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Background: Voice and laryngeal pathologies are traditionally arranged in categories. A recent study has suggested an alternative approach, using two continuous scales, Organicity and Tonicity, which form a two-dimensional plane on which all pathologies/conditions can be arranged., Objectives: This study was designed to examine the validity and reliability of the new continuous 2D model and to learn how it is affected by experts' background characteristics., Methods: Ninety-three international experts from 16 countries participated in the study and rated a comprehensive list of 35 laryngeal and voice pathologies/conditions on two continuous scales. On the Organicity scale, 0 represented "nonorganic," and 10 defined "organic." Similarly, on the Tonicity scale, 0 described "hypotonic" and 10 represented "hypertonic.", Results: Cronbach's alphas were high for Organicity and Tonicity (0.99), with varied interexpert agreement scores. Pathologies/conditions populated all four quadrants of the constructed two-dimensional plane, with a majority of 21 of the 35 located in the first quadrant (high-Tonicity, high-Organicity). Results showed strong replicability when compared to the preliminary study. In addition, ratings on the two scales were found consistent and statistically unaffected by the experts' background characteristics., Conclusions: The new two-dimensional model is valid and reliable, and it provides a simple yet comprehensive approach for arranging voice disorders using a continuous perspective rather than a categorical one. Furthermore, the new model offers a framework that facilitates examination of the differences in how professional experts view different laryngeal pathologies and conditions., Competing Interests: Declaration of Competing Interest None., (Copyright © 2024 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objectives: This study examined the association between voice disorders and personality by comparing a heterogenic group of dysphonic patients to non-dysphonic speakers using the NEO-FFI big-five personality inventory., Methods: A group of 100 dysphonic patients diagnosed with 24 different pathologies was compared to 149 non-dysphonic speakers. Inter-group differences on the five NEO-FFI scales were evaluated using three analysis approaches, a general comparison between the dysphonic and non-dysphonic groups and arranging pathologies using a categorical and a continuous approach., Results: Of the five NEO-FFI scales, Openness emerged as the single personality trait that yielded a statistically significant difference between the dysphonic group and the non-dysphonic group (P < 0.001). Moreover, when the 24 pathologies were arranged categorically, people with structural pathologies were lower on the Openness scale than non-dysphonic speakers (P < 0.001). Similarly, when pathologies were arranged continuously, people with pathologies characterized by high organicity were low on the Openness scale compared to the non-dysphonic group (P < 0.001)., Conclusions: This study represents a new approach to examining the association between voice disorders and personality. Openness emerged as the single personality trait that repeatedly and consistently differentiated between dysphonic and non-dysphonic people and among specific pathologies, using all analysis approaches. Our findings suggest that examining a spectrum of pathologies, rather than focusing on a particular pathology, provides a new perspective and sheds light on the complex association between voice disorders and personality., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objectives: This study developed and validated the children's voice questionnaire (CVQ), a new self-administered instrument for children, and evaluated its internal consistency and reliability., Study Design: Observational, prospective, cross-sectional study., Methods: The initial preparation of the CVQ was conducted in four steps. First, individual interviews were conducted with dysphonic and non-dysphonic children and their parents, teachers, and speech pathologists. Second, the responses collected from the interviews were arranged into a comprehensive list of 175 items. Third, this list was reduced to a preliminary 21-item version of the questionnaire, which was tested as a pilot with 254 children. Fourth, a further reduction to 18 items was performed to construct the final version of the CVQ. The questionnaire was then administered to 342 children (73 dysphonic, 269 non-dysphonic) aged 6-18. Simultaneously, the parents of these children completed the pediatric voice handicap index (pVHI). Finally, after 2 weeks, 30 randomly selected children (nine dysphonic, 21 non-dysphonic) completed the CVQ again to evaluate test-retest reliability., Results: High reliability was found for the CVQ (Cronbach's α = 0.94). Test-retest revealed strong and statistically significant reliability (r = 0.79, P < 0.001). A highly significant group difference was found between the CVQ scores obtained for the dysphonic and non-dysphonic groups (t[78.25] = 6.22, P < 0.001). In addition, significant medium-to-strong positive correlations were found between the children's evaluations using the CVQ and their parents' evaluations using the pVHI (0.59 < r < 0.66, P < 0.01)., Conclusions: The newly developed CVQ is a valid and reliable instrument. Findings reveal general agreement between children and their parents, but also show that children's perspective on their dysphonia is not equivalent to the parent's perspective. This demonstrates that combining both perspectives provides a more holistic and complete overview of dysphonic children's voice-related quality of life. The self-administered CVQ reliably differentiates dysphonic from non-dysphonic children and may serve as a valuable tool for the initial or ongoing evaluation of children with voice disorders in clinical and research settings., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objectives: Balanced hydration is crucial for optimal physiological function, whereas hypohydration may cause adverse effects. Like many other organs, the larynx is negatively affected by hypohydration, potentially affecting voice production. Therefore, the purpose of this study was to examine voice properties in women diagnosed with dry-mouth., Methods: Twenty-four women diagnosed with hyposalivation and 24 age-matched controls were recruited. All participants underwent three sialometry tests for quantifying oral-dryness. These tests were conducted in three conditions: after 2-hour fasting, after gustatory salivary stimulation and after drinking water. After each sialometry, participants were recorded while producing the vowels /a/ and /i/, and during a standardized reading task. A basic set of acoustic measures was extracted from these recordings. Self-evaluation of voice was performed using the VHI-10 questionnaire; and listeners' perception of the voice was performed by five professional judges who rated the recordings perceptually, using the GRBAS scale., Results: Significant group differences were found in fundamental frequency and jitter, but not in shimmer and noise-to-harmonic ratio (corrected P < 0.05). The participants in the hyposalivation group exhibited higher scores on the VHI-10 questionnaire compared to the control group (P = 0.002), and the judges perceptually rated their voices higher on the Grade and Roughness scales (0.03 ≤ P ≤ 0.04). In contrast with the significant group differences, no significant differences were found between the three study conditions., Conclusions: Women suffering from oral-dryness were shown to exhibit degradation in voice quality, evident in both acoustic, perceptual and self-evaluation measures. However, in this paradigm, short-term superficial hydration was not shown to elicit a significant improvement in voice properties. These findings highlight the importance of consistent oral-hydration for voice, especially among people suffering from hyposalivation., (Copyright © 2021 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objective: The COVID-19 pandemic has led to a critical disruption in the music and performing arts industry, and affected singers and other artists. This study was designed to examine the effect of this unique time on artistic voice users, the way they perceive their voice and their voice-related behaviors., Methods: A total of 110 participants volunteered for the study: 57 professional artistic voice users (34 singers and 19 actors) and a control group of 53 nonprofessional voice users. All participants completed three questionnaires related to their self-assessment of their voice, their voice difficulties, vocal training, and current stress in the time of the COVID-19 pandemic., Results: Compared to the controls, artistic voice users were more concerned about their voice (P < 0.001), practiced their voice more often (P < 0.001), and experienced more anxiety and stress (P < 0.05). In addition, within the professional group, singers reported practicing their voice in the time of the COVID-19 significantly more than actors (P < 0.01)., Conclusions: Professional artistic voice users experience the COVID-19 pandemic as a stressful time, with negative effects on their well-being and specifically on their voice. This should be considered in the treatment and maintenance of their voice and professional career at current and future stressful times., (Copyright © 2020 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objective: Data on the prevalence of voice disorders is vital in order to describe and understand the phenomenon. The aim of this study was to estimate the prevalence of voice disorders in Israel, and perform a preliminary comparison between the two major societies in the country., Methods: A sample of 1146 people participated in a survey on voice disorders. This sample comprised 510 Israeli Jews and 627 Israeli Arabs. Each participant completed a questionnaire concerned with voice and its disorders as well as the shortened Voice Handicap Index-10 (VHI-10)., Results: The overall prevalence of voice disorders within our sample was 13.90%. In addition, 30.26% of the participants reported experiencing a voice problem over the last year, while 12.81% reported seeing a physician for that reason. No significant differences were found in the prevalence of voice disorders between participants who identified themselves as either Jews or Arabs. A higher prevalence of voice disorders was found in the older age groups, and among people who reside in the southern region of the country. In contrast, no significant differences in the prevalence of reported voice disorders were found between men and women., Conclusion: The prevalence of reported voice disorders in Israel is comparable with previous prevalence reports from other regions and societies. Data show that despite cultural, religion, language, and other factors, the prevalence of voice disorder among Israeli Jews and Arabs is very similar., (Copyright © 2018. Published by Elsevier Inc.)

Objectives: Stroboscopy is considered the most appropriate tool for evaluating the function of the vocal folds but may harbor significant limitations in children. Still, direct laryngoscopy (DL), under general anesthesia, is regarded the "gold standard" for establishing a diagnosis of vocal fold pathology. The aim of the study is to examine the accuracy of preoperative rigid stroboscopy in children with voice disorders., Study Design: This is a retrospective study., Methods: A retrospective study was conducted on a cohort of 39 children with dysphonia, aged 4 to 18 years, who underwent DL. Twenty-six children underwent rigid stroboscopy (RS) prior to surgery and 13 children underwent fiber-optic laryngoscopy. The preoperative diagnoses were matched with intraoperative (DL) findings., Results: DL was found to contradict preoperative evaluations in 20 out of 39 children (51%) and in 26 out of 53 of the findings (49%). Overdiagnosis of cysts and underdiagnosis of sulci were noted in RS compared to DL. The overall rate of accuracy for RS was 64%., Conclusions: The accuracy of rigid stroboscopy in the evaluation of children with voice disorders was found to be similar with previous reports in adults., (Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objectives: This study aimed to evaluate the validity and reliability of a Hebrew translation of the Pediatric Voice Handicap Index (pVHI). It also examined differences between mothers and fathers in evaluating their child's dysphonia., Study Design: Observational design., Methods: The pVHI was first translated and adapted to Hebrew. The translated version was, then, administered to a group of 141 parents of children aged younger than 14 years. Fifty-eight parents had a dysphonic child, and 83 had a nondysphonic child. Based on the parents' responses to the pVHI, statistical analyses were performed, evaluating validity and reliability, as well as group differences. Following, a subset of the participants, in which only cases where the responses of both parents were available, was examined for evaluating differences between the responses of mothers (n = 46) and fathers (n = 46)., Results: Statistical analyses revealed high reliability of the Hebrew version of the pVHI (Cronbach alpha = .97). Parents of the dysphonic children rated their children significantly higher than parents of the nondysphonic group (P < 0.001). Mothers of the dysphonic children rated their children significantly higher than the fathers, on all subscales of the questionnaire (≥0.001 P < 0.047). In contrast, no significant differences were found between mothers and fathers of the nondysphonic children (P > 0.05)., Conclusions: The Hebrew version of the pVHI is a reliable tool for quantifying parents' perception of their child's voice handicap. Mothers of dysphonic children evaluate their children's voice handicap more severely than fathers, whereas both parents of nondysphonic children perform this evaluation similarly., (Copyright © 2015 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objectives: To examine the effect of in vitro fertilization (IVF) treatment on acoustic properties of women's voice., Study Design: Prospective case series., Methods: Ten women undergoing IVF treatment participated in the study. All participants were recorded repeatedly in three successive sessions, before and during treatment, in addition to collecting hormonal assays, endometrial thickness measurements, and follicular growth data. Recordings were performed while sustaining an isolated vowel repeatedly and during a reading task. Acoustic analyses included a limited set of fundamental frequency (F0) measures, as well as frequency- and amplitude perturbation measures. Repeated-measure analyses of variance were performed to test for the treatment effect, and the correlations between the acoustic measures and the hormonal as well as endometrial thickness data were examined., Results: A significant reduction in the two F0 measures and in the amplitude perturbation measure was found throughout the treatment (P<0.05). Before treatment, a negative correlation was found between F0 and estrogen levels. After treatment, however, a negative correlation was found between F0 and endometrial thickness., Conclusion: An association was found between IVF treatment and specific voice properties. In addition, the possibility of a ceiling effect for the influence of estrogens on female vocal folds was introduced., (Copyright © 2014 The Voice Foundation. Published by Mosby, Inc. All rights reserved.)

Objectives: The human voice provides extensive information about the speaker, in addition to the intended linguistic message. Therefore, voice is an essential component in the process of forming an initial attitude toward the speaker. People with communication disorders are typically judged by listeners more negatively than those speaking normally. This trend, however, was not reported consistently regarding voice disorders. Therefore, the aim of this study was to examine listeners' attitude toward dysphonic speakers. In addition, the impact of speaker's and listener's gender on these attitudes was also examined., Methods: Seventy-four naive listeners evaluated recorded voice samples of six dysphonic and six nondysphonic speakers. Evaluation was performed using a semantic differential scale with 12 bipolar items. In addition, factor analysis was performed to validate listeners' attitudes and allow generalization of the results., Results: Statistically significant negative attitudes toward dysphonic speakers were found at all 12 scales (P<0.001). Moreover, dysphonic women were rated more negatively than dysphonic men. Nonetheless, listeners' gender and age did not affect their attitude toward speakers (P>0.05). These results were further enhanced and supported by a factor analysis performed based on the original attitude rating scores., Conclusions: Our findings provide empirical evidence for the negative attitudes with which dysphonic speakers are faced; demonstrating how women are affected by these attitudes more than men and highlight the importance of addressing and relating to these facets in the diagnostic and therapeutic process., (Copyright © 2013 The Voice Foundation. Published by Mosby, Inc. All rights reserved.)

Hypothesis: Acting students require diverse, high-quality, and high-intensity vocal performance from early stages of their training. Demanding vocal activities, before developing the appropriate vocal skills, put them in high risk for developing vocal problems., Study Design: A retrospective analysis of voice characteristics of first-year acting students using several voice evaluation tools., Methods: A total of 79 first-year acting students (55 women and 24 men) were assigned into two study groups: laryngeal findings (LFs) and no laryngeal findings, based on stroboscopic findings. Their voice characteristics were evaluated using acoustic analysis, aerodynamic examination, perceptual scales, and self-report questionnaires. Results obtained from each set of measures were examined using a factor analysis approach., Results: Significant differences between the two groups were found for a single fundamental frequency (F(0))-Regularity factor; a single Grade, Roughness, Breathiness, Asthenia, Strain perceptual factor; and the three self-evaluation factors. Gender differences were found for two acoustic analysis factors, which were based on F(0) and its derivatives, namely an aerodynamic factor that represents expiratory volume measurements and a single self-evaluation factor that represents the tendency to seek therapy., Conclusions: Approximately 50% of the first-year acting students had LFs. These students differed from their peers in the control group in a single acoustic analysis factor, as well as perceptual and self-report factors. No group differences, however, were found for the aerodynamic factors. Early laryngeal examination and voice evaluation of future professional voice users could provide a valuable individual baseline, to which later examinations could be compared, and assist in providing personally tailored treatment., (Copyright © 2013 The Voice Foundation. Published by Mosby, Inc. All rights reserved.)

Objectives: Voice carries abundant information about the speaker. This acoustic information changes throughout life. Although the ability of identifying audible cues on a speaker's gender and age is considered an intuitive task, little is known about the ability to identify and decipher this perceptual information. Most studies in the field have examined the ability to identify adults' gender and age, thus the purpose of the present study was to evaluate listeners' ability to identify gender and age of children and adolescents., Methods: A total of 120 children in six age groups, 8, 10, 12, 14, 16, and 18 years, were recorded while producing isolated vowels and fixed sentences. The recordings were evaluated by a group of 38 untrained naive listeners, who were asked to identify the speakers' gender and age., Results: Listeners were able to identify children's gender at an overall rate of 81.81%. This task was performed more successfully based on recordings of sentences (85.39%) than on isolated vowels (78.22%). Listeners were able to identify the children's age group at an overall rate of 37.16%. This task was also performed more successfully based on recordings of sentences (39.58%) than on isolated vowels (34.71%). Furthermore, when an error of ±1 age group was allowed, correct responses for age identification exceeded 80%., Conclusions: Listeners have the ability to identify children's gender and age, based on short audio recordings, even before puberty. The success rates in these perceptual tasks are dependent on the child's age and gender., (Copyright © 2012 The Voice Foundation. Published by Mosby, Inc. All rights reserved.)

Objective: To evaluate a translated version of the Voice Handicap Index (VHI) as a diagnostic tool for people with and without a laryngeal pathology, among Hebrew speakers., Study Design: Parallel group design., Methods: The VHI was translated and adapted to Hebrew. The translated version was, then, administered to a group of 182 patients with various laryngeal pathologies and a control group of 171 people with no laryngeal pathology. Based on the participants' responses to the VHI, statistical analyses were, initially, performed to assess validity and reliability, and then to evaluate group differences between the pathological and control groups and among the different pathological groups included in the study., Results: Statistical analyses showed high reliability values of the Hebrew version of the VHI (overall Cronbach's alpha r = 0.976). Participants' scores were not affected by their age (P = 0.156) or gender (P = 0.261). The participants in the control group obtained significantly lower scores on the overall VHI score, as well as on all three subscale scores, in comparison with the pathological group (P < 0.001). In addition, within the pathological group, patients with neurogenic pathologies received higher scores than all other pathological groups, whereas patients with laryngeal inflammation received lower scores than all other pathological groups (P < 0.05)., Conclusion: The VHI is a powerful tool for quantifying patients' perceptions of their voice handicaps, and it maintained its power across translation. The VHI was shown to be valuable for the assessment of speakers with, as well as without laryngeal pathologies.

Vocal warmup is generally accepted as vital for singing performance. However, only a limited number of studies have evaluated this effect quantitatively. In this study, we evaluated the effect of vocal warmup on voice production, among young female singers, using a set of acoustic parameters. Warmup reduced frequency-perturbation (p < 0.001) and amplitude-perturbation values (p < 0.05). In addition, warmup increased singer's formant amplitude (p < 0.05) and improved noise-to-harmonic ratio (p < 0.05). Tone-matching accuracy, however, was not affected by warmup. The effect of vocal warmup on frequency-perturbation parameters was more evident among mezzo-soprano singers than it was among soprano singers. It was also more evident in the low pitch-range than in the higher pitch-ranges (p < 0.05). The results of this study provide valid support for the advantageous effect of vocal warmup on voice quality and present acoustic analysis as a valuable and sensitive tool for quantifying this effect.

Most studies investigating the effect of sex hormones on the larynx and vocal folds focused on the voice quality of women either around menopause or during the menstrual cycle. To our knowledge, however, there have been no studies that investigated the effect of oral contraceptives on the female voice. In the present study five women who ingest oral contraceptives (pill group) and five women who do not (natural group) were recorded producing the vowels /i/ and /a/ repeatedly over a period of 40 days. Acoustic analyses were performed on these recordings including F0, amplitude, jitter, shimmer, and harmonic-to-noise ratio (HNR). Results indicated that jitter and shimmer values of the pill group were significantly lower than those of the natural group. No group differences were found for F0, amplitude, or HNR. In addition, the pill group demonstrated significantly smaller variance for all variables tested. The results suggest that oral contraceptives might increase voice stability associated with smaller hormonal changes. Thus the present study provides preliminary evidence of the effect of oral contraceptives on the female voice.