Ramona C. Steiner 1 , Christian T. Herbst 2 , David M. Howard 3

1 University of Salzburg, Department of Linguistics, Salzburg

2 Palacký University Olomouc, Department of Experimental Physics, Olomouc

3 University of York, Department of Electronics, York

The central deficit in unilateral vocal fold pareses (UVFP) is insufficient glottal adduction. Several well-established therapy methods exist, but their efficiency is rarely evaluated objectively. Except for auditory feedback via bone conduction, patients have no means to assess the targeted change in voice quality. In a recent study, electroglottography (EGG) has successfully been used as a real-time biofeedback tool in order to increase the degree of posterior glottal closure in a healthy amateur singer. EGG has also been used recently in an attempt to document voice quality in patients with vocal fold pareses. In this study we investigate whether electroglottographic real-time biofeedback can be used to increase therapy efficiency by enhancing glottal adduction in patients with UVFP.

For this experiment four patients with diagnosed infranuclear UVFP act as subjects. Habitual phonation was documented simultaneously by means of videolaryngoscopy, electroglottography and audio recording when sustaining a vowel at a comfortable pitch. In a therapeutic session, using phonatory exercises (conservative approach), subjects were shown a real-time EGG-waveform (normalized in both amplitude and time) representing one glottal cycle which changes over time. As they followed the instructions of the therapist, they were asked consciously to introduce changes into the shape of the displayed EGG-waveform. Therapy sessions were documented by means of simultaneous recording of acoustic and electroglottographic data. Immediately after therapy session the patients' attempt to apply the potentially improved phonatory behaviour was documented simultaneously by means of videolaryngoscopy, electroglottography and audio recording, again when sustaining a vowel at a comfortable pitch.

First tests showed that the EGG-signal could be detected in a patient with a chronic UVFP, and that he was able to willingly introduce changes into the displayed EGG-waveform during therapy for a sustained vowel. The sessions further explored the effect of training on the ability of patients to change the shape of the EGG-waveform at will which provides support for the use of EGG in therapy.

John Rubin 1 , Ed Blake 2

1 Royal National Throat Nose and Ear Hospital, ENT, London

2 PhysioEd Medical, , London

Real time ultrasound was used as an adjunct to assess patterns of peri-abdominal musculature in 14 individuals with muscle tension dysphonia.. In 13/14 individuals there was an imbalance between the transversus abdominis (TA) and Internal Oblique (IO) muscles, whereby the IO was found to be overactive and the TA under-active. The significance of this finding and its putative role in muscle tension dysphonia is discussed.

Coen Honig 1

1 Private teacher, , Den Haag

Since 2008 Transvision, the organisation for transsexual individuals in the Netherlands, organises voice  workshops for transsexual people. The groups consist of 10-12 people, both men and women. In these workshops people do speach exercizes and sing together. The focus is on singing but speech does get a lot of attention as well. The songs being sung are well known pop-songs, for example from Abba and Elvis Presley. Each course consists of 6 lessons.

 This way of approaching the voice of transsexual people is effective because of several reasons:

1: People are in a group and recognise their problems in other individuals, which is comforting. They also enjoy sharing the good results with each other and compliments from groupmembers seem to be even more important than compliments from the teacher.

2: Singing is fun, the voice is not being referred to as something problematic. This makes the motivation of the groupmembers very strong. They enjoy working with their voice.

3: It is a cheap method. Because 10 people are treated at the same time, and do get a lot of information and time to practice, it is very cost-effective.

4. In speech therapy a diagnosis needs to be made, and due to the organisation of health care the therapist adresses this very problem. The approach of the groupwork is to improve the quality of the voice, even if there is not a medical problem. This approach is more holistic. 

5. People feel safe in the group because they are in company of people who are going through exactly the same process.

6. Many things in speech and singing need the same basic technique for men and women, like the breathing and resonance. Getting information about the opposite sex voice makes people understand their own vocal problems better: they very well know the voice of the opposite sex! So a mixed group is effective and also makes things possible like singing 2 part pieces.

7. Participants report positive changes in their voice use, and get feedback from their surrounding that their voice sounds better.

In a presentation I would like to give you more information about these workshops.

 

Alfonso Borragan 1 , Enmanuella Lucchini 2 , Andrea Ricci Maccarini 2 , Giovanni de Rossi 3

1 Centro de Foniatría y Logopedia, , Santander

2 Ospedale “M. Bufalini”, ORL, Cesena

3 Ospedale San Bonifacio di Soave, ORL, Verona