectional study, we evaluated, by digital voice analysis, whether it is possible to identify typical voice quality characterizing patients with CH compared with healthy controls (HCs). Furthermore, to investigate whether putative differences in voice characteristics could be underpinned by constitutional aspects or pathological processes of vocal cords, subjects underwent a videolaryngostroboscopy. Smoking habits and alcohol consumption were specifically investigated. METHODS: After conducting digital recording of the voices from both patients with CH and HCs in a soundproof insulated cabin in the laboratory of the Audiology Department, a set of voice parameters was analyzed. We included the measures of fundamental frequency, calculations of jitter and shimmer, and noise-to-harmonics ratios as well as quantities related to the spectral tilt (i.e., H1-H2, H1-A1, H1-A2, and H1-A3) in 20 patients with CH and in 13 HCs. A videolaryngostroboscopy was performed in all subjects. RESULTS: Patients with CH, explored during the cluster bout period, showed significantly lower second harmonic (H1-H2) values compared with HCs (-6.9 ± 7.6 vs. 2.1 ± 6.7, p = 0.002), usually characterizing the so-called creaky voice. By using a laryngoscopy investigation, a significantly higher prevalence of mild to moderate vocal cord edema and laryngopharyngeal reflux signs were found in patients with CH (100% of patients with CH vs. 15% of HC, p < 0.001). CONCLUSION: Creaky phonation is a "physiological mode of laryngeal operation" usually underpinned by shortened and thickened vocal folds. Creaky voice phonation can be due to a vocal fold's reduced capability to become slack or flaccid secondary to vocal cord edema underpinned by laryngopharyngeal reflux affecting the phonatory mechanisms in patients with CH. The laryngopharyngeal reflux may represent a dysautonomic sign related to the increased parasympathetic tone during in-bout period, reinforcing the hypothesis of an extracranial autonomic dysfunction as part of CH clinical picture.

OpenHSV: an open platform for laryngeal high-speed videoendoscopy.

High-speed videoendoscopy is an important tool to study laryngeal dynamics, to quantify vocal fold oscillations, to diagnose voice impairments at laryngeal level and to monitor treatment progress. However, there is a significant lack of an open source, expandable research tool that features latest hardware and data analysis. In this work, we propose an open research platform termed OpenHSV that is based on state-of-the-art, commercially available equipment and features a fully automatic data analysis pipeline. A publicly available, user-friendly graphical user interface implemented in Python is used to interface the hardware. Video and audio data are recorded in synchrony and are subsequently fully automatically analyzed. Video segmentation of the glottal area is performed using efficient deep neural networks to derive glottal area waveform and glottal midline. Established quantitative, clinically relevant video and audio parameters were implemented and computed. In a preliminary clinical study, we recorded video and audio data from 28 healthy subjects. Analyzing these data in terms of image quality and derived quantitative parameters, we show the applicability, performance and usefulness of OpenHSV. Therefore, OpenHSV provides a valid, standardized access to high-speed videoendoscopy data acquisition and analysis for voice scientists, highlighting its use as a valuable research tool in understanding voice physiology. We envision that OpenHSV serves as basis for the next generation of clinical HSV systems.

Perceptual Evaluation of Vocal Fold Vibratory Asymmetry.

OBJECTIVES: Laryngeal vibratory asymmetry occurring with paresis may result in a perceptually normal or abnormal voice. The present study aims to determine the relationships between the degree of vibratory asymmetry, acoustic measures, and perception of sound stimuli. STUDY DESIGN: Animal Model of Voice Production, Perceptual Analysis of Voice. METHODS: In an in vivo canine model of phonation, symmetric and asymmetric laryngeal vibration were obtained via graded unilateral recurrent laryngeal nerve (RLN) stimulation simulating near paralysis to full activation. Phonation was performed at various contralateral RLN and bilateral superior laryngeal nerve stimulation levels. Naïve listeners rated the perceptual quality of 182 unique phonatory samples using a visual sort-and-rate task. Cepstral peak prominence (CPP) was calculated for each phonatory condition. The relationships among vibratory symmetry, CPP, and perceptual ratings were evaluated. RESULTS: A significant relationship emerged between RLN stimulation and perceptual rating, such that sound samples from low RLN levels were preferred to those from high RLN levels. When symmetric vibration was achieved at mid-RLN stimulation, listeners preferred samples from symmetric vibration over those from asymmetric vibration. However, when symmetry was achieved at high RLN levels, a strained voice quality resulted that listeners dispreferred over asymmetric conditions at lower RLN levels. CPP did not have a linear relationship with perceptual ratings. CONCLUSIONS: Laryngeal vibratory asymmetry produces variable perceptual differences in phonatory sound quality. Though CPP has been correlated with dysphonia in previous research, its complex relationship with quality limits its usefulness as clinical marker of voice quality perception. LEVEL OF EVIDENCE: NA, basic science Laryngoscope, 131:2740-2746, 2021.

Estudo de série de casos sobre voz e transexualidade: características acústicas de homens e mulheres trans brasileiras / Case series study on voice and transsexuality: acoustic characteristics of Brazilian trans men and women / Estudio de serie de casos sobre voz y transexualidad: características acústicas de hombres y mujeres trans brasileños

Objetivo: Descrever as características acústicas na voz de homens e mulheres trans. Método: Participaram desta pesquisa seis pessoas trans, dois homens e quatro mulheres trans, com idade superior a 18 anos. Foram utilizados o software SoundForge 10.0®, o Advanced Multi- Dimensional Voice Programm (MDVP-Adv) para extração das medidas da análise acústica computadorizada e o programa Analysis Synthesis Laboratory (Computerized Speech Lab - Kay Pentax®) para análise do filtro vocal. Resultados: Os valores dos formantes se mostraram menores quando comparados à literatura nacional e internacional. As medidas de f0 apresentaram valores abaixo do esperado ao gênero feminino e aumentados ao gênero masculino. Quanto às medidas de frequência fundamental máxima (fhi) e mínima (flo), os resultados apresentaram uma grande variabilidade, sugerindo instabilidade fonatória. Os resultados de jitter e shimmer e os parâmetros relacionados ao ruído, como o Índice de turbulência vocal (VTI) e Índice de fonação suave (SPI) mostraram-se incongruentes quando relacionados aos parâmetros de normalidade. A medida de ruído/harmônico NHR se mostrou maior que os valores de normalidade, sugerindo presença de ruído ou rouquidão durante a emissão. As medidas de tremor vocal (Fatr e Ftri) apresentaram distribuição anormal quando comparadas à literatura. Não foi possível observar relação nas análises das características acústicas entre os valores de referência e as pessoas participantes desta pesquisa. Conclusão: As medidas acústicas de vozes de homens e mulheres trans apresentam análises diferentes quando comparados à literatura, evidenciando fragilidade dos programas de análise vocal acústica que não contemplam a heterogeneidade cultural e as variadas identidades de gênero.

Objective: To describe the acoustic characteristics in the voice of trans men and women. Method: Six trans subjects, two men and four trans women, aged over 18 years participated in this study. The SoundForge 10.0® software was used to edit and select the vowel /a/, the Advanced Multi-Dimensional Voice Program (MDVP-Adv) for extraction of measurements from computerized acoustic analysis, and the Analysis Synthesis Laboratory program (Computerized Speech Lab - Kay Pentax®) for analysis of the vocal filter. Results: Formant values were lower when compared to national and international literature. The measures of f0 presented values below that expected for the female gender and increased to the male gender. Regarding the measures of the highest fundamental frequency (fhi) and the lowest (flo), the results showed great variability, suggesting phonatory instability. The results of jitter and shimmer and noise-related parameters, such as Voice Turbulence Index (VTI) and Soft Phonation Index (SPI), were incongruent when related to normality parameters. The noise / harmonic NHR measurement showed to be higher than the normal values, suggesting the presence of noise or hoarseness during the emission. Measurements of vocal tremor (Fatr and Ftri), presented an abnormal distribution when compared to the literature. It was not possible to observe relations in the analysis of the acoustic characteristics between the reference values and the people participating in this research. Conclusion: The acoustic measures of voices of trans people present different analysis when compared to the literature, evidencing the fragility of acoustic vocal analysis programs that do not contemplate the cultural heterogeneity and the varied gender identities.

Objetivo: describir las características acústicas en la voz de hombres y mujeres trans. Metodos: Seis personas trans, dos hombres y cuatro mujeres trans, mayores de 18 años participaron en esta investigación. El software SoundForge 10.0®, Programa de voz multidimensional avanzado (MDVP-Adv) se utilizaron para extraer las mediciones del análisis acústico computarizado y el programa del Laboratorio de síntesis de análisis (Laboratorio de habla computarizada - Kay Pentax®) para analizar el filtro vocal. Resultados: Los valores de los formantes demostraron ser más bajos en comparación con la literatura nacional e internacional. Las mediciones de f0 mostraron valores inferiores al esperado para el género femenino y aumentaron para el género masculino. En cuanto a las medidas de frecuencia fundamental máxima (fhi) y mínima (flo), los resultados mostraron una gran variabilidad, lo que sugiere inestabilidad fonatoria. Los resultados de jitter y shimmer y los parámetros relacionados con el ruido, como el índice de turbulencia vocal (VTI) y el índice de fonación suave (SPI) fueron incongruentes cuando se relacionaron con los parámetros de normalidad. La medida de ruido / armónicos NHR fue más alta que los valores normales, lo que sugiere la presencia de ruido o ronquera durante la emisión. Las mediciones del temblor vocal (Fatr y Ftri) mostraron una distribución anormal en comparación con la literatura. No fue posible observar una relación en el análisis de las características acústicas entre los valores de referencia y las personas que participan en esta investigación. Conclusión: Las medidas acústicas de las voces de las personas trans presentan diferentes análisis en comparación con la literatura, mostrando la fragilidad de los programas de análisis acústico vocal que no contemplan la heterogeneidad cultural y las diferentes identidades de género.

Disfonía en la edad pediátrica. Análisis descriptivo de los factores implicados, parámetros clínicos y repercusión en la calidad de vida / Dysphonia in children. Descriptive analysis of the factors involved, clinical parameters and impact on quality of life

INTRODUCCIÓN: La prevalencia de la disfonía en la edad pediátrica se estima en torno a un 6%. La disfonía en este grupo de edad suele deberse a un uso incorrecto de la voz, que lleva al desarrollo de lesiones en las cuerdas vocales. Esta alteración puede afectar negativamente a la autoestima del niño. El objetivo del estudio es describir la epidemiología de los trastornos de la voz en la edad pediátrica en nuestra área, realizar un examen detallado de la voz, así como identificar el impacto de esta afección sobre la calidad de vida. MATERIAL Y MÉTODO: Presentamos un estudio descriptivo sobre 87 pacientes diagnosticados de disfonía con edades comprendidas entre los 5 y los 14 años. La recogida de datos se realizó en nuestro centro entre enero del año 2016 y abril del 2019. Analizamos factores epidemiológicos y clínicos. Se estudia el impacto en la calidad de vida mediante el cuestionario Pediatric Voice Handicap Index. RESULTADOS: Se incluyen 87 pacientes, 57 varones (65,5%) y 30 mujeres (34,5%). La edad media fue de 8,5 años (DE 2,08; rango 4-13). Los parámetros más constantes fueron tener un hermano o más (89,6%) y la práctica de deporte en equipo (58,6%). La alteración fonatoria más frecuente fue la tensión muscular global (88,5%). En el examen laringoscópico, el hallazgo más frecuente fue la presencia de nódulos vocales (45,9%). La puntuación media en el Pediatric Voice Handicap Index fue de 24,3 puntos en total: 4,9 en la escala funcional, 17,6 en la física y 1,8 en la emocional. CONCLUSIONES: Es fundamental una correcta anamnesis que incluya datos sobre el entorno familiar o la práctica de deporte en equipo. La exploración física debe incluir el examen laringoscópico. Existe un impacto en la calidad de vida de los pacientes con disfonía, percibido por ellos y por sus familiares, siendo el físico el principal componente percibido como afectado. Consideramos necesario el abordaje multidisciplinar de esta afección

INTRODUCTION: The prevalence of dysphonia in children is estimated at around 6%. Dysphonia in this age group is usually due to misuse of the voice that leads to the development of vocal fold injuries. This condition can negatively affect the child's self-esteem. The aim of the study is to describe the epidemiology of voice disorders in children in our area, perform an examination of the voice, as well as identify the impact of this pathology on quality of life. MATERIAL AND METHOD: We present a descriptive study with 87 patients aged between 5 and 14 years old, diagnosed with dysphonia. Data collection was carried out in our centre between January 2016 and April 2019. We analysed epidemiological and clinical factors. The impact on quality of life was studied using the Pediatric Voice Handicap Index questionnaire. RESULTS: 87 patients, 57 men (65.5%) and 30 women (34.5%) were included. Mean age 8.5 years (SD: 2.08; range 4-13). The most frequent phonatory disturbance was global muscle tension (88.5%). In the laryngoscopic examination, the most frequent finding was the presence of vocal nodules (45.9%). The average score on the Pediatric Voice Handicap Index was 24.3 points in total; 4.9 on the functional scale; 17.6 on the physical scale and 1.8 on the emotional scale. CONCLUSION: A correct anamnesis that includes the family environment and practice of team sport is essential. The physical examination should include a laryngoscopic examination. There is an impact on the quality of life of patients with dysphonia perceived by them and their families; the physical component is perceived to be most affected. We consider a multidisciplinary approach to this condition necessary

Hyoid Bone Syndrome and Dysphonia: Can Throat Pain Affect the Voice?

OBJECTIVES/HYPOTHESIS: To investigate the relationship of throat pain and dysphonia. STUDY DESIGN: Prospective cohort study. METHODS: Forty-five subjects presenting with hyoid bone syndrome (HBS) and dysphonia were asked to rate their pain on a numerical rating scale and complete the 10-item Voice-Related Quality of Life (V-RQOL) questionnaire prior to and at 1-week follow-up after treatment with triamcinolone injection into the attachments to the affected greater cornu(s). Wilcoxon signed-rank tests were applied to evaluate if the overall V-RQOL scores, the physical functioning (PF) and social-emotional (SE) domain scores, and pain scores changed significantly after treatment. To evaluate how change in perceived pain affected V-RQOL, the differences in the V-RQOL, PF, and SE domain scores, and in pain scores were calculated for each subject. Three linear models were fit to the response variables, ΔV-RQOL, ΔPF, and ΔSE, using ΔPain as a predicting variable. RESULTS: V-RQOL, PF, and SE domain scores, and pain scores all improved significantly with treatment. A bigger decrease in the pain score led to a bigger increase in V-RQOL and domain scores, with slopes varying between -1.1 and -1.4. The PF domain scores showed the greatest improvement with decrease in pain scores. CONCLUSIONS: Effective treatment of HBS led to improvement in patients' voice complaints, suggesting that throat pain may have a direct effect on voice. This may be related to compensatory perilaryngeal adjustments patients make when speaking with a "guarding" effect when they have throat pain. LEVEL OF EVIDENCE: IV (Cohort study) Laryngoscope, 131:E2303-E2308, 2021.

Occurrences of non-linear phenomena and vocal harshness in dog whines as indicators of stress and ageing.

During social interactions, acoustic parameters of tetrapods' vocalisations reflect the emotional state of the caller. Higher levels of spectral noise and the occurrence of irregularities (non-linear phenomena NLP) might be negative arousal indicators in alarm calls, although less is known about other distress vocalisations. Family dogs experience different levels of stress during separation from their owner and may vocalise extensively. Analysing their whines can provide evidence for the relationship between arousal and NLP. We recorded 167 family dogs' separation behaviour including vocalisations, assessed their stress level based on behaviour and tested how these, their individual features, and owner reported separation-related problems (SRP) relate to their whines' (N = 4086) spectral noise and NLP. Dogs with SRP produced NLP whines more likely. More active dogs and dogs that tried to escape produced noisier whines. Older dogs' whines were more harmonic than younger ones', but they also showed a higher NLP ratio. Our results show that vocal harshness and NLP are associated with arousal in contact calls, and thus might function as stress indicators. The higher occurrence of NLP in older dogs irrespective to separation stress suggests loss in precise neural control of the larynx, and hence can be a potential ageing indicator.