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Importance: Prevalent schemes that have been used for arranging voice pathologies have shaped theoretical and clinical views and the conceptualization of the pathologies and of the field as a whole. However, these available schemes contain inconsistencies and categorical overlaps., Objective: To develop and evaluate a new approach for arranging voice pathologies, using 2 continuous scales, organicity and tonicity, which were used to construct a 2-dimensional plane., Design, Setting, and Participants: This survey study was conducted among experts in the fields of laryngology and/or voice disorders from 10 countries. The survey was conducted using an online platform from March to May 2021. The data were analyzed in June 2021. Of the 45 experts who were initially approached, 39 (86.7%) completed the survey., Main Outcomes and Measures: The primary outcome measures were group ratings on 2 rating scales: organicity and tonicity. On the organicity scale, 0 represented nonorganic and 10 organic. On the tonicity scale, 0 represented hypotonic and 10 hypertonic., Results: Participants included 16 laryngologists and 23 speech-language pathologists, of whom 27 (69.2%) were women and 12 (30.8%) men with a mean age of 55 years. The Cronbach α was high for organicity and tonicity (0.98 and 0.97, respectively). Interrater agreement (rwg) was moderate to very strong (rwg≥0.50) for most pathologies. The correlation between the 2 scales was moderate and negative (r = -0.38; P = .03). The pathologies were scattered across the full range of both scales and the 4 quadrants of the 2-dimensional plane, suggesting the continuity and bidimensionality of the new arrangement scheme. In addition, a latent profile analysis suggested that the 4-cluster solution is valid and roughly corresponded to the 4 quadrants of the constructed plane., Conclusions and Relevance: The findings of this survey study suggest the potential use of a 2-dimensional plane that was based on 2 continuous scales as a new arrangement scheme for voice disorders. The results suggest that this approach provides a valid representation of the field based on 2 basic measures beyond the specific etiology of each laryngeal pathology or condition. This simple and comprehensive organization scheme has the potential to facilitate new insights on the nature of voice pathologies, considering the interpathology similarities and differences.

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

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

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

Background: Individuals using their voice intensively during physical effort are at risk for developing voice problems. This study was aimed at examining the influence of physical activity on voice characteristics., Methods: Fourteen physical education students (age: 27 ± 4.23 years) were recorded in a resting position, and during mild, moderate, and high exercise intensities (active conditions). Participants were also recorded immediately after each activity, while standing (recovery condition). All recordings were analyzed acoustically., Results: A significant elevation in the fundamental frequency (F0) was observed with the increase in activity level (p < 0.05). For all other acoustic measures, a gradual increase was observed as the activity level was raised. This increase was statistically significant for a specific set of measures (jitter, PPQ5, and shimmer) during the active conditions. In most cases, significant contrasts were found only between the high activity level and the other levels. During the recovery conditions, a similar increase in values was observed. However, these findings failed to reach statistical significance., Conclusion: Findings imply that high levels of physical effort lead to a significant reduction in vocal stability and to an elevation in F0. These changes result from vocal effort and could therefore lead to voice disorders and pathology.

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

Purpose: Two studies are presented here. Study 1 was aimed at evaluating whether the voice characteristics of women who use birth control pills that contain different progestins differ from the voice characteristics of a control group. Study 2 presents a meta-analysis that combined the results of Study 1 with those from 3 recent studies that compared voices of women who use and do not use birth control pills., Method: In Study 1, voice samples from 30 women with no history of voice training, who use pills with different progestins (drospirenone, desogestrel, gestodene), and 10 women who do not use the pill were recorded at specific time points across the menstrual cycle and were analyzed acoustically. In Study 2, results from Study 1 were analyzed jointly with results from three recent studies, which used similar methodologies., Results: Results of Study 1 did not reveal acoustic differences in sustained phonation of vowels across the pill groups and controls. Results of the meta-analysis performed in Study 2 indicated that pill users exhibited lower jitter and shimmer values on sustained vowels, whereas no difference of fundamental frequency was observed among women who use the pill., Conclusions: These results support findings from previous studies, which suggested that no adverse effect on voice was detected among nonprofessional speakers who use new-generation monophasic birth control pills, for the measures studied. Furthermore, results of the meta-analysis suggested that some acoustic properties of the voice, which are reflected in perturbation measures in sustained vowels, may be improved among women who use the pill.

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

The classical literature on endocrine effect on voice considers oral contraceptives (OCs) as a risk factor for voice. However, recent studies revealed no adverse effect of new-generation OCs on voice. It was also suggested that OCs could improve specific voice characteristics via different mechanisms. The aim of the present study was to evaluate the effect of OCs on voices of women who use different formulations containing drospirenone (n=10), desogestrel (n=9) and gestodene (n=10). Acoustic voice measures of the 29 women were evaluated twice during the menstrual cycle. Fundamental frequency, frequency as well as amplitude stability and noise characteristics were measured using a computerized voice analysis program. Results indicated that vocal stability and quality were similar in the three groups tested. Marginal differences were observed between the drospirenone group and the other two groups. This preliminary observational study indicates that although drospirenone was previously shown to reduce water retention, this effect was not found to directly influence voice characteristics of women who use OCs.

Several institutions provide voice practice for their teaching staff. These 'voice courses' provide a unique treatment situation, in which some participants have a diagnosed laryngeal pathology, while others have no vocal complaints. Therefore, these voice courses can be viewed as group voice therapy as well as preventive voice treatment. The present study was aimed at providing a preliminary voice evaluation of participants in such a group, prior to and following treatment, using perceptual and acoustic analyses. Sixteen male teachers, who enrolled in a voice course, participated in eight consecutive sessions. Of this group, seven teachers were diagnosed with laryngeal pathologies, while the others had none. All participants were recorded before and after treatment. Recordings were analyzed acoustically, and also evaluated perceptually by ten experienced speech pathologists. Results indicated that: (i) voice quality improved after the voice course, (ii) vocal improvement was more pronounced in the pathological group than in the nonpathological group, and (iii) the acoustic analysis paradigm yielded results that were not always readily related with those of the perceptual paradigm.

Purpose of Review: Sex hormone fluctuations were shown to affect female vocal folds and laryngeal function. Laryngeal changes are evident throughout the span of life, starting at puberty with the arousal of the hormonal system, fluctuating systematically during the reproductive years with the menstrual cycle, and then changing again with the decline of hormonal activity at menopause. This paper reviews recent developments in this field., Recent Findings: Early studies that explored this relation were based merely on subjective impressions of voice quality, recent studies have used more objective tools for examining this relation, including histologic observations, stroboscope, electroglottography (EGG), and computerized acoustic analyses. In these studies, the larynx was shown to be a hormonal target organ and, as such, sex hormones affect its morphology, histology, and function, similar to their effect on the genitals and other organs., Summary: Examining the relation between sex hormones and the larynx could assist in understanding the mechanisms of voice production, and it could provide the clinician with supplemental diagnostic information on different medical conditions.

Objectives/hypothesis: The objective was to extend our knowledge of the effect of birth control pills on voice quality in women based on various acoustic measures., Study Design: A longitudinal comparative study of 14 healthy young women over a 36- to 45-day period., Methods: Voices of seven women who used birth control pills and seven women who did not were recorded repeatedly approximately 20 times. Voice samples were analyzed acoustically, using an extended set of frequency perturbation parameters (jitter, relative average perturbation, pitch period perturbation quotient), amplitude perturbation parameters (shimmer, amplitude average perturbation quotient), and noise indices (noise-to-harmonics ratio, voice turbulence index)., Results: Voice quality and stability were found to be better among the women who used birth control pills. Lower values were found for all acoustic measures with the exception of voice turbulence index. Results also provided preliminary indication for vocal changes associated with the days preceding ovulation., Conclusion: In contrast to the traditional view of oral contraceptives as a risk factor for voice quality, and in keeping with the authors' previous work, the data in the present study showed that not only did oral contraceptives have no adverse effect on voice quality but, in effect, most acoustic measures showed improved voice quality among women who used the birth control pill. The differences in the noise indices between groups may also shed light on the nature of the effect of sex hormones on vocal fold activity. It was suggested that hormonal fluctuations may have more of an effect on vocal fold regulation of vibration than on glottal adduction.

Objective: To evaluate the effect of low-dose monophasic oral contraceptives on female vocal quality., Methods: Acoustic voice parameters of six women who use oral contraceptives and six women who do not were evaluated repeatedly during the menstrual cycle. Frequency and amplitude variations were measured using a computerized voice analysis program. Repeated-measures analysis of variance was performed to test differences between groups for each acoustic voice parameter., Results: Vocal stability among the women who use oral contraceptives was significantly better than among those who did not use oral contraceptives (P <.05). Specifically, amplitude and frequency variations between successive vocal cycles were smaller in women using oral contraceptives in comparison with the control group (.24 dB versus.37 dB and.86% versus 1.27% for amplitude and frequency variations, respectively)., Conclusion: Contrary to the reports of adverse effects that high-dose pills have on voice, low-dose oral contraceptives show a favorable influence on voice in young women.

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