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Purpose: Background noise and voice problems among teachers can degrade listening conditions in classrooms. The aim of this literature review is to understand how these acoustic degradations affect spoken language processing in 6- to 18-year-old children. Method: In a narrative report and meta-analysis, we systematically review studies that examined the effects of noise and/or impaired voice on children's response accuracy and response time (RT) in listening tasks. We propose the Speech Processing under Acoustic DEgradations (SPADE) framework to classify relevant findings according to three processing dimensions--speech perception, listening comprehension, and auditory working memory--and highlight potential moderators. Results: Thirty-one studies are included in this systematic review. Our meta-analysis shows that noise can impede children's accuracy in listening tasks across all processing dimensions (Cohen's d between -0.67 and -2.65, depending on signal-to-noise ratio) and that impaired voice lowers children's accuracy in listening comprehension tasks (d = -0.35). A handful of studies assessed RT, but results are inconclusive. The impact of noise and impaired voice can be moderated by listener, task, environmental, and exposure factors. The interaction between noise and impaired voice remains underinvestigated. Conclusions: Overall, this review suggests that children have more trouble perceiving speech, processing verbal messages, and recalling verbal information when listening to speech in noise or to a speaker with dysphonia. Impoverished speech input could impede pupils' motivation and academic performance at school.

Purpose: The aim of this study was to investigate children's processing of dysphonic speech in a realistic classroom setting, under the influence of added classroom noise. Method: Typically developing 6-year-old primary school children performed two listening tasks in their regular classrooms--a phoneme discrimination task to assess speech perception and a sentence-picture matching task to assess listening comprehension. Speech stimuli were played back in either a typical or an impaired voice quality. Children performed the tasks in the presence of induced classroom noise at signal-to-noise ratios between +2 and +9 dB. Results: Children's performance in the phoneme discrimination task decreased significantly when the speaker's voice was impaired. The effect of voice quality on sentence-picture matching depended on task demands: Easy sentences were processed more accurately in the impaired-voice condition than in the typical-voice condition. Signal-to-noise ratio effects are discussed in light of methodological constraints. Conclusions: Listening to a dysphonic teacher in a noisy classroom may impede children's perception of speech, particularly when phonological discrimination is needed to disambiguate the speech input. Future research regarding the interaction of voice quality and task demands is necessary.

Purpose: Our aim was to investigate isolated and combined effects of speech-shaped noise (SSN) and a speaker's impaired voice quality on spoken language processing in first-grade children. Method: In individual examinations, 53 typically developing children aged 5-6 years performed a speech perception task (phoneme discrimination) and a listening comprehension task (sentence-picture matching). Speech stimuli were randomly presented in a 2 × 2 factorial design with the factors "noise" (no added noise vs. SSN at 0- dB SNR) and "voice quality" (normal voice vs. impaired voice). Outcome measures were task performance and response time (RT). Results: SSN and impaired voice quality significantly lowered children's performance and increased RTs in the speech perception task, particularly when combined. Regarding listening comprehension, a significant interaction between noise and voice quality indicated that children's performance was hindered by SSN when the speaker's voice was impaired but not when it was normal. RTs in this task were unaffected by noise or voice quality. Conclusions: Results suggest that speech signal degradations caused by a speaker's impaired voice and background noise generate more processing errors and increased listening effort in young school-aged children. This finding is vital for classroom listening and highlights the importance of ensuring teachers' vocal health and adequate room acoustics.

Purpose: Although a global picture exists of teachers' voice demands in general, few studies have compared specific groups of teachers to determine whether some are more at risk than others. This study compared the vocal loadings of kindergarten and elementary school teachers; professional and nonprofessional vocal load were determined for both groups. Method: Twelve kindergarten and 20 elementary school female teachers without voice problems were monitored during 1 workweek using the Ambulatory Phonation Monitor. Vocal loading parameters analyzed were F0, SPL, time dose, distance dose, and cycle dose. Results: Comparisons between the groups showed significantly higher cycle dose and distance dose for kindergarten teachers than for elementary school teachers, in both professional and nonprofessional environments. Professional and nonprofessional voice use comparisons showed significant differences for all parameters, indicating that vocal load was higher in the professional environment for both groups. Conclusions: The higher vocal doses measured in kindergarten teachers suggest that particular attention should be paid to this specific group of teachers. Although nonprofessional vocal load is lower than professional vocal load, it is important to take both into account because of their cumulative effects.

Purpose: Voice feminization for transgender women remains a challenge. The fundamental frequency of the voice (fo) is one of the main parameters contributing to the perception of gender. One of the aims of voice therapy is to help transgender women acquire a new vocal motor behavior to increase their fo. We hypothesized that ambulatory biofeedback could help extend the new vocal behavior to daily life. Materials and methods: This prospective case study assessed the impact of two weeks of ambulatory vibrotactile biofeedback (VTBF) applied to one transgender woman, following two weeks of voice therapy (three 60-minute sessions). The VTBF was activated when the participant's voice was lower than 150 Hz for more than 500 ms and was accompanied by two 60-minute counseling sessions. Results: The results showed that mean fo monitored in daily activities tended to increase following the two weeks of voice therapy (Δ = 8 Hz or 1 semitone) and then increased significantly immediately after the two weeks of VTBF (Δ = 13 Hz or 1.5 semitones). The increase in mean fo from day to day and the decrease in the activation percentage from the first to the second week of VTBF (Δ = 6%) indicated a gradual integration of the motor behavior, making it possible to achieve the targeted female frequency. Conclusions: The results suggest that ambulatory VTBF helped the participant to generalize the techniques acquired during the voice therapy sessions to real-life communication situations. These results are promising for therapeutic programs that integrate tools that can be used outside the clinical context. Design: Prospective case study. [ABSTRACT FROM AUTHOR]

Context: A range of studies have consistently shown that listeners associate negative psychosocial characteristics to speakers with dysphonia. The reasons why have not formerly been explored. A better understanding of the mechanisms behind this negative stereotype could help to develop attitude-changing measures towards voice disorders. Aim: We want to explore if the negative psychosocial stereotype linked to dysphonia is due to dysphonia's negative impact on perceived vocal beauty. Methods: A group of naïve listeners was asked to listen to female voice samples with varying degrees of dysphonia according to the Grade (G) of the GRBAS scale, and then to rate the perceived degree of vocal beauty for each voice on a visual analogue scale. They were also asked to infer personal characteristics of each speaker on a set of 21 Bipolar semantic scales. Results: Mediation analyses showed that G significantly and negatively predicts perceptions of vocal beauty (p <.001) and that vocal beauty in its turn was significantly and positively predicting inferences of negative psychosocial characteristics in the speakers (p <.001). When vocal beauty was partialled out, the negative impact of G was diminished or even cancelled. Conclusion: Our results show that in female speakers, the negative impact of dysphonia on the attribution of speakers' personal characteristic is explained by the negative impact of dysphonia on perceived vocal beauty. Our results support the hypothesis that the beauty stereotype underlies the negative biases existing towards dysphonic speakers. We suggest that clinicians should be aware of this mechanism when promoting awareness about dysphonia. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to assess the suitability of imitated dysphonic voice samples for their application in listening tasks investigating the impact of speakers' voice quality on spoken language processing. Methods: A female voice expert recorded speech samples (sustained vowels and connected speech) in her normal voice and while imitating a dysphonic voice. Voice characteristics, authenticity, and consistency of the two voice qualities were evaluated by means of acoustic measurements (Acoustic Voice Quality Index [AVQI], jitter, shimmer, harmonics-to-noise ratio [HNR]) and perceptual evaluation (GRBAS scale, consistency, and authenticity rated by five speech-language pathologists). Results: Based on acoustic and perceptual assessments, the degree of voice impairment for the imitated dysphonic voice was found to be moderate to severe. Roughness and asthenia were the predominant perceptual features. The perceptual rating indicated a high consistency and acceptable authenticity of the imitated dysphonic voice. Conclusions: Results suggest that an imitation of dysphonic voice quality may resemble the voice characteristics typically found in dysphonic patients. Implications: The voice samples validated here shall be applied in future listening tasks and may promote our understanding of how dysphonic speech is processed. [ABSTRACT FROM AUTHOR]