We previously developed an instrument called the Aerodynamic Vocal Fold Driver (AVFD) for intraoperative magnified assessment of vocal fold (VF) vibration during microlaryngoscopy under general anesthesia. Excised larynx testing showed that the AVFD could provide useful information about the vibratory characteristics of each VF independently. The present investigation expands those findings by testing new iterations of the AVFD during microlaryngoscopy in the canine model.
The AVFD is a handheld instrument that is positioned to contact the phonatory mucosa of either VF during microlaryngoscopy. Airflow delivered through the AVFD shaft to the subglottis drives the VF into phonation‐like vibration, which enables magnified observation of mucosal‐wave function with stroboscopy or high‐speed video. AVFD‐driven phonation was tested intraoperatively (n = 26 VFs) using either the original instrument design or smaller and larger versions three‐dimensionally printed from a medical grade polymer. A high‐fidelity pressure sensor embedded within the AVFD measured VF contact pressure. Characteristics of individual VF phonation were compared with typical two‐fold phonation and compared for VFs scarred by electrocautery (n = 4) versus controls (n = 22).
Phonation was successful in all 26 VFs, even when scar prevented conventional bilateral phonation. The 15‐mm‐wide AVFD fits best within the anteroposterior dimension of the musculo‐membranous VF, and VF contact pressure correlated with acoustic output, driving pressures, and visible modes of vibration.
The AVFD can reveal magnified vibratory characteristics of individual VFs during microlaryngoscopy (e.g., without needing patient participation), potentially providing information that is not apparent or available during conventional awake phonation, which might facilitate phonosurgical decision making.
Level of Evidence
Previous work using ambulatory voice recordings has shown no differences in average vocal behavior between patients with phonotraumatic vocal hyperfunction and matched controls. This study used larger groups to replicate these results and expanded the analysis to include distributional characteristics of ambulatory voice use and measures indicative of glottal closure.
Subjects included 180 adult women: 90 diagnosed with vocal fold nodules or polyps and 90 age-, sex-, and occupation-matched controls with no history of voice disorders. Weeklong summary statistics (average, variability, skewness, kurtosis) of voice use were computed from neck-surface acceleration recorded using an ambulatory voice monitor. Voice measures included estimates of sound pressure level (SPL), fundamental frequency (fo), cepstral peak prominence, and the difference between the first and second harmonic magnitudes (H1–H2).
Statistical comparisons resulted in medium–large differences (Cohen's d ≥ 0.5) between groups for SPL skewness, fo variability, and H1–H2 variability. Two logistic regressions (theory-based and stepwise) found SPL skewness and H1–H2 variability to classify patients and controls based on their weekly voice data, with an area under the receiver operating characteristic curve of 0.85 and 0.82 on training and test sets, respectively.
Compared to controls, the weekly voice use of patients with phonotraumatic vocal hyperfunction reflected higher SPL tendencies (negatively skewed SPL) with more abrupt glottal closure (reduced H1–H2 variability, especially toward higher values). Further work could examine posttreatment data (e.g., after surgery and/or therapy) to determine the extent to which these differences are associated with the etiology and pathophysiology of phonotraumatic vocal fold lesions.
The purpose of this study was to evaluate the effects of nonmodal phonation on estimates of subglottal pressure (Ps) derived from the magnitude of a neck-surface accelerometer (ACC) signal and to confirm previous findings regarding the impact of vowel contexts and pitch levels in a larger cohort of participants.
Twenty-six vocally healthy participants (18 women, 8 men) were asked to produce a series of p-vowel syllables with descending loudness in 3 vowel contexts (/a/, /i/, and /u/), 3 pitch levels (comfortable, high, and low), and 4 elicited phonatory conditions (modal, breathy, strained, and rough). Estimates of Ps for each vowel segment were obtained by averaging the intraoral air pressure plateau before and after each segment. The root-mean-square magnitude of the neck-surface ACC signal was computed for each vowel segment. Three linear mixed-effects models were used to statistically assess the effects of vowel, pitch, and phonatory condition on the linear relationship (slope and intercept) between Ps and ACC signal magnitude.
Results demonstrated statistically significant linear relationships between ACC signal magnitude and Ps within participants but with increased intercepts for the nonmodal phonatory conditions; slopes were affected to a lesser extent. Vowel and pitch contexts did not significantly affect the linear relationship between ACC signal magnitude and Ps.
The classic linear relationship between ACC signal magnitude and Ps is significantly affected when nonmodal phonation is produced by a speaker. Future work is warranted to further characterize nonmodal phonatory characteristics to improve the ACC-based prediction of Ps during naturalistic speech production.
performance of more than 1 motor-oriented task may
exacerbate speech motor deficits in individuals with
Parkinson disease (PD). The purpose of the current
investigation was to examine the extent to which
performing a low-demand manual task affected the
connected speech in individuals with and without PD.
Method: Individuals with PD and neurologically healthy
controls performed speech tasks (reading and
extemporaneous speech tasks) and an oscillatory
manual task (a counterclockwise circle-drawing
task) in isolation (single-task condition) and concurrently
Results: Relative to speech task performance, no changes
in speech acoustics were observed for either group when
the low-demand motor task was performed with the
concurrent reading tasks. Speakers with PD exhibited
a significant decrease in pause duration between the
single-task (speech only) and dual-task conditions
for the extemporaneous speech task, whereas control
participants did not exhibit changes in any speech
production variable between the single- and dual-task
Conclusions: Overall, there were little to no changes in
speech production when a low-demand oscillatory motor
task was performed with concurrent reading. For the
extemporaneous task, however, individuals with PD
exhibited significant changes when the speech and manual
tasks were performed concurrently, a pattern that was
not observed for control speakers.
Supplemental Material: https://doi.org/10.23641/asha.
clear speech production for speakers with and without
Parkinson disease (PD) using several measures of working
vowel space computed from frequently sampled formant
Method: The 1st 2 formant frequencies were tracked for
a reading passage that was produced using habitual and
clear speaking styles by 15 speakers with PD and 15 healthy
control speakers. Vowel space metrics were calculated
from the distribution of frequently sampled formant frequency
tracks, including vowel space hull area, articulatory–acoustic
vowel space, and multiple vowel space density (VSD)
measures based on different percentile contours of the
formant density distribution.
Results: Both speaker groups exhibited significant
increases in the articulatory–acoustic vowel space and
VSD10, the area of the outermost (10th percentile)
contour of the formant density distribution, from habitual
to clear styles. These clarity-related vowel space increases
were significantly smaller for speakers with PD than
controls. Both groups also exhibited a significant increase
in vowel space hull area; however, this metric was not
sensitive to differences in the clear speech response
between groups. Relative to healthy controls, speakers
with PD exhibited a significantly smaller VSD90, the area
of the most central (90th percentile), densely populated
region of the formant space.
Conclusions: Using vowel space metrics calculated from
formant traces of the reading passage, the current work
suggests that speakers with PD do indeed reach the more
peripheral regions of the vowel space during connected
speech but spend a larger percentage of the time in more
central regions of formant space than healthy speakers.
Additionally, working vowel space metrics based on the
distribution of formant data suggested that speakers with
PD exhibited less of a clarity-related increase in formant
space than controls, a trend that was not observed for
perimeter-based measures of vowel space area.
In vocally healthy children and adults, speaking voice loudness differences can significantly confound acoustic perturbation measurements. This study examines the effects of voice sound pressure level (SPL) on jitter, shimmer, and harmonics-to-noise ratio (HNR) in adults with voice disorders and a control group with normal vocal status.
This is a matched case-control study.
We assessed 58 adult female voice patients matched according to approximate age and occupation with 58 vocally healthy women. Diagnoses included vocal fold nodules (n = 39, 67.2%), polyps (n = 5, 8.6%), and muscle tension dysphonia (n = 14, 24.1%). All participants sustained the vowel /a/ at soft, comfortable, and loud phonation levels. Acoustic voice SPL, jitter, shimmer, and HNR were computed using Praat. The effects of loudness condition, voice SPL, pathology, differential diagnosis, age, and professional voice use level on acoustic perturbation measures were assessed using linear mixed models and Wilcoxon signed rank tests.
In both patient and normative control groups, increasing voice SPL correlated significantly (P < 0.001) with decreased jitter and shimmer, and increased HNR. Voice pathology and differential diagnosis were not linked to systematically higher jitter and shimmer. HNR levels, however, were statistically higher in the patient group than in the control group at comfortable phonation levels. Professional voice use level had a significant effect (P < 0.05) on jitter, shimmer, and HNR.
The clinical value of acoustic jitter, shimmer, and HNR may be limited if speaking voice SPL and professional voice use level effects are not controlled for. Future studies are warranted to investigate whether perturbation measures are useful clinical outcome metrics when controlling for these effects.