Flag Counter
AKILLI SİSTEMLER VE UYGULAMALARI DERGİSİ
JOURNAL OF INTELLIGENT SYSTEMS WITH APPLICATIONS
J. Intell. Syst. Appl.
E-ISSN: 2667-6893
Creative Commons License This work is licensed under a Creative Commons Attribution 4.0 International License.

Effects of Auricular Vagus Nerve Stimulation on Voice Characteristics

Auriküler Vagus Sinir Stimülasyonunun İnsan Ses Özelliklerine Etkileri

How to cite: Özden AV, Tatar T. Effects of auricular vagus nerve stimulation on voice characteristics. Akıllı Sistemler ve Uygulamaları Dergisi (Journal of Intelligent Systems with Applications) 2022; 5(1): 12-18. DOI: 10.54856/jiswa.202205193

Full Text: PDF, in English.

Total number of downloads: 91

Title: Effects of Auricular Vagus Nerve Stimulation on Voice Characteristics

Abstract: Vagus nerve stimulation (VNS) has been used in the treatment of epilepsy and depression for more than 20 years. Although the invasive cervical method is the most preferred application, side effects such as cough, voice change and hoarseness can be seen due to negative effects on the recurrent laryngeal nerve (a branch of the vagus nerve). Auricular VNS has been preferred recently due to its non-invasiveness, but uncertainty about the stimulation parameters continues. We tested the hypothesis that auricular VNS can affect voice and its features indirectly via afferent nerve connections reaching the nucleus tractus solitarius. Two patients previously using auricular VNS device for different diseases were requested to record their voices before and after the stimulation. Their devices (Vagustim) were changed with new version to check the usage of the patients. Sound recordings at different VNS frequencies (1-150 Hz) were collected by a mobile phone and analyzed with Praat and our MATLAB algorithm. Fundamental frequency (f0), jitter, shimmer, and harmonic to noise ratio (HNR) owere evaluated. The alteration was highest at 100 Hz and 30 Hz VNS for the male and female patients respectively. Audio recordings before and after 30 Hz (for female) and 100 Hz (for male) VNS at different durations (5-30 min) on different days were repeated and compared by Praat and our algorithm. Some discrepancy between the parameters jitter, shimmer, and HNR are detected between the algorithms, which is accounted to the fact that it is not standardized whether the algorithm uses only a specific part of the input signal or the whole signal. However, when the ratio of change of these parameters are considered, fundamental frequency and the HNR were found to be highly consistent for developing an algorithm to govern the stimulation parameters in an automated way. Furthermore, the same ratios for jitter and shimmer are also promising after some improvement to be included in such an algorithm. These results suggest that auricular VNS can affect voice and its parameters, but this change is related with stimulation parameters. It seems necessary to develop specific software and algorithms that can detect this change well.

Keywords: auricular vagus nerve stimulation; parameter optimization; sound analysis; algorithm; software


Başlık: Auriküler Vagus Sinir Stimülasyonunun İnsan Ses Özelliklerine Etkileri

Özet: Vagus sinir uyarımı (VSU), epilepsi ve depresyon tedavisinde 20 yılı aşkın süredir kullanılmaktadır. İnvaziv servikal yöntem en çok tercih edilen uygulama olmasına rağmen rekürren laringeal sinir (vagus sinirinin bir dalı) üzerindeki olumsuz etkilerinden dolayı öksürük, ses değişikliği ve ses kısıklığı gibi yan etkiler görülebilmektedir. Auriküler VSU, non-invaziv olması nedeniyle yakın zamanda tercih edilmeye başlanmıştır, ancak stimülasyon parametreleriyle ilgili belirsizlik devam etmektedir. Auriküler VSU'nun nükleus traktus solitarius'a ulaşan afferent sinir bağlantıları yoluyla sesi ve özelliklerini dolaylı olarak etkileyebileceği hipotezini test ettik. İki yazar auriküler VSU cihazını (Vagustim) kullandılar ve stimülasyondan önce ve sonra seslerini kaydettiler. Farklı VSU frekanslarındaki (1-150 Hz) ses kayıtları bir cep telefonu ile toplanmış ve Praat yazılımı ve MATLAB algoritmamız ile günlük olarak analiz edilmiştir. Sesin temel frekansı veya perdesi (f0), jitter, shimmer ve harmonik gürültü oranı (HNR) değerlendirildi ve değişiklik her birey için 100 Hz ve 30 Hz'de (VSU frekansı) en yüksek bulundu. Bir birey için 30 Hz VSU ve diğer birey için 100 Hz, farklı sürelerde (5-30 dk) VSU öncesi ve sonrasında farklı günlerde ses kayıtları tekrarlanarak Praat ve algoritmamız ile karşılaştırılmıştır. Algoritmalar arasında jitter, shimmer ve HNR parametreleri arasında bir miktar tutarsızlık tespit edildi; bu durumun, algoritmanın, sinyalin yalnızca belirli bir kısmını mı yoksa tüm sinyali mi kullandığının standartlaştırılmadığı gerçeğine bağlı olduğu düşünüldü. Bununla birlikte, bu parametrelerin değişim oranı göz önüne alındığında, temel frekans ve HNR'nin, stimülasyon parametrelerini otomatik bir şekilde yönetmek ve bir algoritma geliştirmek için oldukça tutarlı olduğu bulundu. Ayrıca, jitter ve shimmer için benzer oranlar da, böyle bir algoritmaya dahil edilecek bazı iyileştirmelerden sonra umut verici olabilir. Bu sonuçlar auriküler VSU'nun sesi ve parametrelerini etkileyebileceğini, ancak bu değişikliğin stimülasyon parametreleriyle ilgili olduğunu düşündürmektedir. Bu değişikliği iyi tespit edebilecek spesifik yazılımlar ve algoritmalar geliştirmek gerekli görünmektedir.

Anahtar kelimeler: auriküler vagus sinir stimülasyonu; parametre optimizasyonu; ses analizi; algoritma; yazılım


Bibliography:
  • Gonzalez HFJ, Yengo-Kahn A, Englot DJ. Vagus nerve stimulation for the treatment of epilepsy. Neurosurgery Clinics of North America 2019; 30(2): 219–230.
  • Santos PM. Evaluation of laryngeal function after implantation of the vagus nerve stimulation device. Otolaryngology-Head and Neck Surgery 2003; 129(3): 269-273.
  • Al Omari AI, Alzoubi FQ, Alsalem MM, Aburahma SK, Mardini DT, Castellanos PF. The vagal nerve stimulation outcome, and laryngeal effect: Otolaryngologists roles and perspective. American Journal of Otolaryngology 2017; 38(4): 408-413.
  • Vespa S, Stumpp L, Bouckaert C, Delbeke J, Smets H, Cury J, Ferrao Santos S, Rooijakkers H, Nonclercq A, Raedt R, Vonck K, El Tahry R. Vagus nerve stimulation-induced laryngeal motor evoked potentials: A possible biomarker of effective nerve activation. Frontiers in Neuroscience 2019; 13: 880.
  • Kochilas HL, Cacace AT, Arnold A, Seidman MD, Tarver WB. Vagus nerve stimulation paired with tones for tinnitus suppression: Effects on voice and hearing. Laryngoscope Investigative Otolaryngology 2020; 5(2): 286-296.
  • Charous SJ, Kempster G, Manders E, Ristanovic R. The effect of vagal nerve stimulation on voice. The Laryngoscope 2001; 111(11): 2028-2031.
  • Gurkan S, Kirkim G, Isler Y, Uzun YO, Mungan Durankaya S, Mutlu B, Basokcu O, Dogan E. The effect of signal to noise ratio on cortical auditory evoked potentials in patients with presbycusis. Journal of International Advanced Otology 2015; 11(Supp. 1): 73-74.
  • Isler Y. New hyperbaric oxygen therapy software for measuring hear losses. Journal of International Advanced Otology 2015; 11(Supp. 1): 55.
  • Kersing W, Dejonckere PH, van der Aa HE, Buschman HPJ. Laryngeal and vocal changes during vagus nerve stimulation in epileptic patients. Journal of Voice 2002; 16(2): 251-257.
  • Saibene AM, Fuccillo E, Felisati G, Pipolo GC, Chiesa V, Canevini MP, Maccari A, De Gasperis M, Pizzorni N, Schindler A. Vocal outcomes in vagus nerve stimulation: A laryngeal pattern-based objective analysis. Journal of Voice 2020; PMID: 32843258, In Press Corrected Proof.
  • Van Lierde K, Kryshtopava M, Gadeyne S, Luyten A, D'haeseleer E, Bruneel L, Van Maele G, Boehme B, Piens N, Vonck K. Impact of vagal nerve stimulation on objective vocal quality, a pilot study. Journal of Voice 2015; 29(6):777.e9-15.
  • Gillespie AI, Helou LB, Ingle JW, Baldwin M, Rosen CA. The role of voice therapy in the treatment of dyspnea and dysphonia in a patient with a vagal nerve stimulation device. Journal of Voice 2014; 28(1): 59-61.
  • Alantie S, Makkonen T, Hietala S, Peltola J. Clinical management of voice and breathing problems in two patients with vagus nerve stimulation therapy. Epileptic Disorders 2021; 23(1): 173-179.
  • Shaffer MJ, Szabo CA, Jackson CE, Simpson CB. Vagal nerve stimulation: Clinical and electrophysiological effects on vocal fold function. Annals of Otology, Rhinology \& Laryngology 2005; 114(1): 7-14.
  • Broniatowski M, Grundfest-Broniatowski S, Tucker HM, Tyler DJ. Artificial voice modulation in dogs by recurrent laryngeal nerve stimulation: Electrophysiological confirmation of anatomic data. Annals of Otology, Rhinology \& Laryngology 2007; 116(2): 145-155.
  • Butt MF, Albusoda A, Farmer AD, Aziz Q. The anatomical basis for transcutaneous auricular vagus nerve stimulation. Journal of Anatomy 2020; 236(4): 588-611.
  • Yap JY, Keatch C, Lambert E, Woods W, Stoddart PR, Kameneva T. Critical review of transcutaneous vagus nerve stimulation: Challenges for translation to clinical practice. Frontiers in Neuroscience 2020; 14: 284.
  • Kaniusas E, Kampusch S, Tittgemeyer M, Panetsos F, Gines RF, Papa M, Kiss A, Podesser B, Cassara AM, Tanghe E, Samoudi AM, Tarnaud T, Joseph W, Marozas V, Lukosevicius A, Istuk N, Sarolic A, Lechner S, Klonowski W, Varoneckas G, Szeles JC. Current directions in the auricular vagus nerve stimulation I-A physiological perspective. Frontiers in Neuroscience 2019; 13: 854.
  • Kaniusas E, Kampusch S, Tittgemeyer M, Panetsos F, Gines RF, Papa M, Kiss A, Podesser B, Cassara AM, Tanghe E, Samoudi AM, Tarnaud T, Joseph W, Marozas V, Lukosevicius A, Istuk N, Lechner S, Klonowski W, Varoneckas G, Szeles JC, Sarolic A. Current directions in the auricular vagus nerve stimulation II-An engineering perspective. Frontiers in Neuroscience 2019; 13: 772.
  • Shama K, Krishna A, Cholayya NU. Study of harmonics-to-noise ratio and critical-band energy spectrum of speech as acoustic indicators of laryngeal and voice pathology. EURASIP Journal on Advances in Signal Processing 2007; 2006(1): 085286.
  • Oller LL. Analysis of voice signals for the harmonics-to-noise crossover frequency. Thesis, KTH-School of Computer Science and Communication (CSC), Department of Speech, Music and Hearing, UPC, Barcelona, Spain, June 2008.
  • Cardoso R, Lumini-Oliveira J, Meneses RF. Associations between autonomic nervous system function, voice, and Dysphonia: A systematic review. Journal of Voice 2021; 35(1): 104-112.