Acoustic analysis of voice in children with cleft palate and velopharyngeal insufficiency

Laryngeal Aerodynamics, Acoustics, and Hypernasality in Children With Cleft Palate

OBJECTIVE

The objective of this study was to examine the relationship between laryngeal aerodynamics, acoustics, and hypernasality in children with cleft palate with or without lip (CP ± L).

METHOD

This study used a prospectively performed cross-sectional design. Fifty-six children between the ages of 6 and 17 years with CP ± L participated (Mage= 11.7, SD = 3.4; male = 32, female = 24). Children were separated into four groups based on auditory-perceptual ratings of hypernasality made using the Cleft Audit Protocol for Speech-Augmented-Americleft Modification protocol. Laryngeal aerodynamic measures including subglottal pressure, transglottal airflow, laryngeal aerodynamic resistance (LAR), and phonation threshold pressure were collected. Acoustic measures of smoothed cepstral peak prominence (CPP) and low-to-high ratio on sustained vowels and connected speech were also considered. Analyses controlled for age, sex, auditory-perceptual ratings of voice quality, and speech intelligibility.

RESULTS

Children with minimally or mildly hypernasal resonance demonstrated significantly increased subglottal pressure, reduced transglottal airflow, and increased LAR, when compared with children with balanced or moderately hypernasal resonance. CPP on sustained vowel was significantly lower for children with moderate hypernasality when compared with all other groups-suggesting poorer voice quality. Other acoustic measures were in or near normative pediatric range.

CONCLUSIONS

Children with CP ± L and minimal or mildly hypernasal resonance demonstrated aerodynamic voice measures indicative of vocal hyperfunction. These findings suggest that children with CP ± L may compensate for velopharyngeal dysfunction on a laryngeal level, thus increasing the risk of laryngeal pathology. Future study should explore the relationship between laryngeal function and velopharyngeal port closure and consider how voice problems can be prevented or mitigated in children with CP ± L.

From phenotype to phonotype: a comprehensive description of voice features of Cri du chat syndrome

Genetic syndromes have been studied by extensive research allowing a better definition of their clinical manifestations, natural history, and etiopathogenetic mechanisms. Nevertheless, some relevant, but still unexplored aspects of these multisystemic conditions need to be clarified. One of these aspects is the characterization of the vocal production, especially in some genetic syndromes in which the distinctive voice is the hallmark of the syndrome (e.g., Cri du chat syndrome, CdCS). The aim of this study is to provide a detailed description of phonotype of patients affected by CdCS. We prospectively recorded and analysed acoustical features of three corner vowels [a], [i], and [u] and number listing from 1 to 10 of 29 patients with molecularly confirmed CdCS (age range 4-21 years; mean 11 ± 6; median 10 years). For perceptual analysis, the GIRBAS scale was completed. The acoustical analysis was performed through BioVoice software. When stratified by age and gender, in the older men subgroup the grade, roughness, and asthenia mean values are the highest for each vowel, when compared with values of the same parameters obtained in the other subgroups. Statistical analysis highlighted 26 significant differences: 38% (10) concern the sustained phonation of /a/, 27% (7) are related to /i/ whereas 19% (5) to /u/. Ratio1, Ratio2, VSA, and FCR were also significant. Conclusion: The voice production not only conveys linguistic and paralinguistic information but also can give information regarding the speaker's biological and clinical characteristics.

Influence of speech aid prosthesis with speech therapy on speech outcomes in adult patients with persisting velopharyngeal insufficiency: A retrospective analysis

STATEMENT OF PROBLEM

Prosthetic intervention with a speech aid prosthesis (SAP) along with speech therapy has been reported to improve speech outcomes in patients with persisting velopharyngeal insufficiency (VPI). However, little is known regarding the impact of this treatment on different speech parameters over time in adult patients with VPI.

PURPOSE

The purpose of this retrospective study was to evaluate the change in speech parameters after rehabilitation with an SAP and speech therapy in adult patients with VPI using subjective and objective tests.

MATERIAL AND METHODS

Patients above 16 years of age who had received prosthetic treatment for VPI and had complete speech assessment records between 2017 and 2020 were included in the analysis. After completion of the prosthetic treatment, speech therapy comprising 2 sessions per week of 45 minutes was provided by a speech pathologist. Speech evaluation was performed using tests that included speech intelligibility calculation, nasal pinch test, audible nasal air emissions, acoustic analysis, and the nasalance check. Assessments were done at 4 time intervals: T0: without an SAP; T1: 1 week with an SAP; T2: 1 month with an SAP; and T3: 3 months with an SAP. A descriptive analysis was followed by a comparison between groups using the Friedman test for subjective assessments and repeated measures ANOVA for objective tests (α=.05).

RESULTS

Of 10 individuals who had received an SAP, 5 participants, 2 men and 3 women with a mean age of 38 years were included in the analysis. Statistically significant improvement in mean scores was observed from T0 to T3 concerning speech intelligibility (P<.001), hypernasality (P<.001), audible nasal air emission (P<.001), mean fundamental frequency (P=.034), shimmer percentage (P=.004), and nasalance (P=.004). Improvement in jitter percentage was not statistically significant (P=.218).

CONCLUSIONS

An SAP along with speech therapy should be considered as a conservative and effective treatment option for addressing speech issues in adult patients with VPI.

Acoustic evaluation of voice signal distortion by videoconferencing platforms and devices used in telepractice for cleft palate

The usefulness and effectiveness of telepractice have been reported in recent years. Treatment of cleft palate patients with compensatory articulation is based on perceptual identification. Telepractice using videoconferencing platforms causes voice signal distortion and impacts auditory-perceptual perception. This study aimed acoustically examine voice signal distortion and determine the optimal videoconferencing platforms, in addition to the phonemes that can be discriminated with the same quality as in face-to-face interactions. ATR503 with 50 phoneme-balanced Japanese speech sentences was used as a reference corpus. Four videoconferencing platforms, -Zoom, Cisco Webex, Skype, and Google Meet, -and five devices, -iPhone, Android, iPad Air, Windows, and MacBook Pro were used as transmission conditions to examine voice signal distortions with the objective measure log-spectral distortion (LSD). Tukey's test was conducted to evaluate the degree of consonant distortion related to voicings (voiceless and voiced), places of articulation (bilabial, alveolar, alveolo-palatal, palatal, velar, labial-velar, and glottal), and manners of articulation (plosive, fricative, affricate, tap or flap, nasal, and approximant). With statistically significant differences, voiced, bilabial, labial-velar, nasal, and plosive consonants exhibited smaller distortions. In contrast, voiceless, alveolo-palatal, fricative, and affricate consonants exhibited larger distortions. Google Meet exhibited the lowest distortion among videoconferencing platforms and MacBook exhibited the lowest distortion among devices. This study provides significant insights into the telepractice strategies with the appropriate videoconferencing platform and device, and useful settings for cleft palate patients with compensatory articulations with respect to acoustics.

The Immediate Effect of Straw Phonation in Children With Repaired Cleft Palate

OBJECTIVE

This study aims to investigate the immediate effect of straw phonation on the phonation of Persian-speaking children with repaired cleft palate.

STUDY DESIGN

Quasi-experimental preintervention and postintervention.

METHODS

Seventeen children with repaired cleft palate and velopharyngeal dysfunction were investigated. A control group was established comprising children without a cleft palate (control group), carefully matched in terms of age and gender. All participants underwent straw phonation and assessment. The assessments were made two times: at baseline and immediately after straw phonation. Each participant performs straw phonation (a short straw measuring 3 mm in inner diameter and 20 cm in length) once for 3 minutes. The acoustic analysis including parameters, such as jitter, shimmer, harmonics-to-noise ratio (HNR), cepstral peak prominence (CPP) parameters, as well as the electroglottography (closed quotient [CQ]) analysis were performed at pretreatment and immediately after treatment.

RESULTS

Compared with the pretreatment values, after-treatment observation demonstrated a significant reduction in Jitter % and Shimmer %, and a significant enhancement in HNR and CPP among children with repaired cleft palate. There is no significant difference in intragroup data in the CPP and CQ in pretreatment.

CONCLUSIONS

The proposed straw phonation technique results in an immediate positive change in the quality of voice in both groups. Moreover, assessments in the clinical group showed a significant decrease in shimmer and jitter perturbation, alongside elevated levels of HNR and CPP subsequent to straw phonation, irrespective of the phonatory task.

Velopharyngeal Insufficiency After Botox Injection for Persistent Bruxism

Botulinum toxin type-A (BTX-A) injections have emerged as a promising treatment for bruxism and temporomandibular joint (TMJ) disorders. However, there is a need for further exploration of optimal dosage, injection techniques, and intervals to maximize treatment effectiveness. Complications, such as velopharyngeal insufficiency, can occur after BTX-A injections, emphasizing the importance of precautionary measures. The utilization of ultrasound guidance and electromyography assistance can aid in precise injections and minimize the risk of complications. In addition, patients should receive appropriate medication and adhere to post-treatment instructions to alleviate symptoms. Follow-up procedures are essential to monitor potential complications, and in some cases, professional mental health care may be required. Further research is warranted to establish the safety and efficacy of BTX-A injections for the treatment of bruxism and TMJ disorders. This case study presents the development velopharyngeal insufficiency in a patient with chronic bruxism 3 days after receiving a BTX-A injection.

Objective and subjective evaluation of Velopharyngeal Dysfunction (VPD) following surgical repair of the cleft palate using the furlow palatoplasty - A new tool

Velopharyngeal dysfunction (VPD) diagnosis and speech surgery outcomes are currently based solely on subjective evaluation criteria consisting of perceptual speech assessment and functional imaging. This study describes an objective and comparable method in VPD assessment and investigates the concurrence between the objective and subjective evaluations. The present study included 20 paediatric patients presenting with VPD after primary repair (intravelar veloplasty) of cleft palate. Our protocol was based on computerized analysis of voice parameters by means of an objective tool, spectrography integrated with Multi-Dimensional Voice Program (MDVP). The protocol also included perceptual evaluation by speech therapist and phoniatrician (consensus listening), and parents. This is a single surgeon, single centre experience and all patients underwent a secondary Furlow's palatoplasty. Assessments were performed pre- and postoperatively and upon completion of speech therapy. Results were compared using the two-tailed t student test for paired data. Statistical significance was set for p-values <0.05. Data analysis confirmed an improvement in velopharyngeal closure after surgery and speech therapy consistently with the results of perceptual evaluations. The results of the study confirmed the availability and reliability of an objective method for VPD evaluation based on the analysis of voice parameters with investigations that are simple and easily available in a hospital setting.

Changes in voice quality of the children with cleft/lip in relation to children without anomaly

Children with cleft palate/lip are exposed to risk for verbal communication disorders that include resonance, articulation, voice disorders, and expressive language. The aim of this paper was to evaluate the changes in the voice quality of the children with cleft palate in relation to children without anomaly. The study included 52 participants, 26 with previously corrected cleft palate / lip, and 26 respondents without anomaly who are between 3 and 6 years old. Subjective assessment of voice quality was performed by using the GRBAS scale. Perceptual scales are important in assessing the voice quality, determining the degree and severity of voice disturbance, and deciding on further clinical procedures. Although the instrumental approach to voice examination is relevant because it provides objectivity, the subjective impression in assessing voice quality is crucial. Statistical processing was performed by groups, group structure (gender and age), a certain highest value, as well as percentage participations. The results showed that 50% of the participants were diagnosed with certain changes in the voice. Children aged 3-5 years have a 2.25 times higher incidence of voice changes than children aged 6-8 years. The largest number of participants belong to group 0 - There is no change in voice quality which represents as much as 50% of the total number of patients in the first group. While "3 - Pronounced changes in the voice" were not identified in the respondents aged 3-5 years. In 50% of the total number of participants there is no change in voice quality and these are located in girls aged 3-5 years.

Exploration of the Influences of Temporary Velum Paralysis on Auditory-Perceptual, Acoustic, and Tomographical Markers

Purpose To better understand hypernasality (HN), we explored the relations between velopharyngeal orifice, auditory perception of HN, and acoustic-spectral measures in an in vivo within-subject design: (a) with a normally functioning velum as the control condition and (b) with a temporarily paralyzed velum as the experimental condition. Method The velum of eight volunteers was injected with ropivacaine hydrochloride (Naropin) in the area of the levator veli palatini and tensor veli palatini muscles to induce temporary velopharyngeal inadequacy (VPI) and HN. Sustained [a] and [i] and oronasal text readings were recorded, and 3D cone-beam computed tomography images of the vocal tract were built before and during velar anesthesia. Differences between conditions and correlations in normal-to-numb differences between velopharyngeal cross-sectional area (VP_area), mean ratings of HN severity, and nine acoustic-spectral measures were determined. Results Three subjects already had some incomplete velopharyngeal closure in the control condition. Temporary motor nerve blockage of the velum (increased VP_area) was accomplished in seven subjects, leading to increased HN and changes in three acoustic-spectral measures. Furthermore, significant correlations only emerged between VP_area, HN, and Model_Kataoka. Conclusions In most of the participants, it was possible to temporarily increase the velopharyngeal orifice to investigate HN while controlling other speech variables and cephalic morphology. Although this study was exploratory and its are findings preliminary, it provided additional evidence for the possible clinical value of Model_Kataoka, A ₃-P ₀, and B _F1 for the objective measurement of VPI or HN.

The effect of velopharyngeal insufficiency on voice quality in Estonian Children with Cleft Palate

Most children born with cleft palate (CP) or cleft lip and palate (CL/P) have velopharyngeal insufficiency (VPI), some degree of hypernasal resonance, articulation disorders and laryngeal dysphonia. Combination of different CL/P specific problems may mask laryngeal dysphonia and therefore, it may remain undiagnosed and untreated by clinicians. The research aimed to study the effect of VPI on voice quality in Estonian CL/P children. We included 18 CL/P and 79 healthy children. Combination of objective (Multi-Dimensional Voice Program (MDVP)) and subjective (Pediatric Voice Handicap Index (pVHI), GRBAS scale, video-nasoendoscopy (VNE), video-laryngostroboscopy (VLS)) assessment methods were assisted and performed by our multidisciplinary cleft teams. We found that (1) overall quality of life is greatly affected by voice, resonance and articulation disorders in CL/P group, (2) more than half of the CL/P children had morphological changes of the vocal folds, (3) the severity of VPI did not result in worse outcomes of acoustic parameters of voice.

Effects of maxillary expansion on hearing and voice function in non-cleft lip palate and cleft lip palate patients with transverse maxillary deficiency: a multicentric randomized controlled trial

INTRODUCTION

The association between the treatment of transverse maxillary deficiency and the recovery of hearing and voice functions has gained attention in recent years.

OBJECTIVE

This prospective controlled trial aimed to evaluate the effects of rapid maxillary expansion on hearing and voice function in children with non-cleft lip palate and bilateral cleft lip palate with transverse maxillary deficiency METHODS: 53 patients (26 non-cleft and 27 bilateral cleft lip palate; mean age, 11.1±1.8 years) requiring rapid maxillary expansion for correction of narrow maxillary arches were recruited for this trial. Eight sub-groups were established based on the degree of hearing loss. Pure-tone audiometric and tympanometric records were taken for each subject at four different time periods. The first records were taken before rapid maxillary expansion (T0), the second after expansion (T1) (mean, 0.8 months), the third after three months (T2) (mean, 3 months) and the fourth at the end of retention period (T3) (mean, 6 months). ANOVA and Tukey HSD post-hoc tests were used for data analysis. Additionally, voice analysis was done using an updated PRAAT software program in a computerized speech lab at T0 and T2. A paired-samplet-test was used for comparisons of mean values of T0 and T2 voice parameters within both groups.

RESULTS

Rapid maxillary expansion treatment produced a significant increase in the hearing levels and middle ear volumes of all non-cleft and bilateral cleft lip palate patients with normal hearing levels and with mild conductive hearing loss, during the T0-T1, T1-T2, T0-T2, and T0-T3 observation periods (p<0.05). The significant increase was observed in right middle ear volumes during the T0-T1, T0-T2 and T0-T3 periods in non-cleft patients with moderate hearing loss. For voice analysis, significant differences were observed only between the T0 and T2 mean fundamental frequency (F0) and jitter percentage (p<0.05) in the non-cleft group. In the cleft group, no significant differences were observed for any voice parameter between the T0 and T2 periods.

CONCLUSION

Correction of the palatal anatomy by rapid maxillary expansion therapy has a beneficial effect on both improvements in hearing and normal function of the middle ear in both non-cleft and bilateral cleft lip palate patients. Similarly, rapid maxillary expansion significantly influences voice quality in non-cleft patients, with no significant effect in BCLP patients.

Acoustic analysis of voice in children with cleft lip and palate following vocal rehabilitation. Preliminary report

BACKGROUND

Cleft lip and palate (CLP) is the most common craniofacial anomaly. CLP affects resonance, voice and speech. Besides the most frequently reported resonance and speech disorders, several reports have addressed acoustic abnormalities in the voice of patients with CLP. However, there are just a few reports focusing on vocal treatment in this population.

OBJECTIVE

To study whether a Speech and Language Pathology (SLP) intervention including vocal rehabilitation for children with CLP and velopharyngeal insufficiency (VPI) provides significant improvement of abnormal acoustic parameters of voice.

MATERIAL AND METHODS

Fifteen children with cleft lip and palate (CLP) and velopharyngeal insufficiency (VPI) were studied. Age ranged 4-5 years. A matched control group of children without craniofacial anomalies and adequate speech, resonance and voice was assembled. All children underwent acoustic analysis of voice at the onset and at the end of SLP intervention including vocal rehabilitation.

RESULTS

Hypernasality persisted unchanged following SLP intervention. Mean Fundamental Frequency (F0) did not demonstrate a significant difference between the control and the active groups. At the onset of the intervention mean shimmer and jitter were significantly higher in all patients with CLP as compared to controls. At the end of the intervention shimmer and jitter significantly decreased in patients with CLP showing no differences as compared to controls.

CONCLUSION

SLP intervention including vocal rehabilitation improves abnormal acoustic parameters of voice. Besides surgical treatment for VPI the SLP intervention in children with CLP should also address vocal rehabilitation.

Comparison of three different surgical techniques for designing pharyngeal flaps according to findings of videonasopharyngoscopy and multiplanar videofluoroscopy

BACKGROUND

Velopharyngeal insufficiency (VPI) occurs when the velopharyngeal sphincter (VPS) is unable to completely seal anatomical closure between the nasal and oral cavities during speech. Palatal repair can restore VPS function but the prevalence of VPI after repair has been reported ranging from 20% to 40%. The combination of flexible videonasopharyngoscopy (FVNP) and multiplanar videofluoroscopy (MPVF) has been reported as the best approach for assessing the VPS mechanism and planning effective surgical procedures aimed to correct VPI.

OBJECTIVE

To study the outcome of three different techniques for performing pharyngeal flaps with the common denominator of individually designing the flap according to findings of VFNP and MPVF.

MATERIAL AND METHODS

A total of 140 cases of pharyngeal flap surgery were reviewed. Three surgeons performed 3 different surgical techniques. All cases underwent nasometry, VNP and MPVF preoperatively. All surgical procedures were carefully planned and designed according to findings of VNP and MPVF.

RESULTS

Nasal emission was completely eliminated in all cases. One-hundred-thirty-four patients (95%) demonstrated mean nasalance within normal limits after the surgical procedure whereas 6 patients persisted with mean nasalance scores above reference values postoperatively. There were no intraoperative or postoperative complications in any of the cases. No clinical data of sleep disordered breathing was detected in any of the cases after 2 months of postoperative follow-up. However, one case presented with clinical data of sleep disordered breathing 8 months postoperatively.

CONCLUSIONS

The results of this study suggest that as long as pharyngeal flaps are being designed according to the findings of imaging procedures, different surgical techniques can provide similar successful outcomes with minimal complications.

Voice Quality in Adults Treated for Unilateral Cleft Lip and Palate: Long-Term Follow-Up After One- or Two-Stage Palate Repair

OBJECTIVES

The aim of the current study was to assess voice quality among adults treated for unilateral cleft lip and palate (UCLP), after one- or two-stage palate closure, and compare it to a noncleft control group.

STUDY DESIGN

Cross-sectional study of patients with UCLP with long-term follow-up and noncleft controls.

PARTICIPANTS

Patients with UCLP born between 1960 and 1987, treated at Uppsala University Hospital, Sweden, were examined (n = 73) at a mean of 35 years after primary surgery. Forty-seven (64%) patients had been treated with 1-stage palate closure and 26 with 2-stage closure (36%). The noncleft control group consisted of 63 age-matched volunteers.

MAIN OUTCOME MEASURES

Ratings of perceptual voice characteristics from blinded voice recordings with Swedish Voice Evaluation Approach method. Acoustic voice analysis including pitch and spectral measures.

RESULTS

Among the patients, the mean values for the 12 evaluated variables on a visual analog scale (0 = no abnormality, 100 = maximal abnormality) ranged between 0.1 and 17, and the mean for all was 6 mm. Voice variables were similar between patients and controls, except the total mean of all the perceptual voice variables, as well as "vocal fry"; both slightly lower among patients ( P = .018 and P = .009). There was no difference in any variable between patients treated with 1-stage and 2-stage palate closure. No clear relationship was found between velopharyngeal insufficiency and dysphonia.

CONCLUSIONS

The voice characteristics among adults treated for UCLP in childhood are not different from those of individuals without cleft.

Voice Quality in Adults Treated for Unilateral Cleft Lip and Palate: Long-term Follow-up After 1- or 2-Stage Palate Repair

OBJECTIVES

The aim of the current study was to assess voice quality among adults treated for unilateral cleft lip and palate (UCLP), after 1- or 2-stage palate closure, and compare it to a noncleft control group.

STUDY DESIGN

Cross-sectional study in UCLP patients with long-term follow-up and noncleft controls.

PARTICIPANTS

UCLP patients born 1960-1987, treated at Uppsala University Hospital, Sweden, were examined (n = 73) at a mean of 35 years after primary surgery. Forty-seven patients (64%) had been treated with 1-stage palate closure and 26 with 2-stage closure (36%). The noncleft control group consisted of 63 age-matched volunteers.

MAIN OUTCOME MEASURE(S)

Ratings of perceptual voice characteristics from blinded voice recordings with Swedish Voice Evaluation Approach (SVEA) method. Acoustic voice analysis including pitch and spectral measures.

RESULTS

Among the patients, the mean values for the 12 evaluated variables on a VAS scale (0 = no abnormality, 100 = maximal abnormality) ranged between 1 and 22 and the mean for all was 6 mm. Voice variables were similar between patients and controls except the total mean of all the perceptual voice variables, as well as "vocal fry"-both slightly lower among patients ( P = .018 and P = .009). There was no difference in any variable between patients treated with 1-stage and 2-stage palate closure. No clear relationship was found between VPI and dysphonia.

CONCLUSION

The voice characteristics among adults treated for UCLP in childhood are not different from those of individuals without cleft.

Long-term Average Spectra Analysis of Voice in Children With Cleft Palate

OBJECTIVES

The purpose of this study was to survey the spectral characteristics and to compare, using an acoustic analyzer, the objective data obtained from patients with cleft palates with the objective data of normal children using long-term average spectra (LTAS) analysis.

METHODS

Participants were divided into a clinical group and a control group. All participants were asked to practice reading a sentence to become fluent. The duration of each recording was about 60 seconds. All samples were subjected to acoustic analysis using Praat software. All recordings were analyzed acoustically using LTAS.

RESULTS

In this study, there was no significant difference between the control group and the clinical group in the low-frequency region (boys: 0-2720 Hz; girls: 0-2240 Hz). LTAS measurements showed a great difference between the control group and the clinical group in the middle-frequency region (boys: 2720-4000 Hz; girls: 2240-4000 Hz). We also found that the energy distributed in the clinical group was lower than that of the control group in the high-frequency region (4000 Hz-8000 Hz) in both boys and girls.

CONCLUSIONS

The results reveal a lack of flat region in the middle-frequency range in the clinical group (both boys and girls) in comparison with the control group. The results also reveal that there is no significant difference across the control group and the clinical group in the low-frequency region.

Effect of Vocal Fry on Voice and on Velopharyngeal Sphincter

Introduction It is known that the basal sound promotes shortening and adduction of the vocal folds and leaves the mucosa looser. However there are few studies that address the supralaryngeal physiological findings obtained using the technique. Objective To check the effectiveness of using vocal fry on the voice and velopharingeal port closure of five adult subjects, whose cleft palate has been corrected with surgery. Methods Case study with five subjects who underwent otolaryngology examination by means of nasopharyngoscopy for imaging and measurement of the region of velopharyngeal port closure before and after using the vocal fry technique for three minutes. During the exam, the subjects sustained the isolated vowel /a:/ in their usual pitch and loudness. The emission of the vowel /a:/ was also used for perceptual analysis and spectrographic evaluation of their voices. Results Four subjects had an improvement in the region of velopharyngeal port closure; the results of the spectrographic evaluation were indicative of decreased hypernasality, and the results of the auditory-perceptual analysis suggested improved overall vocal quality, adequacy of loudness, decreased hypernasality, improvement of type of voice and decreased hoarseness. Conclusion This study showed a positive effect of vocal fry on voice and greater velopharyngeal port closure.