Female suprasegmental speech parameters in reproductive age and postmenopause

Menopause and its Effect on Voice

Abstract

This study was designed to study the impact of menopause on voice quality. Cross-sectional Observational study with a total of 100 subjects. All subjects underwent biochemical analysis which included thyroid function tests, estrogen levels, progesterone levels and underwent voice analysis using the VAUGHMI voice analyser software. 50 postmenopausal females as cases and 50 premenopausal females as controls were taken for the study. The females were of the age group 35-55 yrs in order to remove age as confounding factor. The primary outcome measure was Total score, calculated based on harshness, hoarseness and breathiness. The postmenopausal females had a poorer voice quality than the premenopausal females (Total score 1.62 vs 2.48, p < 0.001). There was a significant difference between the fundamental frequency and pitch and perturbation in frequency of the postmenopausal females as compared to premenopausal females. The difference in the perturbation in the intensity of the voice was not significant. No linear correlation could be established between the voice quality and oestrogen or progesterone levels but the intergroup variation of the two parameters was significant. The premenopausal females have better voice quality than postmenopausal females. The relationship between hormonal level and voice quality couldn't be established. Further studies are required to assess the relation of hormone levels & voice quality with the possibility of exploring voice cosmesis.

Level of Evidence

Level 3.

High-Speed Characterization of Vocal Fold Vibrations in Normally Cycling and Postmenopausal Women: Randomized Double-Blind Analyses

Purpose The aim of this study was to examine the influence of menstrual cycle phases (follicular, ovulatory, luteal, and ischemic) and hormone levels (estradiol, testosterone, progesterone, and neuropeptide Y) on vocal fold vibrations in reproductive and postmenopausal women. Method Glottal area waveforms were extracted from high-speed videoendoscopy during sustained phonation, inhalation phonation, and voice onset/offset in the reproductive (n = 15) and postmenopausal (n = 13) groups. Linear mixed-model analysis was conducted to evaluate hormone levels and high-speed videoendoscopy outcome variables between the reproductive and postmenopausal groups. In the reproductive group, simple linear regression and multiple regression were conducted to determine the effects of hormones on the dependent variables. Results Group differences between reproductive and postmenopausal women were identified for stiffness index, oscillatory onset time, and oscillatory offset time. Neuropeptide Y hormone in the ischemic phase significantly predicted changes in the reproductive group for some dependent variables; however, the relationship varied for sustained phonation and inhalation phonation. Conclusion These findings provide preliminary evidence that vocal fold vibrations in the reproductive group are different predominantly in the ischemic phase due to neuropeptide Y changes.

Blood Plasma Hormone-Level Influence on Vocal Function

Purpose This preliminary study examined the influence of menstrual cycle phase and hormone levels on acoustic measurements of vocal function in reproductive and postmenopausal females. Mean fundamental frequency (f0), speaking fundamental frequency (Sf0), and cepstral peak prominence (CPP) were evaluated. It was hypothesized that Sf0 and CPP would be lower during the luteal and ischemic phases of the menstrual cycle. Group differences with lower values in postmenopausal females and greater variability in the reproductive females were also hypothesized. Method A mixed factorial analysis of variance was used to examine differences between reproductive and postmenopausal females and the four phases of the menstrual cycle. Separate analyses of variances were implemented for each of the dependent measures. Twenty-eight female participants (15 reproductive cycling, 13 postmenopausal) completed the study. Participants were recorded reading the Rainbow Passage and sustaining the vowel /a/. Mean vocal f0, Sf0, and CPP were determined from the acoustic samples. Blood assays were used to determine estrogen, progesterone, testosterone, and neuropeptide Y levels at four data collection time points. Results Group differences in hormone levels and Sf0 values were established with the postmenopausal group having significantly lower hormone levels and significantly lower Sf0 than the reproductive cycling group across the phases. Analysis of the reproductive group by hormone levels and cycle phase revealed no significant differences for CPP or Sf0 across phases. Higher estrogen was identified in the ovulation phase, and higher progesterone was identified in the luteal phase. Conclusions Significant differences in hormone levels and Sf0 were identified between groups. Within the reproductive cycling group, the lack of significant difference in acoustic measures relative to hormone levels indicated that the measures taken may not have been sensitive enough to identify hormonally mediated vocal function changes. The participant selection may have biased the findings in that health conditions and medications that are known to influence voice function were used as exclusion criteria.

The Protective Effect of Echinochrome A on Extracellular Matrix of Vocal Folds in Ovariectomized Rats

Here, we investigated the effects of sex hormones on extracellular matrix (ECM)-related gene expression in the vocal fold lamina propria of ovariectomized (after ovary removal) rats and verified whether echinochrome A (ECH) exerts any therapeutic effects on ECM reconstitution after estrogen deficiency in ovariectomized rats. Sprague–Dawley female rats (9 weeks old) were acclimatized for a week and randomly divided into three groups (n = 15 each group) as follows: group I (sham-operated rats, SHAM), group II (ovariectomized rats, OVX), group III (ovariectomized rats treated with ECH, OVX + ECH). Rats from the OVX + ECH group were intraperitoneally injected with ECH at 10 mg/kg thrice a week after surgery for 6 weeks. And rats were sacrificed 6 weeks after ovariectomy. Estradiol levels decreased in OVX group compared with the SHAM group. ECH treatment had no effect on the levels of estradiol and expression of estrogen receptor β (ERβ). The evaluation of ECM components showed no significant changes in elastin and hyaluronic acid levels between the different groups. Collagen I and III levels were lower in OVX group than in SHAM group but increased in OVX + ECH group. The mRNA levels of matrix metalloproteinase (MMP)-1, -2, -8, and -9 were significantly higher in the OVX group than in the SHAM group, but decreased in the OVX + ECH group. Thus, changes were observed in ECM-related genes in the OVX group upon estradiol deficiency that were ameliorated by ECH administration. Thus, the vocal fold is an estradiol-sensitive target organ and ECH may have protective effects on the ECM of vocal folds in ovariectomized rats.

Effect of sex hormones on extracellular matrix of lamina propria in rat vocal fold

OBJECTIVES

The role of sex hormones for voice changes in men and women is presently unknown. To determine the effect of sex hormone on the vocal fold, changes of the extracellular matrix (ECM) in vocal fold lamina propria were assessed in orchiectomized (ORX) and ovariectomized (OVX) rats.

METHODS

Male and female Sprague-Dawley rats were divided into sham-operated control male (CON-ORX), ORX, sham-operated female (CON-OVX), and OVX rats. Histological changes and expression of ECM-related genes in lamina propria of the vocal fold were evaluated at 4 and 12 weeks after surgery.

RESULTS

Testosterone and estradiol levels decreased in the ORX and OVX groups, respectively. ORX groups did not have significant changes compared with CON-ORX groups. However, the expression of hyaluronic acid (HA) was decreased in the OVX group compared with the CON-OVX group. The expression of collagen I in OVX was lower than in the CON-OVX group. Collagen III levels were elevated at 4 weeks in the OVX group, but collagen III levels were diminished at 12 weeks in the OVX group. Expression of elastin in the ECM was less dense in the OVX group compared with controls. The expression MMP-1 and MMP-9 showed significantly increase in the OVX group compared to the CON-OVX group.

CONCLUSION

No changes of the ECM-related genes in the vocal fold lamina propria were observed in ORX groups with reduced testosterone. However, changes of several ECM-related genes were observed in OVX groups with decreased estrogen. These results indicate that the vocal fold is an estrogen-sensitive target organ and that decreased estrogen, not testosterone, can affect the expression of several ECM-related molecules of vocal fold.

LEVEL OF EVIDENCE

NA Laryngoscope, 130:732-740, 2020.

Presbiphonya

Aim: This article attempts to describe the aging process of the vocal folds and the main features of the aged voice. Background: In the world ageing population era, aging diseases and aging disorders are crucial. Voice disorders (presbyphonia) are common in the elderly and have a significant impact on communication and quality of life. Some of these disorders depend on the vocal folds, which consist of an extracellular matrix (ECM), fibrous proteins, interstitial proteins, and glycosaminoglycans. The density and spatial arrangement of these elements are important, as changes in their deposition can alter the biomechanical properties and vibratory function of the vocal folds. Discussion: The aging voice process is analyzed in detail from mechanical factors like pulmonary bellows alteration, to hormonal factors and life style. Conclusions: The elderly people undergoe mechanical, anatomical and functional changes: alterations of the pulmonary bellows, systemic changes like hormonal disregulation, and laryngeal changes, that resulting in hoarseness, which is difficult to treat. (www.actabiomedica.it)

Autoavaliação vocal de mulheres na menopausa

RESUMO: Objetivo: analisar os dados da autoavaliação vocal de mulheres na menopausa e compará-los aos obtidos por um grupo controle. Métodos: estudo transversal, observacional e analítico no qual participaram 42 mulheres com idades entre 19 e 60 anos, divididas em grupo controle (21 mulheres na menacme) e grupo de estudo (21 mulheres na menopausa). Cada participante respondeu a um questionário elaborado pelas pesquisadoras, que continha dados referentes a: saúde geral, tratamentos realizados, tabagismo, etilismo, utilização profissional da voz e dados ginecológicos, e aos protocolos de autoavaliação vocal Escala de Sintomas Vocais, Índice de Desvantagem Vocal e Qualidade de Vida em Voz. Os dados foram analisados por meio dos testes não-paramétricos Mann-Whitney e Correlação de Pearson, considerando-se o nível de significância de 5%. Resultados: o grupo estudo apresentou índices significantemente maiores no domínio funcional do Índice de Desvantagem Vocal e significantemente menores no domínio socioemocional de Qualidade de Vida em Voz. Apesar disso, os escores desses domínios estavam dentro do esperado para vozes saudáveis. Não houve correlação entre os resultados da autoavaliação vocal e o tempo em que as mulheres pararam de menstruar. Conclusão: conclui-se que mulheres na menopausa, apesar de apresentarem diferenças em relação às mulheres na menacme quanto à autoavaliação vocal, apresentam sintomatologia, qualidade de vida em voz e desvantagem vocal compatível com as apresentadas por indivíduos com vozes saudáveis.

Speech Articulation of Low-Dose Oral Contraceptive Users

OBJECTIVES

In the female life cycle, hormonal fluctuations may result in impaired verbal efficiency and vocal worsening during the premenstrual phase. Oral contraceptives may interfere with vocal range. Voice, resonance, and articulation variations clarify speech content. To investigate the phonoarticulatory sounds produced by oral contraceptive users aged between 20 and 30 years.

STUDY DESIGN

This is a cross-sectional study.

METHODS

Our study included four groups of women (n = 66): two groups used low-dose oral contraceptives and two groups did not use any oral contraceptives. Questionnaires and sound records were used. Acoustic analysis was performed using the Computerized Speech Laboratory program, Model 4341 (Kay Elemetrics Corp, Lincoln Park, New Jersey). The statistical analysis of the SPPS database, version 13.0, was performed by means of generalized estimating equation.

RESULTS

In the groups that did not use oral contraceptives, sustained vowel tones were more acute in the two phases and cycles of women older than 25 years (w/oOC1, 175 ± 74 to 190 ± 55 Hz; w/oOC2, 194 ± 56 to 210 ± 32 Hz). At the midfollicular phase (Fph) and midluteal phase (Lph) of the two cycles, the speed of the speech was slower in this group (w/oOC1: Fph, 5.3 ± 1.6/s and Lph, 5.4 ± 1.4/s; w/oOC2: Fph, 4.5 ± 1.7/s and Lph, 4.8 ± 1.1/s). In both groups that used oral contraceptives, there was a higher modulation frequency in the sentences when compared with nonusers (OC1, 33 ± 10 Hz; w/oOC1, 28 ± 10 Hz; OC2, 34 ± 10 Hz; w/oOC2, 27 ± 10 Hz). Vocal intensity was closer between the OC1 (62 ± 4 dB), w/oOC1 (61 ± 3 dB), and OC2 (63 ± 4 dB) groups when compared with the w/oOC2 (67 ± 6 dB) group.

CONCLUSIONS

We demonstrated hormonal influences on speech articulation of contraceptive users and nonusers.

The relation between body mass index and speaking fundamental frequency in premenopausal and postmenopausal women

OBJECTIVE

The purpose of this study was to investigate the association between body mass index (BMI) and speaking fundamental frequency (SFF) in premenopausal and postmenopausal women with and without hormone therapy (HT).

METHODS

A total of 105 middle-aged women participated and were divided into three groups: premenopausal women (n = 41), postmenopausal women without HT (n = 26), and postmenopausal women with HT (n = 38). The mean SFF (in hertz) of connected speech was measured using the Real-Time Pitch program from Computerized Speech Lab (Kay). Correlation coefficients were calculated using partial correlation between BMI and SFF, controlling for age.

RESULTS

A positive correlation was apparent between BMI and SFF in the group of postmenopausal women without HT (P = 0.021). In the group of premenopausal women and the group of postmenopausal women with HT, no correlation was found between BMI and SFF.

CONCLUSIONS

In postmenopausal women without HT, increasing BMI is associated with increasing SFF. This correlation is possibly related to the higher amount of estrogen production in adipose tissue in women with a higher BMI.

Common Diagnoses and Treatments in Professional Voice Users

Common problems among all patients seen by the laryngologist are also common among professional voice users. These include laryngopharyngeal reflux, muscle tension dysphonia, fibrovascular vocal fold lesions (eg, nodules and polyps), cysts, vocal fold scarring, changes in vocal fold mobility, and age-related changes. Microvascular lesions and their associated sequelae of vocal fold hemorrhage and laryngitis due to voice overuse are more common among professional voice users. Much more common among professional voice users is the negative impact that voice problems have on their ability to work, on their overall sense of well-being, and sometimes on their very sense of self. This article reviews the diagnosis and treatment options for these and other problems among professional voice users, describing the relevant roles of medical treatment, voice therapy, and surgery. The common scenario of multiple concomitant entities contributing to a symptom complex is underscored. Emphasis is placed on gaining insight into the "whole" patient so that individualized management plans can be developed. Videos of select diagnoses accompany this content online.

Aging thyroarytenoid and limb skeletal muscle: lessons in contrast

Voice production is vital throughout life because it allows for the communication of basic needs as well as the pursuit and enjoyment of social encounters. Unfortunately, for many older individuals the ability to produce voice is altered. Structural and functional declines in the neuromuscular system occur with aging and likely contribute to the modification of voice. One specific target of the aging process is the thyroarytenoid (TA) muscle, the primary muscle of voice production. The objectives of this overview article are to (1) share current findings related to the aging of limb skeletal muscle, (2) identify age-related morphological and physiological features of TA muscle, (3) compare and contrast age-related changes in TA with those in limb skeletal muscle, and (4) describe therapies for reversing sarcopenia in limb muscle and consider the applicability of these therapies for addressing vocal fold atrophy and age-related voice changes. The article shares current knowledge from the basic sciences related to skeletal muscle aging and compares/contrasts typical muscle aging to TA aging. Current evidence suggests that (1) the TA muscle undergoes notable remodeling with age, (2) aging of the TA is multifactorial, resulting from a myriad of neurologic, metabolic, and hormonal changes, many of which are distinct from the age-related processes of typical limb skeletal muscle, (3) investigation of the aging of the TA and its role in the aging of voice is in its infancy, and (4) potential behavioral and nonbehavioral therapies for reversing aging of the TA must be further examined.

Speech across the menstrual cycle: a replication and extension study

Whiteside et al. [S.P. Whiteside, A. Hanson, P.E. Cowell, Hormones and temporal components of speech: sex differences and effects of menstrual cyclicity on speech, Neurosci. Lett. 367 (2004) 44-47] documented effects of menstrual cycle phase and sex on voice onset time (VOT) in naturally timed speech using whole words. VOT is a temporal component of speech that plays an important role in production and perception [L.L. Koenig, Laryngeal factors in voiceless consonant production in men, women, and 5-year-olds, J. Speech Lang. Hear. Res. 43 (2000) 1211-1228; A. Löfqvist, L.L. Koenig, R.S. McGowan, Vocal tract aerodynamics in /aCa/ utterances: measurements, Speech Commun. 16 (1995) 49-66; T.M. Nearey, B. Rochet, Effects of place of articulation and vowel context in VOT production and perception for French and English Stops, J. Int. Phon. Assoc. 24 (1994) 1-18; L.M. Rimol, T. Eichele, K. Hugdahl, The effect of voice-onset-time on dichotic listening with consonant-vowel syllables, Neuropsychologia 44 (2006) 191-196; P.G. Simos, R.L. Diehl, J.I. Breier, M.R. Molis, G. Zouridakis, A.C. Papanicolaou, MEG correlates of categorical perception of a voice onset time continuum in humans, Cogn. Brain Res. 7 (1998) 215-219; S.P. Whiteside, J. Marshall, Developmental trends in voice onset time: some evidence for sex differences, Phonetica 58 (2001) 196-210]. The present study was designed to replicate and expand upon Whiteside et al. [S.P. Whiteside, A. Hanson, P.E. Cowell, Hormones and temporal components of speech: sex differences and effects of menstrual cyclicity on speech, Neurosci. Lett. 367 (2004) 44-47] using a speeded syllable repetition paradigm. VOT measurements for 6 English plosives (/p b t d k g/) were obtained from speech samples of 15 women and 20 men (age 20-25 years). Women were tested across two points in the menstrual cycle (Days 2-5: low estrogen and progesterone/low-EP; Days 18-25: high estrogen and progesterone/high-EP) and men were tested once. Results indicated significant interaction between menstrual cycle phase and voicing (F(1,14)=8.239, P<0.02), whereby the voiced plosives (b, g) displayed shorter VOT values and the voiceless plosives (p, k) displayed longer values at the high-EP phase. Thus, the distinction between the voiced and voiceless plosive was enhanced at high-EP. Significant sex effects (F(1,33)=10.080, P<0.005) were seen with women at high-EP but not the low-EP phase having longer VOT values than men for voiceless plosives. Sex differences between the voiced and voiceless plosives were enhanced at the high-EP phase. This study indicates a role for activational ovarian hormones in regulating temporal features of speech in both whole words and speeded syllable repetition.