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Journal of Speech, Language, and... Apr 2023The increased use of telehealth practices has created a critical need for home-based surrogate markers for prognostic respiratory indicators of disease progression in...
PURPOSE
The increased use of telehealth practices has created a critical need for home-based surrogate markers for prognostic respiratory indicators of disease progression in persons with amyotrophic lateral sclerosis (pALS). Given that phonation relies on the respiratory subsystem of speech production, we aimed to examine the relationships between maximum phonation time (MPT), forced vital capacity, and peak cough flow and to determine the discriminant ability of MPT to detect forced vital capacity and peak cough flow impairments in pALS.
METHOD
MPT, peak cough flow, forced vital capacity, and ALS Functional Rating Scale scores were obtained from 62 pALS (El-Escorial Revised) every 3 months as part of a longitudinal natural history study. Pearson's correlations, linear regressions, and receiver operator characteristic curve analyses with the area under the curve (AUC), sensitivity, specificity, and likelihood ratios were calculated.
RESULTS
The mean age of pALS was 63.14 ± 10.95 years, 49% were female, and 43% had bulbar onset. MPT predicted forced vital capacity, (1, 225) = 117.96, < .0001, and peak cough flow, (1, 217) = 98.79, < .0001. A significant interaction was noted between MPT and ALS Functional Rating Scale-Revised respiratory subscore for forced vital capacity, (1, 222) = 6.7, = .010, and peak cough flow, (1, 215) = 4.37, = .034. The discriminant ability of MPT was excellent for peak cough flow (AUC = 0.88) and acceptable for forced vital capacity (AUC = 0.78).
CONCLUSIONS
MPT is a simple clinical test that can be measured via telehealth and represents a potential surrogate marker for important respiratory and airway clearance indices. Further larger studies are required to validate these findings with remote data collection.
SUPPLEMENTAL MATERIAL
https://doi.org/10.23641/asha.22186408.
Topics: Humans; Female; Middle Aged; Aged; Male; Cough; Amyotrophic Lateral Sclerosis; Disease Progression; Phonation; Biomarkers
PubMed: 36877985
DOI: 10.1044/2022_JSLHR-22-00522 -
Journal of Voice : Official Journal of... Jul 2022Maximum phonation time (MPT) is a test to measure glottic efficiency for laryngeal pathology screening and treatment monitoring. The normative value of MPT for South...
OBJECTIVE
Maximum phonation time (MPT) is a test to measure glottic efficiency for laryngeal pathology screening and treatment monitoring. The normative value of MPT for South East Asia population has yet to be reported. It is postulated that MPT may be affected by body mass index (BMI) despite the paucity of evidence. Therefore, this study was designed to establish the normative value of MPT for a South East Asia population and investigate its relation to BMI.
DESIGN & SETTING
This cross-sectional study was conducted in Universiti Kebangsaan Malaysia Medical Center between May and September 2017.
PARTICIPANTS AND METHODS
Three hundred males and females with mean age of 30.23 (±11.04) years were recruited in equal number for each gender (n = 150) and divided into 3 groups of 50 according to their BMI (n = 50). The three groups are non-obese (BMI≤22.9kg/m); obese (BMI between 23 and 34.9 kg/m); and morbidly obese (BMI >35kg/m). BMI and Voice Handicap Index-10 (VHI-10) were obtained. The average of three readings of MPT was measured using a stopwatch while the participants phonate /a/, /i/ and /u/. Unpaired t-test and ANOVA were used to compare means between and across groups. Spearman correlation assessed the correlation between MPT and BMI.
MAIN OUTCOME MEASURES
The normative values of MPT of both genders and correlation with BMI were analyzed.
RESULTS
The MPT normative values for males and females in the non-obese group were of 21.41 (±6.85) seconds and 18.05 (±5.06)seconds respectively for /a/. The MPT for all vowels were significantly higher in males across the BMI groups (P ≤ 0.05). There was low negative correlation between MPT and BMI in both genders.
CONCLUSIONS
This pioneering study documented the normative values of MPT among Malaysians showed that males had longer MPT than females across the BMI groups. Obesity affects the MPT in that as BMI increases, the MPT decreases.
Topics: Adult; Body Mass Index; Cross-Sectional Studies; Female; Humans; Larynx; Male; Obesity, Morbid; Phonation
PubMed: 32861567
DOI: 10.1016/j.jvoice.2020.07.015 -
Wiley Interdisciplinary Reviews.... May 2021Creaky phonation (also known as creaky voice, vocal fry, laryngealization, or glottalization) is a voice quality that refers to shortened and thickened vocal folds that...
Creaky phonation (also known as creaky voice, vocal fry, laryngealization, or glottalization) is a voice quality that refers to shortened and thickened vocal folds that vibrate at a low and quasi-regular fundamental frequency with a long period of damping. Cross-linguistically, creaky phonation can span either short or long domains. When implemented on individual vowels or consonants (as in Zapotec or Montana Salish), it can signal phonemic contrast with other voice qualities, or it can be an additional acoustic cue to enhance other contrasts, such as tone (as in Mandarin or Cantonese). Another segmental use of creaky phonation in many languages is as a variant of glottal stop. Creaky phonation can also be implemented as a prosodic element that signals the end of a phrase (as in English or Mandarin), or indicates relinquishing a conversational turn (as in Finnish). It can also express meaning in a social interaction, such as irritation (in Vietnamese). Lastly, creaky phonation can be deployed as a sociolinguistic marker to establish identities, convey affect, or distinguish one speech group from another within the same language. In some social circumstances, such as the perception that young women use creaky phonation at greater rates than men do, it can be evaluated negatively by listeners. As creaky phonation can be combined with linguistic elements at various levels and is easily perceptible, it has taken on a remarkable number of roles in our linguistic repertoires. This article is categorized under: Linguistics > Language in Mind and Brain.
Topics: Female; Humans; Internationality; Male; Multilingualism; Phonation; Phonetics; Voice Quality
PubMed: 33015958
DOI: 10.1002/wcs.1547 -
The Laryngoscope Aug 2016In speech and singing, the intrinsic laryngeal muscles set the prephonatory posture prior to the onset of phonation. The timing and shape of the prephonatory glottal...
INTRODUCTION
In speech and singing, the intrinsic laryngeal muscles set the prephonatory posture prior to the onset of phonation. The timing and shape of the prephonatory glottal posture can directly affect the resulting phonation type. We investigated the dynamics of human laryngeal phonatory posturing.
METHODS
Onset of vocal fold adduction to phonation was observed in 27 normal subjects using high-speed video recording. Subjects were asked to utter a variety of phonation types (modal, breathy, pressed, /i/ following sniff). Digital videokymography with concurrent acoustic signal was analyzed to assess the timing of the following: onset of adduction to final phonatory posture (FPT), phonation onset time (POT), and phonatory posture time (PPT). Final phonatory posture time was determined as the moment at which the laryngeal configuration used in phonation was first achieved.
RESULTS
Thirty-three audiovisual recordings met inclusion criteria. Average FPT, PPT, and POT were as follows: 303, 106, and 409 ms for modal; 430, 104, and 534 ms for breathy; 483, 213, and 696 ms for pressed; and 278, 98, and 376 ms for sniff-/i/. The following posturing features were observed: 1) pressed phonation: increased speed of closure just prior to final posture, complete glottal closure, and increased supraglottic hyperactivity; and 2) breathy phonation: decreased speed of closure prior to final posture, increased posterior glottal gap, and increased midmembranous gap.
CONCLUSIONS
Phonation onset latency was shortest for modal and longest for pressed voice. These findings are likely explained by glottal resistance and subglottal pressure requirements.
LEVEL OF EVIDENCE
NA. Laryngoscope, 126:1837-1843, 2016.
Topics: Glottis; Humans; Phonation
PubMed: 26690882
DOI: 10.1002/lary.25816 -
Biomechanics and Modeling in... Feb 2023Fundamental frequency patterns during phonation onset have received renewed interest due to their promising application in objective classification of normal and...
Fundamental frequency patterns during phonation onset have received renewed interest due to their promising application in objective classification of normal and pathological voices. However, the associated underlying mechanisms producing the wide array of patterns observed in different phonetic contexts are not yet fully understood. Herein, we employ theoretical and numerical analyses in an effort to elucidate the potential mechanisms driving opposing frequency patterns for initial/isolated vowels versus vowels preceded by voiceless consonants. Utilizing deterministic lumped-mass oscillator models of the vocal folds, we systematically explore the roles of collision and muscle activation in the dynamics of phonation onset. We find that an increasing trend in fundamental frequency, as observed for initial/isolated vowels, arises naturally through a progressive increase in system stiffness as collision intensifies as onset progresses, without the need for time-varying vocal fold tension or changes in aerodynamic loading. In contrast, reduction in cricothyroid muscle activation during onset is required to generate the decrease in fundamental frequency observed for vowels preceded by voiceless consonants. For such phonetic contexts, our analysis shows that the magnitude of reduction in the cricothyroid muscle activation and the activation level of the thyroarytenoid muscle are potential factors underlying observed differences in (relative) fundamental frequency between speakers with healthy and hyperfunctional voices. This work highlights the roles of sometimes competing laryngeal factors in producing the complex array of observed fundamental frequency patterns during phonation onset.
Topics: Phonation; Vocal Cords; Laryngeal Muscles; Muscles
PubMed: 36370231
DOI: 10.1007/s10237-022-01652-8 -
Logopedics, Phoniatrics, Vocology 2008
Topics: Female; Humans; Male; Phonation; Phonetics; Sex Factors; Transsexualism; Voice; Voice Quality
PubMed: 18344139
DOI: 10.1080/14015430801999866 -
Journal of Voice : Official Journal of... Sep 2019This study aimed to investigate the duration of straw phonation effects using aerodynamic, electroglottographic, and acoustic metrics.
OBJECTIVE
This study aimed to investigate the duration of straw phonation effects using aerodynamic, electroglottographic, and acoustic metrics.
METHODS
Twenty-four participants were recruited to perform both a 5-minute and a 10-minute straw phonation exercise. Upon completion of the exercises, phonation threshold pressure (PTP), mean airflow, contact quotient, fundamental frequency, jitter, shimmer, and noise-to-harmonics ratio were measured over a 20-minute time frame. Parameters were measured before the intervention (baseline), immediately after the intervention (m0), 5 minutes (m5), 10 minutes (m10), 15 minutes (m15), and 20 minutes (m20) after the intervention.
RESULTS
PTP significantly decreased immediately after 5 minutes of straw phonation and returned to initial state within 5 minutes. PTP remained decreased over 5 minutes after 10 minutes of straw phonation. Mean airflow increased immediately after both 5 minutes and 10 minutes of straw phonations and remained improved for 20 minutes. No significant changes were obtained for contact quotient and acoustic parameters over the intervention period.
CONCLUSIONS
The results extended our knowledge of proper clinical application of straw phonation regarding the duration of exercise. This study confirmed that 10 minutes of straw phonation lead to optimal and relatively continuous effects in PTP and mean airflow. Although straw phonation did show lingering effects in aerodynamics, repeated practices were recommended to obtain optimum and therapeutic effects.
Topics: Acoustics; Adult; Electrodiagnosis; Equipment Design; Female; Healthy Volunteers; Humans; Male; Phonation; Predictive Value of Tests; Speech Acoustics; Time Factors; Vocal Cords; Voice Quality; Voice Training; Young Adult
PubMed: 29866635
DOI: 10.1016/j.jvoice.2018.05.002 -
Anaesthesia Nov 1990
Topics: Humans; Intubation, Intratracheal; Laryngoscopy; Larynx; Phonation
PubMed: 2082969
DOI: 10.1111/j.1365-2044.1990.tb14639.x -
European Archives of... Jun 2018Voice abuse is known to be a common risk factor of voice disorders and prolonged; high-intensity phonation has been shown to damage the vocal fold epithelium. We aim to...
PURPOSE
Voice abuse is known to be a common risk factor of voice disorders and prolonged; high-intensity phonation has been shown to damage the vocal fold epithelium. We aim to evaluate the effects of phonation on the integrity and barrier function of vocal fold epithelium using a porcine laryngeal model.
METHODS
Ex vivo porcine larynges were phonated at low intensity or high intensity for 15, 30, or 60 min within 4 h after harvest. Vocal fold epithelium was visualized using transmission electron microscopy (TEM). The barrier function of vocal fold epithelium was evaluated by measuring the permeability to model molecules, fluorescein (376 Da), and fluorescein isothiocyanate (FITC)-dextrans of 4000 and 10,000 Da (FD4, FD10), in a Franz diffusing cell.
RESULTS
Cell death and dilated intercellular space after phonation were observed using TEM. Thickness of vocal fold epithelium was significantly reduced after low-intensity phonation for 30 and 60 min and high-intensity phonation for 15, 30, and 60 min. Epithelial permeability to fluorescein was significantly increased after low-intensity phonation for 30 and 60 min, and high-intensity phonation. Permeability to FD4 was significantly increased after high-intensity phonation for 30 and 60 min. Phonation did not alter the permeability to FD10 significantly.
CONCLUSION
Long-duration phonation destroys the integrity and barrier function of vocal fold epithelium. These effects likely make vocal folds more vulnerable to other environmental irritants, such as tobacco smoke, reflux components, allergens, and inhaled pollutants. Destroyed barrier function may be an important factor in the pathogenesis of voice lesions related to voice abuse.
Topics: Animals; Epithelium; Microscopy, Electron, Transmission; Permeability; Phonation; Swine; Time Factors; Tissue Culture Techniques; Vocal Cords; Voice Disorders
PubMed: 29671091
DOI: 10.1007/s00405-018-4973-9 -
The Laryngoscope Jan 2022The anatomy of the posterior glottis, specifically the states of the posterior glottis during phonation, has not been thoroughly explored in laryngology. Conventional...
OBJECTIVES/HYPOTHESIS
The anatomy of the posterior glottis, specifically the states of the posterior glottis during phonation, has not been thoroughly explored in laryngology. Conventional wisdom about the posterior glottis indicates that it tends to be completely closed in men but may be open in women. Furthermore, professional singers are expected to have a completely closed posterior glottis. The aim of this study was to investigate whether these generalizations are true by comparing rigid videolaryngostroboscopy results with high-resolution computed tomography (HRCT) and three-dimensional (3D) reconstruction findings.
STUDY DESIGN
Prospective study.
METHODS
Of the 90 volunteers (58 women, 32 men) examined, 48 were female professional singers, 10 were female nonsingers, 22 were male professional singers, and 10 were male nonsingers. Rigid videolaryngostroboscopy as well as HRCT scans were performed during singing at the average singing fundamental frequency. HRCT images of the larynx and air-column were 3D visualized using the software MIMICS®. The states of the posterior glottis were assessed in both examinations and compared among participants.
RESULTS
The sensitivity of endoscopy was 67.5%. Complete closure of the posterior glottis was observed in 62.5% men and 52% women (P = .33). Complete closure of the posterior glottis was observed in 35% nonsingers and 61% professional singers (P = .036).
CONCLUSIONS
The closure of the posterior glottis seen on videolaryngostroboscopy does not always correlate with actual closure. There seems to be no link between sex and complete closure of the glottis. However, there is strong evidence that posterior glottis closure can be influenced, to some degree, by vocal training.
LEVEL OF EVIDENCE
4 Laryngoscope, 132:124-129, 2022.
Topics: Adult; Aged; Female; Glottis; Humans; Imaging, Three-Dimensional; Laryngoscopy; Larynx; Male; Middle Aged; Phonation; Singing; Tomography, X-Ray Computed
PubMed: 34165798
DOI: 10.1002/lary.29707