A N A COUSTIC S TUDY OF S USTAINED V OWELS PRODUCED BY P ATIENTS WITH OR WITHOUT R ECURRENT L ARYNGEAL N ERVE P ARALYSIS 4th Summer School AFTER T HYROID S URGERY Camille Fauth 1 , Béatrice Vaxelaire 2 , Jean-François Rodier 3 , Pierre-Philippe Volkmar 3 ,Marion Béchet 2, Rudolph Sock 2 1 LORIA CNRS UMR 7503 - Nancy 1 2 Université de Strasbourg, Institut de Phonétique de Strasbourg – France – IPS & U.R. 1339 Linguistique, Langues et Parole – LilPa, E.R. Parole et Cognition 3 Centre Paul Strauss – Strasbourg – France, Département de Chirurgie Oncologique
4th Summer School B ACKGROUND 2
B ACKGROUND Centre Paul Strauss – Strasbourg (France) 4th Summer School 3
T HYROID G LAND Located at the base of the neck 4th Summer School Is responsible for secretion of hormones indispensable for important functions of the organism (cardiac rhythm, body temperature … ) 4
A NATOMY (1) 4th Summer School 5 Illustrations F.H. Netter in Anatomie en Orthophonie . Parole , déglutition et audition. Atlas commenté (2009). D. H. Mc Farland. Elsevier Masson Paris.
C ONSEQUENCES OF S URGERY 4th Summer School Two recurrent nerves, responsible for the vocal folds' mobility However, after surgery, at the laryngeal level, the patient's voice and speech may be altered 6
A NATOMY (2) 4th Summer School 7 Illustrations F.H. Netter in Anatomie en Orthophonie . Parole , déglutition et audition. Atlas commenté (2009). D. H. Mc Farland. Elsevier Masson Paris.
4th Summer School A IMS 8
A IMS Assess the consequences of thyroid surgery 4th Summer School on the patient’s voice Identify various vocal perturbations caused by this surgery Uncover the possible compensatory strategies or adjustments the patient may implement either by himself or thanks to the speech therapy (longitudinal study) 9
4th Summer School M ETHOD 10
P ATIENTS Two groups of speakers: 7 patients without unilateral paralysis ( 2 4th Summer School men and 5 women) NPP group (No Paralysis Patient) 7 patients with unilateral paralysis ( 2 men and 5 women) UPP group (Unilateral Paralysis Patient) 11
R ECORDINGS – M ETHOD NPP Recording phases: 4th Summer School • Preop: the day before surgery Reference voice • Post-op 1: the day after surgery Voice is altered in variable degrees • Post-op 2 : 15 days after surgery Measure possible recovery 12
NPP G ROUP Speakers Gender Date of birth Sugery NPPGER Féminin 1947 T Totale 4th Summer School NPPHOE Féminin 1953 T Totale NPPHOF Féminin 1945 T Totale NPPKRE Féminin 1961 T Totale NPPLEN Féminin 1948 T Totale NPPENS Masculin 1958 T Totale NPPKAU Masculin 1954 T Totale 13
R ECORDINGS – M ETHOD UPP Recording phases: • Control Speaker matched with age and gender Reference voice 4th Summer School • Post-op 2 : 2 weeks after surgery Voice slightly to severely impaired with paralysis • Post-op 3 : 1 month after surgery Mesure possible recovery • Post-op 4 : 2 months after surgery 14 Mesure possible recovery
UPP G ROUP Speakers Gender Date of birth Sugery Post-op diagnoses UPPBAS Féminin 1947 T Totale C droite en abduction 4th Summer School UPPHEI Féminin 1946 T Totale C droite immobile UPPHUB Féminin 1953 T Totale C gauche immobile C gauche immobile UPPWAL Féminin 1977 T Totale paramédiane UPPWAN Féminin 1949 T Totale C gauche immobile UPPLAT Masculin 1944 T Totale C gauche adduction UPPPAI Masculin 1945 T Totale C gauche adduction 15
4th Summer School C ORPUS 16
C ORPUS 3 cardinal vowels /i, a, u/ 4th Summer School Repeated 10 times Sustained 5 seconds 17
S OUNDS 4th Summer School Female Speaker Male Speaker Vowels Vowels Without paralysis With paralysis 18
4th Summer School M EASUREMENTS 19
M EASUREMENTS Fondamental frequency (F0) 4th Summer School Harmonics-to-Noise Ratio (HNR) Vowel Space Area 20
4th Summer School H YPOTHESES 21
H YPOTHESES Difficulty in controlling voicing would 1) expectedly affect F0 values 4th Summer School Altered laryngeal activity could modify coupling 2) between the larynx and the vocal tract, thus affecting usual target HNR values Perturbation of voicing at the source may affect 3) the size and shape of vowel spaces With speech therapy or time, the 4) abovementioned parameters would be less 22 modified could be meliorated
4th Summer School R ESULTS 23
Fondamental Frequency 230 230 220 220 210 210 200 200 190 190 a a Hz Hz 180 i i 180 u u 170 170 160 160 150 150 140 140 LC Postop2 Postopt3 Postop4 Préop Postop1 Postop2 Phases Enregistrements Enregistrements Mean values of F0 (Hz) – Female Mean values of F0 (Hz) – Female speaker UPP speaker NPP 24 4th Summer School
Mean values of F0 (Hz) – NPP speakers F0 [a] 230 210 190 NPPENS 170 NPPKAU NPPGER Hz 150 NPPHOE NPPHOF 130 NPPKRE 110 NPPLEN 90 70 Préop Post-Op 1 Post-Op 2 Enregistrements 4th Summer School 25
Mean values of F0 (Hz) - UPP speakers F0 [a] 320 270 UPPBAS 220 UPPHEI Hz UPPLAT 170 UPPPAI UPPWAL UPPWAN 120 70 LC Post-Op 2 Post-Op 3 Post-Op 4 Recordings 4th Summer School 26
Harmonics-to-Noise-Ratio (HNR) 35 35 30 30 25 a a dB 25 dB i i 20 u u 20 15 15 10 Préop Postop1 Postop2 LC Postop2 Postop3 Postop4 Phases d'enregistrement Phases enregistrement HNR (dB) mean values – Female speaker HNR (dB) mean values – Female speaker NPP UPP 27 4th Summer School
HNR (dB) mean values – NPP speakers HNR [a] 30 25 20 NPPENS NPPGER 15 NPPHOE dB NPPHOF NPPKAU 10 NPPKRE NPPLEN 5 0 Préop Post-Op 1 Post-Op 2 Enregistrements 4th Summer School 28
HNR (dB) mean values – UPP speakers HNR [a] 30 25 20 BAS HEI 15 HUB dB LAT PAI 10 WAL WAN 5 0 LC Post-Op 2 Post-Op 3 Post-Op 4 Enregistrements 4th Summer School 29
Vowel Space Area Preop Postop1 Postop2 CS Postop2 Postop3 Postop4 0,34kHz² 0,21kHz² 0,28kHz² 0,36kHz² 0,25kHz² 0,28kHz² 0,35kHz² Mean Values of VSA – UPP speakers Mean Values of VSA – NPP speakers VSA calculated using the Heron’s formula 4th Summer School 30
Vowel Space Area kHz² Préop Post-Op 1 Post-Op 2 LC Post-Op 2 Post-Op 3 Post-Op 4 NPPENS 0,29 0,31 0,17 UPPBAS 0,42 0,40 0,37 0,19 NPPGER 0,46 0,15 0,34 UPPHEI 0,36 0,11 0,33 0,34 NPPHOE 0,22 0,03 0,16 UPPHUB 0,42 0,54 0,35 0,29 NPPHOF 0,42 0,34 0,38 UPPLAT 0,18 0,30 0,30 0,30 NPPKAU 0,20 0,07 0,17 UPPPAI 0,21 0,23 0,18 0,23 NPPKRE 0,33 0,22 0,37 UPPWAL 0,41 0,31 0,39 0,34 NPPLEN 0,38 0,40 0,33 UPPWAN 0,49 0,19 0,44 0,49 Mean Values of VSA – NPP speakers Mean Values of VSA – UPP speakers 4th Summer School 31
4th Summer School C ONCLUSIONS 32
C ONCLUSIONS (1) P atient’s voice would be altered either because of vocal fold paralysis OR simply because of the surgery: 4th Summer School Difficulty in controlling voicing would expectedly affect F0 values 33
C ONCLUSIONS (2) Patient’s voice would be altered either because of vocal fold paralysis OR simply because of the 4th Summer School surgery: Altered laryngeal activity could modify coupling between the larynx and the vocal tract, thus affecting usual HNR target values 34
C ONCLUSIONS (3) Patient’s voice would be altered either because of vocal fold paralysis OR simply because of the 4th Summer School surgery: Impact on supraglottal resonances, may affect the size and shape of vowel spaces 35
C ONCLUSIONS (4) Patient’s voice would be altered either because of vocal fold paralysis OR simply because of the 4th Summer School surgery: The precedent parameters may be meliorated with time or by the speech therapy 36
C ONCLUSIONS (5) According to the literature and our data : 4th Summer School Voice quality can be modified even without laryngeal immobility Timing recuperation is delayed for patients with diagnosed laryngeal immobility Patients should be informed about voice quality 37
4th Summer School L IMITS – F URTHER RESEARCH 38
T O BE CONTINUED … • More speakers • Articulatory data 4th Summer School • Work on VCV sequences • Read speech • Perception Tests 39
4th Summer School T HANK YOU This work was supported by the program « Perturbations et Réajustements : parole normale vs parole pathologique » of the Maison Inter-Universtaire des Sciences de l’Homme 40 Alsace (MISHA), 2008-2012, and also by an ANR Grant “DOCVACIM” to the Phonetics Institute of Strasbourg / U.R. LiLPa, E.R. Parole et Cognition.
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