Kazuistika se věnuje pacientce s parézou levé hlasivky. K tomuto stavu došlo po operaci adenomu příštítného tělíska. Případová studie se zaměřuje na popis průběhu hlasové reedukace a míru jejího efektu na kvalitu pacientčina hlasu. Paréza hlasivky je nejčastěji způsobená obrnou zvratného nervu (nervus laryngeus recurrens) v důsledku operace v jeho blízkém okolí (Dršata, 2010). Ztráta hybnosti hlasivky s sebou přináší řadu obtíží manifestujících se v oblasti dechu a kvality hlasu. Pacienta omezuje v jeho osobním, ale často i v pracovním životě. Pro efekt hlasové reedukace je nezbytné její včasné zahájení.
The case report is about a patient with left vocal cord palsy. This condition occurred after parathyroid adenoma surgery. The case study focuses on the description of the course of vocal re-education and the extent of its effect on the quality of the patient's voice.
Voice registers are assumed to be related to different laryngeal adjustments, but objective evidence has been insufficient. While chest register is usually associated with the lower pitch range, and head register with the higher pitch range, here we investigated a professional singer who claimed an ability to produce both these registers at every pitch, throughout her entire singing range. The singer performed separated phonations alternating between the two registers (further called chest-like and head-like) at all pitches from C3 (131 Hz) to C6 (1047 Hz). We monitored the vocal fold vibrations using high-speed video endoscopy and electroglottography. The microphone sound was recorded and used for blind listening tests performed by the three authors (insiders) and by six "naive" participants (outsiders). The outsiders correctly identified the registers in 64% of the cases, and the insiders in 89% of the cases. Objective analysis revealed larger closed quotient and vertical phase differences for the chest-like register within the lower range below G4 (<392 Hz), and also a larger closed quotient at the membranous glottis within the higher range above Bb4 (>466 Hz), but not between Ab4-A4 (415-440 Hz). The normalized amplitude quotient was consistently lower in the chest-like register throughout the entire range. The results indicate that that the singer employed subtle laryngeal control mechanisms for the chest-like and head-like phonations on top of the traditionally recognized low-pitched chest and high-pitched head register phenomena. Across all pitches, the chest-like register was produced with more rapid glottal closure that was usually, but not necessarily, accompanied also by stronger adduction of membranous glottis. These register changes were not always easily perceivable by listeners, however.
- MeSH
- akustika * MeSH
- audiovizuální záznam MeSH
- biomechanika MeSH
- dospělí MeSH
- elektrodiagnostika MeSH
- fonace * MeSH
- hlasové řasy fyziologie MeSH
- kvalita hlasu * MeSH
- laryngoskopie MeSH
- larynx fyziologie MeSH
- lidé MeSH
- vibrace MeSH
- zpívání * MeSH
- zvuková spektrografie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
INTRODUCTION: Vibratory positive expiratory pressure (PEP) devices are now commonly used as a resource for voice therapy. PEP devices promote improved vocal economy with the added benefit of producing a massage effect in the vocal tract. Although the benefits of PEP devices for voice have already been demonstrated, their impact on the vocal source is still not very clear. This study assesses the impact of phonation into the Acapella Choice (a type of PEP device) on the voice. METHODS: Three normophonic subjects underwent high-speed videoendoscopy assessment while pressure, flow and electroglottographic data was collected. RESULTS: Phonation into the Acapella device produces large changes in the pressure and flow profiles consequently affecting the voice source. In specific, when intraoral pressure increases as a consequence of the downward movement of the rocker arm in the Acapella device (reduction of the airflow outlet), phonation is hindered, demonstrated by the lower amplitude of vibration of the vocal folds and weaker modulation of the pressure and flow values by the glottal cycle. When the rocker arm in the Acapella device opens (increasing the airflow outlet), the opposite trend is observed where vocal fold vibration is aided and the modulation of pressure and flow by the vocal cycle increases. Based on the pressure and flow signals, we can assume that the impedance of the vocal tract alternates between two dominant regimes: increased inertive reactance (aided vibration) and increased resistance (hindered vibration). CONCLUSIONS: PEP devices, such as the Acapella device, are efficient in modulating the pressure and flow profiles in the vocal tract leading to the alternation of glottal vibration from aided to hindered. These changes in the glottal vibration can be considered an additional consequence of the massage effect caused by the Acapella device.
- MeSH
- audiovizuální záznam * MeSH
- biomechanika MeSH
- časové faktory MeSH
- design vybavení * MeSH
- dospělí MeSH
- elektrodiagnostika přístrojové vybavení MeSH
- fonace * MeSH
- glottis * fyziologie MeSH
- hlasové řasy fyziologie MeSH
- hlasový trénink * MeSH
- kvalita hlasu * MeSH
- laryngoskopie přístrojové vybavení MeSH
- lidé MeSH
- tlak * MeSH
- ventilace umělá s výdechovým přetlakem přístrojové vybavení MeSH
- vibrace * MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
INTRODUCTION: To update the European guidelines for the assessment of voice quality (VQ) in clinical practice. METHODS: Nineteen laryngologists-phoniatricians of the European Laryngological Society (ELS) and the Union of the European Phoniatricians (UEP) participated to a modified Delphi process to propose statements about subjective and objective VQ assessments. Two anonymized voting rounds determined a consensus statement to be acceptable when 80% of experts agreed with a rating of at least 3/4. The statements with ≥ 3/4 score by 60-80% of experts were improved and resubmitted to voting until they were validated or rejected. RESULTS: Of the 90 initial statements, 51 were validated after two voting rounds. A multidimensional set of minimal VQ evaluations was proposed and included: baseline VQ anamnesis (e.g., allergy, medical and surgical history, medication, addiction, singing practice, job, and posture), videolaryngostroboscopy (mucosal wave symmetry, amplitude, morphology, and movements), patient-reported VQ assessment (30- or 10-voice handicap index), perception (Grade, Roughness, Breathiness, Asthenia, and Strain), aerodynamics (maximum phonation time), acoustics (Mean F0, Jitter, Shimmer, and noise-to-harmonic ratio), and clinical instruments associated with voice comorbidities (reflux symptom score, reflux sign assessment, eating-assessment tool-10, and dysphagia handicap index). For perception, aerodynamics and acoustics, experts provided guidelines for the methods of measurement. Some additional VQ evaluations are proposed for voice professionals or patients with some laryngeal diseases. CONCLUSION: The ELS-UEP consensus for VQ assessment provides clinical statements for the baseline and pre- to post-treatment evaluations of VQ and to improve collaborative research by adopting common and validated VQ evaluation approach.
- MeSH
- hlas * MeSH
- kvalita hlasu MeSH
- lidé MeSH
- nemoci laryngu * MeSH
- otorinolaryngologie * MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- MeSH
- čich fyziologie MeSH
- dýchání MeSH
- estetika MeSH
- kvalita hlasu fyziologie MeSH
- lidé MeSH
- nos fyziologie imunologie MeSH
- nosní dutina * fyziologie imunologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
In this study we propose a new tool for the perceptual assessment of voice quality. For its design, we have adapted the Simplified Vocal Profile Analysis so that the new tool features two main characteristics: (1) the ordinal scalar degrees of the original protocol are turned into a visual analog scale; and (2) the original paper-based version of the protocol is now a computer-based implementation. In order to assess the reliability of the new tool, five phoneticians listened to 12 different speakers and evaluated their voice quality using the proposed tool. Inter-rater agreement was then calculated using the Intraclass Correlation Coefficient. The results show that high agreement was reached for most of the perceptual settings of the protocol. Yet more investigations seem necessary into the continuous nature of the perceptual dimensions making up the voice quality of a speaker. As a preliminary approach to the graphical possibilities that the visual analog scale offers to the Simplified Vocal Profile Analysis, we explore the usefulness of multiple dot plots and propose an adaptation of the Bland-Altman plot to be used in pairwise comparisons. In this study, these visualization techniques are tested on two pairs of identical twins.
- MeSH
- kvalita hlasu * MeSH
- lidé MeSH
- měření tvorby řeči MeSH
- počítače * MeSH
- reprodukovatelnost výsledků MeSH
- vizuální analogová stupnice MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
Classical singers use nasal consonants as "resonance exercises," and experimental results have shown that singers may use some velopharyngeal opening (VPO), most often in [a:] and more seldom in [i:] or [u:]. In particular, male singers have been found to increase VPO as pitch rises toward register change frequencies (passaggi). Laryngoscopic findings have shown that some VPO stabilizes vocal fold vibration; the effect is related to positive reactance. This study investigates the effects of VPO on vocal tract (VT) reactance over the range of fundamental frequencies (f0) used in singing using a computerized tomography-based finite element model of the VT and nose of a female. According to the results, by raising the lowest VT resonances, the VPO increased the VT reactance in the frequency ranges 207-359 Hz for [i:], 265-411 Hz for [u:], and 500-611 Hz for [a:], depending on the VPO size (full or half VPO). These frequency ranges are close to the first and second passaggio of a female singer. The change may have an especially practical stabilizing effect for [a:], which is otherwise characterized by very large changes in VT reactance and negative reactance at the second passaggio.
The present study compares the voice quality of female and male speech in two languages: Czech, a Slavic language, and Danish, a Germanic language. For both languages, the results based on a total of 120 vocally healthy speakers are in line with the claim that females are universally breathier than males. This was supported by the Cepstral Peak Prominence (CPP) and H1*-H2* measures, which are generally known as the most robust correlates of breathiness, and also by the H1*-A3* measure. However, the sex distinction was unsupported or even contradictory when using some other measures suggested to reflect breathiness, which provides an incentive to insist on employing a number of acoustic measures in future voice research. The perceptual component of the study nevertheless suggests that these contradictory findings are due to differences in perceived roughness rather than breathiness, and that CPP and H1*-H2* do reflect breathiness differences, and CPP in particular. We therefore conclude that it is indeed the case that female speakers are breathier than male speakers. Finally, in terms of the two robust measures (CPP and H1*-H2*), no language-specific differences in the magnitude of the effect of sex on breathiness were found.
- MeSH
- akustika řeči * MeSH
- jazyk (prostředek komunikace) * MeSH
- kvalita hlasu MeSH
- lidé MeSH
- měření tvorby řeči MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika MeSH
- Dánsko MeSH
BACKGROUND: The clinical application of voice technology provides novel opportunities in the field of telehealth. However, patients' readiness for this solution has not been investigated among patients with cardiovascular diseases (CVD). OBJECTIVE: This paper aims to evaluate patients' anticipated experiences regarding telemedicine, including voice conversational agents combined with provider-driven support delivered by phone. METHODS: A cross-sectional study enrolled patients with chronic CVD who were surveyed using a validated investigator-designed questionnaire combining 19 questions (eg, demographic data, medical history, preferences for using telehealth services). Prior to the survey, respondents were educated on the telemedicine services presented in the questionnaire while being assisted by a medical doctor. Responses were then collected and analyzed, and multivariate logistic regression was used to identify predictors of willingness to use voice technology. RESULTS: In total, 249 patients (mean age 65.3, SD 13.8 years; 158 [63.5%] men) completed the questionnaire, which showed good repeatability in the validation procedure. Of the 249 total participants, 209 (83.9%) reported high readiness to receive services allowing for remote contact with a cardiologist (176/249, 70.7%) and telemonitoring of vital signs (168/249, 67.5%). The voice conversational agents combined with provider-driven support delivered by phone were shown to be highly anticipated by patients with CVD. The readiness to use telehealth was statistically higher in people with previous difficulties accessing health care (OR 2.920, 95% CI 1.377-6.192) and was most frequent in city residents and individuals reporting a higher education level. The age and sex of the respondents did not impact the intention to use voice technology (P=.20 and P=.50, respectively). CONCLUSIONS: Patients with cardiovascular diseases, including both younger and older individuals, declared high readiness for voice technology.
- MeSH
- kardiovaskulární nemoci terapie MeSH
- kvalita hlasu fyziologie MeSH
- lidé MeSH
- průřezové studie MeSH
- průzkumy a dotazníky MeSH
- senioři MeSH
- technologie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
