Objective: To evaluate the effect of Wendler Glottoplasty to elevate vocal pitch in transgender women. Methods: The voice parameters of pre-and 3-month post-surgery of 29 transgender women who underwent Wendler Glottoplasty in department of otorhinolaryngology head and neck surgery of Beijing Friendship Hospital from January, 2017 to October, 2020 were retrospectively analyzed. The 29 transgender women ranged in age from 19-47 (27.0±6.3) years old. Subjective evaluation was performed using Transsexual Voice Questionnaire for Male to Female (TVQ^MtF). Objective parameters included fundamental frequency (F₀), highest pitch, lowest pitch, habitual volume, Jitter, Shimmer, maximal phonation time (MPT), noise to harmonic ratio (NHR) and formants frequencies(F1, F2, F3, F4). SPSS 25.0 software was used for statistically analysis. Results: Three months after surgery, the score of TVQ^MtF was significantly decreased [(89.9±14.7) vs. (50.4±13.6), t=11.49, P<0.001]. The F₀ was significantly elevated [(152.7±23.3) Hz vs. (207.7±45.9) Hz, t=-6.03, P<0.001]. Frequencies of F1, F2 and F3 were significantly elevated. No statistical difference was observed in the frequencies of F4. The highest pitch was not significantly altered while the lowest pitch was significantly elevated [(96.8±17.7) Hz vs. (120.0±28.9) Hz, t=-3.71, P=0.001]. Habitual speech volume was significantly increased [(60.0±5.2) dB vs. (63.6±9.6) dB, t=-2.12, P=0.043]. Jitter, Shimmer, NHR and MPT were not obviously altered (P>0.05). Conclusions: Wendler Glottoplasty could notably elevate the vocal pitch, formants frequencies and degree of vocal femininity in transgender women without affecting phonation ability and voice quality. It can be an effective treatment modality for voice feminization.
Humans ; Male ; Female ; Young Adult ; Adult ; Middle Aged ; Transgender Persons ; Retrospective Studies ; Speech Acoustics ; Voice Quality ; Phonation

Objective:To determine the effectiveness of individualized voice therapy in persistent pediatric voice disorders. Methods:Thirty-eight children who were admitted to the Department of Pediatric Otolaryngology Shenzhen Hospital, Southern Medical University due to persistent voice disorder from November 2021 to October 2022 were included. All children were evaluated by dynamic laryngoscopy before voice therapy. Two voice doctors performed GRBAS score and acoustic analysis on the children's voice samples to obtain the relevant parameters including F0, Jitter, Shimmer, and MPT; All children were given personalized voice therapy for 8 weeks. Results:Among 38 children with voice disorders, 75.8%（29 cases） were diagnosed with vocal nodules, 20.6%（8 cases） were vocal polyps, and 3.4%（1 case） were vocal cysts. And in all children. And 51.7%（20 cases） had the sign of supraglottic extrusion under dynamic laryngoscopy. GRBAS scores decreased from 1.93 ± 0.62, 1.82 ± 0.55, 0.98 ± 0.54, 0.65 ± 0.48, 1.05 ± 0.52 to 0.62 ± 0.60, 0.58 ± 0.53, 0.32 ± 0.40, 0.22 ± 0.36, 0.37 ± 0.36. F0, Jitter, Shimmer decreased from（243.11±39.73） Hz, （0.85±0.99）%, （9.96±3.78）% to（225.43±43.20） Hz, （0.33±0.57）%, （7.72±4.32）%, respectively MPT was prolonged from（5.82±2.30） s to（7.87±3.21） s after treatment. All parameters changes had statistical significance. Conclusion:Voice therapy can solve children's voice problems, improve their voice quality and effectively treat children's voice disorders.
Humans ; Child ; Voice Disorders/diagnosis* ; Voice ; Voice Quality ; Acoustics ; Speech Acoustics ; Vocal Cords/surgery*

Objective: To study voice changes in children after adenotonsillectomy or adenoidectomy and the relationship with the vocal tract structure. Methods: Fifty patients were recruited in this study prospectively, aged from 4 to 12 years old with the median age of 6. They were underwent adenotonsillectomy or adenoidectomy in Beijing Tongren Hospital, Capital Medical University from July 2019 to August 2020. In the cases, there are 31 males and 19 females. Thirty-six patients underwent adenotonsillectomy and 14 patients underwent adenoidectomy alone. Twenty-two children (13 males, 9 females) with Ⅰ degree of bilateral tonsils without adenoid hypertrophy and no snoring were selected as normal controls. Adenoid and tonsil sizes were evaluated. Subjective changes of voice were recorded after surgery. Moreover, voice data including fundamental frequency(F0), jitter, shimmer, noise to harmonic ratio(NHR), maximum phonation time(MPT), formant frequencies(F1-F5) and bandwidths(B1-B5) of vowel/a/and/i/were analyzed before, 3 days and 1 month after surgery respectively.SPSS 23.0 was used for statistical analysis. Results: Thirty-six patients(72.0%,36/50) complained of postoperative voice changes. The incidence was inversely correlated with age. In children aged 4-6, 7-9, and 10-12, the incidence was 83.3%(25/30), 63.6%(7/11) and 44.4%(4/9) respectively. Voice changes appeared more common in children underwent adenotonsillectomy(77.8%,28/36) than in those underwent adenoidectomy alone(57.1%,8/14), but there was no statistical difference. After operation, for vowel/a/, MPT(Z=2.18,P=0.041) and F2(t=2.13,P=0.040) increased, B2(Z=2.04,P=0.041) and B4(Z=2.00,P=0.046) decreased. For vowel/i/, F2(t=2.035,P=0.050) and F4(t=4.44,P=0.0001) increased, B2(Z=2.36,P=0.019) decreased. Other acoustic parameters were not significantly different from those before surgery. The F2(r=-0.392, P =0.032) of vowel/a/and F2(r=-0.279, P=0.048) and F4 (r=-0.401, P =0.028) of vowel/i/after adenotonsillectomy were significantly higher than those of adenoidectomy alone. Half of patients with postopertive voice changes can recover spontaneously 1 month after surgery. Conclusions: Voice changes in children underwent adenotonsillectomy or adenoidectomy might be related to their changes in formants and bandwidths. The effect of adenotonsillectomy on voice was more significant compared with that of adenoidectomy alone. The acoustic parameters did not change significantly after surgery except MPT.
Adenoidectomy ; Adenoids/surgery* ; Child ; Child, Preschool ; Female ; Humans ; Male ; Speech Acoustics ; Tonsillectomy ; Voice Quality

With a high sound quality stimulated by the electrical device and a large inclusion in medical insurance, the number of cochlear implant recipients has been rapidly increased in Korea. Today, it is not surprising that early implanted young children with congenital deafness show a similar performance to their normal hearing peers in speech perception. However, the cochlear implant users still have a trouble to enjoy music. This review study aims to introduce briefly about acoustic components that required to perceive the music and understand a relationship between cochlear implantation and temporal fine structure. For the pediatric implant users who have less experience on acoustical sound features but are much familiar with the electrically stimulated sound, perceiving the music seems to be challengeable due to the lack of temporal fine resolution related to pitch and timbre among various components of music. Four representative test batteries for evaluating the recipients' ability of the music perception were mentioned and effective auditory music trainings were discussed with analysis of related investigations. Unlike hearing aids users who usually depend on fitting algorism for better music quality, the cochlear implant users need systematic training to improve their music perception ability. In conclusion, advancement of speech processing technology which can provide accurate information about the temporal fine structure of incoming music to the recipients needs to be developed. Also, a practical application of music training should be recommended as a part of auditory training for the cochlear implant users.
Acoustics ; Child ; Cochlear Implantation ; Cochlear Implants ; Deafness ; Hearing ; Hearing Aids ; Humans ; Insurance ; Korea ; Music ; Perception ; Pitch Perception ; Speech Perception

BACKGROUND AND OBJECTIVES: Clear speech is an effective communication strategy used in difficult listening situations that draws on techniques such as accurate articulation, a slow speech rate, and the inclusion of pauses. Although too slow speech and improperly amplified spectral information can deteriorate overall speech intelligibility, certain amplitude of increments of the mid-frequency bands (1 to 3 dB) and around 50% slower speech rates of clear speech, when compared to those in conversational speech, were reported as factors that can improve speech intelligibility positively. The purpose of this study was to identify whether amplitude increments of mid-frequency areas and slower speech rates were evident in Korean clear speech as they were in English clear speech. SUBJECTS AND METHODS: To compare the acoustic characteristics of the two methods of speech production, the voices of 60 participants were recorded during conversational speech and then again during clear speech using a standardized sentence material. RESULTS: The speech rate and long-term average speech spectrum (LTASS) were analyzed and compared. Speech rates for clear speech were slower than those for conversational speech. Increased amplitudes in the mid-frequency bands were evident for the LTASS of clear speech. CONCLUSIONS: The observed differences in the acoustic characteristics between the two types of speech production suggest that Korean clear speech can be an effective communication strategy to improve speech intelligibility.
Acoustics ; Rehabilitation ; Speech Acoustics ; Speech Intelligibility ; Speech Perception ; Voice

BACKGROUND AND OBJECTIVES: The aim of this study was to evaluate the usefulness of speech mapping based on real ear measurement for routine hearing aid fitting and to compare functional gains for evaluating subjective satisfaction of hearing aid users. SUBJECTS AND METHOD: Twenty two participants with bilateral symmetric (< 10 dB HL difference) sensorineural hearing loss were enrolled in this study. All participants were fitted unilateral hearing aids with speech mapping using the National Acoustic Laboratories-Nonlinear 2 formula. After the initial fitting, patients were followed with the 2nd and 3rd fitting at two weeks and six weeks, respectively, and measured for aided pure tone average (PTA), aided speech discrimination score (SDS), the difference between target gain and real ear insertion gain (REIG) using speech mapping and subjective satisfaction via Korean Adaptation of the International Outcome Inventory for Hearing Aids (K-IOI-HA) questionnaire before further fitting was performed. We analyzed correlation of each parameter at 2nd and 3rd fitting with the K-IOI-HA score. RESULTS: Every sequential aided PTA and SDS at 2nd fitting and 3rd fitting were significantly improved after repeated hearing aid fitting (all p < 0.01). In the correlation analysis between K-IOI-HA and each parameter, the aided PTA and aided SDS did not show significant correlations with subjective satisfaction from the 2nd and 3rd fittings. But the difference between the target gain and R EIG in speech mapping showed significant negative correlations with the satisfaction scores at various speech level (r=–0.609 to –0.709, all p < 0.01). CONCLUSION: Speech mapping using real ear measurement was useful to expect subjective satisfaction of hearing aid users and it would be a valuable tool for fine tuning to achieve individual preferences.
Acoustics ; Auditory Threshold ; Ear ; Hearing Aids* ; Hearing Loss ; Hearing Loss, Sensorineural ; Hearing* ; Humans ; Methods ; Speech Perception

Perception of sound is associated with the use of multiple acoustic cues in the human auditory system. These acoustic cues can be classified by their temporal and spectral properties. Temporal information can be considered as a slowly varying envelope (ENV) superimposed on a more rapid temporal fine structure (TFS). Various sound-processing techniques have been developed to assess the role of acoustic information carried by temporal ENV and TFS information. Previous studies demonstrated that ENV cues are associated with speech recognition in quiet, while TFS cues have a role to melody/pitch perception and listening to speech in a competing background noise. Besides, a number of studies have shown that the relative insensitivity of hearing-impaired subjects to TFS information. Although current technologies used in cochlear implants are not efficient in delivering the TFS cues, new speech processing strategies have been proposed to deliver TFS information. We herein review the cutting edge of TFS related studies and discuss the clinical implication of TFS.
Acoustics ; Cochlear Implants ; Cues ; Hearing Loss ; Humans ; Noise ; Speech Perception

BACKGROUND AND OBJECTIVES: The purpose of this study was to classify patients with unilateral vocal fold paralysis according to their fixed location and to analysis the effects of two treatment methods by early voice therapy and injection laryngoplasty. MATERIALS AND METHODS: Twenty patients who were classified as full abduction and slight abduction according to the position of paralysis were treated injection laryngoplasy, and 23 patients were treated by voice therapy. Twenty patients were treated injection laryngoplasy and 23 patients were treated voice therapy. Results were evaluated by acoustic analysis, electroglottography, cepstrum analysis before and after therapy. The voice therapy was conducted by improving the larynx movement and glottal contact, whilst removing hypertension of the supraglottic and use the breathing. RESULTS: Significant improvement was found in the acoustic parameter, cepstrum parameter, and EGG before and after treatment in both groups. There was no significant difference between the two groups when compared before and after treatment to compare the effects of injection laryngoplasty and voice therapy. CONCLUSION: The initial treatments for unilateral vocal cord paralysis are injection laryngoplasty and voice therapy. however, there is no precise standard about which method should be applied first. Therefore, in this study, we tried to classify patients according to their paralysis position and then apply two methods. The results of this study suggest that voice therapy and Injection laryngoplasty at the initial stage is a very useful method to improve voice quality of vocal fold paralysis and improve laryngeal function.
Acoustics ; Humans ; Hypertension ; Laryngoplasty* ; Larynx ; Methods ; Ovum ; Paralysis ; Respiration ; Speech Therapy ; Therapeutic Uses* ; Vocal Cord Paralysis* ; Vocal Cords ; Voice Quality ; Voice*

BACKGROUND AND OBJECTIVES: Various hearing tests and vestibular function tests are used to diagnose acoustic neuroma. We analyzed the clinical characteristics and the results of audiovestibular function tests between patients of intrameatal and extrameatal acoustic neuroma. SUBJECTS AND METHOD: Reviewing the medical records for 64 patients with acoustic neuroma between March 2007 and February 2014, we divided the patients into two groups, intrameatal (31 patients) and extrameatal acoustic neuroma (33 patients) according to the involvement of cerebropontine angle. We compared the clinical characteristics, pure tone audiograms, speech audiometry, caloric test, and vestibular evoked myogenic potential (VEMP) between the two groups. RESULTS: While hearing loss was the most frequent presenting symptom in patients with intrameatal acoustic neuroma, dizziness was the most common symptom in patients with extrameatal acoustic neuroma. Hearing thresholds measured by pure tone audiometry and speech discrimination scores were significantly worse for patients with extrameatal acoustic neuroma. Abnormal unilateral canal paresis of caloric test was significantly higher for extrameatal acoustic neuroma than for intrameatal acoustic neuroma. Most patients with acoustic neuroma showed abnormal findings in the VEMP test, but the number of patients between intrameatal and extrameatal acoustic neuroma did not differ significantly. CONCLUSION: Clinical symptoms and the results of audiovestibular function tests differed according to the tumor size of acoustic neuroma. Physicians should counsel patients presenting with audiovestibular symptoms of the possibility of acoustic neuroma.
Acoustics* ; Audiometry ; Audiometry, Speech ; Caloric Tests ; Dizziness ; Hearing ; Hearing Loss ; Hearing Tests ; Humans ; Medical Records ; Methods ; Neuroma, Acoustic* ; Paresis ; Speech Perception ; Vestibular Function Tests

OBJECTIVES: Speech intelligibility is severely affected in children with congenital profound hearing loss. Hypernasality is a problem commonly encountered in their speech. Auditory information received from cochlear implants is expected to be far superior to that from hearing aids. Our study aimed at comparing the percentages of nasality in the speech of the cochlear implantees with hearing aid users and also with children with normal hearing. METHODS: Three groups of subjects took part in the study. Groups I and II comprised 12 children each, in the age range of 4-10 years, with prelingual bilateral profound hearing loss, using multichannel cochlear implants and digital hearing aids respectively. Both groups had received at least one year of speech therapy intervention since cochlear implant surgery and hearing aid fitting respectively. The third group consisted of age-matched and sex-matched children with normal hearing. The subjects were asked to say a sentence which consisted of only oral sounds and no nasal sounds ("Buy baby a bib"). The nasalance score as a percentage was calculated. RESULTS: Statistical analysis revealed that the children using hearing aids showed a high percentage of nasalance in their speech. The cochlear implantees showed a lower percentage of nasalance compared to children using hearing aids, but did not match with their normal hearing peers. CONCLUSION: The quality of speech of the cochlear implantees was superior to that of the hearing aid users, but did not match with the normal controls. The study suggests that acoustic variables still exist after cochlear implantation in children, with hearing impairments at deviant levels, which needs attention. Further research needs to be carried out to explore the effect of the age at implantation as a variable in reducing nasality in the speech and attaining normative values in cochlear implantees, and also between unilateral versus bilateral implantees.
Acoustics ; Child ; Cochlear Implantation ; Cochlear Implants ; Hearing ; Hearing Aids ; Hearing Loss ; Humans ; Speech Intelligibility ; Speech Therapy