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Purpose: This study examined the contribution of voice to the self via implicit associations., Method: An implicit association test (IAT) of the voice and the self was created and presented to vocal performers and community controls. One-hundred eleven participants completed this voice-self IAT, the Vocal Congruence Scale (VCS), and the Voice Handicap Index (VHI) via an in-person, monitored, and timed Qualtrics survey. Student t tests comparing timing differences between congruent and incongruent conditions revealed the presence of an implicit relationship., Results: The findings demonstrated an implicit relationship between the voice and the self as measured using the IAT. Strength of implicit relationships between self and voice was significantly greater for community controls than vocal performers. Additionally, this IAT revealed divergent validity with the VCS, and the VHI using Spearman's correlation., Conclusion: Implications suggest that even if overt declarations are absent, individuals with an implicit voice-self relationship rely on their voice to contribute to their sense of self. This implicit relationship is greater for community members than vocal performers., Competing Interests: Declarations of Interest None., (Copyright © 2024 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Background: In voice clinics, vocal effort is a prevalent complaint, with around 25% of clinicians citing it as the primary issue., Aim: This study had two objectives. First, it sought to establish the prevalence of vocal effort, both as the primary and the only symptom, among patients receiving treatment from clinicians specializing in voice disorders in various countries across South and North America. Second, this study aimed to distinguish key factors, including country of clinical practice, clinicians' experience, and the instruments employed to assess effort, associated with the identification of vocal effort., Methods: This cross-sectional study surveyed speech-language pathologists (SLPs) from North and South America on vocal effort in patients. The survey covered SLP demographics, caseload composition, patient challenges, and measures of vocal effort that were used. Statistical analysis assessed relationships between SLP demographics, caseload, and vocal effort factors., Results and Conclusion: The results suggest significant geographical variations in SLPs' experiences with vocal effort. Colombian clinicians report significantly fewer voice cases and a lower proportion of vocal effort in their caseload, while Argentinian clinicians were more likely to report vocal effort in their voice cases. Years of experience were identified as a significant predictor of a higher likelihood of a voice-dominant caseload and higher rates of vocal effort among patients. Interestingly, using the Vocal Fatigue Index during the assessments increased the likelihood of reporting vocal effort in the clinicians' caseload. These findings suggest a potential association between experience, outcome measure selection, and vocal effort caseload. These lead to suggestions that opportunities for additional voice disorder training beyond that which SLPs find in school are valuable., Competing Interests: Declaration of Competing Interest We wish to confirm that there are no known conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcome., (Copyright © 2024 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Pregnancy has profound effects on a variety of body systems by way of hormonal and physical changes. Many of these changes directly affect body systems involved in singing. Assumptions exist about what can happen to a person's voice during pregnancy, but these assumptions are based on theoretical predictions leaving little knowledge of the lived experiences of voice changes during pregnancy. An anonymous mixed-method survey was given to 321 professional singers to gain insights on the lived experiences of pregnant singers. This investigation explored what people were told about the effects of pregnancy on the voice in comparison to what they actually experienced. Results show that about half of the respondents' experience matched what they were told for respiration. For phonation and vocal quality less than 25% respondent's experience matched what they were told. In addition, most of the information respondents received came from friends, colleagues, and teachers compared to medical professionals suggesting a need for more interdisciplinary education to best prepare vocalists who are contemplating becoming pregnant., Competing Interests: Declaration of Interest None, (Copyright © 2022 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Purpose: This study aims to determine if the act of voicing can have an effect on mood., Design: A within-participant reversal paradigm, where each participant served as their own control., Methods: Following a baseline condition, 40 participants (8 male, 32 female, none disclosed as other) underwent three experimental conditions: breathing, articulating, and voicing. After each condition, participants underwent a picture-viewing emotion-induction paradigm using the International Affective Picture System followed by rating their current mood and arousal., Results: Immediately following the articulating condition, aversive pictures were rated as less unpleasant compared with the other conditions. Additionally, arousal levels were rated lower immediately following the articulating and voicing conditions in response to the positive pictures., Conclusions: The findings showed that the act of making speech sounds, not simply voicing by itself, may influence the way we process emotions., Competing Interests: Declaration of Competing Interest None., (Copyright © 2024 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Purpose: This article provides a commentary on voice-related self-reports and presents various shortcomings endemic in the development and validation of these measures. Emphasis is placed on issues of construct validity, translation, and cross-cultural adaptation. Finally, a demonstration is provided to elucidate the importance of cross-cultural adaptation., Methods: An example of a voice-related self-report that lacks cross-cultural adaptation is provided, and a linguistic translation and cross-cultural adaptation process is outlined and demonstrated. A bilingual voice scientist, a bilingual speech-language pathologist (SLP), and two experts in voice-related self-reports completed a multistep linguistic translation and cross-cultural adaptation process and obtained back-translations from five SLPs native to the self-report's source culture., Results: Analyses of the back-translations demonstrated that the mean BiLingual Evaluation Understudy (BLEU) scores of the adapted items were higher overall than the back-translations of the original English items., Conclusions: Unvalidated translations of voice-related self-reports are commonly used as a baseline to further translate the measure, and this deteriorates cross-cultural health equity. Cross-cultural adaptation is a crucial, but often overlooked process when translating and adapting self-reports. The present article calls for standardized methodologies with an emphasis on the necessity of careful translation methods and cultural adaptation processes., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

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

Purpose: With the emphasis on patient-centered care, tools to adequately measure the experience of swallowing are an important part of clinical care. Swallowing effort is one such experience. However, few measurement tools capture swallowing effort in the moment of swallowing to quantify effort. The Borg Category Ratio 10 Perceived Exertion Scale (Borg CR 10), designed to track effort in a variety of tasks from lifting, breathing, and running, appears to be a likely candidate to measure swallowing effort in the moment of swallowing., Method: In a quasi-random design, 32 healthy individuals, ages 40-80 years (average age: 63 years), consumed seven bolus consistencies in both small and large quantities, three times. Following each individual swallow, they rated the amount of effort it took to swallow each bolus using an adapted Borg CR 10 for swallowing effort., Results: Results showed significantly greater reports of swallowing effort on the Borg CR 10 for more adhesive consistencies, larger quantities, and increased number of swallows., Conclusion: Results suggest that the Borg CR 10 is a reasonable measurement tool to capture patient-perceived effort in swallowing.

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

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

Objectives/hypothesis: Recent investigations into the behavior of aerosolized emissions from the oral cavity have shown that particulate emissions do indeed occur during speech. To date, there is little information about the relative contribution of different speech sounds in producing particle emissions in a free field. This study compares airborne aerosol generation in participants producing isolated speech sounds: fricative consonants, plosive consonants, and vowel sounds., Study Design: Prospective, reversal experimental design, where each participant served as their own control and all participants were exposed to all stimuli., Methods: While participants produced isolated speech tasks, a planar beam of laser light, a high-speed camera, and image software calculated the number of particulates detected over time. This study compared airborne aerosols emitted by human participants at a distance of 2.54 cm between the laser sheet and the mouth., Results: Statistically significant increases in particulate count over ambient dust distribution for all speech sounds. When collapsed across loudness levels, emitted particles in vowel sounds were statistically greater than consonants, suggesting that mouth opening, as opposed to the place of vocal tract constriction or manner of sound production, might also be influential in the degree to which particulates become aerosolized during speech., Conclusions: The results of this research will inform boundary conditions for computational models of aerosolized particulates during speech., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

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

Purpose: Glottal fry is an increasingly prevalent voice type in young female speakers. The purpose of this study was to identify employers' perceptions toward young female speakers presenting with glottal fry and the impact on hirability., Methods: Sixty employers responsible for hiring at their business in the Southeast region of the United States completed a survey developed to capture employers' perceptions toward young women using glottal fry. Employers listened to three voice samples of young women with varying levels of glottal fry and rated the voice on 14 semantic differential items. The semantic differential items were derived from the hiring constructs literature to capture perceptions related to mental capability, personality tendencies, and applied social skills. Additionally, questions related to hirability were captured at the end of the survey., Results: Employers were able to identify continuous glottal fry compared to nonglottal fry voice samples. Employers rated voice samples with glottal fry more negatively (eg, less trustworthy, less competent, less educated) compared to nonglottal fry voice samples and were less likely to hire female speakers with continuous glottal fry., Conclusion: This study highlights the impact of negative perceptions toward glottal fry on hirability of young female speakers. Such information can provide insight to increase awareness of the impact of a voice type on listener perceptions and communication among young female speakers., (Copyright © 2022 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Communication problems (eg, dysphonia, dysfluency and language and articulation disorders), swallowing disorders (dysphagia and globus), cough and upper airway symptoms, resulting from functional neurological disorder (FND), are commonly encountered by speech and language professionals. However, there are few descriptions in the literature of the most effective practical management approaches. This consensus document aims to provide recommendations for assessment and intervention that are relevant to both adults and young people. An international panel of speech and language professionals with expertise in FND were approached to take part. Participants responded individually by email to a set of key questions regarding best practice for assessment and interventions. Next, a video conference was held in which participants discussed and debated the answers to these key questions, aiming to achieve consensus on each issue. Drafts of the collated consensus recommendations were circulated until consensus was achieved. FND should be diagnosed on the basis of positive clinical features. Speech and language therapy for FND should address illness beliefs, self-directed attention and abnormal movement patterns through a process of education, symptomatic treatment and cognitive behavioural therapy within a supportive therapeutic environment. We provide specific examples of these strategies for different symptoms. Speech and language professionals have a key role in the management of people with communication and related symptoms of FND. It is intended that these expert recommendations serve as both a practical toolkit and a starting point for further research into evidence-based treatments., Competing Interests: Competing interests: LM is funded by a University of Edinburgh Clinical Research Fellowship funded philanthropically by Baillie Gifford. LM provides independent medical testimony in court cases regarding patients with functional disorders. AC is a director of a limited personal services company that provides independent medical testimony in Court Cases on a range of neuropsychiatric topics on a 50% pursuer 50% defender basis, is an associate editor of the Journal of Neurology Neurosurgery and Psychiatry, and is the treasurer of the International Functional Neurological Disorder Society. JS reports personal fees from UptoDate, outside the submitted work, runs a self help website for patients with functional neurological symptoms (www.neurosymptoms.org) which is free and has no advertising, provides independent medical testimony in personal injury and negligence cases regarding patients with functional disorders, and is secretary of the International Functional Neurological Disorder Society. JS is a Chief Scientists Office NHS Research Scotland Career Researcher., (© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: The purpose of this study is to determine the relation between specific eating disorder diagnoses/purging behaviors and voice disorders., Method: One hundred-nine participants with eating disorders completed a survey inquiring about eating disorder symptoms, purging behaviors, and voice disorder symptoms. Participants also completed the Eating Disorders Examination Questionnaire, Voice Handicap Index, and the Reflux Symptom Index., Results: The prevalence of voice disorders among the group with eating disorders was 21.88%. Of those with both eating disorders and voice disorders, anorexia nervosa appeared to be more prevalent in this group than bulimia nervosa. In addition, purging behaviors of exercise presented with a higher prevalence of voice problems than vomiting., Conclusion: Individuals with eating disorders seem to be at a higher risk for voice disorders than the general population. Anorexia nervosa and exercise as a purging method were identified as the highest risk factors for voice disorders., (Copyright © 2020 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Purpose Patients with voice problems commonly report increased vocal effort, regardless of the underlying pathophysiology. Previous studies investigating vocal effort and voice production have used a range of methods to quantify vocal effort. The goals of the current study were to use the Borg CR100 effort scale to (a) demonstrate the relation between vocal intensity or vocal level (dB) and tasked vocal effort goals and (b) investigate the repeated measure reliability of vocal level at tasked effort level goals. Method Three types of speech (automatic, read, and structured spontaneous) were elicited at four vocal effort level goals on the Borg CR100 scale (2, 13, 25, and 50) from 20 participants (10 females and 10 males). Results Participants' vocal level reliably changed approximately 5 dB between the elicited effort level goals; this difference was statistically significant and repeatable. Biological females produced a voice with consistently less intensity for a vocal effort level goal compared to biological males. Conclusions The results indicate the utility of the Borg CR100 in tracking effort in voice production that is repeatable with respect to vocal level (dB). Future research will investigate other metrics of voice production with the goal of understanding the mechanisms underlying vocal effort and the external environmental influences on the perception of vocal effort.

Voices are, by nature, idiosyncratic representations of individuals because they possess anatomical, physiological, and psychological characteristics that are unique to them, which contribute to vocal output, and thus, establish the voice as a salient marker of their individuality. The areas of experimental psychology and cognitive neuroscience have examined the psychological and neurological constructs that form one's sense of self and have employed measures of interoceptive and exteroceptive abilities to discover the underlying constructs of the sense of self. This study employed measures of interoceptive awareness to assess level of vocal congruence. Forty-one participants analyzed in this study underwent a heartbeat detection task designed to assess the level of interoceptive awareness and were placed into two groups: those high in interoceptive awareness and those low in interoceptive awareness. They completed two tasks, a speaking task, which included structured passages and conversation, and a listening task, where they listened to themselves in the speaking task. Following each task, they completed a Vocal Congruence Scale designed to assess the level of identification they have within themselves related to the sound of their voice. Individuals scoring high in interoceptive awareness scored significantly higher in vocal congruence than those scoring lower in interoceptive awareness. Additionally, when analyzed with other measures of personality, anxiety, mood, and voice handicap, the Vocal Congruence Scale appears to measure a unique aspect of vocal identity with one's self that encompasses interoceptive awareness., (Copyright © 2019 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Purpose: Vocal effort has been of increasing interest to voice clinicians and researchers. However, little is known about the prevalence of vocal effort in voice patients presenting to voice clinics. The purpose of this study was to better understand how vocal effort is perceived and used in a clinical setting, including the current opinions on this symptom and experiences of voice clinicians regarding vocal effort measurement and management., Method: Speech language pathologists who regularly treat voice patients were queried about their years of voice experience, number of voice patients treated yearly, percentage of voice patients who complain of vocal effort, methods of clinically measuring vocal effort, and treatment strategies that address vocal effort in therapy., Results: Survey results revealed that vocal effort is a commonly presented complaint in the voice clinic with over two-thirds of clinicians reporting that the majority of their patients complain of vocal effort and approximately 25% of clinicians reporting that vocal effort is the main complaint in their patients. Although most clinicians measure vocal effort in the clinic, very few use a dedicated vocal effort measure. About half of the clinicians reported that they specifically address vocal effort reduction as a therapy goal., Conclusion: Despite the high prevalence of observed vocal effort complaints in patients and the focus of vocal effort reduction in therapy, there is no standardized measure of vocal effort widely utilized in the clinic. Future research should address clinically tractable methods to measure vocal effort validly and reliably., Competing Interests: Conflict of interest: The authors have no conflict of interest regarding this project.

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

Objectives: The purpose of the present study was to examine the nature of the relationship between perceptions of vocal and mental (cognitive) effort during reading and speaking tasks. Methods: One hundred and four young, healthy adult participants were randomized into one of three groups. Each group performed a writing task meant to elicit low mental effort, high mental effort, or high mental effort followed by a period of relaxation. Participants then engaged in reading and speaking tasks, meant to elicit high (suppression of a prepotent desire to speak louder) or low (no suppression of a prepotent desire to speak louder) mental effort, and completed ratings of mental effort and vocal effort via adapted versions of the Borg CR10. Results: Findings indicate that ratings of perceived mental and vocal effort are related to one another, evidenced by strong correlations, and additional analyses reveal that mental effort might drive this relationship. Conclusions: Perceptions of vocal effort appear to mirror ratings of mental effort during tasks for which vocal activity is relatively stable but cognitive demands fluctuate. The possibility that perceptions of mental effort might influence perceptions of vocal effort should be considered when creating reliable and valid measures of vocal effort as well as when interpreting currently adapted measures of vocal effort in the clinical context.

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

Relative fundamental frequency, a measure of the muscular and aerodynamic influences of voicing offset and onset of vowel-voiceless consonant-vowel production, has been known to reflect conditions of vocal hyperfunction and serves as a measure that might be influenced by transient emotional states. Twenty-six vocally healthy females underwent aversive, neutral, and positive emotional induction while saying /afa/. Results show that individuals had a steeper fundamental frequency decline on the 10 cycles of offset of vocalization during positive and neutral conditions than aversive conditions. Individuals had an overall elevated fundamental frequency curve during the 10 cycles of vocalization onset in positive conditions. Findings suggest that the vocal offset reflected reduced muscular engagement in positive and neutral conditions compared with aversive conditions, suggesting that aversive emotional influence on voicing has a muscular component., (Copyright © 2018 The Voice Foundation. All rights reserved.)

Vocal fatigue is a frequent symptom and a debilitating condition affecting individuals with voice disorders. In spite of the various attempts to define and quantify vocal fatigue, this complex trait has not been well understood. Mokken scaling was performed on the Vocal Fatigue Index (VFI) to develop a hierarchical understanding of the latent trait of vocal fatigue. Two hundred nine patients with voice disorders completed the VFI and provided the item responses necessary to complete the Mokken scaling. Results revealed a moderately strong Mokken scale and that the VFI presents a hierarchical structure to the underlying trait of vocal fatigue. Mokken scaling contributes to the ongoing investigation to the underlying construct of vocal fatigue and may provide additional information about specific complaints within the population of those with voice disorders., (Copyright © 2019 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objectives: Reduction of vocal effort is a therapeutic goal in resonant voice therapy and in the treatment of a variety of voice disorders. The Borg CR10 is a perceived effort scale that is widely accepted across a wide variety of disciplines. The purpose of the present study was to examine (1) the utility of an anchored, adapted Borg CR10 in observing treatment-related vocal effort reduction and (2) the convergent validity of the Borg CR10 in its relation to Voice Handicap Index (VHI) item 14., Study Design: This is a pretest-posttest experimental design., Methods: A total of 36 individuals with phonotraumatic hyperfunctional voice disorders completed item 14 of the VHI and the Borg CR10 at the start and completion of four sessions of resonant voice therapy treatment., Results: Scores from the Borg CR10 significantly differentiated pre- from post-therapy perceived effort levels. Convergent validity was demonstrated through significant associations with scores from item 14 of the VHI., Conclusion: The anchored Borg CR10 is an easy to use clinical tool to capture treatment-related vocal effort reduction. Whereas VHI item 14 indicates how frequently increased perceived effort is experienced, the Borg CR10 captures the severity of perceived effort used. Thus, the two measures complement each other., (Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objectives/hypothesis: The prevalence of voice disorders among various educator groups is well known, and voice disorders among music educators are higher than the general classroom educators. Music educators vary with respect to behavioral and personality factors, personal characteristics, type of music taught, job-specific environment, and governmental professional expectations. This study aims to identify risk factors for voice disorders in a heterogeneous population of music educators., Study Design: An online survey was conducted with 213 respondents., Methods: Survey questions addressed demographics, level of education, years of music teaching experience, specialty training, primary teaching assignments and instrument, vocal health behaviors, and diagnoses of voice disorders. Summary statistics and group comparisons are reported., Results: Those whose primary instrument was voice reported a greater frequency of voice disorders. Female and older music educators also had a higher prevalence of voice disorders., Conclusions: Music educators are a heterogeneous group of individuals who require more careful consideration in the prevention and treatment of occupational voice problems., (Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objectives: The purpose of this study was to investigate electroglottography (EGG) contact quotient modulation with emotional state in the presence of increased arousal., Study Design: A within-subject reversal paradigm using multiple experimental conditions., Methods: A total of 11 healthy undergraduate students underwent emotion induction with intermittent startles to increase physiologic arousal. During emotion induction, they vocalized on the vowel /u/ while EGG was recorded., Results: EGG contact quotient was significantly greater for negative emotions compared with positive emotions with increased arousal commensurate with past research. In addition, overall EGG contact quotient was greater with elevated arousal. However, the effect sizes were small., Conclusions: EGG contact quotient appears to increase with elevated arousal and be greater for negative mood states than positive mood states confirming that emotion states directly influence vocal functioning., (Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objectives: Self-regulation (SR) relies on the capacity to modify behavior. This capacity may diminish with use and result in self-regulatory depletion (SRD), or the reduced ability to engage in future SR efforts. If the SRD effect applies to vocal behavior, it may hinder success during behavioral voice treatment. Thus, this proof-of-concept study sought to determine whether SRD affects vocal behavior change and if so, whether it can be repaired by an intervention meant to replete SR resources., Methods: One hundred four women without voice disorders were randomized into groups that performed either (1) a high-SR writing task followed by a high-SR voice task; (2) a low-SR writing task followed by a high-SR voice task; or (3) a high-SR writing task followed by a relaxation intervention and a high-SR voice task. The high-SR voice tasks in all groups involved suppression of the Lombard effect during reading and free speech., Results: The low-SR group suppressed the Lombard effect to a greater extent than the high-SR group and high-SR-plus-relaxation group on the free speech task. There were no significant group differences on the reading task., Conclusions: Findings suggest that SRD may present challenges to vocal behavior modification during free speech but not reading. Furthermore, relaxation did not significantly replete self-regulatory resources for vocal modification during free speech. Findings may highlight potential considerations for voice treatment and assessment and support the need for future research focusing on effective methods to test self-regulatory capacity and replete self-regulatory resources in voice patients., (Published by Elsevier Inc.)

Objective/hypothesis: Emergency 911 dispatchers or telecommunicators have been cited as occupational voice users who could be at risk for voice disorders. To test the theoretical assumption that the 911 emergency telecommunicators (911ETCs) are exposed to risk for voice disorders because of their heavy vocal load, this study assessed the prevalence of voice complaints in 911ETCs., Study Design: A cross-sectional survey was sent to two large national organizations for 911ETCs with 71 complete responses providing information about voice health, voice complaints, and work load., Results: Although 911ETCs have a higher rate of reported voice symptoms and score higher on the Voice Handicap Index-10 than the general public, they have a voice disorder diagnosis prevalence that mirrors the prevalence of the general population., Conclusions: The 911ETCs may be underserved in the voice community and would benefit from education on vocal health and treatments for voice complaints., (Copyright © 2015 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Vocal changes in emotional situations may identify contributing factors in behavioral voice disorders and direct more efficient therapies. Finding appropriate measures of voicing that detect emotional conditions is a first step in this line of investigation. The purpose of this study was to determine whether electroglottography (EGG) contact quotient is a viable measure to detect vocal changes in different emotion states. Vocal responses in 18 vocally healthy participants were measured using EGG contact quotient during picture viewing from the International Affective Picture System. Results demonstrated that in negative emotional conditions participants employed significantly greater EGG contact quotient than in neutral or positive conditions. EGG contact quotient appears to be a viable measure to investigate voice and emotion.

Purpose: Previous research has proposed that persons with functional dysphonia (FD) present with temperamental traits that predispose them to their voice disorder. We investigated this theory in a controlled experiment and compared them with social anxiety (SA) and healthy control (HC) groups., Method: Twelve participants with FD, 19 participants with SA, and 23 HC participants were studied before, during, and after mental imagery of positive, neutral, and aversive scripts in a within-subject reversal paradigm with multiple experimental conditions using psychometric, self-report, and psychophysiological measures., Results: In psychometric tests, those with FD demonstrated increased fear in social situations but not increased avoidance. On measures of mood, all groups responded with predicted increases in pleasant mood for positive scripts and unpleasant mood for aversive scripts; on vocal effort ratings, those with FD reported greater effort for all scripts following imagery. Under experimentally controlled conditions, the SA and HC groups demonstrated predicted activation of EMG measures of mood, whereas the FD group demonstrated overall reduced activation of EMG measures., Conclusion: Results may suggest that those with FD respond to emotional stimuli with reduced behavioral expression, compared with SA and HC groups, consistent with the temperamental trait of behavioral constraint.

Four vocally untrained healthy adults, 2 men and 2 women, completed the study. A double-blind placebo-controlled approach was used to administer three treatments to each participant on separate days. Drugs treatments involved a single 60-mg dose of a diuretic, Lasix (LA), on one day, and a single 50-mg dose of an oral antihistamine, diphenhydramine hydrochloride (DH), on another day. A third day involved the administration of a placebo, sugar pills (SP). Critical posttreatment measures were weight (kg), which estimated systemic dehydration, saliva viscosity (centipoise), which estimated secretion dehydration, and phonation threshold pressure (PTP, in cm H2O), at high pitches, which indicated pulmonary drive for phonation. The central experimental question was: Does systemic dehydration, or secretory dehydration, or both, mediate increases in PTP that are known to occur following dehydration treatments? The results showed that LA induced systemic dehydration, as shown by a decrease in total body mass of about 1%. Weight losses were seen during a 1- to 4-hour block following drug administration and persisted for at least 8 hours thereafter. PTPs also increased in that condition, about 23% relative to baseline, but only several hours after whole-body dehydration was initially seen (5-12 hours after drug administration). In contrast, no evidence was seen that DH accomplished either secretory dehydration or PTP shifts. The results indicate that systemic dehydration can mediate PTP increases. The influence of secretory dehydration on PTP is unclear.

This study investigates the academic and clinical preparation a speech-language pathologist receives in the area of voice. The purpose is to determine how to structure continuing education and specialty training in vocology, defined as the science and practice of voice habilitation. Surveys were sent to the graduate programs in speech-language pathology accredited by the American Speech-Language-Hearing Association (ASHA) in 1994, and again in 1999. Results from the 1994 survey indicated that students received limited information and clinical experience in handling typical voice cases. Although most programs required a voice disorders course, fewer mandated coursework in normal voice production or clinical experience with voice patients. The follow-up survey showed that the educational environment in 1999 is similar to that in 1994. It is evident that the programs are in compliance with the Educational Training Board model developed by ASHA for basic clinical competence, but no structure for specialty training has yet emerged.

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