• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.24 no.2
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• pp.112-117
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• 2013

Background and Objectives : This study aimed to determine the clinical effect of $Artecoll^{(R)}$ injection laryngoplasty for patients with vocal atrophy and mild sulcus vocalis. Materials and Method : Forty-one patients with vocal atrophy and/or mild sulcus vocalis received transcutaneous $Artecoll^{(R)}$ injection into the vocal folds under local anesthesia. Subjective evaluations including voice handicap index (VHI) and perceptual grading with Grade, Roughness, Breathiness, Asthenia, Strain (GRBAS) scales and objective evaluations including jitter, shimmer, noise-to-harmonic ratio (NHR), speaking fundamental frequency (SFF) and maximum phonation time (MPT) were evaluated before and 3 months after the injection. Results : VHI and Grade, Breathiness and Strain scales in GRBAS showed significant improvement 3 months after injection. SFF and MPT also significantly improved after the injection ; MPT increased and SFF in male patients decreased. Conclusion : Injection laryngoplasty with $Artecoll^{(R)}$ is an effective method for correcting the glottal insufficiency and improving voice quality in patients with vocal atrophy and/or mild sulcus.

• Speech Sciences
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• v.15 no.2
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• pp.131-141
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• 2008

The purpose of this study was to find out the acoustic variation on the pre-and post respiration and oral motor for children with cerebral palsy. Five children with spastic CP at the age of 6 in average were practiced by a caregiver at home each for 25 minutes, in total, 45 times. The sustained of vowel /a/ and vowels /a/, /i/, /u/, /e/, /o/ were recorded on CSL and MDVP and analyzed by acoustic parameters. As a result, the maximum phonation time(MPT) was increased from 2.06 to 6.31 and the formant of vowels(F1, F2, F3) had significant differences in F1(/a, i/), F2(/i.u.o/), and F3(/a/) between the controls and the children with CP in pre-treatment. The total average value of vowels had significant differences between the pre-and post-treatment (p< .05). The energy of vowels had significant differences in the vowels /i, u, e, o/ and the total average value between the pre-and post-treatment(p< .001). The jitter percent, shimmer percent, and noise to harmonic ratio had significant differences between the pre-and post-treatment(p< .05). As the respiration and the oral motor improved MPT, voice quality, and articulation of vowel, and the variation of the formant(F1, F2, F3) showed the changes in the shape of lips, the place and the height of the tongue, the various development of therapy programs and the consistent intervention of treatment is needed for the children with cerebral palsy.

• Phonetics and Speech Sciences
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• v.4 no.4
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• pp.139-146
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• 2012

This study was designed to examine comfort levels of pitch and loudness with target matching and their effects on electroglottographic (EGG) and acoustic measures. Twelve speakers, six males and six females, were instructed to produce /a/ sustained vowel for three seconds at a comfortable pitch and loudness level without any instruction and with a target matching procedure of either a certain f0 or SPL separately with visual and auditory feedback. The range of pitch for females and males were presented by progressing up and down randomly at intervals of 5Hz from 150 Hz to 310 Hz (total 33 frequency targets) and from 85 Hz to 190 Hz (total 22 frequency targets), respectively. The loudness levels were 65, 75, 85, 95 dB (total of four intensity targets) for both males and females. Subjective estimations of comfortable levels were obtained using a 10-point equal-appearing interval rating scale following each phonation. The results showed that males and females demonstrated similar trends in loudness levels with greatest comfort at 75 dB, whereas pitch comfort ratings showed a greater variability with females having a wider range with target matching. In the comfort levels of individuals, most male and female speakers rated higher comfort at soft, rather than loud phonations. On the other hand, most male speakers perceived highest comfort levels below the comfort pitch levels they phonated under natural conditions. Higher frequency ranges, however, were perceived to be more comfortable than those of natural condition in most female speakers, although the comfortable pitch levels in spontaneous phonations were within the comfort level ranges determined by targeted phonations. When comparing acoustic (%jitter, %shimmer, SNR) and EGG measures (CQ%) between spontaneous comfortable phonations and targeted phonations produced by the same subject at similar f0 and intensity, no significant differences were observed (p>0.05). Thus, target matching procedures may be considered a compatible and alternative method to reduce the variability of comfortable pitch and loudness levels by eliciting consistent comfortable phonations.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.9 no.1
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• pp.66-70
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• 1998

Background and Objectives : The managements of unilateral vocal cord palsy include type Ⅰ thyroplasty and arytenoid adduction. One type operation has been shown no satisfactory effect. We evaluated preoperative and postoperative speech of unilateral vocal cord palsy patients who received combined operation of type Ⅰ thyroplasty and arytenoid adduction to help for the management plan of unilateral vocal cord palsy patients. Materials and Methods : We reviewed the postoperative results and complication of 17 surgically treated patients of unilateral vocal cord palsy at Severance hospital from Nov. 1996 to Dec. 1997 retrospectively. They were received combined operation of type Ⅰ thyroplasty and arytenoid adduction. Their pre and post-operative speech were analyzed with MDVP(Multi-Dimension-Voice analysis Program) of CSL(Computerized Speech Lab). Results : After the operation, MPT(Maximal Phonation Time) was increased and MFR(Mean Flow Rate) was decreased in all patients. NHR(Noise to Harmonic Ratio) and VTI(Voice Turbulence Index) were decreased : liner, RAP(Relative Average Perturbation Quotient), PPQ(Pitch Period Perturbation Quotient), sPPQ(smoothed Pitch Period Perturbation Quotient), vFo(fundamental frequency Variation) were decreased : Shimmer, APQ(Amplitude Perturbation Quotient), sAPQ(Smoothed Amplitude Perturbation Qoutient), vAm(Peak Amplitude Variation) were decreased in all the patients. Conclusions : In unilateral vocal cord pals), combined operation of type Ⅰ thyroplasty and arytenoid adduction could obtain satisfactory postoperative voice. MDVP has many parameters and good method for evaluation of voice surgery.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.16 no.2
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• pp.129-134
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• 2005

Background and Objectives : Artecoll(R) is an injectable soft tissue filler, which is a suspension of polymethylmethacrylate microspheres in $3.5\%$ bovine collagen solution. The authors aimed to determine the clinical of Artecoll of Artecoll(R) as an injection material into the vocal fold to correct the glottal insufficiency caused by unilateral vocal cord paralysis. Materials and Methods : Forty-one consecutive patients with unilateral vocal cord paralysis received percutaneous Artecoll injections under local anesthesia. Acoustic, aerodynamic and stroboscopic analyses were prospectively provided before, 1 week and 3 months after injection. Perceptual GRBAS grading by speech language pathologists and subjective ratings of the hoarseness and aspiration by the patients were also obtained. Results : Aerodynamic parameter(maximal phonation time) were significantly improved after the injection (p<0.05). Acoustic parameters (jitter and shimmer) were improved at the 3rd month follow-up. GRBAS uading and patients own subjective scaling of hoarseness and aspiration also showed significant improvement (p<0.05). Early or delayed significant side effects were not observed. Conclusion : Vocal fold injection with Artecoll is a convenient, safe and useful method of temporarily correcting the glottal insufficiency. Further long-term follow-up studies will answer the usefulness and safety of the Artecoll injection laryngoplasty.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.10 no.2
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• pp.135-139
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• 1999

Objectives : The purpose of this study was to systematically analyze and compare the acoustic characteristics of vocal major students with vocal nodule when singing. Materials and Methods : Ten sopranos with vocal nodule, who have never been treated due to voice problems, were the subject group. Twenty healthy sopranos major students were the control group for this study. The vocal nodule was confirmed by stroboscopy and the acoustic and electroglottographic analysis was conducted on be groups. Additionally, an inquiry on usual voice problems during speaking and singing were performed on each of the groups. Results : The vowel /a/ was spoken and sung by sopranos of each group. There were no significant differences in Fo, jitter, shimmer, NHR at speaking and singing in either group. We did not register any significant differences of closed quotient and speed quotient in electroglottography for both groups at singing, but speed quotient was increased in subject group at speaking(p＜0.05). And the sopranos with nodule demonstrated voice fatigue(70%), strained and tired voice after long period of performance and conversation(60%) on inquiry. Conclusions : Although they had a vocal nodule, this group, who had a long period of voice training, did not present any differences in acoustic and electroglottographic problems during short performance, but, the vocalists noticed delicate voice problems after a long performance. We conclude that the voice training teacher and laryngologist must initiate voice management and speech therapy for vocal nodule, even if there is no specific abnormality in acoustic analysis.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.13 no.1
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• pp.18-22
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• 2002

Background and Objectives : It has been pointed out that alcohol intake in human beings induces changes in voice register and maximum phonation time. These changes supposedly result from injection of the vibratory vocal folds. The purpose of this study was to clarify the voice changes associated with alcohol intake and the changes of laryngeal mucosa. Materials and Methods : The subjects included 29 volunteers, including 20 men and 9 women ranging in age from 22 to 31 years. Alcohol intake was accomplished by oral administration of 23% soju 1 bottle (255cc). Serum alcohol concentration levels were evaluated hourly for 3 h after ingestion of alcohol. Seven measurements were performed at pre-alcohol intake and post-alcohol intake hourly : fundamental frequency, jitter, shimmer, noise to harmonic ratio as the acoustic analysis, maximal phonation time, mean flow rate, and subglottal pressure as the aerodynamic analysis. The changes of laryngeal mucosa were evaluated by flexible laryngoscope at each measurement. Results : By comparing the acoustic and aerodynamic data and laryngeal mucosa before and after alcohol intake, there were not remarkable changes (p>0.05). Conclusion : The voice and laryngeal mucosa have not remarkably changed according to alcohol concentration in this study. Furthermore studies on the voice change induced by multiple alcohol concentrations are required.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.10 no.2
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• pp.124-129
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• 1999

Background and Objectives : Classical singers are capable of masking abnormalities due to their high level of training and may present with apparent technical deficits rather than with obvious dysfunction. Therefore, some variations from expected normal laryngeal behavior may be present in trained classical singers. Consequently it is important for otolaryngologist to obtain a baseline assessment of their laryngeal function. Materials and Methods : Acoustic measurement including strobovideolaryngoscopy from 50 classically trained singers was done for this study, which was compared with the data from 20 untrained adults. Results and Conclusion : This study showed that 50-healthy asymptomatic classical singers revealed an incidence of 50% abnormal strobovideolaryngoscopic findings, but their acoustic data was within normal limit despite the abnormal laryngeal findings. Therefore the author recommends that the classical singers need objective voice analysis and their baseline data should be used for the accurate diagnosis of the cause of voice dysfunction In classical singer whose baseline laryngeal behavior may be unusual.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.19 no.2
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• pp.117-122
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• 2008

Background and Objectives: $Radiesse^{(R)}$ is a gell-formed material of calcium hydroxylapatite (CaHA) and carboxymethylcellulose (CMC) used for vocal fold injections. The authors aimed to study injection laryngoplasty with $Radiesse^{(R)}$, and determine the efficacy of $Radiesse^{(R)}$ for unilateral vocal cord palsy using objective and subjective measures. Materials and Method: Nine patients with unilateral vocal cord palsy received injection laryngoplasty with $Radiesse^{(R)}$ under general anesthesia from Jul. 2007 to Jan. 2008. $Radiesse^{(R)}$ was injected with 25gauze long needle perorally or percutaneously. The Acoustic, aerodynamic, stroboscopic analysis and pre-injection/post-injection perceptual assessment were evaluated in all patients. Results: Postoperative jitter and shimmer scores tended to diminish compared to preoperative scores, and maximum phonation time increased with statistical significantly. Stroboscopic findings demonstrated improvement postoperatively. The degree of hoarseness, which is a part of perceptual assessment, decreased after the procedure. Conclusion: $Radiesse^{(R)}$ may be an altemative material for injection laryngoplasty. We suggest long-term follow up with more cases.

• Phonetics and Speech Sciences
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• v.3 no.3
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• pp.133-140
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• 2011

Muscle misuse dysphonia (MMD) is defined as a behavioral voice disorder resulting from inappropriate contractions of intrinsic and/or extrinsic laryngeal muscles. The purpose of this study was to investigate the effect of motor learning guided laryngeal motor control therapy (MLG-LMCT) which is designed to improve an existing LMT and further the effective voice treatment on people with muscle misuse dysphonia. Forty-six people with MMD (M:F=16:30) participated in this study. The voice samples of the participants were recorded to investigate the effect of MLG-LMCT before and after the voice therapy. Voice samples were analyzed via electro-glotto-graph (EGG). Contact quotient (CQ), speed quotient (SQ), and waveform were reported. In addition, perceptual and acoustical evaluation were conducted to determine the change of voice improvement after treatment. The experimenter massaged the tensioned muscles around the neck. In order to find more proper phonation the experimenter showed the subjects their EGG wave forms as to whether or not they are moving the vocal folds to the appropriate position. Therefore, the EGG wave forms were used as a type of visual feedback. With the wave form, the experimenter helped subjects move the vocal folds and laryngeal muscles to find more proper voice production. The sensory stimuli from the experimenter gradually faded out. A paired dependent t- test revealed that there was significant differences in CQ between pre- and post-therapy. Perceptually, overall, rough, breathy, strain, and transition were significantly reduced. Acoustically, there were significant differences in Fo, jitter, shimmer, and NHR. After using MLG-LMCT, most of the subjects showed improvements in voice quality. The results from this study led us to the following conclusions: Motor learning guided laryngeal motor control therapy (MLG-LMCT) has reduces muscle misuse dysphonia. These results may occur because a visual feedback from EGG wave form can maintain the effect of the muscle tension reduction from laryngeal manual therapy. In case of people with MMD who reduced muscle tension from the therapy (LMT) but, not appropriately manipulating the location of larynx or adducting the vocal folds, MLG-LMCT might be an alternative therapy approach.