• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.27 no.2
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• pp.102-107
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• 2016

Background and Objectives : Vocal polyps are caused by inflammation induced by stress or irritation. Many patients with vocal polyps complain voice discomfort. For vocal polyps, surgery such as laryngeal microsurgery has been the mainstay of management. We analyzed the clinical features of vocal polyps, and how the size and location of vocal polyps affect the outcomes of surgery. Methods : We retrospectively reviewed 42 patients from March 2014 to December 2015, who were diagnosed as unilateral single vocal polyp. When we operated on a vocal polyp with laryngeal microscopy, we measured their size and location. The quality of voice was evaluated by GRABS scale, jitter, shimmer, NHR (noise to harmonic ratio), MPT (maximum phonation time), and VHI (voice handicap index) before operation and 4 weeks after operation. Results : When we divided the patients into large-sized vocal polyp group (the longest length >3 mm) and small-sized vocal polyp group (the longest length ${\leq}3mm$), all parameter differences tend to be greater at large sized vocal polyp. However, these differences were not statistically significant (p>0.05). When we divided into two groups depending on the volume of vocal polyp, no distinct tendency was found. When we compared the location (anterior, mid and posterior) of vocal polyp with the improvement of voice quality, more change was found at mid portion vocal polyp, except the difference of VHI. However, these differences were also not statistically significant (p>0.05). Conclusion : All parameter differences tend to be greater at large vocal polyp and polyp of the mid location.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.27 no.2
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• pp.108-113
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• 2016

Background and Objectives : After thyroidectomy, many patients experience problems report such things as reduced voice range and vocal fatigue, swallowing problems without superior and recurrent laryngeal nerve injury. The purpose of this study was to evaluate voice and swallowing problems before and after thyroid surgery without laryngeal nerve injury. Materials and Methods : Ninety-three patients who underwent thyroidectomy without laryngeal nerve injury and completed the follow-up evaluations were studied between June 2013 and December 2015. Each evaluation was performed preoperatively, as well as 1 week, 1 month postoperatively. Analysis was performed including voice handicap index (VHI), dysphagia handicap index (DHI), and acoustic voice analysis. Results : Patients show significant variation of parameters in the fundamental frequency (F), maximal phonation time (MPT), shimmer, jitter and soft phonation index (SPI) early after operation, and most of them showed recovery of parameters after 1month of operation. Perceptive complaint of voice and swallowing also showed significant decreased after operation (p<0.005). After 1month of operation, MPT, highest frequency and frequency ranges still showed significant decreased parameters. Comparing acoustic and perceptive parameters of total thyroidectomy and lobectomy, there was no significant changes between them except highest frequency (p=0.042). Conclusion : The results from both subjective and objective evaluations show voice and swallowing disturbance after thyroidectomy even in the absence of laryngeal nerve and provide patients information about the recovery process after surgery. Highest frequency parameter showed most significant changes after operation.

• Speech Sciences
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• v.10 no.3
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• pp.7-27
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• 2003

Esophageal Speech uses the esophageal air during phonation. Fluent esophageal speakers frequently intake air in oral communication, but unskilled esophageal speakers are difficult with swallowing lots of air. The purpose of this study was to investigate the difference of acoustic characteristics of vowel and consonants production according to the speech proficiency level in esophageal speech. 13 normal male speakers and 13 male esophageal speakers (5 unskilled esophageal speakers, 8 skilled esophageal speakers) with age ranging from 50 to 70 years old. The stimuli were sustained /a/ vowel and 36 meaningless two syllable words. Used vowel is /a/ and consonants were 18 : /k, n, t, m, p, s, c, $C^{h},\;k^{h},\;t^{h},\;p^{h}$, h, I, k', t', p', s', c'/. Fundermental frequency (Fx), Jitter, shimmer, HNR, MPT were measured with by electroglottography using Lx speech studio (Laryngograph Ltd, London, UK). 36 meaningless words produced by esophageal speakers were presented to 3 speech-language pathologists who phonetically transcribed their responses. Fx, Jitter, HNR parameters is significant different between skilled esophageal speakers and unskilled esophageal speakers (P<.05). Considering manner of articulation, ANOVA showed that differences in two esophageal speech groups on speech proficiency were significant; Glide had the highest number of confusion with the other phoneme class, affricates are the most intelligible in the unskilled esophageal speech group, whereas in the skilled esophageal speech group fricatives resulted highest number of confusions, nasals are the most intelligible. In the place of articulation, glottal /h/ is the highest confusion consonant in both groups. Bilabials are the most intelligible in the skilled esophageal speech, velars are the most intelligible in the unskilled esophageal speech. In the structure of syllable, 'CV+V' is more confusion in the skilled esophageal group, unskilled esophageal speech group has similar confusion in both structures. In unskilled esophageal speech, significantly different Fx, Jitter, HNR acoustic parameters of vowel and the highest confusions of Liquid, Nasals consonants could be attributed to unstable, improper contact of neoglottis as vibratory source and insufficiency in the phonatory air supply, and higher motoric demand of remaining articulation due to morphological characteristics of vocal tract after laryngectomy.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.22 no.2
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• pp.137-142
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• 2011

Background and Objectives : The aim of this study is to introduce Korea version of pediatric VHI and to compare pVHI-K scores between children with dysphonia and children without voice problems before pVHI-K is developed as a preliminary study. Additionally, the relationship between pVHI and acoustic measures were investigated. Materials and Methods : pVHI-K scores in normal group were obtained from 15 parents who have children with no present or past history of a voice disorder, hearing loss, or related disability that can affect the their voice or speech. Dysphonia group consisted of 15 parents who have children with bilateral vocal fold nodule's at Department of Otolaryngology, the Seoul National University Hospital (SNUH). pVHI-K and acoustic parameters were measured in two group. Results : The mean pVHI scores (total, functional, physical, emotional) in normal group were 2.33 (T), 0.80 (F) 1.33 (P) and 0.27 (E), respectively whereas those of pVHI in children group with dysphonia were 23.13 (T), 11.07 (F), 5.73 (P) and 6.13 (E), respectively and significant differences were revealed in total pVHI score as well as in all of the sub-pVHI scores. Moreover, significant correlation between pVHI-K parameters (T, F, P) and acoustic measures [Shimmer(%)] were shown in children in dysphonia group. Conclusion : Reported by parents can be useful as a supplementary clinical tool for diagnosing and measuring treatment effectiveness in young children with dysphonia.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.20 no.1
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• pp.63-67
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• 2009

Background and Objectives: In patients with asthma, increased obstruction and resistance of airway result in impairment in the generation of voice. Allergy and nasal polyposis, which are frequently observed in patients with asthma, are other factors that affect the vocal performance. Bronchodilators and steroids are commonly used in the treatment of asthma, and these agents also have been reported to be associated with voice changes. The aim of this study is to evaluate the voice quality in patients with mild to-moderate asthma by subjective and objective methods. Materials and Methods: A total of 36 patients with asthma established in the Department of Respiratory Medicine were included in this study. 23 were women and 13 were men, with a mean age of 51.7 years. The average duration of asthma was 77.0 months. All patients had mild-to moderate asthma. Acoustic and aerodynamic analyses were performed and the movements of the vocal cords were examined by videolaryngostroboscopy (VLS). Voice Handicap Index (VHI) and GRABS scales were used for subjective evaluations. Results: 50% of patients suffered from dysphonia and FO was 119.3${\pm}$23.7 Hz in male and 198.2${\pm}$18.4 Hz in female patients. There were no significant differences in average shimmer and NHR between females (4.90${\pm}$2.95% ; 0.1O${\pm}$0.04 dB) and males (4.64${\pm}$2.45% ; 0.20${\pm}$0.15 dB). However, the value of jitter was greater for females (2.60${\pm}$1.92%) than for males (1.21${\pm}$0.84%). The VHI score was above the normal limit in 35%, and VLS findings were shown diverse abnormality in 89% asthmatics from mucosal change to hyperfunction of supragottis and contact granuloma. But duration of illness and steroid dose did not correlate with these findings. Conclusion: Subjective and objective abnormality was shown in more than 50% of asthmatic patients. We suggest that persons who suffer from asthma should be examined for possible voice disorders by laryngologist. Additionally, appropriate medical care and voice therapy should be provided for those who have voice disorders associated with asthma.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.20 no.1
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• pp.57-62
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• 2009

Background and Objectives : There are few studies reported that specifically examine the laryngeal function in patients with profound hearing loss or deafness, This study was designed to examine videostroboscopic findings and phonetic characteristics in adult patients with prelingually deaf. Materials and Method: Sixteen patients (seven males, nine females) diagnosed as prelingually deaf aged from 19 to 54 years, and were compared with a 20 normal control group with no laryngeal pathology and normal hearing group, Videostroboscopic evaluations were rated by experienced judges on various parameters describing the structure and function of the laryngeal mechanism during comfortable pitch and loudness phonations. Acoustic analysis test were done, and a nasalance test performed to measure rabbit, baby, and mother passage. CSL were measured to determine the first and two formant frequencies of vowels /a/, /i/, /u/, Statistical analysis was done using Mann-Whitney U or Wilcoxon signed ranks test. Results: Videostroboscopic findings showed phase symmetry but significantly more occurrences decrement in the amplitude of vibration, mucosal wave, irregularity of the vibration and increased glottal gap size during the closed phase of phonation, In addition, group of prelingually deaf patients were observed to have significantly more occurrences of abnormal supraglottic activities during phonation. The percentage of shimmer in the group of prelingually deaf patients were higher than in the control group. Characteristics of vowels were lower of the second formant of the vowel /i/. Nasalance in prelingually deaf patients showed normal nasality for all passages, Conclusion: Prelingually deaf patients show stroboscopic abnormal findings without any mucosal lesion, suggesting that they have considerable functional voice disorder. We suggest that prelingually deaf adults should perform vocal training for normalized laryngeal function after cochlear implantation.

• Journal of Sasang Constitutional Medicine
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• v.17 no.1
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• pp.67-83
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• 2005

1. Objectives The purpose of this study lies on the objectification of the Sasang Constitutional diagnosis. This study was analyzing the constitutional characteristic of adult men voices by PSSC-2004. 2. Methods The study was conducted on the subjects inputted /a/ 2.5-3 sec of 231 adult men voices to PSSC-2004. The statistical analyses are applied to three groups: total group, under 55 year-old group, over 55 year-old group. The group of total 231 was composed with 5 Taeyangins, 32 Soyangins, 102 Taeumins and 92 Soeumins. The under 55 years old group was composed with 4 Taeyangins, 23 Soyangins, 83 Taeumins and 77 Soeumins. The over 55 year-old group was composed with 1 Taeyangin, 9 Soyangins, 19 Taeumins and 15 Soeumins. 3. Results 1) In total group, the Soeumin's mean value of center pitch(4)$(1,000{\sim}2,000Hz)$ was significantly high compared with the others (P=0.034). 2) In total group, the Soeumin's group 3 APQ was significantly low compared with the others (P=0.042). 3) In under 55 year-old group, the Soeumin's center value of center pitch 4$(1,000{\sim}2,000Hz)$ was significantly high compared with the others (P=0.025) 4) In over 55 year-old group, no statistical significance was found between the Taeyangin, Soyangin, Taeumin and Soeumin. 4. Conclusions In under 55 year-old group, Soeumin's voice showed high pitched sound (clearness) at the low frequency (1000-2000Hz). In over 55 year-old group, there is no significant differences. This fits in with that 'Soeumin's voice is 'Yu-tone' born by 'Shang-tone', very short and high.' 'Yu-tone' corresponds to 'Ra' and witch is highest among Gong, Shang, Gao, Chi and Yu. This is related with the appearance that the Soeumin's voice is weak, thin and high tone. Therefore it is supposed that Soeumin adult men's voices are thick, and there are vibrations of the ending. It is accepted one of the Soeumin's characters like as a mild tremor of limbs and deep breath caused by Soeumin's Qi-deficiency. This outcome accords with the theory that Soeumin's Qi is less than the Other constitutions.

• Phonetics and Speech Sciences
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• v.2 no.4
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• pp.245-252
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• 2010

Korea does not have a certain criteria on the respiratory ability and phonation of the normal aged, and also has no clear standard to examine the boundaries of geriatric diseases. This study analyzed the characteristics in respiration and phonation of the aged in normal healthy elderly from diverse angles with different variables. Thirty-three participants in total, seven males and eight females in the age group 55-64 participated in the study. Seven males and eleven females in the age group 65-74 were selected for the respiration and phonation experiments, and 10 different variables such as FVC, $FEV_1$, $FEV_1$/FVC, MPT, MFR, Psub, f0, jitter, shimmer and NHR were comparatively analyzed for each group of different age and gender. To see the difference in respiration and phonation by age and gender, the study conducted a two-way ANOVA. First, from the result of the analysis on respiratory ability, FVC of male appeared to be significantly greater than female. In both age groups of 55-64 and 65-74, male displayed greater FVC than female did. Second, as for $FEV_1$, $FEV_1$/FVC, the age group of 55-64 showed greater values than the values measured in the age group of 65-74. Third, MFR showed a significant difference by gender. In both age groups, male showed significantly higher MFR than female. Fourth, for different gender, a significant difference in MFR was observed. In both age groups of 55-64 and 65-74, male exhibited higher MFR than female. This study has a clinical implication in that it analyzed the criteria on respiration and phonation in normal healthy elderly according to gender and age. The normal aged showed a difference in their respiratory and phonatory functions by age and gender, it was closely related to the decline of pulmonary function due to the physical aging and the weak respiration coming from weakness of respiratory muscles. Also, the physical differences in height, weight, and the muscles in laryngeal and respiratory system between males and females had an influence on the performance. These results from this study might be a helpful guideline for the clinical criterion in the future.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.18 no.1
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• pp.39-43
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• 2007

Background and Objectives: There are few studies reported that specifically examine the phonetic characteristics and voice handicap index (VHI) in patients with Allergic Rhinitis. This study was designed to examine phonetic characteristics and VHI in adult patients with allergic rhinitis. Materials and Methods: Forty-two male patients diagnosed as allergic rhinitis were given skin-prick test and others, aged from 20 to 56 years, and were compared with a 16 male control group with no pathology and in the same age group. The VHI was used to measure the changes of patient's perception. Acoustic and aerodynamic analysis test were done, and a nasalance test performed to measure rabbit, baby, and mother passage. Acoustic rhionometry (AR) was performed to evaluate nasal volume and nasal crosssectional area. Statistical analysis was done using independent sample t-test. Results: VHI showed significantly different score in the studied group, higher than that of control group. AR graph showed that there was no significant differences of nasal volume and nasal cross-sectional area. The Shimmer and SFF value in the group of allergic patients were higher than in the control group. MPT value in the group of allergic patients was lower than in the control group. Nasalance in allergic patients showed hypernasality all passage. Conclusion: We suggest that patients with allergic rhinitis have considerable voice problems. Most of them have hypernasality, which may be a compensatory mechanism by nasal obstruction.

• 재활복지
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• v.22 no.1
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• pp.169-194
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• 2018

The aim of this study is to examine changes in swallowing function and quality of life with therapeutic singing-based music therapy for patients with dysphagia. The music therapy program was based on the previous study (Kim, 2010), and designed to improve breathing, phonation, and swallowing functions focusing on laryngeal elevation. Three patients with dysphagia participated in this study and each participant received a total of 11 or 12 individual music therapy sessions and each session was conducted for 30 minutes. In this study, three kinds of measurements were used. First, the measures of maximum phonation time (MPT), fundamental frequency, average intensity, jitter, shimmer, noise to harmonics ratio (NHR) by Praat test, second, laryngeal-diadochokinesis (L-DDK) to investigate laryngeal elevation, and last, the Swallowing-Quality of Life (SWAL-QOL) was measured. These cases have shown improved breathing, phonation, swallowing function, and the scores of SWAL-QOL in all of the patients. It suggests that this music therapy intervention was effective on laryngeal elevation, and the music intervention with therapeutic singing can be effectively implemented in further research for patients with dysphagia.