Informace o kvalifikační práci Selected topics in laryngeal, perceptual and acoustic assessments of human voice:
Videokymographic evaluations of vocal folds and investigations of teachers' voices
- Všechny požadované údaje o této VŠKP jsou vyplněny.
Hlavní téma
Výzkum kmitání hlasivek pomocí videokymografie
Hlavní téma v angličtině
Investigations of the vocal fold vibrations using videokymography
Název dle studenta
Selected topics in laryngeal, perceptual and acoustic assessments of human voice:
Videokymographic evaluations of vocal folds and investigations of teachers' voices
Název dle studenta v angličtině
Selected topics in laryngeal, perceptual and acoustic assessments of human voice:
Videokymographic evaluations of vocal folds and investigations of teachers' voices
The present thesis is based on four publications. In the first part of the thesis, the clinical value of the VKG method as an additional tool to stroboscopy (gold standard) was evaluated for diagnosing and treating various voice disorders (manuscript I). An exploratory questionnaire was designed for this purpose and used to evaluate results of examination of outpatients in a laryngology department. The results showed that VKG was useful in 95 % of cases, by either confirming the stroboscopic diagnosis (in 31 % cases), or making the diagnosis more accurate (44 %) or adjusting the treatment recommendations (20 %). After VKG examination, the diagnostic confidence improved in 68 % cases. VKG provided insights into the vibration characteristics of the vocal folds, and helped the clinicians to take some important diagnostic and treatment decisions when the diagnosis based on stroboscopy was uncertain. Analysis of the results also showed that the shape of lateral peaks (sharp versus rounded) and missing/reduced mucosal waves were the most helpful visual features in VKG images for obtaining the final diagnosis and providing insights into the health and pliability of vocal fold mucosa. The shape of the lateral peaks in VKG images was therefore in focus of the manuscript II which aimed at quantifying the sharpness of the lateral peak using automatic image analysis methods. Open Time Percentage Quotients (OTQ) and Plateau Quotients (PQ) were defined as two types of parameters which were expected to capture the shape of the lateral peaks in the vocal fold contours. The OTQ parameters were derived as fractions of the period and PQ as a fraction of the open phase during which the vocal folds displacement exceeded a pre-determined percentage of the vibratory amplitude. Results showed that the OTQ and PQ parameters derived at 95 % (OTQ95, PQ95) and at 80 % of the vocal fold amplitude (OTQ80, PQ80), had strong and significant correlations with the visual ratings of lateral peak sharpness (P<0.001). Therefore these quotients were considered to be the best objective parameters for quantification of lateral peak sharpness. The quotients increased their values when the shape of the lateral peak changed from sharp to round. In the second part of the thesis, teachers' voices were investigated using perceptual (subjective) evaluation and acoustic (objective) voice measures. Teachers are sensitive to voice attrition as a result of teaching in vocally demanding conditions and therefore investigations of teachers are important for better understanding of the voice properties and conditions influencing teachers' voice quality. In manuscript III, the participants were Finnish teachers who had no voice complaints, but in some of them laryngeal pathology was detected laryngoscopically. The changes in the values of non-smoothed and smoothed cepstral peak prominence (CPP & CPPS), voice sound pressure level (SPL) and perceptual ratings (vocal quality and vocal firmness) for three voice tasks (comfortable vowel phonation, comfortable and loud speech samples) were investigated and the influence of laryngeal pathology on these measures was studied. The results showed that CPP, CPPS and SPL values were significantly higher for vowels and loud speech than for comfortable speech (P<0.001). Significant correlations were found between SPL and cepstral measures. Loud speech was perceived to be firmer and have a better voice quality than comfortable speech. No significant relationships of the laryngeal pathology status with cepstral values, perceptual ratings, or voice SPL were found, however (P>0.05). It was concluded that neither the acoustic measures (CPP, CPPS, and SPL) nor the perceptual evaluations could clearly distinguish between healthy and disordered larynges when the pathologies are not self-perceived negatively by the teachers. Considering no vocal complaints of the subjects, the acoustic data are considered representative for teachers with functionally heal
Anotace v angličtině
The present thesis is based on four publications. In the first part of the thesis, the clinical value of the VKG method as an additional tool to stroboscopy (gold standard) was evaluated for diagnosing and treating various voice disorders (manuscript I). An exploratory questionnaire was designed for this purpose and used to evaluate results of examination of outpatients in a laryngology department. The results showed that VKG was useful in 95 % of cases, by either confirming the stroboscopic diagnosis (in 31 % cases), or making the diagnosis more accurate (44 %) or adjusting the treatment recommendations (20 %). After VKG examination, the diagnostic confidence improved in 68 % cases. VKG provided insights into the vibration characteristics of the vocal folds, and helped the clinicians to take some important diagnostic and treatment decisions when the diagnosis based on stroboscopy was uncertain. Analysis of the results also showed that the shape of lateral peaks (sharp versus rounded) and missing/reduced mucosal waves were the most helpful visual features in VKG images for obtaining the final diagnosis and providing insights into the health and pliability of vocal fold mucosa. The shape of the lateral peaks in VKG images was therefore in focus of the manuscript II which aimed at quantifying the sharpness of the lateral peak using automatic image analysis methods. Open Time Percentage Quotients (OTQ) and Plateau Quotients (PQ) were defined as two types of parameters which were expected to capture the shape of the lateral peaks in the vocal fold contours. The OTQ parameters were derived as fractions of the period and PQ as a fraction of the open phase during which the vocal folds displacement exceeded a pre-determined percentage of the vibratory amplitude. Results showed that the OTQ and PQ parameters derived at 95 % (OTQ95, PQ95) and at 80 % of the vocal fold amplitude (OTQ80, PQ80), had strong and significant correlations with the visual ratings of lateral peak sharpness (P<0.001). Therefore these quotients were considered to be the best objective parameters for quantification of lateral peak sharpness. The quotients increased their values when the shape of the lateral peak changed from sharp to round. In the second part of the thesis, teachers' voices were investigated using perceptual (subjective) evaluation and acoustic (objective) voice measures. Teachers are sensitive to voice attrition as a result of teaching in vocally demanding conditions and therefore investigations of teachers are important for better understanding of the voice properties and conditions influencing teachers' voice quality. In manuscript III, the participants were Finnish teachers who had no voice complaints, but in some of them laryngeal pathology was detected laryngoscopically. The changes in the values of non-smoothed and smoothed cepstral peak prominence (CPP & CPPS), voice sound pressure level (SPL) and perceptual ratings (vocal quality and vocal firmness) for three voice tasks (comfortable vowel phonation, comfortable and loud speech samples) were investigated and the influence of laryngeal pathology on these measures was studied. The results showed that CPP, CPPS and SPL values were significantly higher for vowels and loud speech than for comfortable speech (P<0.001). Significant correlations were found between SPL and cepstral measures. Loud speech was perceived to be firmer and have a better voice quality than comfortable speech. No significant relationships of the laryngeal pathology status with cepstral values, perceptual ratings, or voice SPL were found, however (P>0.05). It was concluded that neither the acoustic measures (CPP, CPPS, and SPL) nor the perceptual evaluations could clearly distinguish between healthy and disordered larynges when the pathologies are not self-perceived negatively by the teachers. Considering no vocal complaints of the subjects, the acoustic data are considered representative for teachers with functionally heal
The present thesis is based on four publications. In the first part of the thesis, the clinical value of the VKG method as an additional tool to stroboscopy (gold standard) was evaluated for diagnosing and treating various voice disorders (manuscript I). An exploratory questionnaire was designed for this purpose and used to evaluate results of examination of outpatients in a laryngology department. The results showed that VKG was useful in 95 % of cases, by either confirming the stroboscopic diagnosis (in 31 % cases), or making the diagnosis more accurate (44 %) or adjusting the treatment recommendations (20 %). After VKG examination, the diagnostic confidence improved in 68 % cases. VKG provided insights into the vibration characteristics of the vocal folds, and helped the clinicians to take some important diagnostic and treatment decisions when the diagnosis based on stroboscopy was uncertain. Analysis of the results also showed that the shape of lateral peaks (sharp versus rounded) and missing/reduced mucosal waves were the most helpful visual features in VKG images for obtaining the final diagnosis and providing insights into the health and pliability of vocal fold mucosa. The shape of the lateral peaks in VKG images was therefore in focus of the manuscript II which aimed at quantifying the sharpness of the lateral peak using automatic image analysis methods. Open Time Percentage Quotients (OTQ) and Plateau Quotients (PQ) were defined as two types of parameters which were expected to capture the shape of the lateral peaks in the vocal fold contours. The OTQ parameters were derived as fractions of the period and PQ as a fraction of the open phase during which the vocal folds displacement exceeded a pre-determined percentage of the vibratory amplitude. Results showed that the OTQ and PQ parameters derived at 95 % (OTQ95, PQ95) and at 80 % of the vocal fold amplitude (OTQ80, PQ80), had strong and significant correlations with the visual ratings of lateral peak sharpness (P<0.001). Therefore these quotients were considered to be the best objective parameters for quantification of lateral peak sharpness. The quotients increased their values when the shape of the lateral peak changed from sharp to round. In the second part of the thesis, teachers' voices were investigated using perceptual (subjective) evaluation and acoustic (objective) voice measures. Teachers are sensitive to voice attrition as a result of teaching in vocally demanding conditions and therefore investigations of teachers are important for better understanding of the voice properties and conditions influencing teachers' voice quality. In manuscript III, the participants were Finnish teachers who had no voice complaints, but in some of them laryngeal pathology was detected laryngoscopically. The changes in the values of non-smoothed and smoothed cepstral peak prominence (CPP & CPPS), voice sound pressure level (SPL) and perceptual ratings (vocal quality and vocal firmness) for three voice tasks (comfortable vowel phonation, comfortable and loud speech samples) were investigated and the influence of laryngeal pathology on these measures was studied. The results showed that CPP, CPPS and SPL values were significantly higher for vowels and loud speech than for comfortable speech (P<0.001). Significant correlations were found between SPL and cepstral measures. Loud speech was perceived to be firmer and have a better voice quality than comfortable speech. No significant relationships of the laryngeal pathology status with cepstral values, perceptual ratings, or voice SPL were found, however (P>0.05). It was concluded that neither the acoustic measures (CPP, CPPS, and SPL) nor the perceptual evaluations could clearly distinguish between healthy and disordered larynges when the pathologies are not self-perceived negatively by the teachers. Considering no vocal complaints of the subjects, the acoustic data are considered representative for teachers with functionally heal
Anotace v angličtině
The present thesis is based on four publications. In the first part of the thesis, the clinical value of the VKG method as an additional tool to stroboscopy (gold standard) was evaluated for diagnosing and treating various voice disorders (manuscript I). An exploratory questionnaire was designed for this purpose and used to evaluate results of examination of outpatients in a laryngology department. The results showed that VKG was useful in 95 % of cases, by either confirming the stroboscopic diagnosis (in 31 % cases), or making the diagnosis more accurate (44 %) or adjusting the treatment recommendations (20 %). After VKG examination, the diagnostic confidence improved in 68 % cases. VKG provided insights into the vibration characteristics of the vocal folds, and helped the clinicians to take some important diagnostic and treatment decisions when the diagnosis based on stroboscopy was uncertain. Analysis of the results also showed that the shape of lateral peaks (sharp versus rounded) and missing/reduced mucosal waves were the most helpful visual features in VKG images for obtaining the final diagnosis and providing insights into the health and pliability of vocal fold mucosa. The shape of the lateral peaks in VKG images was therefore in focus of the manuscript II which aimed at quantifying the sharpness of the lateral peak using automatic image analysis methods. Open Time Percentage Quotients (OTQ) and Plateau Quotients (PQ) were defined as two types of parameters which were expected to capture the shape of the lateral peaks in the vocal fold contours. The OTQ parameters were derived as fractions of the period and PQ as a fraction of the open phase during which the vocal folds displacement exceeded a pre-determined percentage of the vibratory amplitude. Results showed that the OTQ and PQ parameters derived at 95 % (OTQ95, PQ95) and at 80 % of the vocal fold amplitude (OTQ80, PQ80), had strong and significant correlations with the visual ratings of lateral peak sharpness (P<0.001). Therefore these quotients were considered to be the best objective parameters for quantification of lateral peak sharpness. The quotients increased their values when the shape of the lateral peak changed from sharp to round. In the second part of the thesis, teachers' voices were investigated using perceptual (subjective) evaluation and acoustic (objective) voice measures. Teachers are sensitive to voice attrition as a result of teaching in vocally demanding conditions and therefore investigations of teachers are important for better understanding of the voice properties and conditions influencing teachers' voice quality. In manuscript III, the participants were Finnish teachers who had no voice complaints, but in some of them laryngeal pathology was detected laryngoscopically. The changes in the values of non-smoothed and smoothed cepstral peak prominence (CPP & CPPS), voice sound pressure level (SPL) and perceptual ratings (vocal quality and vocal firmness) for three voice tasks (comfortable vowel phonation, comfortable and loud speech samples) were investigated and the influence of laryngeal pathology on these measures was studied. The results showed that CPP, CPPS and SPL values were significantly higher for vowels and loud speech than for comfortable speech (P<0.001). Significant correlations were found between SPL and cepstral measures. Loud speech was perceived to be firmer and have a better voice quality than comfortable speech. No significant relationships of the laryngeal pathology status with cepstral values, perceptual ratings, or voice SPL were found, however (P>0.05). It was concluded that neither the acoustic measures (CPP, CPPS, and SPL) nor the perceptual evaluations could clearly distinguish between healthy and disordered larynges when the pathologies are not self-perceived negatively by the teachers. Considering no vocal complaints of the subjects, the acoustic data are considered representative for teachers with functionally heal
1. Literature search on the topic of videokympgraphy and other vocal fold visualization techniques, to know what is the diagnostic value of these techniques, so as to prepare the protocol.
2. manage the methodology of extracting the videokymographic and videostroboscopic images from clinical exams on video tapes and in a digital form
3. To familiarize with the method of quantifying the VKG images (collaboration with C.Herbst and UTIA)
4. begin to proces the extracted records for systematic categorization of the findings analyse the data and compute the results. present at conference (national/international) and publish the work in an impacted journal.
5. Work on the topic of videokymography of hydrated vocal folds,prepare the protocol, analyse the data and compute the results. Publish the work in impacted journal.
6. Work on the topic of study of development of voice using videokymography and publish the work in an impacted journal.
Zásady pro vypracování
1. Literature search on the topic of videokympgraphy and other vocal fold visualization techniques, to know what is the diagnostic value of these techniques, so as to prepare the protocol.
2. manage the methodology of extracting the videokymographic and videostroboscopic images from clinical exams on video tapes and in a digital form
3. To familiarize with the method of quantifying the VKG images (collaboration with C.Herbst and UTIA)
4. begin to proces the extracted records for systematic categorization of the findings analyse the data and compute the results. present at conference (national/international) and publish the work in an impacted journal.
5. Work on the topic of videokymography of hydrated vocal folds,prepare the protocol, analyse the data and compute the results. Publish the work in impacted journal.
6. Work on the topic of study of development of voice using videokymography and publish the work in an impacted journal.
Seznam doporučené literatury
1. Schutte, H. K., Švec, J. G., & Šram, F. (1998). First results of clinical application of videokymography. The Laryngoscope, 108(8), 1206-1210.
2. Švec, J. G., & Schutte, H. K. (1996). Videokymography: high-speed line scanning of vocal fold vibration. Journal of Voice, 10(2), 201-205.
3. Švec, J. G., Šram, F., & Schutte, H. K. (2007). Videokymography in voice disorders: What to look for?. Annals of Otology, Rhinology & Laryngology, 116(3), 172-180.
4. Qiu, Q., Schutte, H. K., Gu, L., & Yu, Q. (2003). An automatic method to quantify the vibration properties of human vocal folds via videokymography. Folia Phoniatrica et Logopaedica, 55(3), 128-136.
5. Verdonck-de Leeuw, I. M., Festen, J. M., & Mahieu, H. F. (2001). Deviant vocal fold vibration as observed during videokymography: the effect on voice quality. Journal of Voice, 15(3), 313-322.
6. Qiu, Q., & Schutte, H. K. (2006). A new generation videokymography for routine clinical vocal fold examination. The Laryngoscope, 116(10), 1824-1828.
7. Casiano, R. R., Zaveri, V., & Lundy, D. S. (1992). Efficacy of videostroboscopy in the diagnosis of voice disorders. Otolaryngology--Head and Neck Surgery, 107(1), 95-100.
8. Paul, B. C., Chen, S., Sridharan, S., Fang, Y., Amin, M. R., & Branski, R. C. (2013). Diagnostic accuracy of history, laryngoscopy, and stroboscopy. The Laryngoscope, 123(1), 215-219.
9. Spiegel, J. R., Sataloff, R. T., & Hawkshaw, M. J. (1991). Strobovideolaryngoscopy: results and clinical value. Annals of Otology, Rhinology & Laryngology, 100(9), 725-727.
10.Woo, P., Colton, R., Casper, J., & Brewer, D. (1991). Diagnostic value of stroboscopic examination in hoarse patients. Journal of Voice, 5(3), 231-238.
11. Mendelsohn, A. H., Remacle, M., Courey, M. S., Gerhard, F., & Postma, G. N. (2013). The diagnostic role of high-speed vocal fold vibratory imaging. Journal of Voice, 27(5), 627-631.
12. Casiano, R. R., Zaveri, V., & Lundy, D. S. (1992). Efficacy of videostroboscopy in the diagnosis of voice disorders. Otolaryngology--Head and Neck Surgery, 107(1), 95-100.
13. Cohen, S. M., Kim, J., Roy, N., Wilk, A., Thomas, S., & Courey, M. (2015). Change in diagnosis and treatment following specialty voice evaluation: A national database analysis. The Laryngoscope.
14. Chan, R. W., & Tayama, N. (2002). Biomechanical effects of hydration in vocal fold tissues. Otolaryngology-Head and Neck Surgery, 126(5), 528-537.
15. Leydon, C., Sivasankar, M., Falciglia, D. L., Atkins, C., & Fisher, K. V. (2009). Vocal fold surface hydration: A review. Journal of Voice, 23(6), 658-665.
16. Verdolini-Marston, K., Titze, I. R., & Druker, D. G. (1990). Changes in phonation threshold pressure with induced conditions of hydration. Journal of voice, 4(2), 142-151.
17. Titze, I. R., Schmidt, S. S., & Titze, M. R. (1995). Phonation threshold pressure in a physical model of the vocal fold mucosa. The Journal of the Acoustical Society of America, 97(5), 3080-3084.
Seznam doporučené literatury
1. Schutte, H. K., Švec, J. G., & Šram, F. (1998). First results of clinical application of videokymography. The Laryngoscope, 108(8), 1206-1210.
2. Švec, J. G., & Schutte, H. K. (1996). Videokymography: high-speed line scanning of vocal fold vibration. Journal of Voice, 10(2), 201-205.
3. Švec, J. G., Šram, F., & Schutte, H. K. (2007). Videokymography in voice disorders: What to look for?. Annals of Otology, Rhinology & Laryngology, 116(3), 172-180.
4. Qiu, Q., Schutte, H. K., Gu, L., & Yu, Q. (2003). An automatic method to quantify the vibration properties of human vocal folds via videokymography. Folia Phoniatrica et Logopaedica, 55(3), 128-136.
5. Verdonck-de Leeuw, I. M., Festen, J. M., & Mahieu, H. F. (2001). Deviant vocal fold vibration as observed during videokymography: the effect on voice quality. Journal of Voice, 15(3), 313-322.
6. Qiu, Q., & Schutte, H. K. (2006). A new generation videokymography for routine clinical vocal fold examination. The Laryngoscope, 116(10), 1824-1828.
7. Casiano, R. R., Zaveri, V., & Lundy, D. S. (1992). Efficacy of videostroboscopy in the diagnosis of voice disorders. Otolaryngology--Head and Neck Surgery, 107(1), 95-100.
8. Paul, B. C., Chen, S., Sridharan, S., Fang, Y., Amin, M. R., & Branski, R. C. (2013). Diagnostic accuracy of history, laryngoscopy, and stroboscopy. The Laryngoscope, 123(1), 215-219.
9. Spiegel, J. R., Sataloff, R. T., & Hawkshaw, M. J. (1991). Strobovideolaryngoscopy: results and clinical value. Annals of Otology, Rhinology & Laryngology, 100(9), 725-727.
10.Woo, P., Colton, R., Casper, J., & Brewer, D. (1991). Diagnostic value of stroboscopic examination in hoarse patients. Journal of Voice, 5(3), 231-238.
11. Mendelsohn, A. H., Remacle, M., Courey, M. S., Gerhard, F., & Postma, G. N. (2013). The diagnostic role of high-speed vocal fold vibratory imaging. Journal of Voice, 27(5), 627-631.
12. Casiano, R. R., Zaveri, V., & Lundy, D. S. (1992). Efficacy of videostroboscopy in the diagnosis of voice disorders. Otolaryngology--Head and Neck Surgery, 107(1), 95-100.
13. Cohen, S. M., Kim, J., Roy, N., Wilk, A., Thomas, S., & Courey, M. (2015). Change in diagnosis and treatment following specialty voice evaluation: A national database analysis. The Laryngoscope.
14. Chan, R. W., & Tayama, N. (2002). Biomechanical effects of hydration in vocal fold tissues. Otolaryngology-Head and Neck Surgery, 126(5), 528-537.
15. Leydon, C., Sivasankar, M., Falciglia, D. L., Atkins, C., & Fisher, K. V. (2009). Vocal fold surface hydration: A review. Journal of Voice, 23(6), 658-665.
16. Verdolini-Marston, K., Titze, I. R., & Druker, D. G. (1990). Changes in phonation threshold pressure with induced conditions of hydration. Journal of voice, 4(2), 142-151.
17. Titze, I. R., Schmidt, S. S., & Titze, M. R. (1995). Phonation threshold pressure in a physical model of the vocal fold mucosa. The Journal of the Acoustical Society of America, 97(5), 3080-3084.
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Studentka nejprve přednesla prezentaci výsledků disertace. Náslědně školitel, dr. Švec přečetl hodnocení práce doktorandky . Poté přečetla svůj posudek doc. Vitásková. Studentka ospověděla na dotazy z posudku a oponenta. Oponentka byla s odpovědí spokojená. Poté přečetl svůj posudek doc. kubínek a studenta opět odpověděla na jeho dotazy. Oponent byl rovněž s odpovědí sokojen. Jelikož třetí oponent byl nemocen a nemohl se obhajoby zúčastnit, tak studentka odpověděla na jeho otázky mailem. Poté následovaly dotazy dalších členů komise. Na závěr prověhlo tajné hlasování a sdělení o výsledku doktorandce.