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Alaryngeal Speech – Analysis of Two Forms of Voice Production in the Same Subject

Susana Vaz-Freitas 1 2 3, MsC, PhD, SLP
Elisabete Cardoso 4 5, MsC, SLP
Ricardo Sousa 3, PhD, Data Science Researcher
Diogo Coelho 4, Bachelor, Informatic Engineer
Luis Coelho 4 6, PhD, Adjunct Professor, ...Electronics Engineer

¹Serviço Otorrinolaringologia do Centro Hospitalar Universitário do Porto – Hospital de Santo António (CHUP-HSA), ²Escola Superior de Saúde – Universidade Fernando Pessoa. 3Laboratório de Inteligência Artificial e Apoio à Decisão- INESCTEC 4Instituto Superior de Engenharia do Porto, 5Hospital-Escola da UFP, ⁶ Centro de Inovação em Engenharia e Tecnologia Industrial

Contact Author:
Susana Vaz Freitas, Serviço Otorrinolaringologia, Centro Hospitalar Universitário do Porto, Largo Professor Abel Salazar, 4100-099, Porto - Portugal. Email: svazfreitas@gmail.com

Objective: vocal communication in laryngectomized patients is compromised because of laryngeal surgical removal, so vocal restoration is mandatory. There are different alaryngeal speech alternatives. The goal was to determine – in the same subject – the acoustic differences of his esophageal speech (ES) and tracheoesophageal puncture (TEP).
Methods/Design: Patient is a male, European Portuguese speaker, submitted to total laryngectomy in a General Hospital in Oporto Area. The clinician who did the speech restoration was the same. Ethical committee approval was obtained. Informed consent was gathered. Data analysis was done using European Portuguese oral vowels, /a/, /i/ and /u/. For Maximum Phonation Time (MFT) calculation we used the isolated production. Then the vowels were extracted from a reading task, in syllables with association to occlusive consonants /p/, /t/ and /k/.
Results: MPT measures for ES and TEP were defined and considered different, with statistical significance (p=0.050). In addition, statistically significant differences were also found comparing ES with TEP for the acoustic measures of: f0 (p=0.035) and Harmonic-to-Noise Ratio (p=0.031).
Conclusions: The obtained results confirm the difference between ES and TEP. The best qualitative and quantitative outcomes are attributed to TEP. However, the patient identifies himself and says that his "natural voice" is when using ES. Personal identification and naturalness of the obtained voice can be associated to adherence and motivation for therapy, influencing its outcomes and efficacy.[+] Show More

Alaryngeal Speech – Analysis of Two Forms of Voice Production in the Same Subject

Susana Vaz-Freitas 1 2 3, MsC, PhD, SLP Elisabete Cardoso 4 5, MsC, ...

Categorization of Vocal Fry in Running Speech Katherine Proctor, Voice Foundation Symposium 2020

Katherine Proctor, B.S. (in progress), Ronald C. Scherer, Ph.D., ...

Katherine Proctor, B.S. (in progress), Ronald C. Scherer, Ph.D., Brittany Perrine, Ph.D., Kiersten McCormick, B.S. (in progress)

Abstract:
Objective: The purpose of this study was to examine and categorize patterns of ...vocal fry in running speech. Since no other research studies have attempted to fully categorize vocal fry before, and due to the universality of the phenomenon of vocal fry, and the potential psychosocial and voice disorder consequences that come with using it, this topic is of great significance.

Methods: For this study, voice samples were read into Praat and analyzed, and minor differences in the physiologies that produce different “types” of fry were examined.

Results: Temporal categories of vocal fry we discovered were as follows: “onset,” “earlier,” “later,” and “final,” depending on if the fry occurs at the onset of the syllable, earlier in the syllable, later in the syllable, or at the final part (end) of the syllable.

We also explored different physiological categories of the fry, including “single pulses,” “double pulses,” and “multiple pulses,” which refer to the number of glottal pulses within the fry production. Other physiological categories explored through this study include period doubling fry, as well as delay fry and inaudible fry, which have not been described in previous literature.

As for frequency of occurrence of these categories, fry in the onset of the syllable and early in the syllable tended to be the most common. Single pulse fry was the most frequent physiological pattern exhibited by the speakers in the study.

Conclusion: Vocal fry is a complex, multifaceted phenomenon. The results of this study suggest that there are definitively types of vocal fry that also need to be differentiated physiologically.

Authors:

Katherine Proctor, B.S. (in progress), Department of Communication Sciences and Disorders, Bowling Green State University, OH

Ronald C. Scherer, Ph.D., Department of Communication Sciences and Disorders, College of Health and Human Services, Bowling Green State University, OH

Brittany Perrine, Ph.D., Department of Communication Sciences and Disorders, Robbins College of Health and Human Services, Baylor University, Waco, TX

Kiersten McCormick, B.S. (in progress), Department of Communication Sciences and Disorders, Bowling Green State University, OH[+] Show More

Fundamental Frequency and Intensity Effects on Cepstral Measures in Vowels from Connected Speech

Fundamental Frequency and Intensity Effects on Cepstral Measures in ...

Fundamental Frequency and Intensity Effects on Cepstral Measures in Vowels from Connected Speech of Speakers with Voice Disorders

Marilia Carvalho Sampaio, Ph.D., Ŧ t, Jörg Edgard Bohlender, KD, MD t ŧ, ...Meike Brockmann-Bauser, Ph.D., MSc, t ŧ

t University Hospital Zurich, ŧ University of Zurich, Ŧ Federal University of Bahia - email: marilia.sampaio@ufba.br

Objective: Cepstral peak prominence (CPP) and smoothed CPP (CPPS) are described as reliable parameters to detect overall dysphonia in standardized connected speech samples. Voice intensity (SPL) and fundamental frequency (f0) show prosody related variations during speech tasks, which may influence cepstral measurement results in dysphonic adults. Therefore, we evaluated the effects of f0 and SPL on CPP and CPPS across vowels from connected speech of adults with voice disorders.
Methods/Design: In a retrospective cross-sectional study, the voice recordings of 27 Brazilian Portuguese speakers with voice disorders (19 women, 8 men) with a mean age of 45 years (SD=13) were assessed. Perceptual dysphonia was absent or mild in 59%, and moderate or severe in 41% of patients. Five /a/ vowels were manually extracted from stressed syllables in different positions of CAPE-V sentences. Acoustic analysis was done using PRAAT. Statistical analysis comprised Linear Mixed Models (LMM) with ANCOVA and post hoc tests.
Results: SPL as single factor had a highly significant effect on CPP and CPPS, followed by the interaction between f0 and SPL (p ≤.001). However, f0 alone had no significant impact on cepstral measures (p ≥.77). CPP, CPPS, f0, and SPL of the first vowel were all lower compared to the last vowel (p ≤.03). The first vowel was in the end of a word/sentence and before the consonant /h/, while the last vowel was in the beginning of a sentence and part of the glide /ai/.
Conclusions: Higher SPL alone and combined with higher f0 were related to better CPP and CPPS, reflecting an increase in vocal tension and harmonic organization. Thus, CPP and CPPS were affected by speaking prosody patterns, but also vowel position in the sentence and word and co-articulation effects. A larger clinical study should confirm how these effects may be controlled for in cepstral measurements.[+] Show More

How Do Tube Diameter and Vocal Tract Configuration affect Oral Pressure during Water Bubbling?

Karol Acevedo, SLP. Universidad San Sebastian/ Universidad de los ...

Karol Acevedo, SLP. Universidad San Sebastian/ Universidad de los Andes.
Marco Guzman, PhD. Universidad de los Andes.
Christian Castro, SLP. Universidad de Valparaiso.
Camilo Moran, SLP. Universidad de los Andes
Victor Espinoza, PhD. Universidad ...de Chile.
Camilo Quezada, PhD. Universidad de Chile.

Contact: guzmann.marcoa@gmail.com

Purpose: The present study aimed to observe how do tube diameter and vocal tract configuration affect frequency and amplitude of oral pressure oscillation caused by bubbling during water resistance therapy. A secondary purpose was to examine self-perceived sensation of massage-like effect produced by bubbles. Methods: 40 participants were asked to phonate into three different silicon tubes (three different inner diameters, 30 cm length) and two different vocal tract configurations (regular configuration and elongated vocal tract configuration) in a random order. All tubes were submerged 5 cm below the water surface during voice production. Participants were asked to maintain the same pitch for all tasks while producing a target subglottic pressure (10-12 cm H2O). While bubbling, subjects were asked to self-assess the degree of massage-like effect using a 100 mm visual analogue scale. The oral pressure was captured with a pressure transducer connected to a thin flexible plastic tube. Oral pressure signals were analyzed to obtain the bubbling frequency, amplitude of oscillation, frequency regularity, and amplitude regularity during the non-shuttered phase in tube phonation submerged into water. A MATLAB custom script was created for the present study to estimate dependent variables. Results: Significant differences for all oral pressure related variables caused by bubbling were observed when comparing different tube diameters. Lower bubbling frequency, greater amplitude, and greater frequency and amplitude regularity from the oral pressure signals were detected for wider tubes and greater vocal tract volume (elongated vocal tract configuration). Self-assessment of massage-like sensation increased when phonating with wider tubes and elongated vocal tract. Conclusions: Inner diameter of tube and vocal tract configuration affect oral pressure related variables caused by bubbling, which in turn, cause a differential degree of massage-like effect. Tube diameter and vocal tract configuration should be controlled during voice therapy to promote the best possible sensation.[+] Show More

How Individuals Cope with Chronic Dysphonia

Jared Roduard Hermogenes, BAppSc(SpeechPathology)(Hons), The ...

Jared Roduard Hermogenes,
BAppSc(SpeechPathology)(Hons),
The University of Sydney, NSW, Australia

A/Prof Steven Cumming
B.A (Hons), M.Psych, Ph.D.,
The University of Sydney, NSW, Australia

Adj. A/Prof Janet Baker
L.A.C.S.T., M.SC., Ph.D.,
Flinders University, ...South Australia, Australia,

A/Prof Catherine Madill
Ph.D., BAppSc (Hons1), BA (Hons)
The University of Sydney, New South Wales, Australia,
Contact : cate.madill@sydney.edu.au

Background: Chronic illnesses present individuals with significant challenges, including associated risks to health and psychological related problems. Dysphonia has been shown by previous research to have complex biopsychosocial implications on individuals’ quality of life. Despite the pervasive effects of dysphonia across an individual’s life, limited literature currently explores the effects of chronicity on how people cope with dysphonia.
Objective: To describe the coping style of individuals with chronic dysphonia and to investigate relationships between coping styles and impact on quality of life, activity limitations, and participation restrictions in voice-related activities. This study also compared differences between scores on patient-reported outcome measures of individuals with different coping styles, illness and demographic variables.
Design: Survey-based, descriptive study design on individuals with chronic dysphonia. Questions consisted of general demographics, the VDCQ, VHI-30, and VAPP. Descriptive and correlational statistical analyses were used to analyse data.
Participants: Forty-three individuals with dysphonia who had a diagnosis from an Ear, Nose, and Throat Specialist and/or Speech and Language Pathologist for longer than four months.
Main Outcome Measures: Demographic and voice-related information, scores on the Voice Disability Coping Questionnaire, Voice Handicap Index-30, and the Voice Activity and Participation Profile.
Results: “Information seeking” was the most endorsed coping style. Scores from the VAPP and VHI-30 indicate significant self-perceived disability consequent to diagnosis of chronic dysphonia. There is a strong correlation between passive/avoidant VDCQ coping scales and VHI-30 and VAPP scores. No significant differences in scores of patient-reported outcome measures were noted between individuals with different coping styles and on various demographic and illness factors.
Conclusions: The study highlights the importance for voice practitioners to recognise the experiences and coping styles of individuals with chronic dysphonia. Readily available, accurate information about the disorder that promotes increased knowledge of services and supports available may foster healthier coping styles in the population.[+] Show More

Identity and Voice Therapy Outcomes:A Model for Adherence, Habilitation, and Rehabilitation of Voice

Marianna (Annie) Rubino, MFA, MS, CCC-SLP, PhD Student, University of ...

Impact of Hearing Protection and Background Noise on the Voice of Steam Train Engineers

Desi Gutierrez, BA, MA Graduate Student, Dept. of Communication ...

Desi Gutierrez, BA, MA Graduate Student, Dept. of Communication Sciences and Disorders, University of Iowa, Iowa City, IA, desi-gutierrez@uiowa.edu

Pasquale Bottalico, PhD, Assistant Professor, Dept. of Speech and Hearing Science, University ...of Illinois at Urbana-Champaign, Champaign, IL, pb81@illinois.edu

Supraja Anand, PhD, Assistant Professor, Dept. of Communication Sciences and Disorders, University of South Florida, Tampa, FL, suprajaanand@usf.edu

Objective: Exposure to background noise triggers an alteration in the speech production mechanism referred to as the Lombard effect. Although well-studied, prior research is largely focused on teachers. This study investigated Lombard effect in steam train engineers, who constantly communicate for safety and proper operation of the trains. Due to hazardous levels of exposure to background noise, steam train engineers are required to wear hearing protection devices (HPDs). Such devices alter the wearer’s perception of his/her own voice and also lead to changes in speech production. To our knowledge, no studies have examined these effects and their combination among steam train engineers, for whom the implications are likely to be significant.

Methods/Design: Thirteen steam train engineers phonated vowel /a/, read a phrase, and described a map under different noise and HPD conditions. Background noises with similar loudness equivalent levels but different spectral shapes were selected from multiple steam train recordings. Objective acoustic measures of relative sound pressure level (∆SPL) and relative fundamental frequency (∆fo) were extracted from all stimuli. Participants also subjectively reported their vocal effort and vocal disturbance using a 100 mm visual analog scale.

Results and conclusions: In the presence of background noise, participants significantly raised their ∆SPL and ∆fo compared to silent conditions demonstrating a Lombard effect. In the presence of background noise and HPDs, they significantly decreased their ∆SPL and ∆fo. On the contrary, there was an increase in ∆SPL in the silence condition when the participants wore HPDs. Additionally, participants perceived decreased vocal disturbance as a result of HPDs. Majority of the research examining the effects of hearing protection on speech communication has focused on the listener. Understanding the changes in voice and speech production by talkers who are required to wear HPDs can provide the basis for developing better communication in noisy environments.[+] Show More

The Impact of Student Rating Preferences using an Online Auditory Perceptual Training Tool

A/Prof Cate Madill, Ph.D., BAppSc (Speech Pathology)HonsM1, BA (Hons), ...

A/Prof Cate Madill,
Ph.D., BAppSc (Speech Pathology)HonsM1, BA (Hons), CPSP
University of Sydney
Contact : cate.madill@sydney.edu.au

Ayin Huzmeli
BAppSc(Speech Pathology)Hons
University of Sydney

Dr Duong Nguyen
MD, Ph.D.
University of Sydney

Background. Auditory-Perceptual rating of speech and voice is ...a core clinical competency of all SLP graduates. Auditory-perceptual (AP) training for brief periods with feedback has been proven to increase the reliability of judgments (Chan, Li, Law, & Yiu, 2012). Madill et al (2018) found that online auditory-perceptual rating increases practice and increased practice improves performance on auditory-perceptual assessment tasks. Currently, there are no recommendations for when to rate an AP task: whilst listening, after listening or pausing to rate while listening.
Objectives. To investigate the effects of listening-rating patterns on rating scores using the CAPE-V rating scale on a freely available online platform.
Methods. 1735 auditory-perceptual ratings of teaching class case voice samples from undergraduate and professional entry Masters students were collected via an online rating tool (Bridge2Practice.com) over a 2 year time period and analysed using SPSS 25.0. Measures analysed included mean ratings of overall severity, roughness, and breathiness, and the number of times a recording was played or stopped/paused.
Results. 3.8% of the ratings were performed before the voice samples were played and were excluded from analyses. The remaining 1670 ratings were divided into four groups: 2.0% were made after the rater finished listening; 42.0% were rated whilst listening and at the end of the recording without using pauses; 4.3% were rated during pauses; and 51.7% were completed while listening without pauses. One-way analysis of variance showed significant main effects for group for overall severity, roughness, breathiness, and strain (p less than 0.001). Results also showed significant correlations between the time that the raters ended or paused the media and the rating scores of overall severity (r = -0.133, p less than 0.01), breathiness (r = -0.104, p less than 0.01), and strain (r = -0.157, p less than 0.01).
Conclusion: These findings implied that the way raters used/played/paused vocal stimuli/media had significant effects on auditory-perceptual assessment.[+] Show More

Nasal and Vocal Tract Coupling: Variation of the Velopharyngeal Opening in 3-D Casts

Miriam Havel MD, Dept. of Otorhinolaryngology, Head&Neck Surgery, ...

Miriam Havel MD, Dept. of Otorhinolaryngology, Head&Neck Surgery, Section Phoniatrics, Munich University Hospital (LMU), Munich, Germany

Johan Sundberg PhD, 2Dept. of Speech, Music and Hearing, School of Computer Science and ...Communication, KTH (Royal Institute of Technology), Stockholm, Sweden

Abstract: Background: The acoustic contribution of the nasal cavity to the resonance properties of the vocal tract depends on the velopharyngeal opening (VPO). In this work, we investigate the acoustic effects of different sizes of the VPO by coupling 3 D casts of vocal tracts to a 3 D cast of a nasal tract.

Method: 3D replicas of human vocal tracts for the vowels /a, ae, i/ were connected to a 3D replica of a human nasal tract via tubes obtained from standard syringes. The system was excited by sine tone sweeps from an earphone placed at the glottis. The response was picked up by a microphone at the lip opening. The acoustical responses obtained for different diameters and lengths of the coupling tube were recorded and the effect on the transfer function was analyzed.

Results: The lowest resonance of the nasal tract alone was 535 Hz. For all three vowels, a marked dip appeared in the transfer functions near 600Hz, when a VPO coupling of at least 2.3 mm diameter and 14 mm length was introduced, i.e. when the nasal tract was acoustically included in the resonator system. With increasing size of the VPO the dip moved upward in frequency and became deeper. In addition, minor dips appeared above 2000Hz. With a specific narrow coupling tube, the level difference between the first and fourth formants was a few dB smaller than for the remaining coupling tubes tested.

Conclusions: The transfer functions obtained in 3D replicas of coupled human nasal and vocal tracts showed systematic effects that depended on the diameter of the introduced velopharyngeal opening. The results support the assumption that the high frequency part of a spectrum can be slightly enhanced by an optimized size of the VPO.[+] Show More

Respiratory Muscle Strength Training for Patients with Presbyphonia

Maude Desjardins, PhD, Post-doctoral Researcher, Department of ...

Maude Desjardins, PhD, Post-doctoral Researcher, Department of Communication Sciences and Disorders, University of Delaware

Lucinda Halstead, MD, Associate Professor, Medical Director, Evelyn Trammell Institute for Voice & Swallowing, Dept. of Otolaryngology ...HNS, Medical University of South Carolina

Annie Simpson, PhD, Associate Professor, Department of Healthcare Leadership and Management - College of Health Professions; Department of Otolaryngology – Head and Neck Surgery, Medical University of South Carolina

Patrick Flume, MD, Professor, Pulmonary and Critical Care Division - College of Medicine, Medical University of South Carolina

Heather Bonilha, PhD, Associate Professor, Department of Health Sciences and Research - College of Health Professions; Evelyn Trammel Institute for Voice and Swallowing, Medical University of South Carolina

Background/Objective: The effects of presbyphonia are compounded by the decline in respiratory function that occurs with age. Commonly suggested exercises to optimize the use of respiratory muscles during speech are unlikely to be intensive enough to induce respiratory changes and impact vocal function. The objective of this study was to acquire preliminary data on the effect of adding respiratory muscle strength training to voice exercises in a sample of patients with presbyphonia. Methods/Design: In this prospective, randomized-controlled trial, 12 participants were assigned to receive either 1) vocal function exercises (VFEs), 2) VFEs combined with inspiratory muscle strength training (IMST), or 3) VFEs combined with expiratory muscle strength training (EMST). Data collected prior to and following four, weekly intervention sessions included respiratory measures (pulmonary function and respiratory muscle strength) and voice measures (videostroboscopy, acoustic, auditory-perceptual, aerodynamic, and self-assessment measures). Results: Participants who received IMST improved their voice quality during connected speech (smoothed cepstral peak prominence (CPPS) and ratings of overall voice quality) and their scores on the three self-assessment questionnaires with large to very large effect sizes (|d|=0.82 to 1.61). In addition, participants reduced their subglottal pressure in phonation with a large effect size (d=-0.92). Participants who received EMST improved their maximum expiratory strength and CPPS with large effect sizes (d=0.80 and 0.99, respectively) but had limited improvements in other outcomes. Participants who received only VFEs decreased their amount of vocal fold bowing, improved their voice quality on a sustained vowel (amplitude perturbation quotient), and improved their Glottal Function Index score with large effect sizes (|d|=0.74 to 1.00). Conclusion: Preliminary data indicate that adding IMST to voice exercises may lead to the greatest benefits in patients with presbyphonia by promoting improved subglottal pressure control as well as increasing air available for phonation.[+] Show More

Self-perceived Voice Problems in a Non-treatment Seeking Older Population in Hong Kong

Estella P.-M. Ma, Ph.D., Associate Professor, Human Communication ...

The Speech-Language Pathology First Contact Assessment for Voice Disorders

Christopher Payten, PhD Candidate, Gold Coast University Hospital and ...

Christopher Payten, PhD Candidate, Gold Coast University Hospital and The University of Sydney.
Associate Professor Cate Madill, PhD, Director Dr Liang Voice Program, The University of Sydney.
Dr Kelly Weir, PhD, Conjoint ...Principal Research Fellow - Allied Health, Griffith University.

Abstract
Objectives: A new extended scope Speech-Language Pathology (SLP) assessment clinic aimed to reduce Ear, Nose and Throat (ENT) service demand for patients referred with symptoms of dysphonia through SLP-led first contact assessment. The aim was to reduce waiting times for patients referred to a tertiary referral public hospital ENT outpatient service and provide access to the right care for patients suitable for SLP treatment, within clinically recommended time-frames.
Methods/Design: The SLP-led clinic commenced in May 2016. The SLP provided a comprehensive multidimensional “one-stop” assessment in a clinic running parallel to a specialist ENT clinic. Assessments included case history, audio-perceptual voice evaluation, video stroboscopy, and psychometric measures. Video stroboscopy images were reviewed jointly by the ENT and SLP for diagnostic interpretation, and treatment planning. After SLP assessment, patients were either managed by SLP without ENT, or reinstated onto ENT wait list. We measured: waiting times 24 months pre and 12 months post implementation; number of patients requiring ENT intervention after assessment in the SLP-led clinic; adverse events; and service delivery costs.
Results: A total of 153 patients were seen in the SLP-led first contact clinic between May 2016 – July 2017. Waiting times to initial assessment for patients with low priority symptoms of dysphonia reduced from an average of 151 days to 50 days. Most patients were managed by SLP and discharged without the need for ENT intervention (81.05%), 29 patients were returned to ENT for management, 11 of which where recategorised for urgent ENT assessment. No adverse events were recorded.
Conclusion: The SLP-led first contact assessment improved waiting times for assessment of patients with symptoms of dysphonia, and improved access to treatment. Future research on cost effectiveness, sensitivity of the SLP assessment process and predicted capability of the SLP assessments to identify surgical need will provide more confidence in the model.[+] Show More

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About JOV
Journal Home
JOV Annual Best Papers

2022 Symp Program
2019 Abstracts
Programs and Abstracts

Exhibitor Prospectus
Marketing
Leading Roles