Patient Motivation for Voice Therapy Increases After Stimulability Testing: Validation of a Voice Therapy Motivation and Voice Perception Inventory.

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.

Relationships Between Vocal Fold Adduction Patterns, Vocal Acoustic Quality, and Vocal Effort in Individuals With and Without Hyperfunctional Voice Disorders.

Objectives/hypothesis: Increased vocal effort and aberrant vocal quality are often attributed to vocal fold hyperadduction in hyperfunctional voice disorders. However, there are currently no established methods to quantify vocal fold adduction beyond subjective descriptors in this clinical population. Furthermore, relationships between vocal fold adduction patterns, vocal effort severity, and vocal quality are not well characterized.

Relationships Among Stimulability Testing, Patient Factors, and Voice Therapy Compliance.

Objective: Voice stimulability testing to determine voice therapy efficacy and prognosis is commonly used during the voice evaluation, but little is known about how patient factors (eg, voice diagnosis, dysphonia severity) can influence stimulability outcomes. The predictability of voice therapy success with different stimulability facilitating techniques (eg, hums, pitch glides) is also unknown. The goals of this study were to identify relationships between patient factors, voice therapy compliance, and stimulability testing.

Acoustic and Physiologic Correlates of Vocal Effort in Individuals With and Without Primary Muscle Tension Dysphonia.

Objectives: The aims of this study were to determine relationships between vocal effort and (a) acoustic correlates of vocal output and (b) supraglottic compression in individuals with primary muscle tension dysphonia (pMTD) and without voice disorders (controls) in the context of a vocal load challenge.

Method: Twenty-six individuals with pMTD and 35 vocally healthy controls participated in a 30-min vocal load challenge. The pre- and postload relationships among self-ratings of vocal effort, various acoustic voice measures, and supraglottic compression (mediolateral and anteroposterior) were tested with multiple regression models and post hoc Pearson's correlations.

Acoustic-Aerodynamic Voice Outcome Ratios Identify Changes in Vocal Function Following Vocal Fold Medialization for Unilateral Vocal Fold Paralysis.

Purpose: This study aimed to determine whether ratio-based measures that combine acoustic (output) and aerodynamic (input) parameters detect postoperative change in vocal function following vocal fold medialization for unilateral vocal fold paralysis.

Method: Pre- and postoperative acoustic and aerodynamic measures were analyzed retrospectively from 149 patients who underwent vocal fold medialization for unilateral vocal fold paralysis. A 2 × 2 repeated-measures analysis of variance was conducted for each of four acoustic-aerodynamic ratios-traditional vocal efficiency (VE), sound pressure level to aerodynamic power (SPL/AP), SPL to average airflow (SPL/AFLOW), and SPL to subglottal pressure (SPL/Ps)-to investigate the main effects and interaction of treatment stage and loudness level (comfortable and loud).

Understanding the Use and Importance of Voice Stimulability Assessment Among Speech-Language Pathologists Who Treat Voice Disorders: An International Survey.

Purpose: Stimulability assessment is a common part of the voice evaluation, but little information exists about what is involved in the process, how it is measured, and how it impacts therapeutic decisions. The aim of this study was to establish the frequency, circumstances, techniques, and rationale for stimulability assessment among voice-specialized speech-language pathologists (SLPs).

Method: An anonymized online survey was distributed to voice-specialized SLPs through email lists, online communities, and professional networks.

Automated Creak Differentiates Adductor Laryngeal Dystonia and Muscle Tension Dysphonia.

Objective: The purpose of this study was to determine whether automated estimates of vocal creak would differentiate speakers with adductor laryngeal dystonia (AdLD) from speakers with muscle tension dysphonia (MTD) and speakers without voice disorders.

Methods: Sixteen speakers with AdLD, sixteen speakers with MTD, and sixteen speakers without voice disorders were recorded in a quiet environment reading aloud a standard paragraph. An open-source creak detector was used to calculate the percentage of creak (% creak) in each of the speaker's six recorded sentences.

Clinical Utility of the Ratio of Sound Pressure Level to Subglottal Pressure in Patients Surgically Treated for Phonotraumatic Vocal Fold Lesions.

Purpose: This study aimed to determine whether a simplified, and potentially more stable, acoustic-aerodynamic voice outcome ratio (ratio of sound pressure level [SPL] to subglottal pressure) is comparable to a traditional vocal efficiency measure (ratio of acoustic power to the product of average subglottal pressure and average phonatory airflow) in terms of the ability to detect change in vocal function following surgical removal of bilateral phonotraumatic lesions.

Method: Pre- and postoperative acoustic and aerodynamic measures were analyzed retrospectively from 75 female patients who underwent surgical removal of bilateral phonotraumatic lesions. A 2 × 2 repeated-measures analysis of variance was conducted for each of three acoustic-aerodynamic voice outcome ratios-traditional vocal efficiency, an SPL-based ratio with both airflow and subglottal pressure, and a simplified SPL-based ratio with subglottal pressure only-to investigate the main effects of treatment stage (pre- and postsurgery), loudness condition (comfortable and loud), and their interaction.

Relationships Among Personality, Daily Speaking Voice Use, and Phonotrauma in Adult Female Singers.

Purpose: This study sought to determine whether personality traits related to extraversion and impulsivity are more strongly associated with singers with nodules compared to vocally healthy singers and to understand the relationship between personality and the types of daily speaking voice use.

Method: Weeklong ambulatory voice recordings and personality inventories were obtained for 47 female singers with nodules and 47 vocally healthy female singers. Paired tests investigated trait differences between groups.

Psychometric Analysis of an Ecological Vocal Effort Scale in Individuals With and Without Vocal Hyperfunction During Activities of Daily Living.

Objective The purpose of this study was to examine the psychometric properties of an ecological vocal effort scale linked to a voicing task. Method Thirty-eight patients with nodules, 18 patients with muscle tension dysphonia, and 45 vocally healthy control individuals participated in a week of ambulatory voice monitoring. A global vocal status question was asked hourly throughout the day.

Changes in the Daily Phonotrauma Index Following the Use of Voice Therapy as the Sole Treatment for Phonotraumatic Vocal Hyperfunction in Females.

Purpose The aim of this study was to use the Daily Phonotrauma Index (DPI) to quantify group-based changes in the daily voice use of patients with phonotraumatic vocal hyperfunction (PVH) after receiving voice therapy as the sole treatment. This is part of an ongoing effort to validate an updated theoretical framework for PVH. Method A custom-designed ambulatory voice monitor was used to collect 1 week of pre- and posttreatment data from 52 female patients with PVH.

Differences in Daily Voice Use Measures Between Female Patients With Nonphonotraumatic Vocal Hyperfunction and Matched Controls.

Purpose The purpose of this study was to obtain a more comprehensive understanding of the pathophysiology and impact on daily voice use of nonphonotraumatic vocal hyperfunction (NPVH). Method An ambulatory voice monitor collected 1 week of data from 36 patients with NPVH and 36 vocally healthy matched controls. A subset of 11 patients with NPVH were monitored after voice therapy.

Differences Between Female Singers With Phonotrauma and Vocally Healthy Matched Controls in Singing and Speaking Voice Use During 1 Week of Ambulatory Monitoring.

Purpose Previous ambulatory voice monitoring studies have included many singers and have combined speech and singing in the analyses. This study applied a singing classifier to the ambulatory recordings of singers with phonotrauma and healthy controls to determine if analyzing speech and singing separately would reveal voice use differences that could provide new insights into the etiology and pathophysiology of phonotrauma in this at-risk population. Method Forty-two female singers with phonotrauma (vocal fold nodules or polyps) and 42 healthy matched controls were monitored using an ambulatory voice monitor.

Changes in a Daily Phonotrauma Index After Laryngeal Surgery and Voice Therapy: Implications for the Role of Daily Voice Use in the Etiology and Pathophysiology of Phonotraumatic Vocal Hyperfunction.

Purpose This study attempts to gain insights into the role of daily voice use in the etiology and pathophysiology of phonotraumatic vocal hyperfunction (PVH) by applying a logistic regression-based daily phonotrauma index (DPI) to predict group-based improvements in patients with PVH after laryngeal surgery and/or postsurgical voice therapy. Method A custom-designed ambulatory voice monitor was used to collect 1 week of pre- and postsurgery data from 27 female patients with PVH; 13 of these patients were also monitored after postsurgical voice therapy. Normative weeklong data were obtained from 27 matched controls.

Ambulatory monitoring of Lombard-related vocal characteristics in vocally healthy female speakers.

Speakers typically modify their voice in the presence of increased background noise levels, exhibiting the classic Lombard effect. Lombard-related characteristics during everyday activities were recorded from 17 vocally healthy women who wore an acoustic noise dosimeter and ambulatory voice monitor. The linear relationship between vocal sound pressure level and environmental noise level exhibited an average slope of 0.

Amount and Characteristics of Speaking and Singing Voice Use in Vocally Healthy Female College Student Singers During a Typical Week.

Objectives: Singers, college students, and females are groups known to be at an elevated risk of developing functional/hyperfunctional voice disorders; therefore, female college students majoring in vocal performance may be at an even higher risk. To mitigate this risk, it would be helpful to know the "safe limits" for voice use that would help maintain vocal health in this vulnerable group, but there is a paucity of high-quality objective information upon which to base such limits. This study employed weeklong ambulatory voice monitoring in a large group of vocally healthy female college student singers to begin providing the types of objective data that could be used to help develop improved vocal health guidelines.

Impact of Nonmodal Phonation on Estimates of Subglottal Pressure From Neck-Surface Acceleration in Healthy Speakers.

Purpose The purpose of this study was to evaluate the effects of nonmodal phonation on estimates of subglottal pressure (Ps) derived from the magnitude of a neck-surface accelerometer (ACC) signal and to confirm previous findings regarding the impact of vowel contexts and pitch levels in a larger cohort of participants. Method Twenty-six vocally healthy participants (18 women, 8 men) were asked to produce a series of p-vowel syllables with descending loudness in 3 vowel contexts (/a/, /i/, and /u/), 3 pitch levels (comfortable, high, and low), and 4 elicited phonatory conditions (modal, breathy, strained, and rough). Estimates of Ps for each vowel segment were obtained by averaging the intraoral air pressure plateau before and after each segment.

Automatic speech and singing classification in ambulatory recordings for normal and disordered voices.

Ambulatory voice monitoring is a promising tool for investigating phonotraumatic vocal hyperfunction (PVH), associated with the development of vocal fold lesions. Since many patients with PVH are professional vocalists, a classifier was developed to better understand phonatory mechanisms during speech and singing. Twenty singers with PVH and 20 matched healthy controls were monitored with a neck-surface accelerometer-based ambulatory voice monitor.

Correlating an Ambulatory Voice Measure to Electrodermal Activity in Patients with Vocal Hyperfunction.

We investigate the connection between the autonomic nervous system and the voice in patients with vocal hyperfunction and healthy-control groups. We present a methodology and preliminary results of two multi-modal measurement streams that capture this relationship. Subjects were instrumented for daily, ambulatory collection of their voice and wrist-based electrodermal activity.

Intervention Outcomes of Two Treatments for Muscle Tension Dysphonia: A Randomized Controlled Trial.

Purpose The aim of this study was to test the hypothesis that stretch-and-flow voice therapy (SnF) is noninferior to resonant voice therapy (RVT) for speakers with muscle tension dysphonia. Method Participants with primary muscle tension dysphonia were randomly assigned to 1 of 2 treatment groups. Participants received 6 sessions of either SnF or RVT for 6 weeks (1 session per week).

Individualized Patient Vocal Priorities for Tailored Therapy.

Purpose: The purposes of this study are to introduce the concept of vocal priorities based on acoustic correlates, to develop an instrument to determine these vocal priorities, and to analyze the pattern of vocal priorities in patients with voice disorders.

Method: Questions probing the importance of 5 vocal attributes (vocal clarity, loudness, mean speaking pitch, pitch range, vocal endurance) were generated from consensus conference involving speech-language pathologists, laryngologists, and voice scientists, as well as patient feedback. The responses to the preliminary items from 213 subjects were subjected to exploratory factor analysis, which confirmed 4 of the predefined domains.

A randomized controlled trial of stretch-and-flow voice therapy for muscle tension dysphonia.

Objectives: To investigate the effect of stretch-and-flow voice therapy on vocal function and handicap.

Study Design: Randomized controlled trial.

Methods: Participants with primary muscle tension dysphonia were randomly assigned to experimental or control groups.

The effect of stretch-and-flow voice therapy on measures of vocal function and handicap.

Objectives: To investigate the efficacy of stretch-and-flow voice therapy as a primary physiological treatment for patients with hyperfunctional voice disorders.

Study Design: Prospective case series.

Methods: Participants with a diagnosis of primary muscle tension dysphonia or phonotraumatic lesions due to hyperfunctional vocal behaviors were included.

Relationship between patient-perceived vocal handicap and clinician-rated level of vocal dysfunction.

Objectives/hypothesis: The relationship between patient-reported vocal handicap and clinician-rated measures of vocal dysfunction is not understood. This study aimed to determine if a correlation exists between the Voice Handicap Index-10 (VHI-10) and the Voice Functional Communication Measure rating in the National Outcomes Measurement System (NOMS).

Study Design: Retrospective case series.