Cross-linguistic study of vocal pathology: perceptual features of spasmodic dysphonia in French-speaking subjects

Clinical characterisation of Spasmodic Dysphonia of the adductor type (SD) in French speakers by Klap and colleagues (1993) appears to differ from that of SD in English. This perceptual analysis aims to describe the phonetic features of French SD. A video of 6 French speakers with SD supplied by Klap and colleagues was analysed for frequency of phonatory breaks, pitch breaks, harshness, creak, breathiness and falsetto voice, rate of production, and quantity of speech output. In contrast to English SD, the French speaking SD patients demonstrated no evidence pitch breaks, but phonatory breaks, harshness and breathiness were prominent features. This verifies the French authors’ (1993) clinical description. These findings suggest that phonetic properties of a specific language may affect the manifestation of pathology in neurogenic voice disorders

Auditory feedback control mechanisms do not contribute to cortical hyperactivity within the voice production network in adductor spasmodic dysphonia

Adductor spasmodic dysphonia (ADSD), the most common form of spasmodic dysphonia, is a debilitating voice disorder characterized by hyperactivity and muscle spasms in the vocal folds during speech. Prior neuroimaging studies have noted excessive brain activity during speech in ADSD participants compared to controls. Speech involves an auditory feedback control mechanism that generates motor commands aimed at eliminating disparities between desired and actual auditory signals. Thus, excessive neural activity in ADSD during speech may reflect, at least in part, increased engagement of the auditory feedback control mechanism as it attempts to correct vocal production errors detected through audition. To test this possibility, functional magnetic resonance imaging was used to identify differences between ADSD participants and age-matched controls in (i) brain activity when producing speech under different auditory feedback conditions, and (ii) resting state functional connectivity within the cortical network responsible for vocalization. The ADSD group had significantly higher activity than the control group during speech (compared to a silent baseline task) in three left-hemisphere cortical regions: ventral Rolandic (sensorimotor) cortex, anterior planum temporale, and posterior superior temporal gyrus/planum temporale. This was true for speech while auditory feedback was masked with noise as well as for speech with normal auditory feedback, indicating that the excess activity was not the result of auditory feedback control mechanisms attempting to correct for perceived voicing errors in ADSD. Furthermore, the ADSD group had significantly higher resting state functional connectivity between sensorimotor and auditory cortical regions within the left hemisphere as well as between the left and right hemispheres, consistent with the view that excessive motor activity frequently co-occurs with increased auditory cortical activity in individuals with ADSD.First author draf

Using Beatboxing for Creative Rehabilitation After Laryngectomy:Experiences From a Public Engagement Project

Laryngectomy is the surgical removal of the larynx (voice box), usually performed in patients with advanced stages of throat cancer. The psychosocial impact of losing the voice is significant, affecting a person’s professional and social life in a devastating way, and a proportion of this patient group subsequently must overcome depression (22–30%) and social isolation (40%). The profound changes to anatomical structures involved in voicing and articulation, as a result of surgery, radiotherapy or chemotherapy (separately or in combination with one another), introduce challenges faced in speech rehabilitation and voice production that complicate social reintegration and quality of life. After laryngectomy, breathing, voicing, articulation and tongue movement are major components in restoring communication. Regular exercise of the chest, neck and oropharyngeal muscles, in particular, is important in controlling these components and keeping the involved structures supple. It is, however, a difficult task for a speech therapist to keep the patient engaged and motivated to practice these exercises. We have adopted a multidisciplinary approach to explore the use of basic beatboxing techniques to create a wide variety of exercises that are seen as fun and interactive and that maximize the use of the structures important in alaryngeal phonation. We herein report on our empirical work in developing patients’ skills, particularly relating to voiced and unvoiced consonants to improve intelligibility. In collaboration with a professional beatboxing performer, we produced instructional online video materials to support patients working on their own and/or with support from speech therapists. Although the present paper is focused predominantly on introducing the structure of the conducted workshops, the rationale for their design and the final public engagement performance, we also include feedback from participants to commence the critical discourse about whether this type of activity could lead to systematic underlying research and robustly assessed interventions in the future. Based on this exploratory work, we conclude that the innovative approach that we employed was found to be engaging, useful, informative and motivating. We conclude by offering our views regarding the limitations of our work and the implications for future empirical research

Acoustical properties in inhaling singing : a case-study

A highly experienced versatile female professional singer displaying no apparent vocal complaint, developed inhaling singing, an innovative approach to reverse phonation. Although there are some reports in literature that describe the characteristics of ingressive phonation and sounds, to the best of our knowledge, no reports on actual inhaling singing are available in literature. This paper reports a case study on the acoustical analysis of inhaling singing, comparing this innovative technique with traditional exhaling singing. As this is rather undiscovered territory, we have decided to address several questions: is it possible to match the same pitches using inhaling singing compared to exhaling singing? Is the harmonic structure and energy distribution similar? Is it possible to maintain the same phonation duration in both techniques? Are there differences in volume and tessitura (vocal range)? This paper, reporting on the experience of one individual, demonstrates that a tessitura can be mastered in inhaling singing. Spectral analysis reveals a similar frequency distribution in both conditions. However, in inhaling singing the energy of the harmonics is significantly lower for the first 3 overtones, while the maximum phonation time is larger, than in exhaling singing. The singer reports that less effort is required for inhaling singing in the high register. As such, inhaling singing offers new possibilities for vocal performance

INVESTIGATING THE EFFICACY OF VOCAL FUNCTION EXERCISES IN IMPROVING VOCAL FUNCTION IN ADULTS IRRADIATED FOR LARYNGEAL CANCERS: A THREE PART DISSERTATION

Deterioration in voice quality following radiation therapy for the treatment of laryngeal cancers (LC) is well documented in literature. The majority of studies show that these voice problems are long term and in some cases permanent. Deterioration in voice quality, especially over a period of time could lead to significant communication difficulties in daily life or in some cases could even result in loss of profession. Despite the negative effects of radiation therapy on voice quality being well documented, few studies have focused on the efficacy of voice therapy in the irradiated LC population. The purpose of this study was to investigate the efficacy of a well researched, evidence based voice therapy approach, known as Vocal Function Exercises (VFEs) in improving vocal function in patients who have been irradiated for LCs. The present study conducted in three systematic stages with distinct and related study aims. The first involved characterizing the head and neck cancer treatment seeking population at the University of Kentucky (UK). Stage 2 involved characterizing vocal function following irradiation for LC using a multidimensional assessment approach. Stage 3 was a phase 2 clinical trial aimed at treating these deficits in vocal function identified through stage 2 using a systematic evidence based voice therapy approach, Vocal Function Exercises. For the phase 2 clinical trial, the comparison group received vocal hygiene (VH) counseling. Observations from stage 1 showed that majority of patients from the treatment seeking population at UK between a 3 year time period from 2008 to 2010 were diagnosed with laryngeal cancers and were treated with chemoradiation therapy. Stage 2 demonstrated a multidimensional deterioration in vocal function following radiation therapy for laryngeal cancers. Stage 3 demonstrated a significant improvement in vocal function across the primary outcome measure (Voice Handicap Index) as a result of VFE+VH. Improvements were also seen in select parameters across the five domains of voice assessment in the VFE group. No significant improvements were observed in the vocal hygiene group in any parameters in each domain of voice assessment. Our study demonstrated adults irradiated for laryngeal cancers demonstrated a multi-dimensional deterioration of vocal function. These changes were long term since study participants were 2- 7 years post radiation therapy. Implementation of VFE+VH demonstrated a significant improvement in voice related quality of life and select parameters across the five domains of voice assessment. The present study demonstrated promising preliminary evidence for the use of VFE+VH to improve vocal function in patients irradiated for laryngeal cancers

Vocal Registration: History, Analysis, and Modern Pedagogical Applications

A controversial aspect of vocal pedagogy is vocal registration or common divisions of the compass of the voice. A history of theories of registration, beginning in 1250, is compiled in chronological order. From this list, five contrasting theories are examined. Practical suggestions have been presented for use and application of this information, especially by the high school voice teacher

Crossing over: examining the challenges of a classically trained female performing music theater repertoire

I. Solo Recital: Friday, April 11, 2013, 7:30 p.m., Taylor Theatre. Cendrillon (Jules Massanet) Opera Role. II. Solo Recital: Saturday, February 8, 2014, 7:30 p.m., Recital Hall. "Warum betrübst du dich," "Wilst du dein Herz mir schenken" (Johann Sebastian Bach); Bachianas Brasileiras No. 5 (Hector Villa-Lobos); "Kennst du das Land" (Hugo Wolf); "Kennst du das Land" (John Duke); "Nur wer die Sehnsucht kennt" (Robert Schumann); "Net tolko tot kto znal;" (Pyotr Ilyich Tchaikovsky); "Aime-moi" (Pauline Viardot); "Vaga Luna" (Vincenzo Bellini); "Aragonese" (Gioacchino Rossini); "Befreit," "Ruhe Meine Seele," "Ständchen," "Amor" (Richard Strauss). III. Solo Recital: Thursday, March 5, 2015, 7:30pm., Recital Hall. "Youkali," "J'attends un navire," "Wie lange noch?," "Come up from the Fields, Father" (Kurt Weill); "Tom Sails Away" (Charles Ives); "Le disparu," "Bleuet," "C," "Fêtes galantes" (Francis Poulenc); Ariettes Oubliées (Claude Debussy); Cabaret Songs (Benjamin Britten); "Waldseligkeit," "Selige Nacht," "Hat dich die Liebe berührt" (Joseph Marx). IV. D.M.A. Research Project. CROSSING OVER: EXAMINING THE CHALLENGES OF A CLASSICALLY TRAINED FEMALE PERFORMING MUSIC THEATER REPERTOIRE. This document explores the pedagogy of a classically trained singer as well as that of a music theater performer exploring similarities and differences. Musical examples are referenced throughout. A discussion of style of the megamusical and the 21st century musical provides context. A final chapter on repertoire suitable for bridging the styles provides a reference for the teacher and singer

Prognostic biomarkers, treatment and follow-up of T1 glottic laryngeal cancer

Laryngeal cancer is, worldwide, the 22nd most common cancer. In Finland, those diagnosed with laryngeal cancer account annually for approximately 130 patients. The most common histological subtype is squamous cell carcinoma (SCC), covering over 95% of cases. Approximately 70% of laryngeal squamous cell carcinomas (LSCC) are glottic; the other subtypes are supraglottic and subglottic. This thesis focuses on T1 glottic LSCC, in which recurrences are rarer than at advanced stages, developing in approximately 10% of cases. The early diagnosis of recurrence is essential; delay can cause major functional deficit or mortality. Treatment of T1 glottic LSCC with transoral laser microsurgery (TLM) or radiotherapy (RT) shows a favorable outcome. This thesis study examined the treatment, follow-up, and prognosis of T1 glottic LSCC patients at five Finnish university hospitals between 2003 and 2015. The patient total was 303. The primary treatment modality (surgery vs. RT) did not show any association with improved laryngeal preservation or 5-year disease-specific survival (DSS). The majority of the 38 recurrences were detectable during a routine follow-up visit, and of those 38, 21 (55%) of the recurrences were asymptomatic, and 15 of the recurrences were detectable more than 2 years following diagnosis of the primary LSCC. Routine post-treatment follow-up of T1 glottic LSCC seems beneficial. Furthermore, to examine the prognosis of T1a glottic LSCC in a randomized study, we recruited 56 male patients with T1a glottic LSCC. Of these 56, 31 we randomized for TLM, and 25 for RT. The prognoses in both treatment groups of T1a glottic LSCC were similar. Five-year recurrence-free survival (RFS) in patients treated with TLM was 81%, DSS 97%, and overall survival (OS) 87%. In patients treated with RT, five-year RFS was 88%, DSS 100%, and OS 92%. The laryngeal preservation rate in both treatment groups (TLM 97% vs. RT 92%) were similar. Studies comparing treatment modalities and prognosis of T1a glottic LSCC have been mainly retrospective. This study showed similar results in a randomized study setting. Immunological changes in the tumor microenvironment affect enormously both tumorigenesis and tumor spread. Programmed death-ligand 1 (PD-L1) is a transmembrane protein, the overexpression of which in tumor cells can lead to T cell exhaustion and immune escape. High tumor-infiltrating lymphocyte (TIL) density is associated in many solid tumors with improved prognosis. We investigated PD-L1 expression, stromal and intratumoral TIL density, and toll-like receptors (TLRs) 4 and 5 expression in T1 glottic LSCC patients treated at five Finnish university hospitals; these totaled 174. Over half the patients had positive PD-L1 expression, yet PD-L1 showed no prognostic relevance. Low stromal TIL density was associated with local recurrence and new primary tumors of the larynx. TLR4 and TLR5 expression were not connected with survival. Matrix metalloproteinases (MMPs) are zinc-dependent endopeptidases that remodel the extracellular matrix. Tissue inhibitors of MMPs (TIMPs) can deactivate MMPs. MMPs play several roles in tumorigenesis, and MMP-8 has both tumor-promoting and tumor-suppressing effects. This study included 55 recurrent respiratory papillomatosis (RRP) patients and 59 with T1-T4 LSCC. Five of the RRP patients developed LSCC during follow-up. LSCC patients and RRP patients with malignant transformation had higher S-MMP-8 levels than did RRP patients without malignant transformation. High S-MMP-8 levels predicted malignant RRP transformation. In LSCC patients, an elevated level of S-TIMP-1 was associated with poorer RFS and OS.Kurkunpäänsyöpä on 22:ksi yleisin syöpä maailmassa ja Suomessa diagnosoidaan vuosittain noin 130 kurkunpäänsyöpää. Kurkunpäänsyövän yleisin histologinen alatyyppi on levyepiteelikarsinooma ja se todetaan yli 95 %:lla potilaista. Yli 70 % kurkunpäänsyövistä sijaitsee äänihuulissa ja loput supra- ja subglottisesti. Tämä väitöskirja keskittyy erityisesti varhaisiin T1-äänihuulisyöpiin. Vaikka tautiuusiutumat eli residiivit eivät ole yhtä yleisiä T1-äänihuulisyövissä kuin suuremissa kasvaimissa, niitä todetaan seurannassa yli 10 %:lla potilaista. Residiivin varhainen tunnistaminen on tärkeää, sillä diagnoosin viivästyminen voi aiheuttaa merkittävää toiminnallista haittaa ja lisätä kuolleisuutta. T1-äänihuulisyöpää voidaan hoitaa kirurgisesti tai sädehoidolla ja molemmilla hoitomuodoilla ennuste on erinomainen. Väitöskirjatutkimuksessa tarkasteltiin 303 T1-äänihuulisyöpä-potilaan hoitoa, seurantaa ja ennustetta viidessä suomalaisessa yliopistosairaalassa vuosina 2003-2015. Hoitomuoto (kirurgia vs. sädehoito) ei vaikuttanut kurkunpään säilymiseen tai tautikohtaiseen eloonjäämiseen viiden vuoden seurannassa. Suurin osa 38:sta residiivistä todettiin rutiinikontrollikäynnillä ja yli puolella potilaista ei ollut uusia oireita residiivin toteamishetkellä. 15 residiiviä todettiin yli 2 vuotta primäärikasvaimen diagnosoi-misen jälkeen. Tulosten perusteella T1-äänihuulisyövän rutiiniseuranta vaikuttaa hyödylliseltä. T1a-äänihuulisyövän ennustetta selvitettiin myös satunnaistetussa tutkimusasetelmassa. Tutkimukseen otettiin mukaan 56 miespotilasta, joilla oli diagnosoitu T1a-äänihuulisyöpä. 31 potilasta satunnaistettiin kirurgisesti hoidettavien ja 25 sädehoidettavien ryhmään. Ennuste oli samanlainen molemmissa hoitoryhmissä. Kirurgisesti hoidetuilla potilailla viiden vuoden uusiutumisvapaa eloonjääminen oli 81 %, tautikohtainen eloonjääminen 97 % ja kokonaiseloonjääminen 87 %. Vastaavat tulokset sädehoidetuilla potilailla olivat 88 %, 100 % ja 92 %. Hoitoryhmien välillä ei ollut eroa kurkunpään säilymisessä (kirurgia 97 % vs. sädehoito 92 %). Aiemmin T1a-äänihuulisyövän hoitoa ja ennustetta on selvitetty pääasiassa retrospektiivisissä tutkimuksissa. Tämä tutkimus osoitti, että tulokset ovat vastaavat myös satunnaistetussa tutkimusasetelmassa. Syövän mikroympäristössä immuunipuolustusjärjestelmän muutokset vaikuttavat syövän kehittymiseen ja leviämiseen. PD-L1 on solukalvon proteiini, jonka yli-ilmentyminen syöpäsolussa voi johtaa T-solujen uupumiseen. Kasvaimeen tunkeutuvien lymfosyyttien eli TIL-solujen korkea määrä on yhdistetty parempaan ennusteeseen useissa eri syövissä. Tutkimuksessa selvitimme PD-L1:n, TIL-solujen ja tollin kaltaisten reseptoreiden (TLR) 4 ja 5 esiintymistä 174:llä T1-äänihuulisyöpäpotilaalla, jotka oli hoidettu viidessä suomalaisessa yliopistosairaalassa. Yli puolella potilaista kasvainkudoksen PD-L1 oli positiivinen, mutta PD-L1:llä ei ollut vaikutusta taudin ennusteeseen. Matala stromaalinen TIL-solujen määrä oli yhteydessä paikallisiin residiiveihin ja kurkunpään uusiin primäärikasvaimiin. TLR4:n ja TLR5:n esiintymisellä ei todettu olevan yhteyttä ennusteeseen. Matriksin metalloproteinaasit (MMP) ovat sinkkiriippuvaisia endopeptidaaseja, jotka hajottavat soluväliainetta. MMP:n estäjät (TIMP) voivat vähentää MMP:n aktiivisuutta. MMP:t osallistuvat monella tavalla syövän kehittymiseen ja MMP-8:lla on sekä syövän kehittymistä edistäviä että estäviä vaikutuksia. Tutkimukseen otettiin mukaan 55 toistuvaa kurkunpään papillomatoosia (RRP) sairastavaa potilasta ja 59 T1-T4-kurkunpäänsyöpäpotilasta. Viidelle RRP-potilaalle kehittyi kurkunpäänsyöpä seurannan aikana. Kurkuunpäänsyöpäpotilailla ja RRP-potilailla, joille kehittyi kurkunpäänsyöpä, todettiin korkeampi S-MMP-8-pitoisuus verrattuna RRP-potilaisiin, joille ei kehittynyt kurkunpäänsyöpää. Korkea S-MMP-8-pitoisuus ennusti myös RRP:n malignisoitumista. Lisäksi korkea S-TIMP-1-pitoisuus oli yhteydessä kurkunpäänsyöpäpotilaiden alentuneeseen uusiutumisvapaaseen eloonjäämiseen ja kokonaiseloonjäämiseen

The Utilization of Perceptual Motor-Learning Principles for the Acquisition of Head Voice in the Post-Adolescent Bass Voice

Over the last two centuries, knowledge of the voice has grown exponentially due to advances in science, technology, and medicine. One no longer needs to guess regarding certain functions of the instrument through pure empiricism, but rather, principles or ideas can be brought to the laboratory and tested through simulation and studies. In the last few decades, scientists and pedagogues have realized that registration is not solely the result of laryngeal musculature, but also has implications in the acoustic environment of the vocal tract. This discovery has completely changed the way a teacher may look at training a voice, or fixing vocal issues. One avenue of voice training and science that has not received the same level of interest is the process in which we learn to sing. Significant strides have been made recently in the science of perceptual motor learning and is utilized to great effect in the field of Speech and Language Pathology. Given that the musical use of the voice is a highly complex motor skill, it is easy to appreciate the possible implications of borrowing theories and principles from motor learning science in order to better train singers. This study offers a discussion regarding commonly used terms in male registration, as well as a brief look at the history of male high voice singing. In addition, it explores certain principles of motor learning and subsequently how they can be employed to train the upper range of the low male voice. Detailed examples of exercises are provided, as well as short repertoire extracts for context