RESUMEN
OBJECTIVES/HYPOTHESIS: Automatic voice evaluation is usually performed on stable sections of sustained vowels, which often cannot capture hoarseness properly. The measures cepstral peak prominence (CPP) and smoothed CPP (CPPS) do not require exact determination of the cycles of fundamental frequency like established perturbation-based measures. They can also be applied to text recordings. In this study, they were compared with perceptual evaluation of voice quality and the German roughness-breathiness-hoarseness (RBH) scheme. STUDY DESIGN: Retrospective data analysis. METHODS: Seventy-three hoarse patients (48.3±16.8 years) uttered the vowel /e/ and read the German version of the text "The North Wind and the Sun". The text recordings were evaluated perceptually by five speech therapists and physicians according to the RBH scale. The criterion "overall quality" was measured on a 4-point scale and a visual analog scale. For the human-machine correlation, the automatic measures of the Praat program (vowels only) and the "cpps" software were compared with the experts' ratings. The experiments were repeated for speakers with jitter ≤5% or shimmer ≤5% (n=47). RESULTS: For the entire group (n=73), the best human-machine results for most of the rating criteria were obtained for text-based CPP and CPPS (up to |ρ|=0.73). For the 47 selected speakers, the correlation was remarkably worse for all measures but still best for text-based CPP and CPPS (|ρ|≤0.50). CONCLUSIONS: Cepstrum analysis should be performed on a text recording. Then, it outperforms all perturbation-based measures, and it can be a meaningful objective support for perceptual analysis.
Asunto(s)
Ronquera , Acústica del Lenguaje , Adulto , Anciano , Anciano de 80 o más Años , Enfermedad Crónica , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Percepción del Habla , Adulto JovenRESUMEN
Objective assessment of intelligibility on the telephone is desirable for voice and speech assessment and rehabilitation. A total of 82 patients after partial laryngectomy read a standardized text which was synchronously recorded by a headset and via telephone. Five experienced raters assessed intelligibility perceptually on a five-point scale. Objective evaluation was performed by support vector regression on the word accuracy (WA) and word correctness (WR) of a speech recognition system, and a set of prosodic features. WA and WR alone exhibited correlations to human evaluation between |r| = 0.57 and |r| = 0.75. The correlation was r = 0.79 for headset and r = 0.86 for telephone recordings when prosodic features and WR were combined. The best feature subset was optimal for both signal qualities. It consists of WR, the average duration of the silent pauses before a word, the standard deviation of the fundamental frequency on the entire sample, the standard deviation of jitter, and the ratio of the durations of the voiced sections and the entire recording.
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Laringectomía/efectos adversos , Procesamiento de Señales Asistido por Computador , Acústica del Lenguaje , Inteligibilidad del Habla , Percepción del Habla , Software de Reconocimiento del Habla , Teléfono , Calidad de la Voz , Adulto , Anciano , Anciano de 80 o más Años , Automatización , Análisis por Conglomerados , Femenino , Alemania , Humanos , Masculino , Cadenas de Markov , Persona de Mediana Edad , Espectrografía del Sonido , Medición de la Producción del Habla , Voz Alaríngea , Máquina de Vectores de Soporte , Factores de TiempoRESUMEN
Treatment of small carcinoma of the larynx may lead to voice handicap and restricted quality of life. The relationship between the two is revealed. Sixty-five patients aged 62.1 ± 10.0 years rated their voice handicap and quality of life after treatment of T1 (n = 35) or T2 (n = 30) laryngeal carcinoma during regular out-patient examinations. For the self-assessment of the voice, the Voice Handicap Index (VHI) and the disease-independent Short Form-36 Health Survery (SF-36) questionnaires were used. Voice handicap (total score 38.9 ± 26.0) did not differ in the two tested groups, T1 and T2, and the data of SF-36 (physical score 43.0 ± 10.7; mental score 50.2 ± 9.1) showed significant differences for the mental score. Patients rated their voice handicap worse than healthy persons did after treatment of laryngeal carcinoma. VHI and SF-36 data were strongly correlated. Voice handicap is significantly related to the quality of life, especially affecting the mental domain. Thus, the rehabilitation of voice disorders should have a beneficial impact on quality of life.
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Carcinoma/terapia , Neoplasias Laríngeas/terapia , Complicaciones Posoperatorias/etiología , Calidad de Vida , Trastornos de la Voz/etiología , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma/tratamiento farmacológico , Carcinoma/patología , Carcinoma/radioterapia , Carcinoma/cirugía , Quimioterapia Adyuvante/efectos adversos , Autoevaluación Diagnóstica , Emociones , Femenino , Humanos , Neoplasias Laríngeas/tratamiento farmacológico , Neoplasias Laríngeas/patología , Neoplasias Laríngeas/radioterapia , Neoplasias Laríngeas/cirugía , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/psicología , Radioterapia Adyuvante/efectos adversos , Índice de Severidad de la Enfermedad , Encuestas y Cuestionarios , Carga Tumoral , Trastornos de la Voz/psicologíaRESUMEN
BACKGROUND: Many studies have referred to the effects of age on voice and the consequences of these changes. However, only little is known about the adverse effects of voice changes on quality of life in the elderly. OBJECTIVE: This study focuses on self-perception of voice in seniors as assessed by the Voice-Related Quality of Life (V-RQOL) questionnaire, on voice quality as measured by the Dysphonia Severity Index (DSI) and on the correlation between these parameters. METHODS: V-RQOL and DSI were measured as previously described in 107 non-treatment-seeking test persons without voice complaints (76 women and 31 men; mean age 78.7 ± 6.8 years, range 66-94 years). RESULTS: The mean V-RQOL value was 94.4 ± 9.8%. The mean value of the DSI in all participants was 1.2 ± 2.4. There was no significant correlation between the V-RQOL and DSI, either in women (p = 0.11), men (p = 0.58) or the whole study group (p = 0.26). CONCLUSION: Both the V-RQOL questionnaire and the DSI may be applied to seniors. As self-perception of voice and voice function do not correlate, both parameters have to be measured for voice assessment.
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Envejecimiento/psicología , Disfonía/diagnóstico , Disfonía/psicología , Calidad de Vida , Calidad de la Voz , Anciano , Anciano de 80 o más Años , Femenino , Alemania , Humanos , Masculino , Escala del Estado Mental , Índice de Severidad de la Enfermedad , Encuestas y CuestionariosRESUMEN
OBJECTIVE: Restrictions of verbal communication and high prevalence of voice disorders in the elderly are suspected to influence the quality of life. For assessment, both voice-specific and unspecific methods are already established and fundamental components of clinical diagnostics, but the question of correlation between voice-related and general health-related quality of life is still open in this subpopulation. METHODS: One hundred and seven socially active persons aged 65+ years were recruited and asked to complete Voice-Related Quality of Life (V-RQOL) and Short Form (SF)-36 questionnaires. RESULTS: There was a mild correlation between V-RQOL score and both of the SF-36 subscores (r(s)=0.28 for the physical subscore and r(s)=0.27 for the mental subscore). CONCLUSION: As correlation of voice- and health-related quality of life in elderly persons is only mild, both voice-specific and unspecific assessment methods are required for clinical diagnostics.
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Envejecimiento/psicología , Evaluación Geriátrica , Calidad de Vida , Encuestas y Cuestionarios , Trastornos de la Voz/diagnóstico , Calidad de la Voz , Factores de Edad , Anciano , Anciano de 80 o más Años , Análisis de Varianza , Estudios Transversales , Femenino , Alemania , Humanos , Masculino , Trastornos de la Voz/fisiopatología , Trastornos de la Voz/psicologíaRESUMEN
OBJECTIVE: This study focuses on the relation between objective voice quality and the self-perception of a voice handicap. PATIENTS AND METHODS: The study group consisted of 86 German-speaking patients (51 women, 35 men) suffering from benign dysphonia. The test persons completed the German version of the Voice-Related Quality of Life (V-RQOL) Questionnaire without prior information about their diagnosis and underwent voice analysis with the Dysphonia Severity Index (DSI) being the parameter of this study. RESULTS: No correlation between V-RQOL and DSI could be found (p>0.05). On the V-RQOL, women scored worse than men, but not at a significant level. Patients with dysphonia of organic origin scored significantly worse than patients with functional dysphonia (p=0.026). On the DSI, men's values were significantly lower than women's (p=0.001). Organic dysphonia caused significantly lower DSI values than functional dysphonia (p=0.011). CONCLUSION: Objective voice quality and the individual perception of voice quality by the patient are independent parameters. Both need to be assessed in clinical practice.
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Personas con Discapacidad/psicología , Disfonía/psicología , Autoimagen , Trastornos del Habla/psicología , Calidad de la Voz , Adolescente , Adulto , Anciano , Disfonía/fisiopatología , Miedo , Femenino , Humanos , Neoplasias Laríngeas/psicología , Masculino , Persona de Mediana Edad , Índice de Severidad de la Enfermedad , Fumar/psicología , Factores Socioeconómicos , Trastornos del Habla/fisiopatología , Encuestas y Cuestionarios , Adulto JovenRESUMEN
OBJECTIVE: The Hoarseness Diagram, a program for voice quality analysis used in German-speaking countries, was compared with an automatic speech recognition system with a module for prosodic analysis. The latter computed prosodic features on the basis of a text recording. We examined whether voice analysis of sustained vowels and text analysis correlate in tracheoesophageal speakers. PATIENTS AND METHODS: Test speakers were 24 male laryngectomees with tracheoesophageal substitute speech, age 60.6 +/- 8.9 years. Each person read the German version of the text 'The North Wind and the Sun'. Additionally, five sustained vowels were recorded from each patient. The fundamental frequency (F(0)) detected by both programs was compared for all vowels. The correlation between the measures obtained by the Hoarseness Diagram and the features from the prosody module was computed. RESULTS: Both programs have problems in determining the F(0) of highly pathologic voices. Parameters like jitter, shimmer, F(0), and irregularity as computed by the Hoarseness Diagram from vowels show correlations of about -0.8 with prosodic features obtained from the text recordings. CONCLUSION: Voice properties can reliably be evaluated both on the basis of vowel and text recordings. Text analysis, however, also offers possibilities for the automatic evaluation of running speech since it realistically represents everyday speech.
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Fonética , Software de Reconocimiento del Habla , Voz Alaríngea/psicología , Ronquera/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Lectura , Acústica del Lenguaje , Trastornos de la Voz/diagnóstico , Calidad de la VozRESUMEN
OBJECTIVE: Tracheoesophageal voice is state-of-the-art in voice rehabilitation after laryngectomy. Intelligibility on a telephone is an important evaluation criterion as it is a crucial part of social life. An objective measure of intelligibility when talking on a telephone is desirable in the field of postlaryngectomy speech therapy and its evaluation. PATIENTS AND METHODS: Based upon successful earlier studies with broadband speech, an automatic speech recognition (ASR) system was applied to 41 recordings of postlaryngectomy patients. Recordings were available in different signal qualities; quality was the crucial criterion for this study. RESULTS: Compared to the intelligibility rating of 5 human experts, the ASR system had a correlation coefficient of r = -0.87 and Krippendorff's alpha of 0.65 when broadband speech was processed. The rater group alone achieved alpha = 0.66. With the test recordings in telephone quality, the system reached r = -0.79 and alpha = 0.67. CONCLUSION: For medical purposes, a comprehensive diagnostic approach to (substitute) voice has to cover both subjective and objective tests. An automatic recognition system such as the one proposed in this study can be used for objective intelligibility rating with results comparable to those of human experts. This holds for broadband speech as well as for automatic evaluation via telephone.
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Medición de la Producción del Habla/métodos , Software de Reconocimiento del Habla , Voz Alaríngea , Anciano , Procesamiento Automatizado de Datos/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Inteligibilidad del Habla , TeléfonoRESUMEN
In this study, structure and validity of the German version of the Voice-Related Quality of Life (V-RQOL) questionnaire and its correlation to age, gender, and type of dysphonia (organic vs. functional) were assessed. Correlations of the V-RQOL result on the one hand and emotional and physical complaints on the other hand were investigated. Data were collected in 62 adult patients with dysphonia of benign origin and the following results were found: the German version of the V-RQOL questionnaire describes voice-related quality of life in one single value. Age, gender and type of dysphonia do not influence its result. Dysphonic patients present with an increased number of emotional and physical complaints when compared with normative values derived from the literature. However, not all of these complaints correlate with voice-related quality of life at a significant level.
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Disfonía/fisiopatología , Calidad de Vida , Voz/fisiología , Adulto , Edad de Inicio , Anciano , Anciano de 80 o más Años , Disfonía/psicología , Emociones , Análisis Factorial , Femenino , Alemania , Humanos , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Encuestas y Cuestionarios , Adulto JovenRESUMEN
OBJECTIVE: This study focuses on the relation of smoking, carcinophobia and voice handicap in dysphonic patients. PATIENTS AND METHODS: Fifty-four German-speaking outpatient voice clinic attendees suffering from dysphonia of benign origin took part in this study. All patients completed the German version of the Voice Handicap Index (VHI) and were asked about their fear of suffering from laryngeal cancer without prior information about their diagnosis. RESULTS: Smokers did not fear to suffer from laryngeal cancer more than nonsmokers. However, former smokers were slightly more often found to be carcinophobic than nonsmokers. There was neither a significant difference in VHI scores comparing smokers to non- and former smokers nor when comparing carcinophobic to noncarcinophobic patients. CONCLUSION: Smoking may cause laryngeal cancer and influence the voice but does not affect patients' handicap due to dysphonia as measured by the VHI. Smoking habits do not influence the development of carcinophobia and carcinophobic dysphonic patients do not experience their voice problem differently than dysphonic patients without cancerophobia as measured by the VHI.
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Miedo/psicología , Neoplasias Laríngeas/psicología , Índice de Severidad de la Enfermedad , Fumar/psicología , Trastornos de la Voz/psicología , Adulto , Actitud Frente a la Salud , Enfermedad Crónica , Femenino , Alemania , Humanos , Laringitis/psicología , Masculino , Persona de Mediana Edad , Cese del Hábito de Fumar/psicología , Encuestas y Cuestionarios , Parálisis de los Pliegues Vocales/psicologíaRESUMEN
Tactile-kinesthetic perception (TKP) is the processing, arrangement, evaluation, and integration of sensations, which are transmitted via both surface and depth sensibility. In the phoniatric field TKP is of special importance for speech development. In this study, two German diagnostic test procedures for the assessment of TKP, i.e. the 'Diagnostischer Elternfragebogen zur taktil-kinasthetischen Responsivitat' (DEF-TK) and the 'Gottinger Entwicklungstest der taktil-kinasthetischen Wahrnehmung' (TAKIWA), were evaluated in 30 preschool children. The DEF-TK could not be analyzed in 14/30 of the children because of too many unobservable (not missing) items. This result does not correspond with data presented in the test manual but with results obtained in a former study of the reporting group. Three quarters of the children showed abnormal tactile-kinesthetic features in their DEF-TK, whereas in the TAKIWA test, a quarter of the children were found to have abnormal TKP. The DEF-TK questionnaire is not suited for clinical purposes. The nosologic and prognostic value of the TAKIWA has to be investigated in the future.
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Cinestesia , Tacto , Preescolar , Femenino , Humanos , MasculinoRESUMEN
OBJECTIVE: Evaluation of perceived subjective burden in mothers of speech-impaired children against the presence or absence of an emotional disorder. METHODS: 89 mothers (age 33.3 +/- 5.5 years, range: 19.6-43.8 years) of 89 preschool children (23 girls, 66 boys, age: 3.9 +/- 1.5 years, range: 1.6- 7.1 years) with specific speech impairment were investigated. German versions of the Hospital Anxiety and Depression Scale (HADS) and the Burden Scale for Family Caregivers (BSFC) were applied. RESULTS: 11% of the mothers met criteria for a depressive disorder (normal controls: 2.5%; p = 0.008). Twenty-eight percent of the mothers met criteria for anxiety disorders (normal controls: 9.6%; p = 0.000). The HADS depression subscore and the BSFC correlate with r = 0.75. The HADS anxiety subscore and the BSFC correlate with r = 0.59. CONCLUSIONS: Results suggest the need for routine clinical assessment of mothers' well-being when their children are affected by speech impairment.
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Trastornos de Ansiedad/etiología , Trastorno Depresivo/etiología , Niños con Discapacidad , Madres/psicología , Trastornos del Habla/psicología , Estrés Psicológico/etiología , Adulto , Trastornos de Ansiedad/diagnóstico , Trastornos de Ansiedad/epidemiología , Cuidadores/psicología , Preescolar , Trastorno Depresivo/diagnóstico , Trastorno Depresivo/epidemiología , Femenino , Humanos , Relaciones Madre-Hijo , Autoimagen , Autoevaluación (Psicología) , Índice de Severidad de la Enfermedad , Estrés Psicológico/diagnóstico , Estrés Psicológico/epidemiología , Encuestas y CuestionariosRESUMEN
OBJECTIVE: To compare the maturation of speech-evoked N170 components of cortical auditory evoked potentials with that of tone-evoked N1 components. PATIENTS AND METHODS: Cortical auditory evoked potentials to speech and tone stimuli were derived in 42 children from age 4 to 14 years. The N170 was derived from the difference curve of responses to monosyllabic words with initial consonant-to-vowel transitions and their intensity-equivalent noise signals. RESULTS: The incidence of N1 increased from 71% below age 9 to 91% above, that of N170 tended to increase from 40 to 67% above. From age 9, adult-like morphologies of the difference waveforms were found and the time constants of N1 and N170 latency maturation were nearly identical. CONCLUSION: The N170 component is interpreted as a response to speech-specific acoustic changes such as the consonant-vowel transition. The late appearance of N170 indicates an electrophysiological correlate of speech perception that continues to develop into adolescence. Its clinical application, however, is limited due to the low incidence of N170.
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Estimulación Acústica , Corteza Cerebral/fisiología , Potenciales Evocados Auditivos , Habla , Adolescente , Factores de Edad , Niño , Preescolar , Electroencefalografía , Potenciales Evocados Auditivos/fisiología , Femenino , Humanos , Masculino , Tiempo de ReacciónRESUMEN
In comparison with laryngeal voice, substitute voice after laryngectomy is characterized by restricted aero-acoustic properties. Until now, an objective means of prosodic differences between substitute and normal voices does not exist. In a pilot study, we applied an automatic prosody analysis module to 18 speech samples of laryngectomees (age: 64.2 +/- 8.3 years) and 18 recordings of normal speakers of the same age (65.4 +/- 7.6 years). Ninety-five different features per word based upon the speech energy, fundamental frequency F(0) and duration measures on words, pauses and voiced/voiceless sections were measured. These reflect aspects of loudness, pitch and articulation rate. Subjective evaluation of the 18 patients' voices was performed by a panel of five experts on the criteria "noise", "speech effort", "roughness", "intelligibility", "match of breath and sense units" and "overall quality". These ratings were compared to the automatically computed features. Several of them could be identified being twice as high for the laryngectomees compared to the normal speakers, and vice versa. Comparing the evaluation data of the human experts and the automatic rating, correlation coefficients of up to 0.84 were measured. The automatic analysis serves as a good means to objectify and quantify the global speech outcome of laryngectomees. Even better results are expected when both the computation of the features and the comparison method to the human ratings will have been revised and adapted to the special properties of the substitute voices.
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Procesamiento Automatizado de Datos , Voz Alaríngea , Voz Esofágica , Fístula Traqueoesofágica , Calidad de la Voz , Anciano , Humanos , Laringectomía , Masculino , Persona de Mediana EdadRESUMEN
Investigation of voice disorders requires the examination of vocal fold vibrations. State of the art is the recording of endoscopic high-speed movies which capture vocal fold vibrations in real-time. It enables investigating the interrelation between disturbances of vocal fold vibrations and voice disorders. However, the lack of clinical studies and of a standardized procedure to reconstruct vocal fold vibrations from high-speed videos constrain the clinical acceptance of the high-speed technique. An image processing approach is presented that extracts the vibrating vocal fold edges from digital high-speed movies. The initial segmentation is principally based on a seeded region-growing algorithm. Even in movies with low image quality the algorithm segments successfully the glottal area by an introduced two-dimensional threshold matrix. Following segmentation, the vocal fold edges are reconstructed from the computed time-varying glottal area. The performance of the procedure was objectively evaluated within a study comprising 372 high-speed recordings. The accuracy of vocal fold reconstruction exceeds manual segmentation results obtained by clinical experts. The algorithm reaches an information flow-rate of up to 98 images per second. The robustness and high accuracy of the procedure makes it suitable for the application in clinical routine. It enables an objective and highly accurate description of vocal fold vibrations which is essential to realize extensive clinical studies which focus on the classification of voice disorders.
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Endoscopía/métodos , Grabación de Cinta de Video/métodos , Pliegues Vocales/fisiología , Algoritmos , Humanos , VibraciónRESUMEN
BACKGROUND: In preliminary studies of mothers of children with developmental language disorders it was found that the mothers' quality of life was diminished and that they suffered from increased emotional disorders. Studies have shown that women with emotional problems also experience increased somatic afflictions. This phenomenon has not yet been confirmed in the context of mothers of children with developmental language disorders. MATERIALS AND METHODS: Ninety mothers (aged 21-48 years) of 90 preschoolers diagnosed with a developmental language disorder, but otherwise of normal development, were questioned using the Giessen Complaint Questionnaire (Giessener Beschwerdebogen, GBB), to assess their level of somatic complaints. The multivariate statistical method used was the regression analysis. RESULTS: In comparison to women of the same age in the normal population, the mothers in this study had significantly more somatic symptoms. This was shown to be true even for those mothers who, though specifically asked, could not name any particular illness. In mothers of children being treated for developmental language disorders, psychosomatic complaints occurred more frequently. The same result can be observed in mothers who perceived a lack of adequate support in caring for their children as opposed to those who perceived support to be adequate. CONCLUSIONS: Physicians and health workers treating children with developmental language disorders must reckon with a considerable number of mothers with somatic complaints. As these complaints often occur without any specific illness, they must be considered psychosomatic in nature. These findings are in accordance with earlier studies looking at the relationship between specific emotional disorders and diminished quality of life of those affected. Specific channels of help include utilization of self-help groups or mothers' groups, educational enhancement programs and speech therapists.
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Trastornos del Desarrollo del Lenguaje/epidemiología , Trastornos del Desarrollo del Lenguaje/psicología , Relaciones Madre-Hijo , Madres/psicología , Madres/estadística & datos numéricos , Trastornos Somatomorfos/epidemiología , Trastornos Somatomorfos/psicología , Adulto , Preescolar , Femenino , Alemania/epidemiología , Humanos , Masculino , Persona de Mediana Edad , PrevalenciaRESUMEN
OBJECTIVE: Cleft lip and palate (CLP) may cause functional limitations even after adequate surgical and non-surgical treatment, speech disorders being one of them. Interindividually, they vary a lot, showing typical articulation specifics such as nasal emission and shift of articulation and therefore a diminished intelligibility. Until now, an objective means to determine and quantify the intelligibility does not exist. METHOD: An automatic speech recognition system, a new method, was applied on recordings of a standard test to evaluate articulation disorders (psycholinguistic analysis of speech disorders of children PLAKSS) of 31 children at the age of 10.1+/-3.8 years. Two had an isolated cleft lip, 20 a unilateral cleft lip and palate, 4 a bilateral cleft lip and palate, and 5 an isolated cleft palate. The speech recognition system was trained with adults and children without speech disorders and adapted to the speech of children with CLP. In this study, the automatic speech evaluation focussed on the word accuracy which represents the percentage of correctly recognized words. Results were confronted to a perceptive evaluation of intelligibility that was performed by a panel of three experts. RESULTS: The automatic speech recognition yielded word accuracies between 1.2 and 75.8% (mean 48.0+/-19.6%). The word accuracy was lowest for children with isolated cleft palate (36.9+/-23.3) and highest for children with isolated cleft lip (72.8+/-2.9). For children with unilateral cleft lip and palate it was 48.0+/-18.6 and for children with bilateral cleft lip and palate 49.3+/-9.4. The automatic evaluation complied with the experts' subjective evaluation of intelligibility (p<0.01). The multi-rater kappa of the experts alone differed only slightly from the multi-rater kappa of experts and recognizer. CONCLUSION: Automatic speech recognition may serve as a good means to objectify and quantify global speech outcome of children with cleft lip and palate.
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Labio Leporino/fisiopatología , Fisura del Paladar/fisiopatología , Trastornos del Habla/diagnóstico , Inteligibilidad del Habla , Adolescente , Audiometría del Habla , Niño , Preescolar , Labio Leporino/complicaciones , Fisura del Paladar/complicaciones , Femenino , Humanos , Masculino , Proyectos Piloto , Análisis de Regresión , Trastornos del Habla/etiologíaRESUMEN
OBJECTIVE: Noise exceeding a certain level can damage outer hair cells and thus cause hearing loss. In the past, noise-induced hearing loss was mainly caused by occupational noise. Leisure-time noise may be a promoting factor, particularly in young adults. The purpose of this study was to investigate whether transient evoked otoacoustic emissions (TEOAE) can be used to evaluate outer hair cell damage in young adults with no history of hearing complaints. The data obtained from the measurement of TEOAE were correlated with the participants' listening habits and exposure to leisure-time noise. METHODS: Eighty-eight young adults (47 women, 41 men; age 22.9+/-2.9 years) were examined. TEOAE were measured using standard ILO 88 equipment. All participants had normal hearing (hearing thresholds better than 20 dB HL; frequency range 0.125-10 kHz). None of the participants suffered from permanent tinnitus. All participants answered a questionnaire concerning their listening habits. RESULTS: On average, the participants frequented a discotheque 1.4 times a month; 25% had never visited a discotheque, 35% visited once a month and 32% twice or three times a month. Sixteen per cent reported transient tinnitus after every visit to a discotheque and 58% after nearly every visit. Eight per cent suffered from transient hearing loss after every visit to a disco and 37% after nearly every visit. Three per cent (4%) reported tinnitus (nearly) every morning after visiting a discotheque. The TEOAE level was above 6 dB in all participants [9.2+/-3.6 dB (mean +/- SD)] and reproducibility was above 60% (90+/-9%). All values matched pass criteria for normal TEOAE under clinical conditions. However, TEOAE levels and reproducibility decreased significantly with an increased number of visits to discotheques. CONCLUSION: Outer hair cell damage could be measured using TEOAE in individuals exposed to leisure-time noise, although these individuals exhibited no measurable puretone hearing loss.
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Células Ciliadas Auditivas Externas/fisiopatología , Pérdida Auditiva Provocada por Ruido/diagnóstico , Actividades Recreativas , Ruido/efectos adversos , Adulto , Audiometría , Umbral Auditivo , Exposición a Riesgos Ambientales/efectos adversos , Exposición a Riesgos Ambientales/estadística & datos numéricos , Femenino , Pérdida Auditiva Provocada por Ruido/epidemiología , Humanos , Masculino , Música , Emisiones Otoacústicas Espontáneas/fisiología , Estudiantes de Medicina , Encuestas y CuestionariosRESUMEN
Substitute speech after laryngectomy is characterized by restricted aero-acoustic properties in comparison with laryngeal speech and has therefore lower intelligibility. Until now, an objective means to determine and quantify the intelligibility has not existed, although the intelligibility can serve as a global outcome parameter of voice restoration after laryngectomy. An automatic speech recognition system was applied on recordings of a standard text read by 18 German male laryngectomees with tracheoesophageal substitute speech. The system was trained with normal laryngeal speakers and not adapted to severely disturbed voices. Substitute speech was compared to laryngeal speech of a control group. Subjective evaluation of intelligibility was performed by a panel of five experts and compared to automatic speech evaluation. Substitute speech showed lower syllables/s and lower word accuracy than laryngeal speech. Automatic speech recognition for substitute speech yielded word accuracy between 10.0 and 50% (28.7+/-12.1%) with sufficient discrimination. It complied with experts' subjective evaluations of intelligibility. The multi-rater kappa of the experts alone did not differ from the multi-rater kappa of experts and the recognizer. Automatic speech recognition serves as a good means to objectify and quantify global speech outcome of laryngectomees. For clinical use, the speech recognition system will be adapted to disturbed voices and can also be applied in other languages.
Asunto(s)
Neoplasias Laríngeas/cirugía , Laringectomía/rehabilitación , Laringe Artificial , Inteligibilidad del Habla , Software de Reconocimiento del Habla , Calidad de la Voz , Humanos , Masculino , Persona de Mediana EdadRESUMEN
OBJECTIVE: To evaluate the vibration pattern of the substitute voice generator of patients who have undergone laryngectomy. For automatic quantification of the oscillations of the pharyngoesophageal (PE) segments, image processing of digital high-speed video sequences is applied. DESIGN: Physiologic analysis. SETTING: An acute care hospital. PATIENTS: Endoscopic recordings were taken of 10 men who underwent laryngectomy (mean +/- SD age, 61.5 +/- 5.2 years) during sustained phonation of a vowel using a 90 degree endoscope coupled to a high-speed camera. MAIN OUTCOME MEASURES: An image-processing algorithm was developed to automatically define the pseudoglottis in each recording and track its movements. RESULTS: The clinical assessment of the high-speed technique for the endoscopic examination of the substitute voice generator yields the following results. The forms and oscillation characteristics of the pseudoglottides varied considerably: 3 pseudoglottides were circular, 6 were split shaped, and 1 was triangle shaped. A quasi-periodic opening and closing were observed and automatically detected by the described algorithm in each recording independently from quality of the recording and from morphologic and oscillation characteristics of the PE segment. The frequencies of the extracted oscillations of the pseudoglottides correspond to the structure of the acoustic signals. CONCLUSIONS: Automatic image processing of PE segments derived from high-speed endoscopic recordings enables the detection and quantification of the substitute voice generator's oscillations in high temporal resolution. These data directly prove that the detected pseudoglottis is the source of the substitute voice. Close relations between substitute voice and functional properties of the PE segment exist. In the future, these data will be interpreted by applying biomechanical models of the PE segment. Presumably, results may help to optimize surgical and adaptive procedures for specific substitute voice restoration.