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Objectives: This study aimed to adapt the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) protocol for perceptual voice assessment to the French language. The primary objective was to achieve consensus among an international panel of voice experts on the content of the adapted protocol., Methods: To ensure the relevance and robustness of the French CAPE-V protocol, this study employed a systematic Delphi method and involved an international panel primarily comprising speech therapists and lecturers from France and Belgium. The multi-stage process included an initial panel size of 15 experts. Three rounds of online questionnaires, integrating both quantitative and qualitative data collection, were conducted. Participants provided feedback and ratings on various protocol elements until a consensus was reached. Adaptations targeted the choice of task stimuli (sustained vowel, sentence reading, semi-spontaneous speech), of the rating scales, and vocal quality terminology., Results: The Delphi process achieved consensus on all elements of the adapted CAPE-V protocol. Notably, the sustained vowel task saw consensus in favor of the vowel /a/. Sentence adaptations achieved substantial agreement, with the final set unanimously approved. The simple Visual Analog Scale emerged as the preferred rating scale. Agreement on terms for describing vocal qualities marked a crucial step in establishing a shared vocabulary among French-speaking voice experts., Conclusions: The study successfully adapted the CAPE-V protocol for perceptual voice assessment to the French language through a systematic Delphi process. The final protocol closely resembles the original English version, maintaining its structure and core objectives. Consensus on sustained vowel tasks, sentence adaptations, rating scales, and vocal quality terminology indicates the relevance and robustness of the adapted protocol. Ongoing validation studies in France demonstrate the potential clinical utility of the adapted CAPE-V in French-speaking contexts, representing a significant step toward standardized and validated voice assessment tools for clinicians and researchers globally., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Purpose: This study measured the impact of articulation exercises using a cork and articulation exercises for lip spreading on the formant frequencies of vowels and listener perceptions of femininity in transgender women., Methods: Thirteen transgender women were recorded before and after the cork exercise and before and after the lip spreading exercise. Speech samples included continuous speech during reading and were analyzed using Praat software. Vowel formant frequencies (F1, F2, F3, F4, F5) and vowel space were determined. A listening experiment was organized using naïve cisgender women and cisgender men rating audio samples of continuous speech. Masculinity/femininity, vocal quality and age were rated, using a visual analogue scale (VAS)., Results: Concerning vowel formant frequencies, F2 /a/ and F5 /u/ significantly increased after the lip spreading exercise, as well as F3 /a/, F3 /u/ and F4 /a/ after the cork exercise. The lip spreading exercise had more impact on the F2 /a/ than the cork exercise. Vowel space did not change after the exercises. The fundamental frequency (f o ) increased simultaneously during both exercises. Both articulation exercises were associated with significantly increased listener perceptions of femininity of the voice., Conclusion: Subtle changes in formant frequencies can be observed after performing articulation exercises, but not in every formant frequency or vowel. Cisgender listeners rated the speech of the transgender women more feminine after the exercises. Further research with a more extensive therapy program and listening experiment is needed to examine these preliminary findings., (Copyright © 2021 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objectives: To investigate the impact of standardized mobile phone recordings passed through a telecom channel on acoustic markers of voice quality and on its perception by voice experts in normophonic speakers., Methods: Continuous speech and a sustained vowel were recorded for fourteen female and ten male normophonic speakers. The recordings were done simultaneously with a head-mounted high-quality microphone and through the telephone network on a receiving smartphone. Twenty-two acoustic voice quality, breathiness and pitch-related measures were extracted from the recordings. Nine vocologists perceptually rated the G, R and B parameters of the GRBAS scale on each voice sample. The reproducibility, the recording type, the stimulus type and the gender effects, as well as the correlation between acoustic and perceptual measures were investigated., Results: The sustained vowel samples are damped after one second. Only the frequencies between 100 and 3700Hz are passed through the telecom channel and the frequency response is characterized by peaks and troughs. The acoustic measures show a good reproducibility over the three repetitions. All measures significantly differ between the recording types, except for the local jitter, the harmonics-to-noise ratio by Dejonckere and Lebacq, the period standard deviation and all six pitch measures. The AVQI score is higher in telephone recordings, while the ABI score is lower. Significant differences between genders are also found for most of the measures; while the AVQI is similar in men and women, the ABI is higher in women in both recording types. For the perceptual assessment, the interrater agreement is rather low, while the reproducibility over the three repetitions is good. Few significant differences between recording types are observed, except for lower breathiness ratings on telephone recordings. G ratings are significantly more severe on the sustained vowel on both recording types, R ratings only on telephone recordings. While roughness is rated higher in men on telephone recordings by most experts, no gender effect is observed for breathiness on either recording types. Finally, neither the AVQI nor the ABI yield strong correlations with any of the perceptual parameters., Conclusions: Our results show that passing a voice signal through a telecom channel induces filter and noise effects that limit the use of common acoustic voice quality measures and indexes. The AVQI and ABI are both significantly impacted by the recording type. The most reliable acoustic measures seem to be pitch perturbation (local jitter and period standard deviation) as well as the harmonics-to-noise ratio from Dejonckere and Lebacq. Our results also underline that raters are not equally sensitive to the various factors, including the recording type, the stimulus type and the gender effects. Neither of the three perceptual parameters G, R and B seem to be reliably measurable on telephone recordings using the two investigated acoustic indexes. Future studies investigating the impact of voice quality in telephone conversations should thus focus on acoustic measures on continuous speech samples that are limited to the frequency response of the telecom channel and that are not too sensitive to environmental and additive noise., Competing Interests: CONFLICT OF INTEREST The authors declare that there is no conflict of interest., (Copyright © 2022 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objectives: The Acoustic Voice Quality Index (AVQI), version 03.01, is a tool for quantitative assessment of the overall severity of dysphonia. It is based on the recordings of a sustained vowel and part of a text read aloud. For the Dutch sample, 34 syllables must be read aloud to balance the duration of the two tasks. The first part of this study thus aimed to determine how many syllables of a commonly used text in the French-speaking part of Belgium should be used to achieve the same balance. The psychometric qualities of the AVQI have been confirmed by numerous publications in various languages. However, its validation in French relies on a small cohort of patients, who were not native French speakers. Furthermore, version 03.01 of the AVQI has not yet been validated at all on French samples. Hence, the main aim of this study was to assess the criterion-related concurrent validity and diagnostic accuracy of the AVQI 03.01 applied to a sample of native French speakers., Methods: For the first part of this study, the optimal part of the text to be used for the AVQI was identified, taking into account both its phonemic contents and its time balance with the sustained vowel. For the validation study, 90 recordings from the University Hospital of Liège's ENT caseload database were used, as well as 30 new recordings of normophonic individuals, composing a control group. Four judges assessed the recordings using the G parameter of the GRBAS scale. Once the intra- and inter-rater reliability of the perceptual ratings was confirmed, the AVQI 03.01's criterion validity was assessed on the French sample. The diagnostic accuracy of the AVQI 03.01 in French was measured, and the cut-off score allowing for the greatest diagnostic precision determined., Results: The most appropriate syllable number of the text to be read aloud was found to be 27, in order to balance the time analyzed for both the sustained vowel and the continuous speech. Regarding the validation study, intra-rater reliability was substantial for each of the four vocologists (κ mean  = .778, P < 0.0001), and inter-rater reliability was high (W = .895, P < 0.0001). The Spearman correlation between the perceptual judgments and the AVQI 03.01 score was strong (r s  = .84, P < 0.0001). The receiver operating characteristic-curve parameters indicated that the ideal cut-off score allowing for the highest diagnostic accuracy of the AVQI, version 03.01, applied to a French sample is 2.33, with a sensitivity of 59.8%, a specificity of 100%, an infinite positive likelihood ratio (LR+) and a negative likelihood ratio (LR-) of 0.4., Conclusions: This study confirms the external validity of the AVQI 03.01 when applied on a French 27-syllable sample. The AVQI 03.01 is a robust, ecologically valid objective measure of overall voice quality. The cut-off score to be used is 2.33. However, clinicians should be cautious when the AVQI score is lower than 2.33. The AVQI 03.01 does not yield a sufficiently low negative likelihood ratio to be sure that this score indeed indicates normophonia. Also, taking into account the limitations regarding the perceptual judgements used in this study, a replication study should be carried out in order to confirm the cut-off score., (Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objectives: The Acoustic Voice Quality Index (AVQI), version 03.01, is a tool for quantitative assessment of the overall severity of dysphonia. Its computation includes six acoustic parameters, which are all analyzed with Praat freeware. It is based on recordings of a sustained vowel and part of a text read aloud. The psychometric qualities of this tool in various languages, including French, have been confirmed by numerous publications. However, studies investigating the correlation between tools for objective vocal assessment and voice-related quality of life show inconsistent results. Hence, the aim of this study was to contribute to the debate on measuring the correlations between the AVQI 03.01 score computed on French samples and the Voice Handicap Index (VHI)., Methods: Data from 78 patients were used; they were collected during initial vocal assessment and stored in the ear, nose, and throat caseload database of the University Hospital of Liège. The Spearman rank-order correlations (r s ) between the VHI total score and subscores and the AVQI 03.01 scores for French samples were measured. The correlation between the diagnostic decisions ("normophonia" versus "dysphonia") of both tools was assessed using Cramer's phi., Results: The Spearman correlation between AVQI 03.01 score and total VHI score, controlling for age, was moderate (r s  = 0.62, P < 0.0001). The correlations between the AVQI 03.01 score and the functional, emotional, and physical subscores of the VHI were also moderate (r s  = 0.643, 0.543, and 0.514, respectively, P < 0.0001). The correlation between the two instruments' diagnostic decisions ("normophonia" versus "dysphonia") was also moderate (φ = 0.52, P = 0.000)., Conclusions: Although AVQI 03.01 scores were moderately correlated with the VHI total score and subscores, they measure two different things. The AVQI 03.01 assesses overall voice quality in terms of acoustic parameters, whereas the VHI assesses the multidetermined impact on the patient's everyday life. Both results should thus be taken into account, as part of a comprehensive vocal assessment., (Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objective: Little is known about the impact of smoking on voice acoustics. Some studies have found that tobacco affects the fundamental frequency of the voice, whereas others have not. This study aimed to overcome the major methodological limitations observed in previous studies by strictly controlling several variables that could clarify the effect of smoking on the speaking voice., Methods: Lebanese men were chosen for this study. Thirty nonsmokers, 30 cigarette smokers, and 30 water-pipe smokers were matched on the basis of age, height, and weight. The 90 participants were asked to complete the Voice Handicap Index, sustain the vowel /a/, read 10 sentences in French and Arabic, and speak spontaneously in both languages. The mean fundamental frequency (F0), speaking fundamental frequency (SFF), jitter, and standard deviation of F0 were measured using Praat and Vocalab4 and were compared between the groups., Results: The Voice Handicap Index scores differed significantly between nonsmokers and cigarette smokers and between nonsmokers and water-pipe smokers. Results also show that cigarette smokers' F0 and SFF were significantly lower than nonsmokers' results. No significant differences were found between water-pipe smokers and nonsmokers. The jitter and the standard deviation of F0 did not differ significantly between the two groups., Conclusions: Our findings clearly demonstrate the effect of smoking on the voice: smokers reported more voice complaints, and cigarette smokers presented lower F0 and SFF in French and in Arabic when age, height, and weight were controlled. Further investigations using similar strict controls over individual variables and additional measures are encouraged to better understand the effect of water-pipe smoking on the voice., (Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

This is a case-control study investigating the personality profiles of children with vocal fold nodules (VFNs). Personality has been suggested as a contributing factor to VFN in adults and in children. However, previous studies in children have focused on psychopathologic traits and have reported contradictory findings. The aim of our study was to explore whether general, nonpathologic personality structure predicts the presence of VFN in children. Personality traits were measured in 34 children with VFN, aged 6.0-13.6, and 34 age- and sex-matched normophonic controls by means of a pediatric five-factor personality questionnaire. Children with VFN were found to be significantly more extroverted than controls (P = 0.022, d = 0.61), and a binary logistic regression showed that extraversion significantly predicted the presence of VFN in our population (P = 0.027). The clinical implications of the results are discussed., (Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Transgender MtF people (trans women) consult otorhinolaryngologists and vocologists with the aim of feminizing their voice and being consistently perceived as women. Treatment of these trans women always begins with a vocal assessment that is relatively unspecific as it was originally constructed for individuals with dysphonia., Objectives: This study examines the subjective portion of the assessment and specifically the self-assessment questionnaire. There is no French-language questionnaire designed to identify the issues facing people who want voice feminization and quantify the impact of their voice disorder on their daily lives. We present a translation and adaption into French of the questionnaire developed by Dacakis et al [6]., Methods: This work follows the World Health Organization recommendations [12] regarding translation. Thirty-six Belgian and French trans women took part in this study., Results: The results show excellent repeatability and reliability, while the construct validity measures show that the items correlate with six areas of concern for trans women identified by Davies and Johnson [7] in a previous study. The domains are the following: effect of voice on ease of social interaction, effect of voice on emotions, relationship between voice and gender identity, effort and concentration required to produce voice, physical aspects of voice production, and pitch. Concurrent validity could not be measured owing to lack of sufficiently detailed stories., Conclusion: The psychometric properties of the French version of the questionnaire are acceptable. The questionnaire can be used as is in daily clinical practice., (Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objectives: This study aimed (1) to investigate music theory teachers' professional and extra-professional vocal loading and background noise exposure, (2) to determine the correlation between vocal loading and background noise, and (3) to determine the correlation between vocal loading and self-evaluation data., Methods: Using voice dosimetry, 13 music theory teachers were monitored for one workweek. The parameters analyzed were voice sound pressure level (SPL), fundamental frequency (F0), phonation time, vocal loading index (VLI), and noise SPL. Spearman correlation was used to correlate vocal loading parameters (voice SPL, F0, and phonation time) and noise SPL. Each day, the subjects self-assessed their voice using visual analog scales. VLI and self-evaluation data were correlated using Spearman correlation., Results: Vocal loading parameters and noise SPL were significantly higher in the professional than in the extra-professional environment. Voice SPL, phonation time, and female subjects' F0 correlated positively with noise SPL. VLI correlated with self-assessed voice quality, vocal fatigue, and amount of singing and speaking voice produced., Conclusions: Teaching music theory is a profession with high vocal demands. More background noise is associated with increased vocal loading and may indirectly increase the risk for voice disorders. Correlations between VLI and self-assessments suggest that these teachers are well aware of their vocal demands and feel their effect on voice quality and vocal fatigue. Visual analog scales seem to represent a useful tool for subjective vocal loading assessment and associated symptoms in these professional voice users., (Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Background: The original Dysphonia Severity Index (ie, DSI) weighs and combines four voice markers in a single number to size dysphonia gradation in the clinic: percent jitter (from Multi-Dimensional Voice Program; KayPENTAX Corp., Montvale, NJ), softest intensity and highest fundamental frequency (both from Voice Range Profile; KayPENTAX Corp.), and maximum phonation time. To be more generally applied, however, implementation of DSI in the program Praat (Paul Boersma and David Weenink, Institute for Phonetic Sciences, University of Amsterdam, The Netherlands) would be advantageous for all voice clinicians. The presented project was therefore designed (1) to develop such a Praat application and (b) to test its concurrent validity., Methods: The four voice markers for the original DSI, as well as ten additional voice markers in Praat, were administered on a total of 49 subjects in three different clinical voice centers. A crossover research design was implemented to counterbalance for possible exercise effects. First, stepwise multiple linear regression was applied to build a statistical model with the best combination of Praat predictors for the original DSI. Second, correlation statistics were applied to compare Praat's DSI with the original DSI., Results: Both DSI versions correlated strongly. A custom script was therefore written for automated DSI determination in Praat., Conclusion: With this script, every voice clinician can easily determine DSI in the Praat program., (Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objective: The operatic singing technique is frequently used in classical music. Several acoustical parameters of this specific technique have been studied but how these parameters combine remains unclear. This study aims to further characterize the Western operatic singing technique by observing the effects of melody and technique on acoustical and musical parameters of the singing voice., Methods: Fifty professional singers performed two contrasting melodies (popular song and romantic melody) with two vocal techniques (with and without operatic singing technique). The common quality parameters (energy distribution, vibrato rate, and extent), perturbation parameters (standard deviation of the fundamental frequency, signal-to-noise ratio, jitter, and shimmer), and musical features (fundamental frequency of the starting note, average tempo, and sound pressure level) of the 200 sung performances were analyzed., Results: The results regarding the effect of melody and technique on the acoustical and musical parameters show that the choice of melody had a limited impact on the parameters observed, whereas a particular vocal profile appeared depending on the vocal technique used., Conclusions: This study confirms that vocal technique affects most of the parameters examined. In addition, the observation of quality, perturbation, and musical parameters contributes to a better understanding of the Western operatic singing technique., (Copyright © 2014 The Voice Foundation. Published by Mosby, Inc. All rights reserved.)

Objective: The quality of a music performance can be lessened or enhanced if the performer experiences stressful conditions. In addition, the quality of a sung performance requires control of the fundamental frequency of the voice, which is particularly sensitive to stress. The present study aimed to clarify the effects of stress on singing voice accuracy., Methods: Thirty-one music students were recorded in a stressful condition (ie, a music examination) and a nonstressful condition. Two groups were defined according to the challenge level of the music examination (first and second music levels). Measurements were made by self-reported state anxiety (CSAI-2R questionnaire) and by observing heart rate activity (electrocardiogram) during each performance. In addition, the vocal accuracy of the sung performances was objectively analyzed., Results: As expected, state anxiety and heart rate were significantly higher on the day of the music examination than in the nonstressful condition for all the music students. However, the effect of stress was positive for the first-year students but negative for the second-year students, for whom the music examination was particularly challenging. In addition, highly significant correlations were found between the intensity of cognitive symptoms and the vocal accuracy criteria., Discussion: This study highlights the contrasting effects of stress on singing voice accuracy but also the need to consider the challenge level and perception of the symptoms in experimental and pedagogical settings., (Copyright © 2014 The Voice Foundation. Published by Mosby, Inc. All rights reserved.)

Objective: Vocal accuracy of a sung performance can be evaluated by two methods: acoustic analyses and subjective judgments. Acoustic analyses have been presented as a more reliable solution but both methods are still used for the evaluation of singing voice accuracy. This article presents a first time direct comparison of these methods., Methods: One hundred sixty-six untrained singers were asked to sing the popular song "Happy birthday." These recordings constituted the database analyzed. Acoustic analyses were performed to quantify the pitch interval deviation, number of contour errors, and number of tonality modulations for each recording. Additionally, 18 experts in singing voice or music rated the global pitch accuracy of these performances., Results: A high correlation occurred between acoustic measurements and subjective rating. The total model of acoustic analyses explained 81% of the variance of the judges' scores. Their rating was influenced by both tonality modulations and pitch interval deviation., Conclusions: This study highlights the congruence between objective and subjective measurements of vocal accuracy within this first time comparison. Our results confirm the relevance of the pitch interval deviation criterion in vocal accuracy assessment. Furthermore, the number of tonality modulations is also a salient criterion in perceptive rating and should be taken into account in studies using acoustic analyses., (Copyright © 2013 The Voice Foundation. Published by Mosby, Inc. All rights reserved.)

Objectives: This study evaluates the effect of a 2-hour reading task between 70 and 75 dB(A) in 16 normophonic and 16 dysphonic female teachers with vocal nodules., Methods: Objective measurements (acoustic analysis, voice range measurements, and aerodynamic measurements) and subjective self-ratings were collected before and every 30 minutes during the reading to determine the voice evolution in both groups., Results: Fundamental frequency, lowest frequency, highest frequency (F-High), highest intensity, and intensity range increase through the reading, whereas shimmer decreases. Maximum phonation time decreases after 30 minutes. Estimated subglottal pressure (ESP) and sound pressure level increase during the first hour. Afterward, ESP decreases. Self-ratings worsen through time. When comparing the normophonic and the dysphonic teachers, self-ratings reveal more complaints in the dysphonic group. Few differences in objective measurements are found between both groups: normophonic teachers show lower ESP, higher F-High, and greater frequency range., Conclusions: Frequency modifications from acoustic analysis and voice range measurements suggest an increased laryngeal tension during vocal load, while subjects perceive a worsening of voice. Aerodynamic parameters depict first a deterioration of voice efficiency and then an adaptation to the prolonged reading. The comparison between both groups shows a discrepancy between objective measurements and self-ratings, suggesting that both approaches are necessary to have a complete view of vocal load effects. Surprisingly, both groups behave similarly through vocal load, without more or quicker deterioration of voice in the dysphonic group., (Copyright © 2012 The Voice Foundation. Published by Mosby, Inc. All rights reserved.)

Objectives: The objectives of this study are to evaluate the impact on voice of both duration and intensity level of 2 hours of continuous oral reading. Voice modifications accompanying changes in intensity level during prolonged reading tasks are analyzed., Methods: Fifty normophonic women undergo two sessions of voice loading in which the required intensity level of voice varied between 60-65 dB(A) for the first session and 70-75 dB(A) for the second session. The effects of loading on objective data (average fundamental frequency [F0], jitter%, shimmer%, noise-to-harmonic ratio, maximum phonation time, lowest frequency [F-Low], highest frequency [F-High], frequency range [Range], lowest intensity [I-Low] level, and highest intensity level) and self-ratings (voice quality, phonation effort, vocal fatigue, and laryngeal discomfort) are assessed every 30 minutes during the loading tasks., Results: Results indicate that average F0, F-Low, I-Low, maximum phonation time, feeling of phonation effort, vocal fatigue, and laryngeal discomfort increase during prolonged reading, whereas shimmer% and self-rating of voice quality decrease. Average F0, F-High, and Range are the only parameters influenced by the required intensity of vocal load; they are significantly higher in the 70- to 75-dB session compared with the 60- to 65-dB session. Concerning the subjective self-ratings, similar results for the four ratings used suggest that only one would suffice in future studies., Conclusions: These results confirm the importance of both duration and intensity level as loading factors, even if intensity level affects fewer variables than duration., (Copyright © 2012 The Voice Foundation. Published by Mosby, Inc. All rights reserved.)

Subjective evaluation of the voice by the patient is routinely assessed in the adult dysphonic population; this is, however, not the case in the pediatric population. There were three objectives of this study: the first goal was to study the ability of children aged 5-13 years to express themselves about physical, emotional, and sociofunctional aspects of their voice. The second goal was to explore if specific voice-related complaints were expressed by dysphonic children as compared with normophonic children. The third goal was to compare the dysphonic children's voice-related complaints with those of their mothers. The overall objective was to set the grounds for the elaboration of a standardized questionnaire in French concerning subjective evaluation of voice in children. Twenty-five dysphonic children with vocal complaint (15 nodules, one polyp, one microweb, eight unspecified) and 55 normophonic children aged 5-13 years were interviewed. The interviews were semistructured based on a canvas of voice-related questions. The dysphonic children's mothers were interviewed with the mean of a written questionnaire and were invited to discuss their answers orally with the examiner. The results were analyzed qualitatively and statistically. A Chi-square test and the Fisher's test were used to analyze the differences between the complaints expressed by the dysphonic and the normophonic children, and a binomial test was used to compare the children's answers with their mothers' answers. The qualitative analysis of the interviews suggests that children are capable of reflecting over their own voice and of giving autonomous information about different aspects of their voice. It also appeared that voice is a complex phenomenon and that it needs to be clearly and cautiously defined to the children. We identified 27 different complaints related to the voice, out of which 17 were significantly more expressed by dysphonic than by normophonic children (P<0.05). Three of the 27 identified complaints show significant discordances between the mothers and the dysphonic children. The results suggest that children are capable of making a subjective and autonomous evaluation of their voice and that dysphonic children experience significantly more voice-related discomfort than nondysphonic children. The complaints expressed by the dysphonic children and their mothers are not all in concordance. The main conclusion is that a standardized subjective evaluation of the voice, not only by the parents but also by the child him/herself, would be relevant in the assessment of pediatric dysphonia., (Copyright © 2011 The Voice Foundation. Published by Mosby, Inc. All rights reserved.)

Objectives: The aim of this study was to evaluate the objective voice results of Wendler's glottoplasty in male-to-female transsexuals., Method: We retrospectively reviewed our patients treated with Wendler's technique with minor modifications. Glottoplasty consisted in CO(2)-laser epithelial ablation of the anterior commissure and the two vocal folds in anterior third, suturing of the two vocal folds with two stitches of 3.0 resorbable thread, and application of fibrin sealant to strengthen the suture. Voice assessment was based mainly on fundamental frequency (F(0)), frequency range, jitter, maximum phonation time, phonation quotient, estimated subglottic pressure (ESGP) grade of dysphonia (G), and voice handicap index (VHI). These measures were taken before surgery and on the last follow-up visit., Results: Our series included 15 patients with a mean age of 36 years. The mean follow-up period was 7.2 months. We did not observe any early complications related to the technique. The comparison between the preoperative and the postoperative measurements, using Wilcoxon signed rank test, showed a significant improvement of median F(0) from 139 to 191 Hz (P=0.006) with an increase in the grade of dysphonia (G(pre)=0.2, G(post)=1, P=0.013) and ESGP (ESGP(pre)=8.1 ± 3.2, ESGP(post)=12.0 ± 3.8, P=0.002). Other measurements, including VHI, did not show any significant differences pre- and postoperatively., Conclusion: Wendler's glottoplasty can contribute to feminize the voice., (Copyright © 2011 The Voice Foundation. Published by Mosby, Inc. All rights reserved.)