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Daily voice use of patients with NPVH (Van Stan et al., 2021)

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posted on 2021-04-26, 20:02 authored by Jarrad H. Van Stan, Andrew J. Ortiz, Juan P. Cortés, Katherine L. Marks, Laura E. Toles, Daryush D. Mehta, James A. Burns, Tiffiny Hron, Tara Stadelman-Cohen, Carol Krusemark, Jason Muise, Annie B. Fox-Galalis, Charles Nudelman, Steven Zeitels, Robert E. Hillman
Purpose: The purpose of this study was to obtain a more comprehensive understanding of the pathophysiology and impact on daily voice use of nonphonotraumatic vocal hyperfunction (NPVH).
Method: An ambulatory voice monitor collected 1 week of data from 36 patients with NPVH and 36 vocally healthy matched controls. A subset of 11 patients with NPVH were monitored after voice therapy. Daily voice use measures included neck-skin acceleration magnitude, fundamental frequency (fo), cepstral peak prominence (CPP), and the difference between the first and second harmonic magnitudes (H1–H2). Additional comparisons included 118 patients with phonotraumatic vocal hyperfunction (PVH) and 89 additional vocally healthy controls.
Results: The NPVH group, compared to the matched control group, exhibited increased fo (Cohen’s d = 0.6), reduced CPP (d = −0.9), and less positive H1–H2 skewness (d = −1.1). Classifiers used CPP mean and H1–H2 mode to maximally differentiate the NPVH and matched control groups (area under the receiver operating characteristic curve of 0.78). Classifiers performed well on unseen data: the logit decreased in patients with NPVH after therapy; ≥ 85% of the control and PVH groups were identified as “normal” or “not NPVH,” respectively.
Conclusions: The NPVH group’s daily voice use is less periodic (CPP), is higher pitched (fo), and has less abrupt vocal fold closure (H1–H2 skew) compared to the matched control group. The combination of CPP mean and H1–H2 mode appears to reflect a pathophysiological continuum in NPVH patients of inefficient phonation with minimal potential for phonotrauma. Further validation of the classification model is needed to better understand potential clinical uses.

Supplemental Material S1. Audio samples of the three patients in Figure 4 reading the Rainbow Passage.

Van Stan, J. H., Ortiz, A. J., Cortes, J. P., Marks, K. L., Toles, L. E., Mehta, D. D., Burns, J. A., Hron, T., Stadelman-Cohen, T., Krusemark, C., Muise, J., Fox-Galalis, A. B., Nudelman, C., Zeitels, S., & Hillman, R. E. (2021). Differences in daily voice use measures between female patients with nonphonotraumatic vocal hyperfunction and matched controls. Journal of Speech, Language, and Hearing Research. Advance online publication.


This work was supported by the Voice Health Institute and the National Institute on Deafness and Other Communication Disorders under Grants R33 DC011588 and P50 DC015446 (Principal Investigator for both: Robert Hillman).