Massachusetts General Hospital, Boston.
MGH Institute of Health Professions, Boston, MA.
Am J Speech Lang Pathol. 2021 Jan 27;30(1):199-209. doi: 10.1044/2020_AJSLP-20-00227. Epub 2021 Jan 20.
Purpose Previous ambulatory voice monitoring studies have included many singers and have combined speech and singing in the analyses. This study applied a singing classifier to the ambulatory recordings of singers with phonotrauma and healthy controls to determine if analyzing speech and singing separately would reveal voice use differences that could provide new insights into the etiology and pathophysiology of phonotrauma in this at-risk population. Method Forty-two female singers with phonotrauma (vocal fold nodules or polyps) and 42 healthy matched controls were monitored using an ambulatory voice monitor. Weeklong statistics (average, standard deviation, skewness, kurtosis) for sound pressure level (SPL), fundamental frequency, cepstral peak prominence, the magnitude ratio of the first two harmonics ( ), and three vocal dose measures were computed from the neck surface acceleration signal and separated into singing and speech using a singing classifier. Results Mixed analysis of variance models found expected differences between singing and speech in each voice parameter, except SPL kurtosis. SPL skewness, SPL kurtosis, and all distributional parameters differentiated patients and controls when singing and speech were combined. Interaction effects were found in kurtosis and all vocal dose measures. Patients had significantly higher vocal doses in speech compared to controls. Conclusions Consistent with prior work, the pathophysiology of phonotrauma in singers is characterized by more abrupt/complete glottal closure (decreased mean and variation for ) and increased laryngeal forces (negatively skewed SPL distribution) during phonation. Application of a singing classifier to weeklong data revealed that singers with phonotrauma spent more time speaking on a weekly basis, but not more time singing, compared to controls. Results are used as a basis for hypothesizing about the role of speaking voice in the etiology of phonotraumatic vocal hyperfunction in singers.
目的 先前的门诊嗓音监测研究包含了许多歌手，并在分析中结合了言语和歌唱。本研究将歌唱分类器应用于患有声带创伤的歌手和健康对照者的门诊录音，以确定分别分析言语和歌唱是否会揭示出能为该高危人群的声带创伤病因和病理生理学提供新见解的嗓音使用差异。
方法 使用门诊嗓音监测仪对 42 名患有声带创伤（声带小结或息肉）的女性歌手和 42 名健康匹配对照者进行监测。从颈表面加速度信号中计算了声音压力级（SPL）、基频、倒谱峰突出度、前两个谐波的幅度比（ ）和三个嗓音剂量测量值的一周统计数据（平均值、标准差、偏度、峰度），并使用歌唱分类器将其分为歌唱和言语。
结果 混合方差分析模型发现，除 SPL 峰度外，每个嗓音参数在歌唱和言语之间均存在预期差异。当将歌唱和言语结合时，SPL 偏度、SPL 峰度和所有分布参数可区分患者和对照者。在 峰度和所有嗓音剂量测量值中发现了交互效应。与对照组相比，患者在言语中的嗓音剂量明显更高。
结论 与先前的工作一致，歌手声带创伤的病理生理学特征是在发声时更突然/完全的声门闭合（ 均值和变异性降低）和喉内压增加（SPL 分布偏度为负）。歌唱分类器在一周数据中的应用表明，与对照组相比，患有声带创伤的歌手每周说话的时间更多，但唱歌的时间并没有更多。研究结果被用来假设在歌手的声带创伤性发声亢进的病因中，说话声音的作用。
