• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.32 no.1
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• pp.9-14
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• 2021

Spasmodic dysphonia, essential tremor, and vocal tremor related with Parkinson's disease are different disorders showing fairly similar symptoms such as difficulty in the speech onset, and tremble in the voice. However, the cause and the resulting treatment of these diseases are different. Spasmodic dysphonia is a vocal disorder characterized by spasms of the laryngeal muscles during a speech, invoking broken, tense, forced, and strangled voice patterns. Such difficult-to-treat dysphonia disease is classified as central-origin-focal dystonia, of a yet unknown etiology. Its symptoms arise because of intermittent and involuntary muscle contractions during speech. Essential tremor, on the other hand, is characterized by a rhythmic laryngeal movement, resulting in alterations of rhythmic pitch and loudness during speech or even at rest. Severe cases of tremor may cause speech breaks like those of adductor spasmodic dysphonia. In the case of hyper-functional tension of vocal folds and accompanying tremors, it is necessary to distinguish these disorders from muscular dysfunction. A diversified assessment through the performance of specific speech tasks and a thorough understanding for the identification of the disorder is necessary for accurate diagnosis and effective treatment of patients with vocal tremors.

• Phonetics and Speech Sciences
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• v.2 no.2
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• pp.117-121
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• 2010

The This study aimed to evaluate the effects of the voice therapy we operated to the patients with age-related dysphonia. Thirty four participants who were diagnosed as age-related dysphonia in laryngoscopic finding from January, 2009 to December, 2009 completed the study. The participants were aged from 60 to 82 years old with a mean age of 70.6. All participants had received the abdominal breath technique, SKHPIP with laughter, and basic vocal training with description of their problem, the length of which ranged from four sessions to twelve sessions. We executed the videostroboscopy to compare the aspect of voicing change and the perceptual assessment, voice range profile, acoustic and aerodynamic measures to identify change of voice. Participants had glottal gap due to incomplete glottic closure during voicing on the pretest. After they took the voice therapy, the glottic gap became narrow and rough and breathy voice was reduced. There were significant difference in acoustic and aerodynamic measures. Jitter, Shimmer, MFR were reduced and MPT, Psub were increased(p<.05). Participants' pitch range and intensity range were increased on the posttest performance after taking voice therapy. Especially, most of them were showed that pitch range was increased significantly in high frequency area. The results of this investigation indicate that the voice therapy using abdominal breath, SKHPIP, and exercise together is effective for the patients who have age-related dysphonia to improve their voice quality. We recommend to apply this technique to functional voice disorders who are showed glottal gap.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.21 no.1
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• pp.13-16
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• 2010

Diagnosis of a patient with dysphonia begins with a thorough history and physical examination. Larynx can be visualized either indirectly or directly with a rigid or flexible laryngoscope. One notable limitation of simple indirect laryngoscopy is that the examination dose not yields a recordable and reproducible image of the larynx and vocal tract. And unaided human eye is unable to visualize the vibratory patterns of the true vocal cord during phonantion. When available, stroboscopy provides useful information regarding vocal told closure, vibration, and mucosal wave which is useful to decide between microsurgery, vocal reeducation or a combined treatment Even there are some limitations, recognition of the advantages and disadvantages of stroboscopy allows for optimal appreciation and stroboscopy remains an essential diagnostic tool in the assessment of dysphonia.

• Proceedings of the Korean Society for Emotion and Sensibility Conference
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• 2009.05a
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• pp.181-182
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• 2009

GRBAS(G : grade, R : rough, B : breathy, S : strained, A : asthenic) 음성장애평가는 성대의 이상 또는 말마비장애 등의 환자들을 평가하는 척도로 널리 사용된다. 하지만 사람에 의해 주관적인 평가로 이루어지는 방식의 문제점이 많이 제기되어, 자동화 알고리즘에 의한 객관적인 청지각적 음성장애 평가도구를 개발하려는 시도가 많이 연구되어왔다. 이러한 개발에 있어 보편적으로 선행되어야 하는 음소 분류 및 일치성 판단을 위한 객관적인 파라미터를 구하고자 함이 본 연구의 목적이다.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.33 no.3
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• pp.183-187
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• 2022

Dysphonia is well known as one of the otolaryngological symptoms of coronavirus disease 2019 (COVID-19) infection. The vocal changes of the COVID-19 condition have been reported in terms of parameters of multi-dimensional voice assessment, including acoustic analysis, auditory-perceptual evaluation, and psychometric assessment. However, there has not been a daily followup study in patients with acute COVID-19 infection. In this study, a 41-year-old male performed daily voice recordings of vowel phonation and passage-reading tasks during the self-quarantine period of one week. Compared to the normal voice status of the prepandemic period, voice abnormalities peaked on day two after the diagnosis of COVID-19 infection and recovered after one week.

• Phonetics and Speech Sciences
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• v.6 no.3
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• pp.63-72
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• 2014

The current study assessed the utility of acoustic analyses the most commonly used in routine clinical voice assessment including perturbation, nonlinear dynamic analysis, and Spectral/Cepstrum analysis based on signal typing of dysphonic voices and investigated their applicability of clinical acoustic analysis methods. A total of 70 dysphonic voice samples were classified with signal typing using narrowband spectrogram. Traditional parameters of %jitter, %shimmer, and signal-to-noise ratio were calculated for the signals using TF32 and correlation dimension(D2) of nonlinear dynamic parameter and spectral/cepstral measures including mean CPP, CPP_sd, CPPf0, CPPf0_sd, L/H ratio, and L/H ratio_sd were also calculated with ADSV(Analysis of Dysphonia in Speech and VoiceTM). Auditory perceptual analysis was performed by two blinded speech-language pathologists with GRBAS. The results showed that nearly periodic Type 1 signals were all functional dysphonia and Type 4 signals were comprised of neurogenic and organic voice disorders. Only Type 1 voice signals were reliable for perturbation analysis in this study. Significant signal typing-related differences were found in all acoustic and auditory-perceptual measures. SNR, CPP, L/H ratio values for Type 4 were significantly lower than those of other voice signals and significant higher %jitter, %shimmer were observed in Type 4 voice signals(p<.001). Additionally, with increase of signal type, D2 values significantly increased and more complex and nonlinear patterns were represented. Nevertheless, voice signals with highly noise component associated with breathiness were not able to obtain D2. In particular, CPP, was highly sensitive with voice quality 'G', 'R', 'B' than any other acoustic measures. Thus, Spectral and cepstral analyses may be applied for more severe dysphonic voices such as Type 4 signals and CPP can be more accurate and predictive acoustic marker in measuring voice quality and severity in dysphonia.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.8 no.2
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• pp.199-203
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• 1997

In the treatment of spasmodic dysphonia, local injection of botulinum toxin A has been reported to be successful. The treatment of adductor type spasmodic dysphonia with botulinum toxin type A injection using a flexible nasopharyngoscope was conducted in 29 patients and using a telearyngoscope in 31 patients. These patients were given toxins in the vocal fold(s), unilaterally or bilaterally, under flexible nasopharyngoscopic guidance with sclerosing needle or telelaryngoscopic guidance with 23 gauge scalp needle attached by laryngeal forceps. Before the above procedure, laryngeal anesthesia was done with 2% pontocain instillation. Among the 60 patients, 59 patients were given the toxin successfully. Telephone interview were made at 2weeks and then at 4 weeks post injection. Among 29 patients using a flexible nasopharyngoscope, 75.8% and among 31 patients using a telelaryngoscope, 90.0% reported that the patients' symptom was improved. The functional status of the patient's disorder was classified into four grades. The mean pre-injection grade fir the patients using flexible nasopharyngoscope and telelaryngoscope was 1.6 and 2.1 respectively. And it was lowered to 0.7 and 1.1 respectively after the injection. The result was similar(p<0.05). As a self assessment method, the patients were asked to rate their voice on a scale of 100. In this study, the mean pre-injection score was 44 and 40 respectively. And it was improved to 77.7 and 69.8 respectively after the injection. The result was similar(p<0.05). In conclusion, botulinum toxin injection using a flexible nasopharyngoscope is also an effective method for the treatment of adductor type spasmodic dysphonia as using a telelaryngoscope.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.8 no.2
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• pp.204-209
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• 1997

In the treatment of spasmodic dysphonia, laryngeal injection of botulinum toxin has been reported to be successful. The treatment of adductor type spasmodic dysphonia with botulinum toxin type A injection using EMG was conducted in 24 patients and it's effect was compared with results from flexible nasopharyngoscopy guided injection(29 patients) and telelaryngoscopy guided injection(31 patients). Sixty two point five percent(62.5%) of patients using EMG and 75.8% of patients using flexible nasopharyngoscope and 90.0% of patients using telelaryngoscope reported that the patient's symptom was improved. The functional status of the patient's disorder was classified into low grades. The mean pre-injection grade for patients using EMG, flexible nasopharyngoscope and telelaryngoscope was 1.7, 1.6 and 2.1 respectively. And it was lowered to 1.0, 0.7 and 1.1 respectively after the injection. Results were similar(p＜0.05). As a self assessment method, patients were asked to rate their voice on a scale of 100. In this study, the mean pre-injection score was 66.3, 44.0 and 40.0 respectively. And it was improved to 74.8, 77.7 and 69.8 respectively after the injection. Among 23 patients who undergone above 3method, 17 patients(73.9%) told that EMG-guided botulinum injection was preferable method in its convenience and effectiveness. In conclusion, EMG guided botulinum toxin injection is an another effective method for the treatment of adductor type spasmodic dysphonia similar to telelaryngoscopy-guided injection and flexible nasopharyngoscopy guided injection.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.28 no.2
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• pp.106-111
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• 2017

Background and Objectives : The purpose of this study was to investigate the criterion-related concurrent validity of two standardized auditory-perceptual assessments and the Acoustic Voice Quality Index (AVQI) for measuring dysphonia severity in patients with vocal cord paralysis (VCP). Materials and Methods : Total 210 patients with VCP and 236 normal voice subjects were asked to sustain the vowel [a:] and to read aloud the Korean text "Walk". A 2 second mid-vowel portion of the sustained vowel and two sentences (with 26 syllables) were recorded. And then voice samples were edited, concatenated, and analyzed according to Praat script. Two standardized auditory-perceptual assessment (GRBAS and CAPE-V) were performed by three raters. Results : The VCP group showed higher AVQI, Grade (G) and Overall Severity (OS) values than normal voice group. And the correlation among AVQI, G, and OS ranged from 0.904 to 0.926. In ROC curve analysis, cutoff values of AVQI, G, and OS were <3.79, <0.00, and <30.00, respectively, and the AUC of each analysis was over .89. Conclusion : AVQI and auditory evaluation can improve the early screening ability of VCP voice and help to establish effective diagnosis and treatment plan for VCP-related dysphonia.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.33 no.2
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• pp.103-109
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• 2022

Background and Objectives The Voice Perceived Present Control scale (VPPC) has been developed to provide better insight into patients' perceived control over their thoughts or behaviors related to voice disorders. The objective of the present study was to validate the Korean VPPC (K-VPPC) by evaluating its internal consistency and reliability. Materials and Method All items of the English VPPC were translated into Korean. Content validity was analyzed through three Delphi survey rounds by an expert panel (n=44) with active clinical and research experience in treating dysphonic patients. Twenty-three patients with a heterogeneous diagnosis of dysphonia and twenty-three gender-matched vocally normal controls (total n=46) were asked to complete the K-VPPC and the Korean Voice Handicap Index-10 (KVHI-10). Psychometric properties including internal consistency and reliability were evaluated to examine the appropriateness of cross-cultural use of K-VPPC. Results Cronbach's alpha coefficient of K-VPPC was 0.89 for dysphonic patients, indicating good internal consistency in clinical samples. Furthermore, patients with dysphonia scored significantly lower on the total score of K-VPPC and higher on voice handicap than the vocally normal controls. Spearman's correlation coefficients indicated an inverse and moderate association between the K-VPPC and all domains of KVHI-10 (Spearman's r=-0.44- -0.68). Conclusion The findings of the current study indicated that the K-VPPC is a valid and reliable tool for the assessment of perceived control in Korean patients with dysphonia. Therefore, the K-VPPC could be a useful and complementary tool for the comprehensive evaluation of dysphonia, thereby improving care in Korean patients with voice disorders.