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Acta Neurochirurgica Jun 2024Velopharyngeal insufficiency (VPI) is a known complication of transoral surgery, with a reported incidence of 8.1%. The main factor related to VPI is the split of the...
BACKGROUND
Velopharyngeal insufficiency (VPI) is a known complication of transoral surgery, with a reported incidence of 8.1%. The main factor related to VPI is the split of the soft palate. However, dead space resulting from transoral decompression may play a pivotal role in the pathogenesis of the dysfunction. In our experience, functionally significant dead space is almost constantly present after transoral decompression. This is probably due to malformation in children and postoperative scarring, thus configuring a nosological entity that we could define as "syndrome of the nasopharyngeal dead space." Palatal prosthesis and pharyngoplasty have been proposed, though these surgical procedures are technically tricky and with possible complications, such as OSA symptoms, snoring, and nasopharyngeal stenosis.
METHODS
We proposed an effortless and minimally invasive procedure to treat this condition based on lipofilling the nasopharynx posterior wall endoscopically. To test the procedure's functional result, the submucosa of the nasopharynx posterior wall was initially filled with resorbable material, namely fibrin glue and autologous blood. The result was optimal but regressed after one month. Then, we repeated the procedure by lipofilling with autologous abdominal fat, resulting in a more stable anatomical and functional outcome at six months follow-up.
RESULTS
The patient had a prompt significant improvement of his complaints (rhinolalia and oronasal regurgitation) and a correct projection of the nasopharynx posterior wall, with correct closure during phonation and absence of oronasal reflux.
CONCLUSIONS
The "syndrome of the nasopharyngeal dead space" should be correctly identified after transoral surgery. It can be effectively treated with lipofilling of the posterior nasopharyngeal wall, a simple and minimally invasive procedure.
Topics: Humans; Male; Adipose Tissue; Endoscopy; Nasopharynx; Palate, Soft; Postoperative Complications; Treatment Outcome; Velopharyngeal Insufficiency; Child
PubMed: 38880842
DOI: 10.1007/s00701-024-06160-5 -
Journal of Speech, Language, and... Jun 2024This systematic review aimed to evaluate the effects of singing as an intervention for aging voice.
PURPOSE
This systematic review aimed to evaluate the effects of singing as an intervention for aging voice.
METHOD
Quantitative studies of interventions for older adults with any medical condition that involves singing as training were reviewed, measured by respiration, phonation, and posture, which are the physical functions related to the aging voice. English and Chinese studies published until April 2024 were searched using 31 electronic databases, and seven studies were included. The included articles were assessed according to the Grading of Recommendations, Assessment, Development, and Evaluations rubric.
RESULTS
Seven studies were included. These studies reported outcome measures that were related to respiratory functions only. For the intervention effect, statistically significant improvements were observed in five of the included studies, among which three studies had large effect sizes. The overall level of evidence of the included studies was not high, with three studies having moderate levels and the rest having lower levels. The intervention activities included trainings other than singing. These non-singing training items may have caused co-intervention bias in the study results.
CONCLUSIONS
This systematic review suggests that singing as an intervention for older adults with respiratory and cognitive problems could improve respiration and respiratory-phonatory control. However, none of the included studies covers the other two of the physical functions related to aging voice (phonatory and postural functions). The overall level of evidence of the included studies was not high either. There is a need for more research evidence in singing-based intervention specifically for patient with aging voice.
PubMed: 38875480
DOI: 10.1044/2024_JSLHR-23-00641 -
Proceedings of Meetings on Acoustics.... Dec 2023The vocal folds experience repeated collision during phonation. The resulting contact pressure is often considered to play an important role in vocal fold injury, and...
The vocal folds experience repeated collision during phonation. The resulting contact pressure is often considered to play an important role in vocal fold injury, and has been the focus of many experimental studies. In this study, vocal fold contact pattern and contact pressure during phonation were numerically investigated. The results show that vocal fold contact in general occurs within a horizontal strip on the medial surface, first appearing at the inferior medial surface and propagating upward. Because of the localized and travelling nature of vocal fold contact, sensors of a finite size may significantly underestimate the peak vocal fold contact pressure, particularly for vocal folds of low transverse stiffness. This underestimation also makes it difficult to identify the contact pressure peak in the intraglottal pressure waveform. These results showed that the vocal fold contact pressure reported in previous experimental studies may have significantly underestimated the actual values. It is recommended that contact pressure sensors with a diameter no greater than 0.4 mm are used in future experiments to ensure adequate accuracy in measuring the peak vocal fold contact pressure during phonation.
PubMed: 38872712
DOI: 10.1121/2.0001894 -
Cureus Jun 2024A patient with multiple comorbidities and an eight-year history of tracheostomy was being treated for tracheitis. At this point, she became incapable of using regular...
A patient with multiple comorbidities and an eight-year history of tracheostomy was being treated for tracheitis. At this point, she became incapable of using regular speaking valves, and multiple attempts to reintroduce the speaking valve failed. A Ferrer adjustable speaking valve (FASV) was designed with gradations of outflow closure, allowing air to go through the vocal cords for phonation. The FASV was offered to her through the compassionate use program at the FDA. At 20% initial closure, the patient was able to tolerate the valve and was advanced to 50% closure, at which point she could phonate partially. The use of the valve was terminated at the time of her transfer, 23 days after the initiation of use. This suggests the safety and possible efficacy of using an adjustable speaking valve earlier than regular valves, allowing patients to communicate earlier and further exercise their diaphragms.
PubMed: 38868548
DOI: 10.7759/cureus.62081 -
NPJ Parkinson's Disease Jun 2024Approximately 90% of Parkinson's patients (PD) suffer from dysarthria. However, there is currently a lack of research on acoustic measurements and speech impairment... (Review)
Review
Approximately 90% of Parkinson's patients (PD) suffer from dysarthria. However, there is currently a lack of research on acoustic measurements and speech impairment patterns among Mandarin-speaking individuals with PD. This study aims to assess the diagnosis and disease monitoring possibility in Mandarin-speaking PD patients through the recommended speech paradigm for non-tonal languages, and to explore the anatomical and functional substrates. We examined total of 160 native Mandarin-speaking Chinese participants consisting of 80 PD patients, 40 healthy controls (HC), and 40 MRI controls. We screened the optimal acoustic metric combination for PD diagnosis. Finally, we used the objective metrics to predict the patient's motor status using the Naïve Bayes model and analyzed the correlations between cortical thickness, subcortical volumes, functional connectivity, and network properties. Comprehensive acoustic screening based on prosodic, articulation, and phonation abnormalities allows differentiation between HC and PD with an area under the curve of 0.931. Patients with slowed reading exhibited atrophy of the fusiform gyrus (FDR p = 0.010, R = 0.391), reduced functional connectivity between the fusiform gyrus and motor cortex, and increased nodal local efficiency (NLE) and nodal efficiency (NE) in bilateral pallidum. Patients with prolonged pauses demonstrated atrophy in the left hippocampus, along with decreased NLE and NE. The acoustic assessment in Mandarin proves effective in diagnosis and disease monitoring for Mandarin-speaking PD patients, generalizing standardized acoustic guidelines beyond non-tonal languages. The speech impairment in Mandarin-speaking PD patients not only involves motor aspects of speech but also encompasses the cognitive processes underlying language generation.
PubMed: 38866758
DOI: 10.1038/s41531-024-00720-3 -
Journal of Speech, Language, and... Jun 2024Although different factors and voice measures have been associated with phonotraumatic vocal hyperfunction (PVH), it is unclear what percentage of individuals with PVH...
PURPOSE
Although different factors and voice measures have been associated with phonotraumatic vocal hyperfunction (PVH), it is unclear what percentage of individuals with PVH exhibit such differences during their daily lives. This study used a machine learning approach to quantify the consistency with which PVH manifests according to ambulatory voice measures. Analyses included acoustic parameters of phonation as well as temporal aspects of phonation and rest, with the goal of determining optimally consistent signatures of PVH.
METHOD
Ambulatory neck-surface acceleration signals were recorded over 1 week from 116 female participants diagnosed with PVH and age-, sex-, and occupation-matched vocally healthy controls. The consistency of the manifestation of PVH was defined as the percentage of participants in each group that exhibited an atypical signature based on a target voice measure. Evaluation of each machine learning model used nested 10-fold cross-validation to improve the generalizability of findings. In Experiment 1, we trained separate logistic regression models based on the distributional characteristics of 14 voice measures and durations of voicing and resting segments. In Experiments 2 and 3, features of voicing and resting duration augmented the existing distributional characteristics to examine whether more consistent signatures would result.
RESULTS
Experiment 1 showed that the difference in the magnitude of the first two harmonics (H1-H2) exhibited the most consistent signature (69.4% of participants with PVH and 20.4% of controls had an atypical H1-H2 signature), followed by spectral tilt over eight harmonics (73.6% participants with PVH and 32.1% of controls had an atypical spectral tilt signature) and estimated sound pressure level (SPL; 66.9% participants with PVH and 27.6% of controls had an atypical SPL signature). Additionally, 77.6% of participants with PVH had atypical resting duration, with 68.9% exhibiting atypical voicing duration. Experiments 2 and 3 showed that augmenting the best-performing voice measures with univariate features of voicing or resting durations yielded only incremental improvement in the classifier's performance.
CONCLUSIONS
Females with PVH were more likely to use more abrupt vocal fold closure (lower H1-H2), phonate louder (higher SPL), and take shorter vocal rests. They were also less likely to use higher fundamental frequency during their daily activities. The difference in the voicing duration signature between participants with PVH and controls had a large effect size, providing strong empirical evidence regarding the role of voice use in the development of PVH.
PubMed: 38861454
DOI: 10.1044/2024_JSLHR-23-00515 -
The Pan African Medical Journal 2024Guillain-Barré syndrome/Miller-Fisher syndrome (GBS/MFS) overlap syndrome is an extremely rare variant of Guillain-Barré syndrome (GBS) in which Miller-Fisher syndrome...
Guillain-Barré syndrome/Miller-Fisher syndrome (GBS/MFS) overlap syndrome is an extremely rare variant of Guillain-Barré syndrome (GBS) in which Miller-Fisher syndrome (MFS) coexists with other characteristics of GBS, such as limb weakness, paresthesia, and facial paralysis. We report the clinical case of a 12-year-old patient, with no pathological history, who acutely presents with ophthalmoplegia, areflexia, facial diplegia, and swallowing and phonation disorders, followed by progressive, descending, and symmetrical paresis affecting first the upper limbs and then the lower limbs. An albuminocytological dissociation was found in the cerebrospinal fluid study. Magnetic resonance imaging of the spinal cord showed enhancement and thickening of the cauda equina roots. The patient was treated with immunoglobulins with a favorable clinical outcome.
Topics: Humans; Miller Fisher Syndrome; Guillain-Barre Syndrome; Child; Magnetic Resonance Imaging; Male; Immunoglobulins; Treatment Outcome
PubMed: 38854867
DOI: 10.11604/pamj.2024.47.127.42985 -
Scientific Reports Jun 2024Voice production of humans and most mammals is governed by the MyoElastic-AeroDynamic (MEAD) principle, where an air stream is modulated by self-sustained vocal fold...
Voice production of humans and most mammals is governed by the MyoElastic-AeroDynamic (MEAD) principle, where an air stream is modulated by self-sustained vocal fold oscillation to generate audible air pressure fluctuations. An alternative mechanism is found in ultrasonic vocalizations of rodents, which are established by an aeroacoustic (AA) phenomenon without vibration of laryngeal tissue. Previously, some authors argued that high-pitched human vocalization is also produced by the AA principle. Here, we investigate the so-called "whistle register" voice production in nine professional female operatic sopranos singing a scale from C6 (≈ 1047 Hz) to G6 (≈ 1568 Hz). Super-high-speed videolaryngoscopy revealed vocal fold collision in all participants, with closed quotients from 30 to 73%. Computational modeling showed that the biomechanical requirements to produce such high-pitched voice would be an increased contraction of the cricothyroid muscle, vocal fold strain of about 50%, and high subglottal pressure. Our data suggest that high-pitched operatic soprano singing uses the MEAD mechanism. Consequently, the commonly used term "whistle register" does not reflect the physical principle of a whistle with regard to voice generation in high pitched classical singing.
Topics: Humans; Female; Singing; Biomechanical Phenomena; Vocal Cords; Adult; Sound; Voice; Phonation
PubMed: 38849382
DOI: 10.1038/s41598-024-62598-8 -
JASA Express Letters Jun 2024The automatic classification of phonation types in singing voice is essential for tasks such as identification of singing style. In this study, it is proposed to use...
The automatic classification of phonation types in singing voice is essential for tasks such as identification of singing style. In this study, it is proposed to use wavelet scattering network (WSN)-based features for classification of phonation types in singing voice. WSN, which has a close similarity with auditory physiological models, generates acoustic features that greatly characterize the information related to pitch, formants, and timbre. Hence, the WSN-based features can effectively capture the discriminative information across phonation types in singing voice. The experimental results show that the proposed WSN-based features improved phonation classification accuracy by at least 9% compared to state-of-the-art features.
PubMed: 38847582
DOI: 10.1121/10.0026241 -
Nature Communications Jun 2024Humans produce two forms of cognitively complex vocalizations: speech and song. It is debated whether these differ based primarily on culturally specific, learned...
Humans produce two forms of cognitively complex vocalizations: speech and song. It is debated whether these differ based primarily on culturally specific, learned features, or if acoustical features can reliably distinguish them. We study the spectro-temporal modulation patterns of vocalizations produced by 369 people living in 21 urban, rural, and small-scale societies across six continents. Specific ranges of spectral and temporal modulations, overlapping within categories and across societies, significantly differentiate speech from song. Machine-learning classification shows that this effect is cross-culturally robust, vocalizations being reliably classified solely from their spectro-temporal features across all 21 societies. Listeners unfamiliar with the cultures classify these vocalizations using similar spectro-temporal cues as the machine learning algorithm. Finally, spectro-temporal features are better able to discriminate song from speech than a broad range of other acoustical variables, suggesting that spectro-temporal modulation-a key feature of auditory neuronal tuning-accounts for a fundamental difference between these categories.
Topics: Humans; Speech; Male; Female; Machine Learning; Adult; Acoustics; Cross-Cultural Comparison; Auditory Perception; Sound Spectrography; Singing; Music; Middle Aged; Young Adult
PubMed: 38844457
DOI: 10.1038/s41467-024-49040-3