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Effects of Using Laryngeal High-Speed Videoendoscopy Images Visualizing Partial Views of The Glottis on Measurement Outcomes

Mohd Khairuddin KA, Ahmad K, Ibrahim HM, Yan Y

J Voice, 2022 Jan;36(1):106-112.
PMID: 32456835 DOI: 10.1016/j.jvoice.2020.04.027

Ideally, an analysis method for laryngeal high-speed videoendoscopy (LHSV) based on the glottal area waveforms (GAW) requires images of a complete view of the glottis to ensure findings that are representatives of the vibratory behaviors of the whole vocal folds. However, in practice, the preferred images may not be obtained at all times. Often, the only available images that a clinician has to work with consist of a partial view of the glottis. This study aims to examine the effects of using images of a partial view of the glottis (ie, posterior-middle, anterior-middle, or middle) on the LHSV-based measures (ie, fundamental frequency (F0GAW), frequency perturbation (jitterGAW), amplitude perturbation (shimmerGAW), open quotient (OQGAW), and Nyquist plot). The participants consisted of 9 young normophonic females. The procedures involved LHSV recording of the vibration of the vocal folds. The images of the complete view of the glottis were analyzed to obtain the LHSV-based measures. The same images were used to simulate the images of partial views of the glottis by changing the outline of the region of interest to include only either the posterior-middle, anterior-middle, or middle parts of the glottis. The LHSV-based measures from the images of the partial views were then compared to those with the complete view . The results showed that all LHSV-based measures from the images of the posterior-middle view were similar to those of the complete view. However, only the F0GAW, jitterGAW, and shimmerGAW from the images of the anterior-middle and middle views were similar to those of the complete view. Lower OQGAW and different Nyquist plots than those of the complete view were generated by the images of the anterior-middle and middle views. In conclusion, all LHSV-based measures from the images of the posterior-middle view of the glottis, and only the F0GAW, jitterGAW, and shimmerGAW from the images of the anterior-middle and middle views of the glottis reflect the vibratory behaviors of the whole vocal folds. The same conclusion could not be applied to the OQGAW and Nyquist plots of the images of the anterior-middle and middle views of the glottis. A possible effect of the presence or absence of a posterior glottal gap on the findings warrants further confirmation.

Matched MeSH terms: Phonation*
Analysis Method for Laryngeal High-Speed Videoendoscopy: Development of the Criteria for the Measurement Input

Mohd Khairuddin KA, Ahmad K, Mohd Ibrahim H, Yan Y

J Voice, 2021 Jul;35(4):636-645.
PMID: 31864891 DOI: 10.1016/j.jvoice.2019.12.005

Despite its clear advantages, laryngeal high-speed videoendoscopy (LHSV) has not yet been accepted as a routine imaging tool for the evaluation of vocal fold vibration due to the unavailability of methods to effectively analyze the huge number of images from the LHSV recording. Recently, a promising LHSV-based analysis method has been introduced. The ability of this analysis method in studying the vocal fold vibratory behaviors had been substantially demonstrated. However, some practical aspects of its clinical applications still require further attention. Most fundamental is that the criteria for the measurement input ie, a segment of interest (SOI), which has not been fully defined. Particularly, the length of the SOI and the location along the sample, where it needs to be selected require further confirmation. Meanwhile, the analysis using any options of a well-delineated glottal area demands verification. Without clear criteria for the SOI, it is difficult to demonstrate the relevance of this analysis method in clinical voice assessment. Therefore, the aim of the present study is to establish the criteria for the SOI, which involved the investigations on the length of the SOI and the location along the sample, where it needs to be selected, as well as the use of any options of a well-delineated glottal area for analysis. The participants in the present study consisted of 36 young normophonic females. The methods involved LHSV recording of the images of the vibrating vocal folds. The captured images were then analyzed using the method. The LHSV-based measures from the analyses were compared according to the specified procedures of each investigation. Results indicated that 2000 frames should be used as the SOI length. The SOI could be selected at any location along the sample as long as well-delineated glottal areas were observed. With the current findings, a more conclusive measurement protocol is available to ensure reliable LHSV-based measures. The findings further support this analysis method for clinical application, which in turn promote LHSV as a reliable laryngeal imaging tool in clinical setting.

Matched MeSH terms: Phonation*
Vocal fold vibratory characteristics in normal female speakers from high-speed digital imaging

Ahmad K, Yan Y, Bless DM

J Voice, 2012 Mar;26(2):239-53.
PMID: 21621975 DOI: 10.1016/j.jvoice.2011.02.001

The purpose of the study was to investigate relationships between vocal fold vibrations and voice quality. Laryngeal images obtained from high-speed digital imaging (HSDI) were examined for their open-closed timing characteristics and perturbation values. A customized software delineated the glottal edges and used the Hilbert transform-based method of analysis to provide objective quantification of glottal perturbation. Overlay tracings of the transformed glottal cycles provided visual patterns on the overall vibratory dynamics. In this paper, we described the use of this method in looking at vibratory characteristics of a group of young female speakers (N=23). We found that, females with no voice complaints and who had been perceived to have normal voices were not a homogeneous group in terms of their glottal vibratory patterns during phonation. Their vibratory patterns showed characteristics similar to exemplar voices targeted to be clear (50%), pressed (27%), breathy (15%), or a mixed quality (8%). Perturbation range in terms of cycle-to-cycle frequency and amplitude was small and did not discriminate patterns. All these patterns yielded perceptually normal voices suggesting that in normal young speakers, the level of perturbation may be more important to the judgment than the actual pattern of closure.

Matched MeSH terms: Phonation*
Vocal fundamental frequency and perturbation measurements of vowels by normal Malaysian Chinese adults

Ting HN, Chia SY, Kim KS, Sim SL, Abdul Hamid B

J Voice, 2011 Nov;25(6):e311-7.
PMID: 21376529 DOI: 10.1016/j.jvoice.2010.05.004

The acoustic properties of vowel phonation vary across cultures. These specific characteristics, including vowel fundamental frequency (F(0)) and perturbation measures (Absolute Jitter [Jita], Jitter [Jitt], Relative Average Perturbation [RAP], five-point Period Perturbation Quotient [PPQ5], Absolute Shimmer [ShdB], Shimmer [Shim], and 11-point Amplitude Perturbation Quotient [APQ11]) are not well established for Malaysian Chinese adults. This article investigates the F(0) and perturbation measurements of sustained vowels in 60 normal Malaysian Chinese adults using acoustical analysis. Malaysian Chinese females had significantly higher F(0) than Malaysian males in all six vowels. However, there were no significant differences in F(0) across the vowels for each gender. Significant differences between vowels were observed for Jita, Jitt, PPQ5, ShdB, Shim, and APQ11 among Chinese males, whereas significant differences between vowels were observed for all the perturbation parameters among Chinese females. Chinese males had significantly higher Jita and APQ11 in the vowels than Chinese females, whereas no significant differences were observed between males and females for Jitt, RAP, PPQ5, and Shim. Cross-ethnic comparisons indicate that F(0) of vowel phonation varies within the Chinese ethnic group and across other ethnic groups. The perturbation measures cannot be simply compared, where the measures may vary significantly across different speech analysis softwares.

Matched MeSH terms: Phonation*
Blind source computer device identification from recorded VoIP calls for forensic investigation

Jahanirad M, Anuar NB, Wahab AWA

Forensic Sci Int, 2017 Mar;272:111-126.
PMID: 28129583 DOI: 10.1016/j.forsciint.2017.01.010

The VoIP services provide fertile ground for criminal activity, thus identifying the transmitting computer devices from recorded VoIP call may help the forensic investigator to reveal useful information. It also proves the authenticity of the call recording submitted to the court as evidence. This paper extended the previous study on the use of recorded VoIP call for blind source computer device identification. Although initial results were promising but theoretical reasoning for this is yet to be found. The study suggested computing entropy of mel-frequency cepstrum coefficients (entropy-MFCC) from near-silent segments as an intrinsic feature set that captures the device response function due to the tolerances in the electronic components of individual computer devices. By applying the supervised learning techniques of naïve Bayesian, linear logistic regression, neural networks and support vector machines to the entropy-MFCC features, state-of-the-art identification accuracy of near 99.9% has been achieved on different sets of computer devices for both call recording and microphone recording scenarios. Furthermore, unsupervised learning techniques, including simple k-means, expectation-maximization and density-based spatial clustering of applications with noise (DBSCAN) provided promising results for call recording dataset by assigning the majority of instances to their correct clusters.

Matched MeSH terms: Phonation*
Nonselective Laryngeal Reinnervation versus Type 1 Thyroplasty in Patients with Unilateral Vocal Fold Paralysis: A Single Tertiary Centre Experience

Ab Rani A, Azman M, Ubaidah MA, Mohamad Yunus MR, Sani A, Mat Baki M

J Voice, 2021 May;35(3):487-492.
PMID: 31732294 DOI: 10.1016/j.jvoice.2019.09.017

OBJECTIVE: This study compared the voice outcomes of selected patients with unilateral vocal fold palsy (UVFP) who underwent either nonselective laryngeal reinnervation (LR) or Type 1 thyroplasty (thyroplasty) in a Malaysian tertiary centre using multidimensional voice assessments.
PARTICIPANTS: The study included 16 patients with UVFP who underwent either LR (9 patients) or thyroplasty (7 patients) between 2015 and 2018 who fulfilled the inclusion criteria.
MAIN OUTCOME MEASURES: The outcomes were measured subjectively and objectively with: (1) voice handicap index-10 (VHI-10- Malay version); (2) auditory perceptual evaluation using the breathiness component of Grade, Roughness, Breathiness, Asthenia, Strain scale; (3) maximum phonation time (MPT); and (4) acoustic analysis (jitter%, shimmer%, and NHR) using OperaVOXTM. The outcomes were measured at baseline, 6 and 12-months postoperative. The comparison of outcomes between pre and postoperative of each group was evaluated using one-way ANOVA test. Mann-Whitney test was used to compare the outcomes between the two groups.
RESULTS: Comparison of each group at different time points showed significant improvement of VHI-10 and MPT of LR group between baseline and 12 months (P ≤ 0.05) whereas, the improvement in thyroplasty group was observed at all time points (P ≤ 0.05). When comparing between the two groups at 12 months, the VHI-10 and MPT was significantly better in the LR group than thyroplasty group with P = 0.004 and P = 0.001 respectively. Other outcome measures did not reveal significant difference between the two groups.
CONCLUSION: This observational study showed that LR may be better than thyroplasty in improving VHI-10 and MPT in selected patients with UVFP.

Matched MeSH terms: Phonation
Correlation between subjective and objective voice analysis pre- and post-shift among teleoperators in a tertiary hospital

Rahman M, Saniasiaya J, Abu Bakar MZ

J Laryngol Otol, 2023 Jul;137(7):789-793.
PMID: 36444560 DOI: 10.1017/S0022215122002493

OBJECTIVE: Teachers and singers have been extensively studied and are shown to have a greater tendency to voice disorders. This study aimed to investigate the correlation between subjective and objective voice analysis pre- and post-shift among teleoperators in a tertiary hospital.
METHODS: This was a prospective cohort study. Each patient underwent pre- and post-shift voice analysis.
RESULTS: Among 42 teleoperators, 28 patients (66.7 per cent) completed all the tests. Female predominance (62 per cent) was noted, with a mean age of 40 years. Voice changes during working were reported by 48.1 per cent. Pre- and post-shift maximum phonation time (p < 0.018) and Voice Handicap Index-10 (p < 0.011) showed significant results with no correlation noted between subjective and objective assessment.
CONCLUSION: Maximum phonation time and Voice Handicap Index-10 are good voice assessment tools. The quality of evidence is inadequate to recommend 'gold standard' voice assessment until a better-quality study has been completed.

Matched MeSH terms: Phonation
Perceptual processing of Mandarin nasals by L1 and L2 Mandarin speakers

Lai YH

J Psycholinguist Res, 2012 Aug;41(4):237-52.
PMID: 22089521 DOI: 10.1007/s10936-011-9190-2

Nasals are cross-linguistically susceptible to change, especially in the syllable final position. Acoustic reports on Mandarin nasal production have recently shown that the syllable-final distinction is frequently dropped. Few studies, however, have addressed the issue of perceptual processing in Mandarin nasals for L1 and L2 speakers of Mandarin Chinese. The current paper addressed to what extent and in what directions L1 and L2 speakers of Mandarin differed in perceiving Mandarin nasals. Possible variables, including the linguistic backgrounds (i.e. L1 vs. L2 speakers of Mandarin Chinese), the vocalic contexts (i.e. [i, ə, a, y, ua, uə, ia]) and the phonetic settings (i.e. syllable-initial vs. syllable-final), were discussed. Asymmetrical findings in the current investigation indicated limitations of speech learning theories developed from European languages in the context of Mandarin nasals. A tri-dimensional model was thus suggested for interpreting the cognitive mechanism in Mandarin nasal perception.

Matched MeSH terms: Phonation/physiology
Gender classification in children based on speech characteristics: using fundamental and formant frequencies of Malay vowels

Zourmand A, Ting HN, Mirhassani SM

J Voice, 2013 Mar;27(2):201-9.
PMID: 23473455 DOI: 10.1016/j.jvoice.2012.12.006

Speech is one of the prevalent communication mediums for humans. Identifying the gender of a child speaker based on his/her speech is crucial in telecommunication and speech therapy. This article investigates the use of fundamental and formant frequencies from sustained vowel phonation to distinguish the gender of Malay children aged between 7 and 12 years. The Euclidean minimum distance and multilayer perceptron were used to classify the gender of 360 Malay children based on different combinations of fundamental and formant frequencies (F0, F1, F2, and F3). The Euclidean minimum distance with normalized frequency data achieved a classification accuracy of 79.44%, which was higher than that of the nonnormalized frequency data. Age-dependent modeling was used to improve the accuracy of gender classification. The Euclidean distance method obtained 84.17% based on the optimal classification accuracy for all age groups. The accuracy was further increased to 99.81% using multilayer perceptron based on mel-frequency cepstral coefficients.

Matched MeSH terms: Phonation*
Fulltext Feasibility of vocal fold abduction and adduction assessment using cine-MRI

Baki MM, Menys A, Atkinson D, Bassett P, Morley S, Beale T, et al.

Eur Radiol, 2017 Feb;27(2):598-606.
PMID: 27085701 DOI: 10.1007/s00330-016-4341-3

OBJECTIVE: Determine feasibility of vocal fold (VF) abduction and adduction assessment by cine magnetic resonance imaging (cine-MRI) METHODS: Cine-MRI of the VF was performed on five healthy and nine unilateral VF paralysis (UVFP) participants using an axial gradient echo acquisition with temporal resolution of 0.7 s. VFs were continuously imaged with cine-MRI during a 10-s period of quiet respiration and phonation. Scanning was repeated twice within an individual session and then once again at a 1-week interval. Asymmetry of VF position during phonation (VF phonation asymmetry, VFPa) and respiration (VF respiration asymmetry, VFRa) was determined. Percentage reduction in total glottal area between respiration and phonation (VF abduction potential, VFAP) was derived to measure overall mobility. An un-paired t-test was used to compare differences between groups. Intra-session, inter-session and inter-reader repeatability of the quantitative metrics was evaluated using intraclass correlation coefficient (ICC).
RESULTS: VF position asymmetry (VFPa and VFRa) was greater (p=0.012; p=0.001) and overall mobility (VFAP) was lower (p=0.008) in UVFP patients compared with healthy participants. ICC of repeatability of all metrics was good, ranged from 0.82 to 0.95 except for the inter-session VFPa (0.44).
CONCLUSION: Cine-MRI is feasible for assessing VF abduction and adduction. Derived quantitative metrics have good repeatability.
KEY POINTS: • Cine-MRI is used to assess vocal folds (VFs) mobility: abduction and adduction. • New quantitative metrics are derived from VF position and abduction potential. • Cine-MRI able to depict the difference between normal and abnormal VF mobility. • Cine-MRI derived quantitative metrics have good repeatability.

Matched MeSH terms: Phonation
Maximum Phonation Time Normative Values Among Malaysians and Its Relation to Body Mass Index

Al-Yahya SN, Mohamed Akram MHH, Vijaya Kumar K, Mat Amin SNA, Abdul Malik NA, Mohd Zawawi NA, et al.

J Voice, 2020 Aug 27.
PMID: 32861567 DOI: 10.1016/j.jvoice.2020.07.015

OBJECTIVE: Maximum phonation time (MPT) is a test to measure glottic efficiency for laryngeal pathology screening and treatment monitoring. The normative value of MPT for South East Asia population has yet to be reported. It is postulated that MPT may be affected by body mass index (BMI) despite the paucity of evidence. Therefore, this study was designed to establish the normative value of MPT for a South East Asia population and investigate its relation to BMI.
DESIGN & SETTING: This cross-sectional study was conducted in Universiti Kebangsaan Malaysia Medical Center between May and September 2017.
PARTICIPANTS AND METHODS: Three hundred males and females with mean age of 30.23 (±11.04) years were recruited in equal number for each gender (n = 150) and divided into 3 groups of 50 according to their BMI (n = 50). The three groups are non-obese (BMI≤22.9kg/m2); obese (BMI between 23 and 34.9 kg/m2); and morbidly obese (BMI >35kg/m2). BMI and Voice Handicap Index-10 (VHI-10) were obtained. The average of three readings of MPT was measured using a stopwatch while the participants phonate /a/, /i/ and /u/. Unpaired t-test and ANOVA were used to compare means between and across groups. Spearman correlation assessed the correlation between MPT and BMI.
MAIN OUTCOME MEASURES: The normative values of MPT of both genders and correlation with BMI were analyzed.
RESULTS: The MPT normative values for males and females in the non-obese group were of 21.41 (±6.85) seconds and 18.05 (±5.06)seconds respectively for /a/. The MPT for all vowels were significantly higher in males across the BMI groups (P ≤ 0.05). There was low negative correlation between MPT and BMI in both genders.
CONCLUSIONS: This pioneering study documented the normative values of MPT among Malaysians showed that males had longer MPT than females across the BMI groups. Obesity affects the MPT in that as BMI increases, the MPT decreases.

Matched MeSH terms: Phonation
Fulltext Technical considerations in the surgical management of external laryngotracheal trauma: surgical outcomes

Mohd Sayuti, R., Raja Ahmad, R.L.A., Wan Ishlah, L., Kahairi, A., Asha’ari, Z.A., Norie Azilah, K.

International Medical Journal Malaysia, 2016;15(2):7-12.
MyJurnal

Introduction: External laryngotracheal (ELT) trauma is rarely encountered in clinical practice. In most
circumstances, this injury is overlooked by the primary attending team. Surgical management of ELT trauma
is complicated, because there is no established management approach for this potentially life-altering, high
morbidity injury. It is important for this injury to be identified early, as any delay in surgical intervention
may result in poor airway and phonatory outcomes. The aim of surgical reconstruction is to minimise the
above debilitating morbidities by restoring the main laryngeal functions as much as possible. Methods: We
reviewed the outcomes of six surgical interventions for ELT trauma at Tengku Ampuan Afzan Hospital from
June 2007 to June 2014. Clinical presentations, computed tomography (CT) scans features, intraoperative
findings, and postoperative outcomes were evaluated. Results: All patients made a good recovery in terms of
phonation except for one patient who had reduced speech function. After one year, one patient was still
dependent on a fenestrated tracheostomy. This article describes the surgical reconstruction techniques used
to achieve these positive outcomes. Stenting is helpful to aid healing and re-epithelialisation. Conclusion:
Prompt recognition and non-traumatised airway control are essential for addressing laryngotracheal trauma.
Subcutaneous emphysema is an important hallmark that should alert the attending physician to the
possibility of ELT trauma. Immediate surgical intervention using appropriate techniques can produce
favorable patient outcomes.

Matched MeSH terms: Phonation
Vocal fold vibratory characteristics of healthy geriatric females--analysis of high-speed digital images

Ahmad K, Yan Y, Bless D

J Voice, 2012 Nov;26(6):751-9.
PMID: 22633334 DOI: 10.1016/j.jvoice.2011.12.002

A high proportion of the geriatric population suffers from presbylaryngis and presbyphonia; however, our knowledge of vibratory patterns in this population is almost nonexistent. In this study, we investigate the vocal fold vibratory patterns of healthy elderly females to determine which features or combination of them could best describe the geriatric voices.

Matched MeSH terms: Phonation*
Immediate selective laryngeal reinnervation in vagal paraganglioma patients

Mat Baki M, Clarke P, Birchall MA

J Laryngol Otol, 2018 Sep;132(9):846-851.
PMID: 30180919 DOI: 10.1017/S0022215118000476

OBJECTIVE: This prospective case series aimed to present the outcomes of immediate selective laryngeal reinnervation.
METHODS: Two middle-aged women with vagal paraganglioma undergoing an excision operation underwent immediate selective laryngeal reinnervation using the phrenic nerve and ansa cervicalis as the donor nerve. Multidimensional outcome measures were employed pre-operatively, and at 1, 6 and 12 months post-operatively.
RESULTS: The voice handicap index-10 score improved from 23 (patient 1) and 18 (patient 2) at 1 month post-operation, to 5 (patient 1) and 1 (patient 2) at 12 months. The Eating Assessment Tool 10 score improved from 20 (patient 1) and 24 (patient 2) at 1 month post-operation, to 3 (patient 1) and 1 (patient 2) at 12 months. There was slight vocal fold abduction observed in patient one and no obvious abduction in patient two.
CONCLUSION: Selective reinnervation is safe to perform following vagal paraganglioma excision conducted on the same side. Voice and swallowing improvements were demonstrated, but no significant vocal fold abduction was achieved.

Matched MeSH terms: Phonation/physiology
A new hybrid intelligent system for accurate detection of Parkinson's disease

Hariharan M, Polat K, Sindhu R

Comput Methods Programs Biomed, 2014 Mar;113(3):904-13.
PMID: 24485390 DOI: 10.1016/j.cmpb.2014.01.004

Elderly people are commonly affected by Parkinson's disease (PD) which is one of the most common neurodegenerative disorders due to the loss of dopamine-producing brain cells. People with PD's (PWP) may have difficulty in walking, talking or completing other simple tasks. Variety of medications is available to treat PD. Recently, researchers have found that voice signals recorded from the PWP is becoming a useful tool to differentiate them from healthy controls. Several dysphonia features, feature reduction/selection techniques and classification algorithms were proposed by researchers in the literature to detect PD. In this paper, hybrid intelligent system is proposed which includes feature pre-processing using Model-based clustering (Gaussian mixture model), feature reduction/selection using principal component analysis (PCA), linear discriminant analysis (LDA), sequential forward selection (SFS) and sequential backward selection (SBS), and classification using three supervised classifiers such as least-square support vector machine (LS-SVM), probabilistic neural network (PNN) and general regression neural network (GRNN). PD dataset was used from University of California-Irvine (UCI) machine learning database. The strength of the proposed method has been evaluated through several performance measures. The experimental results show that the combination of feature pre-processing, feature reduction/selection methods and classification gives a maximum classification accuracy of 100% for the Parkinson's dataset.

Matched MeSH terms: Phonation

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