Search

Purpose: Although speech-language pathologists have provided gender-affirming voice training for trans women since the 1970s, evidence for this training's effectiveness remains weak. Our study aimed to redress limitations of earlier studies and evaluate voice training effects on outcomes important to trans women., Method: Seventy-four trans women (19-54 years old) who wanted a more female-sounding voice were recruited through two health facilities and provided with an eight- to 12-session voice training program based on contemporary literature, usual clinical practice, and client-centered care principles. Self-reported outcomes and an audio-recorded reading sample were collected 3 months before, immediately before and after, and 3 months after training. Forty cisgender speakers were audio-recorded reading the same sample material as comparison voices. Seventy-nine naive listeners made gender-related voice ratings of an extract from these audio recordings. Training effectiveness was evaluated using group-level analyses (linear mixed-effects models) and individual-level analyses to establish what proportion of participants improved to a predetermined relevant degree., Results: Group-level analyses demonstrated positive training effects, maintained 3 months posttraining, for trans women's vocal satisfaction, perceptions of voice-related social participation, and self- and listener perceptions of their voices. Individual-level analyses also demonstrated positive effects. Two thirds of trans women increased vocal satisfaction to a relevant degree, one third who reported restricted social participation before training reduced this restriction to a relevant degree, and all were rated more female-sounding after training (although not all to a relevant degree)., Conclusions: All trans women participants made progress toward their voice goals and maintained those gains at follow-up. These findings provide evidence that gender-affirming speech-language pathology services warrant prioritization. Further research is warranted to investigate factors predicting outcomes of voice training for trans women.

Intensive schedules in behavioral voice therapy and training have been proposed to have a range of positive benefits including enhanced outcomes, high client and clinician satisfaction, and reduced client attrition. In the sub-field of behavioral voice training for trans and gender diverse clients, intensive schedules may also present a means of increasing service access opportunities for a vulnerable population. Despite the proposed benefits there has been limited research investigating client experiences in intensive voice training programs. The current study utilized a mixed-methodological approach to compare participant experiences in an intensively scheduled (three 45-minute sessions per week, over 4 weeks) versus a traditionally scheduled (one 45-minute session per week, over 12 weeks) voice training program for trans and gender diverse participants aiming to develop a perceptually feminine-sounding voice. Participant experiences were compared using a satisfaction questionnaire delivered to both training groups as well as thematic analysis of semi-structured interviews conducted with participants in the intensive group. Results suggested that individuals in the intensive training program had both positive and negative experiences related to the intensive schedule, but all viewed the program favorably and expressed a preference for intensive training based on their experiences. However, it was also found that overall satisfaction and attrition did not differ significantly between the intensive and traditional training groups and that many factors contributing to participant satisfaction in the intensive program were unrelated to the intensive schedule. Results from the current study also suggest that experiences in intensive programs may be highly variable and mediated by factors such as clients' individual personalities and preferences. The current study concludes that intensive schedules present a viable alternative to traditional schedules in practice, with additional considerations and directions for future research also discussed., (Copyright © 2021 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Introduction: There exist a cohort of transmasculine patients who remain dissatisfied with vocal function following testosterone therapy and voice training., Aim: The objective of this case report was to describe the use of injection laryngoplasty in this cohort as an alternative to laryngeal framework surgery., Method: A case report and literature review was undertaken., Results: Our case describes a 45-year-old transmasculine patient who remained unsatisfied with vocal pitch despite testosterone therapy and voice training. On initial presentation, the patient had fundamental frequency (fo) ranging from 70-344 Hz with a mean of approximately 135 Hz on reading, and 146 Hz in monologue. Injection augmentation of the vocal folds under local anesthesia with an injectable carboxymethylcellulose gel (prolaryn) was trialed. Following re-absorption of this, further injection was performed using autologous fat and subsequently a longer acting Calcium Hydroxyapatite injectable (Prolaryn Plus). This was followed by re-injection 1 year later. Patient satisfaction has been sustained throughout this period. Repeat acoustic evaluation in 2019 revealed a mean fo of 108 Hz on reading, 100 Hz in monologue, and a fo range of 85-134 Hz across these tasks., Conclusion: This case report presents an alternative surgical intervention to supplement testosterone and voice training in transmasculine patients unsatisfied with vocal function., (Copyright © 2020 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Aims: The aim of this study was to provide a description of normative speaking fundamental frequency (f os ) characteristics for adult speakers of Australian English. The effects of age, sex, and geographical location on f os were also examined to assess whether variations existed., Methods: f os data for 244 female and 135 male speakers aged 18-60 years from a recent large-scale corpus of Australian English were analyzed on a passage reading task. Creak phonation frequencies were first separated from the modal phonation frequencies algorithmically. Descriptive statistics were then generated for modal voice., Results: The mixed effects linear regression model suggested that geographical location had no effect on f os (P = 0.0677). The multiple linear regression model suggested that both sex (P = 0.000) and age (P = 0.000) significantly predicted f os . f os of the female speakers was greater than males by 76 Hz, when accounted for by age, and for every increase in age by one year, f os decreased by 0.37 Hz. Normative data on f os were therefore provided with reference to speaker sex and age only., Conclusion: Both clinicians and researchers are provided with normative f os data for 18-60 year-old speakers of Australian English. These updated data have increased internal and external validity relative to previous literature. These increases were achieved by having a larger sample size, systematically sampling speakers of different age groups and geographical locations, sampling contemporary speakers of Australian English and excluding speakers with known concomitant factors that affect f os ., (Copyright © 2020 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Background/aim: Scales used to collect perceptual ratings related to a speaker's gender are widely used in gender affirming voice training for trans individuals. Such scales may be used as outcome measures to gain insight into whether training has helped clients meet personal goals related to gender expression. These scales are also widely used in general research investigating the relationship between vocal characteristics and perceptions of speaker gender. However, past studies in these areas have varied in the terminology used to label rating scales and the impact of this variation is currently unknown. Additionally, research has not yet fully explored the relationship between self- and listener ratings of trans participant voices and trans participant satisfaction with voice, and whether or not these relationships change after trans participants undertake gender affirming voice training. This research paper aimed to explore these relationships and address these research gaps., Methods: A group of 34 trans participants were asked to rate their voices before and after participating in gender affirming voice training. Trans participant voice samples from before and after training were also presented to a group of 25 listeners for rating. Perceptual ratings were made on two visual analogue scales (VAS) with anchors "very feminine/very masculine" and "very female/very male." Trans participants also rated their satisfaction with their current voice on a VAS with anchors "very satisfied/very unsatisfied." Correlation coefficients were calculated to investigate the relationship between collected ratings., Results: Differences in scale labels were found to have minimal impact on ratings made by both trans participants and listeners. Trans participant self-ratings were found to correlate with listener ratings, but this correlation was not strong. Trans participant self-ratings had a consistently stronger relationship with their self-rated vocal satisfaction. The study contributed new findings that these differences may be more pronounced after trans participants have completed voice training., Discussion/conclusion: This study suggests that results from past studies that have used differently labelled scales to collect ratings related to gender perception based on voice are suitable to compare. This study also discusses the implications reported differences between trans participant self-ratings and listener ratings may have for research and clinical practice., (© 2021 S. Karger AG, Basel.)

Background: Work-system participation and factors are associated with occupational vocal health for vocally reliant workers, such as sports coaches. However, there is limited use of systems approaches and worker collaboration to address occupational voice., Objective: The current research aimed to cooperatively consider coaches' vocally reliant systems participation, including addressing vocal ergonomic factors that can create barriers for occupational vocal health and voice use., Methods: Collaborative action inquiries explored vocal ergonomics with coaches (n = 24) from nine professional basketball teams. Across three basketball seasons, coaches and a subject matter expert identified what influenced coaches' voices and trialed approaches to optimize vocally reliant coaching participation. Nine action inquiry methods were used, including search conferences, ergonomic approaches to enhance systems participation, and focus groups. Multi-level analyses were also undertaken., Results: Participants cooperatively generated, implemented, and evaluated different strategies. A cumulative total of 57 strategies were explored within teams (team mean = 6.33, SD = 3, range = 4-14). Cross-case analysis identified 25 different strategy types. Overall, participants appraised 31.58% (18/57) strategies as supportive (i.e., enhanced facilitators for voice), 61.40% (35/57) strategies as somewhat supportive (i.e., some enhanced facilitators and some ongoing barriers), and 7.02% (4/57) strategies as unsupportive (i.e., pervasive ongoing barriers not mitigated by strategies). Further, factors across coaches' work-systems continued to influence coaches' voices in dynamic and complex ways., Conclusions: Collaboration with coaches enriched vocal ergonomic approaches by providing novel, context-anchored insights. Collaboration should form 'part' of broader mechanisms to support coaches' voice use and vocal health at work.

Background: Coaches critically rely on voice for occupational functioning, which has associated risks to vocal health. However, vocal occupational health and safety (OHS) and vocal ergonomics are not typically considered for, by, or with coaches., Objective: This study piloted a participatory approach to vocal ergonomics, aiming to collaboratively (i) understand coaches' vocally reliant occupational participation, and (ii) consider vocal ergonomic factors., Methods: This research was undertaken at an international tournament for floorball (also known as 'Innebandy', 'Salibandy', or 'Unihockey'). Three national coaches (n = 3) and the lead researcher undertook cooperative action inquiry. This piloted a participatory vocal ergonomics programme. Action inquiry methods included fieldnotes, interviews, observations, a workshop, ergonomics approaches, and a focus group. Multi-level analyses supported the findings, including categorical aggregation, direct interpretation, and reflexive thematic analysis., Results: Participants identified vocal ergonomic factors present at the tournament; including personal, activity, physical environmental, and organisational factors. Participants developed four vocal ergonomic approaches responsive to factors. These were: (1) player consultation, (2) ongoing feedback discussions, (3) movement and postural change, and (4) specific task adaptation. Approaches 1-2 directly supported coaches' voices. Coaches posited limitations to other strategies, but made recommendations for future use. Coaches also reflected that this collaboration provided actionable voice insights and opportunities to address vocal ergonomics. They advocated for extended engagement with coaches, increased focus on vocal health, and inclusion of early career coaches in future programmes., Conclusions: These findings support engagement of coaches, and other vocally reliant workers, in addressing voice use and vocal health at work.

Purpose: The aim of this study was to provide a systematic review of the aspects of verbal communication contributing to listener perceptions of speaker gender with a view to providing clinicians with guidance for the selection of the training goals when working with transsexual individuals., Method: Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) guidelines were adopted in this systematic review. Studies evaluating the contribution of aspects of verbal communication to listener perceptions of speaker gender were rated against a new risk of bias assessment tool. Relevant data were extracted, and narrative synthesis was then conducted. Meta-analyses were conducted when appropriate data were available., Results: Thirty-eight articles met the eligibility criteria. Meta-analysis showed speaking fundamental frequency contributing to 41.6% of the variance in gender perception. Auditory-perceptual and acoustic measures of pitch, resonance, loudness, articulation, and intonation were found to be associated with listeners' perceptions of speaker gender. Tempo and stress were not significantly associated. Mixed findings were found as to the contribution of a breathy voice quality to gender perception. Nonetheless, there exists significant risk of bias in this body of research., Conclusions: Speech and language clinicians working with transsexual individuals may use the results of this review for goal setting. Further research is required to redress the significant risk of bias.

Objective: To explore the occupational voice use and vocal health of elite football coaches., Study Design: This pilot study explored coaches' voice use patterns and vocal demands across workplace environments. Each coach's experiences of voice symptoms and voice problems were also investigated., Methods: Twelve Australian professional football coaches participated in a mixed-methods data collection approach. Data were collected through acoustic voice measurement (Ambulatory Phonation Monitor), semistructured interviews, and a voice symptom questionnaire (Voice Capabilities Questionnaire)., Results: Acoustic measures suggested heavy vocal loads for coaches during player training. All participants reported experiencing voice symptoms. They also suggested that the structure of their working week, workplace tasks, and vocal demands impacted on their voices. Despite this, participants reported little previous reflection or awareness of what impacted on their voices. Coaches typically did not consider how to support their voices during daily work and discussed experiencing voice symptoms as an inevitable part of their jobs., Conclusions: This study demonstrates that occupational vocal demands may negatively impact on sports coaches' vocal health. This is particularly important, considering coaches' heavy vocal loads across coaching tasks and reported negative occupational vocal health experience. Furthermore, coaches' limited insight into voice use and vocal health management may impact on their vocal performance and health. Given the exploratory nature of this study, further research into coaches' occupational vocal health is warranted., (Copyright © 2015 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objectives: This study investigated acoustic change in singers' vibrato following imagery and non-imagery tasks., Study Design: The study used a fully randomized cross-over (six conditions × two times) block design, in which each singer received each intervention in random order. Data were analyzed using the general linear model (GLM). Main effects for time and condition and interaction effects (time × condition) were calculated for each dependent measure., Methods: Six classically trained female singers recorded an 8-bar solo before and after three nonvocal, 25 minute tasks. Each singer performed the tasks in a different randomized order in a single sitting. Task 1 involved imagery of the breath directed up and down as far from the larynx as possible; Task 2 used Braille music code, enabling the singer to engage in tactile, kinesthetic and visual imagery related to music but unrelated to breath function; Task 3 was a nonimagery activity requiring the completion of a cloze passage about breath function. From the 11 longest notes in each solo, spectrograms of the partials were produced and assessed for pre- to post-test changes in vibrato rate, vibrato extent, and sound pressure level (SPL)., Results: Only the breathing imagery task produced significantly more moderate and regular vibrato rates. Vibrato extent was not responsive to any intervention., Conclusions: Findings indicate that breathing imagery regulates singers' vibrato in a manner consistent with that of a more proficient, warmed-up voice., (Copyright © 2015 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objectives: To determine whether emotional expression, alexithymia, illness behavior, and coping strategies differed between women with muscle tension voice disorder (MTVD) and those without voice disorder and between women with and without mucosal pathology of the vocal folds, and to explore possible links between psychosocial constructs and clinical features in women with MTVD., Study Design and Method: A within-subjects design matched 20 women with MTVD and 20 women without voice disorder on validated self-report measures of the psychosocial constructs. The effect of mucosal pathology was assessed using between-groups analyses. Correlations assessed relationships between psychosocial constructs and clinical features., Results: Comparisons between women with MTVD and those without voice disorder showed an elevated sense of illness identity and greater belief in the presence of somatic illness in women with MTVD. There was a trend toward women with MTVD showing lower levels of emotional awareness. Women without vocal fold pathology reported lower levels of emotional awareness than those with pathology, whereas women with pathology reported greater use of a mixed pattern of adaptive and maladaptive coping strategies than those with no pathology. Low vocal load was associated with higher scores on alexithymia, higher numbers of vocal symptoms were associated with the use of adaptive coping, and greater impact of symptoms was associated with higher levels of emotional awareness and greater belief in the presence of somatic illness., Conclusions: These findings encourage further investigation of relationships between emotional awareness, illness behavior, and coping in women with functional voice disorders., (Copyright © 2014 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objectives: This exploratory study reports instrumental and subjective data for 25 male-to-female transsexual (M-F TS) individuals using their attempted female voice. The aim was to examine the usefulness of phonetograms and aerodynamic measures for voice assessment of this client group., Study Design: Descriptive and correlational., Methods: Phonetogram speech-range profiles (SRPs) were recorded for the M-F TS participants' attempted female voice. Transglottal air pressure and airflow were estimated from oral recordings. All recordings were made in typical- and loud-voice conditions. Relationships among acoustical and aerodynamic measurements, background data, self-evaluations, and auditory perceptual ratings were examined. M-F TS data were compared with male and female normative data., Results: Agreement between naive and voice-expert listeners as well as intra- and interlistener reliability was good. Fundamental frequency (F(0)) accounted for 41-49% of variation in gender ratings for the group, but individual exceptions were found. Background data did not account for female voice success. Perceptual ratings of strain and breathiness were low. No data indicated hyperfunctional vocal behavior. The aerodynamic data agreed with normative male high-pitch data. The speech sound pressure level (SPL) was higher than the female norms. Phonetogram speech-range data fell between male and female data., Conclusions: The importance of speaking fundamental frequency (SFF) in perception of gender was confirmed. Instrumental and subjective data suggested that the use of low speech intensities and avoidance of vocal fry could help contribute to a successful female voice. Phonetograms were suggested to be useful for visual feedback and documentation of changes in voice therapy for M-F TS clients., (2010 The Voice Foundation. Published by Mosby, Inc. All rights reserved.)

This study explored whether acoustic and perceptual features could distinguish comfortable from maximally projected acting voice. Thirteen professional male actors performed a passage from William Shakespeare's Julius Caesar twice. The first delivery used their comfortably projected voices, whereas the second used maximal projection. Acoustic measures, expert ratings, and self-ratings of projection and voice quality were investigated. Long-term average spectra (LTAS) and sound pressure level (SPL) analyses were conducted. Perceptual variables included projection, breathiness, roughness, and strain. When comparing the intensity difference between the higher (2-4 kHz) and lower (0-2 kHz) regions of the spectrum in voice samples from the maximal projected condition, LTAS analyses demonstrated increased acoustic energy in the higher part of the spectrum. This LTAS pattern was not as evident in the comfortable projected condition. These findings offered some preliminary support for the existence of an actor's formant (prominent peak in the upper part of the spectrum) during maximal projection.

Operatic sopranos need to be audible over an orchestra yet they are not considered to possess a singer's formant. As in other voice types, some singers are more successful than others at being heard and so this work investigated the frequency range of the singer's formant between 2000 and 4000 Hz to consider the question of extra energy in this range. Such energy would give an advantage over an orchestra, so the aims were to ascertain what levels of excess energy there might be and look at any relationship between extra energy levels and performance level. The voices of six operatic sopranos (national and international standard) were recorded performing vowel and song tasks and subsequently analyzed acoustically. Measures taken from vowel data were compared with song task data to assess the consistency of the approaches. Comparisons were also made with regard to two conditions of intended projection (maximal and comfortable), two song tasks (anthem and aria), two recording environments (studio and anechoic room), and between subjects. Ranking the singers from highest energy result to lowest showed the consistency of the results from both vowel and song methods and correlated reasonably well with the performance level of the subjects. The use of formant tuning is considered and examined.

Background The Transsexual Voice Questionnaire (TVQMtF) was designed to capture the voice-related perceptions of individuals whose gender identity as female is the opposite of their birth-assigned gender (MtF women). Evaluation of the psychometric properties of the TVQMtF is ongoing. Aims To investigate associations between TVQMtF scores and (1) self-perceptions of voice femininity and (2) acoustic parameters of voice pitch and voice quality in order to evaluate further the validity of the TVQMtF. A strong correlation between TVQMtF scores and self-ratings of voice femininity was predicted, but no association between TVQMtF scores and acoustic measures of voice pitch and quality was proposed. Methods & Procedures Participants were 148 MtF women (mean age 48.14 years) recruited from the La Trobe Communication Clinic and the clinics of three doctors specializing in transgender health. All participants completed the TVQMtF and 34 of these participants also provided a voice sample for acoustic analysis. Pearson product-moment correlation analysis was conducted to examine the associations between TVQMtF scores and (1) self-perceptions of voice femininity and (2) acoustic measures of F0, jitter (%), shimmer (dB) and harmonic-to-noise ratio (HNR). Outcomes & Results Strong negative correlations between the participants' perceptions of their voice femininity and the TVQMtF scores demonstrated that for this group of MtF women a low self-rating of voice femininity was associated with more frequent negative voice-related experiences. This association was strongest with the vocal-functioning component of the TVQMtF. These strong correlations and high levels of shared variance between the TVQMtF and a measure of a related construct provides evidence for the convergent validity of the TVQMtF. The absence of significant correlations between the TVQMtF and the acoustic data is consistent with the equivocal findings of earlier research. This finding indicates that these two measures assess different aspects of the voice-related experience. Conclusions & Implications Evidence supporting the validity of the TVQMtF is strong and indicates that it is a sound measure for capturing the MtF woman's self-perceptions of her vocal functioning and how her voice impacts on her everyday life. [ABSTRACT FROM AUTHOR]

The recently developed Transsexual Voice Questionnaire (TVQMtF) is a self-report tool that assesses the perceptions of male-to-female transsexual women (MtF women) regarding their voices and the impact of voice on their everyday lives. Initial psychometric evaluation has demonstrated strong reliability of the TVQMtF, however, there has been relatively little investigation of its validity. There is evidence in the literature to support the notion that MtF women who have undergone gender reassignment surgery (GRS) have different perceptions of their voice than MtF women who have not undergone GRS. This information was used to examine the validity of the TVQMtF using a known-groups analysis. Method: The TVQMtF scores of 26 MtF women who had undergone GRS were compared with the scores of 27 MtF women who had not undergone GRS. A one-way analysis of variance (ANOVA) was used to compare the total TVQMtF scores. Mann Whitney U tests were used for comparison across individual items. Results: Individuals who had undergone GRS perceived that they experienced fewer voice-related difficulties and impacts on their lives than individuals who had not undergone GRS. This difference was significant (F(1, 51) = 8.87, p =.004). MtF women who had undergone GRS reported less impact of voice on their gender identity, however, perceived impact of vocal-functioning and voice-related activity and participation limitations did not differ between groups. The study findings support the construct validity of the TVQMtF. [ABSTRACT FROM AUTHOR]