Changes in Voice Quality after a Pure Tone Stimulation (PTS) Program

Cambios en la calidad vocal después de un Programa de Estimulación con Tonos Puros (PTS)

Published 2024-11-28

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Vol. 7 No. 1 (2025)
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Research Article
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Cantor-Cutiva LC, Bottalico P, Codino J, Hunter EJ, Rubin AD, Jackson-Menaldi MC. Changes in Voice Quality after a Pure Tone Stimulation (PTS) Program. Rev. Investig. Innov. Cienc. Salud [Internet]. 2024 Nov. 28 [cited 2025 May 21];7(1):1-15. Available from: https://riics.info/index.php/RCMC/article/view/325
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https://doi.org/10.46634/riics.325
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Lady Catherine Cantor-Cutiva
University of Iowa image/svg+xml
Roles:  
Perfil Google Scholar
https://orcid.org/0000-0002-4530-4345
Pasquale Bottalico
University of Illinois Urbana-Champaign image/svg+xml
Roles:  
Perfil Google Scholar
https://orcid.org/0000-0002-7394-4796
Juliana Codino
Lakeshore Professional Voice Center
Roles:  
Perfil Google Scholar
https://orcid.org/0000-0002-9616-3378
Eric J. Hunter
University of Iowa image/svg+xml
Roles:  
Perfil Google Scholar
https://orcid.org/0000-0001-5571-464X
Adam D. Rubin
Lakeshore Professional Voice Center
Roles:  
Perfil Google Scholar
https://orcid.org/0000-0002-6571-7307
Show authors biography

Lady Catherine Cantor-Cutiva,

Department of Communication Sciences and Disorders; The University of Iowa; Iowa City; United States.

Pasquale Bottalico,

Department of Speech and Hearing Science; University of Illinois Urbana-Champaign; Champaign; Illinois; United States.

Juliana Codino,

Lakeshore Professional Voice Center, Lakeshore Ear, Nose & Throat Center; St Clair Shores; Michigan; United States.

Eric J. Hunter,

Department of Communication Sciences and Disorders; The University of Iowa; Iowa City; United States.

Adam D. Rubin,

Lakeshore Professional Voice Center, Lakeshore Ear, Nose & Throat Center; St Clair Shores; Michigan; United States.

Maria Cristina Jackson-Menaldi,

Lakeshore Professional Voice Center, Lakeshore Ear, Nose & Throat Center; St Clair Shores; Michigan; United States.

† In Memoriam of Dr. Maria Cristina Jackson-Menaldi
Dr. Maria Cristina Jackson-Menaldi was a steadfast advocate of PTS as an effective technique for treating voice disorders, and our results bear testament to her wisdom. Her enthusiasm was the driving force behind this study. Dr. Jackson-Menaldi dedicated her life to the fields of voice pathology and voice science, and her passion for clinical care, voice research, and education deeply influenced the many individuals she encountered. Although she passed away before the completion of this work, her contributions were invaluable during the design, data collection, and preparation of this manuscript. Dr. Jackson-Menaldi will always be missed by her students, colleagues, friends, and family, all of whom were fortunate to have known such an exceptional woman. We will always remember you, Dr. Menaldi.

Introduction. Auditory feedback allows individuals to monitor their vocal characteristics and adjust to maintain optimal voice quality. One type of auditory stimulation for conversational voice training/therapy is pure tone stimulation. This technique presents binaural auditory stimuli consisting of pure tones separated by half-step intervals to modify the fundamental frequency of the speaking voice and expand the vocal range.

Objectives. This study aimed to characterize detectable changes in voice production following the application of pure tone stimulation (PTS) among speakers with and without voice disorders.

Methods. Data from thirty-nine participants (28 individuals with voice disorders and 11 individuals with normal voices) were analyzed for this study. All participants engaged in binaural PTS exercises. Participants recorded a sustained vowel /a/ before and after the PTS exercises. Multiple acoustic voice parameters were extracted from the sustained vowel samples (fundamental frequency, pitch strength, harmonics-to-noise ratio, and smoothed cepstral peak prominence). Additionally, a visual analogue scale (VAS) interpretation of narrowband (NB) spectrograms was conducted to assess voice quality.

Results. Statistically significant increases in fundamental frequency were found after the PTS exercises, except for males in the normal voices group. Pitch strength increased after the PTS, regardless of gender. Participants also demonstrated an increase in the harmonics-to-noise ratio. VAS ratings of NB spectrograms indicated improvement in voice quality following the program.

Conclusions. Voice changes after performing PTS suggest voice quality improvement, as measured by acoustic analysis of vowel production and qualitative assessment of NB spectrograms among participants with and without voice disorders.

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