• 대한약침학회지
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• 제17권3호
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• pp.57-61
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• 2014

Objectives: When a person speaks, voice problems usually include pain or discomfort and/or difficulties in terms of the pitch, the loudness and the quality of the voice. When patients with voice problems induced by stroke, Parkinson's disease, and systemic diseases involving the voice are examined, generally, of the Four Diagnoses (四診), a Diagnosis of Hearing can be used in current Korean medicine. The effects of acupuncture and herb medicine on voice problems have been reported for over 20 years. However, when it comes to improvements, objective and subjective evaluation methods need to be explained. Methods: Subjective methods for evaluating voice were studied through a literature search of old medicinal books containing Korean medicine diagnostics, and an objective evaluation method using Praat software is presented. Results: Korean medicine doctors analyze the patient's voice in clinical settings unconsciously on a daily basis. However, most voice diagnoses depend on the doctor's subjective evaluation. Voice qualities can be evaluated by using the Eight Principles (八綱), including Yin-Yang; the Five Elements (Phases); the Grade, Roughness, Breathy, Asthenic, Strained (GRBAS) score, and the Visual Analogue Scale (VAS) as subjective methods, and an acoustic analysis using the Praat program can be used as an objective method. Conclusion: A more complete voice examination can be achieved by using subjective and objective methods at the same time. For an objective explanation and management of patient's voice problems or systemic disorders, an objective method should be used in Korean medicine, which already has many subjective diagnostic methods. More research needs to be conducted, and more clinical evidence needs to be collected in the future.

• 음성과학
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• 제10권4호
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• pp.201-219
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• 2003

Background: The perceptual assessment is generally performed by the voice specialist. The objective evaluation is performed in a voice laboratory. Research in voice laboratories has generated a variety of different objective tests and parameters. The perceptual evaluation is one of the most controversial topics in voice research. Review of literature reveals a wide variety of rating scales and reliability data fluctuating from study to study. Unfortunately, there is no widely accepted valid method for classifying voice disorders and assessing outcome after voice treatment. Objectives: The goals of this research were to identify important objective acoustic parameters of vocal quality, and to establish an objective and quantitative correlate of the perceived vocal quality. Materials and Methods : We evaluated the voice analyzed data from 122 dysphonic patients and 20 normal volunteers. A computerized speech lab. 4300B(CSL) was used to carry out the analysis of each voice sample. Results: Three dysphonia severity indices(DSI) were created using discriminant analysis. DSI is based on the weighted combination of the following selected set of acoustic parameters: absolute jitter(Jita in us), smoothed pitch period perturbation (sPPQ in %), amplitude perturbation quotient(APQ in %), soft phonation index(SPI), average fundamental frequency(Fo in Hz), lowest fundamental frequency(Flo in Hz), and smoothed amplitude perturbation quotient(sAPQ in %). The DSI, being the discriminating rule calculated by the logistic regression, consists of three equation based on statistically significant acoustic parameters. Three DSI were created to reflects best the degree of hoarseness as expressed by G from the GRBAS scale. The more positive this DSI is for a patient, the worse the vocal quality. The more it is negative, the better it is. The effect of sex is included implicitly in the DSI-1 and DSI-2, so that a separate DSI-1 and DSI-2 for males and females need not be used. The DSI is objective because no perceptual input is required for its calculation. Conculsion : This research demonstrates that the voice function values calculated from three different multivariate objective dysphonia severity indices are significantly associated with subjective voice assessments. These multivariate objective dysphonia severity indices may be appropriate for use in clinical trials and outcomes research on treatment effectiveness for voice disorders.

• 대한후두음성언어의학회지
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• 제13권2호
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• pp.151-154
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• 2002

Background and Objectives : The pitch range of the human voice is variable, extending from chest register to falsetto register. Although numerous studies have investigated after laryngeal mechanism description of falsetto tone, systematic and objective studies were lack. The purpose of this study was to systematically analyze and compare modal with falsetto voice. Materials and Methods : Seven adult baritones were selected from a larger population of volunteers at choir. Simultaneous measurements of acoustic, electroglottographic and aerodynamic study were made during /e/ sustained in two vocal registers, lowest modal and highest falsetto. Statistical analysis was performed using Wilkoxson signed rankes test. Results : In the acoustic analysis, shimmer was increased in flasetto voice(p<0.05). In the electroglottographic analysis, closed quotient(CQ), speed quotient(SQ) at the modal voice were higher than at the falsetto voice(p<0.05). In the aerodynamic analysis, and airflow rate(MFR) of falsetto voice was higher than modal voice(p<0.05). Conclusions : In the results of the study indicate that, falsetto register ineffective, inefficient, generally unpleasant because it was produced by incomplete clousure of true vocal cord. We anticipated that further study with large samples can provide an objective criteria for status and classification of singer's modal and falsetto voice.

• 말소리와 음성과학
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• 제3권3호
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• pp.167-172
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• 2011

The purpose of this study was to examine the relationship between subjective and objective evaluation in speakers with voice disorders. Subjective evaluation indicates the self-reports of voice problems by dysphonic speakers. The relating protocol is the Voice Handicap Index (VHI) and the self-awareness index of voice problems (SAIVP-14). A total of 48 individuals with voice disorders replied to the questionnaire and participated in a voice assessment. Objective evaluations included the perceptual judgement of G grade in GRBAS, acoustic measurements (jitter, shimmer, NHR) by MDVP (CSL 4400), and aerodynamic measurements (MPT, MFR, psub) by PAS (Phonatory Aerodynamic System, KayPentax, USA). Pearson and Spearman correlations were used for the analysis. In the correlation with perceptual judgement (G grade) and VHI-Total, VHI-Physical, and SAIVP-14, there was a significant correlation, but the overall correlation was poor. NHR, jitter, and shimmer were significantly correlated with overall VHI and SAIVP-14. Specifically, the correlation with shimmer was stronger compared to the other measurements. In aerodynamic measures, MFR and MPT showed a significant correlation with VHI-Total, VHI-Emotional, and SAIVP-14, but their correlation was poor. The results of this study suggested that subjective evaluation of self voice problems is meaningfully correlated with objective evaluations, but more data in the multidimensional voice assessment should be collected and analyzed for the reliability and validity of the voice handicap questionnaire.

• 말소리와 음성과학
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• 제6권1호
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• pp.71-76
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• 2014

In this paper voice quality of normal speech is qualitatively classified by five components of breathy, creaky, rough, nasal, and thin/thick voice. To determine whether a correlation exists between a subjective measure of voice and an objective measure of voice, each voice is perceptually evaluated using the 1/2/3 scale by speech processing specialists and acoustically analyzed using speech analysis tools such as the Praat, MDVP, and VoiceSauce. The speech parameters include features related to speech source and vocal tract filter. Statistical analysis uses a two-independent-samples non-parametric test. Experimental results show that statistical analysis identified a significant correlation between the speech feature parameters and the components of voice quality.

• 대한후두음성언어의학회지
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• 제32권2호
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• pp.75-80
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• 2021

Background and Objectives Functional aphonia refers to in which by presenting whispering voice and almost producing very high-pitched tensed voices are produced. Voice therapy is the most effective treatment, but there is a lack of consensus for application of voice therapy. The purpose of this study was to examine the vocal characteristics of functional aphonia and the effect of voice therapy applied accordingly. Materials and Method From October 2019 to December 2020, 11 patients with functional aphonia were treated using voice therapy which was processing three stages such as vocal hygiene, trial therapy, and behavioral therapy. Of these, 7 patients who completed the voice evaluation before and after voice therapy was enrolled in this study. By retrospective chart review, clinical information such as sex, age, symptoms, duration, social and medical history, process of voice therapy, subjective and objective findings were analyzed. Voice parameters before and after voice therapy were compared. Results In GRBAS study, grade, rough, and asthenic, and in Consensus Auditory-Perceptual Evaluation of Voice, overall severity, roughness, pitch, and loudness were significantly improved after voice therapy. In Voice handicap index, all of the scores of total and sub-categories were significantly decreased. In objective voice analysis, jitter, cepstral peak prominence, and maximum phonation time were significantly improved. Conclusion The voice therapy was effective for the treatment of functional aphonia by restoring patient's vocalization and improving voice quality, pitch and loudness.

• 말소리와 음성과학
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• 제7권2호
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• pp.47-54
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• 2015

The objectives of this study are to research the frequency of depression symptom in patients with voice disorders and to investigate parameters associated with depression from voice evaluation. A hundred ninety six patients(106 males and 90 females) who had been diagnosed with voice disorders first in their lifetime were selected. All the patients were examined by laryngeal stroboscopy. For depression and voice study, personal interview, acoustic and aerodynamic analysis, voice handicap index(VHI), reflux symptom index(RSI), and beck depression index(BDI) were done respectively. Mild to severe BDI were seen in 26.2%(52 patients) of the whole patients. A BDI mean score of female patients was $8.8{\pm}7.5$ which was higher than that of male patients($5.6{\pm}6.6$), the difference observed being statistically significant(p<0.001). In the acoustic analysis, the score of sent_duration parameter was increasing in the patients with depression, which was significantly higher than the score of the patients without depression(p<0.05). In the addition, the scores of VHI and RSI were higher in the patients with depression(p<0.001). Our findings suggest that the prevalence of depression in patients with voice disorders is related to female, speaking velocity, and self-questionnaire. This result can be used for psychologically based approach to therapy.

• 대한후두음성언어의학회지
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• 제12권2호
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• pp.140-144
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• 2001

Backgrounds & Objectives : Prolonged hearing loss was considered as one of the factors which have the potential to cause vocal changes. However, the analysis of quality of phonation in hearing loss patients has not been achieved enough. The purpose of the study was to evaluate the difference in objective acoustic parameters between long-term hearing impaired patients and normal control group. Material & Methods : The material of this investigation comprised a group of 20 patients (M : F=10 : 10) with moderate or profound hearing loss(over 50dB). The duration of all hearing loss was over 1 year. All of them underwent the acoustic examinations comprising electroglottography, multidimensional voice program and formant analysis during phonation of the bowels /a/ with free confortable tone and /i/ with voluntary high tone. The results of the acoustic examinations were compared with those of a control group, composed of 20 sex- and age-matched normal hearing subjects. Results : In the male hearing loss subjects, the significant increase was detected in pitch and shimmer during phonation of /a/ and in pitch during phonation of /i/. In addition, this group was characterized by decreased fundamental frequency during phonation of /i/. In female, there was no difference between hearing loss group and normal control group except a decreased formant 1 frequency. Conclusion : Long-term moderate and profound sensorineural hearing loss could affect the objective voice parameters.

• 대한후두음성언어의학회지
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• 제6권1호
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• pp.22-26
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• 1995

Change of voice, espicially hoarseness show irregular vibration of vocal cord. So, computerized acoustic analysis has presented many acoustic parameters for objective evaluation of voice. We objectively investigated the vocal vibration of normal persons and hoarseness patients in Korea. The RAP(relative average perturbation), PPQ(pitch period perturbation quotient) and APQ(amplitude perturbation quotient) of normal persons were compared with that of hoarseness patients with multidimensional voice program for the possibility of distinguishing the pathologic vocal vibration from normal. Authors agree that RAP, PPQ and APQ showed interesting differences between the normal and the hoarseness patients by the multivariate statistical analysis. In conculusion, relative average perturbation, pitch period perturbation and amplitude perturbation quotient might be meangingful screening parameters distinguishing hoarseness patients from normal.

• 대한후두음성언어의학회지
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• 제9권1호
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• pp.32-37
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• 1998

Tonsillectomy is the one of operation that is performed the most commonly in otolaryngology field. Many changes that include range of voice, tone, voice quality and resonance were made by tonsillectomy. Sometimes, any patients taken tonsillectomy has suffer from these voice problem after tonsillectomy. However there are less study for these problems until now. Then, we studied to find the anatomical findings that affected the voice quality when tonsillectomy was performed. We evaluated the voice in 2 groups, one is the group showed the normal pharyngeal space by using the transnasal fiberscopy, the other is group showed medially bulging tonsil at pharyngeal cavity by using same method, with perceptual evaluation, nasalance score, nasality, oral formant and nasal formant. We used the computerized speech analysis system, the nasometer and the spectrogram in the CSL program. We could not find any differences in perceptual evaluation between two groups. But objective measures were provided. Nasalance score and nasality on the nasometric analysis were increased significantly and oral formant on the spectrogram was changed singnificantly after tonsillectomy in Group 2. Authors thought medially bulging tonsil in the pharynx is able to affect the voice quality after tonsillectomy when we evaluted through the nasal cavity by the using of fiberscopy and this evaluation would be important especially in singers.