• 대한후두음성언어의학회지
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• 제15권1호
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• pp.21-26
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• 2004

Vocal Register Transition(Passaggio) is one of the most important vocal technique for classically trined male singers(tenor). Passaggio is that it bridges the chest register to head register without a noticeable voice break. Vocalist gest the feeling that voice is not locked a particular register. The purpose of this study was to clarify the difference between easy($B_3$) tone and non passaggio(F#_4$) & passaggio(F#_4$). We selected 6 trained singers(tenor), who had more than 12.6 years of experience and were well trained in passaggio technique. Simulataneous measurement was performed frequency(F0), mean flow rate(MFR), intensity(I), and subglottal pressure(Psub) using a phonatory function analyzer(Nagashima) and Closed Quotient(CQ), Jitter, Shimmer, NHR a Electro-glottography(EGG) of Lx. Speech Studio(Laryngogrph Lt, London, UK) and vocal efficiency was calculated by Carroll's method. For the tenor, target tone/a/was measured in three conditions : 1) easy phonation : $B_3$, 2) high tone without passaggio : F#_4$, 3) high tone with passaggio : F#_4$). The results revealed that F0 of the target tones between non-passaggio group and passaggio group were not significantly different though higher is F0, higher is subglottal pressure. And also CQ, MFR, Psub were increased in passagio than nonpssagio but these values were not statistically different. This study concluded that passaggio is the vocal technique to make the same quality of tone between chest register and head register in tenor.

• 대한후두음성언어의학회지
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• 제24권2호
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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.

• 한국콘텐츠학회논문지
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• 제11권10호
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• pp.380-387
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• 2011

본 연구는 음악요소와 노래 부르기 중심의 호흡 및 구강운동 훈련이 정상노인 음성개선에 효과가 있는지 알아보고자 실시되었다. 연구 대상은 서울 소재 노인 기관에서 노래 부르기 활동에 참여하고 있는 65세~80세 노인 27명을 대상으로 실험군 11명, 통제군 16명을 무작위 분류하여 선정하였으며, 훈련은 4주 동안 25분씩 4회의 그룹치료 형태로 실시되었다. 연구 결과는 두 집단의 사전 사후 결과를 Praat(음성프로그램)으로 분석하였으며, 측정된 결과는 평균을 산출한 후 SPSS 19.0으로 통계처리를 하였다. 연구 결과에서 실험군은 강도(p < .001), 기본주파수(p < .01), 최대발성지속시간(p < .05), 일련운동속도(p < .001)가 유의미하게 향상을 보였으며, 통제군은 강도만 유의미한 차이로 감소를 보이고(p < .05), 나머지는 통계적으로 유의미하지 않은 감소를 보였다. 따라서 음악요소와 노래 부르기를 활용한 호흡 및 구강훈련은 노화로 인한 정상 노인의 음성 기능 개선에 치료적 효과를 나타내며, 이후 음성 장애를 예방하는 음성 훈련프로그램으로 활용될 수 있을 것이다.

• 말소리와 음성과학
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• 제4권4호
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• pp.139-146
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• 2012

This study was designed to examine comfort levels of pitch and loudness with target matching and their effects on electroglottographic (EGG) and acoustic measures. Twelve speakers, six males and six females, were instructed to produce /a/ sustained vowel for three seconds at a comfortable pitch and loudness level without any instruction and with a target matching procedure of either a certain f0 or SPL separately with visual and auditory feedback. The range of pitch for females and males were presented by progressing up and down randomly at intervals of 5Hz from 150 Hz to 310 Hz (total 33 frequency targets) and from 85 Hz to 190 Hz (total 22 frequency targets), respectively. The loudness levels were 65, 75, 85, 95 dB (total of four intensity targets) for both males and females. Subjective estimations of comfortable levels were obtained using a 10-point equal-appearing interval rating scale following each phonation. The results showed that males and females demonstrated similar trends in loudness levels with greatest comfort at 75 dB, whereas pitch comfort ratings showed a greater variability with females having a wider range with target matching. In the comfort levels of individuals, most male and female speakers rated higher comfort at soft, rather than loud phonations. On the other hand, most male speakers perceived highest comfort levels below the comfort pitch levels they phonated under natural conditions. Higher frequency ranges, however, were perceived to be more comfortable than those of natural condition in most female speakers, although the comfortable pitch levels in spontaneous phonations were within the comfort level ranges determined by targeted phonations. When comparing acoustic (%jitter, %shimmer, SNR) and EGG measures (CQ%) between spontaneous comfortable phonations and targeted phonations produced by the same subject at similar f0 and intensity, no significant differences were observed (p>0.05). Thus, target matching procedures may be considered a compatible and alternative method to reduce the variability of comfortable pitch and loudness levels by eliciting consistent comfortable phonations.

• 대한후두음성언어의학회지
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• 제9권1호
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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.

• 대한후두음성언어의학회지
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• 제19권1호
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• pp.11-15
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• 2008

Endoscopic laser cordectomy is known as an oncologically sound procedure for T1 and selected T2 glottic carcinoma ; it has comparable local control rate and better long-term laryngeal preservation rate when compared with those of radiotherapy. Even if results of the reported voice outcome studies after surgery or radiotherapy are diverse and controversial, resection deeper than the body layer of the vocal fold (type III, IV, V cordectomy) usually leads to aerodynamic insufficiency during phonation and results in poor voice quality. A keyhole defect or development of synechiae at the anterior commissure after type VI cordecomy may also result in unsatisfactory vocal outcome. However, many advances in phonosurgical techniques are reported to be successfully applied in the reconstruction of glottal defect that is subsequent to endoscopic laser cordectomy. In case of glottal insufficiency, voice restoration can be achieved by means of augmentation of the paraglottic space or medialization of the excavated vocal fold. Injection laryngoplasty with synthetic materials or autologous fat is gaining its popularity for restoring minor glottal volume defect because of its convenience. Laryngeal framework surgery, especially type I thyroplasty with premade implant systems or Gore-Tex, is most frequently used to correct larger glottic volume defect. In case of anterior commissural keyhole defect, additional procedure including laryngofissure may be required. For anterior commissural synechiae, laryngeal keel may be inserted for several weeks or mitomycin-C may be repeatedly applied after the division of adhesive scar to prevent restenosis. In this paper, current concepts and the authors' experiences of phonosurgical reconstruction of vocal function after endoscopic cordectomy will be introduced.

• 대한후두음성언어의학회지
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• 제19권1호
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• pp.21-27
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• 2008

Total laryngectomy is the most useful procedure tor advanced laryngopharyngeal cancer, but it remains the major problem such as loss of voice. Voice restoration is essential for every patients who undergo a total laryngectomy. Ideal voice rehabilitation methods can resolve three factors. First, every laryngectomee can produce voice sufficient for communication, second every patient should be allowed to use both hands freely during phonation, and last, the voice restoration methods should be easy and safe without complication during and after treatment. Among various voice rehabilitation procedures during or after total laryngectomy, it can be divided electronic and pneumatic methods. In pneumatic methods, there are also divided both pulmonary air and non-pulmonary air methods. The non-pulmonary air methods include esophageal speech, buccal speech, and pharyngeal speech. Pulmonary air methods are divided into surgical and non-surgical such as pneumatic speech aid. In the surgical methods, there are neoglottic operation, tracheopharyngeal shunt, and tracheopharyngeal shunt operations. Recently, tracheoesophageal shunt with or without prosthesis are being recognized the most effective method. Blom-Singer low pressure prosthesis, Panje button, and Provox are well known types of prosthesis in the tracheoesophageal shunt operation. Amatsu method is a kind of famous tracheoesophageal shunt method without using prosthesis. Authors tried to review the published articles for evaluation of effectiveness and problems of tracheoesophageal shunt operation with or without prosthesis. In conclusion, indwelling type of prosthesis and pharyngeal myotomy and plexus neurectomy are recommended for higher success rate during tracheoesophageal puncture procedure. More over, Amatsu method is also one of the recommended voice rehabilitation procedure during total laryngectomy. In this situation, pharyngeal myotomy and plexus neurectomy may be helpful for better fluent communication.

• 대한후두음성언어의학회지
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• 제28권2호
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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.

• 대한후두음성언어의학회지
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• 제16권2호
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• pp.129-134
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• 2005

Background and Objectives : Artecoll(R) is an injectable soft tissue filler, which is a suspension of polymethylmethacrylate microspheres in $3.5\%$ bovine collagen solution. The authors aimed to determine the clinical of Artecoll of Artecoll(R) as an injection material into the vocal fold to correct the glottal insufficiency caused by unilateral vocal cord paralysis. Materials and Methods : Forty-one consecutive patients with unilateral vocal cord paralysis received percutaneous Artecoll injections under local anesthesia. Acoustic, aerodynamic and stroboscopic analyses were prospectively provided before, 1 week and 3 months after injection. Perceptual GRBAS grading by speech language pathologists and subjective ratings of the hoarseness and aspiration by the patients were also obtained. Results : Aerodynamic parameter(maximal phonation time) were significantly improved after the injection (p<0.05). Acoustic parameters (jitter and shimmer) were improved at the 3rd month follow-up. GRBAS uading and patients own subjective scaling of hoarseness and aspiration also showed significant improvement (p<0.05). Early or delayed significant side effects were not observed. Conclusion : Vocal fold injection with Artecoll is a convenient, safe and useful method of temporarily correcting the glottal insufficiency. Further long-term follow-up studies will answer the usefulness and safety of the Artecoll injection laryngoplasty.

• 대한후두음성언어의학회지
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• 제13권1호
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• pp.33-39
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• 2002

Background and Objectives : The vocal fold nodules which were made by excessive contact or vibration of the vocal folds were classified to the soft nodule and the hard nodule in according to the hardness or the duration of nodule. Sometimes laryngologist saw the nodule to be located in different level. Authors thought that each nodule to be located in different level might have the different causes. Therefore we studied to know the relationship between the voicing technique and each vocal fold nodule to be located in different level. Materials and Methods : One-hundred forty nine patients who had the vocal fold nodule were evaluated. Sites and shapes of the vocal fold nodules were investigated using videostroboscopy. Videokymography was also used to scan the center of the vocal fold nodules during phonation and classified to several types. Same procedures were done on normal subject while he simulated the various types of voicing. And we compared the findings between both of them. Three different types of lesion can be distinguished. These are ML group that lesions were located from mid to low, MH group that lesions were located from mid to upper and HL group that lesions were located from lower to upper of the vocal folds. Results : The VKG findings of ML group and situation simulating with hard glottal attack and vocal fry were similar. MH group had a similar VKG findings with situation simulating with whispering or high pitch voicing. HL group had a similar VKG findings with situation simulating with loud voicing. Conclusions : Authors thought that each vocal fold nodule, which had different shapes and located in different level, related with the different types of voicing.