Optimization and automation of relative fundamental frequency for objective assessment of vocal hyperfunction

The project objective is to improve clinical assessment and diagnosis of the voice disorder, vocal hyperfunction (VH). VH is a condition characterized by excessive laryngeal and paralaryngeal tension, and is assumed to be the underlying cause of the majority of voice disorders. Current clinical assessment of VH is subjective and demonstrates poor inter-rater reliability. Recent work indicates that a new acoustic measure, relative fundamental frequency (RFF) is sensitive to the maladaptive functional behaviors associated with VH and can potentially be used to objectively characterize VH. Here, we explored and enhanced the potential for RFF as a measure of VH in three ways. First, the current protocol for RFF estimation was optimized to simplify the recording procedure and reduce estimation time. Second, RFF was compared with the current state-of-the-art measures of VH – listener perception of vocal effort and the aerodynamic ratio of sound pressure level to subglottal pressure level. Third, an automated algorithm that utilized the optimized recording protocol was developed and validated against manual estimation methods and listener perception. This work enables large-scale studies on RFF to determine the specific physiological elements that contribute to the measure’s ability to capture VH and may potentially provide a non-invasive and readily implemented solution for this long-standing clinical issue

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

Models and Analysis of Vocal Emissions for Biomedical Applications

The Models and Analysis of Vocal Emissions with Biomedical Applications (MAVEBA) workshop came into being in 1999 from the particularly felt need of sharing know-how, objectives and results between areas that until then seemed quite distinct such as bioengineering, medicine and singing. MAVEBA deals with all aspects concerning the study of the human voice with applications ranging from the neonate to the adult and elderly. Over the years the initial issues have grown and spread also in other aspects of research such as occupational voice disorders, neurology, rehabilitation, image and video analysis. MAVEBA takes place every two years always in Firenze, Italy

Models and Analysis of Vocal Emissions for Biomedical Applications

The MAVEBA Workshop proceedings, held on a biannual basis, collect the scientific papers presented both as oral and poster contributions, during the conference. The main subjects are: development of theoretical and mechanical models as an aid to the study of main phonatory dysfunctions, as well as the biomedical engineering methods for the analysis of voice signals and images, as a support to clinical diagnosis and classification of vocal pathologies

Exploiting Nonlinear Recurrence and Fractal Scaling Properties for Voice Disorder Detection

Background: Voice disorders affect patients profoundly, and acoustic tools can potentially measure voice function objectively. Disordered sustained vowels exhibit wide-ranging phenomena, from nearly periodic to highly complex, aperiodic vibrations, and increased "breathiness". Modelling and surrogate data studies have shown significant nonlinear and non-Gaussian random properties in these sounds. Nonetheless, existing tools are limited to analysing voices displaying near periodicity, and do not account for this inherent biophysical nonlinearity and non-Gaussian randomness, often using linear signal processing methods insensitive to these properties. They do not directly measure the two main biophysical symptoms of disorder: complex nonlinear aperiodicity, and turbulent, aeroacoustic, non-Gaussian randomness. Often these tools cannot be applied to more severe disordered voices, limiting their clinical usefulness.

Methods: This paper introduces two new tools to speech analysis: recurrence and fractal scaling, which overcome the range limitations of existing tools by addressing directly these two symptoms of disorder, together reproducing a "hoarseness" diagram. A simple bootstrapped classifier then uses these two features to distinguish normal from disordered voices.

Results: On a large database of subjects with a wide variety of voice disorders, these new techniques can distinguish normal from disordered cases, using quadratic discriminant analysis, to overall correct classification performance of 91.8% plus or minus 2.0%. The true positive classification performance is 95.4% plus or minus 3.2%, and the true negative performance is 91.5% plus or minus 2.3% (95% confidence). This is shown to outperform all combinations of the most popular classical tools.

Conclusions: Given the very large number of arbitrary parameters and computational complexity of existing techniques, these new techniques are far simpler and yet achieve clinically useful classification performance using only a basic classification technique. They do so by exploiting the inherent nonlinearity and turbulent randomness in disordered voice signals. They are widely applicable to the whole range of disordered voice phenomena by design. These new measures could therefore be used for a variety of practical clinical purposes.
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Models and Analysis of Vocal Emissions for Biomedical Applications

The MAVEBA Workshop proceedings, held on a biannual basis, collect the scientific papers presented both as oral and poster contributions, during the conference. The main subjects are: development of theoretical and mechanical models as an aid to the study of main phonatory dysfunctions, as well as the biomedical engineering methods for the analysis of voice signals and images, as a support to clinical diagnosis and classification of vocal pathologies

Aerodynamic and Acoustic Features of Vocal Effort

Many voice disorders are associated with an effortful voice; however, there have been very few studies that have examined the physiological changes that contribute to this sense of effort. Determining the factors that contribute to change in vocal effort may help clinicians to effectively target these variables when working with people with voice disorders so that voice improvement is accompanied by decreased vocal effort after treatment. Prior research has shown that alterations in aerodynamic and acoustic variables are often associated with voice disorders involving increased muscular effort, and change in these variables is correlated with abnormal voice qualities. The current study focused on three main questions: 1) When producing speech with increased or decreased vocal effort as compared to comfortable vocal effort, how do healthy adults alter their phonatory physiology? 2) What are the acoustic manifestations of these changes in phonatory function that occur with high vocal effort? 3) Which aerodynamic or acoustic variables are the primary factors that are associated with an increase in vocal effort? The participants included 18 healthy men and women with normal voice and normal hearing, ranging in age from 18 to 26. After training, participants produced repeated syllable combinations at various levels of vocal effort (comfortable, maximal, and minimal). Aerodynamic and acoustic recordings were then analyzed. Three of the four aerodynamic measures in this study showed significant differences between the three vocal effort conditions, and reflected change in airflow, pressure, and rate of airflow change during voice production. Both acoustic measures, which related to the relative degree of harmonic energy in the speech signal also showed significant differences between the three vocal effort conditions

Respiratory Muscle Strength Training to Improve Vocal Function of Patients with Presbyphonia

Background: Presbyphonia is an age-related voice disorder characterized by vocal fold atrophy, and its effects on voice are potentially compounded by declines in respiratory function. We assessed: 1) the relationships between respiratory and voice function; 2) the effect of adding respiratory exercises to voice therapy; and 3) the impact of baseline respiratory function on the response to therapy in patients with presbyphonia. Methods: Twenty-one participants underwent respiratory and voice assessments, from which relationships were drawn. Ten of these participants were blocked-randomized to receive either voice exercises only, or voice exercises combined with inspiratory muscle strength training or expiratory muscle strength training, for a duration of four weeks. Results: FVC, FEV1, and MEP had an impact on phonation physiology through their effect on aerodynamic resistance and vocal fold pliability. Percent predicted values of FVC and FEV1 were strong predictors of perceived voice handicap. IMST induced the largest improvements in perceived handicap, and a lower baseline respiratory function was associated with a greater improvement, regardless of the intervention received. Conclusion: Respiratory function impacts voice and the response to behavioral voice therapy. Adding IMST to voice exercises improves self-reported outcomes even in patients with a normal respiratory function

Models and Analysis of Vocal Emissions for Biomedical Applications

The International Workshop on Models and Analysis of Vocal Emissions for Biomedical Applications (MAVEBA) came into being in 1999 from the particularly felt need of sharing know-how, objectives and results between areas that until then seemed quite distinct such as bioengineering, medicine and singing. MAVEBA deals with all aspects concerning the study of the human voice with applications ranging from the neonate to the adult and elderly. Over the years the initial issues have grown and spread also in other aspects of research such as occupational voice disorders, neurology, rehabilitation, image and video analysis. MAVEBA takes place every two years always in Firenze, Italy