Types of Testosterone Therapy and their Effects on the Voices of Transgender Singers

Hormone therapy (HT) is the administration of hormones in an attempt to relieve gender dysphoria by obtaining the phenotype and vocal quality of one’s gender identi-ty. The information contained in this article is designed to help transgender singers and their voice teachers understand what to expect vocally during initial changes that occur on testosterone therapy in order to build awareness around and facilitate the accommodation of this period of rapid vocal change.

Primary laryngeal lymphoma: a diagnostic challenge

<p class="abstract">Lymphomas of head and neck constitute 5-15% of malignancies in this region. However, its primary occurrence at the larynx is exceedingly rare due to the paucity of lymphoid tissue. Here, we reported a case of a 41 year old male who presented with a 1 month history of hoarseness and odynophagia. The examination revealed right vocal cord palsy and an ipsilateral subglottic exudate, that was misdiagnosed as infectious disease. The lesion quickly progressed to airway obstruction, requiring a tracheotomy. Multiple biopsies under general anesthesia were needed before reaching the final diagnosis of diffuse large B-cell lymphoma, Epstein-Barr positive. Selected treatment modality included 3 cycles of chemotherapy followed by radiotherapy in moderate dose with complete remission after 2 years of follow up. The tracheotomy was removed, however, the patient did not recover vocal quality. This case highlighted the heterogeneous presentation of extra-nodal head and neck lymphomas and emphasized the need for suspicion of neoplasm when an infection doesn’t respond to maximal medical therapy.</p>

Relationships Across Clinical Measures of Vocal Quality and Functioning and Their Relationship With Patient Perception

Purpose The purpose of this study was to investigate the relationships among subjective auditory-perceptual ratings of vocal quality, objective acoustic and aerodynamic measures of vocal function, and patient-perceived severity of their vocal complaint. Method This study was a retrospective chart review of adult patients evaluated at a single outpatient center over a 1.5-year time period. Twenty-two clinical objective and subjective measures of voice were extracted from 676 charts (310 males, 366 females). To identify the underlying concepts addressed in an initial voice assessment, principal component analyses were conducted for males and females to account for sex differences. Linear regression models were conducted to examine the relationship between the principal components and patient perceived severity. Results Seven principal components were identified for both sexes and accounted for 75% and 71% of the variance in the clinical measures, respectively. Of these seven principal components, only two predicted male patient perceived severity, which accounted for 22% of the variance. In contrast, four principal components predicted female patient perceived severity of their voice disorder and accounted for 19% of the variance. Conclusions The results highlight the underlying aspects of vocal quality and functioning that are evaluated during an initial assessment. Male and female patients differ in which of these components may contribute self-perceived severity of a voice disorder. Identifying these underlying components may support clinical decision making when developing a clinical protocol and highlights the overlap between patient concerns and clinical measures. Supplemental Material https://doi.org/10.23641/asha.16879603

EP.WE.852Role of Prophylactic steroids in the prevention of post-thyroidectomy hypocalcaemia and voice dysfunction

Aim Total thyroidectomy, being a common surgical option, for multinodular goitre and selective cases of Graves’ disease, is associated with risks related to temporary hypocalcaemia and vocal quality dysfunction. Dexamethasone, as a steroid, has well-established anti-inflammatory and immune-modulating effects. As researchers continue to understand its pathophysiology on hypocalcaemia and voice quality, we aim to assess the effect of preoperative dexamethasone used to improve hypocalcaemia and vocal cord function/post-thyroidectomy voice disorder. Methods We conducted a single-centre, non-randomised, double-blinded placebo-controlled, parallel-group study with short follow-up in a public sector hospital from January 2014 to December 2019. Patients were equally distributed in two groups to compare the effect of dexamethasone with placebo on hypocalcaemia and vocal cord function/post-thyroidectomy voice disorder Results Out of 192 patients, 36 (18.75) male patients while 156 (81.25) were female. Age range was 18 to 60. Eighteen patients had both low calcium level at 24 hours after the operation and hypocalcemic symptoms, of which 4 remain to have hypocalcaemia on third postoperative day. Forty patients defined as having voice dysfunction at 24 hours after being scored using Voice scale. Of these 40 patients with voice dysfunction, 8 had low calcium level in blood at 24 hours while only 2 of these remained with low calcium level on third postoperative day. 6/8 patients had symptomatic hypocalcaemia on first postoperative day. Conclusions Single-dose dexamethasone, during the preoperative period, is as safe and as effective in improving transient postoperative hypocalcaemia and Temporary vocal quality dysfunction/post-thyroidectomy voice disorder.

Assessment of Dysphonia in Children with Pompe Disease Using Auditory-Perceptual and Acoustic/Physiologic Methods

Bulbar and respiratory weakness occur commonly in children with Pompe disease and frequently lead to dysarthria. However, changes in vocal quality associated with this motor speech disorder are poorly described. The goal of this study was to characterize the vocal function of children with Pompe disease using auditory-perceptual and physiologic/acoustic methods. High-quality voice recordings were collected from 21 children with Pompe disease. The Grade, Roughness, Breathiness, Asthenia, and Strain (GRBAS) scale was used to assess voice quality and ratings were compared to physiologic/acoustic measurements collected during sustained phonation tasks, reading of a standard passage, and repetition of a short phrase at maximal volume. Based on ratings of grade, dysphonia was present in 90% of participants and was most commonly rated as mild or moderate in severity. Duration of sustained phonation tasks was reduced and shimmer was increased in comparison to published reference values for children without dysphonia. Specific measures of loudness were found to have statistically significant relationships with perceptual ratings of grade, breathiness, asthenia, and strain. Our data suggest that dysphonia is common in children with Pompe disease and primarily reflects impairments in respiratory and laryngeal function; however, the primary cause of dysphonia remains unclear. Future studies should seek to quantify the relative contribution of deficits in individual speech subsystems on voice quality and motor speech performance more broadly.

Voice Quality of Children With Cerebral Palsy

Purpose Many children with cerebral palsy (CP) are described as having altered vocal quality. The current study utilizes psychoacoustic measures, namely, low-amplitude (H1*–H2*) and high-amplitude (H1*–A2*) spectral tilt and cepstral peak prominence (CPP), to identify the vocal fold articulation characteristics in this population. Method Eight children with CP and eight typically developing (TD) peers produced vowel singletons [i, ɑ, u] and a story retell task with the same vowels in the words “beets, Bobby, boots.” H1*–H2*, H1*–A2*, and CPP were extracted from each vowel. Results were analyzed with mixed linear models to identify the effect of Group (CP, TD), Task (vowel singleton, story retell), and Vowel [i, ɑ, u] on the dependent variables. Results Children with CP have lower spectral tilt values (H1*–H2* and H1*–A2*) and lower CPP values than their TD peers. For both groups, vowel singletons were associated with lower CPP values as compared to story retell. Finally, the vowel [ɑ] was associated with higher spectral tilt and higher CPP values as compared to [i, u]. Conclusions Children with CP have more constricted and creaky vocal quality due to lower spectral tilt and greater noise. Unlike adults, children demonstrate poorer vocal fold articulation when producing vowel singletons as compared to story retell. Finally, low vowels like [ɑ] seem to be produced with less constriction and noise as compared to high vowels.

A Novel Protocol Designed to Treat Spastic Dysarthria Secondary to Traumatic Brain Injury: A Case Study

Introduction Spastic dysarthria is a motor speech disorder produced by bilateral damage to the activation pathways of the central nervous system. Its speech characteristics reflect the effects of hypertonicity and weakness of the bulbar musculature in a way that slows movement and reduces range of motion and force. Perceptually, speech has a high-pitched, strained, hypernasal vocal quality with decreased intelligibility. Purpose The purpose is to present a case illustration describing the use of a novel treatment protocol to improve speech intelligibility in the presence of spastic dysarthria. Method An underlying framework, including principles of exercise, neuroplasticity, and motor learning with adjunctive biofeedback, is described. The protocol consisted of four sessions per week for 4 weeks with daily homework. Results The participant exhibited improvements in intelligibility, patient satisfaction, lingual, and jaw range of motion, nasality, and tongue strength. Conclusion The use of a novel protocol using biofeedback and incorporating principles of exercise science, neuroplasticity, and motor learning for the treatment of spastic dysarthria demonstrated positive outcomes.

Choral singing and emotional communication in people with Parkinson’s disease

A large part of successful interpersonal communication relies on both the production and interpretation of vocal and facial expressions. Both of these abilities appear to be impaired in people with Parkinson’s disease (PD), a neurodegenerative disease affecting the muscles of the body. Based on positive effects of rhythmic auditory stimulation on overall motor functioning and the effects of intentional simulation of expression on facial mimicry, the present study investigated the impact of a choir program involving singing of happy and sad songs on a group of 12 PD patients. Participants were tested before and after program completion on measures of: (1) facial mimicry of a range of emotional expressions; (2) emotion perception, and; (3) vocal quality. It was found that choir participation improved some measures of vocal quality, while effects on facial mimicry and emotion perception were marginal.

Choral singing and emotional communication in people with Parkinson’s disease

A large part of successful interpersonal communication relies on both the production and interpretation of vocal and facial expressions. Both of these abilities appear to be impaired in people with Parkinson’s disease (PD), a neurodegenerative disease affecting the muscles of the body. Based on positive effects of rhythmic auditory stimulation on overall motor functioning and the effects of intentional simulation of expression on facial mimicry, the present study investigated the impact of a choir program involving singing of happy and sad songs on a group of 12 PD patients. Participants were tested before and after program completion on measures of: (1) facial mimicry of a range of emotional expressions; (2) emotion perception, and; (3) vocal quality. It was found that choir participation improved some measures of vocal quality, while effects on facial mimicry and emotion perception were marginal.