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Female suprasegmental speech parameters in reproductive age and postmenopause
Maturitas 48 (2004) 71–77
Female suprasegmental speech parameters in reproductive age and postmenopause Eliséa Maria Meurer a,c , Maria Celeste Osório Wender b , Helena von Eye Corleta a,b,d , Edison Capp a,b,d,∗ a
Departament of Physiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil b Departament of Obstetrics and Gynecology, Hospital de Cl´ınicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil c Department of Phono-Audiology, Universidade Luterana do Brasil, Canoas, Brazil d Cl´ınica Gerar de Fertilização Assistida, Porto Alegre, Brazil
Received 18 February 2003; received in revised form 4 December 2003; accepted 10 December 2003
Abstract During the female vital cycle verbal processes are influenced by secondary effects of steroid hormones. Verbal expression abilities favor more effective interpersonal communications. Verbal motor fluency is produced by the synchronization among voice, resonance and articulation. The present study compared phono-articulatory characteristics between women in reproductive age and postmenopause. Acoustic variations in vocal intonation, speed of the speech and the pause pattern were measured. Forty-five reproductive age women with regular menstrual cycles and taking no hormonal contraceptives and 45 postmenopause women receiving no hormonal replacement therapy for at least 3 years were interviewed and their verbal productions were recorded. Acoustic analyses were performed using the Kay Elemetrics Motor Speech Profile. Student’s t-test was employed to compare data between the two groups when they presented normal distribution, and Mann–Whitney test when they were asymmetrical. Results showed that in the postmenopause group pause pattern was longer, the speed of the speech was slower, there was a vocal deepening without reduction of the vocal extension and there was also less vocal stability. A better understanding in this field will make possible to elaborate strategies to offer a better life quality for postmenopausal women. © 2004 Elsevier Ireland Ltd. All rights reserved. Keywords: Voice; Phono-articulation; Postmenopause; Reproductive age; Speech speed
1. Introduction During the vital cycle of women, secondary effects of steroid hormones are reflected in motor pro∗ Corresponding author. Tel.: +55-51-3316-3671; fax: +55-51-3316-3166. E-mail address: [email protected] (E. Capp).
cesses of verbal expression. During puberty the female voice presents a slight permanent vocal deepening [8], which also happens temporarily during the days before menses [9,10]. The premenstrual vocal variations may be better noticed by women with vocal training, such as singers [11]. Similarly, the use of certain oral contraceptive pills may reduce the voice octave range [8,10].
0378-5122/$ – see front matter © 2004 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.maturitas.2003.12.005
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E.M. Meurer et al. / Maturitas 48 (2004) 71–77
In the postmenopause period, the most commonly reported voice change refers to the variability in vocal fundamental frequency. There is a reduction in the high registers and an increase in the low registers in voice extension [8,11,12]. The female voice virilization is less evident than other modifications related with the postmenopause period, such as hot flushes, cardiovascular problems, urinary atrophy, osteoporosis, depression and dementia [13–15]. The reduction in vocal sustenance stabilizes in old age. The beginning of presbiphonia (or vocal aging) takes place by the time of menopause onset that is, when women are around 50 years old [16,17]. The reduction in verbal fluency, which had previously been more related with aging, may also be affected by other processes: smoking [18], age of menopause, and hormonal replacement therapy use [8]. Also during aging, atrophic processes affect several organs and structures, such as bones, muscles, and sensorial organs, which are essential for the motor production of the voice [19–23]. Verbal expression abilities favor more effective interpersonal communications. The motor production of the voice requires synchronization among the vibration of the vocal folds, expiratory air flux and supra-glotic pressure [1,2]. This way, the basal sounds or vocal fundamental frequency (Fo) and its harmonics (sounds derived from Fo) are generated. These sounds undergo transformations along the mouth–naso–pharynx pathway, such as those of resonance (sound amplification/damping) and of articulation (differences in opening and closing of the oral tract for the emission of vowels and consonants from the different languages). Voice, resonance and articulation produced by peripheral structures of the body depend also from the integration of complex neurophysiologic processes [3]. Among these processes, specialized actions commanded by areas of the right cortical hemisphere allow the production of inflexions and variations of the voice during speech [4]. Furthermore, the pauses between words are also coordinated by the central nervous system [5]. During the last century, there was an increase in life expectancy. A better understanding of the motor processes of verbal fluency may help to offer a better life quality to women, which have a life expectancy of at least 20–30 years after menopause. The aim of this study was to assess the characteristics of the vo-
cal intonation, rhythm and speed of the speech, and the sound-pause relationships in reproductive age and postmenopausal women.
2. Material and methods 2.1. Design A cross-sectional study was carried out. This project was approved by the Ethics Committee from the Hospital de Cl´ınicas de Porto Alegre, Universidade Federal do Rio Grande do Sul. 2.2. Subjects The sample size was estimated from a pilot study with 30 women, for a statistical power of 80% and a confidential level of 0.05. On this bases, 45 women were enrolled in each group (45 in reproductive age and 45 postmenopause). During the period from July to September 2001, women attending the Gynecology Clinic at the Hospital de Cl´ınicas de Porto Alegre and volunteers from the local community were evaluated. Each subject was in good physical and mental state of well-being. They did not report hormonal treatments or any other organic, neurological, cognitive or emotional conditions. Only non-smokers and women without any history of voice training, were included. The inclusion criteria for the reproductive age group (30–40 years old) were regular menstrual cycles and no use of contraceptives or hormonal medications. The inclusion criteria for the postmenopause group were at least 3 years past menopause and no use of any hormonal therapy. 2.3. Procedures After detailed explanation of the objectives, advantages and risks of the project, the volunteers signed an informed consent letter. They then completed a questionnaire relating to their voice, speech, mouth, diet, other habits, gynecologic status and other associated factors. Voice samples were collected with a digital tape recorder MiniDisc MZ-R70-S1 from Sony with a Shure microphone model 16 A and Sony 74 MiniDiscs. The microphone was polar, unidirectional, with
E.M. Meurer et al. / Maturitas 48 (2004) 71–77
a flat band between 50 and 15000 Hz. In the range between 500 and 8000 Hz the variation in capture was less than 4 db with a peak between 6000 and 7000 Hz. In doing so, a higher accuracy was obtained from the recorded data. The microphone was placed and secured 10 cm in front of the subject’s lips. The volunteers remained standing during the recordings to favor their phono-articulatory processes. Recordings were repeated until consistent patterns for analyses were obtained. Data were collected on a Kay Elemetrics Computerized Speech Laboratory (CSL model 4341), and analyzed using the motor speech profile (MSP) program. Emissions of the sentence “irei a Gramado nas férias de inverno” (I will go to Gramado during my winter holidays) were recorded. The sentence is a reference to a well-known touristic town in Brazil. The sentence was produced with six intonation variations: neutral, exclamation, interrogative, angry, sadness and happiness. The variables studied were: speech fundamental frequency (SFF), the highest frequency (Frhi), the lowest frequency (Frlo), the standard deviation of frequency (std) and pitch. The same sentence “I will go to Gramado during my winter holidays”, which has a meaning and was produced with a neutral timbre was subsequently analysed together with the sentence “já vou pˆor mais sal no xis tão bom que lhe fiz à gás lá da Rua Zˆe”. This sentence had no meaning and included in monosyllables, all consonant sounds of the portuguese language, except for ‘nh’. The initial 2.5 s of production were selected for analysis. For the analysis of the two sentences, the average time of syllables production (syllab pattern (s−1 )), their duration (syllab duration (ms)) and pauses (pause pattern (ms)) were measured. The noise level of the recording room was mesured by the software used for analyses of the phono-articulatory patterns. No interference from environmental noise were present in the analyzed recordings. 2.4. Statistical analysis SFF, pitch, Frlo (neutral intonation), SFF, pitch, Frhi (interrogative intonation), SFF, pitch, Frhi, std (exclamative intonation), SFF, pitch, Frlo (angry intonation), SFF, pitch, Frlo (saddness intonation), SFF, pitch, Frhi, Frlo (happiness intonation) had Gaussian distribution
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and were expressed as mean ± standard deviation. In asymetric situations (Frhi, std neutral intonation, Frlo, std interrogative intonation, Frlo exclamative intonation, Frhi, std angry intonation, Frhi, std saddness intonation, std happiness intonation, syllable pattern, syllabe duration, pause pattern), median and interquartile range was employed. Data were compared within groups through Student’s t-test for independent samples or Mann–Whitney for non-Gaussian variables, as indicated.
3. Results The mean age of the women in the reproductive age group was 35.61 ± 3.25 years. They had normal menstrual cycles with regular periods of 28 days and variations of ±3 days. In the group of postmenopausal women the mean age was 62 ± 7.42 years, and the last period had occurred at least 3 years before (13.95 ± 8.32 years after menopause). The speech fundamental frequency (SFF) of the production of the sentence “I will go to Gramado during my winter holidays” was statistically different between the reproductive age and postmenopause groups, in the interrogative (P = 0.027), the exclamative (P = 0.003) and the happiness (P = 0.027) vocal intonations. Similar results were obtained for the pitch in the interrogative (P = 0.019), exclamative (P = 0.001) and happiness (P = 0.049) sentences. Furthermore, variations in the lowest vocal fundamental frequency (Frlo) were detected when vocal intonations of exclamative (P = 0.001), sadness (P = 0.047) and happiness (P = 0.006) were employed. The standards (std) of SFF variations decreased in the reproductive age group in the following order: interrogative > exclamative > happiness > angry > sadness > normal. In the postmenopause group the order was: interrogative > happiness > exclamative > sadness > angry > normal (Table 1). In the same sentence “I will go to Gramado during my winter holidays”, differences were observed in the speed of the speech (P = 0.005) and in the pause pattern (P = 0.028) (Table 2). In the sentence “já vou pˆor mais sal no xis tão bom que lhe fiz à gás lá da Rua Zˆe”, statistically significant differences in the syllable duration (P = 0.001) and the pause pattern (P = 0.001) were observed be-
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Table 1 Acoustic analysis of the sentence “irei a gramado nas f´erias de inverno” Entonation
Reproductive age
Postmenopause
P
Neutral SFF (Hz) Pitch (ms) Frhi (Hz) Frlo (Hz) STD (Hz)
195.53 ± 23.74 5.14 ± 0.56 238.70 (200.30–506.58) 146.24 ± 31.30 21.06 (8.71–70.10)
188.38 ± 18.17 5.36 ± 0.54 243.72 (193.64–508.68) 134.40 ± 27.22 23.15 (11.44–56.56)
0.112 0.069 0.634 0.059 0.204
Interrogative SFF (Hz) Pitch (ms) Frhi (Hz) Frlo (Hz) STD (Hz)
203.99 ± 17.94 4.93 ± 0.44 297.98 ± 53.38 151.44 (73.70–189.24) 36.28 (12.02–78.48)
194.65 ± 21.27 5.20 ± 0.58 301.21 ± 75.37 142.86 (68.82–183.66) 36.57 (13.50–71.98)
0.027 0.019 0.815 0.760 0.750
Exclamative SFF (Hz) Pitch (ms) Frhi (Hz) Frlo (Hz) STD (Hz)
218.42 ± 24.85 4.63 ± 0.57 293.28 ± 54.50 164.26 (85.36–195.62) 33.67 ± 13.32
201.09 ± 28.38 5.08 ± 0.67 280.64 ± 55.08 142.96 (68.04–183.70) 33.11 ± 13.98
0.003 0.001 0.277 0.001 0.846
Angry SFF (Hz) Pitch (ms) Frhi (Hz) Frlo (Hz) STD (Hz)
201.61 ± 29.93 5.07 ± 0.75 252.18 (183.38–512.60) 144.72 ± 36.22 24.25 (7.68–117.10)
203.04 ± 38.67 5.08 ± 0.85 268.88 (183.08–510.62) 144.43 ± 31.47 25.97 (10.52–90.99)
0.845 0.950 0.245 0.968 0.672
Saddness SFF (Hz) Pitch (ms) Frhi (Hz) Frlo (Hz) STD (Hz)
199.32 ± 32.21 5.15 ± 0.87 250.70 (174.72–418.20) 152.43 ± 34.69 24.05 (10.38–90.23)
196.03 ± 29.62 5.21 ± 0.80 259.66 (168.22–491.50) 138.31 ± 31.85 27.72 (9.51–72.60)
0.615 0.709 0.202 0.047 0.182
Happiness SFF (Hz) Pitch (ms) Frhi (Hz) Frlo (Hz) STD (Hz)
233.03 ± 49.26 4.46 ± 0.86 311.76 ± 68.76 168.48 ± 42.4 33.91 (10.55–93.52)
213.22 ± 32.44 4.79 ± 0.73 298.11 ± 65.67 148.01 ± 23.87 35.07 (11.27–75.01)
0.027 0.049 0.338 0.006 0.701
Table 2 Acoustic pattern of the sentence “irei a gramado nas f´erias de inverno”
(s−1 )
Syllable pattern Syllable duration (ms) Pause pattern (ms)
Reproductive age
Postmenopause
P
4.74 (2.48–10.28) 188.94 (89.30–291.10) 146.14 (0.00–705,63)
3.79 (2.24–9.77) 203.13 (102.40–321.89) 166.62 (0.00–925.07)
0.005 0.150 0.028
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Table 3 Accoustic pattern of the sentence “j´a vou por mais sal no xis que lhe fiz tão bem a g´as l´a da rua zˆe”
Syllable pattern (s−1 ) Syllable duration (ms) Pause pattern (ms)
Reproductive age
Postmenopause
P
3.58 (2.29–6.77) 211.15 (119.83–331.46) 173.93 (0.00–426.62)
3.66 (3.22–7.88) 177.36 (61.73–271.49) 213.37 (128.19–849.91)
0.122 0.001 0.001
tween the reproductive age and postmenopause groups (Table 3).
4. Discussion The present study demonstrated that, different to other studies [17,25,26], postmenopausal women have no different speech fundamental frequency for sentence produced with neutral intonation from women in reproductive age. Particular speech characteristics of different languages were not relevant for the sentence produced with neutral intonation. The speech fundamental frequency was higher than other Brazilian and foreigner women aged less than 74 years [27,28]. The speech fundamental frequency of the interrogative, exclamation and happiness sentences showed lower (deeper) values in the postmenopause than in the reproductive age group of the present study. The tendency to lower emissions in the postmenopausal group was confirmed by the lower fundamental frequency values of the sentences produced with exclamation, sadness and happiness, when compared to women in the reproductive age group. These results were further confirmed by the pitch of the same interrogative, exclamative and happiness sentences. The postmenopause group needed more time to form the vocal sound wave than the reproductive age group, similar to other study [29]. The present results demonstrate deepening of the voice that happens during postmenopause [8,11,12,27]. However, using the same group of individuals from the present study, similar results were not observed when the vocal fundamental frequency was analysed for the sustenance of the isolated vowel ‘a’ [30]. This data suggests differences between the peripheric processes of resonance and articulation similar to what is observed in specific neurophysiologic events [31–33] for isolated voice productions,
such as for the vowel ‘a’ and for chain speech as used in sentences. The increase in variability of the standard frequencies (std), namely the speech lower (Frlo) and higher (Frhi) frequencies, that was more common in the postmenopause than in the reproductive age group suggested a decrease in vocal estability [17,33]. However, the reduction in higher registers during speech emissions in the postmenopause group was not as marked as described in literature [12,18,28]. Similarly, the standard (std) of modulation variations of sentences in each group of the present study shows that both groups had less trembling in the neutral sentence and more variations in the interrogative sentence. In both groups, the variability of the prosodic tones (neutral, interrogative and exclamation) was intercalated by emotional modulations (of angry, sadness and happiness). These observations, which report to the interhemisphere cortical interactions required for the speech emissions [4] with no specification of the conexions and events responsable for them [3], allow us to suggest the existence of a basic neuromuscular integrity in all processes involved with phonation, resonance and articulation in both groups of women. This synchronization is needed for the motor production of the chain speech (in sentences) and emphasizes the diversity of each speaker [24]. Considering the speed of the speech, it was observed that the postmenopause group presented less speed of speech than the reproductive age group for the emission of the sentence “I will go to Gramado during my winter holidays”. Similar result was obtained when the frequency of the alternated phono-articulatory movements of the simple speech (verbal diadochokinesis) was analysed in the same group of postmenopause individuals in a previous study [30]. The present study demonstrates that the decrease in articulation agility happened at the same time that
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there was an increase in the duration of the pauses in the postmenopausal group of women. These responses may be related with neurophysiological, structural or metabolic modifications, as well as with effects of the suppression of steroid hormones [31,32]. Considering the non-sense sentence, both groups of women from the present study presented similar speed of speech and it was inferior than for the sentence with a meaning. Thus, it could be confirmed the influence of the context of the speech, which interfers in the effort–confort relationship necessary for the verbal motor fluency [6,7]. However, the strongest evidences obtained from the analysis of the verbal motor fluency were related to the pause pattern which was longer in the postmenopause group than in the reproductive age group of women, for both sentences, with and without a meaning. Particular characteristics, such as educational level, professional activity and frequency of public contact, which were all less prominent in the postmenopause group, presented a minimal influence in the present analysis due to the fact that we stimulated the training of the emissions prior to the recordings. Values for the pauses in the menopause group were still higher than those obtained for women from São Paulo, Brazil, age 65–85 years before vocal training [27] and lower than the one second period referred by ASHA [7] as the necessary time required to maintain verbal fluency. The pauses during speech, which are attributed to neuromotor processes of the speech and to the fine control performed by the central nervous system [5], also suggest possible effects of the lack of estrogens on the velocity of the verbal articulation and verbal fluency which had already been reported in postmenopausal women [33].
5. Conclusion Important modifications occur in the pause, rhythm and speed pattern of the speech demonstrate particular aspects of the verbal expression in postmenopause and reproductive age groups of women. The variations that happened associated with some characteristics of the female voice virilization are the most evident change during postmenopause, emphasizing the need to expand and integrate researches in this area. During vocal virilization, where an increase in deep registers during
speech was confirmed without reduction in high tones, vocal extension was preserved and the waker vocal estability did not interfere in the efficiency of expression. Also, the present results point out for the need of further multidisciplinary studies on the possible effects of the lack of steroid hormones on motor processes related with verbal expression during postmenopause. A better understanding in this field will make it possible the development of strategies that will favor communication motor abilities of women which may still have a long period of life after reaching menopause.
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[24] Russo ICP. Bases f´ısicas da fonação. Acústica e Psicoacústica Aplicadas à Fonoaudiologia. Lovise, SP; 1999. p. 143–55. [25] Castro VC, Krook MIP. Caracter´ısticas da freqüˆencia fundamental da fala de indiv´ıduos do sexo feminino falantes do portuguˆes brasileiro. Pró-fono 1994;6(2):5–7. [26] Orlikoff RF. Vocal stability and vocal tract configuration: on acoustic and electroglottographic investigation. J Voice 1995;9(2):173–81. [27] Behlau MS, Pontes PAL, Tosi O, Ganança MM. Presbifonia: tratamento da deterioração vocal inerente à idade. Acta Awho 1988;2(2):45–51. [28] Carbonell J, Tolosa F, Juan E. Prebyphonia: a study of acoustic parameters of normalcy. Acta Otorrinolaringol Espanola 1996;47(4):295–9. [29] Deliyski D. Motor speech profile model 4341. USA: Kay Elemetrics Corp.; 1997. p. 19–40. [30] Meurer EM, Wender MCO, Corleta HVE, Capp E. Female phono-articulatory variations in reproductive age and postmenopause. J Voice 2002 [unsubmitted]. [31] Genazzani AR, Somati M, Rubino S, Bersi C, Spinetti A, Salvestroni C, et al. Neuroendocrine changes and climaterium. Maturitas 1997;27:1–10. [32] Morrison JH, Holf PR. Life and death of neurons in the aging brain. Am Assoc Adv Sci 1997;278(5337):412–9. [33] Shaywitz SE, Shaywitz BA, Pugg KR, Fulbrigth RK, Skudlarski P, Mencl WE, et al. Effect of estrogen on brain activation patterns in postmenopause women during working memory tasks. Obstetr Gynecol Surg 2000;55(4):227–8.
Female suprasegmental speech parameters in reproductive age and postmenopause Eliséa Maria Meurer a,c , Maria Celeste Osório Wender b , Helena von Eye Corleta a,b,d , Edison Capp a,b,d,∗ a
Departament of Physiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil b Departament of Obstetrics and Gynecology, Hospital de Cl´ınicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil c Department of Phono-Audiology, Universidade Luterana do Brasil, Canoas, Brazil d Cl´ınica Gerar de Fertilização Assistida, Porto Alegre, Brazil
Received 18 February 2003; received in revised form 4 December 2003; accepted 10 December 2003
Abstract During the female vital cycle verbal processes are influenced by secondary effects of steroid hormones. Verbal expression abilities favor more effective interpersonal communications. Verbal motor fluency is produced by the synchronization among voice, resonance and articulation. The present study compared phono-articulatory characteristics between women in reproductive age and postmenopause. Acoustic variations in vocal intonation, speed of the speech and the pause pattern were measured. Forty-five reproductive age women with regular menstrual cycles and taking no hormonal contraceptives and 45 postmenopause women receiving no hormonal replacement therapy for at least 3 years were interviewed and their verbal productions were recorded. Acoustic analyses were performed using the Kay Elemetrics Motor Speech Profile. Student’s t-test was employed to compare data between the two groups when they presented normal distribution, and Mann–Whitney test when they were asymmetrical. Results showed that in the postmenopause group pause pattern was longer, the speed of the speech was slower, there was a vocal deepening without reduction of the vocal extension and there was also less vocal stability. A better understanding in this field will make possible to elaborate strategies to offer a better life quality for postmenopausal women. © 2004 Elsevier Ireland Ltd. All rights reserved. Keywords: Voice; Phono-articulation; Postmenopause; Reproductive age; Speech speed
1. Introduction During the vital cycle of women, secondary effects of steroid hormones are reflected in motor pro∗ Corresponding author. Tel.: +55-51-3316-3671; fax: +55-51-3316-3166. E-mail address: [email protected] (E. Capp).
cesses of verbal expression. During puberty the female voice presents a slight permanent vocal deepening [8], which also happens temporarily during the days before menses [9,10]. The premenstrual vocal variations may be better noticed by women with vocal training, such as singers [11]. Similarly, the use of certain oral contraceptive pills may reduce the voice octave range [8,10].
0378-5122/$ – see front matter © 2004 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.maturitas.2003.12.005
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E.M. Meurer et al. / Maturitas 48 (2004) 71–77
In the postmenopause period, the most commonly reported voice change refers to the variability in vocal fundamental frequency. There is a reduction in the high registers and an increase in the low registers in voice extension [8,11,12]. The female voice virilization is less evident than other modifications related with the postmenopause period, such as hot flushes, cardiovascular problems, urinary atrophy, osteoporosis, depression and dementia [13–15]. The reduction in vocal sustenance stabilizes in old age. The beginning of presbiphonia (or vocal aging) takes place by the time of menopause onset that is, when women are around 50 years old [16,17]. The reduction in verbal fluency, which had previously been more related with aging, may also be affected by other processes: smoking [18], age of menopause, and hormonal replacement therapy use [8]. Also during aging, atrophic processes affect several organs and structures, such as bones, muscles, and sensorial organs, which are essential for the motor production of the voice [19–23]. Verbal expression abilities favor more effective interpersonal communications. The motor production of the voice requires synchronization among the vibration of the vocal folds, expiratory air flux and supra-glotic pressure [1,2]. This way, the basal sounds or vocal fundamental frequency (Fo) and its harmonics (sounds derived from Fo) are generated. These sounds undergo transformations along the mouth–naso–pharynx pathway, such as those of resonance (sound amplification/damping) and of articulation (differences in opening and closing of the oral tract for the emission of vowels and consonants from the different languages). Voice, resonance and articulation produced by peripheral structures of the body depend also from the integration of complex neurophysiologic processes [3]. Among these processes, specialized actions commanded by areas of the right cortical hemisphere allow the production of inflexions and variations of the voice during speech [4]. Furthermore, the pauses between words are also coordinated by the central nervous system [5]. During the last century, there was an increase in life expectancy. A better understanding of the motor processes of verbal fluency may help to offer a better life quality to women, which have a life expectancy of at least 20–30 years after menopause. The aim of this study was to assess the characteristics of the vo-
cal intonation, rhythm and speed of the speech, and the sound-pause relationships in reproductive age and postmenopausal women.
2. Material and methods 2.1. Design A cross-sectional study was carried out. This project was approved by the Ethics Committee from the Hospital de Cl´ınicas de Porto Alegre, Universidade Federal do Rio Grande do Sul. 2.2. Subjects The sample size was estimated from a pilot study with 30 women, for a statistical power of 80% and a confidential level of 0.05. On this bases, 45 women were enrolled in each group (45 in reproductive age and 45 postmenopause). During the period from July to September 2001, women attending the Gynecology Clinic at the Hospital de Cl´ınicas de Porto Alegre and volunteers from the local community were evaluated. Each subject was in good physical and mental state of well-being. They did not report hormonal treatments or any other organic, neurological, cognitive or emotional conditions. Only non-smokers and women without any history of voice training, were included. The inclusion criteria for the reproductive age group (30–40 years old) were regular menstrual cycles and no use of contraceptives or hormonal medications. The inclusion criteria for the postmenopause group were at least 3 years past menopause and no use of any hormonal therapy. 2.3. Procedures After detailed explanation of the objectives, advantages and risks of the project, the volunteers signed an informed consent letter. They then completed a questionnaire relating to their voice, speech, mouth, diet, other habits, gynecologic status and other associated factors. Voice samples were collected with a digital tape recorder MiniDisc MZ-R70-S1 from Sony with a Shure microphone model 16 A and Sony 74 MiniDiscs. The microphone was polar, unidirectional, with
E.M. Meurer et al. / Maturitas 48 (2004) 71–77
a flat band between 50 and 15000 Hz. In the range between 500 and 8000 Hz the variation in capture was less than 4 db with a peak between 6000 and 7000 Hz. In doing so, a higher accuracy was obtained from the recorded data. The microphone was placed and secured 10 cm in front of the subject’s lips. The volunteers remained standing during the recordings to favor their phono-articulatory processes. Recordings were repeated until consistent patterns for analyses were obtained. Data were collected on a Kay Elemetrics Computerized Speech Laboratory (CSL model 4341), and analyzed using the motor speech profile (MSP) program. Emissions of the sentence “irei a Gramado nas férias de inverno” (I will go to Gramado during my winter holidays) were recorded. The sentence is a reference to a well-known touristic town in Brazil. The sentence was produced with six intonation variations: neutral, exclamation, interrogative, angry, sadness and happiness. The variables studied were: speech fundamental frequency (SFF), the highest frequency (Frhi), the lowest frequency (Frlo), the standard deviation of frequency (std) and pitch. The same sentence “I will go to Gramado during my winter holidays”, which has a meaning and was produced with a neutral timbre was subsequently analysed together with the sentence “já vou pˆor mais sal no xis tão bom que lhe fiz à gás lá da Rua Zˆe”. This sentence had no meaning and included in monosyllables, all consonant sounds of the portuguese language, except for ‘nh’. The initial 2.5 s of production were selected for analysis. For the analysis of the two sentences, the average time of syllables production (syllab pattern (s−1 )), their duration (syllab duration (ms)) and pauses (pause pattern (ms)) were measured. The noise level of the recording room was mesured by the software used for analyses of the phono-articulatory patterns. No interference from environmental noise were present in the analyzed recordings. 2.4. Statistical analysis SFF, pitch, Frlo (neutral intonation), SFF, pitch, Frhi (interrogative intonation), SFF, pitch, Frhi, std (exclamative intonation), SFF, pitch, Frlo (angry intonation), SFF, pitch, Frlo (saddness intonation), SFF, pitch, Frhi, Frlo (happiness intonation) had Gaussian distribution
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and were expressed as mean ± standard deviation. In asymetric situations (Frhi, std neutral intonation, Frlo, std interrogative intonation, Frlo exclamative intonation, Frhi, std angry intonation, Frhi, std saddness intonation, std happiness intonation, syllable pattern, syllabe duration, pause pattern), median and interquartile range was employed. Data were compared within groups through Student’s t-test for independent samples or Mann–Whitney for non-Gaussian variables, as indicated.
3. Results The mean age of the women in the reproductive age group was 35.61 ± 3.25 years. They had normal menstrual cycles with regular periods of 28 days and variations of ±3 days. In the group of postmenopausal women the mean age was 62 ± 7.42 years, and the last period had occurred at least 3 years before (13.95 ± 8.32 years after menopause). The speech fundamental frequency (SFF) of the production of the sentence “I will go to Gramado during my winter holidays” was statistically different between the reproductive age and postmenopause groups, in the interrogative (P = 0.027), the exclamative (P = 0.003) and the happiness (P = 0.027) vocal intonations. Similar results were obtained for the pitch in the interrogative (P = 0.019), exclamative (P = 0.001) and happiness (P = 0.049) sentences. Furthermore, variations in the lowest vocal fundamental frequency (Frlo) were detected when vocal intonations of exclamative (P = 0.001), sadness (P = 0.047) and happiness (P = 0.006) were employed. The standards (std) of SFF variations decreased in the reproductive age group in the following order: interrogative > exclamative > happiness > angry > sadness > normal. In the postmenopause group the order was: interrogative > happiness > exclamative > sadness > angry > normal (Table 1). In the same sentence “I will go to Gramado during my winter holidays”, differences were observed in the speed of the speech (P = 0.005) and in the pause pattern (P = 0.028) (Table 2). In the sentence “já vou pˆor mais sal no xis tão bom que lhe fiz à gás lá da Rua Zˆe”, statistically significant differences in the syllable duration (P = 0.001) and the pause pattern (P = 0.001) were observed be-
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Table 1 Acoustic analysis of the sentence “irei a gramado nas f´erias de inverno” Entonation
Reproductive age
Postmenopause
P
Neutral SFF (Hz) Pitch (ms) Frhi (Hz) Frlo (Hz) STD (Hz)
195.53 ± 23.74 5.14 ± 0.56 238.70 (200.30–506.58) 146.24 ± 31.30 21.06 (8.71–70.10)
188.38 ± 18.17 5.36 ± 0.54 243.72 (193.64–508.68) 134.40 ± 27.22 23.15 (11.44–56.56)
0.112 0.069 0.634 0.059 0.204
Interrogative SFF (Hz) Pitch (ms) Frhi (Hz) Frlo (Hz) STD (Hz)
203.99 ± 17.94 4.93 ± 0.44 297.98 ± 53.38 151.44 (73.70–189.24) 36.28 (12.02–78.48)
194.65 ± 21.27 5.20 ± 0.58 301.21 ± 75.37 142.86 (68.82–183.66) 36.57 (13.50–71.98)
0.027 0.019 0.815 0.760 0.750
Exclamative SFF (Hz) Pitch (ms) Frhi (Hz) Frlo (Hz) STD (Hz)
218.42 ± 24.85 4.63 ± 0.57 293.28 ± 54.50 164.26 (85.36–195.62) 33.67 ± 13.32
201.09 ± 28.38 5.08 ± 0.67 280.64 ± 55.08 142.96 (68.04–183.70) 33.11 ± 13.98
0.003 0.001 0.277 0.001 0.846
Angry SFF (Hz) Pitch (ms) Frhi (Hz) Frlo (Hz) STD (Hz)
201.61 ± 29.93 5.07 ± 0.75 252.18 (183.38–512.60) 144.72 ± 36.22 24.25 (7.68–117.10)
203.04 ± 38.67 5.08 ± 0.85 268.88 (183.08–510.62) 144.43 ± 31.47 25.97 (10.52–90.99)
0.845 0.950 0.245 0.968 0.672
Saddness SFF (Hz) Pitch (ms) Frhi (Hz) Frlo (Hz) STD (Hz)
199.32 ± 32.21 5.15 ± 0.87 250.70 (174.72–418.20) 152.43 ± 34.69 24.05 (10.38–90.23)
196.03 ± 29.62 5.21 ± 0.80 259.66 (168.22–491.50) 138.31 ± 31.85 27.72 (9.51–72.60)
0.615 0.709 0.202 0.047 0.182
Happiness SFF (Hz) Pitch (ms) Frhi (Hz) Frlo (Hz) STD (Hz)
233.03 ± 49.26 4.46 ± 0.86 311.76 ± 68.76 168.48 ± 42.4 33.91 (10.55–93.52)
213.22 ± 32.44 4.79 ± 0.73 298.11 ± 65.67 148.01 ± 23.87 35.07 (11.27–75.01)
0.027 0.049 0.338 0.006 0.701
Table 2 Acoustic pattern of the sentence “irei a gramado nas f´erias de inverno”
(s−1 )
Syllable pattern Syllable duration (ms) Pause pattern (ms)
Reproductive age
Postmenopause
P
4.74 (2.48–10.28) 188.94 (89.30–291.10) 146.14 (0.00–705,63)
3.79 (2.24–9.77) 203.13 (102.40–321.89) 166.62 (0.00–925.07)
0.005 0.150 0.028
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Table 3 Accoustic pattern of the sentence “j´a vou por mais sal no xis que lhe fiz tão bem a g´as l´a da rua zˆe”
Syllable pattern (s−1 ) Syllable duration (ms) Pause pattern (ms)
Reproductive age
Postmenopause
P
3.58 (2.29–6.77) 211.15 (119.83–331.46) 173.93 (0.00–426.62)
3.66 (3.22–7.88) 177.36 (61.73–271.49) 213.37 (128.19–849.91)
0.122 0.001 0.001
tween the reproductive age and postmenopause groups (Table 3).
4. Discussion The present study demonstrated that, different to other studies [17,25,26], postmenopausal women have no different speech fundamental frequency for sentence produced with neutral intonation from women in reproductive age. Particular speech characteristics of different languages were not relevant for the sentence produced with neutral intonation. The speech fundamental frequency was higher than other Brazilian and foreigner women aged less than 74 years [27,28]. The speech fundamental frequency of the interrogative, exclamation and happiness sentences showed lower (deeper) values in the postmenopause than in the reproductive age group of the present study. The tendency to lower emissions in the postmenopausal group was confirmed by the lower fundamental frequency values of the sentences produced with exclamation, sadness and happiness, when compared to women in the reproductive age group. These results were further confirmed by the pitch of the same interrogative, exclamative and happiness sentences. The postmenopause group needed more time to form the vocal sound wave than the reproductive age group, similar to other study [29]. The present results demonstrate deepening of the voice that happens during postmenopause [8,11,12,27]. However, using the same group of individuals from the present study, similar results were not observed when the vocal fundamental frequency was analysed for the sustenance of the isolated vowel ‘a’ [30]. This data suggests differences between the peripheric processes of resonance and articulation similar to what is observed in specific neurophysiologic events [31–33] for isolated voice productions,
such as for the vowel ‘a’ and for chain speech as used in sentences. The increase in variability of the standard frequencies (std), namely the speech lower (Frlo) and higher (Frhi) frequencies, that was more common in the postmenopause than in the reproductive age group suggested a decrease in vocal estability [17,33]. However, the reduction in higher registers during speech emissions in the postmenopause group was not as marked as described in literature [12,18,28]. Similarly, the standard (std) of modulation variations of sentences in each group of the present study shows that both groups had less trembling in the neutral sentence and more variations in the interrogative sentence. In both groups, the variability of the prosodic tones (neutral, interrogative and exclamation) was intercalated by emotional modulations (of angry, sadness and happiness). These observations, which report to the interhemisphere cortical interactions required for the speech emissions [4] with no specification of the conexions and events responsable for them [3], allow us to suggest the existence of a basic neuromuscular integrity in all processes involved with phonation, resonance and articulation in both groups of women. This synchronization is needed for the motor production of the chain speech (in sentences) and emphasizes the diversity of each speaker [24]. Considering the speed of the speech, it was observed that the postmenopause group presented less speed of speech than the reproductive age group for the emission of the sentence “I will go to Gramado during my winter holidays”. Similar result was obtained when the frequency of the alternated phono-articulatory movements of the simple speech (verbal diadochokinesis) was analysed in the same group of postmenopause individuals in a previous study [30]. The present study demonstrates that the decrease in articulation agility happened at the same time that
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there was an increase in the duration of the pauses in the postmenopausal group of women. These responses may be related with neurophysiological, structural or metabolic modifications, as well as with effects of the suppression of steroid hormones [31,32]. Considering the non-sense sentence, both groups of women from the present study presented similar speed of speech and it was inferior than for the sentence with a meaning. Thus, it could be confirmed the influence of the context of the speech, which interfers in the effort–confort relationship necessary for the verbal motor fluency [6,7]. However, the strongest evidences obtained from the analysis of the verbal motor fluency were related to the pause pattern which was longer in the postmenopause group than in the reproductive age group of women, for both sentences, with and without a meaning. Particular characteristics, such as educational level, professional activity and frequency of public contact, which were all less prominent in the postmenopause group, presented a minimal influence in the present analysis due to the fact that we stimulated the training of the emissions prior to the recordings. Values for the pauses in the menopause group were still higher than those obtained for women from São Paulo, Brazil, age 65–85 years before vocal training [27] and lower than the one second period referred by ASHA [7] as the necessary time required to maintain verbal fluency. The pauses during speech, which are attributed to neuromotor processes of the speech and to the fine control performed by the central nervous system [5], also suggest possible effects of the lack of estrogens on the velocity of the verbal articulation and verbal fluency which had already been reported in postmenopausal women [33].
5. Conclusion Important modifications occur in the pause, rhythm and speed pattern of the speech demonstrate particular aspects of the verbal expression in postmenopause and reproductive age groups of women. The variations that happened associated with some characteristics of the female voice virilization are the most evident change during postmenopause, emphasizing the need to expand and integrate researches in this area. During vocal virilization, where an increase in deep registers during
speech was confirmed without reduction in high tones, vocal extension was preserved and the waker vocal estability did not interfere in the efficiency of expression. Also, the present results point out for the need of further multidisciplinary studies on the possible effects of the lack of steroid hormones on motor processes related with verbal expression during postmenopause. A better understanding in this field will make it possible the development of strategies that will favor communication motor abilities of women which may still have a long period of life after reaching menopause.
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