Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics (대한후두음성언어의학회지)

The Korean Society of Laryngology, Phoniatrics and Logopedics. (대한후두음성언어의학회)
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Differentiation of Adductor-Type Spasmodic Dysphonia from Muscle Tension Dysphonia Using Spectrogram

스펙트로그램을 이용한 내전형 연축성 발성 장애와 근긴장성 발성 장애의 감별

  • Noh, Seung Ho (Department of Otorhinolaryngology-Head and Neck Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Kim, So Yean (Department of Otorhinolaryngology-Head and Neck Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Cho, Jae Kyung (Department of Otorhinolaryngology-Head and Neck Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Lee, Sang Hyuk (Department of Otorhinolaryngology-Head and Neck Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Jin, Sung Min (Department of Otorhinolaryngology-Head and Neck Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine)
  • 노승호 (성균관대학교 의과대학 강북삼성병원 이비인후과학교실) ;
  • 김소연 (성균관대학교 의과대학 강북삼성병원 이비인후과학교실) ;
  • 조재경 (성균관대학교 의과대학 강북삼성병원 이비인후과학교실) ;
  • 이상혁 (성균관대학교 의과대학 강북삼성병원 이비인후과학교실) ;
  • 진성민 (성균관대학교 의과대학 강북삼성병원 이비인후과학교실)
  • Received : 2017.10.31
  • Accepted : 2017.11.25
  • Published : 2017.12.30
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Abstract

Background and Objectives : Adductor type spasmodic dysphonia (ADSD) is neurogenic disorder and focal laryngeal dystonia, while muscle tension dysphonia (MTD) is caused by functional voice disorder. Both ADSD and MTD may be associated with excessive supraglottic contraction and compensation, resulting in a strained voice quality with spastic voice breaks. The aim of this study was to determine the utility of spectrogram analysis in the differentiation of ADSD from MTD. Materials and Methods : From 2015 through 2017, 17 patients of ADSD and 20 of MTD, underwent acoustic recording and phonatory function studies, were enrolled. Jitter (frequency perturbation), Shimmer (amplitude perturbation) were obtained using MDVP (Multi-dimensional Voice Program) and GRBAS scale was used for perceptual evaluation. The two speech therapist evaluated a wide band (11,250 Hz) spectrogram by blind test using 4 scales (0-3 point) for four spectral findings, abrupt voice breaks, irregular wide spaced vertical striations, well defined formants and high frequency spectral noise. Results : Jitter, Shimmer and GRBAS were not found different between two groups with no significant correlation (p>0.05). Abrupt voice breaks and irregular wide spaced vertical striations of ADSD were significantly higher than those of MTD with strong correlation (p<0.01). High frequency spectral noise of MTD were higher than those of ADSD with strong correlation (p<0.01). Well defined formants were not found different between two groups. Conclusion : The wide band spectrograms provided visual perceptual information can differentiate ADSD from MTD. Spectrogram analysis is a useful diagnostic tool for differentiating ADSD from MTD where perceptual analysis and clinical evaluation alone are insufficient.

Keywords

References

  1. Aronson AE, Brown JR, Litin EM, Pearson JS. Spastic dysphonia. II. Comparison with essential (voice) tremor and other neurologic and psychogenic dysphonias. Journal of Speech and Hearing Disorders 1968;33(3):219-31. https://doi.org/10.1044/jshd.3303.219
  2. Schaefer SD. Neuropathology of spasmodic dysphonia. The Laryngoscope 1983;93(9):1183-204.
  3. Blitzer A, Brin MF, Stewart CF. Botulinum toxin management of spasmodic dysphonia (laryngeal dystonia): a 12-year experience in more than 900 patients. The Laryngoscope 1998;108(10):1435-41. https://doi.org/10.1097/00005537-199810000-00003
  4. Morrison MD, Rammage LA, Belisle GM, Pullan CB, Nichol H. Muscular tension dysphonia. The Journal of Otolaryngology 1983;12(5):302-6.
  5. Roy N, Ford CN, Bless DM. Muscle tension dysphonia and spasmodic dysphonia: the role of manual laryngeal tension reduction in diagnosis and management. Annals of Otology, Rhinology & Laryngology 1996;105(11):851-6. https://doi.org/10.1177/000348949610501102
  6. Van Houtte E, Van Lierde K, Claeys S. Pathophysiology and treatment of muscle tension dysphonia: a review of the current knowledge. Journal of Voice 2011;25(2):202-7. https://doi.org/10.1016/j.jvoice.2009.10.009
  7. Siemons-Luhring DI, Moerman M, Martens J-P, Deuster D, Muller F, Dejonckere P. Spasmodic dysphonia, perceptual and acoustic analysis: presenting new diagnostic tools. European Archives of Oto-Rhino-Laryngology 2009;266(12):1915. https://doi.org/10.1007/s00405-009-0995-7
  8. Rees CJ, Blalock PD, Kemp SE, Halum SL, Koufman JA. Differentiation of adductor-type spasmodic dysphonia from muscle tension dysphonia by spectral analysis. Otolaryngology-Head and Neck Surgery 2007;137(4):576-81. https://doi.org/10.1016/j.otohns.2007.03.040
  9. Lee HH, Lee SY, Park YH. Characteristics of Adduct Spasmodic Dysphonia and Muscle Tension Dysphonia Using Spectrogram. Korean Journal of Otorhinolaryngology-Head and Neck Surgery 2015;58(7):481-6. https://doi.org/10.3342/kjorl-hns.2015.58.7.481
  10. Houtz DR, Roy N, Merrill RM, Smith ME. Differential diagnosis of muscle tension dysphonia and adductor spasmodic dysphonia using spectral moments of the long-term average spectrum. The Laryngoscope 2010;120(4):749-57. https://doi.org/10.1002/lary.20741
  11. Cannito MP, Woodson G. The spasmodic dysphonias. Voice quality measurement San Diego: Singular Publishing Group 2000:411-30.
  12. Aronson AE, DeSanto LW. Adductor spastic dysphonia: 1 1/2 years after recurrent laryngeal nerve resection. Annals of Otology, Rhinology & Laryngology 1981;90(1):2-6. https://doi.org/10.1177/000348948109000102
  13. Hirano M. "GRBAS" scale for evaluating the hoarse voice & frequency range of phonation. Clinical Examination of Voice 1981;5:83-4.
  14. Klingholz F, Martin F. Quantitative spectral evaluation of shimmer and jitter. J Speech Hear Res 1985;28(2):169-74. https://doi.org/10.1044/jshr.2802.169
  15. Brockmann M, Drinnan MJ, Storck C, Carding PN. Reliable jitter and shimmer measurements in voice clinics: the relevance of vowel, gender, vocal intensity, and fundamental frequency effects in a typical clinical task. Journal of Voice 2011;25(1):44-53. https://doi.org/10.1016/j.jvoice.2009.07.002