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Ma A, Desai N, Lau KK, Palaniswami M, O'Brien TJ, Palaniswami P, Thyagarajan D. Automated measurement of inter-arytenoid distance on 4D laryngeal CT: A validation study. PLoS One 2023; 18:e0279927. [PMID: 36652423 PMCID: PMC9847963 DOI: 10.1371/journal.pone.0279927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 12/16/2022] [Indexed: 01/19/2023] Open
Abstract
Changes to the voice are prevalent and occur early in Parkinson's disease. Correlates of these voice changes on four-dimensional laryngeal computed-tomography imaging, such as the inter-arytenoid distance, are promising biomarkers of the disease's presence and severity. However, manual measurement of the inter-arytenoid distance is a laborious process, limiting its feasibility in large-scale research and clinical settings. Automated methods of measurement provide a solution. Here, we present a machine-learning module which determines the inter-arytenoid distance in an automated manner. We obtained automated inter-arytenoid distance readings on imaging from participants with Parkinson's disease as well as healthy controls, and then validated these against manually derived estimates. On a modified Bland-Altman analysis, we found a mean bias of 1.52 mm (95% limits of agreement -1.7 to 4.7 mm) between the automated and manual techniques, which improves to a mean bias of 0.52 mm (95% limits of agreement -1.9 to 2.9 mm) when variability due to differences in slice selection between the automated and manual methods are removed. Our results demonstrate that estimates of the inter-arytenoid distance with our automated machine-learning module are accurate, and represents a promising tool to be utilized in future work studying the laryngeal changes in Parkinson's disease.
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Affiliation(s)
- Andrew Ma
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
- Department of Neurology, Monash Health, Melbourne, Victoria, Australia
| | - Nandakishor Desai
- Department of Electrical and Electronic Engineering, The University of Melbourne, Melbourne, Victoria, Australia
| | - Kenneth K Lau
- School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Monash Health Imaging, Monash Health, Melbourne, Victoria, Australia
| | - Marimuthu Palaniswami
- Department of Electrical and Electronic Engineering, The University of Melbourne, Melbourne, Victoria, Australia
| | - Terence J O'Brien
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
| | - Paari Palaniswami
- School of Computing and Information Systems, Faculty of Engineering and Information Technology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Dominic Thyagarajan
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
- Department of Neurology, Monash Health, Melbourne, Victoria, Australia
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Silva JMSD, Gomes ADOC, Coriolano MDGWDS, Teixeira JP, Lima HVSLD, Paulino CEB, Silva HJD, Lira ZSD. Oropharyngeal geometry and acoustic parameters of voice in healthy and Parkinson's disease subjects. Codas 2023; 35:e20210304. [PMID: 37075413 PMCID: PMC10137768 DOI: 10.1590/2317-1782/20232021304pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 03/29/2022] [Indexed: 04/21/2023] Open
Abstract
PURPOSE to verify whether there are differences in acoustic measures and oropharyngeal geometry between healthy individuals and people with Parkinson's disease, according to age and sex, and to investigate whether there are correlations between oropharyngeal geometry measures in this population. METHODS 40 individuals participated, 20 with a diagnosis of Parkinson's disease and 20 healthy individuals, matched by age, sex, and body mass index. Acoustic variables included fundamental frequency, jitter, shimmer, glottal-to-noise excitation ratio, noise, and mean intensity. Oropharyngeal geometry variables were measured with acoustic pharyngometry. RESULTS geometry variables were smaller in the group with Parkinson's disease, and older adults with Parkinson's disease had a smaller oropharyngeal junction area than healthy older adults. Regarding acoustic parameters of voice, fundamental frequency values were lower in males with Parkinson's disease, and jitter values were higher in the non-elderly subjects with Parkinson's disease. There was a moderate positive correlation between oral cavity length and volume, pharyngeal cavity length and vocal tract length, and pharyngeal cavity volume and vocal tract volume. CONCLUSION individuals with Parkinson's disease had smaller glottal areas and oropharyngeal junction areas than healthy individuals. When distributed into sex and age groups, the fundamental frequency was lower in males with Parkinson's disease. There was a moderate positive correlation between oropharyngeal length and volume measures in the study sample.
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Affiliation(s)
- Joice Maely Souza da Silva
- Programa de Pós-graduação em Saúde da Comunicação Humana, Universidade Federal de Pernambuco - UFPE - Recife (PE), Brasil
| | - Adriana de Oliveira Camargo Gomes
- Programa de Pós-graduação em Saúde da Comunicação Humana, Universidade Federal de Pernambuco - UFPE - Recife (PE), Brasil
- Departamento de Fonoaudiologia, Universidade Federal de Pernambuco - UFPE - Recife (PE), Brasil
| | | | - Julianne Pitanga Teixeira
- Programa de Pós-graduação em Saúde da Comunicação Humana, Universidade Federal de Pernambuco - UFPE - Recife (PE), Brasil
| | | | | | - Hilton Justino da Silva
- Programa de Pós-graduação em Saúde da Comunicação Humana, Universidade Federal de Pernambuco - UFPE - Recife (PE), Brasil
- Departamento de Fonoaudiologia, Universidade Federal de Pernambuco - UFPE - Recife (PE), Brasil
| | - Zulina Souza de Lira
- Programa de Pós-graduação em Saúde da Comunicação Humana, Universidade Federal de Pernambuco - UFPE - Recife (PE), Brasil
- Departamento de Fonoaudiologia, Universidade Federal de Pernambuco - UFPE - Recife (PE), Brasil
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Ma A, Lau KK, Thyagarajan D. Radiological correlates of vocal fold bowing as markers of Parkinson's disease progression: A cross-sectional study utilizing dynamic laryngeal CT. PLoS One 2021; 16:e0258786. [PMID: 34653231 PMCID: PMC8519464 DOI: 10.1371/journal.pone.0258786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 10/05/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To determine whether arytenoid cartilage position and dynamics change with advancing duration and severity (as graded by MDS-UPDRS part III scores) in Parkinson's disease, in a cross-sectional study design, we performed laryngeal four-dimensional computed tomography (4D-CT) in people with Parkinson's disease and controls. METHODS 31 people with Parkinson's disease covering a range of disease duration and severity and 19 controls underwent laryngeal 4D-CT whilst repeatedly vocalizing. We measured on each CT volume the glottic area (GA), inter-arytenoid distance (IAD), IAD-Area index (IAI) and arytenoid cartilage velocity ([Formula: see text]). RESULTS People with Parkinson's disease had reductions in the mean/effective minimum IAD when compared to controls, while mean/effective minimum GA and mean/effective maximum IAI were increased. Arytenoid cartilage velocities showed no difference. On Spearman correlation analyses, advancing disease duration and severity of PD showed moderately strong and significant correlations with increasing mean/effective minimum GA, increasing mean/effective maximum IAI and decreasing effective minimum IAD. Linear mixed models which considered the effects of intra and inter-individual variation showed that both disease duration (b = -0.011, SEb = 0.053, 95% CI [-0.022, 0], t(27) = -2.10, p = 0.045) and severity (b = -0.069, SEb = 0.032, 95% CI [-0.14,-0.0039], t(27) = -2.17, p = 0.039) were significant predictors for IAD, and also for transformed values of the GA and IAI. CONCLUSIONS There are progressive alterations in phonatory posturing as Parkinson's disease advances. The increases in GA despite reductions in IAD are concordant with prior observations of vocal fold bowing. Our study provides a basis for using laryngeal 4D-CT to assess disease progression in Parkinson's disease.
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Affiliation(s)
- Andrew Ma
- Department of Neurosciences, Central Clinical School, Monash University, Melbourne, Australia
- Department of Neurology, Monash Health, Melbourne, Australia
- Department of Neurology, Alfred Health, Melbourne, Australia
| | - Kenneth K. Lau
- School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
- Monash Health Imaging, Monash Health, Melbourne, Australia
| | - Dominic Thyagarajan
- Department of Neurosciences, Central Clinical School, Monash University, Melbourne, Australia
- Department of Neurology, Monash Health, Melbourne, Australia
- Department of Neurology, Alfred Health, Melbourne, Australia
- * E-mail:
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Panzone L, Watts CR. Regulation of Transglottal Airflow in Speakers With Parkinson's Disease. J Voice 2020; 34:961.e1-961.e7. [DOI: 10.1016/j.jvoice.2019.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 06/28/2019] [Accepted: 06/28/2019] [Indexed: 11/17/2022]
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McKenna VS, Hylkema JA, Tardif MC, Stepp CE. Voice Onset Time in Individuals With Hyperfunctional Voice Disorders: Evidence for Disordered Vocal Motor Control. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2020; 63:405-420. [PMID: 32013664 PMCID: PMC7210440 DOI: 10.1044/2019_jslhr-19-00135] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Purpose This study examined vocal hyperfunction (VH) using voice onset time (VOT). We hypothesized that speakers with VH would produce shorter VOTs, indicating increased laryngeal tension, and more variable VOTs, indicating disordered vocal motor control. Method We enrolled 32 adult women with VH (aged 20-74 years) and 32 age- and sex-matched controls. All were speakers of American English. Participants produced vowel-consonant-vowel combinations that varied by vowel (ɑ/u) and plosive (p/b, t/d, k/g). VOT-measured at the release of the plosive to the initiation of voicing-was averaged over three repetitions of each vowel-consonant-vowel combination. The coefficient of variation (CoV), a measure of VOT variability, was also computed for each combination. Results The mean VOTs were not significantly different between the two groups; however, the CoVs were significantly greater in speakers with VH compared to controls. Voiceless CoV values were moderately correlated with clinical ratings of dysphonia (r = .58) in speakers with VH. Conclusion Speakers with VH exhibited greater variability in phonemic voicing targets compared to vocally healthy speakers, supporting the hypothesis for disordered vocal motor control in VH. We suggest future work incorporate VOT measures when assessing auditory discrimination and auditory-motor integration deficits in VH.
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Affiliation(s)
- Victoria S. McKenna
- Department of Speech, Language, & Hearing Sciences, Purdue University, West Lafayette IN
- Department of Speech, Language, and Hearing Sciences, Boston University, MA
| | | | - Monique C. Tardif
- Department of Speech, Language, and Hearing Sciences, Boston University, MA
| | - Cara E. Stepp
- Department of Speech, Language, and Hearing Sciences, Boston University, MA
- Department of Biomedical Engineering, Boston University, MA
- Department of Otolaryngology–Head and Neck Surgery, Boston University School of Medicine, MA
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Ma A, Lau KK, Thyagarajan D. Voice changes in Parkinson's disease: What are they telling us? J Clin Neurosci 2020; 72:1-7. [PMID: 31952969 DOI: 10.1016/j.jocn.2019.12.029] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 12/16/2019] [Indexed: 10/25/2022]
Abstract
Emerging evidence suggests voice dysfunction is the earliest sign of motor impairment in Parkinson's disease (PD). The complexity and fine motor control involved in vocalization may result in dysfunction here before the limbs. The voice in PD demonstrates characteristic changes on perceptual and acoustic analyses. The physiological and anatomical correlates of these have been investigated through laryngoscopy, stroboscopy, photoglottography, laryngeal electromyography, computed-tomography, pulmonary function testing and aerodynamic assessments. These have revealed numerous abnormalities including incomplete glottic closure and vocal fold hypoadduction/bowing to account for these voice changes. Many of these phenomena are likely related to rigidity or bradykinesia of the laryngeal muscles. The early onset of voice changes is resonant with the pathophysiological insights offered by Braak's hypothesis and murine models of the disease. These physiological abnormalities and pathological models largely stand to support dopaminergic and non-dopaminergic mechanisms being implicated in the pathogenesis of voice dysfunction. This review focuses on characterizing the voice changes in PD. These stand as a promising area of enquiry to further our understanding of the pathophysiology of the disease and offer potential to be utilized as an early diagnostic biomarker or marker of disease progression.
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Affiliation(s)
- Andrew Ma
- Department of Neurology, The Alfred Hospital, Melbourne, Victoria 3004, Australia; Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria 3004, Australia
| | - Kenneth K Lau
- Monash Imaging, Monash Health, Melbourne, Victoria 3168, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Dominic Thyagarajan
- Department of Neurology, The Alfred Hospital, Melbourne, Victoria 3004, Australia; Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria 3004, Australia.
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Ma Y, Bao H, Wang X, Chen X, Zhang Z, Wang J, Zhuang P, Jiang JJ, Wilson A, Wu C. Spatial Motion of Arytenoid Cartilage Using Dynamic Computed Tomography Combined with Euler Angles. Laryngoscope 2019; 130:E646-E653. [PMID: 31872448 DOI: 10.1002/lary.28468] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 10/22/2019] [Accepted: 11/26/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To investigate the feasibility of dynamic computed tomography in recording and describing the spatial motion characteristics of the arytenoid cartilage. METHODS Dynamic computed tomography recorded the real-time motion trajectory of the arytenoid cartilage during inspiration and phonation. A stationary coordinate system was established with the cricoid cartilage as a reference and a motion coordinate system was established using the movement of the arytenoid cartilage. The Euler angles of the arytenoid cartilage movement were calculated by transformation of the two coordinate systems, and the spatial motion characteristics of the arytenoid cartilage were quantitatively studied. RESULTS Displacement of the cricoid cartilage was primarily inferior during inspiration. During phonation, the displacement was mainly superior. When the glottis closed, the superior displacement was about 5-8 mm within 0.56 s. During inspiration, the arytenoid cartilage was displaced superiorly approximately 1-2 mm each 0.56 s. The rotation angle was subtle with slight rotation around the XYZ axis, with a range of 5-10 degrees. During phonation, the displacement of the arytenoid cartilage was mainly inferior (about 4-6 mm), anterior (about 2-4 mm) and medial (about 1-2 mm). The motion of the arytenoid cartilage mainly consisted of medial rolling, and there was an alternating movement of anterior-posterior tilting. The arytenoid cartilage rolled medially (about 20-40 degrees within 0.56 s), accompanied by anterior-posterior tilting (about 15-20 degrees within 0.56 s). CONCLUSION Dynamic computed tomography recordings of arytenoid cartilage movement can be combined with Euler transformations as a tool to study the spatial characteristics of laryngeal structures during phonation. LEVEL OF EVIDENCE 4 Laryngoscope, 130:E646-E653, 2020.
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Affiliation(s)
- Yanli Ma
- Department of ENT, Zhongshan Hospital Xiamen University, Xiamen, Fujian, China
| | - Huijing Bao
- the School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Xi Wang
- the School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Xi Chen
- Department of Physics, Xiamen University, Xiamen, Fujian, China
| | - Zheyi Zhang
- the Department of Radiology, Zhongshan Hospital Xiamen University, Xiamen, Fujian, China
| | - Jinan Wang
- the Department of Radiology, Zhongshan Hospital Xiamen University, Xiamen, Fujian, China
| | - Peiyun Zhuang
- Department of ENT, Zhongshan Hospital Xiamen University, Xiamen, Fujian, China
| | - Jack J Jiang
- the Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Azure Wilson
- Department of Communication Science and Disorders, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Chenxu Wu
- Department of Physics, Xiamen University, Xiamen, Fujian, China
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Dashtipour K, Tafreshi A, Lee J, Crawley B. Speech disorders in Parkinson's disease: pathophysiology, medical management and surgical approaches. Neurodegener Dis Manag 2018; 8:337-348. [DOI: 10.2217/nmt-2018-0021] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The prevalence of speech disorders among individuals with Parkinson's disease (PD) has been reported to be as high as 89%. Speech impairment in PD results from a combination of motor and nonmotor deficits. The production of speech depends upon the coordination of various motor activities: respiration, phonation, articulation, resonance and prosody. A speech disorder is defined as impairment in any of its inter-related components. Despite the high prevalence of speech disorders in PD, only 3–4% receive speech treatment. Treatment modalities include pharmacological intervention, speech therapy, surgery, deep brain stimulation and vocal fold augmentation. Although management of Parkinsonian dysarthria is clinically challenging, speech treatment in PD should be part of a multidisciplinary approach to patient care in this disease.
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Affiliation(s)
- Khashayar Dashtipour
- Department of Neurology, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Ali Tafreshi
- Department of Neurology, Loma Linda University School of Medicine, Loma Linda, CA, USA
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jessica Lee
- Department of Neurology, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Brianna Crawley
- Department of Otolaryngology, Loma Linda University School of Medicine, Loma Linda, CA, USA
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