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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.

This study measured the impact of articulation exercises using a cork and articulation exercises for lip spreading on the formant frequencies of vowels and listener perceptions of femininity in transgender women. Thirteen transgender women were recorded before and after the cork exercise and before and after the lip spreading exercise. Speech samples included continuous speech during reading and were analyzed using Praat software. Vowel formant frequencies (F1, F2, F3, F4, F5) and vowel space were determined. A listening experiment was organized using naïve cisgender women and cisgender men rating audio samples of continuous speech. Masculinity/femininity, vocal quality and age were rated, using a visual analogue scale (VAS). Concerning vowel formant frequencies, F2 /a/ and F5 /u/ significantly increased after the lip spreading exercise, as well as F3 /a/, F3 /u/ and F4 /a/ after the cork exercise. The lip spreading exercise had more impact on the F2 /a/ than the cork exercise. Vowel space did not change after the exercises. The fundamental frequency (f o) increased simultaneously during both exercises. Both articulation exercises were associated with significantly increased listener perceptions of femininity of the voice. Subtle changes in formant frequencies can be observed after performing articulation exercises, but not in every formant frequency or vowel. Cisgender listeners rated the speech of the transgender women more feminine after the exercises. Further research with a more extensive therapy program and listening experiment is needed to examine these preliminary findings. [ABSTRACT FROM AUTHOR]

Summary Objectives This study aimed (1) to investigate music theory teachers' professional and extra-professional vocal loading and background noise exposure, (2) to determine the correlation between vocal loading and background noise, and (3) to determine the correlation between vocal loading and self-evaluation data. Methods Using voice dosimetry, 13 music theory teachers were monitored for one workweek. The parameters analyzed were voice sound pressure level (SPL), fundamental frequency (F0), phonation time, vocal loading index (VLI), and noise SPL. Spearman correlation was used to correlate vocal loading parameters (voice SPL, F0, and phonation time) and noise SPL. Each day, the subjects self-assessed their voice using visual analog scales. VLI and self-evaluation data were correlated using Spearman correlation. Results Vocal loading parameters and noise SPL were significantly higher in the professional than in the extra-professional environment. Voice SPL, phonation time, and female subjects' F0 correlated positively with noise SPL. VLI correlated with self-assessed voice quality, vocal fatigue, and amount of singing and speaking voice produced. Conclusions Teaching music theory is a profession with high vocal demands. More background noise is associated with increased vocal loading and may indirectly increase the risk for voice disorders. Correlations between VLI and self-assessments suggest that these teachers are well aware of their vocal demands and feel their effect on voice quality and vocal fatigue. Visual analog scales seem to represent a useful tool for subjective vocal loading assessment and associated symptoms in these professional voice users. [ABSTRACT FROM AUTHOR]

Summary: Objective: The operatic singing technique is frequently used in classical music. Several acoustical parameters of this specific technique have been studied but how these parameters combine remains unclear. This study aims to further characterize the Western operatic singing technique by observing the effects of melody and technique on acoustical and musical parameters of the singing voice. Methods: Fifty professional singers performed two contrasting melodies (popular song and romantic melody) with two vocal techniques (with and without operatic singing technique). The common quality parameters (energy distribution, vibrato rate, and extent), perturbation parameters (standard deviation of the fundamental frequency, signal-to-noise ratio, jitter, and shimmer), and musical features (fundamental frequency of the starting note, average tempo, and sound pressure level) of the 200 sung performances were analyzed. Results: The results regarding the effect of melody and technique on the acoustical and musical parameters show that the choice of melody had a limited impact on the parameters observed, whereas a particular vocal profile appeared depending on the vocal technique used. Conclusions: This study confirms that vocal technique affects most of the parameters examined. In addition, the observation of quality, perturbation, and musical parameters contributes to a better understanding of the Western operatic singing technique. [Copyright &y& Elsevier]

Summary: Objective: The quality of a music performance can be lessened or enhanced if the performer experiences stressful conditions. In addition, the quality of a sung performance requires control of the fundamental frequency of the voice, which is particularly sensitive to stress. The present study aimed to clarify the effects of stress on singing voice accuracy. Methods: Thirty-one music students were recorded in a stressful condition (ie, a music examination) and a nonstressful condition. Two groups were defined according to the challenge level of the music examination (first and second music levels). Measurements were made by self-reported state anxiety (CSAI-2R questionnaire) and by observing heart rate activity (electrocardiogram) during each performance. In addition, the vocal accuracy of the sung performances was objectively analyzed. Results: As expected, state anxiety and heart rate were significantly higher on the day of the music examination than in the nonstressful condition for all the music students. However, the effect of stress was positive for the first-year students but negative for the second-year students, for whom the music examination was particularly challenging. In addition, highly significant correlations were found between the intensity of cognitive symptoms and the vocal accuracy criteria. Discussion: This study highlights the contrasting effects of stress on singing voice accuracy but also the need to consider the challenge level and perception of the symptoms in experimental and pedagogical settings. [Copyright &y& Elsevier]

Summary: Subjective evaluation of the voice by the patient is routinely assessed in the adult dysphonic population; this is, however, not the case in the pediatric population. There were three objectives of this study: the first goal was to study the ability of children aged 5–13 years to express themselves about physical, emotional, and sociofunctional aspects of their voice. The second goal was to explore if specific voice-related complaints were expressed by dysphonic children as compared with normophonic children. The third goal was to compare the dysphonic children''s voice-related complaints with those of their mothers. The overall objective was to set the grounds for the elaboration of a standardized questionnaire in French concerning subjective evaluation of voice in children. Twenty-five dysphonic children with vocal complaint (15 nodules, one polyp, one microweb, eight unspecified) and 55 normophonic children aged 5–13 years were interviewed. The interviews were semistructured based on a canvas of voice-related questions. The dysphonic children''s mothers were interviewed with the mean of a written questionnaire and were invited to discuss their answers orally with the examiner. The results were analyzed qualitatively and statistically. A Chi-square test and the Fisher''s test were used to analyze the differences between the complaints expressed by the dysphonic and the normophonic children, and a binomial test was used to compare the children''s answers with their mothers'' answers. The qualitative analysis of the interviews suggests that children are capable of reflecting over their own voice and of giving autonomous information about different aspects of their voice. It also appeared that voice is a complex phenomenon and that it needs to be clearly and cautiously defined to the children. We identified 27 different complaints related to the voice, out of which 17 were significantly more expressed by dysphonic than by normophonic children (P <0.05). Three of the 27 identified complaints show significant discordances between the mothers and the dysphonic children. The results suggest that children are capable of making a subjective and autonomous evaluation of their voice and that dysphonic children experience significantly more voice-related discomfort than nondysphonic children. The complaints expressed by the dysphonic children and their mothers are not all in concordance. The main conclusion is that a standardized subjective evaluation of the voice, not only by the parents but also by the child him/herself, would be relevant in the assessment of pediatric dysphonia. [Copyright &y& Elsevier]

Summary: Objectives: The aim of this study was to evaluate the objective voice results of Wendler''s glottoplasty in male-to-female transsexuals. Method: We retrospectively reviewed our patients treated with Wendler''s technique with minor modifications. Glottoplasty consisted in CO2-laser epithelial ablation of the anterior commissure and the two vocal folds in anterior third, suturing of the two vocal folds with two stitches of 3.0 resorbable thread, and application of fibrin sealant to strengthen the suture. Voice assessment was based mainly on fundamental frequency (F 0), frequency range, jitter, maximum phonation time, phonation quotient, estimated subglottic pressure (ESGP) grade of dysphonia (G), and voice handicap index (VHI). These measures were taken before surgery and on the last follow-up visit. Results: Our series included 15 patients with a mean age of 36 years. The mean follow-up period was 7.2 months. We did not observe any early complications related to the technique. The comparison between the preoperative and the postoperative measurements, using Wilcoxon signed rank test, showed a significant improvement of median F 0 from 139 to 191Hz (P =0.006) with an increase in the grade of dysphonia (G pre =0.2, G post =1, P =0.013) and ESGP (ESGPpre =8.1±3.2, ESGPpost =12.0±3.8, P =0.002). Other measurements, including VHI, did not show any significant differences pre- and postoperatively. Conclusion: Wendler''s glottoplasty can contribute to feminize the voice. [Copyright &y& Elsevier]

Summary: The objective of the study was to measure the subjective long-term effects of vocal therapy (more than 6 months) in 29 patients suffering from dysfunctional dysphonia. Four subjective measurements were used: one visual analog scale ranging from 0 (not efficient at all) to 100 (very efficient); one question “Is the speech therapy still efficient?,” answered by yes or no; the GRB parameters of the GRBAS scale (evaluated by the patient); and the VHI-10. The results show that 76% of the patients consider that the vocal therapy they received is still efficient. On the vocal quality (G), roughness (R), and breathiness (B) parameters, we observe a high degree of satisfaction on the G parameter (median=77). The scores on the R and B parameters are lower (median R =12, S =5). Roughness is significantly correlated to the Grade (Spearman coefficient r =0.516, P =0.004), whereas breathiness is not (P =0.251, NS). The comparison of the results on the VHI-10 pre and post treatment shows a significant decrease in the grade of perceived handicap (medians 15 vs 11, P =0.017). The correlations between the judgment of the treatment's efficacy and the vocal quality is significant (r =0.623, P <0.001) as well as the correlation between the VHI-10 and the length of the treatment (r =0.416, P =0.035). The conclusion can be made that speech therapy plays an important role in long-term treatment of dysfunctional dysphonias. [Copyright &y& Elsevier]

The objective of the study was to measure the subjective long-term effects of vocal therapy (more than 6 months) in 29 patients suffering from dysfunctional dysphonia. Four subjective measurements were used: one visual analog scale ranging from 0 (not efficient at all) to 100 (very efficient); one question 'Is the speech therapy still efficient?,' answered by yes or no; the GRB parameters of the GRBAS scale (evaluated by the patient); and the VHI-10. The results show that 76% of the patients consider that the vocal therapy they received is still efficient. On the vocal quality (G), roughness (R), and breathiness (B) parameters, we observe a high degree of satisfaction on the G parameter (median=77). The scores on the R and B parameters are lower (median R=12, S=5). Roughness is significantly correlated to the Grade (Spearman coefficient r=0.516, P=0.004), whereas breathiness is not (P=0.251, NS). The comparison of the results on the VHI-10 pre and post treatment shows a significant decrease in the grade of perceived handicap (medians 15 vs 11, P=0.017). The correlations between the judgment of the treatment's efficacy and the vocal quality is significant (r=0.623, P<0.001) as well as the correlation between the VHI-10 and the length of the treatment (r=0.416, P=0.035). The conclusion can be made that speech therapy plays an important role in long-term treatment of dysfunctional dysphonias. [ABSTRACT FROM AUTHOR]

The Acoustic Voice Quality Index (AVQI), version 03.01, is a tool for quantitative assessment of the overall severity of dysphonia. It is based on the recordings of a sustained vowel and part of a text read aloud. For the Dutch sample, 34 syllables must be read aloud to balance the duration of the two tasks. The first part of this study thus aimed to determine how many syllables of a commonly used text in the French-speaking part of Belgium should be used to achieve the same balance. The psychometric qualities of the AVQI have been confirmed by numerous publications in various languages. However, its validation in French relies on a small cohort of patients, who were not native French speakers. Furthermore, version 03.01 of the AVQI has not yet been validated at all on French samples. Hence, the main aim of this study was to assess the criterion-related concurrent validity and diagnostic accuracy of the AVQI 03.01 applied to a sample of native French speakers. For the first part of this study, the optimal part of the text to be used for the AVQI was identified, taking into account both its phonemic contents and its time balance with the sustained vowel. For the validation study, 90 recordings from the University Hospital of Liège's ENT caseload database were used, as well as 30 new recordings of normophonic individuals, composing a control group. Four judges assessed the recordings using the G parameter of the GRBAS scale. Once the intra- and inter-rater reliability of the perceptual ratings was confirmed, the AVQI 03.01's criterion validity was assessed on the French sample. The diagnostic accuracy of the AVQI 03.01 in French was measured, and the cut-off score allowing for the greatest diagnostic precision determined. The most appropriate syllable number of the text to be read aloud was found to be 27, in order to balance the time analyzed for both the sustained vowel and the continuous speech. Regarding the validation study, intra-rater reliability was substantial for each of the four vocologists (κ mean =.778, P < 0.0001), and inter-rater reliability was high (W =.895, P < 0.0001). The Spearman correlation between the perceptual judgments and the AVQI 03.01 score was strong (r s =.84, P < 0.0001). The receiver operating characteristic-curve parameters indicated that the ideal cut-off score allowing for the highest diagnostic accuracy of the AVQI, version 03.01, applied to a French sample is 2.33, with a sensitivity of 59.8%, a specificity of 100%, an infinite positive likelihood ratio (LR+) and a negative likelihood ratio (LR−) of 0.4. This study confirms the external validity of the AVQI 03.01 when applied on a French 27-syllable sample. The AVQI 03.01 is a robust, ecologically valid objective measure of overall voice quality. The cut-off score to be used is 2.33. However, clinicians should be cautious when the AVQI score is lower than 2.33. The AVQI 03.01 does not yield a sufficiently low negative likelihood ratio to be sure that this score indeed indicates normophonia. Also, taking into account the limitations regarding the perceptual judgements used in this study, a replication study should be carried out in order to confirm the cut-off score. [ABSTRACT FROM AUTHOR]

The Acoustic Voice Quality Index (AVQI), version 03.01, is a tool for quantitative assessment of the overall severity of dysphonia. Its computation includes six acoustic parameters, which are all analyzed with Praat freeware. It is based on recordings of a sustained vowel and part of a text read aloud. The psychometric qualities of this tool in various languages, including French, have been confirmed by numerous publications. However, studies investigating the correlation between tools for objective vocal assessment and voice-related quality of life show inconsistent results. Hence, the aim of this study was to contribute to the debate on measuring the correlations between the AVQI 03.01 score computed on French samples and the Voice Handicap Index (VHI). Data from 78 patients were used; they were collected during initial vocal assessment and stored in the ear, nose, and throat caseload database of the University Hospital of Liège. The Spearman rank-order correlations (r s) between the VHI total score and subscores and the AVQI 03.01 scores for French samples were measured. The correlation between the diagnostic decisions ("normophonia" versus "dysphonia") of both tools was assessed using Cramer's phi. The Spearman correlation between AVQI 03.01 score and total VHI score, controlling for age, was moderate (r s = 0.62, P < 0.0001). The correlations between the AVQI 03.01 score and the functional, emotional, and physical subscores of the VHI were also moderate (r s = 0.643, 0.543, and 0.514, respectively, P < 0.0001). The correlation between the two instruments' diagnostic decisions ("normophonia" versus "dysphonia") was also moderate (φ = 0.52, P = 0.000). Although AVQI 03.01 scores were moderately correlated with the VHI total score and subscores, they measure two different things. The AVQI 03.01 assesses overall voice quality in terms of acoustic parameters, whereas the VHI assesses the multidetermined impact on the patient's everyday life. Both results should thus be taken into account, as part of a comprehensive vocal assessment. [ABSTRACT FROM AUTHOR]

This is a case-control study investigating the personality profiles of children with vocal fold nodules (VFNs). Personality has been suggested as a contributing factor to VFN in adults and in children. However, previous studies in children have focused on psychopathologic traits and have reported contradictory findings. The aim of our study was to explore whether general, nonpathologic personality structure predicts the presence of VFN in children. Personality traits were measured in 34 children with VFN, aged 6.0–13.6, and 34 age- and sex-matched normophonic controls by means of a pediatric five-factor personality questionnaire. Children with VFN were found to be significantly more extroverted than controls (P = 0.022, d = 0.61), and a binary logistic regression showed that extraversion significantly predicted the presence of VFN in our population (P = 0.027). The clinical implications of the results are discussed. [ABSTRACT FROM AUTHOR]