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Objectives: Characterization of psychotherapy as the "talking cure" de‐emphasizes the importance of an active listener on the curative effect of talking. We test whether the working alliance and its benefits emerge from expression of voice, per se, or whether active listening is needed. We examine the role of listening in a social identity model of working alliance. Methods: University student participants in a laboratory experiment spoke about stress management to another person (a confederate student) who either did or did not engage in active listening. Participants reported their perceptions of alliance, key social‐psychological variables, and well‐being. Results: Active listening led to significantly higher ratings of alliance, procedural justice, social identification, and identity leadership, compared to no active listening. Active listening also led to greater positive affect and satisfaction. Ultimately, an explanatory path model was supported in which active listening predicted working alliance through social identification, identity leadership, and procedural justice. Conclusions: Listening quality enhances alliance and well‐being in a manner consistent with a social identity model of working alliance, and is a strategy for facilitating alliance in therapy. [ABSTRACT FROM AUTHOR]

Objectives: Vocal process granuloma (VPG) is a chronic condition resulting from a mucoperichondrial injury of vocal process. Initial conservative treatment typically involves vocal hygiene education and antireflux medication. Treatment challenges arise with refractory cases. Outcomes of second‐line treatments such as surgical excision and botulinum toxin injections remain inconsistent. Thus, we propose this study to investigate the effectiveness of intralesional steroid injections for refractory VPG. Methods: We conducted a retrospective review of 23 patients with VPG who showed no improvement after 3 months of proton pump inhibitors. These patients underwent one to three courses of monthly in‐office intralesional steroid injections as a second‐line therapy. Treatment outcomes were evaluated by measuring the size of the VPG relative to the length of the vocal folds before and after the final injection procedure. Results: Results showed a significant reduction in VPG size from baseline of 27.74 ± 15.06 to 5.48 ± 8.95 (p <.001). 15 out of 23 patients were responsive (size reduction ≥ 75%) to intralesional steroid injection. Alcohol consumption and longer symptom duration were associated with a poor response (size reduction <75%), whereas prior intubation was associated with better response. Conclusions: For refractory VPG not responding to conservative treatment, intralesional steroid injection appears to be a promising alternative option without significant adverse effects. [ABSTRACT FROM AUTHOR]

In a context where more than 40% of LGBTQIA+ individuals in the UK are estimated to avoid sports due to experiences of discrimination, with disengagement closely linked to negative experiences during physical education at school, the ability of specifically LGBTQIA+‐oriented sports clubs to buck this trend and create vibrant inclusive sporting communities across the country warrants both celebration and investigation. Safer, a new play centred on the experiences of the recently formed Hull Roundheads ‘gay and inclusive’ rugby club, has been part of such an investigation led by a creative research team at the University of Hull (England) since 2022. This paper reports on the use of Safer and Applied Drama workshops in schools and colleges in the Hull and Humber region as a highly effective means of amplifying the voices of LGBTQIA+ youth and supporting educational environments in improving their understanding and capacity to be inclusive in sports settings and beyond. [ABSTRACT FROM AUTHOR]

Background Objectives Methods Expected results WHAT THIS PAPER ADDS What is already known on the subject What this paper adds to the existing knowledge What are the potential or actual clinical implications of this work? Although psychological factors have been implicated in patients with functional dysphonia (FD), conventional voice therapy (CVT) typically targets the aberrant voice symptoms exclusively. Yet, CVT is not always successful, and in view of the significant adverse quality of life impact combined with the financial burden on the healthcare system and society, research is needed to elucidate the underlying psychophysiology of FD and improve treatment outcomes.The first objective of this research project is to compare the occurrence and frequency of symptoms and/or disorders related to autonomic nervous system (ANS) dysfunction in patients with FD with gender‐ and age‐matched vocally healthy controls, using a case‐control study. The second objective is to compare the effects of a novel therapy for FD based on ANS regulation (i.e., ANS therapy: heart rate variability (HRV) biofeedback) on both autonomic function and voice function versus CVT alone or in combination with ANS therapy (i.e., ANS therapy + CVT), using a randomized controlled trial (RCT).Case‐control study: Autonomic (dys)function of patients with FD will be compared with gender‐ and age‐matched vocally healthy controls, using both physiological measures (e.g., HRV, skin conductance level) and psychological patient‐reported outcome measures (PROMs, e.g., Neuroception of Psychological Safety Scale, Depression Anxiety and Stress Scale). RCT: The FD group will be randomly assigned to the innovative ANS therapy group, the CVT group or the ANS therapy + CVT group. All patients received 1 month of treatment with 20 min of daily practice. Both the autonomic assessment and the voice assessment will be performed pretherapy and immediately after therapy by assessors blinded to group allocation and study phase.Higher occurrences of symptoms and/or disorders related to autonomic dysfunction are expected in patients with FD compared with vocally healthy controls. Physiological outcomes: lower HRV, lower cardiac pre‐ejection period, higher respiration rate and higher skin conductance level are hypothesized in patients with FD compared with vocally healthy controls. Psychological PROMs: higher self‐report of feelings/symptoms related to autonomic dysfunction (e.g., perceived stress, anxiety) is expected in patients with FD compared with vocally healthy controls. The autonomic function is hypothesized to improve more after the ANS therapy and the ANS therapy + CVT compared with the CVT only. Voice function is expected to improve more after the ANS therapy + CVT compared with the ANS therapy and the CVT alone. Autonomic dysfunction is well recognized in the field of psychology but remains understudied in the area of voice. Given that the vagus nerve, innervating the larynx, also helps to regulate the ANS, and psychological symptoms commonly observed in patients with FD may reflect ANS dysregulation, research in this area is needed. There is some preliminary evidence that autonomic dysfunction might indeed be associated with FD. However, physiological ANS measures are needed, as well as validated psychological PROMs. The first objective of this study is to investigate the occurrence and frequency of symptoms and/or disorders related to autonomic dysfunction in patients with FD as compared with a gender‐ and age‐matched vocally healthy control group. Autonomic (dys)function will be determined by employing both physiological measures (e.g., HRV, skin conductance level) and psychological PROMs (e.g., Neuroception of Psychological Safety Scale, Depression Anxiety and Stress Scale). The second objective is to compare the effects of a novel therapy for FD based on ANS regulation (HRV biofeedback) versus CVT alone or in combination with ANS therapy. Success rates of symptomatic CVT for FD are highly variable. This study is expected to lead to innovative results related to the pathogenesis and psychophysiology of FD, a prevalent voice disorder associated with a significant adverse quality of life impact and a substantial financial burden on the healthcare system and society. The results of this study will lead to crucial new insights into both the diagnosis and treatment of FD, contributing to evidence‐based practice in the field of voice. [ABSTRACT FROM AUTHOR]

This paper draws from our own experiences of sexism within Business Schools to bring attention to the effects of the operation of a highly masculinized, white, cis‐gendered, and patriarchal culture, whether enacted by men or women, and to how we come to be silenced within it. Our work reflects on intersectional issues of race, health (mental and physical), and care‐work, using faction built from six paired interviews to tell a truth we feel unable to tell individually. This piece highlights the real fear of repercussions that still persist for female academics, and uses the acts of collecting data and writing differently to offer the authors a safe space in which to resist both overt and structural sexism in Business Schools. It highlights the need to take seriously those subtleties of sexism that we are often expected to put up with, those difficult‐to‐name aspects of our working lives that leave us feeling it would be "silly" to complain and act as a form of micro‐coercive control over our lives. We operationalize our collective voice as a form of activism in the academy that is situated within our individual silences. [ABSTRACT FROM AUTHOR]

Background: Communication is a key tool in the nursing profession. It is known that listeners are sensitive to the speaker's voice and interpret the speaker's intentions primarily from the non‐verbal signal conveyed. Aim: To map and discuss the current state of knowledge and research evidence on professional voice use in health and nursing care. Design and Method: A scoping review adherent to the EQUATOR guidelines PRISMA‐ScR. Data Sources: Searches in the EBSCO, CINAHL, Medline, PubMed, PsychInfo and PsycArticles databases were conducted between 1 and 28 February 2023. Results: According to the data (n = 23), health professionals use voice as a vital aspect of caring communication and caring relationships, and in leadership as well as inter‐professional collaboration, to facilitate information exchange and understanding and promote shared decision‐making. The data showed that there is also a rising tendency to explore vocal demands and problems among health professionals. No studies were found on the use of voice in digital health and nursing care services or by social robots. Most of the reviewed studies were cross‐sectional, rather small, and focused primarily on the perspectives of healthcare professionals. Conclusion: The use of voice should be explored as a vital aspect of caring communication and caring relationships from the patients' perspective, and the effects of voice use on listeners' emotions and actions should be examined in different contexts with modern, voice‐specific data collection methods. Studies focusing on voice use in digital health care and by social robots are also needed. By integrating training programmes, education and technological innovations, health care can leverage the full potential of voice‐based communication to promote a more coordinated and patient‐centred care environment, true inter‐professional collaboration and effective leadership. Impact: Professional voice use is an essential part of all health and nursing care and an impressive method that should be used consciously. Therefore, the meaning and methods of voice use, including speech accommodation, should be systematically introduced into health and nursing care and included in nursing education. [ABSTRACT FROM AUTHOR]

Background: Transitions into adult services for young people with complex communication needs are often experienced as challenging and rarely include the voices of young people. Methods: We piloted a person‐centred method to enable one young person's (Dominic) voice to be included in his transition to adult services. An 'I am' Digital Story is a short video (c.6 min) that provides a strengths‐based representation of a young person that is designed to be shared with and between settings. The process and outcomes of story cocreation were evaluated through semi‐structured interviews with key stakeholders. Findings: The process of story creation was evaluated very positively by key stakeholders. The information about Dominic's strengths and preferences helped the new setting to prepare for Dominic's arrival. Conclusions: The 'I am' Digital Story method provides a powerful and accessible method for including the voices of young people with complex communication needs in their transitions. Accessible summary: Young people and their families say it can be hard moving from school to adult services. We think young people with complex communication needs should be part of planning for this move.Often, young people with complex communication needs are not part of planning for this move. We have tried a new way for them to be part of the planning. It is called an 'I am' Digital Story.We created an 'I am' Digital Story with Dominic, his mother, his teacher and his speech and language therapist. They told the story of who Dominic is. The story tells people what Dominic likes doing and what Dominic is good at. The story helps people get to know Dominic, even if they cannot meet Dominic.We asked questions after to see if the Digital Story was a good idea. The people who made the Digital Story said it was easy to make the video. The people in adult services said it was a big help to watch the video. We are happy because the Digital Story made Dominic part of planning his move from school to adult services. [ABSTRACT FROM AUTHOR]

ABSTRACT Mate choice, and sex differences in romantic behaviours, represented one of the first major applications of evolutionary biology to human behaviour. This paper reviews Darwinian approaches to heterosexual mate assessment based on physical characteristics, placing the literature in its historical context (1871–1979), before turning (predominantly) to psychological research on attractiveness judgements based on physical characteristics. Attractiveness is consistently inferred across multiple modalities, with biological theories explaining why we differentiate certain individuals, on average, from others. Simultaneously, it is a judgement that varies systematically in light of our own traits, environment, and experiences. Over 30 years of research has generated robust effects alongside reasons to be humble in our lack of understanding of the precise physiological mechanisms involved in mate assessment. This review concludes with three questions to focus attention in further research, and proposes that our romantic preferences still provide a critical window into the evolution of human sexuality. [ABSTRACT FROM AUTHOR]

Many people dislike the sound of their voices, especially when listening back to audio recordings (voice confrontation). Previous research reports that disliking the sound of one's voice is associated with elevated levels of social anxiety. The present study investigated the relationship between social anxiety and voice dislike and voice misrecognition among a bilingual population: Arabic (L1) and English (L2). Participants (N = 176) completed self‐report measures of social anxiety and own voice liking. Additionally, they performed a novel own voice recognition task, assessing their ability to recognise a recording of their voice, differentiating it from digitally altered versions of the same recording. Social anxiety symptomatology was associated with disliking the sound of one's voice, with a larger effect for L1 than L2. Social anxiety was also associated with own voice misrecognition, but only for L1. Highly negative evaluations about the sound of one's voice may represent a vulnerability for social anxiety disorder. [ABSTRACT FROM AUTHOR]

Purpose Method Results Conclusion WHAT THIS PAPER ADDS What is already known on this subject What this paper adds to existing knowledge What are the clinical implications of this work? This study was designed based on the need to verify the effectiveness of education in the vocology area concerning refining perceptual auditory skills. The purpose of the project described in this paper was to examine the effect of knowledge and skills training during a 2‐week voice disorders graduate course on auditory‐perceptual skills of pre‐professional speech‐language pathologists. The training effect was evaluated by comparing pre‐ and post‐course results of ratings of voice quality using auditory‐perceptual measures.A cohort of 24 graduate students in speech‐language pathology participated in this study. Each student rated a total of 24 voice samples of typical and disordered voice quality from a database using Consensus Auditory‐Perceptual Evaluation of Voice (CAPE‐V). The same voice samples were rated before and after the training, in randomised order. The speakers ranged in age from 35 to 80 years; 16 identified as females and 8 as males. A total of 16 samples were associated with various degrees of dysphonia of organic and functional aetiologies; the remaining 8 voice samples included in the study were classified as normal. The training involved different components including knowledge and auditory‐perceptual skills as part of a voice class offered as an intensive 2‐week course with daily blocks of 4 h sessions. Exploratory comparisons of results to objective outcomes were conducted through comparisons with computer‐generated indicators of the Cepstral Spectral Index of Dysphonia (CSID), a component of the Analysis of Dysphonia in Speech and Voice (ADSV) software from Pentax for capturing the CSID.There was a significant increase in ratings of roughness, breathiness, loudness, pitch and overall severity after the course. Furthermore, there was a significant increase in the intra‐ and interrater reliability post training. Statistically significant positive indications were found in correlations between mean perceptual ratings and the acoustic measure of CSID. Reliability of data was measured by using Pearson's correlations. Intrarater reliability resulted in values of ≥0.90 in all parameters. Similar findings were demonstrated by intraclass coefficients used to estimate interrater consistency: all values were >0.90 but in the Loudness parameter [r (22) = 0.60].Effectiveness of the training in improving the auditory perceptual skills of students was based on the increased reliability of ratings. Indications of successful implementation and outcomes on auditory‐perpetual training procedures in classroom environments will support the development of effective educational methods, which will in turn lead to increased efficacy of service delivery in voice disorders. The effects of training on perceptual assessment performance have been indicated in the literature. Past evidence has demonstrated that various types of training produce a significant impact on auditory perceptual skills. Although dedicated research has been advancing over the past decade, further aspects of auditory‐perceptual reliable assessment include queries about specific training approaches, optimal duration, and interval time for recalibration. While past research suggests that increased exposure in identifying voice characteristics impacts assessment skills, there are limited published data on the relationship of knowledge and skill in association with teaching and learning environments, particularly at the pre‐professional stage. Practical data from actual classroom application constitute an ideal scenario for inspecting effectiveness of graduate training in voice disorders involving acquiring knowledge and applied skills, including auditory‐perceptual voice evaluation. This study is an attempt to expand on previous literature, particularly by examining effects of auditory‐perceptual skills training in graduate students following teaching and learning in a systematic 2‐week voice disorders course. Outcomes indicative of successful training procedures in a classroom environment will support the development of effective educational methods to increase efficacy of service delivery in voice disorders. [ABSTRACT FROM AUTHOR]

In the wake of rising energy prices and the cost of living crisis, some have claimed that climate policies are at odds with citizens' more pressing everyday living concerns. Critics challenge these simplifying narratives that shorter term economic and social wellbeing priorities and ‘longer term’ decarbonization policies are in tension with one another and argue that effective policies must treat them as interconnected. Evidence regarding how citizens think about climate policy mostly focus on policy acceptability, highlighting the role of perceptions of effectiveness and fairness, but there is a quite limited conceptualization of contexts of social inequality, and even more limited engagement with the views of marginalized groups whose buy‐in is seen as crucial for effective net zero transitions. This paper reviews the evidence and analyses new data from a small exploratory study with citizens from low income and marginalized backgrounds. In group discussions several participants emphasized the importance of tackling both social hardships and climate priorities, seen by some as interlinked. Further, many described wider societal unfairness relating to experiences of poverty, exploitation, a lack of voice or even recognition and a keen sense of disconnect between politics and their own everyday concerns and lived experiences. I argue that climate policy making should engage more fully with contexts of social inequality and that social wellbeing and systematic action on climate change need to be treated by policy makers and politicians as profoundly interlinked challenges. [ABSTRACT FROM AUTHOR]

Idiomatic expressions are not just neutral equivalents of their literal counterparts, but exert some sort of evaluative force. This study employed the appraisal system (AS) to explore the functions of idiomatic expressions and their variations in English as a lingua franca context, and to compare different academic domains in terms of use of evaluative language in the form of idiomatic expressions. To this end, the corpus of English as a lingua franca in academic settings and the Vienna–Oxford International Corpus of English were searched for idiom tokens through whole‐phrase and keyword search. The idioms and their variations were classified based on the AS. The findings indicated that social and behavioral scientific texts included higher proportions of evaluative idiomatic expressions whereas medical and natural scientific texts generated lower percentages of appraisal idioms. There was a stronger tendency in both corpora toward using idioms as appreciation as compared to judgment and affect. Given the employed methodology, the AS could not be applied to some idioms for their compositionality nature. [ABSTRACT FROM AUTHOR]

Introduction: It was reported that voice can carry information about personality and psychological distress. In the current study, the relationship between five‐factor personality traits and psychological distress with voice was enlightened from diverse aspects. Methods: A total of 119 participants (55 with and 64 without dysphonia) sustained vowels /a/ and /i/, read six standard sentences, and answered a question. Three raters auditory–perceptually evaluated the vocal samples using the Persian version of CAPE‐V. The participants were distributed into four groups (vocally healthy, mild, moderate, and severe dysphonia). They completed two questionnaires: NEO Five‐Factor Inventory (NEO‐FFI) and Depression, Anxiety, and Stress Scale‐21. Results: Results showed that the conscientiousness (U = 1146.500, z = −3.27, p =.001) in the dysphonia group was significantly less than the vocally healthy group. Depression (U = 1381.000, z = −2.03, p =.042) and anxiety (U = 1181.000, z = −3.10, p =.002) in the dysphonia group were significantly higher than in the vocally healthy group. In comparing different abnormal overall voice qualities, the mild dysphonia group revealed significantly lower conscientiousness (p =.001) and significantly higher anxiety (p =.002) relative to the vocally healthy group. Conclusions: Findings indicated that the conscientiousness trait could play an influential role in persons with dysphonia and its psychological status. The voice care team should consider conscientiousness and psychological distress during the assessment and treatment of dysphonic patients. [ABSTRACT FROM AUTHOR]

Purpose: To establish normative values for the OMNI‐Vocal Effort Scale (VES) in healthy adults without voice complaints. Secondary objective is to determine if there are differences in perceived vocal effort across age groups and between sexes. Study Design: Prospective data collection across groups. Method: A nine‐item survey was administered by speech‐language pathologists with specialization in voice to consenting adults 18 years or older. Participants underwent an auditory perceptual evaluation of voice and answered questions regarding age, history of voice problems, history of voice surgery, smoking history and hearing loss. Participants were instructed to rate their perceived vocal effort in conversational speech using the OMNI‐VES. Multivariant analysis was conducted. Results: Two hundred and fifty‐one participants were recruited. The majority of adults without voice complaints reported that producing conversational voice was within the "extremely easy" to "easy" range, 0–3 (92.4%). Conclusions: This study provides preliminary data for perceived vocal effort. The OMNI‐VES may be a useful tool in understanding changes in perceived vocal effort as a result of treatment for voice disorders. Further normative data are needed between sexes, across the gender spectrum, and older adult populations. Future directions include examining the magnitude of difference between numeric values on the scale and use of the scale with other dysphonic populations. Level of Evidence: 3 Laryngoscope, 134:3726–3731, 2024 [ABSTRACT FROM AUTHOR]

Objective: To estimate the current prevalence of voice disorders among adults in the United States; to determine the association of individual factors with voice disorders. Methods: The 2022 National Health Interview Survey (NHIS) was analyzed to identify adults reporting voice problems in the past 12 months. Demographics were assessed, as well as the duration, severity, and resolution of the voice problem. The relationship between voice problems, gender, lost workdays, and long COVID was investigated. A comparison to the 2012 NHIS was made to determine changes in voice disorder prevalence. Results: 29.9 million Americans (95%CI[28.3–31.5]) annually report a voice problem, representing 12.2% of the population (95%CI[11.7–12.8%]). Overall, 26.8% and 13.2% reported the severity of their voice problem as moderate or severe, respectively. Only 5.1% (95%CI[4.3–6.0%]) of respondents sought treatment. Most voice problems were resolved within 1 week (53.0%,95%CI[50.9–55.1%]). Females were more likely than males to report a voice problem (14.4% vs. 10.0%,95%CI[13.7–15.1] and [9.3–10.7], respectively). The 17.6 million Americans with long COVID symptoms were more likely to have voice complaints than those without (21.1% vs. 11.6%,95%CI[18.9–23.5%] and [11.1–12.1%], respectively). Lost workdays were not significantly higher for those with voice disorders compared to those without (17.1 vs. 12.9 days,95%CI[12.0–22.1] and [11.0–14.8], respectively). Conclusions: Voice problems affect approximately 1 in 8 adults in the U.S. annually, demonstrating an alarming increased prevalence since 2012 using the same survey methodology. Relatively few individuals seek care for their voice problem, despite significant self‐reported impact. Further study is required regarding the impact of COVID and changes in voice use patterns on voice disorders. Level of Evidence: 3 Laryngoscope, 134:3713–3718, 2024 [ABSTRACT FROM AUTHOR]

Objectives: To describe the speech and hearing abilities of Erastus "Deaf" Smith, the first Texas Ranger, and speculate on the etiology of his hearing loss. Methods: Review of credible historical data of what Erastus could and could not hear, descriptions of his voice, and loudness tolerance. Modern analysis of acoustical physics data generated by 0.69‐inch diameter non‐spinning musket balls. Results: The onset of Erastus' bilateral hearing loss was early childhood. He could hear some. He was intolerant of very loud sounds. His speech was "weak", "squeaky" and high‐pitched. He did not use manual communication. He could not hear musket balls passing near his head. The frequency of sound generated by flying 0.69‐inch diameter musket balls has been determined as predominantly in the range of 2000–2500 Hz. In contrast to most bilateral childhood sensorineural hearing losses that are worse in high and mid frequencies, Erastus' hearing loss was worse in the low and mid frequencies – preserving at least some high‐frequency hearing. Conclusion: Erastus' reverse‐slope hearing problem may well have been attributable to incomplete partition type III. If you can't hear it, you can't speak it. Level of Evidence: NA Laryngoscope, 134:3532–3536, 2024 [ABSTRACT FROM AUTHOR]

Gay men who believe to sound 'gay' expect to be discriminated against because of their voices and gay‐sounding men are discriminated against in the hiring process. We examined whether uttering an agency‐based message decreased discrimination expectancy and enactment. In Study 1a (N = 256; gay and bisexual men) and Study 1b (N = 216; gay men), speakers uttered agentic (vs. neutral) messages. We assessed their self‐perception as gay sounding, agency self‐attribution and discrimination expectancy. Uttering agentic (vs. neutral) messages made the speakers self‐perceive as more agentic and this decreased discrimination expectancy. Additionally, self‐perception as gay sounding predicted discrimination expectancy. In Study 2 (N = 466), heterosexual participants listened to gay‐ and straight‐sounding speakers uttering either neutral or agentic messages and rated them in terms of agency and employability. Gay‐sounding speakers uttering agentic messages were less likely to be discriminated against than when uttering neutral messages. Results show the positive impact of linguistic strategies involving agentic messages to reduce discrimination expectancy and hiring biases. [ABSTRACT FROM AUTHOR]

Moderating the intensity and expression of our emotions is necessary for successful engagement in learning. This systematic review explored, "what are schools doing to support autistic children and young people to develop their emotion regulation skills?" Critical analyses considered the inclusiveness of interventions and whether/how autistic pupils were asked about their participation. PsycINFO, Web of Science (Core Collection) and ERIC were searched on 18 July 2022. Eight studies were included, incorporating 419 autistic pupils, aged three to 17, from at least 955 schools in the USA, Australia and France. A narrative synthesis was used to provide an overview of the literature. Seven different approaches to emotion regulation were utilised, and only one was used in the school prior to the research. Forty out of 419 autistic pupils were asked for their views of the intervention they received. There is a lack of research considering school‐led approaches to embedding emotion regulation skill development in everyday school practices and a lack of involvement of autistic pupil's views about emotion‐regulation interventions. More research is needed to enable educational professionals to provide evidence‐informed support for autistic pupils to develop their emotion regulation skills. [ABSTRACT FROM AUTHOR]

This article is different. Original testimonies are reproduced, in full, from three autistic adults who reflect on their education experiences. These accounts evolved from a webinar which explored autistic 'voice' through research presentations and lived experiences, and this co‐authored article seeks to communicate these reflections to a wider audience. The testimonies are brought together, interpreted and analysed through the lens of the social model of disability exposing the ableist systems in which these adults had to operate. All share the challenge of trying to fit in to a socially, neuronormatively constructed education system, experiencing marginalisation, lack of understanding and lack of appropriate support. However, all three writers emerge as more than 'sea‐glass survivors', weathered and worn, having developed survival strategies, but demonstrate their determination to improve lives for those who follow in their wake. This article draws attention to the need to listen to autistic people more frequently, but more importantly to involve them as architects of change for the future. The article was co‐created by three autistic people, who identify as neurodivergent, in discussion and collaboration with the lead author who is an autism ally, autism and education researcher, and parent to an autistic son. [ABSTRACT FROM AUTHOR]

Wolves howl and dogs bark, both are able to produce variants of either vocalization, but we see a distinct difference in usage between wild and domesticate. Other domesticates also show distinct changes to their vocal output: domestic cats retain meows, a distinctly subadult trait in wildcats. Such differences in acoustic output are well‐known, but the causal mechanisms remain little‐studied. Potential links between domestication and vocal output are intriguing for multiple reasons, and offer a unique opportunity to explore a prominent hypothesis in domestication research: the neural crest/domestication syndrome hypothesis. This hypothesis suggests that in the early stages of domestication, selection for tame individuals decreased neural crest cell (NCCs) proliferation and migration, which led to a downregulation of the sympathetic arousal system, and hence reduced fear and reactive aggression. NCCs are a transitory stem cell population crucial during embryonic development that tie to diverse tissue types and organ systems. One of these neural‐crest derived systems is the larynx, the main vocal source in mammals. We argue that this connection between NCCs and the larynx provides a powerful test of the predictions of the neural crest/domestication syndrome hypothesis, discriminating its predictions from those of other current hypotheses concerning domestication. Research highlights: We outline the developmental link between the larynx and the neural crest. This connection provides a powerful test of the predictions of the most prominent hypothesis in domestication research, the neural crest domestication syndrome hypothesis. [ABSTRACT FROM AUTHOR]

Objective: Adenotonsillectomy is one of the most common surgical procedures performed on children. Caregivers are often concerned about voice change after the procedure, and such concerns remain unsettled. This meta‐analysis analyzed voice change in children after adenotonsillectomy. Data Sources: The PubMed, Medline, EMBASE, and Cochrane databases. Review Methods: The study protocol was registered on PROSPERO. Two authors independently searched for articles using keywords "adenoidectomy," "tonsillectomy, "voice," "nasalance,"and "speech." English articles specifying voice changes after adenotonsillectomy were pooled with standardized mean difference (SMD) using random‐effects model. Evaluation methods were computerized acoustic voice analysis, aerodynamic analysis, nasometer, rhinomanometry, evaluations from a speech‐language pathologist or otolaryngologist, and a caregiver assessment questionnaire. Results: Twenty‐three studies with 2154 children were analyzed (mean age: 8.0 y; 58% boys; mean sample size: 94 children). Due to insufficient data for other outcome variables, this meta‐analysis only summarized changes in the computerized acoustic voice analysis 1 month and 3 months after surgery. The computerized acoustic analysis revealed significant changes in jitter (SMD = −0.36; 95% confidence interval [CI]: −0.60 to −0.11), shimmer (SMD = −0.34; 95% CI: −0.57 to −0.11), and soft phonation index (SMD = −0.36; 95% CI: −0.57 to −0.15) at 1 month after surgery. Parameters including fundamental frequency, jitter, noise‐to‐harmonics ratio, and shimmer were not significantly changed at 3 months after surgery. Conclusions: This meta‐analysis observed small improvements in jitter, shimmer, and soft phonation index 1 month after surgery. No significant effects were observed in voice outcomes 3 months after surgery. Laryngoscope, 134:2538–2550, 2024 [ABSTRACT FROM AUTHOR]

This paper explores the politics and praxis of ‘youth voice assemblages’ in an exploratory and pARTicipatory research project where 125 young people (aged 11–18) from England, Scotland and Wales shared what and how they are learning about relationships, sex and sexuality. Creative methods enabled us to ‘attune’ to this learning and generate ‘darta’ (arts‐based data). We then ‘animated’ these darta as dartaphacts (creative objects) including films, poetry and education cards. Finally, we ‘amplified’ these dartaphacts in a face‐to‐face launch event. We argue that a creative ontology of ‘youth voice’ is imperative to develop more relevant, responsive and ethical sexuality and relationships education. [ABSTRACT FROM AUTHOR]

This article investigates three key moments from a sequence of learning facilitated within a Singapore preschool. Delivered as part of a wider study aimed at identifying the value of dramatic pedagogies for developing young children's global competence, the learning sequence was facilitated by the researcher—an experienced early childhood drama educator. The learning experiences were designed to be responsive to the children's interests and ideas, with an emphasis on ensuring their active participation and agency. Analysis of the data was supported using the 2018 Organisation for Economic Co‐operation and Development Global Competence Framework and the Elements of Drama model. Despite limitations such as the small sample size, the findings suggest that for these children, dramatic pedagogies were effective in providing opportunities for engagement with the complex ideas associated with global competence and sustainable development. However, analysis also reveals that in order to be effective, careful management of the elements of drama is required. The article concludes by outlining implications for educators and public policy‐makers interested in identifying pedagogies suitable for developing young children's global competence and supporting their awareness of the importance of sustainable development. [ABSTRACT FROM AUTHOR]

Objectives: Airway reconstruction for laryngo tracheal stenosis (LTS) improves dyspnoea. There is little evidence relating to impact upon voice and swallowing. We explored voice and swallowing outcomes in adults with LTS before and after reconstructive surgery. Design: Outcome measures were collected pre‐reconstructive surgery, two‐weeks post‐surgery and up to 4‐6 months post‐surgery. Setting: Tertiary referral centre. Participants: With ethical approval, twenty consecutive adult (≥18 years) LTS patients undergoing airway reconstruction were prospectively recruited. Main outcome measures: These included physiological values (maximum phonation time (MPT) and fundamental frequency; penetration aspiration score, residue score), clinician‐reported (GRBAS, functional oral intake score, 100ml Water Swallow Test) and patient‐reported outcomes (Voice Handicap Index‐10, Reflux Symptoms Index, Eating Assessment Tool, Dysphagia Handicap Index). Results: The observational study identified patient‐reported and clinician‐reported voice and swallow difficulties pre‐ and post‐surgery; median and interquartile range are reported at each time point: Voice Handicap Index‐10 23 (8‐31); 20.5 (9‐33.5), 24.5 (12.5‐29); Dysphagia Handicap Index 9 (0‐37); 13 (7‐44); 15 (4‐34); GRBAS grade 1(1‐2); 2 (1‐2.5); 2(1‐2); 100ml Water Swallow Test volume score 16.7 (11.1‐20); 14.3 (12.5‐16.7); 16.7 (14.3‐20.0); 100ml Water Swallow Test capacity score 16.3 ± 9.0; 11.0 ± 4.1; 12.5 ± 2.6. Conclusions: We present the first prospective data on voice and swallowing outcomes in adults with LTS before and after reconstructive surgery. The variability of the outcomes was higher than expected but importantly, for many the voice and swallow outcomes were not within normal limits before surgery. The clinical value of the study demonstrates the need for individual assessment and management of LTS patients' voice and swallowing. [ABSTRACT FROM AUTHOR]

Background: Undertaking voice and communication training is an important part of the gender‐affirming journey for many trans, gender‐diverse and non‐binary individuals. Training supports the alignment of voice with gender identity helping to reduce gender dysphoria as individuals are better able to connect with their voices. However, for training to be effective, regular practice is needed and the demands of training can often be difficult to meet. Aims: To investigate the interest, attitudes and perspectives on the use of immersive virtual reality (VR) to support gender‐affirming voice and communication training by transgender, gender non‐binary and gender‐diverse people, and speech–language pathologists providing gender‐affirming voice and communication training. Methods & Procedures: A mixed‐methods survey (i.e., collecting quantitative data through multiple‐choice question and qualitative data through free text questions) was hosted online from 23 August to 21 September 2021. A total of 17 questions asked about technology use, and attitudes and perspectives towards VR. The survey included video examples of three different voice‐activated VR applications to prompt participant responses about the technology. Outcomes & Results: A total of 70 survey responses were included in the analysis. All participants had previous experience using smart phones, but only 27.2% had previously used VR. Four key themes were identified relating to potential uptake of VR in gender‐affirming voice and communication training: (1) general audience appeal, (2) perceived therapeutic value, (3) exposure to or protection from harm and (4) relatability to real life. Conclusions & Implications: VR games may represent a viable option to support practice of voice exercises. Gamification through VR is likely to motivate some to increase frequency of practice. VR applications that are used in voice training need to be fit‐for‐purpose, and detailed co‐design is necessary to build appropriate applications for future use. This study provides a foundation to inform the design, development and implementation of VR applications to be used in gender‐affirming voice training. WHAT THIS PAPER ADDS: What is already known on the subject?: Speech–language pathologists work closely with transgender and gender‐diverse individuals to help them achieve gender congruent voice and communication. Clients need to undertake regular and ongoing practice outside of training sessions to achieve and maintain their ideal voice. Motivation and adherence to regular practice sessions remain an ongoing challenge. What this study adds to the existing knowledge: This study explores the use of immersive VR technologies to create safe, motivating and enjoyable environments to encourage regular practice of gender‐affirming voice and communication exercises. It engages stakeholders in an early‐stage participant‐involved design to gauge interest in, and perspectives on, VR and technology‐based training support tools. The results suggest that voice‐activated VR applications would highly motivate some individuals if they were appropriately designed but would not be ideal for all. What are the actual and clinical implications of this work?: Immersion in VR can be a highly motivating tool to enhance adherence to practice schedules for some individuals. However, tools need to be specifically designed with outcomes in mind to be fit‐for‐purpose, to support individual goals and to minimize the risk of harm. The few existing VR voice‐activated applications that are available require further assessment, and redesign through co‐design with users to functionally and safely support gender‐affirming voice and communication training. [ABSTRACT FROM AUTHOR]

Firms and their managers have long been concerned with encouraging customers to take on an active role in their marketing research activities. The critical question for these firms is how to foster collaboration with customers in marketing research to enhance the firm's marketing effectiveness and simultaneously benefit the customers. This study focuses on the role that individuals' cultural values and customer voice potentially play in shaping how customers perceive marketing research cooperation with the firm. We analyzed data from a sample of 270 customers of apparel store brands in an African country. Utilizing fuzzy‐set qualitative comparative analysis, our research reveals that the combinations of antecedent conditions that enhance marketing research cooperation significantly differ from those that impede it. Theoretically and managerially, our study expands the understanding of how marketing research cooperation is contingent upon the combination of customers' cultural values and their voice. [ABSTRACT FROM AUTHOR]

Humanoid robots can serve as in‐store communication medium, providing functional as well as hedonic value. Previous studies have demonstrated their proficiency in providing functional value, such as guiding customers, advertising products, or carrying groceries. However, in a retailing context, engaging customers often requires more than meeting their basic functional needs. This study is the first to examine the potential of humanoid service robots (HSRs) in providing hedonic value as well, comparing their performance to that of more traditional in‐store media in entertaining customers. Based on media richness effectiveness theory, the role of robot voice is also investigated. An experimental field study was performed administering a fun quiz to passers‐by at an airport store considering three conditions (via tablet, robot with voice, or robot without voice). The results show that the quiz via a humanoid robot (as compared to via a tablet kiosk) provides customers more functional and hedonic value. While functional value favorably affects loyalty intentions mainly via enhanced store image, hedonic value has a direct and indirect effect mainly via store attitude. Adding voice to the HSR does not seem to provide significant added value. Data on actual purchase behavior also hint at superiority of the robot over a traditional tablet kiosk. [ABSTRACT FROM AUTHOR]

Rapid maxillary expansion (RME) may change speech sound parameters due to the enlargement of oral and nasal cavities. This study aimed to systematically review the current evidence on speech changes as a side effect of RME. An electronic search was conducted in nine databases, and two of them accessed the 'grey literature'. The eligibility criteria included clinical studies assessing orthodontic patients with maxillary transverse deficiency and the relationship with speech alterations without restricting publication year or language. Only interventional studies were included. The JBI Critical Appraisal Tool assessed the risk of bias. The initial search provided 4853 studies. Seven articles (n = 200 patients) met the inclusion criteria and were analysed. The primary source of bias was the absence of a control group in four studies. RME altered speech production by changing vowel fundamental frequency and fricative phoneme formant frequency. Shimmer and jitter rates changed in one and two studies, respectively. Two studies presented deterioration during orthodontic treatment, but speech improved after appliance removal. Despite the limited evidence, RME affects speech during and after treatment. [ABSTRACT FROM AUTHOR]

Objective: Granular cell tumor of the larynx is an uncommon, typically benign lesion that may be confused for a malignant neoplasm based on histopathology. This review examines cases of granular cell tumor of the larynx in adults to highlight key distinctions in diagnosis/management and demonstrate how misclassification may lead to unnecessary escalations in therapy. Data Sources and Methods: A systematic search of PubMed, Ovid, and EBSCO Search Hosts was completed in December 2021. The search yielded 501 articles with 87 full‐text articles included in the review. Primary search terms included granular cell, tumor, larynx, and adult. Primary endpoints were patient presentation, primary management, pathological features, and disease course. Results: A systematic review of 87 articles identified 200 patients with granular cell tumors (GCTs) of the larynx. Of the 200 patients, 50.3% were males and 49.7% were females. Of these, 54.0% were reported as white patients, and 46.0% were reported as black patients. The most common presenting symptoms were dysphonia (85.9%) and stridor/dyspnea (14.1%). On examination, the lesions were most commonly polypoid/nodular and firm. Pseudoepitheliomatous hyperplasia (PEH) was identified in 33.5% of cases, and 2% of cases were malignant. GCTs were misdiagnosed as other malignant lesions in 11% of cases. In benign cases, 13.5% of patients underwent additional surgeries beyond simple excision/laryngofissure, including laryngectomy and neck dissection. Less than 2% of lesions reoccurred. Conclusion: Granular cell tumors of the larynx are typically benign lesions that may be misdiagnosed with unnecessary escalation of treatment. However, most lesions resolve via primary surgical excision. Laryngoscope, 134:1523–1530, 2024 [ABSTRACT FROM AUTHOR]

Objective: To review the current literature about epidemiology, etiologies and surgical management of bilateral vocal fold paralysis (BVFP). Data Sources: PubMED, Scopus, and Cochrane Library. Review Methods: A systematic review of the literature on epidemiology, etiologies, and management of adult patients with BVFP was conducted through preferred reporting items for systematic reviews and meta‐analyses statements by 2 investigators. Results: Of the 360 identified papers, 245 were screened, and of these 55 were considered for review. The majority (76.6%) of BVFP cases are iatrogenic. BVFP requires immediate tracheotomy in 36.2% of cases. Laterofixation of the vocal fold was described in 9 studies and is a cost‐effective alternative procedure to tracheotomy while awaiting potential recovery. Unilateral and bilateral posterior transverse cordotomy outcomes were reported in 9 and 7 studies, respectively. Both approaches are associated with a 95.1% decannulation rate, adequate airway volume, but voice quality worsening. Unilateral/bilateral partial arytenoidectomy data were described in 4 studies, which reported lower decannulation rate (83%) and better voice quality outcome than cordotomy. Revision rates and complications vary across studies, with complications mainly involving edema, granuloma, fibrosis, and scarring. Selective posterior cricoarytenoid reinnervation is being performed by more surgeons and should be a promising addition to the BVFP surgical armamentarium. Conclusion: Depending on techniques, the management of BVFP may be associated with several degrees of airway improvements while worsened or unchanged voice quality. The heterogeneity between studies, the lack of large‐cohort controlled randomized studies and the confusion with posterior glottic stenosis limit the draw of clear conclusion about the superiority of some techniques over others. [ABSTRACT FROM AUTHOR]

Introduction: Accuracy and validity of voice AI algorithms rely on substantial quality voice data. Although commensurable amounts of voice data are captured daily in voice centers across North America, there is no standardized protocol for acoustic data management, which limits the usability of these datasets for voice artificial intelligence (AI) research. Objective: The aim was to capture current practices of voice data collection, storage, analysis, and perceived limitations to collaborative voice research. Methods: A 30‐question online survey was developed with expert guidance from the voicecollab.ai members, an international collaborative of voice AI researchers. The survey was disseminated via REDCap to an estimated 200 practitioners at North American voice centers. Survey questions assessed respondents' current practices in terms of acoustic data collection, storage, and retrieval as well as limitations to collaborative voice research. Results: Seventy‐two respondents completed the survey of which 81.7% were laryngologists and 18.3% were speech language pathologists (SLPs). Eighteen percent of respondents reported seeing 40%–60% and 55% reported seeing >60 patients with voice disorders weekly (conservative estimate of over 4000 patients/week). Only 28% of respondents reported utilizing standardized protocols for collection and storage of acoustic data. Although, 87% of respondents conduct voice research, only 38% of respondents report doing so on a multi‐institutional level. Perceived limitations to conducting collaborative voice research include lack of standardized methodology for collection (30%) and lack of human resources to prepare and label voice data adequately (55%). Conclusion: To conduct large‐scale multi‐institutional voice research with AI, there is a pertinent need for standardization of acoustic data management, as well as an infrastructure for secure and efficient data sharing. Level of Evidence: 5 Laryngoscope, 134:1333–1339, 2024 [ABSTRACT FROM AUTHOR]

Objective: Voice feminizing surgery is frequently needed for transgender female patients. Among several surgical options, Wendler glottoplasty (WG) and laser reduction glottoplasty (LRG) are two endoscopic procedures. However, because a single procedure may not produce sufficient benefit, the two surgeries may sometimes be sequentially performed. This study was carried out to present the voice results of such sequential surgeries. Methods: This is an individual retrospective cohort study, performed at a tertiary referral center, that is a university hospital. 18 transgender patients were treated with WG initially and then underwent LRG; 17 had LRG first then WG. All 35 cases were performed during a 15‐year period and followed for at least 1 year postoperatively. Voice Handicap Index (VHI‐30), transsexual voice questionnaire (TVQ), and acoustic analysis with /a/ and running speech were obtained pre‐ and postoperatively. Results: VHI and TVQ improved significantly postoperatively (p < 0.05). Their preoperative, first, and second postoperative mean sF0 were 146, 175, and 215 Hz, respectively; these differences were statistically significant (p < 0.001). Their postoperative mean jitter percent, shimmer percent, noise to harmonic ratio (NHR), cepstral peak prominence (CPP), and cepstral spectral index of dysphonia (CSID) worsened significantly compared to preop values (p < 0.05); however, mean postoperative acoustic results were still within normal limits. Patients' self‐ratings of their postsurgery voices revealed all feminine, leading to a patient gratification score of 100%. Conclusion: If transgender female patients are unsatisfied with their voice after WG or LRG, the addition of the alternative procedure may significantly feminize their voice. Sequential WG and LRG is a successful surgical option for voice feminization. Level of Evidence: 4 Laryngoscope, 134:1133–1138, 2024 [ABSTRACT FROM AUTHOR]

People often form first impressions of others based on face and/or voice cues. This study aimed to compare the first impressions formed under these two cues. First, we compared free descriptions based on face and voice cues and found differences in the content and frequency of the personality words. We then compiled three wordlists used for face‐based and voice‐based first impression evaluations separately or simultaneously. Second, using these wordlists, we compared face‐based and voice‐based first impression ratings and found that both had significant intra‐rater and inter‐rater reliability. However, using the mean of the actors' self‐rating and their acquaintance rating as the validity criterion, only the ratings of 'ingenuous' and 'mature' traits in the face‐based first impression evaluation were significantly correlated with the validity criterion. Factor analysis revealed that face‐based first impression had the dimensions of capability and approachability, while voice‐based first impression had capability, approachability and reliability. The findings indicate that stable first impressions can be formed by either face or voice cues. However, the specific composition of impressions will vary between the cues. These results also provide a foundation for studying first impressions formed by an integrated perception of voice and face cues. [ABSTRACT FROM AUTHOR]

Objective: Patients with eating disorders report the experience of living with an eating disorder voice, a second‐ or third‐person, negative commentary about eating, weight, shape and their implications for self‐esteem. Qualitative and cross‐sectional studies suggest that the severity and characteristics of the eating disorder voice might play a role in the maintenance of eating disorder symptoms. The goal of this study was to expand the evidence base as to how the eating disorder voice changes over time and whether the characteristics of the voice are associated with changes in eating disorder symptoms during treatment. Method: Seventy‐two patients with anorexia nervosa receiving intensive eating disorder treatment were recruited. They completed self‐report measures of eating disorder symptoms, psychological distress and eating disorder voice's severity and characteristics (e.g., malevolence, benevolence and omnipotence) at baseline and approximately 6 months later. Results: Over time, patients reported lower levels of eating and weight concern (small effect size), shape concern (large effect size) and anxiety (small effect size). They also reported a reduction in the severity, perceived malevolence (medium effect size) and omnipotence (small effect size) of the eating disorder voice. Greater severity and malevolence of the voice, and lower benevolence at baseline predicted greater reductions in eating disorder symptoms (i.e., restraint and shape concern). Conclusion: Beliefs about the eating disorder voice (i.e., malevolence) and severity of the voice appear to be malleable to treatment and are associated with a reduction of eating disorder symptoms. The potential of using dialogical approaches to target the eating disorder voice is discussed. [ABSTRACT FROM AUTHOR]

Trans men often face discrimination in the hiring process. However, it remains unclear whether the disclosure of gender identity and perceived masculinity during transition play a role in first impressions and perceived job suitability of trans male applicants. Across two studies (N = 332), we examined how cisgender heterosexual participants perceived a transgender male candidate in terms of his masculinity and whether they judged him suitable for a stereotypically masculine job. Such judgments were first based on the candidate's voice at different stages of gender transition and, secondly, after disclosure of gender identity in the job application form. In Study 1, participants judged a trans man at the beginning of the voice transition (3 months on testosterone) or a trans man in advanced transitioning (1 year on testosterone). Study 2 involved the judgments of the same trans men at different times in the voice transition (1 week—beginning, 6 months—intermediate, and 1 year—advanced). Masculinity judgments were influenced by voice transitioning, but judgments were adjusted after his gender identity was disclosed. Disclosure created an advantage in perception of the trans man candidate as more suitable for the role, especially when he was at the beginning of the voice transition when his voice was not perceived as masculine. Findings are discussed in relation to trans men's employability and identity disclosure. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Early detection of Alzheimer's disease and cognitive impairment is critical to improving the healthcare trajectories of aging adults, enabling early intervention and potential prevention of decline. METHODS: To evaluate multi‐modal feature sets for assessing memory and cognitive impairment, feature selection and subsequent logistic regressions were used to identify the most salient features in classifying Rey Auditory Verbal Learning Test‐determined memory impairment. RESULTS: Multimodal models incorporating graphomotor, memory, and speech and voice features provided the stronger classification performance (area under the curve = 0.83; sensitivity = 0.81, specificity = 0.80). Multimodal models were superior to all other single modality and demographics models. DISCUSSION: The current research contributes to the prevailing multimodal profile of those with cognitive impairment, suggesting that it is associated with slower speech with a particular effect on the duration, frequency, and percentage of pauses compared to normal healthy speech. [ABSTRACT FROM AUTHOR]

The voices of autistic young people are frequently excluded from transition planning and decision‐making, especially when they have more complex needs and may not use speech to communicate. The aim of this research, based at a residential special school in England, was to extend and evaluate the use of the 'I am' Digital Stories methodology. 'I am' Digital Stories are short (c.3–5 min) videos that use a strengths‐based framework to support the sharing of voice, experiences, and preferences in visual form. 'I am' Digital Stories is an accessible and inclusive methodology that enables young people to present their 'best selves' to people in new settings who are meeting them for the first time. Digital Stories were co‐created with and/or for three young adults aged 18–19, their families and the school, and shared with stakeholders as part of the transition to post‐school contexts. Reflexive thematic analysis of data from 17 semi‐structured interviews with stakeholders resulted in five themes: benefits of Digital Stories, humanising approach; ownerships and agency, ethical considerations and direct impact on practice. Stakeholders highlighted how powerful the 'I am' Digital Stories were for gaining a fuller, more humanising understanding of the young person that was unavailable or impossible via other sources. [ABSTRACT FROM AUTHOR]

Objective: Division of the sternothyroid muscle during thyroidectomy is a widely accepted surgical technique to provide improved exposure of the thyroid gland, thus facilitating the ligation of superior pole vessels and identification of the laryngeal nerves. However, few have examined the impact on voice outcomes. We evaluate the impact of sternothyroid muscle division on patient‐perceived voice outcomes after thyroidectomy. Study Design: Prospective cohort study. Setting: Tertiary academic institution. Methods: A prospective cohort study was conducted comparing pre‐ and postoperative voice outcome data after thyroidectomy, measured using Voice Handicap Index‐10. The cohort of 109 patients underwent lobectomy or total thyroidectomy by a single surgeon at 1 institution. The sternothyroid muscle was fully divided in all surgeries. The integrity of the recurrent laryngeal and external branches of the superior laryngeal nerve was assessed using intraoperative nerve monitoring and postoperative laryngoscopy. Pre‐ and postoperative Voice Handicap Index‐10 scores were compared. Results: No statistically significant difference was found between total pre‐ and postoperative Voice Handicap Index‐10 scores (μpreop = 1.92, μpostop = 1.83, p =.87). There were no questions yielding statistically significant responses between pre‐ and postoperative groups. This was consistent regardless of whether the sternothyroid muscle was cut unilaterally or bilaterally. Men showed a statistically significant improvement in score after surgery. Conclusion: These findings support no difference in postoperative voice outcomes after the intraoperative division of the sternothyroid muscle. This supports the usage of this technique as a safe means to facilitate exposure during thyroid surgery and will serve as important information to guide intraoperative surgical decision‐making. [ABSTRACT FROM AUTHOR]

Objectives: Voice enhancement for patients without obvious vocal pathology or loss of function is rarely discussed clinically or in academic research. Our objectives were to: (1) determine voice satisfaction on a population level, and (2) assess willingness to consider interventions to change one's voice. Methods: A standardized questionnaire was created to assess current and past voice disorders. Questions assessed demographics, health status, prevalence of voice disorders, and questions regarding satisfaction with voice. Iterative survey testing and piloting were performed. A cohort with age, gender, and geographic distribution of the general adult population was then queried in an online survey. Qualitative analysis and both descriptive and multivariate statistics were performed. Results: A total of 1522 respondents were included, with an age, gender, and regional distribution reflective of the US population. A minority (38.8%) of respondents reported that they did not like the sound of their own voice in normal conversation; when asked about listening to a recording of their own voice, a majority (57.5%) reported dissatisfaction with voice. Discontent with one's voice was associated with being middle age (p = 0.005), female gender (p < 0.0001), and white race (p < 0.0001). Approximately 50.6% of respondents without a history of dysphonia would consider interventions to change their voice. Of those who indicated they may elect to change their voice, qualities regarding clarity and pitch were paramount. Conclusion: Dissatisfaction with one's speaking voice is common. A considerable percentage of the general population without a voice disorder would consider interventions to change their voice. Level of Evidence: 3 Laryngoscope, 133:3455–3461, 2023 [ABSTRACT FROM AUTHOR]

Objective: The diversity of glucocorticoid (GC) properties may underlie variability of clinical efficacy for vocal fold (VF) disease. Optimized therapeutic approaches must account for tissue complexity as well as interactions between cell types. We previously reported that reduced GC concentrations inhibited inflammation without eliciting fibrosis in mono‐cultured VF fibroblasts and macrophages. These data suggested that a refined approach to GC concentration may improve outcomes. In the current study, co‐culture of VF fibroblasts and macrophages was employed to investigate the effects of different concentrations of methylprednisolone on fibrotic and inflammatory response genes in VF fibroblasts to optimize management paradigms. Study Design: In vitro. Methods: THP‐1 monocyte‐derived macrophages were stimulated with interferon‐γ (IFN‐γ), lipopolysaccharide (LPS), or transforming growth factor‐β (TGF‐β) to induce inflammatory (M(IFN/LPS)) and fibrotic (M(TGF)) phenotypes. Macrophages were then co‐cultured with a human VF fibroblast cell line using a 0.4 μm pore membrane with or without 0.1–3000 nM methylprednisolone. Inflammatory (CXCL10, TNF, and PTGS2) and fibrotic (ACTA2, CCN2, and COL1A1) gene expression was quantified in fibroblasts. Results: Incubating VF fibroblasts with M(IFN/LPS) macrophages increased expression of TNF and PTGS2, and this effect was inhibited by methylprednisolone. Incubation of VF fibroblasts with M(TGF) macrophages increased expression of ACTA2, CCN2, and COL1A1, and this effect was enhanced by methylprednisolone. The concentration of methylprednisolone required to downregulate inflammatory genes (TNF and PTGS2) was lower than that to upregulate fibrotic genes (ACTA2, CCN2, and COL1A1). Conclusion: Reduced concentration of methylprednisolone effectively suppressed inflammatory genes without enhancing fibrotic genes, suggesting that a refined approach to GC concentration may improve clinical outcomes. Level of Evidence: N/A Laryngoscope, 133:3116–3122, 2023 [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: Myofiber culture has been employed to investigate muscle physiology in vitro and is well‐established in the rodent hind limb. Thyroarytenoid (TA) myofiber culture has not been described, providing an opportunity to employ this method to investigate distinct TA myofiber functions. The purpose of this study was to assess the feasibility of a TA myofiber culture model. Study Design: In vitro. Methods: TA muscles from five Sprague Dawley rats were independently isolated and digested for 90 min. A smooth‐tip, wide‐bored pipette dissociated TA myofibers from cartilage, and the fibers were distributed on collagen‐coated dishes and incubated at 37°C, 5% CO2 for 2 h. Myofiber specificity was determined via immunolabeling for desmin and myosin heavy chain (MHC). Myofibers viability was assessed over 7 days via esterase assay. Additional myofibers were immunolabeled for satellite cell marker Pax‐7. Glucocorticoid (GC) receptor (GR) was immunolabeled following GC treatment. Results: The harvest technique yielded ~120 myofibers per larynx. By day 7, ~60% of the fibers remained attached and were calcein AM‐positive/ethidium homodimer‐negative, indicating viability. Myofibers were positive for desmin and MHC, indicating muscle specificity. Cells surrounding myofibers were positive for Pax‐7, indicating the presence of myogenic satellite cells. Myofibers also responded to GC treatment as determined by GR nuclear translocation. Conclusion: TA myofibers remained viable in culture for at least 7 days with a predictable response to exogenous stimuli. This technique provides novel investigative opportunities regarding TA structure and function. Level of Evidence: N/A Laryngoscope, 133:3109–3115, 2023 [ABSTRACT FROM AUTHOR]

Objective: Variable outcomes of glucocorticoid (GC) therapy for laryngeal disease are putatively due to diverse interactions of the GC receptor (GR) with cell signaling pathways, limited consideration regarding concentration‐dependent effects, and inconsistent selection of GCs. In the current study, we evaluated the concentration‐dependent effects of three frequently administered GCs on transcription factors with an emphasis on the phosphorylation of GR at Ser203 and Ser211 regulating the nuclear translocation of GR. This study provides foundational data regarding the diverse functions of GCs to optimize therapeutic approaches. Study design: In vitro. Methods: Human vocal fold fibroblasts and THP1‐derived macrophages were treated with different concentrations of dexamethasone, methylprednisolone, and triamcinolone in combination with IFN‐γ, TNF‐α, or IL4. Phosphorylated STAT1, NF‐κB family molecules, and phosphorylated STAT6 were analyzed by Western blotting. Ser211‐phosphorylated GR (S211‐pGR) levels relative to GAPDH and Ser203‐phosphorylated GR (S203‐pGR) were also analyzed. Results: GCs differentially altered phosphorylated STAT1 and NF‐κB family molecules in different cell types under IFN‐γ and TNF‐α stimuli. GCs did not alter phosphorylated STAT6 in IL4‐treated macrophages. The three GCs were nearly equivalent. A lower concentration of dexamethasone increased S211‐pGR/GAPDH ratios relative to increased S211‐pGR/S203‐pGR ratios regardless of cell type and treatment. Conclusion: The three GCs employed in two cell lines had nearly equivalent effects on transcription factor regulation. Relatively high levels of Ser203‐phosphorylation at low GC concentrations may be related to concentration‐dependent differential effects of GCs in the two cell lines. Level of Evidence: NA Laryngoscope, 133:2704–2711, 2023 [ABSTRACT FROM AUTHOR]

Objectives: This study examined the effects of a combination corticosteroid plus long‐acting beta2‐adrenergic agonist inhaler (IC) on rabbit phonation. Methods: White New Zealand male rabbits were assigned randomly to experimental and control groups (n = 11 per group). The experimental group received twice‐daily doses of Advair HFA™ (fluticasone propionate 45 mcg and salmeterol 21 mcg) via a veterinary facemask with 1‐way valve and spacer; the control group received aerosolized saline. After 8 weeks, animals were euthanized, larynges excised, frozen, and subsequently thawed and mounted on a standard bench apparatus. Phonation was elicited during 15 successive trials, and phonation threshold pressure (PTP; cmH2O) and flow (PTF; L/min) were quantified. Results: Repeated measures analysis of variance indicated significant differences between the experimental and control groups (p < 0.05). Mean PTP and PTF values were higher (worse) for rabbits that received Advair HFA™. Conclusion: Following 8‐week exposure to ICs, rabbit larynges required greater air pressure and flow to initiate phonation. Because even modest phonation onset differences can have a meaningful clinical impact on voice function, these findings suggest that LABA ICs may put patients at risk for voice disorders. Furthermore, these voice disorders may occur within a relatively short timeframe. The results from this study have important clinical implications for voice care in those who use ICs. Level of Evidence: NA Laryngoscope, 133:2680–2686, 2023 [ABSTRACT FROM AUTHOR]

CONCLUSION Prolonged intubation used in severe COVID-19 patients is associated with significant laryngeal disorders including laryngeal edema, posterior glottic stenosis, granuloma, laryngeal necrosis, or vocal fold insufficiency. • COVID-19 patients who were intubated >14 days mainly reported posterior glottic stenosis, posterior commissure hypertrophy or laryngeal diffuse edema, and granuloma 51.6 days after the hospital discharge. The number of intubation days was significantly higher in patients with posterior glottic stenosis (26.1 ± 9.4) compared with those presenting posterior commissure hypertrophy (11.5 ± 2.9) or granuloma (15.1 ± 5.8; I p i < 0.001). Keywords: complications; coronavirus; COVID-19; intubation; laryngeal; larynx; otolaryngology; SARS-CoV-2; stenosis; voice EN complications coronavirus COVID-19 intubation laryngeal larynx otolaryngology SARS-CoV-2 stenosis voice 779 784 6 08/17/23 20230901 NES 230901 Key Points • At the start of the pandemic, many COVID-19 patients were intubated more than 14 days in intensive care units. [Extracted from the article]

Objectives: This systematic review and meta‐analysis examines if intralaryngeal injection of basic fibroblast growth factor 2 (FGF2) can improve voice outcomes in those with vocal disability. Design: A Systematic review of original human studies reporting voice outcomes following intra‐laryngeal injection of basic fibroblast growth factor 2 in those with vocal dysfunction. Databases searched were Medline (1946–July 2022), Embase (1947–July 2022), Cochrane database and Google Scholar. Setting: Secondary or tertiary care centres that undertook the management of voice pathology Hospital. Participants: Inclusion criteria were original human studies reporting voice outcome measurements following intralaryngeal injection of FGF2 to treat vocal fold atrophy, vocal fold scarring, vocal fold sulcus or vocal fold palsy. Articles not written in English, studies that did not include human subjects and studies where voice outcome measures were not recorded before and after FGF2 injection were excluded from the review. Main Outcome Measures: The primary outcome measure was maximum phonation time. Secondary outcome measures included acoustic analysis, glottic closure, mucosal wave formation, voice handicap index and GRBAS scale. Results: Fourteen articles were included out of a search of 1023 and one article was included from scanning reference lists. All studies had a single arm design without control groups. Conditions treated were vocal fold atrophy (n = 186), vocal cord paralysis (n = 74), vocal fold fibrosis (n = 74) and vocal fold sulcus (n = 56). A meta‐analysis of six articles reporting on the use of FGF2 in patients with vocal fold atrophy showed a significant increase of mean maximum phonation time of 5.2 s (95% CI: 3.4–7.0) at 3–6 months following injection. A significant improvement in maximum phonation time, voice handicap index and glottic closure was found following injection in most studies assessed. No major adverse events were reported following injection. Conclusions: To date, intralaryngeal injection of basic FGF2 appears to be safe and it may be able to improve voice outcomes in those with vocal dysfunction, especially vocal fold atrophy. Randomised controlled trials are needed to further evaluate efficacy and support the wider use of this therapy. [ABSTRACT FROM AUTHOR]

There is widespread discourse and policy on children's participation in decision‐making. This is not matched with an equal level of implementation in practice. This qualitative research explores the policy to practice gap with senior decision makers in the child protection system in New South Wales (NSW), Australia. Their reflections on the challenges associated with translating the participation principles into practice are deconstructed to understand the complex and overlapping ways in which participation is perceived. The research data indicate there are competing understandings of participation at play, depending on the actor, their role and organisation. This paper suggests that genuine participation in practice relies on bridging the epistemic differences and interests of different stakeholder groups who are all critical to achieving children's participation in service decision‐making. [ABSTRACT FROM AUTHOR]

The functional‐typological literature distinguishes two kinds of inverse constructions: inverse voice, in which the patient becomes the subject, and inverse alignment, in which the patient is agreed with like a canonical subject. In this literature, Algonquian languages are held to be the prototypical example of a system in which the two kinds of inverses coexist: the inverse is a "deep" voice construction in clauses with two third‐person arguments and a "shallow" alignment pattern in clauses in which a third person acts on a speech‐act participant. This article argues that that conclusion is correct and attempts to reconcile it with formal models of voice and agreement. It is proposed that despite their distinct syntactic underpinnings, both inverse constructions result in a derivation in which Voice lacks phi features and Infl indexes only the patient. This shared outcome explains why the inverse appears to be a unified phenomenon from a morphological perspective even though its syntactic correlates differ in third‐person and speech‐act‐participant contexts. [ABSTRACT FROM AUTHOR]

Background: Although speech and voice disorders are common in Parkinson's disease (PD), there is insufficient evidence to support the effectiveness of behavioural speech therapies in these patients. Aims: This study aimed to examine the effects of a new tele‐rehabilitation program, a combining of conventional speech therapy and singing intervention, on voice deficits in patients with PD. Methods & Procedures: This study was a three‐armed, assessor‐masked, randomised controlled trial. Thirty‐three people with PD were randomly assigned to the combination therapy, conventional speech therapy, or singing intervention group. This study followed the Consolidated Standards of Reporting Trials guidelines for non‐pharmacological treatment. Each patient participated in 12 tele‐rehabilitation sessions over 4 weeks. The combination therapy group received speech and singing interventions simultaneously (respiratory, speech, voice, and singing exercises). Voice intensity as a primary outcome and the voice handicap index (VHI), maximum frequency range, jitter and shimmer as secondary outcomes were evaluated 1 week before the first intervention session, 1 week after the last intervention session and 3 months after the last evaluation. Outcomes & Results: The results of repeated measures analysis of variance showed a significant main effect of time on all outcomes in all three groups after treatment (p < 0.001). There was a significant group effect for voice intensity (p < 0.001), VHI (p < 0.001), maximum frequency range (p = 0.014) and shimmer (p = 0.001). The combination therapy group demonstrated a significant outperformance in the VHI and shimmer than the speech therapy (p = 0.038) and singing intervention (p < 0.001) groups. The results of this study also indicated that combination therapy group compared to singing intervention group had a larger effect on voice intensity (p < 0.001), shimmer (p < 0.001) and maximum frequency range (p = 0.048). Conclusions & Implication: The results demonstrated that combining speech therapy with a singing intervention delivered through tele‐rehabilitation might be more effective in improving voice problems in patients with PD. What this paper adds: What is already known on the subject: Parkinson's disease (PD) is a neurological disorder that frequently causes disturbances in speech and voice, which negatively affect patients' quality of life. Although speech difficulties occur in 90% of patients with PD, evidence‐based treatment options for speech and language problems in these patients are limited. Therefore, further studies are required to develop and assess evidence‐based treatment programs. What this study adds: The findings of this study showed that a combination therapy program including conventional speech therapy approaches and individual singing intervention provided through tele‐rehabilitation may have a greater effect on the improvement of voice problems in people with PD compared to speech therapy and singing intervention alone. What are the clinical implications of this work?: Tele‐rehabilitation combination therapy is an inexpensive and enjoyable behavioural treatment. The advantages of this method are that it is easy to access, appropriate for many stages of voice problems in PD, requires no prior singing training, encourages voice health and self‐management and maximises treatment resources available to people with PD. We believe that the results of this study can provide a new clinical basis for treatment of voice disorders in people with PD. [ABSTRACT FROM AUTHOR]

Background: After total laryngectomy, surgical voice restoration is used to establish communication via tracheoesophageal voice prosthesis. Once voice is established, there is a paucity of information on what speech and language therapists (SLTs) should do to improve tracheoesophageal voice quality to ensure functional communication. No existing surveys or studies investigate this specific question. There is also a disconnect between guidelines, knowledge and clinical practice, whereby clinical guidelines stipulate the requirement for SLT intervention, but do not detail what this entails in the rehabilitation context. Aims: (1) To advance understanding of current clinical practice beyond voice prosthesis management and care. (2) To explore what approaches are implemented in clinical practice across the UK and Republic of Ireland to rehabilitate tracheoesophageal voice. (3) To investigate the barriers and facilitators to provision of tracheoesophageal voice therapy. Methods & Procedures: A self‐administered 10‐min online survey was developed using Qualtrics software and piloted before dissemination. Survey development was informed by the Behaviour Change Wheel to identify barriers, facilitators and additional factors contributing to SLTs' provision of voice therapy to tracheoesophageal speakers. The survey was disseminated via social media and professional networks. Eligibility criteria included SLTs with at least one year post‐registration experience and with experience of working with laryngectomy in the past 5 years. Descriptive statistics were used to analyse closed answer questions. Open question responses were analysed using content analysis. Outcomes & Results: The survey received 147 responses. Participants were representative of the head and neck cancer SLT workforce. SLTs believe that tracheoesophageal voice therapy is an important aspect of laryngectomy rehabilitation; however, there was a lack of knowledge about therapy approaches and insufficient resources for implementing therapy. SLTs expressed a desire for more training, specific guidelines and a stronger evidence base to inform clinical practice. Some SLTs expressed feelings of frustration and lack of acknowledgement for the specialist skills required to undertake laryngectomy rehabilitation and tracheoesophageal work in general. Conclusions & Implications: The survey identifies the need for a robust training approach and detailed clinical guidelines to promote consistent practice across the profession. The evidence base within this clinical area is emergent, hence there is a need for increased research and clinical audit to inform practice. Under‐resourcing was highlighted, which should be considered in service planning to ensure that adequate staff, access to expert practitioners or time ring‐fenced for therapy are available for tracheoesophageal speakers to receive the support they require. WHAT THIS PAPER ADDS: What is already known on this subject: Total laryngectomy results in life‐altering changes to communication. Clinical guidelines advocate for speech and language therapy intervention; however, there is no clear information on what SLTs should do to optimize tracheoesophageal voice and the evidence base to support practice is lacking. What this study adds to existing knowledge: This survey identifies what interventions SLTs provide in clinical practice to rehabilitate tracheoesophageal voice; and it explores the barriers and facilitators that influence the provision of tracheoesophageal voice therapy. What are the potential or actual clinical implications of this work?: Specific training, clinical guidelines, increased research and audit are required to support clinical practice in laryngectomy rehabilitation. Service planning should address the under‐resourcing of staff, expert practitioners and therapy allocated time. [ABSTRACT FROM AUTHOR]

Background: Post‐COVID Syndrome (also known as Long COVID) refers to the multi‐system condition affecting individuals following COVID‐19 infection. This can include speech and language therapy (SLT) needs, including voice, swallowing, communication and upper airway difficulties. There is limited published literature in this clinical area of practice, particularly for those receiving input from community SLT services. Aims: To describe and compare demand, typical SLT presentation and service delivery across two National Health Service (NHS) Long COVID multidisciplinary services. Independent retrospective service evaluation was completed for each service. Descriptive statistics were produced and compared across services. This service evaluation followed The Strengthening the Reporting of Observation Studies in Epidemiology guidelines for cohort studies. Outcomes & Results: The findings indicated similarities across the two services in SLT service need and demand, clinical presentations and intervention approaches provided within Long COVID services. There were specific differences in the service provision and delivery of intervention in cognitive communication and upper airways subspecialities. Conclusions & Implications: This study highlights the clinical complexities of SLT needs in individuals with Long COVID and the importance for an appropriately skilled and supported workforce within effective multidisciplinary teams. We call for consensus on SLT practices and a consistent and standardized approach to evaluation for SLT needs in Long COVID. WHAT THIS PAPER ADDS: What is already known on this subject: SLT needs, including voice, swallowing, communication and upper airway difficulties, are present in individuals presenting with Long COVID, both in those who were or were not hospitalized. SLTs are seeing such individuals in a variety of settings, including community services and Long COVID multidisciplinary teams. There is minimal evidence of the clinical presentations and interventions provided to individuals with SLT needs compared across Long COVID services. What this study adds to existing knowledge: This study compares two NHS Long COVID services providing a SLT service pathway. It highlights the similarities and differences in service demand and capacity, patient presentation, and SLT intervention to make suggestions for future practice consideration and priority evaluation. Expert consensus among SLT clinicians is a priority to ensure clinicians are delivering consistent and equitable care for patients, while new evidence and data emerge. A consistent and standardized approach to data collection and outcome measures is essential to ensure future research captures the impact and value of SLT input with individuals with Long COVID. What are the clinical implications of this work?: The complexities and multifactorial SLT needs of individual with Long COVID call for appropriate SLT staffing provision, skill and training to fulfil the needs of this population. Speech and language therapists should be integrated with multidisciplinary Long COVID services to provide holistic care for patients and to support the professionals working with individuals with post‐COVID voice, swallowing, communication and upper airway symptoms. [ABSTRACT FROM AUTHOR]