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Objective: Measuring patient motivation for voice therapy is an important component of determining prognosis and estimating compliance. Voice stimulability testing is assumed to influence the patient's motivation by improving their perception of the sound and/or feel of the voice. The purpose of this study was to validate a Voice Therapy Motivation and Voice Perception Inventory and to determine whether stimulability testing elicits improvements in motivation and patient-perceived voice status., Method: Seventy-five patients who underwent initial voice therapy evaluation completed a four-item inventory that queried their commitment to voice therapy, confidence that they could change their voice through voice therapy, perception of their voice severity, and ratings of their vocal effort. Inventories were completed shortly before and after stimulability testing. A psychometric analysis of the survey was conducted, including the internal consistency of each construct of the inventory along with content, predictive, and concurrent validity. Paired-samples statistical analyses were conducted to determine differences before and after stimulability testing, and Spearman correlations between voice and motivation ratings were conducted to determine relationships between the patient's perception of their voice and their motivation for voice therapy., Results: Internal consistency reliability was acceptable to good for each construct, particularly after stimulability testing. Motivation scales were predictive of returning for voice therapy sessions, subjective improvement of voice by the first therapy session, and likelihood of the patient practicing the home practice program. Patient ratings of voice severity and effort were positively correlated with clinician ratings of overall severity. Motivation and voice impairment perception improved following stimulability testing. Reduction in vocal effort was related to improved motivation, but change in voice severity was not., Conclusions: Voice stimulability testing can influence patient motivation for voice therapy and patient-perceived voice improvements. It should be considered a critical part of the voice evaluation.

Purpose: Marfan Syndrome (MFS) is a connective tissue disorder that affects skeletal, ocular, pulmonary, cardiovascular, and central nervous systems. Symptoms may lead to diminished quality of life (QoL) in individuals with MFS compared with healthy individuals. Currently, there is little evidence regarding the impact of MFS on voicing and QoL. This study examined perceptions of voicing difficulties and QoL among persons with MFS., Method: A total of 356 participants with a self-reported diagnosis of MFS completed the Quality-of-Life Index (QLI) and voice handicap index-10 (VHI-10) and provided medication regime., Results: Some degree of voice handicap was reported by a majority of participants. Analyses assessing correlations between responses to the VHI-10, QLI scores, and reported medications were conducted. Specific medications and responses on the VHI-10 were significantly associated with QLI scores. Multiple regression analyses revealed that a summed VHI-10 score was the strongest predictor of QLI satisfaction, QLI importance, and overall QLI., Conclusions: The findings of the current study suggest that individuals with MFS may experience self-perceived phonatory dysfunction which impact QoL. Specific classes of drugs may also be associated with reported voice handicap and QoL satisfaction in MFS. These findings have implications for physicians and clinicians who work with individuals with MFS., (Copyright © 2022 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Introduction: Negative psychological factors such as depression and other common mental disorders have been found to be associated with voice problems in teachers. However, there is little research with teachers that investigates the relationship between positive psychological factors such as wellbeing and voice problems. Although negative and positive mental states are on a continuum of psychological health, research suggests negative and positive effects are not necessarily inversely correlated and therefore need to be investigated separately., Objective/hypothesis: To explore the relationship between voice symptoms and wellbeing in teachers working in primary and secondary schools in England. We hypothesise that as wellbeing increases voice symptoms will decrease., Design: Cross sectional study using a self-administered web-based questionnaire conducted with primary and secondary school teachers in England., Methods: The study included 1205 teachers from 608 primary and secondary schools, including state and fee paying, and mainstream and special schools. Voice symptoms were measured using The Voice Symptom Scale and wellbeing was measured using the Warwick Edinburgh Mental Wellbeing Scale. Information was also obtained on health, lifestyle, sociodemographic and environmental factors. Analysis was conducted using a linear multi-level regression model., Results: A statistically significant relationship between voice symptoms and wellbeing was identified (-0.31 95% CI -0.41, -0.20 P =< 0.001). Other factors found to be statistically significantly associated with voice symptoms were age, sex, gastroesophageal reflux, class size, background noise, speaking louder than normal and respiratory infection. Hours teaching per week, deprivation of school, voice training, teaching subject, smoking status and asthma were not associated with voice symptoms., Conclusions: This study suggests that there is an association between vocal symptoms and wellbeing. Teachers with higher wellbeing had fewer voice symptoms., Competing Interests: Conflict of Interest None., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

Aim: To determine the relationship between working conditions, especially room acoustics, with voice symptoms and voice-related quality of life among Colombian school and college teachers during online classes in times of COVID-19 pandemic., Method: Exploratory cross-sectional study. Participants were thirty-two primary, secondary and university Colombian teachers, who were invited to fill in an online survey about working conditions and voice symptoms during online classes in times of COVID-19 pandemic. In the statistical analysis, four dependent variables and eight independent variables were defined. We used Generalized Linear Model with a Gamma distribution and Binary Logistic Regression to determine the association between voice with working conditions., Results: High reverberation time and stress during online classes in times of the COVID-19 pandemic reduced slightly the VRQOL scores. For Factor 3 of the VFI, high reverberation time and months teaching online classes were associated at the multivariate analysis. Stress and years of experience were statistically associated with an increased odds of reporting hoarseness., Conclusion: Similar to pre-COVID-19, teachers with online classes during the COVID-19 pandemic are affected by two work-related factors namely high reverberation time and stress. These two factors are increasing their likelihood of reporting hoarseness and having lower voice-related quality of life, which may confirm the relationship between reverberation, stress, and voice also during online classes. This highlights the need of implementing workplace vocal and mental health programs to decrease the occurrence of voice problems among teachers in times of and post-COVID-19 pandemic., (Copyright © 2022 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objective: Teachers are the most common occupational group reporting to the voice clinics with dysphonia across the globe. However, less is known about teachers' perceptions about their voice and voice problems. Hence the present study aimed to explore teachers' perception about their teaching voice, voice problems and vocal health-seeking behaviors., Method: A qualitative phenomenological research design using semi-structured interviews were conducted with fifteen female primary school teachers. Participants were asked to express their perception of teaching voice, vocal health care knowledge, and vocal hygiene practices. Using inductive analysis, the researchers converted the raw data into concepts or themes and discussed., Result: The present study results showed that teachers perceive voice as the primary tool for their profession. However, teachers consider voice problems as part of their professional commitments. Despite knowing the harmful effects of voice problems, teachers' pay less attention to their voice problems and perceive them as usual, unavoidable and part of their profession. Due to their demanding work schedule and not getting enough support from the management, they hesitate to consult medical professionals unless it severely affects them., Conclusions: The data obtained from this study can be used to improve the teachers' knowledge regarding vocal health and convince the school management to extend their support for the successful implementation of the vocal health training programs for teachers., (Copyright © 2022 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objective: To determine whether there is a difference in patient satisfaction between in-person and virtual voice therapy., Methods: Patient satisfaction answers to the National Research Corporation (NRC) Health patient survey were retrieved for two separate 11 month periods. The first was for an in-person cohort, from April 2019 to February 2020. The second was for a virtual cohort between April 2020 and February 2021. Two group t tests or Wilcoxon rank sum tests were used to compare responses between the in-person and virtual cohorts. The effect of modality of therapy by gender, age, and race was examined by testing interactions with separate ANOVA models., Results: Responses were compared between 224 patient satisfaction surveys for the virtual cohort and 309 patient satisfaction surveys for the in-person cohort. Overall, responses were highly favorable in all categories. There were no differences between the in-person and virtual cohorts' responses with respect to three main categories: likelihood of future referral of clinic or provider; communication with provider; and comprehension of the treatment plan. The interaction between modality of therapy delivery and age was significant for the question, "Did you know what to do after your visit," with 18-44 year olds in the in-person group reporting a better understanding of the treatment plan compared to the 18-44 year olds in the virtual therapy cohort (P = 0.004). There were no interactions between modality of therapy and gender, or race., Conclusion: Virtual delivery of voice therapy was associated with comparable visit satisfaction scores to in-person delivery, with both delivery modalities demonstrating very high satisfaction. Future studies are needed to identify which patients and conditions are most suited for virtual versus in-person delivery of speech-language pathology services in voice clinics., (Copyright © 2022 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objectives: Hearing loss (HL) (receptive communication impairment) is a known risk factor for depression. However, dysphonia (expressive communication impairment), has received little study. We study HL, self-reported voice disorder, and combined impairment as risk factors for depression in a large national cohort., Methods: This was a cross-sectional epidemiologic study. Data were analyzed from the Korean National Health and Nutrition Examination Survey (KNHANES) cycles 2008-2012 and 2019-2020. KNHANES uniquely contains both audiometry and voice disorder data. HL (yes/no) was defined as ≥25 dB pure tone average. Voice disorder (yes/no) was defined by self-report. Depression (yes/no) was defined by physician diagnosis. Odds ratios for depression were calculated using multivariable logistic regressions with HL and voice disorder., Results: 8,524 individuals aged 19 to 80 years old had complete data. The mean age was 57.3 years (SD = 13.4) and 64% were women. All regressions were controlled for age and sex. Those with HL, versus those without, had 1.27 times the odds (95% CI = 1.07-1.52, p = 0.007) of depression. Those with self-reported voice disorder, versus those without, had 1.48 times the odds (1.22-1.78, p < 0.001) of depression. Those with HL and self-reported voice disorder, versus those with neither, had 1.79 times the odds (1.27-2.48, p < 0.001) of depression., Conclusions: This study demonstrates independent relationships between HL and depression and self-reported voice disorder and depression. Combined HL and self-reported voice disorder had nearly 1.8 times the odds of depression. This is likely due to the grossly additive effect of difficulty with incoming and outgoing communication streams., Level of Evidence: II Laryngoscope, 134:4060-4065, 2024., (© 2024 The American Laryngological, Rhinological and Otological Society, Inc.)

Introduction: Teachers face vocal problems related to long periods of speech and increased sound pressure, as well as environmental noise, inadequate posture and tension of the cervical muscles., Objective: To verify the results of self-assessment of teachers with normal larynges and vocal and musculoskeletal complaints, and compare them with the reference values., Methods: Fifty-seven teachers, aged between 21 and 60 years (average 40.14 years) participated in the study. Anamnesis, otorhinolaryngological examination, hearing screening and self-assessment protocols were performed., Results: In the Nordic musculoskeletal questionnaire, the majority of teachers had discomfort in most parts of the body and in the situations evaluated; on the voice-related quality of life, the total and physical subscores were lower than the normative values while the emotional subscore was higher; regarding voice symptoms scale and vocal tract discomfort scale, the scores were higher than the normative values; in the hospital anxiety and depression scale, there was alteration in the total score; in the Vocal Activity and Participation Profile, the effects on work and emotion were above the normative values; on the University of Rhode Island change assessment-voice and on the voice handicap index there were no significant differences., Conclusion: Most of the teachers presented vocal, musculoskeletal, and emotional complaints on the self-assessment results, what suggests excessive voice use as well as overload on the body muscles, including the larynx and vocal tract, and that they presented emotional changes. These aspects had an impact on their quality of life, but they showed no action in coping with the condition., (Copyright © 2022 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Background: The aging voice index (AVI) is a 23-item self-administered, patient-reported outcome measure. It was developed in the English language to assess the impact of voice disorders on the elderly population., Objectives: This study aimed to develop an Arabic version of the AVI (A-AVI), test its reliability and validity, and assess its psychometric aspects in Arabic-speaking elderly persons with voice disorders., Study Design/methods: This was an observational, cross-sectional study involving elderly patients aged ≥60 years. Eighty-two patients with voice disorders were included in the dysphonia group and 77 patients without voice disorders were included in the vocally healthy group. The translated A-AVI and Arabic voice handicap index 10 (A-VHI10) were distributed to the study groups. The A-AVI was tested for its reliability (test-retest reliability and internal consistency) and validity (content, construct, and concurrent with A-VHI10)., Results: The A-AVI showed excellent test-retest reliability and internal consistency (intraclass correlation coefficient = 0.987 and Cronbach's alpha = 0.954, respectively). There was a significant difference in A-AVI scores between the elderly in the dysphonia and vocally healthy groups (P < 0.001). In addition, a significant correlation was demonstrated between A-AVI and A-VHI10 (r = 0.89). Unilateral vocal fold immobility and inflammatory laryngeal disorders were most frequently reported by the dysphonia group (28%)., Conclusions: A-AVI has excellent validity and reliability in Arab-speaking elderly patients with voice disorders. It can be considered in the assessment of the effect of voice disorders on the quality of life of the elderly., Competing Interests: Conflict of Interest The authors declare that they have no known competing financial interests or personal relationships that could have operated to influence the work reported in this paper., (Copyright © 2022 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Purpose: To establish normative values for the OMNI-Vocal Effort Scale (VES) in healthy adults without voice complaints. Secondary objective is to determine if there are differences in perceived vocal effort across age groups and between sexes., Study Design: Prospective data collection across groups., Method: A nine-item survey was administered by speech-language pathologists with specialization in voice to consenting adults 18 years or older. Participants underwent an auditory perceptual evaluation of voice and answered questions regarding age, history of voice problems, history of voice surgery, smoking history and hearing loss. Participants were instructed to rate their perceived vocal effort in conversational speech using the OMNI-VES. Multivariant analysis was conducted., Results: Two hundred and fifty-one participants were recruited. The majority of adults without voice complaints reported that producing conversational voice was within the "extremely easy" to "easy" range, 0-3 (92.4%)., Conclusions: This study provides preliminary data for perceived vocal effort. The OMNI-VES may be a useful tool in understanding changes in perceived vocal effort as a result of treatment for voice disorders. Further normative data are needed between sexes, across the gender spectrum, and older adult populations. Future directions include examining the magnitude of difference between numeric values on the scale and use of the scale with other dysphonic populations., Level of Evidence: 3 Laryngoscope, 134:3726-3731, 2024., (© 2024 The American Laryngological, Rhinological and Otological Society, Inc.)

Objectives: The aim was to compare voice outcomes over time in patients treated with Imitation Model voice therapy and Verbal Instructions Model voice therapy., Methods: A prospective clinical trial was performed with 56 consecutive patients diagnosed with a primary or secondary functional voice disorder. Thirty-one patients were included for voice therapy following the Imitation Model and 25 patients for the Verbal Instructions Model. Assessments included a self-rated Voice Handicap Index, self-perceived hoarseness and vocal fatigue, perceptual voice evaluation by a Speech Language Pathologist, and maximum Voice Range Profiles. All assessments were completed before therapy, at end of therapy, at six-months posttherapy follow-up and 12-months posttherapy follow-up. For maximum Voice Range Profiles group differences were also compared for effects from end-of-treatment to follow-up assessments. Linear mixed models were used for analysis., Results: Comparison between treatment groups showed significantly larger long-term improvement from the baseline, for verbal instructions model as compared to imitation model for Voice Handicap Index total, and also the physical and emotional subscales, while there was no difference between groups for the functional subscale. Also, voice quality improved more after verbal instructions model, as compared to imitation model, at end of therapy. Results from self-rated hoarseness and vocal fatigue showed no difference between groups. There was no difference between treatment groups in the change of maximum Voice Range Profile from end-of-treatment to follow-up assessments., Conclusions: The study showed that both Imitation Model voice therapy and Verbal Instructions Model voice therapy improved voice function. Compared to Imitation Model, the Verbal Instructions model showed larger long-term effect on physical and emotional aspects of voice function in everyday life. The two approaches for voice therapy might have different impacts on patients' learning., (Copyright © 2022 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objective: This study explored the voice experience, singing ability, and wellbeing of singers diagnosed with Hypermobility Spectrum Disorder (HSD) or hypermobile Ehlers-Danlos Syndrome (h-EDS)., Study Design: This was a mixed-method study. A purposive sampling strategy was used. Data were collected via an online survey, using written closed and open-ended questions., Methods: 276 adults completed the survey. This study focuses on a subset of professionally-trained singers (n=71). Responses elicited information about participants' voice health and function, symptoms of hypermobility, singing experiences and training. Data were analysed using template analysis., Results: Many participants reported wide vocal ranges and enjoyment of singing but 74.6% of participants across all age groups (18-60 years) experienced voice difficulties. Three common themes were identified: (1) 'My unreliable voice': The ups and downs; (2) Wider effects of HSD/h-EDS on singers, and (3) Need for acknowledgment and support., Conclusions: Voice difficulties and hypermobility-related health conditions affected the participants' abilities to sing and perform; this impacted their professional and personal opportunities, communication, relationships, and wellbeing. Our results indicate that symptoms of voice disorder worsen over time. We suggest practical strategies that singers and training providers could implement to support hypermobile singers. More research is needed to fully understand voice difficulties in singers with HSD/H-EDS and to inform tuition and support., (Copyright © 2021 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Purpose of Review: The purpose of this review is to update the reader with recent advances and current opinion on the assessment and management of paediatric voice disorders., Recent Findings: Access to advanced multidisciplinary paediatric voice clinics has increased over the last decade. Often the assessment is combined between speech therapy/pathology and ENT surgery. Vocal fold nodules remain the most prevalent diagnosis at a paediatric voice clinic, but significant diseases will also present, for example laryngeal papilloma. Recently, more consideration of the psychosocial aspect of voice disorders and evaluation of auditory processing disorders have shown how these can have a negative impact. There also appears to be a lack of parental and teacher awareness of paediatric voice disorders and their significance., Summary: We would recommend multiparametric assessment and analysis of all children with a voice disorder. Most paediatric voice conditions will respond to skilled voice therapy. However, the exact techniques and dosage requires further evaluation and research. Paediatric voice conditions are common and should not be dismissed, as they may represent significant disease, for example papilloma, vagal palsy or have a significant psychosocial impact on the child., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Individuals with Parkinson's disease (PD) experience speech and voice-related symptoms that diminish communication and quality of life. Semi-occluded vocal tract (SOVT) exercises are targeted interventions that, when combined with the positive psychosocial benefits of therapeutic group singing (TGS), may affect outcomes. The purpose of this study was to explore the effectiveness of SOVT exercises, specifically straw phonation combined with TGS, to improve voice quality and mood for individuals with PD. We used a true experimental pretest-posttest between-subjects design (i.e., randomized controlled trial) facilitated by a board-certified music therapist. All participants (N = 27) were randomly assigned to one of three groups (a) straw phonation combined with TGS (SP + TGS, n = 10), (b) TGS (n = 10), and (c) speaking-only control group (n = 7). Participants completed voice recordings for acoustic measures and the Visual Analogue Mood Scale for mood analysis before and after a 30-min intervention. The results demonstrated significant improvement in voice quality evidenced by decreasing Acoustic Voice Quality Index scores following a single session for both SP + TGS and TGS intervention groups when compared to the control. Happiness scores improved in the experimental groups when compared to control. Although not statistically significant, participants in the experimental groups (SP + TGS, TGS) demonstrated better mean mood scores on happiness, anxiety, and angry when compared to control, indicating a positive psychological response to the singing interventions. Overall, this study indicated the effectiveness of SP + TGS and TGS as promising therapeutic interventions for voice quality and mood in individuals with PD., (© The Author(s) 2024. Published by Oxford University Press on behalf of American Music Therapy Association. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Objectives: The reliability and validity of the Voice-Related Quality of Life (V-RQOL) measure has been conducted in languages other than Mandarin. Therefore, this study aims to analyze the reliability and validity of the Mandarin version of the V-RQOL (MV-RQOL) questionnaire., Methods: The MV-RQOL was completed by a total of 57 participants, including 27 individuals with voice disorders (VD) and 30 individuals without voice disorders (NVD). Statistical analyses were carried out to evaluate the validity, reliability, reproducibility, and the Receiver Operating Characteristic (ROC) curve was also derived., Results: Statistical analyses demonstrated the MV-RQOL has strong internal consistency. The test-retest reliability was found to be high as well. There was a significant difference between the groups with and without voice disorders. The NVD group had higher scores compared with the VD group for the overall MV-RQOL score and for the 2 domains. In addition, the scores between males and females showed no significant differences. A significant difference was found between the MV-RQOL scores of individuals who defined their voices as good and very good, and those who defined their voices as poor and fair. Area under the curve value from ROC curve was found to be 0.994. The optimal cutoff value was found to be 85.00, with sensitivity of 96.7% and specificity of 96.3%., Conclusions: Based on the results, it can be suggested that the MV-RQOL measure is a reliable and valid self-assessment tool, that discriminates well between patients with and without voice disorders, in the Taiwanese population., (Copyright © 2021 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Background: Simulation is a safe, supported, and accessible learning method for students to gain skills and experience, especially in difficult to access range of practice areas such as voice., Objective: The study aimed to explore change in students' perceptions of knowledge, confidence, anxiety, and clinical readiness for assessment and management of an adult with a voice disorder after participation in simulation-based learning activities., Methods: Participants (N = 113) were students enrolled in a mandatory course dedicated to the voice and voice disorders. Students completed 32 hours of academic coursework which included lectures and tutorials and two 30-minute simulation-based learning activities with a standardized patient playing the role of an adult with a voice disorder. The impact of the simulation-based learning activities on student perceptions of their knowledge, confidence, anxiety, and clinical readiness for work within the area of voice were surveyed at three time points: (1) pre lectures, (2) post lectures but pre simulation, and (3) post simulation. Change across time was analyzed using repeated measures analysis of variance with post hoc Bonferroni adjustment., Results: All students perceived significant (P ≤ 0.001) positive changes in knowledge and confidence across time points for all activities, except for writing an assessment report. Anxiety related to the management of a client with a voice disorder fluctuated significantly (P ≤ 0.001) throughout the program. Overall, the majority (>90%) of students agreed or strongly agreed that the simulation-based learning activities were useful and helped them to develop clinical skills, apply content taught in lectures, and gain confidence and interest in voice., Conclusion: This study supports incorporation of simulation-based learning as part of students' clinical preparation for the assessment and management of voice disorders., (Crown Copyright © 2021. Published by Elsevier Inc. All rights reserved.)

Objective: To examine the effect of traditional voice therapy and cognitive therapy on the voice and client-wellbeing outcomes in adults with functional voice disorders (FVD)., Methods: A systematic review of English articles was conducted using Medline (Ovid), Embase (Elsevier), CINAHL (Ebsco), The Cochrane Central Register of Controlled Trials (CENTRAL), PsychInfo (Ebsco) and Speechbite from inception to current date. Additional studies were identified through bibliographies and authors were contacted when further information was required from an article. All study designs were included with pretest/posttest outcome measures related to voice. Independent extraction of studies was completed by three authors using predefined data fields and quality assessment tools., Results: Outcomes of 23 studies (2 RCTs and 21 cohort or case studies) are summarised using a narrative style due to heterogeneity of interventions and outcome scales used. Overall research quality of included studies was low, with many cohort and case studies lacking controls, blinding and robust outcome measures., Conclusions: There are some benefits to pairing cognitive behavioural therapy (CBT) with traditional voice therapy for FVD including improved voice quality, psychosocial wellbeing and prevention of relapse. It is feasible to train speech-language pathologists (SLPs) in CBT-enhanced voice therapy. Further high-quality research is needed, however, to guide the clinical implementation of CBT for the management of FVD., (Copyright © 2021 The Voice Foundation. All rights reserved.)

Purpose: This paper's purpose is to provide a resource for clinicians and researchers of select voice-related patient-reported outcome measures (PROMs) available in the English language., Method: A systematic search for voice-related PROMs was conducted between September 2020 and July 17, 2021. Databases included APA PsychInfo, Nursing and Allied Health Source, MEDLINE via the EBSCO interface, and Science Direct. Reference lists for PROMs-related articles were mined for reference to PROMs protocols., Results: Thirty voice-related PROMs were identified and categorized as either developed primarily for use in the clinic (n = 12), developed primarily for use in a specific research study (n = 6), or translated into English for publication (n = 12). Twelve PROMs were summarized: Aging Voice Index, Disease Specific Self-Efficacy in Spasmodic Dysphonia, Evaluation of the Ability to Sing Easily, Evaluating Voice Disability - Quality of Life Questionnaire, Glottal Function Index, Linear Analog Scale of Assessment of Voice Quality, Quality of Life in Recurrent Respiratory Papillomatosis, Speech Disability Questionnaire, Trans Woman Voice Questionnaire, Vocal Cord Dysfunction Questionnaire, Vocal Fatigue Index, and the Vocal Tract Discomfort Scale., Conclusion: The PROMs can be categorized into English-language voice-related PROMs developed primarily for clinical use, English-language PROMs developed primarily for research use, and English-language PROMs translated into English. The extent of reliability and validity testing completed varies in the PROMs developed primarily for clinical use. A PROM's psychometric properties as well as the language in which the PROM was tested, should guide clinicians and researchers as they consider which instrument(s) to use., (Copyright © 2021 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Background: To compare voice rehabilitation-related quality of life among patients surgically treated for total laryngectomy and rehabilitated with esophageal (EV) and tracheoesophageal (TEV) voice., Methods: A systematic literature review of articles from the past 20 years was conducted, and only full-text English articles comparing VTE and EV results in laryngectomized patients were included., Results: We provided 15 articles for a total of 1085 laryngectomized patients undergoing voice rehabilitation, of which 869 (80.1%) were treated with voice prosthesis while 216 (19.9%) to esophageal speech. Pooled VHI outcomes showed a significantly better score for the TEV group than EV one (31.93±12.11 versus 35.39±20.6; P = 0.003), but no significant difference was recorded at VrQoL (8.27±5.98 versus 9.27±2.02; P = 0.19)., Conclusion: TEV and EV are both effective procedures in voice rehabilitation after laryngectomy. Although TEV allows for significantly better speech performance, it does not necessarily correlate with a high VrQoL., (Copyright © 2021 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Purpose: The purpose of this study is to explore the effectiveness of telepractice in voice intervention for female teachers in elementary schools with self-reported voice disorders., Methods: Thirty-five female elementary school teachers with self-reported voice disorders volunteered to participate in the study. They were divided into a telepractice voice intervention group (experimental group N=18) and a face-to-face voice intervention group (control group N=17) based on their employment setting. The exact same treatment protocol was applied to both groups of subjects, except that the intervention group was seen through telepractice, and the control group was seen face-to-face. The treatment protocol includes vocal hygiene education and resonant voice therapy twice a week for a total of eight sessions. Auditory perceptual analysis, acoustic assessment, aerodynamic assessment and self-assessment protocol were conducted before the intervention and one week after the last intervention, and the differences before and after interventions within each group and between groups were compared., Results: There was no significant difference in baseline data including age, working years, and voice symptoms between the two groups. Both groups showed significant improvement (P<0.05) in all voice assessment before and after the treatment sessions, except for the Voice Handicap Index-10 (VHI-10) assessment. No statistical difference was found in other pre- and post-intervention voice assessment changes between the two study groups. The control group presented higher improvement in the total score, and the two subdomain assessments of physiology and emotion., Conclusions: Telepractice voice intervention can effectively improve the voice quality of female teachers in elementary schools, and telepractice therapy can be an effective alternative to face-to-face voice intervention., (Copyright © 2021 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Background: Due to elevated vocal health risk in industries such as call centers, there is a need to have accessible and quick self-report tools for voice symptoms. This study aimed to determine if the concurrent and construct validity of three visual analog scales (VASs) of voice quality and symptoms could be used as a screening tool in call center agents., Methods: A cross-sectional study was carried out in three call center companies. The Voice Handicap Index-10 (VHI-10) and a vocal hygiene and symptoms survey were administered to 66 call center workers. Further, acoustic parameters including harmonics-to-noise ratio (HNR), smoothed cepstral peak prominence (CPPs), L1-L0 slope, and Alpha ratio were collected. Finally, workers completed three VASs capturing self-perception of vocal effort (VAS-1), voice quality (VAS-2), and vocal fatigue (VAS-3). Linear regression models with bootstrapping evaluated the possible relationship between the three VASs measurements, self-perceived vocal symptoms, and acoustic parameters., Results: VAS-1 scores were associated with HNR and voice breaks, VAS-2 with voice breaks, and VAS-3 with Alpha ratio. Using the area under a receiver operating characteristic curve (AUC), the highest AUC for detecting an altered VHI-10 questionnaire score was observed for the three VASs. Also, the highest AUC for detecting altered CPPs was reached for the VAS-1., Conclusions: VAS as a self-report instrument of vocal symptoms is related to psychosocial voice impairment and alterations of acoustic voice parameters in call center workers. Such instruments could be easily implemented to identify voice complaints in these populations., Level of Evidence: 2 (Diagnosis research question) Laryngoscope, 133:1676-1682, 2023., (© 2022 The American Laryngological, Rhinological and Otological Society, Inc.)

Purpose: This study examines communicative congruence and communicative dysphoria in adults who deny having a voice disorder. Communicative congruence is the degree to which a person's communication is consistent with their sense of self/identity. Communicative dysphoria is the psychological entropy resulting from communicative in congruence. We propose that these experiences may influence patients' psychosocial well-being and are thus relevant to the field of speech-language pathology. We hypothesized that both constructs would be normally distributed with an inverse relationship. We also hypothesized that communicative congruence would predict scores on the Center for Epidemiological Studies-Depression (CES-D) scale, subscales of the Big Five Aspect Scales (BFAS; a personality measure), and achieve convergent validity with the Vocal Congruence Scale (VCS)., Method: Participants (adults 18-70 years) completed the BFAS, CES-D, VCS, and the Voice Handicap Index-10 (VHI-10) before recording a series of speech tasks. Participants' recordings were played back while they responded to questions probing their communicative congruence and communicative dysphoria., Results: The 196 participants were predominantly female (67.3%) and cisgender (96.4%). Communicative congruence was negatively skewed, and communicative dysphoria was normally distributed. Both variables significantly related to each other: More in congruence was associated with more dysphoria. Communicative congruence was inversely related to CES-D scores. The personality metatrait Plasticity related to communicative congruence, as did the domain of Extraversion and the aspects Withdrawal, Enthusiasm, and Assertiveness. Communicative congruence achieved high convergent validity with the VCS., Conclusions: Counter to our hypothesis, participants reported more congruence than incongruence, but all other hypotheses were supported. Participants who reported in congruence were more likely to report symptoms of depression. These findings suggest that even in a predominantly cisgender cohort, some individuals' mental well-being might relate to how well their communication aligns with their identity. This work may inform future investigations into these constructs and their effects on voice therapy outcomes., Supplemental Material: https://doi.org/10.23641/asha.20739967.

Objective: To correlate, RSI with SVHI, in a group of singing students, by means of a specific anamnestic questionnaire which analyzes the physical, social, emotional, and economic impacts of voice problems on their lives. This study is a cross-sectional single-center observational study., Methods: Forty-two modern singing students (26F/16M; average age: 24.9 ± 5.7; range: 16-46 years old) were recruited. A self-assessment of the singing-voice (SVHI) and of reflux symptom (RSI) was performed., Results: Using the validated RSI threshold, 31% of participants were classified as RSI greater than 13 as an indication of suspected LPR. Classifying the SVHI score as proposed in the recent literature (cutoff of 20.35) our sample was a voice disorders prevalence of 71.4%. There was no significant positive or negative relationship between RSI and SVHI total score (rho = 0.238, P = 0.13). Instead, by considering the relationship between the individual items of the two questionnaires, it is highlighted that the item 1 of SVHI was significantly correlated with most of the RSI items (P = 0.0001-0.006). In the same vein, the item 5 of SVHI was correlated to hoarseness and coughing (P = 0.005-0.006). The item 20 of SVHI was significantly correlated with hoarseness, excess mucus in the throat or postnasal drip and with the pharyngeal Globus sensation (P = 0.001-0.005). By aggregating the SVHI item response as a positive response (2-4) versus a negative response (0 or 1) between "RSI pathology classification," a significant association was observed for SVHI item 1 (P < 0.021), item 5 (P < 0.006), item 20 (P < 0.042), item 24 (P < 0.044) item 25 (P < 0.047). These associations were confirmed by univariate binary logistic. Multivariate binary logistic regression confirms that SVHI Item 1, Item 5 were more associated with RSI positive. Based on results, we propose a questionnaire that combines the most relevant SVHI items correlated to LPRD (SVHI-10-LPRD questionnaire). Cronbach's alpha coefficient for the 10 items selected was 0.87; item-total correlation coefficients for each item were in the range of 0.461 to 0.670., Conclusions: This pilot study shows that, in case of significant RSI for LPR, it is possible to observe a significant association with some symptoms described in SVHI. These results underline that the association of the RSI and SVHI questionnaires administered to singers and singing students, can represent a simple screening to reveal possible alterations of the singing voice correlate to LPR. Moreover, we propose a Singing Voice Handicap Index correlated to LPR (SVHI-10-LPRD). It will be necessary to increase the sample of subjects in the study to confirm these preliminary data., (Copyright © 2020 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Purpose: The purpose of this study was to develop a novel teacher-reported pediatric voice outcome measure and to investigate its psychometric properties., Method: In the first stage, a new instrument, the Teacher-Reported Pediatric Voice Handicap Index (TRPVHI), was developed. After item generation, a panel of experts evaluated the items to assess the content validity. Subsequently, the final version of the preliminary instrument was applied to teachers of 306 children (57 dysphonic and 249 vocally healthy) between the ages of 4 and 11 years. Eventually, the construct validity, criterion-related validity, test-retest reliability, and internal consistency of the developed instrument were examined., Results: The items with a content validity ratio less than .8 were modified or removed, and accordingly, the preliminary version of the index was finalized. After the application of the preliminary version, item reduction was made based on the factor analysis. The index is composed of 27 questions and three subscales: Functional, Physical, and Emotional. A significant difference was observed between the dysphonic and vocally healthy children for the TRPVHI scores ( p < .001). A positive moderate correlation was determined between the Pediatric Voice Handicap Index and TRPVHI scores. Correlation coefficients between the test and retest scores of the TRPVHI were in the range of .92-.98. Cronbach's alpha values computed to assess the internal consistency were in the range of .94-.98., Conclusions: The TRPVHI is the only valid and reliable teacher-reported outcome measure of the effects of voice disorders on children. It is anticipated that the deployment of the TRPVHI in conjunction with other subjective tools, both in the initial evaluation and the follow-up of the treatment results, will allow a better understanding of the physical, functional, and emotional effects of voice disorders on children. Furthermore, it can potentially lead further research to enable the use of the TRPVHI for screening purposes.

Objective: To study the potential changes of health-related quality of life (HRQL), voice quality, and communicative function up to 24 months following radiotherapy for patients with laryngeal cancer., Methods: A total of 28 patients with laryngeal cancer, treated by curatively intended radiotherapy were included in this prospective longitudinal descriptive study. Patients were followed pre-radiotherapy, 12 months, and 24 months post-radiotherapy. At each time point, voice recordings and patient-reported outcome instruments (European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire Core30, Head and Neck35, Swedish Self-Evaluation of Communication Experiences after Laryngeal Cancer) were completed. Perceptual analysis using the Grade-Roughness-Breathiness-Asthenia-Strain was performed using the voice recordings., Results: Voice quality remains inferior to the voices of healthy controls both before and up to 24 months post-radiotherapy, demonstrating no statistically significant changes during the study period. Self-perceived communicative function revealed a trend toward improvement. Health-related quality of life remains mostly at stable levels, however, with statistically significant deterioration regarding dry mouth and sticky saliva. Generally, patients reported inferior scores compared to a normal population., Conclusion: This study demonstrated no statistically significant changes over time in HRQL and perceptual voice quality at pre-radiotherapy compared to 24 months post-radiotherapy. However, the values remain inferior to the voices of healthy controls or a normal population.

Objectives: To characterize the impact of subglottic stenosis (SGS) on voice-related quality of life (V-RQOL) and quantify the effect of treatment on voice outcomes., Study Design: Case series., Methods: Retrospective review of SGS patients treated from 1996 to 2018 at a single institution to assess for 1) V-RQOL association with individual patient cumulative treatment number and 2) V-RQOL correlation with treatment type, time between treatments, and degree of stenosis. Analysis included both parametric and nonparametric statistical comparison across treatment types and multivariable and univariate linear regression., Results: Sixty-one patients, predominantly white (93%) and female (93%), were included. Etiology of SGS included idiopathic (61%), iatrogenic (16%), granulomatosis with polyangiitis (16%), and other (7%). The plurality of patients had four or more treatments (44%), with the remainder having one (28%), two (13%), or three treatments (15%). Analysis of change between pre- and postoperative V-RQOL scores was completed for 130 treatments. These included dilation with laser incision (52%), in-office injection (34%), dilation without division (8%), cricotracheal resection (1%), and all other treatment (8%). For every 10% improvement in airway caliber postoperatively, there was a 1.3-point improvement in calculated V-RQOL (r = 0.27, P = .02). After adjustment for treatment type, age, sex, and SGS etiology, this association held (beta = 1.5, P = .02). Change in V-RQOL was not associated with treatment type, treatment number, or time between treatments., Conclusion: Patients with subglottic stenosis who have greater degree of change in airway caliber experience greater improvement in V-RQOL scores following treatment. V-RQOL scores are not associated with treatment type or time between individual treatments., Level of Evidence: 4 Laryngoscope, 131:360-365, 2021., (© 2020 American Laryngological, Rhinological and Otological Society Inc, "The Triological Society" and American Laryngological Association (ALA).)

Background and Objectives: This study aimed to assess the reliability and validity of the Persian version of the Pediatric Voice Handicap Index (pVHI)., Materials and Methods: The questionnaire was translated into Persian and then administrated to the parents of 45 dysphonic children and parents of 135 normal children. The content validity of the questionnaire was confirmed by eight speech-language pathologists. Internal consistency and test-retest reliability were measured via Cronbach's alpha and intra-class correlation coefficient, respectively. Independent-samples t-test was used to evaluate the discriminative and clinical validity of Persian pVHI., Results: Cronbach's coefficient values were excellent for the total score (α = 0.94) and physical subcomponent (α = 0.91). Moreover, these corresponding values were satisfactory for functional (α = 0.82) and emotional (α = 0.79) subcomponents. Test-retest reliability for the total score was high in both dysphonic and control groups (intra-class correlation coefficient> 0.92). There were significant differences between the control and dysphonic groups in terms of the total score and all subcomponents scores of Persian pVHI. However, no significant difference was observed in the mean total score of the Persian pVHI between the control and dysphonic group regarding gender (P < 0.001)., Discussion: Persian version of pVHI is a valid and reliable tool to evaluate the severity of voice disorder and its negative effects on the daily life of Persian children with voice disorder from the Parents' viewpoint., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Objective: Chronic rhinosinusitis (CRS) has long been associated with vocal dysfunction. However, studies quantifying the presence of voice dysfunction in CRS patients or the effects of functional endoscopic sinus surgery (FESS) are sparse. The goal of this study was to determine the voice-related quality of life in patients undergoing FESS for CRS using the validated Voice Related Quality of Life Survey (VRQL). We correlated the preoperative VRQL scores to the Sino-Nasal Outcome Test (SNOT-22) scores, and we determined the effect of FESS on postoperative VRQL scores., Methods: Consecutive patients undergoing FESS were preoperatively administered both the VRQL and the SNOT-22 surveys. Spearman (ρ) and Pearson ( r ) correlation coefficients were calculated. The VRQL was mailed to patients postoperatively between 3 and 6 months. The paired t-test was used to compare pre- and post-FESS scores., Results: A total of 102 patients were enrolled, and 81 patients completed the two surveys. A total of 51 (62.9%) patients had raw VRQL score ≥ 10, signifying presence of significant vocal symptoms. The mean ± standard deviation (SD) raw VRQL score of the entire study population was 12.4 ± 4.6, and the mean SNOT-22 score was 37.8 ± 19.2. The Spearman correlation coefficient between VRQL and the total SNOT-22 score was 0.34 ( P =.002), and the Pearson correlation coefficient was 0.36 ( P = .001). Both correlations were similar, demonstrating that increasing severity of CRS symptoms correlates with decreasing voice-related quality of life (QOL). Seventy patients completed the postoperative survey for an 86% retention rate. Thirty-six of these patients had abnormal preoperative VRQL scores, and these patients improved significantly after FESS. The mean preoperative versus postoperative raw scores were 15.2 ± 5.6 versus 12.5 ± 4.1, respectively ( P = .003)., Conclusion: This study demonstrates the increasing presence of vocal complaints with increasing severity of CRS. It also demonstrates that VRQL scores improve after FESS in those patients with preoperative vocal complaints., Level of Evidence: IV.

Background: Media frequently report on overall work-place challenges in Swedish schools, including teachers' working conditions, their well-being, and students' declining results. Language is the key to success in every school subject. Therefore, optimal language learning environments are important. Poor sound environments affect teachers' vocal health, their general well-being, and students' performance. To provide better conditions for teachers and students, it is necessary to combine optimized room acoustics with other preventive measures such as vocal training and evidence-based tools to improve classroom communication. Teachers play a key role in the classroom and need knowledge and skills in communicative strategies to ensure first-class communication. The purpose of this study is to explore the effects of an intervention program for primary-school teachers comprising strategies for enhanced language learning and interactions in the classroom, with focus on teachers' verbal and body communication (voice, gaze, and gesture). Methods: Teachers ( n  = 25) from seven schools teaching in school year 3-6 participated. Assessments were made pre/post intervention and at 5-weeks and 3-months follow-up. The assessments included teachers' self-assessments (questionnaires) of vocal health, self-efficacy, stress, burnout, and psychosocial work-environment. Results: The main results were significant decrease in voice problems at the 3-months follow-up and significant decrease of both stress and degree of burnout at 5-weeks follow-up. Self-efficacy score had increased significantly at 5-week follow-up. Conclusion: It can be concluded that the intervention program improves teachers' self-reported vocal health, decreases their perception of stress, and degree of burnout whilst increasing their sense of self-efficacy in classroom management.

Aim: To explore the internal consistency, criterion validity, and discriminative validity of the Arabic version of the vocal tract discomfort scale (VTDS-Arab); and to establish cut-off scores for the VTDS-Arab. Methodology: An overall of 202 participants (31 patients with voice disorders of organic and functional causes, and 171 healthy subjects, mean age 25.3 ± 6.7) were recruited in this study. Participants completed the VTDS-Arab scale and the Arabic version of the voice handicap index (VHI-Arab). Results: The VTDS-Arab had a positive internal consistency confirmed by Cronbach's α = 0.91. The criterion validity of the VTDS-Arab was confirmed by the strong positive correlation between the total scores of the VTDS-Arab and the VHI-Arab ( r  = 0.64, p  < .001). Patients scored higher than the healthy subjects in all the subscales of the VTDS-Arab ( p  < .001 ) which confirmed the discriminative validity of the VTDS-Arab. Age and gender were not found to affect the scores of the VTDS as confirmed by Pearson r test ( r  = 0.02, p  = .80) and insignificant p values of Levene's test (F1, 200 = 0.43, p  = .51), respectively, which supports the validity of the VTDS-Arab. The study posited interpretations for the ranges of scores of the VTDS-Arab based, where the cut-off score for the VTDS-Arab total was 26. Conclusion: The VTDS-Arab is a reliable and a clinically valid tool that can be used in the evaluation of voice disorders alongside other subjective and objective tools of evaluation.

Objective: To investigate patient-level predictors of initiation of voice therapy for paradoxical vocal fold motion disorder (PVFM)., Study Design: Prospective outcomes database study., Methods: Patients consented to the University of Wisconsin Voice and Swallow Clinics Outcomes Database between March 2010 and November 2016 who were diagnosed with PVFM and recommended for voice therapy were eligible. Patients who attended at least one voice therapy session were considered to have initiated therapy. Analyzed variables included age, gender, distance to the clinic, insurance status, socioeconomic factors, comorbidity score, spirometry results, presence of asthma and/or dysphonia diagnoses, length of evaluation and evaluation model, and patient scores on the Voice Handicap Index and Generalized Anxiety Disorder 7-item scale., Results: One-hundred seventy-eight patients met inclusion criteria. Of these, 118 initiated voice therapy as recommended (66.29%). The majority of patients were female (n = 127; 71.35%). Age was the only factor significantly associated with therapy initiation in both univariate (P = 0.0359) and multivariable (P = 0.0295) analyses, with patients aged 30-39 least likely to attend compared with other age groups. Multivariable analysis also showed that patients evaluated by a speech-language pathologist alone were an estimated three times as likely to initiate therapy compared to patients evaluated by speech-language pathologist and otolaryngologist (ENT) together (P = 0.0407). Other variables were not statistically significant for prediction of therapy initiation., Conclusions: This study suggests that age group and evaluation model are associated with initiation of voice therapy for PVFM. Further study is needed to investigate social-cognitive and quality-of-life factors in predicting therapy initiation., (Copyright © 2019 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objective: Collegiate a cappella groups have grown significantly in popularity and prominence; however, there have been few studies that evaluate the vocal health of this subgroup of young singers. The objective of this preliminary study was to conduct a multiparametric evaluation of the vocal health characteristics of a sample of collegiate a cappella singers. We further tested whether differences in vocal health assessments exist between a cappella singers with and without vocal training and trained collegiate singers who do not participate in a cappella groups., Study Design: Point prevalence study., Methods: Forty-one collegiate singers participated in this study. Participants were divided into the following three groups: trained singers (TS), trained a cappella singers (ATS), and untrained a cappella singers (AUS). Participants were administered a set of surveys to assess self-perception of singing voice health and perceived access and attitudes toward voice-related health care. Acoustic and laryngoscopic assessments of participant's speaking and singing voice was performed and validated vocal health questionnaires administered as a means to objectively evaluate for the presence of voice problems., Results: Overall, 87.5% of the ATS and 60% of the AUS groups reported experiencing problems with their singing voice. However, no vocal abnormalities were detected during laryngoscopic and acoustic assessments. Furthermore, minimal differences between any of the measured vocal health parameters were observed between the TS, ATS, and AUS groups., Conclusion: Collectively, a high percentage of collegiate a cappella singers with and without vocal training report singing voice problems. However, our sample of a cappella singers did not have increased singing voice problems as compared to vocally trained collegiate singers not in a cappella groups. We did find that a cappella singers may be more inclined to seek information about maintaining a healthy singing voice from their fellow musicians as opposed to singing teachers or other voice health professionals. Singing teachers, otolaryngologists, and speech-language pathologists may need to play a more active role in educating a cappella singers regarding maintaining good vocal health., (Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objective: The objective of this observational study was to assess the relationship between established aging biobehavioral measures and voice decline in normally aging adults., Study Design: Cross-sectional study., Methods: Participants 60-85 years of age were divided into two age and sex-matched groups, based on the presence or absence of presbylaryngeus. Both groups underwent a battery of tests measuring anthropometric variables, inflammatory markers, general health measures, and vocal function parameters. Differences from the norm were calculated for all variables. Parametric and nonparametric tests were performed to assess group differences. In addition, variable selection analysis was performed to determine variables that were most influential in predicting the occurrence of presbylaryngeus in our current sample., Results: Fifty-three participants were divided into age and sex-matched groups of "presbylaryngeus" (n = 26) and "non-presbylaryngeus" (n = 27). The two groups were statistically different in select measures of inflammatory markers, general health measures, and vocal function parameters. Anthropometric measures were not statistically different. Based on variable selection, the variables most predictive of the presence of presbylaryngeus were measures of the Physical Activity Scale of the Elderly, C-reactive protein, laryngeal airway resistance, and vocal roughness., Conclusions: In addition to group differences in vocal function measures, results for the presbylaryngeus group consistently trended sub-optimally on anthropometric measures, two inflammatory markers, and general health measures. These results suggest that this sample of individuals with presbylaryngeus demonstrated greater biobehavioral deficits associated with aging as compared to age and sex-matched non-presbylaryngeus individuals., (Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objectives: For school teachers, the voice is a mandatory occupational tool during teaching. Several studies, however, proved that teachers are at high risk of developing voice disorders. The aim of this study was to investigate the voice health, voice self-concept, and quality of life in German teachers., Methods: In a cross-sectional study 536 German school teachers had a laryngeal examination, acoustic voice measurements to determine the Dysphonia Severity Index and filled in a self-reporting questionnaire with the Voice Handicap Index-12), the voice self-concept (Fragebogen zur Erfassung des Stimmlichen Selbstkonzepts), and the general quality of life (SF-12)., Results: A total of 58.3% of the teachers reported that they had experienced a voice problem at least once in their career. Female teachers had more often experienced voice problems than male teachers. Twenty-five percent showed a current considerable voice abnormality of vocal fold oscillation pattern. Such voice abnormalities were observed more in male teachers than female teachers. The Dysphonia Severity Index also differed between gender with higher values in the female teachers and a steadily decreasing value over age. The voice self-concept showed differences between gender and age of the teachers. Teachers who experienced a voice problem had higher Voice Handicap Index and lower voice self-concept values compared to those without experienced voice problems. Teachers with voice abnormalities had lower values in the quality of life scales., Conclusions: The findings confirm the high risk of voice health problems among German teachers and illustrate the complexity of vocal health and quality of life issues in teachers associated with gender, age, and the history of experienced voice problems. This study strengthens the necessity for vocal training programs to prepare teachers for a professional and healthy voice use to maintain vocal health., Competing Interests: Conflict of interest The authors declare no conflict of interest., (Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objective: A stumbling-block in voice therapy is how the patient will be able to apply the new voice technique in everyday life. Possibly this generalization process could be facilitated by giving voice therapy in group because of the natural forum for training voice-to-speech early in communication between the patients in a group setting. The aim of the study was to compare treatment results from individual voice therapy and voice therapy in group, at several time points and in comparison to patients with no voice therapy., Methods: A randomized treatment study was performed with 77 consecutive patients diagnosed with a functional voice disorder. Thirty-one patients were randomized to individual and group therapy, respectively, and 15 patients to no therapy. The assessments included standardized voice recording and registration of voice range profile (VRP), answering Voice handicap index (VHI) and visual analogue scales for self-hoarseness and self-vocal fatigue, and perceptual voice evaluation by speech-language pathologist. The assessments were performed before, direct after therapy, and three months later in all groups. The 2 therapy groups were also assessed 12 months after therapy., Results: All VHI scores as well as the self-ratings of hoarseness and vocal fatigue, and the perceptual evaluation of voice quality and maximum VRP improved significantly in both therapy groups 3 months after treatment and at 12 months follow-up. There were no significant changes in the control group, with the exception of decreased self-rated hoarseness and increased maximum VRP. Comparisons between treatment groups showed significant larger improvement after group therapy for VHI physical subscale at 12 months, as well as significant lower VHI total score at all measurement sessions and lower subscale scores at 12 months. There were no differences between treatment groups in self-hoarseness or self-vocal fatigue and no difference in perceptual voice quality or VRP. Comparison between controls and treatment groups showed significant larger change in treatment groups from baseline to three months in VHI total and to end of therapy in functional subscale. Treatment groups also showed significant lower scores than controls at each measurement session, for VHI total and physical subscale as well as lower degree of perceptual aberration of voice quality and vocal fatigue, at three months follow-up., Conclusions: This study shows long-term improvement from behavioral voice therapy, particularly in a group setting. The results indicate the importance of early transfer-to-speech and late posttherapy test to capture whether the goal of voice therapy was fulfilled or not for the patients., (Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objective: This study investigated the relationship between the acoustic measure smoothed cepstral peak prominence (CPPS), teacher's quality of life as measured by the voice activity and participation profile (VAPP), laryngeal signs and symptoms, voice related health problems and laryngoscopic findings in Finnish teachers. The relationship between CPPS and sound pressure level (SPL) was also assessed., Methods: Vowel and text samples from 183 healthy Finnish teachers (99 kindergarten teachers [KT] and 84 primary school teachers [PST]) were analyzed for CPPS. Text reading was recorded in conversational loudness by PST, and KT were recorded wearing headphones, while listening to a masking noise of children talking to simulate their classroom voice and environment. CPPS values were correlated with the VAPP, self-reported laryngeal signs and symptoms, voice related health variables, and laryngoscopic findings., Results: There was a significant difference between the two groups for CPPS text, PST showed significantly lower CPPS values (10.44) than KT (11.52). There was no difference between the two groups for CPPS vowel phonation. There was a significant correlation between SPL text and CPPS text for KT (P < 0.001, r = 0.43) but not for PST (P < 0.10, r = 0.16). There was a significant correlation between SPL vowel and CPPS vowel for both PST (P < 0.001, r = 0.47) and KT (P < 0.001, r = 0.45). CPPS did not correlate with the VAPP, laryngeal signs and symptoms, health variables or laryngeal findings. Factorial analysis of variance resulted in a significant relationship between the VAPP, laryngeal signs and symptoms, and teacher type. Teacher type and symptoms had a significant effect on VAPP scores., Conclusions: In the present work CPPS does not correlate with vocal health indicators of functionally healthy teachers. CPPS was significantly influenced by differences in speaking voice SPL, emphasizing the impact of recording conditions and technique. There was a significant relationship between laryngeal signs and symptoms, teacher type and the VAPP. Laryngeal signs and symptoms and teacher type are important variables and should be included in the clinical evaluation of occupational voice users, and voice problems., (Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Purpose: To verify and compare the immediate effects of the voiced oral high-frequency oscillation (VOHFO) technique and the phonation into a silicone resonance tube in the elderly self-perception of vocal and laryngeal symptoms and in their voice quality., Methods: 14 elderly women, over 60 years old, performed the VOHFO and phonation into a resonance tube technique (35cm in length and 9mm in diameter) with one-week interval between both to avoid carry-over effect. Initially, all participants answered questions regarding the frequency and intensity of their vocal/laryngeal symptoms. Recordings of the sustained vowel /a/ and counting numbers were performed for posterior perceptual and acoustic analyses of the voice quality. The maximum phonation time (MPT) for /a/, /s/, /z/ and counting numbers were also obtained. After that, a draw lot established which technique (VOHFO or resonance tube) would be initially applied for three minutes. After the exercise performance the same procedures were carried out and the elderly women answered a self-assessment questionnaire about the effect of the techniques in her voice, larynx, breathing and articulation. Comparison pre and post each technique were analyzed using ANOVA, Wilcoxon and Mann-Whitney tests. The sensations after the techniques were assessed using the Chi-square test (p<0.05)., Results: The comparison of both techniques showed decrease in roughness and improvement in resonance for counting numbers after the resonance tube and same outcomes post VOHFO. There were no significant differences for the other analyzed variables between groups., Conclusion: The phonation into a resonance tube exercise improves the vocal quality of elderly women. In addition, both exercises are similar regarding self-perception of vocal / laryngeal symptoms and sensations post three minutes of the technique, suggesting that VOHFO can be safely applied in voice therapy for this population.

Purpose: Describe the self-referred personal behavior profiles of university professors and verify the association of these profiles with the self-assessment of communicative aspects and vocal symptoms., Methods: Study conducted with 334 professors at a public university who responded to an online questionnaire regarding voice use in teaching practice. Personal behavior profile classification was the response variable, which was divided into four types: pragmatic, analytical, expressive and affable. Explanatory variables were vocal self-perception, vocal resources, and communicative aspects. Descriptive data analysis was performed with application of the Pearson's Chi-squared and Fisher's Exact tests., Results: University professors identified themselves more with the affable and expressive personal behavior profiles. Overall, professors presented good self-perception about vocal and communicative aspects, in addition to having reported few vocal symptoms. Profiles differed for some of the assessed variables, namely, pragmatic professors reported high speech velocity and sporadic eye contact; expressive professors demonstrated self-perception about their voice and strong voice intensity; those in the analytical profile self-reported negative perception about vocal quality, weak voice intensity, poor articulation and rapid speaking rate; the other professors mostly reported voice tiredness symptoms and difficulty projecting the voice., Conclusion: University professors identify themselves mostly with the affable and expressive profiles. Self-perception analysis of the personal behavior profile in university professors showed the influence of self-reported personality characteristics on communicative skills in the classroom.

Aim: To translate and validate the singing voice handicap index (SVHI-10) for the Tamil speaking Indian population and to evaluate the psychometric properties of the Tamil version SVHI-10 (TSVHI-10) in classically trained Carnatic singers., Method: Following standard translation, a total of 120 classically trained Carnatic singers: 83 singers without voice complaint and 37 singers with voice complaints answered the Tamil translation of the SVHI-10., Results: The TSVHI -10 scores obatined from classically trained Carnatic singers with and singers without voice complaints were analyzed. SVHI-10 has excellent internal consistency and test retest reliability. Singers without/with voice complaint scored 7.08/22.86 total scores and for each domain Emotional (E): 1.73/5.32, Functional (F): 2.11/7.08, and Physical (P): 3.3/10.35 respectively., Conclusion: The TSVHI-10 questionnaire seems to be psychometrically sound and is a valuable instrument for the self-evaluation of handicaps related to voice problems in the context of singing and for making subsequent clinical decisions. The Tamil version of the SVHI-10 was successfully validated as an instrument with proper internal consistency and reliability., (Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objective: Studies have highlighted the importance of having an adequate vocal warm-up exercise regime for prevention of vocal fold injury among singers. Indian classical singing has several singing exercises aimed at improving vocal range and voice. Thus, a need was felt to survey these singers for the warm-up practices they follow and their perception about them., Study Design: Cross-sectional study design., Methods: A 20-item questionnaire was used comprising of questions on demographic details, vocal warm-up singing, and nonsinging-based practices, perceptions about importance of vocal warm-up, and perceptions about effects of vocal warm-up on voice., Results and Conclusion: Fifty Indian classical singers were surveyed. Sixty-four percent of them used vocal warm-up on a daily basis, whereas the remaining did it weekly. Among the singing-based vocal warm-ups, a combination of different singing notes and scales were most commonly used. The popular nonsinging-based warm-up exercises were breathing practice, humming, and meditation. Overall, the singers had a positive perception of the importance of vocal warm-up. Notably, 94% agreed to the importance of having a vocal warm-up regularly before singing. The findings of the present study will help in understanding the existing vocal warm-up regime and perception of the singers. It will benefit counseling singers regarding vocal hygiene, voice care, and management., (Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Background: Voice disorders are frequent after thyroidectomy. We report the long-term voice quality outcomes after thyroidectomy using the voice handicap index self-questionnaire., Methods: Eight hundred patients who underwent total thyroidectomy between 2014 and 2017 in 7 French hospitals were prospectively included. All patients filled in voice handicap index questionnaires, preoperatively and 2 and 6 months after surgery., Results: Median (range) voice handicap index scores were significantly increased at month 2 (4 [0; 108]) compared to preoperative values (2 [0; 76]) and were unchanged at month 6 (2 [2; 92]). Clinically significant voice impairment (voice handicap index score difference ≥18 points) was reported in 19.7% at month 2 and 13% at month 6. Thirty-seven (4.6%) had postoperative vocal cord palsy. In patients with vocal cord palsy compared to those without, median voice handicap index scores were increased at month 2 (14 [0; 107] vs 4 [0; 108]; P = .0039), but not at month 6 (5 [0; 92] vs 2 [0; 87]; P = .0702). Clinically significant impairment was reported in 38% vs 19% at month 2 (P = .010), and in 19% vs 13% at month 6 (P = .310). Thyroid weight, postoperative hypocalcemia, vocal cord palsy, and absence of intraoperative neuromonitoring utilization were associated with an increased risk of clinically significant self-perceived voice impairment at month 2., Conclusion: Thyroidectomy impairs patients' voice quality perception in patients with and without vocal cord palsy., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: Disorders of voice can limit an individual's participation and impair social interaction, thus affecting overall quality of life. Perceptual and objective evaluations can provide the clinician with detailed information regarding voice disorders., Methods: This study comprised 40 subjects aged 34-46 years, 20 of whom (10 male, 10 female) had unilateral vocal fold palsy. Data were obtained for all participants from: the Voice Handicap Index, the grade, roughness, breathiness, asthenia and strain ('GRBAS') scale, acoustic voice analysis, electroglottography, and voice range profiles., Results: The voice evaluations revealed statistically significant (p < 0.05) differences between the controls and study group, both in males and females, pre- and post-therapy., Conclusion: Despite the normalisation of vocal parameters, acoustic, perceptual and self-rated assessments revealed statistically significant differences after therapy. Hence, acoustic measures, namely electroglottographic perturbation, and voice frequency and intensity range, are recommended prior to termination of therapy.

Patient perceptions of the therapeutic process have been shown to influence outcomes in various healthcare fields. However, the voice therapy literature lacks a thorough examination of patients' perceptions of the voice therapy process. This cross-sectional pilot study analyzed patient perceptions of voice therapy across four different areas: patient understanding of therapy, the home therapy program, perception of improvement of symptoms, and prioritization of therapy. The study included patients receiving voice therapy for various disorders (n = 49). Results showed significant differences by patient age and the number of therapy sessions completed. Patients indicate increased understanding (P = 0.0676) and appeared to notice more improvement as therapy progressed (P = 0.010). Younger patients indicate higher adherence to their home program (P < 0.001, P = 0.003). Additionally, correlations were found between patient understanding and the extent to which they prioritize therapy (r = 0.53, P < 0.001) and the extent to which patients notice improvement (r = 0.51, P < 0.001). This study highlights possible age and gender differences and the ways in which perceptions may change over time and affect outcomes., (Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Reliability of the GRBAS tool for perceptual evaluation of paediatric voice disorder is measured in this study of children with a history of laryngotracheal reconstruction surgery (LTR). Additionally, the relationship between parent proxy/child self-report of voice-related quality of life with clinician perceptual rating of voice quality is analysed. Eleven children with a history of LTR provided voice recordings following the stimuli set by the CAPE-V protocol. Subjective impact of voice quality on life was measured using the paediatric voice-related quality of life questionnaire. Four trained judges rated the sound files according to both the GRBAS and CAPE-V protocol. Intra-class correlation coefficients were high for both intra-rater and inter-rater judgments across all parameters of the GRBAS protocol, and a strong correlation was found between the grade rating of the GRBAS and the overall severity rating of the CAPE-V. Some elements of parent proxy reporting of voice-related quality of life were significantly negatively correlated with clinician perceptual rating of voice quality, while there was no significant relationship between child self-report and clinician perceptual rating., (Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objectives: This systematic review examined the evidence linking vocal nodule development in children to personality traits, psychological factors, and associated behavioral tendencies., Methods: Four electronic databases-PubMed, Scopus, ScienceDirect, EBSCO Host-as well as the reference lists from articles (including online sources) were searched. After screening for relevance, eight comparative, case-control studies were identified that met inclusion criteria. The quality of each study was evaluated by two raters using a modified, standardized checklist., Results: Four studies were rated as "good quality" and four were "fair". The questionnaires used to measure personality or psychological factors varied widely among the studies, and the results linking personality dispositions (and associated behavioral inclinations) to vocal nodule development in children were mixed., Conclusions: Fair to good quality evidence exists to suggest that psychological factors or personality traits related to extraversion and impulsivity (and their related behavioral inclinations) might predispose children to vocal nodules and deserve further attention. Clinical implications, limitations of the current systematic review, and recommendations for future research are also discussed., (Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objectives: The purpose of this study was to determine whether patients with functional voice disorders show voice activity and participation profiles different from those of the organic and neurogenic groups., Methods: The Korean Version of the Voice Activity and Participation Profile (K-VAPP) was administered to 200 participants (150 patients with functional, organic, and neurogenic voice disorders, 50 for each etiological group, 50 controls without vocal complaint). The K-VAPP subscale scores of the etiological groups were compared, controlling for age, professional use of voice, and severity of voice disorder measured by overall severity of the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V)., Results: Results of a one-way analysis of variance indicated significant differences in the overall severity across groups (neurogenic > functional = organic > control). Among four groups, the organic group showed higher mean Z-scores of the K-VAPP than the control group, and the functional group showed higher mean Z-scores of the K-VAPP than the organic group. Compared with the neurogenic group, the functional group showed lower mean Z-scores for total score, Activity Limitation Score, SUB3, and SUB5. A comparison among three etiological groups showed that the functional group did not show higher scores than the organic group. On the contrary, the functional group showed a lower total score, Participation Restriction Score, and score for subsection 3 (effect on daily communication) than the neurogenic group., Conclusions: Psychometric assessment of voice disorders using the K-VAPP could provide clinicians with baseline information that is applicable to various voice disorders. Further studies pertaining to the follow-up of voice disorders with various etiologies are needed to extend its clinical usefulness., (Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Changes in voice in aging adults impact their ability to use their voice to communicate in all situations and can lead to decreased quality of life (QOL). The primary objective of this study was to determine the validity and reliability of the Aging Voice Index (AVI)-a tool specifically designed for aging adults with voice disorders. A total of 92 older adults were asked to complete the Voice-Related Quality of Life Scale (VRQOL) and the AVI as well as provide their self-perceived voice severity rating of their voice problem and demographic information. Intraclass correlation for test-retest reliability was 0.952. The AVI was highly correlated to the VRQOL (P < 0.0001). Additionally, the AVI score was found to distinguish between self-rated voice quality (P < 0.0001) and diagnostic voice categories (P < 0.0001). No significant differences were identified for sex or race. The AVI is a valid and reliable quality of life assessment for older adults with voice disorders. The AVI will capture the quality of life impact a voice disorder has on older adults. Future studies will further explore differences in clinical diagnoses and identify clinically significant changes in pre-to post-AVI scores., (Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

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., (Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objectives: Voice handicap has generally been measured at a single timepoint. Little is known about its variability from hour to hour or day to day. Voice handicap has been shown to be negatively related to voice-related perceived control in cross-sectional studies, but the within-person variability in voice-related perceived control is also unknown. We aimed to use ecological momentary assessment (EMA) to (1) assess the feasibility of EMA to examine daily voice handicap and voice-related perceived control in patients with voice disorders, (2) measure within-person variability in daily voice handicap and perceived control, and (3) characterize temporal associations (eg, correlations over time) between daily voice handicap and perceived control., Methods: Adults with voice problems were recruited from a large public university medical center in the Midwest. They completed baseline measures, followed by twice-daily assessments, including selected items measuring voice handicap and perceived control, and then repeated the baseline measures at the final timepoint. Feasibility was assessed via completion rates. Within-person variability was measured using standard deviations. Temporal associations were characterized using simulation modeling analysis., Results: EMA of voice handicap and perceived control was feasible in this patient population. Momentary voice handicap varied more than perceived control, though both were variable. Multiple patterns of temporal associations between daily voice handicap and perceived control were found., Conclusions: These findings identified important variability in (1) measures of voice handicap and perceived control and (2) their associations over time. Future EMA studies in patients with voice disorders are both feasible and warranted.

Objectives: The aim of this study was to verify the effects of the method Vocal Therapy for the Elderly and the differences in treatment efficacy when it was administered intensively or in the conventional way., Methods: Twenty-seven elderly individuals were randomized into two groups and referred for 16 sessions of vocal therapy. The Intensive Group (IG) had therapy four times a week, whereas the Conventional Group had it twice a week. The effects of the therapy were assessed by auditory-perceptual analysis, the Voice-Related Quality of Life protocol, and visual-perceptive analysis of laryngoscopy examinations. The first stage consisted of evaluating the vocal quality and self-assessment of 15 subjects before and after a time period equal to that which they would undergo in vocal therapy. The second stage consisted of comparing the assessments of all participants in the week preceding the beginning of treatment, in the week following the end of treatment, and 1 month after that., Results: There was no difference between perceptual voice parameters and self-assessment when the subjects were not undergoing therapy. When comparing the periods immediately before and after therapy, there was improvement in vocal quality and Voice-Related Quality of Life. One month later, the benefits that had been revealed through the self-assessment protocol, and some of the improvements in vocal parameters were maintained. There was no difference between the IG and Conventional Group with the exception of vocal fold bowing, which decreased in the IG group., Conclusions: The Vocal Therapy for the Elderly program is effective for treating voice presbyphonia. An intensive approach may be superior with regard to vocal fold bowing., (Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)