Blog Archives

Pitfalls in the management of monaural deafness

Conclusion: Cochlear implantation in patients with long-term deafness should be considered carefully, even if deafness is monaural.

from the Journal of Laryngology and Otology

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Combined Modality Treatment of Adductor Spasmodic Dysphonia

Results and Conclusions
Significant effects were observed on perceived quality of life and acoustic variables for all participants, over time. Participants who received voice therapy after BTX-A injection did not experience longer injection effect duration or significantly greater improvements in V-RQOL or acoustic variables than participants in BTX-A only or BTX-A plus sham therapy groups. Additionally, perceptual ratings of voice quality improved for all participants in response to BTX-A injection. For participants in this investigation, undertaking voice therapy did not appear to exert significant beneficial effects on the variables of interest.

from the Journal of Voice

Pharyngeal Swallowing Sound Profile Assessed after Partial and Total Laryngectomy

Recently, we described three components of a normal pharyngeal swallowing sound. The aim of the present study was to identify variations of these components using synchronized acoustic-radiological data in partially laryngectomized (PL) and totally laryngectomized (TL) patients before and after surgery. In this prospective study, from January 2003 to December 2006 we enrolled 14 patients in a PL group and 9 patients in a TL group. A fluoroscopy camera and a microphone were connected to a computer to obtain acoustic-radiological data (25 images/s). The subjects were asked to perform six deglutitions of 10 ml of barium suspension. The average durations of the sound variables were measured before and after surgery. The duration of the preoperative pharyngeal sound was 602 ms in the PL group and 562 ms in the TL group. It was significantly decreased after the TL (296 ms) and was increased after the PL (740 ms). A typical profile of the swallowing sound for each group was obtained. This study allowed us to describe the main variations of the pharyngeal swallowing sound induced by PL and TL. This noninvasive tool could be useful to assess postoperative swallowing function.

from Dysphagia

Spectral- and Cepstral-Based Measures During Continuous Speech: Capacity to Distinguish Dysphonia and Consistency Within a Speaker

Spectral- and cepstral-based acoustic measures are preferable to time-based measures for accurately representing dysphonic voices during continuous speech. Although these measures show promising relationships to perceptual voice quality ratings, less is known regarding their ability to differentiate normal from dysphonic voice during continuous speech and the consistency of these measures across multiple utterances by the same speaker. The purpose of this study was to determine whether spectral moments of the long-term average spectrum (LTAS) (spectral mean, standard deviation, skewness, and kurtosis) and cepstral peak prominence measures were significantly different for speakers with and without voice disorders when assessed during continuous speech. The consistency of these measures within a speaker across utterances was also addressed. Continuous speech samples from 27 subjects without voice disorders and 27 subjects with mixed voice disorders were acoustically analyzed. In addition, voice samples were perceptually rated for overall severity. Acoustic analyses were performed on three continuous speech stimuli from a reading passage: two full sentences and one constituent phrase. Significant between-group differences were found for both cepstral measures and three LTAS measures (P < 0.001): spectral mean, skewness, and kurtosis. These five measures also showed moderate to strong correlations to overall voice severity. Furthermore, high degrees of within-speaker consistency (correlation coefficients ≥0.89) across utterances with varying length and phonemic content were evidenced for both subject groups.

from the Journal of Voice

Voice Characteristics of Female Physical Education Student Teachers

In this study, the subjective and objective voice measures of seven female physical education student teachers during a semester of student teaching were investigated. The participants completed the voice measures at three data collection time points: baseline, middle, and end of the semester. The voice measures included acoustic and aerodynamic data, perceptual rating scales of vocal quality and vocal fatigue, an end-of-semester questionnaire, and the Voice Handicap Index. Results demonstrated that the subjective and objective voice measures changed at the middle and the end of the semester as compared with those at baseline. The change in the voice measures may suggest that the vocal mechanism was adapting to the increased vocal demands of teaching physical education.

from the Journal of Voice

Vestibular schwannoma: role of conservative management

Two-thirds of vestibular schwannomas did not grow. Radiological surveillance is an acceptable approach in carefully selected patients. Once a sporadic vestibular schwannoma reaches 2 cm in intracranial diameter, it is likely to continue growing. We do not recommend conservative management for sporadic tumours with an intracranial diameter of 1.5 cm or more. Vestibular schwannoma management is more complex in patients with neurofibromatosis type two.

from the Journal of Laryngology and Otology

Vowel Acoustics in Adults With Apraxia of Speech

Conclusion: Comparison with normative acoustic measures suggested that vowel production at the word level is unimpaired in the current speakers with AOS, supporting previous studies that have shown vowel production is relatively intact in AOS.

from the Journal of Speech, Language, and Hearing Research

The relative effectiveness of different stimulus waveforms in evoking VEMPs: Significance of stimulus energy and frequency

We compared the effectiveness of a series of different sound stimulus waveforms in evoking VEMPs in normal volunteers. The waveforms were clicks (0.1–0.8 ms), biphasic clicks (0.8 ms) and sine waves (1250 Hz, 0.8 ms and 500 Hz, 2 ms) with different peak intensity and duration but similar root mean square area. VEMP amplitudes varied widely (corrected values 0.35 to 1.06), but when the amplitudes were plotted against the physical energy content and A-weighted intensity (L_{Aeq}: a measure of acoustic energy) of the waveforms, the relationship was found to be highly linear. However, when the stimuli were matched for their A-weighted energy, a 500 Hz 2 ms sine wave was the most effective waveform, suggesting that frequency tuning in the vestibular system is also an important factor. VEMP amplitude is thus determined by three stimulus-related factors: physical energy, transmission through the middle ear and vestibular frequency tuning. Use of a 500 Hz stimulus will maximise the prevalence and amplitude of the VEMP for a given sound exposure level.

from Vestibular Research

Beta-Adrenergic Blockade and Voice: A Double-Blind, Placebo-Controlled Trial

This study investigated the effects of laboratory-induced stress and beta-adrenergic blockade on acoustic and aerodynamic voice measures. In a double-blind, placebo-controlled trial, 12 participants, six males and six females, underwent cold pressor-induced sympathetic activation followed by placebo or treatment with 40 mg propranolol. Aerodynamic and acoustic parameters of voice were collected at baseline, during cold pressor and after treatment with propranolol or placebo. Fundamental frequency, jitter, shimmer, maximum airflow declination rate, voice onset time, speaking rate, and subglottal pressure were measured at baseline, during cold pressor-induced stress, and after treatment with propranolol or placebo. Cardiovascular measures served as indicators of sympathetic nervous system (SNS) activation by cold pressor and antagonism by propranolol, and were collected during all conditions. Cold pressor appeared to adequately agonize the SNS as indicated by significant increases in resting systolic and diastolic blood pressure and heart rate. Propranolol appeared to adequately antagonize the SNS for the participants. Jitter ratio demonstrated a statistically significant increase in the participants treated with propranolol. Speaking rate demonstrated a small but significant increase in the placebo control group during cold pressor. Gender differences were observed in a few measures. Cold pressor adequately agonized and propranolol adequately antagonized the SNS. No statistically significant differences across subjects were observed in the voice parameters during cold pressor-induced stress before treatment. Jitter ratio increased significantly during propranolol treatment and cold pressor. Speaking rate demonstrated a statistically significant increase during cold pressor in the placebo control group. Gender differences were observed, but were few.

from the Journal of Voice

Beta-Adrenergic Blockade and Voice: A Double-Blind, Placebo-Controlled Trial

This study investigated the effects of laboratory-induced stress and beta-adrenergic blockade on acoustic and aerodynamic voice measures. In a double-blind, placebo-controlled trial, 12 participants, six males and six females, underwent cold pressor-induced sympathetic activation followed by placebo or treatment with 40 mg propranolol. Aerodynamic and acoustic parameters of voice were collected at baseline, during cold pressor and after treatment with propranolol or placebo. Fundamental frequency, jitter, shimmer, maximum airflow declination rate, voice onset time, speaking rate, and subglottal pressure were measured at baseline, during cold pressor-induced stress, and after treatment with propranolol or placebo. Cardiovascular measures served as indicators of sympathetic nervous system (SNS) activation by cold pressor and antagonism by propranolol, and were collected during all conditions. Cold pressor appeared to adequately agonize the SNS as indicated by significant increases in resting systolic and diastolic blood pressure and heart rate. Propranolol appeared to adequately antagonize the SNS for the participants. Jitter ratio demonstrated a statistically significant increase in the participants treated with propranolol. Speaking rate demonstrated a small but significant increase in the placebo control group during cold pressor. Gender differences were observed in a few measures. Cold pressor adequately agonized and propranolol adequately antagonized the SNS. No statistically significant differences across subjects were observed in the voice parameters during cold pressor-induced stress before treatment. Jitter ratio increased significantly during propranolol treatment and cold pressor. Speaking rate demonstrated a statistically significant increase during cold pressor in the placebo control group. Gender differences were observed, but were few.

from the Journal of Voice

Treatment of Tinnitus With a Customized, Dynamic Acoustic Neural Stimulus: Underlying Principles and Clinical Efficacy

from Trends in Amplification

Tinnitus has been challenging to treat with consistently positive results. The Neuromonics Tinnitus Treatment is a newly available approach to the treatment of clinically significant, problematic tinnitus (and reduced sound tolerance) that was developed with the intention of simultaneously addressing the auditory, attentional, and emotional processes underlying the condition. It uses a prescribed acoustic stimulus, customized for each patient’s individual audiometric profile, which provides a broad frequency stimulus to address the effects of auditory deprivation, promotes relief and relaxation with the intention of reducing engagement of the limbic system/amygdala and autonomic nervous system, and applies the principles of systematic desensitization to address the attentional processes. This article describes the underlying principles behind this approach. It also summarizes evidence for clinical efficacy from controlled clinical studies and from a private practice clinical setting, where it has been shown to provide consistently positive outcomes for patients meeting suitability criteria.