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This study reports on two experiments to examine vocal fold abduction and its relationship with relative fundamental frequency (RFF), considering two attributes that have been shown to elicit group differences in RFF: age (Experiment 1) and Parkinson's disease (PD; Experiment 2). For both experiments, simultaneous acoustic and nasendoscopic recordings were collected as participants produced the utterance, /ifi/. RFF values were computed from the acoustic signal, whereas abduction duration and glottic angle at voicing offset were identified from the laryngoscopic images. In Experiment 1, 50 speakers with typical voices (18–83 years) were analyzed to examine (1A) the effects of speaker age on individual outcome measures (RFF, abduction duration, glottic angle) via Pearson's correlation coefficients, and (1B) the effects of abductory measures and age on RFF via an analysis of covariance. In Experiment 2, 20 speakers with PD and 20 matched controls were analyzed to examine (2A) the effects of group (with/without PD) on outcome measures via an analysis of variance, and (2B) the relationship of RFF with abduction duration, glottic angle, and age when considering group via an analysis of covariance. Age demonstrated a significant, negative relationship with glottic angle (1A) but was not a significant factor when examining the relationship of vocal fold abduction and RFF (1B). Speaker group (with/without PD) demonstrated a significant effect on measures of RFF and abduction duration (2A) but was not a significant factor when examining the relationship of vocal fold abduction and RFF (2B). RFF is sensitive to changes in vocal fold abductory patterns during devoicing, irrespective of speaker age or PD status. [ABSTRACT FROM AUTHOR]

Childhood and adolescence are essential stages in the development of voice and speech quality; therefore, it is essential to understand the vocal changes that occur during this period. Frequency-based measurement methods like cepstral measurements stand out among the methods described, which are able to identify f o and estimate the periodicity and noise in the acoustic wave without establishing individual cycles of the sound wave. Two hundred seventy-one recordings (128 female and 131 male) from children and adolescents aged 5 to 18 years with no vocal complaints were analyzed. Three speech-language pathologists assessed the vocal quality and determined as appropriate for the age. The recordings were divided into six age groups (G1:5-7; G2:8-9; G3:10-11; G4:12; G5:13-15 and G6:16-18 years old). Sustained production of the vowel /a/ were inspected and edited using the PRAAT software. Then, it was extract de Cepstrum Peak Prominence Smoothed (CPPS) using a script in the same software. A Two-way ANOVA was applied to investigate the effect of sex, age and sex*age interaction, followed by Bonferroni's correction for each gender separately. Finally, the Student's t test for independent samples was performed to compare genders within each age group. Male children and adolescents from G5 and G6 had higher CPPS measures than G1, G2 and G3 (P ≤ 0.001). In addition, G6 also had higher values than G4 (P ≤ 0.001). There was no difference between age groups in the female group. In turn, sex differences were reported from 12 years of age onwards, with higher CPPS values found for male participants compared to female participants (P ≤ 0.01). Vocal changes that usually occur from childhood to adolescence are reflected in the acoustic CPPS measure in males, resulting in higher values in the 13 to 18 years old. On the other hand, no changes in CPPS values were observed in the age groups of female participants. Males have higher CPPS values than females and that sex differences are reported after 12 years of age. [ABSTRACT FROM AUTHOR]

Essential vocal tremor (EVT) is an uncommon but challenging condition to manage. Several medical and interventional treatment options have been reported but efficacy remains unclear. We performed a scoping review of high-quality clinical trials to identify effective evidence-based treatments for EVT. Scoping review. Relevant studies were identified using the databases MedLine, Cochrane Central Register of Controlled Trials, and Embase. Subjective and objective outcomes for each modality were analyzed and the effect sizes were quantified using Hedges' g measure to allow comparison between studies. We identified 421 studies eligible for screening with 11 included in the final analysis. Evidence supporting effective EVT treatments was found for bilateral versus unilateral deep brain stimulation (DBS) (Hedges' g 0.65, 95% CI = 0.10-1.20) and octanoic acid (Hedges' g 1.15, 95% CI = 0.40-1.90). Evidence to support the use of methazolamide was not sufficient (Hedges' g 0.51, 95% CI = -0.64 to 1.66). Botulinum toxin (BT) injections were equivalent when comparing unilateral versus bilateral (Hedges' g -0.18, 95% CI = -1.06 to 0.70); BT did not display any advantage over propranolol (Hedges' g -0.47, 95% CI = -1.73 to 0.78) or injection augmentation (Hedges' g 0.068, 95% CI = -0.98 to 1.12). Our review finds very little high-quality evidence supporting any treatment for EVT. Octanoic acid reduced fluctuations in EVT but did not affect the perception of the tremor. In refractory cases, bilateral DBS was superior to unilateral DBS in improving subjective voice outcomes. Unilateral and bilateral BT injections were equivalent, and BT injection was not more effective than injection augmentation. Further direct comparison in well-designed prospective studies may help clarify optimal treatment for EVT patients. [ABSTRACT FROM AUTHOR]

ObjectiveWhile the vocal fold is in direct contact anteriorly with the thyroid cartilage, posteriorly the vocal fold connects to the thyroid cartilage through a soft tissue layer in the paraglottic space. Currently the paraglottic space is often neglected in computational models of phonation, in which a fixed boundary condition is often imposed on the lateral surface of the vocal fold. The goal of this study was to investigate the effect of the paraglottic space on voice production in an MRI-based vocal fold model, and how this effect may be counteracted by vocal fold stiffening due to laryngeal muscle activation.MethodsParametric simulation study using an MRI-based computational vocal fold model.ResultsThe results showed that the presence of the paraglottic space increased the mean and amplitude of the glottal area waveform, decreased the phonation frequency and closed quotient. For the particular vocal fold geometry used in this study, the presence of the paraglottic space also reduced the occurrence of irregular vocal fold vibration. These effects of the paraglottic space became smaller with increasing paraglottic space stiffness and to a lesser degree with vocal fold stiffening.ConclusionsThe results suggest that the paraglottic space may be neglected in qualitative evaluations of normal phonation, but needs to be included in simulations of pathological phonation or vocal fold posturing.

ObjectiveEstimation of physiological control parameters of the vocal system from the produced voice outcome has important applications in clinical management of voice disorders . Previously we developed a simulation-based neural network for estimation of vocal fold geometry, mechanical properties, and subglottal pressure from voice outcome features that characterize the acoustics of the produced voice. The goals of this study are to (1) explore the possibility of improving the estimation accuracy of physiological control parameters by including voice outcome features characterizing vocal fold vibration; and (2) identify voice feature sets that optimize both estimation accuracy and robustness to measurement noise.MethodsFeedforward neural networks are trained to solve the inversion problem of estimating the physiological control parameters of a three-dimensional body-cover vocal fold model from different sets of voice outcome features that characterize the simulated voice acoustics, glottal flow, and vocal fold vibration. A sensitivity analysis is then performed to evaluate the contribution of individual voice features to the overall performance of the neural networks in estimating the physiologic control parameters.Results and conclusionsWhile including voice outcome features characterizing vocal fold vibration increases estimation accuracy, it also reduces the network's robustness to measurement noise, due to high sensitivity of network performance to voice outcome features measuring the absolute amplitudes of the glottal flow and area waveforms, which are also difficult to measure accurately in practical applications. By excluding such glottal flow-based features and replacing glottal area-based features by their normalized counterparts, we are able to significantly improve both estimation accuracy and robustness to noise. We further show that similar estimation accuracy and robustness can be achieved with an even smaller set of voice outcome features by excluding features of small sensitivity.

Simulation is a safe, supported, and accessible learning method for students to gain skills and experience, especially in difficult to access range of practice areas such as voice. The study aimed to explore change in students' perceptions of knowledge, confidence, anxiety, and clinical readiness for assessment and management of an adult with a voice disorder after participation in simulation-based learning activities. Participants (N = 113) were students enrolled in a mandatory course dedicated to the voice and voice disorders. Students completed 32 hours of academic coursework which included lectures and tutorials and two 30-minute simulation-based learning activities with a standardized patient playing the role of an adult with a voice disorder. The impact of the simulation-based learning activities on student perceptions of their knowledge, confidence, anxiety, and clinical readiness for work within the area of voice were surveyed at three time points: (1) pre lectures, (2) post lectures but pre simulation, and (3) post simulation. Change across time was analyzed using repeated measures analysis of variance with post hoc Bonferroni adjustment. All students perceived significant (P ≤ 0.001) positive changes in knowledge and confidence across time points for all activities, except for writing an assessment report. Anxiety related to the management of a client with a voice disorder fluctuated significantly (P ≤ 0.001) throughout the program. Overall, the majority (>90%) of students agreed or strongly agreed that the simulation-based learning activities were useful and helped them to develop clinical skills, apply content taught in lectures, and gain confidence and interest in voice. This study supports incorporation of simulation-based learning as part of students' clinical preparation for the assessment and management of voice disorders. [ABSTRACT FROM AUTHOR]

There are different parts of a battery of voice assessments to assess voice functions and voice quality. The objective assessment of voice quality using acoustics is recommended and two measurements such as the Acoustic Voice Quality index, 03.01 (AVQI) and the Acoustic Breathiness Index (ABI) are leading in this domain. The purpose of this study was to verify the validity between these two acoustic measurements and other dimensions of the voice assessments (the Voice Handicap Index-10 (VHI-10) and the laryngeal imaging evaluation of the larynx and vocal folds). We used a retrospective database of 150 participants (37 vocally healthy participants and 113 dysphonic patients). To test the validity between the acoustic measurements and the other voice assessments the concurrent validity and diagnostic precision were analyzed using Pearson correlation coefficient and the receiver operating characteristic (ROC) statistics with likelihood ratios. The VHI-10 score presented moderate-significant correlations with the AVQI and the ABI, r= 0.477, P < 0.001 (r2= 0.228) and r= 0.426, P < 0.001 (r2=0.181), respectively. The larynx alteration presented low-significant correlations with the AVQI (r= 0.362, P < 0.001, r2= 0.131), and ABI (r= 0.371, P < 0.001, r2= 0.138), respectively. The area under the curve (AUC) of ROC was almost reasonable ranging from 0.701 to 0.737; except between ABI and VHI-10 (AUC= 0.689). The highest AUC was between the AVQI and VHI-10 at a threshold of 2.10; the highest specificity was between the ABI and VHI-10 at a threshold of 3.77. However, the lowest sensitivity was between ABI and VHI-10 while the lowest specificity was between the laryngeal diagnosis and the ABI. AVQI and ABI presented significantly lower concurrent validity and diagnostic precision when the reference is not the auditory-perceptual judgment of voice quality. However, AVQI seems to be for some validity aspects a more reasonable classifier of vocal handicap and laryngeal alteration than ABI. Both AVQI and ABI values can broaden their range of assessment for the clinical user, thus showing more relationships between the individual voice examination methods. [ABSTRACT FROM AUTHOR]

In recent years cepstral analysis and specific cepstrum-based measures such as smoothed cepstral peak prominence (CPPS) has become increasingly researched and utilized in attempts to determine the extent of overall dysphonia in voice signals. Yet, few studies have extensively examined how specific voice-source parameters affect CPPS values. Using a range of synthesized tones, this exploratory study sought to systematically analyze the effect of fundamental frequency (f o), vibrato extent, source-spectrum tilt, and the amplitude of the voice-source fundamental on CPPS values. A series of scales were synthesised using the freeware Madde. Fundamental frequency, vibrato extent, source-spectrum tilt, and the amplitude of the voice-source fundamental were systematically and independently varied. The tones were analysed in PRAAT , and statistical analyses were conducted in SPSS. CPPS was significantly affected by both f o and source-spectrum tilt, independently. A nonlinear association was seen between vibrato extent and CPPS, where CPPS values increased from 0 to 0.6 semitones (ST), then rapidly decreased approaching 1.0 ST. No relationship was seen between the amplitude of the voice-source fundamental and CPPS. The large effect of f o should be taken into account when analyzing the voice, particularly in singing-voice research, when comparing pre and posttreatment data, and when comparing inter-subject CPPS data. [ABSTRACT FROM AUTHOR]

To investigate the prevalence of obesity in patients with dysphonia and the association between Body Mass Index (BMI) and the Voice Handicap Index-10 (VHI-10). This is a retrospective study that included 304 patients who visited the senior author's Otolaryngology practice between the years 2018 and 2020. Patients were divided into two groups, those presenting for dysphonia and those presenting for other otolaryngologic complaints (Controls). Patients were also stratified as Normal weight (BMI < 25 kg/m2) vs. Overweight (BMI between 25-30 kg/m2), vs. Obese (BMI ≥ 25 kg/m2). The VHI-10 was used as a subjective outcome measure reported by patients with dysphonia. A total of 304 patients included in this study, 203 presenting with dysphonia and 101 with other otolaryngologic complaint. Within the dysphonia group, a significantly higher percentage of patients had a BMI ≥ 25 (70.4%) as compared to the control group (57.4%). The odds ratio were 1.76, meaning that obese patients were 1.76 times more likely to present with dysphonia. There was a weak negative correlation between overweight, obesity, and VHI-10 scores (r=-0.007 and r=-0.039, respectively). There was a significantly higher prevalence of overweight and obesity in patients with dysphonia vs. patients with no dysphonia. Although there was a weak correlation between BMI and VHI, our results demonstrate that overweight and obese patients are more likely to have dysphonia. [ABSTRACT FROM AUTHOR]

To verify the efficiency of thermotherapy perceptively and acoustically with hot vapor in the treatment of acute laryngitis. This is a pre and post test quasi-experimental study without a control group, approved by the ethics committee. Its sample counted with 65 singers – 37 females (56.9%) and 28 males (43.1%), mean age 33.7 years (±7.9) years, nonsmokers, with dysphonia due to acute laryngitis. They were submitted to videolaryngostroboscopy and perceptive-acoustic assessment of the voice before and 30 minutes after applying the inhalation of hot vapor. The appropriate statistical tests were used, adopting the significance level lower than 0.05. In the acoustic assessment, there was a statistically significant improvement in jitter and shimmer for vowels A and E, P < 0.001. The F0 assessed separately per sex, as it presented a significant difference, P < 0.001. The women's F0 results before and after the heat were higher than the men's. In the analysis of the acoustic results based on harmonics-to-noise ratio and normalized noise energy, there was significant improvement after the heat. All the mean values increased after the heat. There was a statistically significant decrease in the parameters related to the perceptive-auditory assessment for G (grade of hoarseness), R (roughness), B (breathiness), and S (strain). Of the 47 singers that scored 2 for G, 28 (59.6%) reduced it to 1 after the heat, P < 0.001. All the 45 that scored 2 for R reduced it to 1, P = 0.011. Of the 8 who scored 2 for B, 6 (75%) reduced it to 1, P = 0.020. All the 28 singers that scored 1 for S reduced it to 0, P < 0.001. Only for A (asthenia), there was no significant improvement, P = 0.513. The results of the videolaryngostroboscopy revealed a statistically significant difference in all parameters analyzed, such as hyperemia, edema, muco-undulatory movement, and glottal coaptation. The thermotherapy with using humid heat, provide symptomatic benefits in the treatment of dysphonia caused by laryngitis, demonstrating that the hyperthermoterapy is a potential auxiliary therapeutic resource for the treatment of acute dysphonia due to laryngitis since the intervention with the technique proposed increased the voice quality. It is suggested that this method be used in speech-language clinical practice and that new studies be conducted with stronger designs for its efficacy to be confirmed. [ABSTRACT FROM AUTHOR]

The Coronavirus Disease 2019 (COVID-19) is an ongoing global pandemic and wearing face mask is recommended across the globe to break the transmission chain of infection. The masks available in the market are of different types and materials and tend to alter the voice characteristics of the speaker. This can therefore impair optimal communication and the present study is a systematic review exploring the effect of various masks on voice production parameters. Systematic review. The titles and abstracts screening was carried out for the inclusion of articles using eight electronic databases spanning the period from 1st January 2020 to 30th April 2021. 10 articles (8 published & 2 in pre-print) that met the inclusion criteria were considered for this systematic review and the pooled age range was 18 –69 years. Three primary studies from the USA, 2 each from Australia & Italy, one each from Brazil, China, and Germany were found to have investigated the influence of wearing N95, KN95, surgical and fabric masks on voice related measures. The users significantly reported vocal fatigue, discomfort, and also perceived voice problems. Attenuation of speech sound amplitude was highest for the transparent mask followed by cloth mask, N95, KN95, and surgical mask. The World Health Organization (WHO) has been repeatedly endorsing the need to use a face mask in the current COVID-19 pandemic. However, for an unintruded voice production, the surgical mask is recommended for everyone, including healthcare professionals when they are not in close contact with patients, and not involved in aerosol-generating procedures. For teachers, doing direct teaching (offline classes), 'surgical mask' can reduce the vocal load of teachers, smoothen the teacher-student interaction and thereby facilitate better learning by the students. Additionally, it would be useful to protect oneself from the risk of developing voice problems by following standard vocal healthcare tips. [ABSTRACT FROM AUTHOR]

A comprehensive protocol to evaluate voice quality can support a full characterisation of voice disorders and be used to plan voice interventions. The purpose of this study was to develop and validate a standardised protocol for voice assessment, contributing with a comprehensive and valuable tool for clinician practice and research. The initial structure and content of the protocol was based on an extensive literature review of existing voice assessment tools. The content validity was then assessed by a panel of voice specialist, using a modified Bland and Altman graphical method and the intraclass correlation coefficient (ICC). A group of participants with vocal pathology was finally assessed by two voice specialists on the same day (inter-rater reliability), and, on a second day, by a single evaluator (intra-rater reliability). Inter and intra-reliability were evaluated through Cohen's kappa (k) for nominal variables, and Spearman's Correlation Coefficient (ρ) for quantitative and ordinal variables. The Bland and Altman analysis, revealed a reasonable agreement between the experts and the ICC values were lower than expected, but the confidence intervals were very wide. The intra-rater reliability of the protocol's nominal variables was almost perfect, with a mean k of 0.977; inter-rater reliability of nominal variables was also almost perfect, with a mean k of 0.893. The ordinal and quantitative variables revealed a very good to excellent relationship, with a mean ρ of 0.912. Evidence of content validity, high intra and inter-rater reliability of a standardised protocol for voice assessment, have been shown. This protocol can be used to assess and collect data from patients, to train voice specialists and to develop reference voice databases. It has been designed to serve voice experts with diverse backgrounds and assessment needs. [ABSTRACT FROM AUTHOR]

To investigate the effects of auditory training with synthesized voices on intra- and inter-rater agreement of the auditory-perceptual voice analysis of roughness and breathiness. This was an experimental study consisting of four auditory training sessions. The sample consisted of twenty raters, students from a Speech-Language Pathology course, who had previous experience with auditory-perceptual assessment. The raters participated in the four training sessions with a seven-day break in between sessions. Each training consisted of three tasks: 1) Pre-training activity: Participants were asked to rate 20 natural voices, normal and dysphonic, from zero to three, according to the parameters of roughness and breathiness; 2) Training activity: Synthesized voice anchor stimuli were presented, and participants were asked to rate them from zero to three. Four stimuli were related to roughness and four to breathiness. Participants heard 20 voice stimuli and were instructed to pair the natural voice with the synthesized anchor stimulus that most resembled it; and 3) Post-training activity: the 20 voices from the pre-training activity were randomized and participants rated the same voices, without prior knowledge that these were repeated. Statistical analysis of data was performed using the AC 2 test, to assess the extent of agreement between raters, and the Friedman test to compare the training sessions. A 5% significance level was considered. For the auditory-perceptual voice analysis of roughness, intra-rater agreement results ranged from 79% to 86% between the first and fourth auditory training session, with improvement in intra-rater agreement from the fourth session forward (P = 0.005). For the analysis of breathiness, results ranged from 88% to 92% between the first and fourth auditory training sessions, with improvement from the fourth session forward (P = 0.036). Inter-rater agreement results for the auditory-perceptual analysis of roughness ranged from 23% to 34%, and from 48% to 61% for breathiness, with no differences regarding training (P = 0.855). The auditory-perceptual breathiness parameter had a higher AC 2 indicator compared to the roughness parameter, suggesting better agreement. The intra-rater agreement showed improvement starting from the fourth auditory training session for the assessment of roughness and breathiness. The auditory training program did not show a positive inter-rater agreement impact. [ABSTRACT FROM AUTHOR]

"Among the most common occupations, schooteachers are the ones who experience the most changes throughout their career. Considering this, the present study aims to verify whether dysphonia in three different degrees may compromise the speech intelligibility of schoolteachers in the classroom. Overall, 39 students, average age 10 years, randomly selected from a public school in the Federal District, Brazil (Distrito Federal, Brasil) performed a transcription task of 20 sentences spoken by four distinct female voices in a classroom, one with a control voice (normal), another with mild dysphonia, 1 with moderate dysphonia and another with severe dysphonia. None of the voices in the study presented changes, neither in fluency nor articulation nor neurological changes. The sentences were previously recorded in an acoustically treated booth, with a microphone on a pedestal 5 cm away from the speaker's mouth. For each sentence to be recorded, the speech model was provided by the speech therapist and then repeated by the speaker according to the model. Each voice recorded 5 different sentences, phonetically balanced and with equivalent number of words. The students included in the study underwent auditory, auditory processing, sequential memory for verbal sounds and sound source location tests, fulfilling the normality criteria. They also did not have neurological or motor disorders or learning, speech or language disorders. Academic success was also taken into account. For the experiment, a speaker was placed in front of the classroom, 1 m from the wall and 1 m from the floor, and students were randomly assigned to the classroom seats. After listening to each sentence, some time was assigned for its transcription by each student. The occurrence of errors was higher in voices with moderate and severe dysphonia, in which a significant difference was found (P ≤0.003) showing that voices with moderate and severe dysphonia were less intelligible than the normal voice (control voice). No difference was found between the normal voice and the mild dysphonic voice. Binary logistic regression analysis also showed that students had a 2.55 times higher chance of making mistakes with moderate dysphonic voice (P ≤0.011), and that this chance was 3.06 times greater for severe dysphonic voice (P ≤0.002) when compared to the normal voice (control voice). Conclusion: Moderate and severe dysphonia in the voices of schoolteachers interferes with the intelligibility of students, and the greater the degree of dysphonia of the teacher, the greater the chance that the student will make intelligibility errors." [ABSTRACT FROM AUTHOR]

Singing is defined as a sensory-motor phenomenon that requires particular balanced physical skills such as respiration, phonation, resonance, and articulation. The long-term average spectrum (LTAS) is widely accepted as a robust and effective tool for the assessment of voice characteristics. Eighty female singers within the age range of 18-30 year s were considered for the study. Among 80 participants, 40 were asked to perform one traditional song from Bangla Folk representing the Baul style and another 40 were asked to perform a traditional song from Rabindra Sangeet. Recordings were done and then acoustic (LTAS) analyses were done through PRAAT software. Statistical analyses were done for the analyzed data. software package of social sciences (Version 20.0) was used. The averaged LTAS curve of Baul style showed a broad peak in the frequency range between 2000 and 3600Hz and its amplitude about 16 dB, Rabindra Sangeet showed a broader peak in the frequency range between 2200 and 3800 Hz and its amplitude about 15 dB. This evidence showed the presence of singer's formants in both singing styles. It can be concluded from the present study that, there is an acoustical difference between the Bangla Folk and Rabindra Sangeet singing style which can be evidenced using LTAS through PRAAT. [ABSTRACT FROM AUTHOR]

To compare the occurrence of vocal signs and symptoms before, during, and after coronavirus disease (COVID-19) and analyze possible risk factors for the persistence of these signs and symptoms after disease resolution. This was an observational, analytical, and cross-sectional study. The participants were 45 individuals of both sexes, with a mean age of 44 years, who were previously affected by COVID-19. All participants answered a questionnaire about sociodemographic data, smoking history, disease course, vocal complaints, and the vocal signs and symptoms list (SSL), referring to three timepoints (before, during, and after COVID-19). The most commonly reported vocal signs and symptoms before COVID-19 were phlegm (26.67%; n=12) and dry throat (24.44%; n=11). During COVID-19, the most frequent vocal signs and symptoms were tired voice after short-term use (73.33%; n=33) and dry throat (71.11%; n=32). After the disease, the most reported vocal signs and symptoms were dry throat (57.78%; n=26) and phlegm (53.33; n=24). The self-perception of vocal signs and symptoms before COVID-19 was lower than that during and after COVID-19 (P < 0.001). Vocal complaints after COVID-19 and oxygen therapy were predictors of self-perception of vocal signs and symptoms after COVID-19. Individuals affected by COVID-19 had a higher frequency of vocal signs and symptoms during the disease. However, after remission, the frequency of vocal signs and symptoms was higher than that at baseline. The need for oxygen therapy may indicate a risk for a higher occurrence of vocal signs and symptoms after COVID-19. [ABSTRACT FROM AUTHOR]

Thyroidectomy is a commonly performed surgical procedure that is offered for different thyroid pathologies. The most frequent complication after total thyroidectomy is transient or permanent hypoparathyroidism followed by transient or permanent recurrent laryngeal nerve palsy. Patients may experience voice impairment despite intact laryngeal nerve function. These patients are of special interest because they experience subjective symptoms which are difficult to measure and therefore to treat. The Voice Handicap Index (VHI) and VHI-10 are the most commonly used subjective questionnaires. Their results correlate with objective findings. Female sex, in particular after menopause, is a dominant factor for developing voice impairment after thyroidectomy. The extent of neck surgery and the weight and volume of the removed thyroid correlates directly with both objective and subjective voice impairment after surgery. Videolaryngostroboscopy should be considered to examine vocal cord pathologies in this patient group. Surprisingly, there are no studies showing that speech and voice therapy are beneficial for patients with voice alterations but with intact laryngeal nerves. While recurrent laryngeal nerve (RLN) paralysis can be evaluated by objective exams postoperatively, we are still left with the issue of possible partial or complete external branch of superior laryngeal nerve (EBSLN) injury. It is therefore quite difficult to segregate neural (RLN and EBSLN) and non-neural voice change populations, regardless of the method of literature evaluation. Perhaps patients' perspectives on how they experience voice functionality should play a superior role in deciding which patients should be investigated further with laryngoscopy, acoustic or perceptual analysis, and which patients should be offered treatment. [ABSTRACT FROM AUTHOR]

The spoken language may influence the way we produce our voice. Therefore, speak more than one language could affect voice production. However, there is limited evidence on the relationship between voice production and bilingualism. To characterize the relationship between bilingualism and voice production determined by means of voice acoustic parameters and voice perception. A review of literature was performed using four computerized databases. The keywords used were voice, bilingualism, and multilingualism. Relevant data were extracted from the publications on country and year of study, participants, sample size, characterization of voice production (acoustics, perceptual), and languages. A bibliometric analysis was performed for co-occurrence analysis. Quality assessment was conducted with the EPHPP tool. A total of 10 publications met our inclusion criteria. Nine of the articles compared English productions with another language. Included studies reported changes in fundamental frequency between English and Spanish, Cantonese Chinese, Mandarin, Russian, Finnish, Arabic, Korean, Welsh, and Hebrew. The co-occurrence analysis shows that fundamental frequency is the most reported parameter, and English is the most compared language among studies including bilingual speakers. Speaking a second language influences voice production determined by voice acoustic parameters, such as fundamental frequency. Therefore, language may be an important factor to take into consideration when planning assessment and intervention programs on the field of voice. [ABSTRACT FROM AUTHOR]

Objective: to compare the self-perception of vocal fatigue and use of singing voice during the COVID-19 pandemic between professional and amateur singers and to relate this self-perception with vocal use characteristics during this period. Methodology: Participants were 121 singers divided into professional singers group (PSG) (12 men and 20 women) comprising singers who depended exclusively on singing as a profession and an amateur singers group (ASG) (37 men and 52 women) of singers who did not depend exclusively on singing for their livelihood. All answered online questionnaires through Google Forms ®. Sociodemographic and vocal characteristics were investigated before and during the pandemic; symptoms of vocal fatigue were assessed through the vocal fatigue index (VFI); and self-perception of use of singing voice through the evaluation of the ability to sing easily protocol for Brazil (EASE-Br). Results: In the comparison between groups, the PSG presented higher scores of vocal fatigue in fatigue and vocal limitation (P = 0.045), vocal restriction (P = 0.002), and recovery with vocal rest (P = 0.008) domains than did the ASG. There was no difference between the groups regarding the use of singing voice. Based on the relationship between self-perception and vocal use characteristics during the pandemic, it was observed that the presence of vocal complaint was the only factor associated with self-perception of fatigue symptomatology in both groups. Regarding the self-perception of the current status of the singing voice, singing time, the presence of vocal complaints, the need to increase visual concentration, and the perception of vocal worsening during the pandemic were considered predictive for amateur singers. For professional singers, vocal complaints and vocal training were predictors for self-perception of the current status of the singing voice. Conclusion: Professional singers presented with higher scores of vocal fatigue than did amateur singers. The symptomatology of vocal fatigue was associated with the presence of vocal complaints in both groups. However, self-perception of the current status of the singing voice was different between the groups and was associated with vocal training for professional singers and characteristics of vocal demand of singing voice during the pandemic period for amateur singers. [ABSTRACT FROM AUTHOR]

To analyze whether voice acoustic parameters are discriminant and predictive in patients with and without depression. Observational case-control study. The following instruments were administered to the participants: Self-Reporting Questionnaire (SRQ-20), Beck Depression Inventory-Second Edition (BDI-II), Voice Symptom Scale (VoiSS) and voice collection for subsequent extraction of the following acoustic parameters: mean, mode and standard deviation (SD) of the fundamental frequency (F0); jitter; shimmer; glottal to noise excitation ratio (GNE); cepstral peak prominence-smoothed (CPPS); and spectral tilt. A total of 144 individuals participated in the study: 54 patients diagnosed with depression (case group) and 90 without a diagnosis of depression (control group). The means of the acoustic parameters showed differences between the groups: F0 (SD), jitter, and shimmer values were high, while values for GNE, CPPS and spectral tilt were lower in the case group than in the control group. There was a significant association between BDI-II and jitter, shimmer, CPPS, and spectral tilt and between CPPS and the class of antidepressants used. The multiple linear regression model showed that jitter and CPPS were predictors of depression, as measured by the BDI-II. Acoustic parameters were able to discriminate between patients with and without depression and were associated with BDI-II scores. The class of antidepressants used was associated with CPPS, and the jitter and CPPS parameters were able to predict the presence of depression, as measured by the BDI-II clinical score. [ABSTRACT FROM AUTHOR]

To analyze and compare cepstral measurements in singing and non-singing men and women to understand if vocal adaptations of singers reflect greater cepstral measurement results. The study included 91 vocally healthy individuals, consisting of 60 erudite or popular singers (30 males, 30 females) and 31 non-singers (16 males, 15 females). The Cepstral Peak Prominence (CPP) and Cepstral Peak Prominence-Smoothed (CPPS) measures were carried out using the sustained /a/ vowel recorded with a unidirectional condenser microphone associated with a sound card on the computer. The Praat software (version 6.1.16) was used to extract the CPP and CPPS measurements. The intra and intergroup values obtained for each sex were compared using the t-test with a 5% significance level. There was a CPP (P = 0,000) and CPPS (P = 0,000 and P = 0,001) value difference between the sexes in both groups. Cepstral measurements showed no statistically significant difference between singing and non-singing participants (male: P = 0,778 and P = 0,622; female: P = 0,622 and P = 0,460). Men presented higher CPP and CPPS values than women, which may be related to the presence of the physiological posterior glottic cleft in women. The knowledge of the cepstral values of singers shows that singing specificities may not reflect in all vocal evaluations. [ABSTRACT FROM AUTHOR]

Military drill instructors have extreme vocal demands that place them at risk for phonotrauma. Characterization of laryngeal pathology and vibratory characteristics among drill instructors presenting for specialized voice care is lacking. A retrospective review in a specialized voice clinic over a two-year period was conducted. Patients identified as current drill instructors between the ages of 28-43 with a diagnosis of dysphonia were included. Laryngeal pathology was diagnosed by a fellowship trained laryngologist and vibratory characteristics were evaluated utilizing the Voice-Vibratory Assessment with Laryngeal Imaging (VALI) rating form. All patients were also evaluated by a speech-language pathologist. Patient reported outcome measures were collected along with perceptual voice evaluations utilizing the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V). Twelve current drill instructors were identified, and all had phonotraumatic lesions. Lesions were categorized as vocal fold hemorrhage (8%), ectasia (25%), unilateral epithelial thickening (33.3%), bilateral epithelial thickening (58.3%), ventricular cyst (8%), polyp (25%), and sulcus vocalis (25%). Vibratory abnormalities were assessed with the VALI rating scale and correlated to CAPE-V perceptual ratings with 83% having reduced mucosal wave, 75% reduced amplitude of lateral excursion, 50% aperiodic vibrations, 50% asymmetric or chasing wave, 58% glottal insufficiency, 100% supraglottic hyperfunction, and an average CAPE-V overall severity of 50% with severe perceptual dysphonia. The average Voice Handicap Index (VHI-10) and Reflux Symptom Index (RSI) score was 15.5 and 14.7, respectively. Phonotraumatic lesions were universally present in drill instructors complaining of hoarseness, suggesting early referral, and intervention may be warranted in this population. 4 [ABSTRACT FROM AUTHOR]

Speaking a second language influences jitter and shimmer when comparing monolingual English speakers with bilingual English-Spanish speakers. However, there is little information about differences on voice acoustic parameters when comparing monolingual Spanish speakers with bilingual Spanish-English speakers during their productions in Spanish. Determine differences in five voice acoustic parameters commonly used in voice assessments (fundamental frequency, jitter, shimmer, Harmonics-to-Noise Ratio and Cepstral Peak Prominence Smoothed) which may be influenced by bilingualism. Exploratory cross-sectional study with two groups of female participants: monolingual Spanish speakers (n = 17), and bilingual Spanish-English speakers (n = 11). Participants filled out a questionnaire and recorded two voice samples (sustained vowel /a/ and reading). For this study, all the participants reported that their native language was Spanish. Being a female bilingual speaker had a significant effect on Shimmer (%) with a Beta = -0.7. Similar tendency was found on harmonics-to-noise ratio (B = 0.2) and cepstral peak prominence smoothed (B = 0.2). Our results indicate that being a native Spanish female speaker, speaking English as a second language, has significant small effects on voice acoustic parameters, such as shimmer, harmonics-to-noise ratio and cepstral peak prominence smoothed, during their productions in Spanish. This information is of interest for assessment and intervention plans of bilingual speakers at clinical and work-related settings. [ABSTRACT FROM AUTHOR]

Neuromuscular electrical stimulation (NMES) offers a potential adjuvant to traditional voice therapy for individuals with dysphonia. The type of vocal task to implement in conjunction with electrical stimulation to achieve maximal therapeutic benefit is unknown. The purpose of this study was to elucidate the impact of tasks on voice outcomes. Nineteen vocally-healthy adult females, between 23 and 27 years of age (Ave: 23.8, SD: 1.13), participated in the study. 15 participants completed all three 30-minute sessions, and four completed at least one session. NMES was paired with three different voice conditions: high-pitched hum, low-pitched hum, and comfortable-pitched hum. Acoustic (average fundamental frequency and loudness; perturbation (jitter, shimmer, noise to harmonic ratio); Cepstral Spectral Index of Dysphonia; pitch range), perceived phonatory effort, and discomfort (delayed onset muscle soreness) measures were compared across conditions. Eight participants experienced discomfort following NMES. Three participants withdrew from the study due to discomfort, and one withdrew due to an unrelated oral surgery. NMES paired with high-pitch humming resulted in increased average fundamental frequency during sustained phonation and reading tasks, and increased Cepstral Spectral Index of Dysphonia during sustained phonation. Low-pitch humming resulted in a decreased noise to harmonic ratio. No statistically significant changes in perceived phonatory effort were noted. Almost half of the participants reported temporary discomfort. Task-specific differences in some outcomes were noted indicating that the nature of voice task performed with NMES must be considered when examining the impact of NMES on voice. Vocal tasks can impact discomfort and acoustic vocal outcomes of NMES. [ABSTRACT FROM AUTHOR]

Voice production is a complex process involving the coordination of various anatomical structures and physiologic systems. The Voice Range Profile (VRP) is an established acoustic measure for evaluating voice production that examines minimum and maximum intensity across the frequency range. This pilot study sought to establish a consistent, efficient, and accessible VRP elicitation method. One primary research question was addressed: Does the proposed Short method provide at least as much information as a full, discrete-steps method, which is generally accepted in the literature? In this quasi-repeated measures design, twenty-four singers completed a full VRP based on accepted methods from the literature, and the same participants returned within one to three weeks to complete the proposed Short VRP protocol. The full VRP consisted of steady state productions at every semitone within a participant's range for both minimum and maximum intensities. The Short VRP consisted of steady state productions at every octave and perfect fifth across the semitone range for both minimum and maximum intensities. Additional sampling was completed between points when a 7 dB or greater difference was found between consecutive points. Analysis compared each protocol's average elicitation time differences, average semitone range differences, visual examination of the average VRP graph, and examination of average intensity differences between protocols at specific semitone points. Male and female results were analyzed separately. The proposed Short protocol produced similar or better intensity ranges when compared with the accepted full elicitation method. The Short protocol produced intensities with 95% or greater similarity to the Full Protocol for male maximum intensity curve, female minimum intensity curve, and female maximum intensity curve. When compared with a Full VRP, a Short VRP protocol appears to generate similar minimum and maximum intensity curves allowing for a time-efficient substitute. [ABSTRACT FROM AUTHOR]

Linear acoustic indices are significantly influenced by speaking voice intensity. The main aim of this work was to compare acoustic measures based on linear and nonlinear models in different speaking voice intensity levels and to analyze the reliability of those measures in different intensity levels in subjects with voice disorders. 435 samples from subjects (314 women, 121 men with a mean age of 41.07 ± 13.73) diagnosed with various voice disorders were used. In total, 17 acoustic measures were derived from the vowel /ɛ/ sustained at three intensity levels (soft, comfortable, and loud). Five were linear (standard deviation of the fundamental frequency (f0), jitter, shimmer, harmonics-to-noise ratio (HNR) and smoothed cepstral peak prominence (CPPS)), and twelve were nonlinear measures, namely correlation dimension (D2), correlation entropy (H2), first minimum of the mutual information function (FMMI), relative entropy (ENTR-R), largest Lyapunov exponent (Lyap), determinism (DET), transitivity, mean diagonal line length (L med), Shannon entropy (ENTR-S), mean length of vertical structures, also known as trapping time (TT), laminarity (LAM) and recurrence period density entropy (RPDE). Differences between speaking voice intensity levels were assessed by Friedman's test and Nemenyi as posthoc test. Intraclass correlation coefficient was used to investigate if each acoustic measure remains in agreement (reliability) between different voice intensity levels. There were significant differences in all acoustic measures about vocal intensity level (P < 0.001). Intraclass correlation coefficient was very good for HNR (>0.61) and good for Lyap, DET, ENTR-S, L med , RPDE, and TT (0.41-0.60). All acoustic measures varied as a function of vocal intensity in voice disordered adults, while this relation was different for linear and nonlinear measures. Only the measures HNR, Lyap, DET, ENTR-S, L med , RPDE and TT had an acceptable reliability between different voice intensity levels. Therefore, patient's voice SPL should be controlled or indicated during acoustic vocal assessment. [ABSTRACT FROM AUTHOR]

Dysphonia has been described in patients affected by coronavirus disease 2019 (COVID-19). The aim of this study was to evaluate the prevalence of dysphonia, and its severity and extent, of voice fatigue and of dysphagia in non hospitalized patients affected by COVID-19 in Lombardy, the Italian region most hit by the first explosive outbreak of COVID-19 in Europe. Demographic and clinical data of 160 consecutive patients, with COVID-19 diagnosis confirmed by nasal swabs processed by reverse transcription polymerase chain reaction, were gathered by means of telephone interviews performed by physicians in charge of daily follow-up. General and specific symptoms concerning voice and swallowing impairment were investigated. Dysphonia grade and duration were graded on 4-point scales, while voice fatigue was graded on a 5-point scale. Dysphonia was reported by 70 (43.7%) patients and was positively associated with voice fatigue (P < 0.001), cough (P = 0.005), rhinitis (P = 0.01), and dyspnea (P = 0.06); it was mild and/or moderate in 69 patients, but its duration was > 2 weeks in 33/70 (47.1%) patients and >1 month in 11/70 (15.7%). Grade and duration of dysphonia were positively associated with cough and rhinitis (all P values < 0.01). Voice fatigue was reported by 43/160 patients (26.8%) and its severity was correlated with dysphonia (P < 0.0001), cough (P = 0.02), rhinitis (P = 0.02), dyspnea (P < 0.001), and loss of appetite (P = 0.01). Dysphagia was encountered in 27/160 patients (16.9%) and was associated with dysgeusia, cough, arthralgia, myalgia and loss of appetite but not with dysphonia. Dysphonia was a highly prevalent and long-lasting symptom in this series; it has been underestimated to date. Further studies might shed light on the pathophysiology of voice disorders in COVID-19 patients. [ABSTRACT FROM AUTHOR]

To evaluate vocal symptoms, voice characteristics and videolaryngoscopy in obese women before and after bariatric surgery. Obese patients (18 to 59 years old), candidates for bariatric surgery were recruited. Evaluation times: T1 (preoperative), T2 (after six months), T3 (after 12 months). Evaluated parameters: weight, height, body mass index, abdominal and neck circumference, vocal self-assessment, perceptual and acoustic vocal assessment, and videolaryngoscopy. A total of 37 obese women were included, average age 40.8 years. There was a decrease in anthropometric measurements between the preoperative assessment and after 12 months: weight (121.18 ± 15.4 kg; 77.1 ± 11.6 kg), BMI (46.6 ± 6.95 kg/m2; 30 ± kg/m2), abdominal circumference (128 ± 16.1; 99.1 ± 12.1), and neck circumference (41.1 ± 5.85; 36.6 ± 3.02). Gastroesophageal (21.6%) and vocal symptoms (27%) prevailed. No difference was identified in vocal self-assessment between the evaluations. In the acoustic analysis, f0 increased and the soft phonation index decreased. The perceptual analysis registered lower scores for the degree of dysphonia (G) and voice instability (I). The maximum phonation time values increased without changing the s/z ratio. Videolaryngoscopies showed a posterior middle cleft and improvement in the signs of reflux. Bariatric surgery led to an important and gradual decrease in anthropometric parameters. The voice became less hoarse, with higher pitch and more stable, with an improvement in maximum phonation time, however with slight breathiness. Such changes were not noticed by the patients. [ABSTRACT FROM AUTHOR]

To determine the prevalence of separate and combined voice and swallowing impairments before and after total thyroidectomy and to delineate risk factors for these symptoms. Retrospective review of 592 consecutive patients who underwent total thyroidectomy from July 2003 to August 2015. Combined voice and swallowing problems occurred preoperatively in 4.7% (11/234), 3.3% (3/92), and 6.0% (16/266) of patients with malignancy, hyperthyroidism, and benign euthyroid disease, respectively. Postoperatively, prevalence was 5.1%, 2.2%, and 1.9%, respectively. Benign euthyroid disease (20.7%) had the greatest risk of preoperative dysphagia (P = 0.003) and the largest glands (P < 0.001). Comparing before and after surgery, the cancer and benign euthyroid groups had decreased dysphagia (cancer: 11.5% vs. 6.0%, P = 0.034; benign: 20.7% vs. 3.8%, P < 0.001) but increased dysphonia (cancer: 19.2% vs. 28.6%, P = 0.017; benign: 15.8% vs. 27.1%, P = 0.002). Overall, 23/592 (3.9%) developed new dysphagia and 122/592 (20.6%) developed new dysphonia after surgery. Intraoperative recurrent laryngeal nerve transection occurred in 12 cases (2.0%). Total thyroidectomy resolved dysphagia but increased dysphonia in benign and malignant euthyroid patients. Voice and swallowing problems following thyroidectomy occurred more frequently than intraoperative recurrent laryngeal nerve transection, confirming symptoms often occur in the absence of suspected nerve injury. [ABSTRACT FROM AUTHOR]

The most common etiologies of dysphonia in the pediatric population are vocal fold nodules and muscle tension dysphonia. Vocal therapy is the first line treatment for these disorders in children. Despite this, not all children undergo therapy. The goal of this study is to examine how factors such as patient demographics and parental perceptions differ between children that choose to undergo or not to undergo voice therapy. A retrospective review was conducted of all pediatric patients seen at a tertiary voice clinic between January 2014 and December 2017. Patients were included if diagnosed with vocal fold nodules and/or muscle tension dysphonia. Patients were divided into groups of children that received voice therapy at our institution and those that did not. Data include demographics, Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) scores and pediatric Voice Handicap Index (pVHI) scores. Distance to therapy site was approximated using patient zip codes. Three hundred and forty-six children were included, 224 (65%) boys and 122 (35%) girls. In the 2 years following initial diagnosis, 74 (21%) children participated in voice therapy at our institution. Patients who underwent voice therapy were older than those who did not (mean age: 9.1 [SD 3.5] vs 7.6 [SD 3.8] years; P = 0.004). Patients who received voice therapy were more likely to live closer to the therapy site (mean distance: 15.5 [SD 13.0] vs 24.3 [SD 23.9] miles; P < 0.001). Likelihood of receiving voice therapy did not differ by gender or health insurance status (private vs public). Patients who underwent voice therapy had significantly greater CAPE-V Overall Severity scores than those who did not (mean score: 44.6 [SD 19.4] vs 37.4 [SD 18.0]; P = 0.003). Higher CAPE-V Strain scores were associated with increased likelihood of voice therapy. pVHI scores did not differ between the two groups. Older age, shorter distance to therapy site, and increased CAPE-V Overall Severity and Strain scores were associated with higher likelihood of receiving voice therapy. Gender, insurance status, and pVHI scores did not affect likelihood of receiving voice therapy. Patients may primarily consider ease of access and necessity of treatment when considering voice therapy. [ABSTRACT FROM AUTHOR]

This study aimed to analyze the effects of microphone and audio compression variables on voice and speech parameters acquisition. Acoustic measures were recorded and compared using a high-quality reference microphone and three testing microphones. The tested microphones displayed differences in specifications and acoustic properties. Furthermore, the impact of the audio compression was assessed by resampling the original uncompressed audio files into the MPEG-1/2 Audio Layer 3 (mp3) format at three different compression rates (128 kbps, 64 kbps, 32 kbps). Eight speakers were recruited in each recording session and asked to produce four sustained vowels: two [a] segments and two [ɛ] segments. The audio was captured simultaneously by the reference and tested microphones. The recordings were synchronized and analyzed using the Praat software. From a set of eight acoustic parameters assessed (f 0 , F1, F2, jitter%, shimmer%, HNR, H1-H2, and CPP), three (f 0 , F2, and jitter%) were suggested as resistant regarding the microphone and audio compression variables. In contrast, some parameters seemed to be significantly affected by both factors: HNR, H1-H2, and CPP; while shimmer% was found sensitive only concerning the latter factor. Moreover, higher compression rates appeared to yield more frequent acoustic distortions than lower rates. Overall, the outcomes suggest that acoustic parameters are influenced by both the microphone selection and the audio compression usage, which may reflect the practical implications of these components on the acoustic analysis reliability. [ABSTRACT FROM AUTHOR]

The vocal tract discomfort scale is a self-rating seven-point Likert scale that quantifies frequency and severity of eight qualitative descriptors including burning, tight, dry, aching, tickling, sore, irritable, and lump in the throat, and ranges from 0 (never/none) to 6 (always/extreme; Mathieson et al. 2009). The objectives of the current study were to compare the vocal tract discomfort scale results between elementary school teachers and high school teachers and between male and female teachers using the Persian vocal tract discomfort scale. Also, teachers in different age ranges and with different experiences were compared regarding vocal tract discomfort symptoms. The researchers chose 20 elementary and high schools by simple random sampling in Khorramabad, Iran. The survey was given to available teachers of the selected schools. Considering the inclusion criteria, required sample size, and after excluding questionnaires that were not correctly answered, 120 were selected such that 30 were chosen for each subgroup. Subjects consisted of 60 elementary school teachers (30 females and 30 males) with the mean age of 40.92 years (standard deviation = 6.07) and 60 high school teachers (30 females and 30 males) with the mean age of 40.67 years (standard deviation = 6.00). SPSS 25 was used for analyzing the data. Results indicated that the frequency and severity of the vocal tract discomfort in elementary school teachers were significantly higher than for the high school teachers with a medium to large effect size. Although the frequency and severity of the symptoms were higher in female compared with male teachers, those differences were not significantly different. Younger teachers had lower frequency and severity ratings of vocal tract discomfort symptoms than older teachers. Teaching experience was not an important factor in predicting vocal tract discomfort symptoms in teachers. The results of this study suggest that there is higher frequency, greater severity, and higher percentages of vocal tract discomfort symptoms in elementary compared with high school teachers. In addition, although the mean frequency and severity of vocal tract discomfort symptoms were not significantly different between females and males, females reported higher percentages of the symptoms. Because each of the eight vocal tract symptoms was experienced at the time of testing by between 42% (tightness) and 68% (dryness) of the participants, it is suggested that an educational program regarding vocal tract discomfort may be helpful for this profession. [ABSTRACT FROM AUTHOR]

The voice is an important marker of the transition process to the new gender identity of the transgender person. For 20% of patients seeking voice feminization, voice therapy is not completely satisfactory, and surgery should be considered, with endoscopic glottoplasty being the current practice. While the increase in fundamental frequency (F0) after glottoplasty has been well described, no systematic review of the literature or meta-analysis regarding other acoustic parameters and quality of voice has been performed yet. To define the effect of endoscopic glottoplasty on acoustic measures and quality of voice by assessing F0, maximum phonation time (MPT), frequency range, and grade of dysphonia. A literature review was performed in Medline/PubMed, Cochrane, Science Direct, LILACS, and Google Scholar, following PRISMA guidelines, with no constraints on publication date. We included studies in English, Portuguese or Spanish that assessed transgender women who underwent endoscopic glottoplasty. All the included articles were measured in terms of their methodological quality. The PRISMA approach yielded 14 studies, totaling 566 patients. There was significant heterogeneity between studies regarding follow-up time, surgical technique and perioperative care. Thirteen studies were submitted to meta-analysis. The results showed significant changes in pre- to postglottoplasty mean differences of F0 = 78.49 Hz (95%CI: 75.69–81.30), MPT = −1.11 seconds (95%CI −1.67 to −0.54), frequency range = −3.55 semitones (95%CI −5.74 to −1.36) and grade of dysphonia on the GRBAS scale = 0.44 (95%CI 0.27–0.61). Glottoplasty is effective in significantly increasing fundamental frequency, but slightly decreases MPT, frequency range and vocal quality measured by the grade of dysphonia on the GRBAS scale. [ABSTRACT FROM AUTHOR]

Singers undergoing tonsillectomy are understandably concerned about possible sequelae to their voice. The surgical risks of laryngeal damage from intubation and upper airway scarring are valid reasons for singers to carefully consider their options for treatment of tonsil-related symptoms. No prior studies have statistically assessed objective voice outcomes in a group of adult singers undergoing tonsillectomy. This study determined the impact of tonsillectomy on the adult singing voice by determining if there were statistically significant changes in preoperative versus postoperative acoustic, aerodynamic, and Voice-Related Quality of Life (VRQOL) measures. Prospective cohort study. Tertiary Referral Academic Hospital Thirty singers undergoing tonsillectomy from 2012 to 2019. Acoustic recordings were obtained with Computerized Speech Lab (CSL) (Pentax CSL 4500) and analyzed with the Multidimensional Voice Program (MDVP) (Pentax MDVP) and Pratt Acoustic Analysis Software. Estimates of aerodynamic vocal efficiency were obtained and analyzed using the Phonatory Aerodynamic System (Pentax PAS 6600). Preoperative VRQOL scores were recorded, and singers were instructed to refrain from singing for 3 weeks following tonsillectomy. Repeat acoustic and aerodynamic measures as well as VRQOL scores were obtained at the first postoperative visit. Average postoperative acoustic (jitter, shimmer, HNR) and aerodynamic (sound pressure level divided by subglottal pressure) parameters related to laryngeal phonatory function did not differ significantly from preoperative measures. The only statistically significant change in postoperative measures of resonance was a decrease in the 3rd formant (F3) for the /a/ vowel. Average postoperative VRQOL scores (79.8, SD18.7) improved significantly from preoperative VRQOL scores (89, SD12.2) (P = 0.007). Tonsillectomy does not appear to alter laryngeal voice production in adult singers as measured by standard acoustic and aerodynamic parameters. The observed decrease in F3 for the /a/ vowel is hypothetically related to increasing the pharyngeal cross-sectional area by removing tonsillar tissue, but this would not be expected to appreciably impact the perceptual characteristics of the vowel. Singers' self-assessment (VRQOL) improved after tonsillectomy. [ABSTRACT FROM AUTHOR]

Gender affirming voice training is a service provided by speech language pathologists to members of the trans and gender diverse community. While there is some evidence to support the effectiveness of this training, the evidence base is limited by a lack of prospective studies with large sample sizes. Finally, there has been only limited research investigating the effectiveness of this training when delivered on intensive (compressed) schedules, even though such schedules are used in clinical practice and may have practical benefits such as increasing service access for this vulnerable population. This study aimed to investigate and compare the effectiveness gender affirming voice training among 34 trans individuals presumed male at birth aiming to develop a perceptually feminine/female-sounding voice. Among these 34 participants, 17 received their training on a traditional schedule (one 45-minute session per week over 12 weeks) and 17 on an intensive scheduled (three 45-minute sessions per week over 4 weeks). Building on a previous mixed methodological study which indicated that these two training groups were equally satisfied with training outcomes, the current study utilised a wide range of self-report, acoustic, and auditory-perceptual outcome measures (including self-ratings and listener-ratings of voice) to investigate training effectiveness. Results from this study indicated that both training programs were similarly effective, producing positive statistically significant change among participants on a range of outcome measures. Participants in both groups demonstrated significant auditory-perceptual and acoustic voice change and reported increased satisfaction with voice, increased congruence between gender identity and expression, and a reduction in the negative impact of voice concerns on everyday life. However, as has been the case in past studies, training was not sufficient for all participants to achieve their goal of developing a consistently feminine/female-sounding voice. This study provides evidence to suggest that gender affirming voice training for transfeminine clients may be similarly effective whether delivered intensively or traditionally. This study provides evidence to support the practice of using a wide range of outcome measures to gain holistic insight into client progress in gender affirming voice training programs. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the factors that influence the perception of one's own voice, and if there are any differences using voice between speaking and singing. Further the study purported to examine how these attitudes affect individuals' vocal behavior in personal and social contexts. A total of 100 participants completed the survey which comprised 23 questions about demographics, music experience, speaking voice, and singing voice. The quantitative data were analyzed by correlations and paired t test. For qualitative analyses, content analysis was conducted. The results revealed an even distribution among negative, neutral, and positive attitudes regarding singing and speaking voices and their effects on vocal behavior. For their negative/positive perceptions of their voices, participants referenced factors related to vocal attributes, personal features, social or external validation, emotional quality of the voice, etc. Lastly, result showed that one's perception of the speaking voice has some influence on behaviors ranging from the personal (expressing oneself) to social (interacting with people) aspects. The findings of this study implies that one's attitude toward one's own voice substantially impacts one's personal, interpersonal and social-presentation. [ABSTRACT FROM AUTHOR]

Negative psychological factors such as depression and other common mental disorders have been found to be associated with voice problems in teachers. However, there is little research with teachers that investigates the relationship between positive psychological factors such as wellbeing and voice problems. Although negative and positive mental states are on a continuum of psychological health, research suggests negative and positive effects are not necessarily inversely correlated and therefore need to be investigated separately. To explore the relationship between voice symptoms and wellbeing in teachers working in primary and secondary schools in England. We hypothesise that as wellbeing increases voice symptoms will decrease. Cross sectional study using a self-administered web-based questionnaire conducted with primary and secondary school teachers in England. The study included 1205 teachers from 608 primary and secondary schools, including state and fee paying, and mainstream and special schools. Voice symptoms were measured using The Voice Symptom Scale and wellbeing was measured using the Warwick Edinburgh Mental Wellbeing Scale. Information was also obtained on health, lifestyle, sociodemographic and environmental factors. Analysis was conducted using a linear multi-level regression model. A statistically significant relationship between voice symptoms and wellbeing was identified (-0.31 95% CI -0.41, -0.20 P =< 0.001). Other factors found to be statistically significantly associated with voice symptoms were age, sex, gastroesophageal reflux, class size, background noise, speaking louder than normal and respiratory infection. Hours teaching per week, deprivation of school, voice training, teaching subject, smoking status and asthma were not associated with voice symptoms. This study suggests that there is an association between vocal symptoms and wellbeing. Teachers with higher wellbeing had fewer voice symptoms. [ABSTRACT FROM AUTHOR]

The aging voice index (AVI) is a 23-item self-administered, patient-reported outcome measure. It was developed in the English language to assess the impact of voice disorders on the elderly population. This study aimed to develop an Arabic version of the AVI (A-AVI), test its reliability and validity, and assess its psychometric aspects in Arabic-speaking elderly persons with voice disorders. This was an observational, cross-sectional study involving elderly patients aged ≥60 years. Eighty-two patients with voice disorders were included in the dysphonia group and 77 patients without voice disorders were included in the vocally healthy group. The translated A-AVI and Arabic voice handicap index 10 (A-VHI10) were distributed to the study groups. The A-AVI was tested for its reliability (test-retest reliability and internal consistency) and validity (content, construct, and concurrent with A-VHI10). The A-AVI showed excellent test-retest reliability and internal consistency (intraclass correlation coefficient = 0.987 and Cronbach's alpha = 0.954, respectively). There was a significant difference in A-AVI scores between the elderly in the dysphonia and vocally healthy groups (P < 0.001). In addition, a significant correlation was demonstrated between A-AVI and A-VHI10 (r = 0.89). Unilateral vocal fold immobility and inflammatory laryngeal disorders were most frequently reported by the dysphonia group (28%). A-AVI has excellent validity and reliability in Arab-speaking elderly patients with voice disorders. It can be considered in the assessment of the effect of voice disorders on the quality of life of the elderly. [ABSTRACT FROM AUTHOR]

To analyze sense of coherence (SOC) of dysphonic individuals considering the type and degree of dysphonia, coping strategies, and sociodemographic variables. This cross-sectional study was performed with 50 dysphonic individuals under follow-up at a Brazilian Speech-Language Pathology Clinic. They answered a questionnaire with sociodemographic information, the PEED-10 (Brazilian Voice Disability Coping Questionnaire) and the Brazilian version of Sense of Coherence scale. The SOC was categorized as high or low using Cluster analysis. After descriptive analysis, data were analyzed through both the bivariate and multivariate logistic regression model method and the Spearman's correlation test (P < 0.05). Most individuals presented a high SOC (60%). Individuals with mild dysphonia were 7.00 times more likely to present high SOC (95% CI = 1.24-39.38). Individuals between 45 and 70 years old were 5.03 times more likely to present high SOC (95% CI = 1.25-20.28). In addition, the higher SOC, as well as the scores of manageability domain, the lower the use of strategies focused on emotion. Patients with mild dysphonia are more likely to have a high SOC. The same goes for individuals over the fourth decade of life. Also, the greater the SOC, the fewer emotional strategies are used to cope with dysphonia. [ABSTRACT FROM AUTHOR]

Impaired respiratory function could potentially explain why some older speakers experience voice-related handicap whereas others do not, despite presenting with similar age-related laryngeal characteristics. The objectives of this study were therefore to (1) describe voice and respiratory function across men and women in a sample of treatment-seeking patients with presbyphonia; (2) assess how respiratory function differed from the general elderly population, based on normative data; and 3) discuss how respiratory function may play a role in the development of voice symptoms across men and women. Twenty one participants with presbyphonia underwent respiratory assessments (spirometry and respiratory muscle strength testing) in addition to standard of care voice assessments. Respiratory variables included forced vital capacity (FVC), forced expiratory volume in one second (FEV 1), FEV 1 /FVC, maximum inspiratory pressure (MIP), and maximum expiratory pressure (MEP). Voice features were consistent with the diagnosis of presbyphonia and values did not different significantly between males and females, although some trends were noted. Regarding respiratory variables, one-third of the participants (n = 7) presented with FVC and FEV 1 less than 80% of predicted, and 57% (n = 12) were <90% of predicted. Nine percent of the males (n = 1) and none of the females had a MIP below the lower limit of normal (LLN) expected for their age, sex, and weight. Eighteen percent of the males (n = 2) and 20% of the females (n = 2) fell below the LLN for MEP. Our sample of participants with presbyphonia included a non-negligible proportion of patients with decreased percent predicted values of FVC and FEV 1 , and with respiratory muscle strength (MEP) below the LLN. Standardized values of pulmonary function were not different across sexes, indicative of a similar respiratory health. However, a lower raw pulmonary function and respiratory muscle strength in women may compound laryngeal changes and have an impact on perceived voice-related handicap. Together, findings warrant further studies to explore the impact of decreased respiratory function on voice and, ultimately, on the response to voice therapy in patients with presbyphonia. [ABSTRACT FROM AUTHOR]

Performing vocal warm-ups prior to singing repertoire has been shown to change the perceived quality and acoustic parameters of the voice. To date, there are no studies that specifically compare singers' and listeners' perceptions of vocal quality after various warm-up durations. To determine if specific warm-up durations (0, 5, 10, or 15 minutes) change subjective and objective measures of voice. Prospective cohort study. Information related to demographics, singing practice, medical history, and vocal hygiene were collected. First- and second-year collegiate classical voice majors completed a series of four warm-up times, 1 week apart, prior to singing Caro mio ben in a standard key for their voice type. A modified Voice Range Profile (mVRP), and the Evaluation of the Ability to Sing Easily (EASE) scale were completed. Participants blindly rated 30-second recorded audio clips using the Auditory-Perceptual Rating Instrument for Operatic Singing. Four independent expert blinded listeners rated all audio clips for each participant in random order. Six first-year and three second-year classical vocal performance majors completed all measures. Results of the EASE scale showed decreased scores with 5- and 10-minute warm-up duration, compared to 0 and 15 minutes of warm-up (P = 0.029 for the total EASE score and P = 0.044 for Rasch score). Delayed perceptual analysis of voice yielded nearly equal medians between warm-up durations for both self and expert-listener ratings. The mVRP showed that both 5 and 10 minutes of warm-up duration led to increased highest fundamental frequency for females (P = 0.017). This pilot study demonstrates the immediate self-perceived benefit for all participants and increased frequency range for females after performing 5 and 10 minutes of vocal warm-up. No significant differences were found in delayed perceptual analyses completed by the participants or the expert raters after the different warm-up durations. Future investigations should include a larger population and different levels of education and genres of singing. [ABSTRACT FROM AUTHOR]

To clarify the relationship between voice and respiratory function, and to understand the role for airflow measures in the evaluation of voice patients. Literature searches of MEDLINE (Ovid) and Web of Science were performed on April 6, 2020, to include articles written in English that both discussed voice in relation to lower respiratory function and reported evaluation of airflow. Search strategies included the keywords voice, respiratory, airflow , and aerodynamic measures. Data were extracted from articles that met inclusion criteria. Twenty studies were included for review. Fourteen (70%) studies evaluated at least 1 spirometric respiratory measure, including Forced Vital Capacity, Forced Expiratory Volume in 1 second, and Forced Expiratory Flow. Other measures assessed included mean flow rate, mean peak airflow, phonatory airflow, inspiratory airflow, expiratory airflow, and phonation quotient. Notably, four studies which included pulmonary function tests (PFTs) as part of voice evaluation discovered previously undiagnosed respiratory disease in their study populations. This review confirms that respiratory function contributes significantly to voice and reveals that few studies have explored the role for airflow measures in clarifying this relationship. Including airflow measures such as PFTs in standard voice evaluation may allow recognition of underlying respiratory disease contributing to voice dysfunction. Further research is recommended to establish indications and diagnostic criteria for the use of PFTs in voice patients. [ABSTRACT FROM AUTHOR]

Maximum phonation time (MPT) is a test to measure glottic efficiency for laryngeal pathology screening and treatment monitoring. The normative value of MPT for South East Asia population has yet to be reported. It is postulated that MPT may be affected by body mass index (BMI) despite the paucity of evidence. Therefore, this study was designed to establish the normative value of MPT for a South East Asia population and investigate its relation to BMI. This cross-sectional study was conducted in Universiti Kebangsaan Malaysia Medical Center between May and September 2017. Three hundred males and females with mean age of 30.23 (±11.04) years were recruited in equal number for each gender (n = 150) and divided into 3 groups of 50 according to their BMI (n = 50). The three groups are non-obese (BMI≤22.9kg/m2); obese (BMI between 23 and 34.9 kg/m2); and morbidly obese (BMI >35kg/m2). BMI and Voice Handicap Index-10 (VHI-10) were obtained. The average of three readings of MPT was measured using a stopwatch while the participants phonate /a/, /i/ and /u/. Unpaired t- test and ANOVA were used to compare means between and across groups. Spearman correlation assessed the correlation between MPT and BMI. The normative values of MPT of both genders and correlation with BMI were analyzed. The MPT normative values for males and females in the non-obese group were of 21.41 (±6.85) seconds and 18.05 (±5.06)seconds respectively for /a/. The MPT for all vowels were significantly higher in males across the BMI groups (P ≤ 0.05). There was low negative correlation between MPT and BMI in both genders. This pioneering study documented the normative values of MPT among Malaysians showed that males had longer MPT than females across the BMI groups. Obesity affects the MPT in that as BMI increases, the MPT decreases. [ABSTRACT FROM AUTHOR]

in order to contribute of the collective actions of the teacher's vocal health, the specific goal was to build a guide gathering the appliable didactic content in these actions. That being, the stages performed in the instrument elaboration of the denominated Teachers' Vocal Health Guide (TVHG) will be presented. The elaboration process of the guide is composed of three stages: (1) parameter selection to compose the guide based on a literature review; (2) submission to a specialist examining board, with the calculation of the Content Validity Index (CVI) and the Kappa agreement coefficient; (3) content validation – the instrument was submitted to an analysis of a judges committee, and from the results the Cronbach Alfa coefficient and the CVI were calculated. The elaboration of the TVHG underwent three stages. In the first stage, called parameter selection, 20 didactic contents were found, consisting of 14 theoretical and six practices. In the second stage, an evaluation of the guide was performed by a specialist examining board and two contents were excluded since their CVI was below 8. The result of the Kappa Coefficient Calculation was 0.281. In the third stage, the TVHG underwent evaluation of a new group denominated judges committee, and the items were punctuated as very relevant and completely relevant. The result of the Cronbach Alfa coefficient for the instrument with 18 items was 0.721, and this value categorizes the instrument as valid. It is necessary to continue the process of instrument validation, possibly investigating the applicability of TVHG in the teachers' opinion. The current study presents the TVHG from the description of the three stages performed to elaborate a systematized instrument denominated TVHG, which suggests a gathering of didactic content that are appliable in collective actions of vocal health with this professional category. [ABSTRACT FROM AUTHOR]

The objective of this study was to investigate the difference between vocal beauty and vocal attractiveness by determining whether perceptual ratings of vocal beauty and vocal attractiveness could be dissociated in a cohort of normal raters without a diagnosed sexual desire disorder. Twenty five gay male participants were presented with randomly-chosen samples from the Geneva Voices and Faces Database, and were asked to rate each sample in terms of beauty, attractiveness for a relationship of short duration, and attractiveness for a relationship of long duration. Responses were recorded on a visual analog scale (0–100) using a touch-screen interface. The number of stimulus repetitions and the participant response times were also recorded. Statistical analyses were done using two-way Analysis of Variance tests and independent student's t tests. P values were considered statistically significant at the P < 0.05 level. Participants rated male voices significantly higher in terms of beauty, attractiveness for a relationship of long duration, and attractiveness for a relationship of short duration (P < 0.001). Participants rated female voices significantly higher for beauty than for attractiveness for relationship of long or short duration (P < 0.001). There was no significant difference in response time between male and female voices when rating vocal beauty (P = 0.5608). Response time was significantly longer for male voices than for female voices when assessing attractiveness for a relationship of short duration (P < 0.002) but not for long duration (P < 0.3496). Attractive voices (male and female) were repeated more often, and male voices were repeated more often than female voices for both long-term and short-term attractiveness. There was no difference in stimulus replay behavior as a function of the beauty ratings. In a cohort of gay male raters without a diagnosed sexual desire disorder, vocal beauty and vocal attractiveness ratings of male and female voices are two related but distinct perceptual constructs that can, under certain circumstances, be dissociated. In general, gay men rated male voices equivalently for beauty, short-term, and long-term attractiveness, while the same ratings for female voices showed a significant difference between ratings of beauty and ratings of short-term and long-term attractiveness. [ABSTRACT FROM AUTHOR]

To verify the immediate effects of voiced gargling on the electrical activity of extrinsic laryngeal muscles and vocal self-assessment. A sample of 20 individuals of both sexes, mean age of 31.95 (±11.57) years, were equally divided in two groups according to the presence or absence of vocal complaint. Both groups were evaluated by surface electromyography of the suprahyoid (SH) and infrahyoid (IH) muscle areas during rest, phonation of the sustained vowel [Ɛ] in habitual and strong intensities; phonation of rising and falling glissando; and counting from 1 to 10. Surface electromyography was assessed before and after the voiced gargling exercise, which lasted 1 minute. All participants self-rated their voice and phonatory comfort after the exercise. Wilcoxon and Mann-Whitney tests were applied, as well as Fisher's exact test and linear-to-linear test. The level of significance was 5%. The percentage of electrical activity of the SH muscle area decreased in the glissando and counting tasks in the group with vocal complaint, as well as in phonation of sustained vowel in strong intensity in the group without complaint. Decrease was also observed in the right IH muscle area at rest and during sustained vowel phonation at habitual and strong intensities. Percentage of muscular electrical activity was lower in the group with complaint in the following situations: IH muscle area on both sides, at rest and during habitual phonation of sustained vowel and glissando before and after the exercise; right IH muscle area, during counting and strong phonation of sustained vowel before and after exercise; left IH muscle area, in the counting task, just after intervention. Most participants noticed improvement in voice (70%) and phonatory comfort (65%). Voiced gargling during 1 minute promotes immediate effects on the electrical activity of the extrinsic laryngeal muscles in individuals with or without vocal complaint. Most individuals reported improved voice and phonatory comfort after exercise. [ABSTRACT FROM AUTHOR]

To provide voice experts with a method for determining the likelihood ratio (LR) from the perceptual evaluation of distinctive voice attribute scores. The proposed method aims to obtain the similarity and typicality judgments made by forensic voice experts (FVEs) during the comparison of attributes in voice pairs. It is based on the scoring method for LR calculation. In the first stage, 17 perceptual attributes grouped into six vocalic categories are specified. A novel graphical interface is used to obtain discriminative responses both globally and for each attribute from ten pairs of test sentences produced by the same and different speakers. The FVEs should discriminate whether the attributes are similar or different in each pair and should indicate the degree to which the attributes are present. In addition, for six specific attributes, the FVEs must decide whether the attribute is typical or atypical in the reference population. In the second stage, the mean score obtained in the first stage is converted to LR using probability density functions of listeners' responses to 1680 same/different speaker pairs discriminated for female and male speakers. The responses of the FVEs to the test pairs show the discriminatory power of the attributes, the incidence of the typicality factor on the final score and the performance of each FVE. With the application of the probability density functions obtained for the responses to pairs of the same or different origin taken from the reference population, the final scores are converted into LRs that are compared with the true conditions of each pair. The application of the developed system allows the global and discriminated evaluation of the perceptual attributes with high agreement in the comparison of pairs of voices. Obtaining the LRs allows associating the perceptual evaluation method with the automatic methods that are used nowadays. The responses of the FVEs taken as a reference, will allow training and evaluating the performance of young FVEs. [ABSTRACT FROM AUTHOR]

To evaluate the vocal characteristics of children with short stature before and 12 months after growth hormone treatment. This analytical, observational cohort study included 23 children (age 5–11 years) diagnosed with short stature. Children in the short stature group (SSG) were matched (1:1) for age and sex with children with normal growth (normal stature group; NSG). Participants in the SSG underwent assessments before and 12 months after growth hormone treatment, while those in the NSG underwent the same assessments at baseline and 12 months. The assessments included evaluation of (A) vocal characteristics (history, vocal self-assessment, auditory-perceptual evaluation, and acoustic analysis), (B) anthropometry, (C) bone age, and (D) measurement of insulin-like growth factor-1 (IGF-1) levels. Children in the SSG had more vocal complaints (P = 0.026) than those in the NSG. The groups were similar in terms of vocal self-assessment and auditory-perceptual evaluation (P = nonsignificant). Results of acoustic analysis were also similar for fundamental frequency (F 0) and perturbation measures (P for both = nonsignificant). F 0 and speech frequency decreased significantly at 12 months in both groups. F1 values were higher at 12 months in the NSG, while F2 values were significantly higher in the baseline evaluation in boys in the SSG. Children in the SSG compared with those in the NSG presented a greater increase in height measurements at 12 months, although the anthropometric means were lower in both evaluations (P < 0.001). Vocal characteristics in children with short stature before and after treatment with growth hormone are comparable to those in children with normal growth. [ABSTRACT FROM AUTHOR]

This study explored the voice experience, singing ability, and wellbeing of singers diagnosed with Hypermobility Spectrum Disorder (HSD) or hypermobile Ehlers-Danlos Syndrome (h-EDS). This was a mixed-method study. A purposive sampling strategy was used. Data were collected via an online survey, using written closed and open-ended questions. 276 adults completed the survey. This study focuses on a subset of professionally-trained singers (n=71). Responses elicited information about participants' voice health and function, symptoms of hypermobility, singing experiences and training. Data were analysed using template analysis. Many participants reported wide vocal ranges and enjoyment of singing but 74.6% of participants across all age groups (18-60 years) experienced voice difficulties. Three common themes were identified: (1) 'My unreliable voice': The ups and downs; (2) Wider effects of HSD/h-EDS on singers, and (3) Need for acknowledgment and support. Voice difficulties and hypermobility-related health conditions affected the participants' abilities to sing and perform; this impacted their professional and personal opportunities, communication, relationships, and wellbeing. Our results indicate that symptoms of voice disorder worsen over time. We suggest practical strategies that singers and training providers could implement to support hypermobile singers. More research is needed to fully understand voice difficulties in singers with HSD/H-EDS and to inform tuition and support. [ABSTRACT FROM AUTHOR]

To develop educational modules to improve vocal wellness and optimize communication in mask-wearing occupational voice users. Module development focused on identifying accurate, understandable, and actionable steps to improve vocal wellness in the workplace. We i) interviewed eight voice-specialized speech-language pathologists and researchers on current speech and voice recommendations for mask-wearers, ii) developed educational content using the standardized Patient Education Materials Assessment Tool (PEMAT), iii) assessed the ability of nine mask-wearing community members to learn educational content, and iv) compared behavioral, acoustical, and perceptual changes in four mask-wearing healthcare professionals following educational training. We created three educational modules that described key vocal health and communication strategies, including microphone amplification, postural alignment, clear speech, hydration, vocal naps, and vocal warm-ups. PEMAT scores were 96% and 93% on understandability and actionability, respectively. Mask-wearing healthcare professionals increased use of 4 out of the 6 strategies following educational training and were able to retain information at rates >90% at 1-week follow-up. We developed a set of free-to-use educational modules to promote vocal wellness among mask-wearing occupational voice users (see VSMechLab.com). Future work should examine the impact of these strategies on voice measures in a larger group of mask-wearing community members. [ABSTRACT FROM AUTHOR]