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Objective: The potential for negative sequalae in psychosocial well-being presents clinical importance to the assessment of voice disorders. Despite the impairment voice disorders cause in the psychosocial domain, the clinical assessment of these disorders relies heavily on visual perceptual judgments of the larynx, audio-perceptual, as well as acoustic and aerodynamic measures. While these measures aid in accurate diagnosis and are necessary for standard of care, they present little insight into the patient experience of having a voice disorder., Design: Retrospective between-subject, non-experimental design., Methods: Data from 335 patients from the University of Pittsburgh Voice Center were collected from scores of the Voice Handicap Index-10 (VHI-10) and two recent questionnaires, the Voice Present Perceived Control scale (VPPC), and the Vocal Congruency Scale (VCS). Examining how these voice-specific scales related to three mental health screeners for stress (Perceived Stress Scale-4), anxiety (Generalized Anxiety Disorder-7) and depression (Patient Health Questionnaire-9) were also examined. Patient diagnoses included primary muscle tension dysphonia (pMTD), unilateral vocal fold paralysis (UVFP), vocal fold atrophy, and mid membranous vocal fold lesions., Results: There were significant differences in scores from the voice-specific scales between diagnostic groups with UVFP being the highest (worst) in VHI-10 and UVFP being the lowest (worst) in VCS compared to healthy controls. There was no significant difference in VPPC scores between diagnostic groups. Results showed statistically significant inverse relationships between the VHI-10 and the VPPC and between the VHI-10 and VCS for all diagnostic groups. A significant direct relationship was found between the VPPC and the VCS for patients diagnosed with MTD, UVFP and Lesions. In sum, patients with UVFP presented with the most frequent and sometimes strongest relationships between voice and mental health measures., Discussion: This study marks an initial investigation into the nuanced patient experience of having a voice disorder. Three theoretically unrelated voice constructs: handicap, perceived control, and sense of self, were measured via self-report. Results from this study describe the patient experience correlating to these constructs with weak correlations to stress, anxiety, and depression. Findings also clearly suggest that patient experience varies among diagnostic groups, as well as varying constructs. Measures of multiple constructs of patient perception provide valuable insight into a patient's experience of their voice disorder, guidance on the direction of voice treatment, and justification for such treatments., (Copyright © 2021 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Purpose: to carry out the cross-cultural adaptation of the Vocal Congruence Scale (VCS) and the Transgender Scale Congruence (TSC) instruments into Brazilian Portuguese., Methods: the study was developed in two stages: cross-cultural adaptation and pre-test. 1. Cross-cultural adaptation: it was composed of a team of two speech therapists and two non-speech therapists, being responsible for the translation of the instruments into Portuguese (a speech therapist and a non-speech therapist native to Brazilian Portuguese - BP and English speakers, independently, with subsequent consensus achieved by the researchers; back-translation of the instruments into English (a speech therapist and a non-speech therapist who are native speakers of English and speakers of BP); analysis of the final version by a committee (a translator, a methodologist, and three speech therapists). Data were analyzed descriptively and inferentially., Results: In the cross-cultural adaptation process of the VCS there were adjustments in five items of the questionnaire, four of them in terms of form and one in terms of content. necessary adjustments regarding form in five items. In the pre-test, for all VCS and TSC items, the non-applicable option had a significantly lower proportion than the instrument response key options (p<0.001, for all). Finally, a translated and adapted version for Brazilian Portuguese of the Vocal Congruence Scale (VCS) and the Transgender Scale Congruence (TSC) instruments was obtained., Conclusion: The VCS and TSC were transculturally adapted to Brazilian Portuguese and named as Vocal Congruence Scale and Transgender Person Congruence Scale.

Introduction: Voice production is a complex process involving the coordination of various anatomical structures and physiologic systems. The Voice Range Profile (VRP) is an established acoustic measure for evaluating voice production that examines minimum and maximum intensity across the frequency range. This pilot study sought to establish a consistent, efficient, and accessible VRP elicitation method. One primary research question was addressed: Does the proposed Short method provide at least as much information as a full, discrete-steps method, which is generally accepted in the literature?, Methods: In this quasi-repeated measures design, twenty-four singers completed a full VRP based on accepted methods from the literature, and the same participants returned within one to three weeks to complete the proposed Short VRP protocol. The full VRP consisted of steady state productions at every semitone within a participant's range for both minimum and maximum intensities. The Short VRP consisted of steady state productions at every octave and perfect fifth across the semitone range for both minimum and maximum intensities. Additional sampling was completed between points when a 7 dB or greater difference was found between consecutive points. Analysis compared each protocol's average elicitation time differences, average semitone range differences, visual examination of the average VRP graph, and examination of average intensity differences between protocols at specific semitone points. Male and female results were analyzed separately., Results: The proposed Short protocol produced similar or better intensity ranges when compared with the accepted full elicitation method. The Short protocol produced intensities with 95% or greater similarity to the Full Protocol for male maximum intensity curve, female minimum intensity curve, and female maximum intensity curve., Conclusions: When compared with a Full VRP, a Short VRP protocol appears to generate similar minimum and maximum intensity curves allowing for a time-efficient substitute., (Copyright © 2021 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Purpose: Vocal fatigue (VF) is a primary vocal symptom experienced by professional voice users, such as teachers, whose voice is an occupational tool. The study determines the utilization of the Vocal Fatigue Index (VFI), a 19-item scale in identifying symptoms of VF and its severity in teachers., Methods: Using responses of 695 teachers who completed the VFI, Mokken scaling was conducted on the items to identify the experiences of VF and its associated hierarchical nature of VF symptoms in teachers. Mokken scaling was completed on a total of four groups: (a) Total teachers group, (b) No VF group, (c) Low VF group, and (d) High VF group., Results: Results revealed differences in item hierarchies between total teachers and across the separate groups of VF severity. Item hierarchy for teachers highlighted items from physical discomfort at the mild end of the hierarchy to items from symptom improvement with rest at the severe end of the hierarchy. Items related to avoidance presented as a separate scale for teachers presenting with high VF., Discussion: Mokken scaling in teachers provides insight into the underlying complexity of the experience of VF symptoms and reliance on differential behavioral strategies in its management, suggesting the heterogenous nature of latent trait for VF in this specific population., (Copyright © 2021 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Introduction: The effects of emotion and cognition have been of interest to voice clinicians and research given the known correlations between psychological states and voice disorders. However, most voice research techniques investigate one psychological state at a time and do not necessarily consider other psychological states or the combination of two or more states occurring simultaneously. The purpose of this study is to employ three Stroop tasks, all known to elicit different psychological states, during a voice study to determine whether separate psychological states have a variable effect on vocalizations., Methods: Fifteen female participants were instructed to view a word on a computer screen and say the name of the color of the font of that word. Words were part of a Color Stroop, Emotional Stroop, or Taboo Stroop paradigm and designed to elicit cognitive, emotional, or the combination of cognitive/emotional interference. Behavioral measures of response time and acoustic measures of frequency, intensity, and noise ratio were extracted from each stimulus., Results: Participants had significantly greater response times for all experimental conditions compared to baseline. Additionally, intensity range was significantly less, and average fundamental frequency and cepstral peak prominence were significantly greater than baseline. However, there was no distinct pattern of response for any condition., Discussion/conclusion: Although there are definite changes in vocalizations when participants were engaged in higher cognitive or emotional processing, no acoustic signatures for these separate conditions exist. These findings suggest that more specific acoustic measures or additional measures such as physiological or self-report may be necessary to parse out the differential effect on the voice in these three conditions., (© 2020 S. Karger AG, Basel.)

Purpose The purpose of this document is threefold: (a) review the uses of the terms "vocal fatigue," "vocal effort," "vocal load," and "vocal loading" (as found in the literature) in order to track the occurrence and the related evolution of research; (b) present a "linguistically modeled" definition of the same from the review of literature on the terms; and (c) propose conceptualized definitions of the concepts. Method A comprehensive literature search was conducted using PubMed/MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Scientific Electronic Library Online. Four terms ("vocal fatigue," "vocal effort," "vocal load," and "vocal loading"), as well as possible variants, were included in the search, and their usages were compiled into conceptual definitions. Finally, a focus group of eight experts in the field (current authors) worked together to make conceptual connections and proposed consensus definitions. Results The occurrence and frequency of "vocal load," "vocal loading," "vocal effort," and "vocal fatigue" in the literature are presented, and summary definitions are developed. The results indicate that these terms appear to be often interchanged with blurred distinctions. Therefore, the focus group proposes the use of two new terms, "vocal demand" and "vocal demand response," in place of the terms "vocal load" and "vocal loading." We also propose standardized definitions for all four concepts. Conclusion Through a comprehensive literature search, the terms "vocal fatigue," "vocal effort," "vocal load," and "vocal loading" were explored, new terms were proposed, and standardized definitions were presented. Future work should refine these proposed definitions as research continues to address vocal health concerns.

Time-of-day effects on voice range profile performance were investigated in 20 vocally healthy untrained women between the ages of 18 and 35 years. Each subject produced two complete voice range profiles: one in the morning and one in the evening, about 36 hours apart. The order of morning and evening trials was counterbalanced across subjects. Dependent variables were (1) average minimum and average maximum intensity, (2) Voice range profile area and (3) center of gravity (median semitone pitch and median intensity). In this study, the results failed to reveal any clear evidence of time-of-day effects on voice range profile performance, for any of the dependent variables. However, a reliable interaction of time-of-day and trial order was obtained for average minimum intensity. Investigation of other subject populations, in particular trained vocalists or those with laryngeal lesions, is required for any generalization of the results.