Objective: To evaluate voice function in patients with adductor spasmodic dysphonia (AdSD) who discontinued botulinum toxin (BTX) treatment because they felt that their voice had improved sufficiently. Patients and Methods: Twenty-eight patients quit treatment in 2004, of whom 20 fulfilled the inclusion criteria for the study, with 3 subsequently excluded because of return of symptoms, leaving 17 patients (11 males, 6 females) included in this follow-up study. A questionnaire concerning current voice function and the Voice Handicap Index were completed. Audio-perceptual voice assessments were done by 3 listeners. The inter- and intrarater reliabilities were r > 0.80. Results: All patients had a subjectively good stable voice, but with differences in their audio-perceptual voice assessment scores. Based on the pre-/posttreatment auditory scores on the overall degree of AdSD, patients were divided into 2 subgroups showing more and less improvement, with 10 and 7 patients, respectively. The subgroup with more improvement had shorter duration from the onset of symptoms until the start of BTX treatment, and included 7 males compared to only 4 males in the subgroup with less improvement. Conclusion: It seems plausible that the symptoms of spasmodic dysphonia may decrease over time. Early intervention and male gender seem to be important factors for long-term reduction of the voice symptoms of AdSD.

Phonation into glass tubes (resonance tubes), keeping the free end of the tube in water, has been a frequently used voice therapy method in Finland and more recently also in other countries. The purpose of this exploratory study was to investigate what effects tube phonation with and without water has on the larynx. Two participants were included in the study. The methods used were high-speed imaging, electroglottographic observations of vocal fold vibrations, and measurements of oral pressure during tube phonation. Results showed that the fluctuation in the back pressure during tube phonation in water altered the vocal fold vibrations. In the high-speed imaging, effects were found in the open quotient and amplitude variation of the glottal opening. The open quotient increased with increasing water depth (from 2 cm to 6 cm). A modulation effect by the water bubbles on the vocal fold vibrations was seen both in the high-speed glottal area tracings and in the electroglottography signal. A second experiment revealed that the increased average oral pressure was largely determined by the water depth. The increased open quotient can possibly be explained by an increased abduction of the vocal folds and/or a reduced transglottal pressure. The back pressure of the bubbles also modulates glottal vibrations with a possible massage effect on the vocal folds. This effect and the well-defined average pressure increase due to the known water depth are different from those of other methods using a semi-occluded vocal tract.

This work studies multilinear McShane-Stieltjes integrals of vector-valued functions defined on intervals in R^n.

In this paper we define and consider multilinear Stieltjes integralsfor vector-valued functions defined on a closed bounded interval in \mathbb{R}^n. Theconvergence of the Stieltjes sums is considered in the Riemann, Moore-Pollardand Henstock-Kurzweil sense.

We studied the application of a stratified seasonal hot water storage tank with a heat pump connected to medium-, low- and very-low-temperature space heat emissions for a single-family house in Stockholm, Sweden. Our aim was to investigate the influence of heat emission design temperature on the efficiency and design parameters of seasonal storage in terms of collector area, the ratio of storage volume to collector area (RVA), and the ratio of height to diameter of storage tank. For this purpose, we developed a mathematical model in MATLAB to predict hourly heat demand in the building, heat loss from the storage tank, solar collector heat production, and heat support by heat pump as a backup system when needed. In total, 108 cases were simulated with RVAs that ranged from 2 to 5 (m³ m⁻²), collector areas of 30, 40, and 50 (m²), height-to-diameter-of-storage-tank ratios of 1.0, 1.5, and 2.0 (m m⁻¹), and various heat emissions with design supply/return temperatures of 35/30 as very-low-, 45/35 as low-, and 55/45 (°C) as medium-temperature heat emission. In order to find the best combination based on heat emission, we considered the efficiency of the system in terms of the heat pump work considering coefficient of performance (COP) of the heat pump and solar fraction. Our results showed that, for all types of heat emission a storage-volume-to-collector area ratio of 5 m³ m⁻², with a collector area of 50 m², and a height-to-diameter ratio of 1.0 m m⁻¹ were needed in order to provide the maximum efficiency. Results indicated that for very-low-temperature heat emission the heat pump work was less than half of that of the medium-temperature heat emission. This was due to 7% higher solar fraction and 14% higher COP of heat pump connected to very-low-temperature heat emission compared to medium-temperature heat emission.

Objectives. Flow ball devices have been used as teaching tools to provide visual real-time feedback of airflow during singing. This study aims at exploring static back pressure and ball height as function of flow for two devices, marketed as flow ball and floating ball game. Study Design. This is a comparative descriptive study. Methods. A flow-driven vocal tract simulator was used to investigate the aerodynamic properties of these two devices, testing them for four different ball sizes. The flow range investigated was between 0 and 0.5 L/s. Audio, flow, pressure, and ball height were recorded. Results. The flow pressure profiles for both tested devices were similar to those observed in previous studies on narrow tubes. For lifting the ball, both devices had a flow and a pressure threshold. The tested floating ball game required considerably higher back pressure for a given flow as compared with the flow ball. Conclusions. Both tested devices have similar effects on back pressure as straws of 3.7 and 3.0 mm in diameter for the flow ball and the floating ball game, respectively. One might argue that both devices could be used as tools for practicing semi-occluded vocal tract exercises, with the additional benefit of providing real-time visual feedback of airflow during phonation. The flow threshold, combined with the flow feedback, would increase awareness of flow, rather than of pressure, during exercises using a flow ball device.

Accurate measurement of the softest sound levels of phonation presents technical and methodological challenges. This study aimed at (1) reliably obtaining normative data on sustained softest sound levels for the vowel [a:] at comfortable pitch; (2) comparing the results for different frequency and time weighting methods; and (3) refining the Union of European Phoniatricians' recommendation on allowed background noise levels for scientific and equipment manufacturers' purposes. Eighty healthy untrained participants (40 females, 40 males) were investigated in quiet rooms using a head-mounted microphone and a sound level meter at 30 cm distance. The one-second-equivalent sound levels were more stable and more representative for evaluating the softest sustained phonations than the fast-time-weighted levels. At 30 cm, these levels were in the range of 48-61 dB(C)/41-53 dB(A) for females and 49-64 dB(C)/35-53 dB(A) for males (5% to 95% quantile range). These ranges may serve as reference data in evaluating vocal normality. In order to reach a signal-to-noise ratio of at least 10 dB for more than 95% of the normal population, the background noise should be below 25 dB(A) and 38 dB(C), respectively, for the softest phonation measurements at 30 cm distance. For the A-weighting, this is 15 dB lower than the previously recommended value.