The Kam language has experienced historical tonal splits, resulting in the development of a complex tonal system. However, there is still limited knowledge regarding the acoustic characteristics associated with aspiration-based tone splitting. This study aims to investigate the acoustic cues related to the tonal registers and laryngeal configurations in Donglei Kam, a dialect of Southern Kam. Sixteen native speakers of Donglei Kam participated, producing lexical tones. Statistical analyses were conducted to examine the acoustic distinctions between tonal registers, using measurements of voice onset time, spectral tilt, noise, and energy. The results indicated that Donglei Kam retained a two-way contrast of aspiration, albeit with a trend toward gradual loss. Additionally, a breathy voice was detected in the Ciyin tonal register, characterized by elevated spectral tilt values and spectral noise throughout the vowels. Moreover, machine learning classifiers effectively identified tonal registers using voice-quality data, suggesting that the phonation contrast between breathy and modal voice could contribute to the tonal split alongside pitch contrast. In summary, these findings enhance our understanding of the acoustic implementation of breathiness in Kam and offer valuable insights into the role of laryngeal contrast in tonal splits.

OBJECTIVE: This case series study investigated the outcomes of an innovative approach, ansa cervicalis nerve (ACN)-to-recurrent laryngeal nerve (RLN) low-tension anastomosis.
METHODS: Patients who received laryngeal nerve anastomosis between May 2015 and September 2021 at the facility were enrolled. The inclusion criteria were patients with RLN dissection and anastomosis immediately during thyroid surgery. Exclusion criteria were cases with anastomosis other than cervical loop-RLN anastomosis or pronunciation recovery time > 6 months. Patients admitted before January 2020 were assigned to group A which underwent the conventional tension-free anastomosis, and patients admitted after January 2020 were group B and underwent the innovative low-tension anastomosis (Dong\'s method).
RESULTS: A total of 13 patients were included, 11 patients received unilateral surgery, and 2 underwent bilateral surgery. For patients who underwent unilateral anastomosis, group B had a significantly higher percentage of normal pronunciation via GRBAS scale (83.3 % vs. 0 %, p = 0.015) and voice handicap index (66.7 % vs. 0 %, p = 0.002), and shorter recovery time in pronunciation (median: 1-day vs. 4 months, p = 0.001) than those in group A after surgery.
CONCLUSIONS: ACNs-to-RLN low-tension anastomosis with a laryngeal segment ≤1 cm (Dong\'s method) significantly improves postoperative pronunciation and recovery time. The results provide clinicians with a new strategy for ACN -to-RLN anastomosis during thyroid surgery.

OBJECTIVE: This study investigates (1) the presence of frequency transmission of oscillation from an external whole-body vibration (WBV) platform to the larynx; and (2) the factors that influence this frequency transmission.
METHODS: Thirty participants (mean age=22.3years) with normal voice were exposed to four frequency-intensity levels of WBV (10 Hz-10%, 10 Hz-20%, 20 Hz-10%, 20 Hz-20%) and were instructed to produce the natural vowel /a/ three times during each WBV setting. The frequency was extracted from the middle 1-second of each electroglottographic (EGG) signal after passing through a Hann band filter with a range of 6-24 Hz. Linear mixed-effects models were applied to determine the factors that influenced the absolute deviation of the frequency transmission.
RESULTS: All participants exhibit an extracted EGG frequency that aligns with the external WBV frequency, deviating by - 0.6 to 1.2 Hz. The absolute deviation of WBV frequency transmission is consistent for both sexes across various WBV settings, except the 10 Hz-10% setting where men tend to exhibit significantly higher deviations (P = 0.018).
CONCLUSIONS: Oscillations at a specific frequency are transmitted from an external WBV platform to the larynx. This study proposes the use of a \"spring\" system to investigate the effect of WBV on the larynx, and recommends further research to explore the potential of WBV in managing voice disorders.

This study set out to investigate whether individuals with dysphonia, as determined by either self-assessment or clinician-based auditory-perceptual judgment, exhibited differences in perilaryngeal muscle activities using surface electromyography (sEMG) during various phonatory tasks. Additionally, the study aimed to assess the effectiveness of sEMG in identifying dysphonic cases.
A total of 77 adults (44 women, 33 men, Mage = 30.4 years) participated in this study, with dysphonic cases identified separately using either a 10-item Voice Handicap Index (VHI-10) or clinician-based auditory-perceptual voice quality (APVQ) evaluation. sEMG activities were measured from the areas of suprahyoid and sternocleidomastoid muscles during prolonged vowel /i/ phonations at different pitch and loudness levels. Normalized root-mean-square value against the maximal voluntary contraction (RMS %MVC) of the sEMG signals was obtained for each phonation and compared between subject groups and across phonatory tasks. Additionally, binary logistic regression analysis was performed to determine how the sEMG measures could predict the VHI-10-based or APVQ-based dysphonic cases.
Participants who scored above the criteria on either the VHI-10 (n = 29) or APVQ judgment (n = 17) exhibited significantly higher RMS %MVC in the right suprahyoid muscles compared to the corresponding control groups. Although the RMS %MVC value from the right suprahyoid muscles alone was not a significant predictor of self-evaluated dysphonic cases, a combination of the RMS %MVC values from both the right and left suprahyoid muscles significantly predicted APVQ-based dysphonic cases with a 69.66% fair level.
This study found that individuals with dysphonia, as determined by either self-assessment or APVQ judgment, displayed more imbalanced suprahyoid muscle activities in voice production compared to nondysphonic groups. The combination of the sEMG measures from both left and right suprahyoid muscles showed potential as a predictor of dysphonia with a fair level of confidence.
https://doi.org/10.23641/asha.25112804.

UNASSIGNED: There is a lack of effective treatment for idiopathic unilateral vocal fold paralysis (IUVFP). A better phonation was reported by patients after laryngeal nerve stimulation during our clinical examination.
UNASSIGNED: This study aims to investigate immediate effect of recurrent laryngeal nerve (RLN) stimulation on phonation in patients with IUVFP.
UNASSIGNED: Sixty-two patients with clinically identified IUVFP underwent RLN stimulation with needle electrodes. Laryngoscopy, acoustic analysis, and voice perception assessment were performed for quantitative comparison of vocal function and voice quality before and after the intervention.
UNASSIGNED: Laryngoscopic images showed a larger motion range of the paralyzed vocal fold (p < .01) and better glottal closure (p < .01) after RLN stimulation. Acoustic analysis revealed that the dysphonia severity index increased significantly (p < .01) while the jitter and shimmer decreased after the intervention (p < .05). According to perceptual evaluation, RLN stimulation significantly increased RBH grades in patients with IUVFP (p < .01). Furthermore, the improvement in voice perception had a moderate positive correlation with the decrease in the glottal closure.
UNASSIGNED: This study shows a short-term improvement of phonation in IUVFP patients after RLN stimulation, which provides proof-of-concept for trialing a controlled delivery of RLN stimulation and assessing durability of any observed responses.

Capturing phonation types such as breathy, modal, and pressed voices precisely can facilitate the recognition of human emotions. However, little is known about how exactly phonation types and decoders\' gender influence the perception of emotional speech. Based on the modified Brunswikian lens model, this article aims to examine the roles of phonation types and decoders\' gender in Mandarin emotional speech recognition by virtue of articulatory speech synthesis.
Fifty-five participants (28 male and 27 female) completed a recognition task of Mandarin emotional speech, with 200 stimuli representing five emotional categories (happiness, anger, fear, sadness, and neutrality) and five types (original, copied, breathy, modal, and pressed). Repeated-measures analyses of variance were performed to analyze recognition accuracy and confusion data.
For male and female decoders, the recognition accuracy of anger from pressed stimuli and fear from breathy stimuli was high; across all phonation-type stimuli, the recognition accuracy of sadness was also high, but that of happiness was low. The confusion data revealed that in recognizing fear from all phonation-type stimuli, female decoders chose fear responses more frequently and neutral responses less frequently than male decoders. In recognizing neutrality from breathy stimuli, female decoders significantly reduced their choice of neutral responses and misidentified neutrality as anger, while male decoders mistook neutrality from pressed stimuli for anger.
This study revealed that, in Mandarin, phonation types play crucial roles in recognizing anger, fear, and neutrality, while the recognition of sadness and happiness seems not to depend heavily on phonation types. Moreover, the decoders\' gender affects their recognition of neutrality and fear. These findings support the modified Brunswikian lens model and have significance for diagnosis and intervention among clinical populations with hearing impairment or gender-related psychiatric disorders.
https://doi.org/10.23641/asha.24302221.

This study evaluated the efficacy of a 4-week straw phonation in water (SPW) exercise program on aging-related vocal fold atrophy (VFA), with a secondary objective to examine the immediate effects of SPW exercises.
Thirty-eight older adults aged 60 years and above formally diagnosed with aging-related VFA were randomly assigned into an experimental group undergoing SPW exercises with an 8-cm depth of straw submersion into water for 4 weeks plus vocal hygiene practice (n = 20), and a control group with only vocal hygiene practice (n = 18). Outcome measures included laryngeal endoscopic measures of glottal gap, auditory-perceptual ratings of voice quality, acoustic measures, aerodynamic measures, and standardized self-assessment questionnaire scores. An additional round of acoustic and aerodynamic assessment following 20 min of SPW exercises was conducted to examine the immediate effects.
Significant improvements in normalized glottal gap area, perceptual rating of breathiness, smoothed cepstral peak prominence, harmonics-to-noise ratio (HNR), mean oral airflow, subglottal pressure and laryngeal airway resistance at comfortable loudness, Voice-related Quality of Life scores, and Chinese Vocal Fatigue Index Factor 3 scores were observed in the experimental group relative to the control group. There were also significant immediate effects for HNR, mean oral airflow, subglottal pressure, and laryngeal airway resistance.
These findings suggested significant immediate improvements in vocal function following SPW exercises, with additional significant improvements in vocal function as well as significant improvements in quality of life following the 4-week SPW exercise program. Further studies with more long-term follow-up are recommended to better understand the efficacy of SPW exercises with deep levels of straw submersion into water as an effective clinical option for the management of hypofunctional dysphonia associated with aging-related VFA.

This study identifies the most suitable syllable for laryngeal diadochokinesis (LDDK) in Mandarin speakers.
One hundred and ten Mandarin speakers aged 18-83 years were used in the study. LDDK was assessed using quick repetitions of /ʔe/, /ʔi/, /ʔa/, /he/, /ha/, and /hi/. The observation index included the average rate (syllable/s) and regularity (%).
In the various age groups, there was no significant difference in LDDK rate and regularity of adducted syllables (p > 0.05), and only the regularity of /ʔi/ is significantly different between aged 18-40 and 41-64 years (p = 0.040). When vocal fold adduction was compared between various syllables, there was no significant difference in LDDK rate and regularity (p > 0.05). In various age groups, the LDDK rate of abduction syllables is different (p < 0.05) compared with the LDDK regularity of abduction syllables (p > 0.05). In various abduction syllables, there is no difference in LDDK rate (p > 0.05); however, /ha/ and /hi/ have significant differences in LDDK regularity (p = 0.007).
According to the preliminary data, /ʔa/ and /ha/ can be used as suitable indicators to analyse the coordination ability of the laryngeal movement of Mandarin speakers.

Objective: To evaluate the effect of Wendler Glottoplasty to elevate vocal pitch in transgender women. Methods: The voice parameters of pre-and 3-month post-surgery of 29 transgender women who underwent Wendler Glottoplasty in department of otorhinolaryngology head and neck surgery of Beijing Friendship Hospital from January, 2017 to October, 2020 were retrospectively analyzed. The 29 transgender women ranged in age from 19-47 (27.0±6.3) years old. Subjective evaluation was performed using Transsexual Voice Questionnaire for Male to Female (TVQMtF). Objective parameters included fundamental frequency (F0), highest pitch, lowest pitch, habitual volume, Jitter, Shimmer, maximal phonation time (MPT), noise to harmonic ratio (NHR) and formants frequencies(F1, F2, F3, F4). SPSS 25.0 software was used for statistically analysis. Results: Three months after surgery, the score of TVQMtF was significantly decreased [(89.9±14.7) vs. (50.4±13.6), t=11.49, P<0.001]. The F0 was significantly elevated [(152.7±23.3) Hz vs. (207.7±45.9) Hz, t=-6.03, P<0.001]. Frequencies of F1, F2 and F3 were significantly elevated. No statistical difference was observed in the frequencies of F4. The highest pitch was not significantly altered while the lowest pitch was significantly elevated [(96.8±17.7) Hz vs. (120.0±28.9) Hz, t=-3.71, P=0.001]. Habitual speech volume was significantly increased [(60.0±5.2) dB vs. (63.6±9.6) dB, t=-2.12, P=0.043]. Jitter, Shimmer, NHR and MPT were not obviously altered (P>0.05). Conclusions: Wendler Glottoplasty could notably elevate the vocal pitch, formants frequencies and degree of vocal femininity in transgender women without affecting phonation ability and voice quality. It can be an effective treatment modality for voice feminization.
目的： 评估声带截短术在提高跨性别女性嗓音音调中的疗效。 方法： 回顾性分析2017年1月至2020年10月就诊于北京友谊医院耳鼻咽喉头颈外科的29例行显微支撑喉镜下声带截短术的跨性别女性术前及术后3个月的嗓音参数。29例跨性别女性年龄为19~47（27.0±6.3）岁。主观嗓音评估采用跨性别女性嗓音问卷（Transsexual Voice Questionnaire for Male to Female，TVQMtF）。客观评估中分析了嗓音基频（F0）、最高音、最低音、习惯言语响度、Jitter、Shimmer、最长发声时间（MPT）、噪谐比（NHR）、共振峰（F1、F2、F3、F4）频率。采用SPSS 25.0软件进行统计学分析。 结果： 与手术前相比，声带截短术后3个月后的TVQMtF评分明显下降［（89.9±14.7）分vs.（50.4±13.6）分，t=11.49，P<0.001］，F0水平明显提高［（152.7±23.3）Hz vs.（207.7±45.9）Hz，t=-6.03，P<0.001］。共振峰F1、F2和F3频率较术前明显提高，F4频率与术前的差异无统计学意义。患者的最高音无明显改变，但最低音较术前有明显提高［（96.8±17.7）Hz vs.（120.0±28.9）Hz，t=-3.71，P=0.001］。习惯言语响度较术前有明显提高［（60.0±5.2）dB vs.（63.6±9.6）dB，t=-2.12，P=0.043］。Jitter、Shimmer、NHR及MPT与术前的差异均无统计学意义（P值均>0.05）。 结论： 声带截短术能够显著提高跨性别女性的嗓音基频、共振峰频率及嗓音女性化程度，对发音能力及嗓音质量无明显不利影响，是嗓音女性化的有效治疗措施之一。.

Objective: To analyze the characteristics of vocal fold vibration of normal people and patients with spasmodic dysphonia (SD) using laryngeal high speed videoendoscopy combined with glottal area wave analysis. Methods: This prospective study examined twenty healthy subjects (10 males and 10 females), 12 patients with adductor spasmodic dysphonia(AdSD) (2 males,10 females)as AdSD group and 2 patients with abductor spasmodic dysphonia(AbSD) (2 males) as AbSD group. Twelve of healthy subjects (2 males,10 females) were selected as control group according to AdSD group gender match. All the subjects were recruited from the Department of Voice, Zhongshan Hospital, Xiamen University from October 2019 to December 2020. All subjects underwent laryngeal high speed videoendoscopy and 10 vibration periods were selected from each recording and were used to quantitatively analyze the change of glottal area and vocal fold vibration parameters (Speed Quotient (SQ), Open Quotient (OQ) and Close Quotient (CQ)). Results: 1. There were statistically significant differences in SQ, CQ and OQ between males and females in the healthy subjects (t=12.28, 5.59, 5.59, P<0.05). The change of the glottal area during each vibration period in healthy subjects was relatively stable(0.19-0.42). 2. The change of the glottal area during each vibration period in AdSD subjects had larger fluctuations, with the glottal area change index fluctuating in the range of 0.31 to 0.62. The SQ value of the AdSD group was significantly lower than that of control group (t=4.246, P<0.05). There were no significant differences in OQ and CQ between AdSD group and normal group (t=1.064, 1.332, P>0.05); The SQ value of the AbSD group tended to increase compared to normal group. Conclusions: Laryngeal high speed videoendoscopy combined with glottal area wave analysis has a certain reference value in the studying the vibration characteristics of SD patients. SQ has good specificity.
目的： 喉高速摄影结合声门区波形（glottal area wave，GAW）分析健康受试者和痉挛性发声障碍（spasmodic dysphonia，SD）患者发声时的声带振动特征。 方法： 本研究为前瞻性研究，于2019年10月至2020年12月纳入20名［男性10名，女性10名，年龄20~53（32±2.5）岁］健康受试者；经厦门大学附属中山医院嗓音科确诊的12例（男性2例，女性10例）内收型SD患者（adductor spasmodic dysphonia，AdSD组）和2例（男性）外展型SD患者（abductor spasmodic dysphonia，AbSD组），年龄19~72（38±12.5）岁；根据AdSD组的性别进行配比，选取12名（男2名，女10名）健康受试者为对照组。对所有健康受试者和痉挛性发声障碍患者进行喉高速摄影检查，选取受试者影像中发声稳定的10个振动周期，分析声门区波形图，获得声门面积变化指数及声带振动参数［速度商（speed quotient，SQ）、开放商（open quotient，OQ）及关闭商（close quotient，CQ）］。采用SPSS 22.0软件进行统计学分析，以P<0.05为差异有统计学意义。 结果： ① 声门面积变化指数在健康受试者中较稳定（0.19~0.42），SQ、CQ及OQ值在健康受试者男性及女性间的差异均有统计学意义（t=12.28，5.59，5.59，P<0.05）；② 声门面积变化指数在AdSD患者中波动范围较大（0.31~0.62）；与对照组相比，AdSD组SQ值较小，且差异有统计学意义（t=4.246，P<0.05），两组的OQ及CQ值间差异无统计学意义（t=1.064，1.332，P>0.05）；与对照组相比，AbSD组的SQ有增大趋势。 结论： 喉高速摄影结合GAW对研究SD患者的声带振动特征具有一定的参考价值，其中SQ参数具有较好的特异性。.