A N A COUSTIC S TUDY OF S USTAINED V OWELS PRODUCED BY P ATIENTS WITH - - PowerPoint PPT Presentation

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A N A COUSTIC S TUDY OF S USTAINED V OWELS PRODUCED BY P ATIENTS WITH - - PowerPoint PPT Presentation

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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 , Batrice Vaxelaire 2 , Jean-Franois Rodier 3 , Pierre-Philippe

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AN ACOUSTIC STUDY OF SUSTAINED VOWELS

PRODUCED BY PATIENTS WITH OR WITHOUT

RECURRENT LARYNGEAL NERVE PARALYSIS

AFTER THYROID SURGERY

Camille Fauth1,

Béatrice Vaxelaire2, Jean-François Rodier3, Pierre-Philippe Volkmar 3,Marion Béchet2, Rudolph Sock2

1LORIA CNRS UMR 7503 - Nancy

2Université de Strasbourg, Institut de Phonétique de Strasbourg – France –

IPS & U.R. 1339 Linguistique, Langues et Parole – LilPa, E.R. Parole et Cognition

3Centre Paul Strauss – Strasbourg – France, Département de Chirurgie

Oncologique

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BACKGROUND

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BACKGROUND

Centre Paul Strauss – Strasbourg (France)

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THYROID GLAND

 Located at the base of the neck  Is responsible for secretion of hormones

indispensable for important functions of the

  • rganism

(cardiac rhythm, body temperature…)

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ANATOMY (1)

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Illustrations F.H. Netter in Anatomie en Orthophonie . Parole , déglutition et

  • audition. Atlas commenté (2009). D. H. Mc Farland. Elsevier Masson Paris.
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CONSEQUENCES OF SURGERY

 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

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ANATOMY (2)

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Illustrations F.H. Netter in Anatomie en Orthophonie . Parole , déglutition et

  • audition. Atlas commenté (2009). D. H. Mc Farland. Elsevier Masson Paris.
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AIMS

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AIMS

 Assess the consequences of thyroid surgery

  • n 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)

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METHOD

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PATIENTS

Two groups of speakers:

 7 patients without unilateral paralysis ( 2

men and 5 women) NPP group (No Paralysis Patient)

 7 patients with unilateral paralysis ( 2 men

and 5 women) UPP group (Unilateral Paralysis Patient)

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RECORDINGS – METHOD NPP

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Recording phases:

  • 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

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NPP GROUP

Speakers Gender Date of birth Sugery NPPGER Féminin 1947 T Totale 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

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RECORDINGS – METHOD UPP

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Recording phases:

  • Control Speaker matched with age and gender

 Reference voice

  • 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 Mesure possible recovery

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UPP GROUP

Speakers Gender Date of birth Sugery Post-op diagnoses UPPBAS Féminin 1947 T Totale C droite en abduction UPPHEI Féminin 1946 T Totale C droite immobile UPPHUB Féminin 1953 T Totale C gauche immobile UPPWAL Féminin 1977 T Totale C gauche immobile 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

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CORPUS

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CORPUS

 3 cardinal vowels /i, a, u/

Repeated 10 times Sustained 5 seconds

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SOUNDS

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Female Speaker Vowels Without paralysis Male Speaker Vowels With paralysis

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MEASUREMENTS

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MEASUREMENTS

 Fondamental frequency (F0)  Harmonics-to-Noise Ratio (HNR)  Vowel Space Area

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HYPOTHESES

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HYPOTHESES

1)

Difficulty in controlling voicing would expectedly affect F0 values

2)

Altered laryngeal activity could modify coupling between the larynx and the vocal tract, thus affecting usual target HNR values

3)

Perturbation of voicing at the source may affect the size and shape of vowel spaces

4)

With speech therapy

  • r

time, the abovementioned parameters would be less modified could be meliorated

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RESULTS

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Fondamental Frequency

140 150 160 170 180 190 200 210 220 230 Préop Postop1 Postop2 Hz Enregistrements a i u 140 150 160 170 180 190 200 210 220 230 LC Postop2 Postopt3 Postop4 Hz Phases Enregistrements a i u

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Mean values of F0 (Hz) – Female speaker NPP Mean values of F0 (Hz) – Female speaker UPP

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Mean values of F0 (Hz) – NPP speakers

70 90 110 130 150 170 190 210 230 Préop Post-Op 1 Post-Op 2 Hz Enregistrements

F0 [a]

NPPENS NPPKAU NPPGER NPPHOE NPPHOF NPPKRE NPPLEN

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Mean values of F0 (Hz) - UPP speakers

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70 120 170 220 270 320 LC Post-Op 2 Post-Op 3 Post-Op 4 Hz Recordings

F0 [a]

UPPBAS UPPHEI UPPLAT UPPPAI UPPWAL UPPWAN

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Harmonics-to-Noise-Ratio (HNR)

15 20 25 30 35 Préop Postop1 Postop2 dB Phases d'enregistrement a i u 10 15 20 25 30 35 LC Postop2 Postop3 Postop4 dB Phases enregistrement a i u

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HNR (dB) mean values – Female speaker NPP HNR (dB) mean values – Female speaker UPP

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HNR (dB) mean values – NPP speakers

5 10 15 20 25 30 Préop Post-Op 1 Post-Op 2 dB Enregistrements

HNR [a]

NPPENS NPPGER NPPHOE NPPHOF NPPKAU NPPKRE NPPLEN

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HNR (dB) mean values –UPP speakers

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5 10 15 20 25 30 LC Post-Op 2 Post-Op 3 Post-Op 4 dB Enregistrements

HNR [a]

BAS HEI HUB LAT PAI WAL WAN

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Vowel Space Area

Preop Postop1 Postop2 0,34kHz² 0,21kHz² 0,28kHz² CS Postop2 Postop3 Postop4 0,36kHz² 0,25kHz² 0,28kHz² 0,35kHz²

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Mean Values of VSA – NPP speakers Mean Values of VSA – UPP speakers VSA calculated using the Heron’s formula

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Vowel Space Area

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Mean Values of VSA – NPP speakers Mean Values of VSA – UPP speakers

LC Post-Op 2 Post-Op 3 Post-Op 4 UPPBAS 0,42 0,40 0,37 0,19 UPPHEI 0,36 0,11 0,33 0,34 UPPHUB 0,42 0,54 0,35 0,29 UPPLAT 0,18 0,30 0,30 0,30 UPPPAI 0,21 0,23 0,18 0,23 UPPWAL 0,41 0,31 0,39 0,34 UPPWAN 0,49 0,19 0,44 0,49 kHz² Préop Post-Op 1 Post-Op 2 NPPENS 0,29 0,31 0,17 NPPGER 0,46 0,15 0,34 NPPHOE 0,22 0,03 0,16 NPPHOF 0,42 0,34 0,38 NPPKAU 0,20 0,07 0,17 NPPKRE 0,33 0,22 0,37 NPPLEN 0,38 0,40 0,33

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CONCLUSIONS

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CONCLUSIONS (1)

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Patient’s voice would be altered either because

  • f vocal fold paralysis OR simply because of the

surgery:

Difficulty in controlling voicing would expectedly affect F0 values

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CONCLUSIONS (2)

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Patient’s voice would be altered either because of vocal fold paralysis OR simply because of the surgery:  Altered laryngeal activity could modify coupling between the larynx and the vocal tract, thus affecting usual HNR target values

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CONCLUSIONS (3)

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Patient’s voice would be altered either because

  • f vocal fold paralysis OR simply because of the

surgery:  Impact on supraglottal resonances, may affect the size and shape of vowel spaces

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CONCLUSIONS (4)

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Patient’s voice would be altered either because

  • f vocal fold paralysis OR simply because of the

surgery:  The precedent parameters may be meliorated with time or by the speech therapy

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CONCLUSIONS (5)

According to the literature and our data :

 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

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LIMITS – FURTHER RESEARCH

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TO BE CONTINUED…

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  • More speakers
  • Articulatory data
  • Work on VCV sequences
  • Read speech
  • Perception Tests
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THANK YOU

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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 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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FAUTH C. (2012) Perturbation de la production de la parole suite à une opération de la glande thyroide. Thèse de Doctorat - Université de Strasbourg. BENNINGER, MICHAEL S, JOHN B GILLEN, ET JERALD S ALTAIAN (1998). Changing Etiology of Vocal Fold Immobility. The Laryngoscope 108 (9): 1346–1350. Friedrich, T, U Hänsch, U Eichfeld, M Steinert, A Staemmler, et M Schönfelder.

  • 2000. « Recurrent laryngeal nerve paralysis as intubation injury? » Der Chirurg;

Zeitschrift Für Alle Gebiete Der Operativen Medizen 71 (5): 539–544. JONES, M. W, S. CATLING, E. EVANS, D. H GREEN, ET J. R GREEN (1992) Hoarseness After Tracheal Intubation. Anaesthesia 47 (3) (mars 1): 213–216. Wagner, H. E, et Ch Seiler. 1994. « Recurrent Laryngeal Nerve Palsy After Thyroid Gland Surgery ». British Journal of Surgery 81 (2): 226–228. HARTL DM, CREVIER-BUCHMAN L, VAISSIÈRE J, BRASNU D. Phonetic effects of paralytic dysphonia. Ann Otol Rhinol Laryngol 2005,114:792-8. SCOTT AR, CHONG PS, HARTNICK CJ, RANDOLPH GW, Spontaneous and evoked laryngeal electromyography of the thyroarytenoid muscles: a canine model for intraoperative recurrent laryngeal nerve monitoring. An Otol Rhinol Laryngol. 2010 Jan ; 119(1):54-63. HONG KH, KIM YK: Phonatory characteristics of patients undergoing thyroidectomy without laryngeal nerve injury. Otolaryngology - Head and Neck Surgery 1997 Oct;117:399–404. TIMON CI, HIRANI SP, EPSTEIN R, RAFFERTY MA: Investigation of the impact of thyroid surgery on vocal tract steadiness. J Voice 2010 Sep;24:610–613.