Hyolaryngeal Kinematics in Primary Muscle Tension Dysphonia Determined by Ultrasound.

Objectives: The purpose of this study was to determine hyolaryngeal kinematics during voicing in people with primary muscle tension dysphonia (pMTD) compared with healthy speakers, and to investigate the relationships between hyolaryngeal displacement and self-perceived vocal function.

Methods: Twenty-six participants, 13 with pMTD and 13 healthy speakers, were assessed using sonography during sustained vowel phonation and rest. Displacement of the hyoid bone and thyroid cartilage was measured from still frames extracted from ultrasound video recordings, with measures normalized to reflect change from rest during voicing for each participant.

A Conceptual Framework and Treatment Taxonomy for Respiratory Lung Volume Training (RLVT).

Objectives: The purpose of this study was to describe the theoretical and procedural framework of a novel intervention, Respiratory Lung Volume Training (RLVT), and to implement a standardized treatment taxonomy to operationalize the RLVT treatment paradigm.

Study Design: This study involved a prospective design with a consensus treatment classification process.

Methods: The RLVT paradigm was developed based on biomechanical constructs governing the interactions of the respiratory and phonatory systems in voice production and principles of motor learning theory.

Evaluating Anterior and Posterior Oral Tongue Contributions to Pressure Generation: A Comparison Between Regular and Effortful Saliva Swallows.

Purpose: This study determined the contributions of the anterior and posterior tongue regions in tongue pressure generation during regular saliva swallows (SSs) and effortful swallows (ESs) completed under two different instructions. The association between tongue pressure and perceived effort to swallow was also examined.

Method: Forty healthy adults without swallowing disorders participated in this study, divided into two age groups: 20 younger ( = 21.

Hyolaryngeal Movement During Normal and Effortful Swallows Determined During Ultrasonography.

Purpose: This study investigated (a) the effects of the effortful swallow under two different instructions (tongue emphasis vs. pharyngeal squeezing) on hyoid displacement and hyoid-larynx approximation, (b) the association between tongue pressure and hyolaryngeal movement during normal swallowing and the effortful swallow produced with tongue emphasis, and (c) age-related differences in hyolaryngeal movement during normal and effortful swallows (tongue emphasis vs. pharyngeal squeezing) in healthy individuals.

Surface Electromyographic Activity of the Masseter Muscle During Regular and Effortful Saliva Swallows: A Preliminary Study.

Biofeedback is a critical component in motor learning of new, complex behaviors such as modifications to swallowing. Surface electromyography (sEMG) is a commonly employed biofeedback tool in swallowing management to assess muscle activity patterns, determine amplitude and duration of swallowing, and train swallowing strategies such as the effortful swallow (EFS) maneuver. The EFS can potentially change multiple physiological components of the swallowing process such as pressure generation and movement of biomechanical structures.

Translating Ultrasound into Clinical Practice for the Assessment of Swallowing and Laryngeal Function: A Speech and Language Pathology-Led Consensus Study.

Ultrasound (US) has an emerging evidence base for the assessment of swallowing and laryngeal function. Accessibility and technological advances support the use of US as a clinical assessment tool; however, there is insufficient evidence to support its translation into clinical practice. This study aimed to establish consensus on the priorities for translation of US into clinical practice for the assessment of swallowing and laryngeal function.

Clinical Features of Essential Voice Tremor and Associations with Tremor Severity and Response to Octanoic Acid Treatment.

Objectives/hypothesis: The purpose of this study was to characterize the clinical features, tremor variability, and factors related to octanoic acid (OA) treatment response in essential voice tremor (EVT).

Study Design: Prospective, double blind, placebo-controlled, crossover study with secondary analysis.

Methods: Clinical tremor features in 16 individuals with EVT were comprehensively assessed, and correlations with acoustic tremor severity were determined.

Isolated and Combined Respiratory Training for Muscle Tension Dysphonia: Preliminary Findings.

Purpose: The purpose of this study was to determine the feasibility of altering speech breathing patterns and dysphonia severity through training increased levels of lung volume use during speech. It was hypothesized that respiratory-based training would increase lung volume levels during speech as well as improve acoustic voice measures, and that the addition of laryngeal-based treatment would further improve voice acoustics by treatment completion.

Method: A multiple baseline, single subject design was replicated over six participants with primary muscle tension dysphonia as a preliminary investigation of novel respiratory treatment methods.

A Systematic Review of the Physiological Effects of the Effortful Swallow Maneuver in Adults With Normal and Disordered Swallowing.

Purpose This systematic review summarizes the biomechanical and functional effects of the effortful swallow in adults with and without dysphagia, highlighting clinical implications and future research needs. Specifically, the effects of the effortful swallow on swallowing physiology, safety, and efficiency were identified, as well as the strengths and limitations of current research. Method Recommendations specified by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses were followed.

Assessment of Tongue Position and Laryngeal Height in Two Professional Voice Populations.

Purpose To advance our current knowledge of singer physiology by using ultrasonography in combination with acoustic measures to compare physiological differences between musical theater (MT) and opera (OP) singers under controlled phonation conditions. Primary objectives addressed in this study were (a) to determine if differences in hyolaryngeal and vocal fold contact dynamics occur between two professional voice populations (MT and OP) during singing tasks and (b) to determine if differences occur between MT and OP singers in oral configuration and associated acoustic resonance during singing tasks. Method Twenty-one singers (10 MT and 11 OP) were included.

The Low Mandible Maneuver: Preliminary Study of Its Effects on Aerodynamic and Acoustic Measures.

Objectives: The purpose of this preliminary study was to determine the aerodynamic and acoustic effects of the low mandible maneuver (LMM) as compared to normal voice production.

Methods: Ten participants with normal voice characteristics who were nonsingers produced sustained vowel and repeated syllable utterances during two different speaking conditions: using the LMM and using normal phonation posture. The LMM involves a wider vocal tract configuration with a lowered and relaxed jaw position.

The Effect of Octanoic Acid on Essential Voice Tremor: A Double-Blind, Placebo-Controlled Study.

Objectives/hypothesis: The purpose of this study was to determine the effects of octanoic acid on acoustic, perceptual, and functional aspects of essential voice tremor (EVT).

Study Design: Prospective, double-blind, placebo-controlled, crossover study.

Methods: Sixteen participants with a diagnosis of EVT were randomized to a 3-week dosing condition of octanoic acid or placebo, followed by a 2-week washout period and crossover to the other condition for an additional 3 weeks.

The effect of anchors on reliability of endoscopic tremor ratings.

Objectives/hypothesis: The purpose of this study was to determine the effects of anchors and training on intrarater and inter-rater reliability for visual-perceptual, endoscopic tremor ratings.

Study Design: Prospective cohort study.

Methods: Nasoendoscopy recordings of 10 participants with a diagnosis of essential voice tremor were evaluated by five voice specialists using the Vocal Tremor Scoring System.

The effect of speaking context on spectral- and cepstral-based acoustic features of normal voice.

The effect of speaking context on four cepstral- and spectral-based acoustic measures was investigated in 20 participants with normal voice. Speakers produced three different continuous speaking tasks that varied in duration and phonemic content. Cepstral and spectral measures that can be validly derived from continuous speech were computed across the three speaking contexts.

A Preliminary Quantitative Comparison of Vibratory Amplitude Using Rigid and Flexible Stroboscopic Assessment.

Study Objective: The purpose of this study was to establish preliminary, quantitative data on amplitude of vibration during stroboscopic assessment in healthy speakers with normal voice characteristics. Amplitude of vocal fold vibration is a core physiological parameter used in diagnosing voice disorders, yet quantitative data are lacking to guide the determination of what constitutes normal vibratory amplitude.

Methods/study Design: Eleven participants were assessed during sustained vowel production using rigid and flexible endoscopy with stroboscopy.

Aerodynamic and acoustic features of vocal effort.

Objectives: The purpose of this study was to determine the aerodynamic and acoustic features of speech produced at comfortable, maximal and minimal levels of vocal effort.

Study Design: Prospective, quasi-experimental research design.

Method: Eighteen healthy participants with normal voice were included in this study.

Predictive value and discriminant capacity of cepstral- and spectral-based measures during continuous speech.

Objectives/hypothesis: The purpose of this study was to determine the relative strength of various cepstral- and spectral-based measures for predicting dysphonia severity and differentiating voice quality types.

Study Design: Prospective, quasi-experimental research design.

Methods: Twenty-eight dysphonic speakers and 14 normal speakers were included in this study.

Spectral- and cepstral-based acoustic features of dysphonic, strained voice quality.

Objectives: We sought to determine whether spectral- and cepstral-based acoustic measures were effective in distinguishing dysphonic-strained voice quality from normal voice quality and whether these measures were related to auditory-perceptual ratings of strain severity.

Methods: Voice samples from 23 speakers with dysphonia characterized predominantly by strained voice quality and 23 speakers with normal voice were acoustically analyzed. Measures related to the prominence of the cepstral peak and the ratio of low- to high-frequency spectral energies, as well as the variation of each, were computed from continuous speech and a sustained vowel.

Functional connectivity and laterality of the motor and sensory components in the volitional swallowing network.

Functional neuroimaging has shown that multiple brain regions are active during volitional swallowing. Little is known, however, about which regions integrate motor execution and sensory feedback in the swallowing system. Although unilateral brain lesions in either hemisphere can produce swallowing deficits, some functional neuroimaging studies indicate that the left hemisphere has greater activation in certain sensory and motor-related swallowing regions.

Position of the hyoid and larynx in people with muscle tension dysphonia.

Objectives/hypothesis: To determine whether radiographic measures of hyoid position, laryngeal position, and hyolaryngeal space during phonation were different for people with primary muscle tension dysphonia (MTD) as compared to control participants without voice disorders.

Study Design: Prospective, quasi-experimental research design.

Methods: Twenty participants, 10 with primary MTD and 10 without voice disorders who were age and sex matched were studied radiographically while producing phonation.

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.

Sensory stimulation activates both motor and sensory components of the swallowing system.

Volitional swallowing in humans involves the coordination of both brainstem and cerebral swallowing control regions. Peripheral sensory inputs are necessary for safe and efficient swallowing, and their importance to the patterned components of swallowing has been demonstrated. However, the role of sensory inputs to the cerebral system during volitional swallowing is less clear.

Respiratory and laryngeal function during spontaneous speaking in teachers with voice disorders.

Purpose: To determine if respiratory and laryngeal function during spontaneous speaking were different for teachers with voice disorders compared with teachers without voice problems.

Method: Eighteen teachers, 9 with and 9 without voice disorders, were included in this study. Respiratory function was measured with magnetometry, and laryngeal function was measured with electroglottography during 3 spontaneous speaking tasks: a simulated teaching task at a typical loudness level, a simulated teaching task at an increased loudness level, and a conversational speaking task.

Simulated effects of cricothyroid and thyroarytenoid muscle activation on adult-male vocal fold vibration.

Adjustments to cricothyroid and thyroarytenoid muscle activation are critical to the control of fundamental frequency and aerodynamic aspects of vocal fold vibration in humans. The aerodynamic and physical effects of these muscles are not well understood and are difficult to study in vivo. Knowledge of the contributions of these two muscles is essential to understanding both normal and disordered voice physiology.

Common input across motor nuclei mediating precision grip in humans.

Short-term synchrony was measured for pairs of motor units located within and across muscles activated during a task that mimicked precision grip in the dominant and nondominant hands of human subjects. Surprisingly, synchrony for pairs of motor units residing in separate muscles (flexor pollicis longus, a thumb muscle, and flexor digitorum profundus, an index-finger muscle) was just as large as that for pairs of units both within the thumb muscle. Furthermore, the high level of synchrony seen across muscles in the dominant hand was absent in the nondominant hand.