• Phonetics and Speech Sciences
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• v.2 no.4
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• pp.75-82
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• 2010

Many previous studies based on respiratory characteristics of Idiopathic Parkinson's Diseases (IPD) patients have not controlled related factors appropriately. Accordingly, these studies produced discordant results. Furthermore, there is currently a lack of studies that can provide precise explanations on the characteristics of respiration and phonation. This study included a total of 40 subjects: 20 mixed gender de novo IPD patients ranging in age from 50 to 80 (Hoehn & Yahr stage 1~3), and 20 normal subjects with similar matches for age and gender. All participants were controlled based on their gender, age, height, weight, vocal fold function, cognitive abilities, and depression factors. K-MMSE (Korean-Mini Mental State Examination), nVHI-10 (new Voice Handicap Index), and KGDS (Korean Form of Geriatric Depression Scale) were evaluated to select this study subjects. In order to compare respiratory functions between the two groups, FVC, FEV1, and FEV1/FVC were measured using microQuark, a PC-based spirometer. CSL was used by measure MPT and PAS was used to measure MFR. To investigate the characteristics of phonation ability, CSL was used to measure jitter and shimmer, while PAS was used to measure Psub. In order to compare the respiratory function averages and phonation ability between the two groups, statistical analysis was conducted using SPSS (version 12.0). The results of this study showed that most de novo IPD patients were included in the normal average range of respiratory and phonatory ability. But the respiratory and phonatory ability of de novo IPD patients showed lower tendency as compared with the normal group. When the average of respiratory and phonatory ability among the gender was compared, the difference of males was greater than the difference of females.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.12 no.1
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• pp.11-16
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• 2001

Background and Objectives : A burn injury to the glottis differs from a burn injury to the trachea, bronchi, and lung parenchyma, in that thermal injury does not occur to any significant degree below the level of the larynx, due to the effective cooling of air by the upper airway and to reflex closure of the vocal cords from a blast of hot air. Therefore, the laryngeal inhalation injury give rise to airway problem and voice change. The objectives of this study is to assess management of laryngeal inhalation injury and voice change after management. Materials and Methods : Voice choses and laryngeal injuries of eight laryngeal inhalation patients were analyzed through questionnaire, voice dynamic laboratory, and laryngeal stroboscopy. Operative management was performed to five patients for airway patiency and vocal cord movement on laryngeal pathology ind voice therapy was performed to all patients. One-year after, voice changes and laryngeal injuries were reanalyzed with same methods. Results : Vocal breathiness, decreased voice intensity, reduced voice range, and easy fatigability were major complaints of laryngeal inhalation patients. Glottic stenosis were developed to five of eight patients, and vocal cord atrophy, bowing were developed to others. Vocal cord mucosal waves were significantly decreased in all patients. Jitter(%), Shimmer(dB) were increased and Maximal phonation time(MPT) was decreased. One-year after, subjective voice changes and objective voice parameters were improved. And vocal cord mucosal waves were recovered in all patients. Conclusions : Subjective voice quality and objective voice parameters were improved after operative management for laryngeal pathology and voice therapy. And we observed recovery of vocal fold mucosal waves by laryngeal stroboscopy. We think that early preventable tracheotomy is necessary to reduce the laryngeal contact injury in laryngeal inhalation patients.

• 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.

• Speech Sciences
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• v.11 no.1
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• pp.73-83
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• 2004

Electromyographic studies of the cricopharyngeus muscle using hooked wire electrodes were performed in thyroidectomized patients. The shape of the cricoid cartilage and soft tissue thickness in the postcricoid area were evaluated during pitch elevation and pitch lowering using conventional neck lateral films. The cricopharyngeus muscle simultaneously activated in the initial task of speech and continuously activated. Its activity lessened in the interrogative stress contrast of sentence terminals and increased in the pitch lowered contrast of sentence terminal. On the radiologic findings the cricoid cartilage was tilted backward during high pitched phonation and tilted forward during low pitched phonation. The soft tissue thickness of postcricoid area was thicker at the low pitch than at high pitch. At low pitch the cricoid cartilage paralleled along the vertebral column. This result suggests that the bulging of cricopharyngeus muscle in contraction induce a thickened the postcricoid area thickened, and exert pressure anteriorly exerted on the cricoid cartilage. This contraction of the cricopharyngeus muscle may result in shortening the vocal fold and lowering pitch.

• 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.22 no.1
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• pp.40-46
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• 2011

Background and Objectives : Vocal fold bowing is an organic voice disorder that is associated with an abnormal structure of the vocal folds whereas vocal fold polyp is a functional voice disorder caused by an abnormal use of the vocal folds. Both types of vocal folds share a common property in that they make one's voice breathy or strained. The purpose of this study is to compare voice from two types of vocal folds and to offer information of clinical importance. Materials and Method: Vocal fold bowing and vocal fold polyp groups consisted of 7 male subjects, respectively. All subjects recorded /a/ in the state of measuring MPT (maximum phonation time), repeating 3 times, by a voice recorder (48 kHz sampling rate; 24 bit quantization). They answered the questions of K-VHI. Time domain parameters (such as perturbation parameters including HNR, Jitter, etc.) were calculated for the whole duration of /a/ and those of the frequency domain were measured in initial 40 ms and stable 40 ms of /a/, respectively. Mann-Whitney V-test was used for the time domain parameters and K-VHI survey, and Wilcoxon signed rank test was applied to the frequency domain parameters (H1, H2, H1-H2). Results: For K-VHI survey and the time domain analysis, there was no significant difference between bowing and polyp group. For frequency domain analysis, H1 and H2 showed a significantly different result between two groups. Vocal fold bowing group has longer duration and lower intensity than that of vocal fold polyp group in the 'aspirated interval', which could be observable prior to ordinary vowel oscillation. Conclusion: Both groups seem to show breathy voice. This could be referred on the basis of the value of H1-H2. The K-VHI survey says that subjects with vocal fold bowing feel more uncomfortable than subjects with vocal fold polyp.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.23 no.2
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• pp.129-132
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• 2012

Background and Objectives : MPT is directly related to degree of glottal closure. So it is widely used in the assessment of glottal closure with unilateral vocal fold paralysis. But MPT could be influenced not only by glottal closure but also by pulmonary function. So MPT might not reflect glottal closure in UVFP with decreased pulmonary function. The purpose of the study is to evaluate usefulness of MPT and ratio of /s/ time to /z/ time before and after injection laryngoplasty in UVCP with decreased pulmonary function. Materials and Methods : This study involved 34 patients with unilateral vocal fold paralysis : with decreased pulmonary function in group A (n=15) : with normal pulmonary function in group B (n=19). All patients underwent injection laryngoplasty. Paramters of perceptual analysis, acoustic analysis, aerodynamic analysis, videostroboscopy were compared between two groups. Results : Breathness and asthenic scale, G scale of perceptual analysis were significantly improved in both groups. Glottal gap index were significantly decreased after injection in both groups. In aerodynamic analysis, MPT was improved after injection laryngoplasty in both groups, but S/Z ratio was improved only in group B. In correlation analysis, /s/ time was not correlated with pulmonary function. Conclusion : S/Z ratio reflects neither the pulmonary function nor the glottal clousure properly. MPT is more useful indicator than S/Z ratio to evaluate vocal fold paralysis even with decreased pulmonary function.

• Phonetics and Speech Sciences
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• v.6 no.3
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• pp.49-56
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• 2014

This research compared the features of respiration and phonation between practical musicology students and general male students, according to their smoking status. Participants of this research are 15 practical musicology male students attending ${\bigcirc}{\bigcirc}$ university and 16 general ${\bigcirc}{\bigcirc}{\bigcirc}$ university students. The participants, both non-smokers and smokers with 5-years of smoking history have no history of voice disease in any case and have normal cognitive functions. The results indicated that, first, there is not a notable difference in the respiratory activity status(FVC, FEV1, FEV1/FVC), regardless of major and smoking status. In MPT, even though there is no significant difference in accordance with their majors, considering smoking status, the smoker group was shorter than non-smoker group significant difference statistically (p<.01). Second, the divisions of participants' major did not show significant difference in Fo, jitter, shimmer, and NHR in the vowel prolongation task. However, the smoker group showed a significantly higher degree of jitter and shimmer than the non-smoker group (p<.05) as Fo and NHR shows no difference. In the case of VRP, maximum frequency and frequency range of the practical group are significantly higher than normal group statistically (p<.001). Moreover, although the difference of the minimum frequency shown at the statistic is not significant, practical group showed a higher tendency of frequency than normal group (p=.051). In conclusion, even though there is no difference in respiratory activity between the smoker group and non-smoker group, the MPT of the smoker group is shorter than that of non-smoker group. In addition, the smoker group showed a higher degree of jitter and shimmer than the non-smoker group. MPT is related to the valve action of vocal fold that passes through the glottis. Thus, it is interpreted that the smoker group has a lower quality of voice and valve action of the vocal fold. Also, the practical group has a higher degree of maximum frequency and frequency range than the normal group. This research can function as basic data for vocal characteristics for the majors in relation to the voice-specializing.

• 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.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.28 no.2
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• pp.84-88
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• 2017

Background and Objectives : The purpose of this study was to compare the usefulness of Cepstral peak prominence (CPP) with parameter of Multiple Dimensional Voice Program (MDVP) in evaluating unilateral vocal fold paraylsis patients with subjective voice impairment. Materials and Methods : From July 2014 to August 2016, 37 patients with unilateral vocal fold paralysis who had been diagnosed with unilateral vocal fold paralysis and had received two or more voice tests before and after the diagnosis were evaluated for maximum phonation time (MPT), MDVP and CPP. Respectively. Voice tests were performed with short vowel /a/ and paragraph reading. Results : The CPP-a (CPP with vowel /a/) and CPP-s (CPP with paragraph reading) of the Cepstrum were statistically negatively correlated with G, R, B, and A before the voice therapy. Jitter, Shimmer, and NHR of MDVP were positively correlated with G, R, B. Jitter, Shimmer, and NHR of the MDVP were significantly correlated with the Cepstrum index. G, B, A and CPP-a and CPP-s showed a statistically significant negative correlation and a somewhat higher correlation coefficient between 0.5 and 0.78. On the other hand, in MDVP index, there was a positive correlation with G and B only with Jitter of 0.4. Conclusion : CPP can be an important evaluation tool in the evaluation of speech in the unilateral vocal cord paralysis when speech energy changes or the cycle is not constant during speech.