Whisper and Phonation: Aerodynamic Comparisons across Adduction and Loudness Levels

The purpose of the present project was to compare the aerodynamics of whisper and phonation. The novel aspect was to have subjects produce both whisper and phonation for nine different conditions, three qualities relative to levels of adduction (breathy, normal, and pressed) and three levels of loudness (soft, medium, and loud). The study reports subglottal pressure (Ps), airflow (F), and laryngeal flow resistance (Rf, the ratio Ps/F) for all conditions. Three males and five females between 20 and 30 years of age whispered and phonated smooth syllable strings of /baep/. This resulted in 18 treatment combinations (i.e., 3 adductions x 3 loudness levels x 2 genders). A regression analysis was performed using a Proc-mixed procedure with SAS statistical software. Results relative to laryngeal source (phonation vs. whisper): Ps was not significantly different between whisper and phonation (except for the breathy soft condition in females, where Ps was greater in phonation). Flow typically was higher for whisper than phonation (except for soft conditions, where flow was about the same). Rf tended to be greater for phonation than for whisper for females, but not for males (where Rf was about the same between phonation and whisper). Results relative to loudness: Ps increased with loudness (soft, medium, loud) at each of the three adduction levels for both phonation and whisper. Flow tended to increase with loudness in whisper at each level of adduction, but flow results were varied for phonation. In phonation, Rf increased with loudness at each level of adduction, but there was no general pattern for whisper (being relatively constant across loudness levels for each gender). Results relative to adduction: Ps increased from normal to breathy to pressed at each level of loudness for phonation, and similarly for whisper (except Ps was about the same for normal and breathy whisper productions). Breathy adduction had the greatest flow at each level of loudness for both phonation and whisper. Flow was about the same in both phonation and whisper for normal and pressed productions. Rf increased from breathy to normal to pressed at each level of loudness (although for whisper, Rf was similar for breathy and normal productions). Results relative to gender: Ps tended to be higher in males than females for all nine conditions for phonation and whisper. Males tended to have greater flow for phonation but lower flow for whisper for all conditions. Males produced greater Rf values for whisper across adduction, but lower Rf values (relatively small differences, however) for phonation across adduction levels. While there are some clear and understandable trends for the aerodynamic measures relative to changes in loudness and adduction for whisper, phonation, and gender, the results are best taken as testable hypotheses for future research

Conversational Vocal Intensity in Parkinson\u27s Disease: Treatment and Environmental Comparisons

BACKGROUND: Vibrotactile Feedback (VF) using wearable devices is an emerging treatment option for hypophonia in Individuals with Parkinson\u27s disease (IwPD). Studies evaluating the effectiveness of VF in improving conversational vocal intensity in real-life environment in IwPD are limited. OBJECTIVE: To determine the effect of VF on conversational vocal intensity and compare vocal intensity between a) clinic and real-life environment b) VF and Lee Silverman Voice Treatment (LSVT LOUD®)vs. VF alone in IwPD using a portable voice monitor (VocaLog2). METHODS: Eight individuals with hypophonia secondary to PD were randomly assigned to two treatment groups- VF and LSVT LOUD® (Group 1) and VF (Group 2). VF was provided using VocaLog2 device. Duration of treatment was 4 weeks for both groups. Vocal intensity was measured in the real-life environment at baseline, during treatment, and at one-month follow-up. Vocal intensity in clinic was obtained at baseline and one-month follow-up. Voice Handicap Index (VHI) questionnaire was administered at baseline and one-month follow-up. RESULTS: There was no significant difference in conversational vocal intensity between a) clinic and real-life environment at any point of time b) baseline and follow up for both treatment groups c) the two treatment groups at baseline, during each of the 4 weeks of treatment and at follow up d) VHI baseline and one month follow up scores. CONCLUSION: VF, including when combined with LSVT LOUD®, is limited in improving conversational vocal intensity in real-life in IwPD. The effects of frequency and duration of VF on conversational vocal intensity must be systematically investigated using large scale studies in IwPD

Whisper and Phonation: Aerodynamic Comparisons Across Adduction and Loudness

INTRODUCTION: Whisper is known to be produced by different speakers differently, especially with respect to glottal configuration that influences glottal aerodynamics. Differences in whisper production and phonation types imply important linguistic information in many languages, are identified in vocal pathologies, are used to communicate mood and emotion, and are used in vocal performance. OBJECTIVE: The present study focused on investigating the aerodynamic differences between whisper and phonation at different loudness and adduction levels. METHODS: Three men and five women between 20 and 40 years of age participated in the study. Smooth syllable strings of the syllable /baep:/ were whispered and phonated at three different loudness levels (soft, medium, and loud) and three voice qualities (breathy, normal, and pressed). The voice qualities are associated with different adduction levels. This resulted in 18 treatment combinations (three adduction levels × three loudness levels × two sexes). RESULTS: A regression analysis was performed using a PROC MIXED procedure with SAS statistical software. Under similar production conditions, subglottal pressure was significantly lower in whisper than in phonation in 10 of 18 combinations, mean glottal airflow was significantly higher in whisper than in phonation in 13 of 18 combinations, and flow resistance was significantly lower in whisper than in phonation in 14 of 18 combinations, with the female subjects demonstrating these trends more frequently than the male subjects do. Of importance, in general, compared with phonation under similar production conditions, whisper is not always accompanied by lower subglottal pressure and higher airflows. CONCLUSION: Results from this study suggest that the typical finding of lower subglottal pressure, higher glottal airflow, and decreased flow resistance in whisper compared with phonation cannot be generalized to all individuals and depends on the whisper type. The nine basic production conditions (three loudness levels and three adduction levels) resulted in data that may help explain the wide range of variation of whisper production reported in earlier studies

Comparison of Oropharyngeal Dysphagia Before and After Botulinum Toxin Injection in Cervical Dystonia

Cervical dystonia (CD) is the most common form of focal dystonia with Botulinum neurotoxin (BoNT) being a frequent method of treatment. Dysphagia is a common side effect of BoNT treatment for CD. Instrumental evaluation of swallowing in CD using standardized scoring for the videofluoroscopic swallowing study (VFSS) and validated and reliable patient-reported outcomes measures is lacking in the literature. (1) to determine if BoNT injections change instrumental findings of swallowing function using the Modified Barium Swallow Impairment Profile (MBSImP) in individuals with CD; (2) to determine if BoNT injections change self-perception of the psychosocial handicapping effects of dysphagia in individuals with CD, using the Dysphagia Handicap Index (DHI); (3) to determine the effect of BoNT dosage on instrumental swallowing evaluation and self-reported swallowing outcomes measures. 18 subjects with CD completed a VFSS and the DHI before and after BoNT injection. There was a significant increase in pharyngeal residue for pudding consistency after BoNT injection, p = 0.015. There were significant positive associations between BoNT dosage and self-perception of the physical attributes of the handicapping effect of dysphagia, the grand total score and patient self-reported severity of dysphagia on the DHI; p = 0.022; p = 0.037; p = 0.035 respectively. There were several significant associations between changes in MBSImP scores and BoNT dose. Pharyngeal efficiency of swallowing may be affected by BoNT for thicker consistencies. Individuals with CD perceive greater physical handicapping effects of dysphagia with increased amounts of BoNT units and have greater self-perceptions of dysphagia severity with increased amounts of BoNT units