Auditory-perceptual Analysis Research Articles

Auditory-perceptual and acoustic analysis of patients undergoing palatoplasty

The most common phonation changes in patients with cleft lip and palate are: hypernasality, compensatory articulation, weak intraoral pressure and nasal air leak. The literature refers to the use of auditory-perceptual assessment in phonation analysis as the most used method by speech therapists, being considered gold standard. However, it depends on the experience of the hearing evaluators who must be highly trained. Therefore, complementary tests are supposed to extend the range of diagnostic and therapeutic possibilities. So, there is a need for a simple, objective and non-invasive test to be used in the routine care of this individual. The objective of this study is to characterize, using auditory-perceptual analysis, the speech and voice profile of a group of patients who underwent palatoplasty in the state of Rio de Janeiro, comparing these findings to the parameters found in acoustic analysis and in the literature. An interview was carried out based on the orofacial myofunctional assessment protocol for individuals with cleft lip and palate. The entire process was recorded on a video camera and directly in the acoustic analysis program using Voxmetria version 2.7, from CTS Informática, with the aid of a noise-reducing microphone. It was concluded that the auditory-perceptual and acoustic characterization of the speech and voice profile of patients who underwent palatoplasty is consistent with data obtained in the literature in other reference centers around the world. Furthermore, acoustic analysis showed statistical significance when compared to auditory-perceptual analysis, extending the range of diagnostic and therapeutic possibilities.

Cepstral Analysis of Voice in School-Aged Children

Dysphonia in school-aged children is attributed primarily to hyperfunctional use of voice. These can be identified through effective protocols using both acoustic and auditory-perceptual analyses. The current study aimed to investigate voice characteristics in school children aged 4-17years using auditory-perceptual rating and cepstral measures of voice. This is a descriptive cross-sectional observational study. Four hundred and fifty-seven recordings of sustained phonation of /a/ in children and adolescents obtained in a quiet room using Zoom h1 voice recorder were analyzed using auditory-perceptual evaluation by three speech-language pathologists using Grade of overall dysphonia, Roughness, Breathiness, Asthenia, and Strain(GRBAS) rating scale. The samples were classified based on age into five groups: 1) 4 to 6; 11 years 2) 7-8; 11 years, 3) 9-11; 11years 4) 12-13; 11years and 5) 14-16; 11 years. PRAAT software was used to extract Cepstral Peak Prominence (CPP) and Cepstral Peak Prominence Smoothed (CPPS). Inter-rater reliability was assessed for both auditory-perceptual and acoustic analysis. Auditory-perceptual analysis revealed dysphonia in 7.8% of samples with higher rate in males than females. Inter-rater reliability for auditory-perceptual rating was found to be good (Intraclass Corelation Coefficient-0.83). Independent t test revealed statistically significant difference (P<0.001) in both cepstral measures and mean values were lower in dysphonic than normal group. Gender effect was present for CPP in group 5(14-16;11 years) and CPPS in group 4 (12-13; 11years). One-way analysis of variance within groups in males (P<0.005) revealed statistical difference in both cepstral measures but not in females. Statistically significant difference was not found between ratings of both speech language pathologists for both CPP (P=0.929) and CPPS (P=0.965) values indicating the ratings to be reliable. Pediatric dysphonia has received less attention when compared to adults. Assessing school-aged children for dysphonia using both auditory-perceptual and acoustic measures would aid in identifying those at risk to make appropriate referrals and plan further intervention.

A Comparison of Countertenor Singing at Various Professional Levels Using Acoustic, Electroglottographic, and Videofluoroscopic Methods

IntroductionThe vocal characteristics of countertenors (CTTs) are poorly understood due to a lack of studies in this field. This study aims to explore differences among CTTs at various professional levels, examining both disparities and congruences in singing styles to better understand the countertenor voice. Materials and MethodsFour CTTs (1 student, 1 amateur and 2 professionals) sang "La giustizia ha già sull'arco" from Handel's Giulio Cesare, with concurrent videofluoroscopic, EGG, and acoustic data collection. Auditory-perceptual analysis was employed to rate professional level. Acoustic analysis included LH1-LH2, formant cluster prominence, and vibrato analysis. EGG data was analysed using FonaDyn software, while anatomical modifications were quantified using videofluoroscopic images. ResultsCTTs exhibited CQ values surpassing typical levels for inexperienced falsettos. Their vibrato characteristics aligned with expectations for classical singing, whereas the presence of the singer's formant was not observed. Variations in supraglottic adjustments among CTTs underscored the diversity of techniques employed by CTT singers. ConclusionsCTTs exhibited vocal techniques that highlighted the influence of individual preferences, professional experience, and stylistic choices in shaping their singing characteristics. The data revealed discernible differences between professional and amateur CTTs, providing insights into the impact of varying levels of experience on vocal expression.

Exploring Motor Speech Disorders in Low and Minimally Verbal Autistic Individuals: An Auditory-Perceptual Analysis.

Motor deficits are widely documented among autistic individuals, and speech characteristics consistent with a motor speech disorder have been reported in prior literature. We conducted an auditory-perceptual analysis of speech production skills in low and minimally verbal autistic individuals as a step toward clarifying the nature of speech production impairments in this population and the potential link between oromotor functioning and language development. Fifty-four low or minimally verbal autistic individuals aged 4-18 years were video-recorded performing nonspeech oromotor tasks and producing phonemes, syllables, and words in imitation. Three trained speech-language pathologists provided auditory perceptual ratings of 11 speech features reflecting speech subsystem performance and overall speech production ability. The presence, attributes, and severity of signs of oromotor dysfunction were analyzed, as were relative performance on nonspeech and speech tasks and correlations between perceptual speech features and language skills. Our findings provide evidence of a motor speech disorder in this population, characterized by perceptual speech features including reduced intelligibility, decreased consonant and vowel precision, and impairments of speech coordination and consistency. Speech deficits were more associated with articulation than with other speech subsystems. Speech production was more impaired than nonspeech oromotor abilities in a subgroup of the sample. Oromotor deficits were significantly associated with expressive and receptive language skills. Findings are interpreted in the context of known characteristics of the pediatric motor speech disorders childhood apraxia of speech and childhood dysarthria. These results, if replicated in future studies, have significant potential to improve the early detection of language impairments, inform the development of speech and language interventions, and aid in the identification of neurobiological mechanisms influencing communication development.

Perceptual-Auditory and Acoustic Analysis of Breathiness in Cis and Transgender Men and Women

ObjectiveTo verify breathiness in the cisgender and transgender men and women’s voices, compare values of acoustic and perceptual indicators of breathiness and fundamental frequency (f0) between groups, and compare them between the voices attributed as female and male. Study designCross sectional retrospective study. MethodsThe study as approved by the Research Ethics Committee (4,937,140). Sustained vowel /a/ and continuous speech recordings of 21 cisgender men (CISM), 31 transgender men (TM), 32 cisgender women (CISW) and 31 transgender women (TW) were analyzed. Three judges conducted a perceptive-auditory analysis regarding the degree breathiness, using visual analogue scale, and attributed gender (female or male). The ABI (Acoustic Breathiness Index) was extracted using the PRAAT software (6.1.16). The f0, Harmonic-Noise Ratio (HNR), Voice Turbulence Index (VTI) and Soft Phonation Index (SPI) were analyzed using the Multi-Dimensional Voice Program (KayPentax). ResultsThe ABI value for CISM was lower than for TM and CISW. CISW had the higher f0 than; TM had a higher f0 than CISM; and TW had a higher f0 than CISM. The groups did not differ for HNR and VTI. Regarding the SPI, CISM had higher values than CISW. Regarding the auditory perception, TM presented more intense breathiness than CISM in the vowel. Regarding gender attribution by voice, the voices CISM and CISW were 100% identified as male and female. On the other hand, in the vowel analysis, 45.2% of the TM voices were perceived as female and 59.4% of TW voices as male. ConclusionBreathiness occurs differently between groups and the voices perceived as male and female. Even when TM are submitted to the use of testosterone and undergo vocal changes, the transglottal airflow remains, which is a female characteristic of phonation.

Early Assessment of Voice Problems in Post-Thyroidectomy Syndrome Using Cepstral Analysis.

Post-thyroidectomy syndrome (PTS), characterized by voice issues after thyroidectomy without recurrent laryngeal nerve injury, was investigated in this study. The Voice Fatigue Index (VFI) and cepstral analysis were employed for subjective and objective voice evaluation. Retrospective analysis involved 96 patients (37 males, 59 females) who underwent thyroidectomy without nerve injury from April 2018 to June 2022. Assessments pre- and post-thyroidectomy included the Voice Handicap Index (VHI) and VFI, along with auditory perceptual, acoustic (including cepstral), aerodynamic, and glottal vibration analyses. In females, although the GRBAS scale showed no significant change, both VHI and VFI increased post-thyroidectomy. Significant correlations were observed between the VHI and VFI in females. Acoustic analysis indicated a decrease in the cepstral peak prominence (CPP) of vowels (/a/) and sentences in females, with significant correlations between changes in the CPP/a/ and VHI/VFI. The maximum fundamental frequency (F0max) exhibited a significant decrease, correlating with the VHI and VFI changes. The VFI demonstrated effectiveness in subjective PTS voice evaluation, comparable to the VHI. The present study highlights the potential of cepstral analysis as an index reflecting subjective voice discomfort, suggesting its promise for a comprehensive PTS voice evaluation.

Effectiveness and Feasibility of Telepractice on Voice Therapy for Female Teachers in Elementary Schools with Self-Reported Voice Disorders.

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. 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. 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. 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.

Is There an Ideal Performance Time for the Latex Tube Exercise?

SOVTE has been widely used in voice clinic. Estimates of time to perform the technique with a flexible latex tube are still unknown. This study aimed to investigate the immediate effect of flexible latex tube immersed in water on amateur singers after 1, 3, 5 and 7 minutes, considering: (a) the singers' self-assessment regarding voice and vocal effort; (b) acoustic parameters; and (c) auditory-perceptual parameters of voice quality. Twenty nine amateur singers (14 women and 15 men) performed the exercise with latex tube (35 cm X 0.9 cm) in one 1-minute set and three 2-minute sets. Data collection was conducted before and immediately after each set using sustained emission of vowel [a]. Women and men were considered separately. Vocal self-assessment showed a statistically significant increase in negative sensations after 7 minutes of exercise for women. Auditory-perceptual analysis indicated voices were perceived more often as "equal" comparing pre exercise with first minute set and more often as "better" in the third and fifth minutes comparing with pre exercise only for women. The other parameters showed no significance. The exercise with flexible latex tube in amateur singers promoted improvement in vocal quality after 3 and 5 minutes for women. Also, the women presented significant negative sensations after 7 minutes. Immediate effect on the analyzed parameters was not observed in men.

Manual Therapy with Neural Mobilization: Immediate Effect on the Vocal Quality of Women with Dysphonia.

To evaluate the immediate effect of neural mobilization on the voice quality, self-perceived phonatory effort, and laryngeal muscles of women with behavioral dysphonia. This is an intrasubject comparative study. The research included 21 women aged 18 to 59 years with vocal complaints. Therefore, the selection of this sample excluded the lower limit of the voice change period and the upper limit of presbyphonia. The participants were assessed by voice acoustic and auditory-perceptual analysis, self-reported vocal effort, and laryngeal palpation performed at three moments: at baseline, after 10 minutes of vocal resting, and after manual therapy. The participants were divided into two groups: the group with 10 minutes of vocal resting (G1) and the group with intervention (G2). The patients in the intervention group underwent manual therapy using neural mobilization in the laryngeal region. For the statistical analysis, a descriptive analysis of the data was performed first with measures of central tendency and dispersion. Subsequently, the Anderson-Darling test was used to verify sample normality. To analyze the difference between three groups were used the parametric One-Way ANOVA or the non-parametric Friedman's test. The McNemar's or chi-squared tests were used to compare categorical variables and to compare an ordinal variable a non-parametric Wilcoxon test was used. The Gwet's AC1 test was used to assess intra-rater agreement in the auditory-perceptual analysis response. Neural mobilization in the laryngeal region showed no positive effects on the acoustic voice parameters and voice quality of women with dysphonia. Phonatory effort improved after neural mobilization in the laryngeal region (p=0.004). There was no significant change in supralaryngeal resistance, lateral laryngeal resistance, and laryngeal position after neural mobilization in the laryngeal region. Neural mobilization improved phonatory comfort but did have any effect on the voice quality and laryngeal musculature of women with dysphonia.

Cochleagram to Recognize Dysphonia: Auditory Perceptual Analysis for Health Informatics

Cochleagram to Recognize Dysphonia: Auditory Perceptual Analysis for Health Informatics

Comparative Study of the Effect of Experience on Auditory Processing Abilities in Voice Therapists and Other Speech-Language Pathologist in Auditory Perceptual Judgment of Voice

This study aimed to compare the effect of experience on central auditory processing skills in voice therapists and other Speech-Language Pathologists in the auditory perceptual evaluation of voice. This research is a descriptive-analytical cross-sectional observational study. Our study population includes three groups; first-year speech-language pathology students who have not undergone any training or education in the evaluation of auditory samples (group 1; n=10), Speech-Language Pathologists who do not have any activity in the field of voice disorders (group 2; n=10), and therapists who have at least 2years of experience in auditory-perceptual judgment (group 3; n=10). Initially, the participants underwent a basic audiological evaluation (Pure Tone Audiometry, Speech Recognition Threshold, Speech Discrimination Score, tympanometry, and acoustic reflex) to assess peripheral hearing. In the next step, the auditory processing skills of the participants were evaluated with the Buffalo model (staggered spondaic word (SSW) test, phonemic synthesis test (PST), speech in noise (SPN) test). In the third step, four recorded voice samples of patients with voice disorders and healthy individuals were randomly selected for auditory perceptual judgment. These samples were the same for all participants. All the voices were previously subjected to auditory perceptual analysis by two Speech-Language Pathologist who had at least 6years of experience in the evaluation and treatment of voice disorders; the voices were played for participants to assess auditory perception using the grade, roughness, breathiness, asthenia, strain (GRBAS) scale. All subjects had normal hearing and auditory processing abilities but there were some differences among the groups in processing skills. A difference was found in the SSW-qualifier and SPN-R components between the three groups. The third group had significant differences with the other two groups in the evaluation of auditory perception in the components of R, B, and S (from the GRBAS scale) in voice number one, and the components of G, R, and A in voice number three. In voice number two, there was a correlation between the SSW order effect component and the G component, as well as between the PST component and the A component. In voice number three, there was a correlation between the SPN-L component and the G component, and between the SSW condition, SSW qualifier, and SSW All errors components with the S component. In voice number four, there was a correlation between the SSW-RC, SSW-LC, SSW condition, SSW competing, and SSW order effect components with the A component. Lastly, there was a correlation between the SSW order effect and SSW type A components with the R component in voice number three in group three. The results of the present study indicate that experience has an impact on auditory processing skills and the participants of the third group, who had more experience in the evaluation of voice disorders obtained better scores than the other two groups in the auditory processing skills. Additionally, the level of experience is related to the accuracy of auditory perceptual judgment of voice. The participants of the third group performed better than the other two groups, and the performance of the first and second groups was almost the same.

The influence of listener experience, measurement scale and speech task on the reliability of auditory-perceptual evaluation of vocal quality.

To assess the influence of the listener experience, measurement scales and the type of speech task on the auditory-perceptual evaluation of the overall severity (OS) of voice deviation and the predominant type of voice (rough, breathy or strain). 22 listeners, divided into four groups participated in the study: speech-language pathologist specialized in voice (SLP-V), SLP non specialized in voice (SLP-NV), graduate students with auditory-perceptual analysis training (GS-T), and graduate students without auditory-perceptual analysis training (GS-U). The subjects rated the OS of voice deviation and the predominant type of voice of 44 voices by visual analog scale (VAS) and the numerical scale (score "G" from GRBAS), corresponding to six speech tasks such as sustained vowel /a/ and /ɛ/, sentences, number counting, running speech, and all five previous tasks together. Sentences obtained the best interrater reliability in each group, using both VAS and GRBAS. SLP-NV group demonstrated the best interrater reliability in OS judgment in different speech tasks using VAS or GRBAS. Sustained vowel (/a/ and /ɛ/) and running speech obtained the best interrater reliability among the groups of listeners in judging the predominant vocal quality. GS-T group got the best result of interrater reliability in judging the predominant vocal quality. The time of experience in the auditory-perceptual judgment of the voice, the type of training to which they were submitted, and the type of speech task influence the reliability of the auditory-perceptual evaluation of vocal quality.

Fidelity to the Consensus Auditory-Perceptual Analysis of Voice (CAPE-V): A Pilot Study

ObjectivesAuditory-perceptual measurements of voice are among the most common diagnostic tools used during a voice evaluation and are considered a gold standard for documenting voice disorders. The goal of this pilot study was to examine the fidelity of clinicians in the administration of the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) and its published protocol. This investigation aimed to determine how the CAPE-V is being used by clinicians and researchers and the extent to which users deviate from the published procedure. Study DesignSurvey MethodsData were collected by surveying a group (N=l7) of speech-language pathologists who regularly evaluate and treat patients with voice disorders. Survey results revealed that few of the sampled speech-language pathologists follow exactly the standardized instructions for administering the CAPE-V. Considerable variability in CAPE-V administration, including tasks and stimuli examined, was found across respondents. ConclusionsThis exploratory project may be used to develop a larger national survey study investigating fidelity to the CAPE-V and to motivate recommendations for possible revisions to the instrument and its protocol for administration.

Immediate Effects of Semi-Occluded Vocal Tract Exercises on Acoustic, Auditory-Perceptual, and Self-Perceptual Measures of Voice Production

Introduction: This study examined the immediate acoustic, auditory-perceptual, and self-perceptual effects of two semi-occluded vocal tract exercises (SOVTs): straw phonation and straw phonation into a cup of water, delivered in a remote setting. Method: Thirty-six participants (19 females and 17 males) completed a baseline battery of acoustic recordings, followed by one of two SOVTs, and an identical post-task battery. The procedure repeated itself to include the other SOVT. Participants were also asked to rate their self-perceived vocal effort and quality following each condition. Recordings were presented to three expert listeners for completion of auditory-perceptual analysis. Results: Acoustically, a significant decrease in shimmer was noted following straw phonation. Auditory-perceptual analysis revealed a significant increase in the perception of strain following straw phonation into a cup of water. While no significant differences were found between SOVT tasks in self-perception of vocal effort, a significant increase in self-perception of vocal loudness was reported following straw phonation into a cup of water. Conclusion: SOVTs have a varied, yet significant short-term impact across acoustic, auditory-perceptual, and self-perceptual measures of voice production. Straw phonation provided consistently significant acoustic results, with nearly every variable improving to some degree. Results also support the notion that shimmer is an acoustic measure that is particularly susceptible to change following modest manipulation. These results, in addition to the auditory-perceptual and self-perceptual findings, have a direct impact on how SOVTs are being used clinically and may generalize to inform the way voice metrics are collected and analyzed.

Vocal tasks for acoustic and/or auditory perceptual analysis for discriminating individuals with and without voice disorders: a systematic review protocol

ObjectiveThe primary objective of the present systematic review is to: (1) identify the current vocal tasks being used for acoustic and/or auditory perceptual analysis to differentiate between individuals with and...

Fibrovascular Change and Sulcus Vocalis: A Case for Voice Therapy

Purpose: A clinical case of right posteromedial true vocal fold sulcus is presented with case history, auditory perceptual analysis and accompanying audio files and ratings, laryngoscopic files and ratings, and acoustic analysis, as well as impressions and plan for treatment. Method: A single clinical case of right posteromedial true vocal fold sulcus is presented for learning purposes. Results: Clinical keys are provided for learning. Conclusion: Learners will be able to follow a clinical case to aid in perceptual, laryngoscopic, acoustic, and voice assessment and goal and treatment planning. Supplemental Material: https://doi.org/10.23641/asha.24470056

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

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. A retrospective chart review was conducted on 50 patients who were seen for their initial voice therapy evaluation at the UT Southwestern Clinical Center for Voice Care. Chart review included documentation of the stimulability tasks that yielded/did not yield voice changes, level of stimulability, voice diagnosis, clinician-rated auditory-perceptual analysis of vocal quality, therapy attendance, and compliance with voice therapy recommendations. Statistical analysis was conducted to determine whether the types of facilitating techniques, voice diagnosis, and dysphonia severity could predict how stimulable patients were and whether any stimulability techniques could predict voice therapy attendance and compliance. Patients diagnosed with functional voice disorders (eg, muscle tension dysphonia) were 11 times more likely to be stimulable for voice improvements than patients with neurological voice disorders (eg, vocal fold paralysis). Patients with lower dysphonia severity were more likely to be stimulable than patients with high dysphonia severity. Specific facilitating voice tasks did not predict the level of stimulability. Stimulability level was not predictive of therapy attendance or compliance with therapy recommendations. Voice diagnosis and severity of dysphonia influenced stimulability levels. However, voice stimulability was not predictive of voice therapy attendance or compliance, and no specific facilitative task predicted the level of stimulability. Future investigations should focus on other means of measuring a patient's motivation for change and on the predictive power of stimulability testing on voice therapy outcomes.

Risk of Dysphonia in Theater Actors: Proposal for a Screening Protocol

To propose a Dysphonia Risk Screening Protocol for Actors (DRSP-A), test its usability in conjunction with the General Dysphonia Risk Screening Protocol (G-DRSP), determine the cut-off point for a high risk of dysphonia in actors, and compare the risk of dysphonia between actors with and without voice disorders. Observational cross-sectional study with 77 professional actors or students. The questionnaires were applied individually and the total scores were summed to calculate the final score of the Dysphonia Risk Screening (DRS-Final). The validityof the questionnaire was verified from the area under the Receiver Operating Characteristic (ROC) curve, and cut-offs were obtained based on diagnostic criteria for screening procedures. Voice recordings were collected for auditory-perceptual analysis and subsequent division into groups with and without vocal alteration. The sample showed a high risk of dysphonia. Higher scores in the G-DRSP and in the DRS-Final were found in the group that presented vocal alteration. The cut-off points established for the DRSP-A and DRS-Final were 0.623 and 0.789, respectively, with higher degrees of sensitivity than specificity. Thus, above these values, the risk of dysphonia is greater. A cut-off value was calculated for the DRSP-A. This instrument was proven to be viable and applicable. The group with vocal alteration had a higher score in the G-DRSP and DRS-Final, but there was no difference in the DRSP-A.

Chronic voice disorder after coronavirus disease 2019 infection and its treatment using the cricothyroid visor maneuver: a case report

BackgroundRegarding human coronavirus, the severe acute respiratory syndrome coronavirus 2 pandemic, the novelty of disease, and consequently the lack of studies, the etiology of dysphonia in patients with coronavirus disease 2019 is still unknown and needs to be investigated. The purpose of the current study is to investigate the effect of a new manual therapy technique, cricothyroid visor maneuver, on muscle tension dysphonia symptoms for a patient who had experienced dysphonia symptoms due to the coronavirus disease 2019 infection.Case presentationA 55-year-old retired Iranian teacher who was diagnosed with muscle tension dysphonia by an otolaryngologist participated in this study. Fifty days before being referred to an otolaryngologist, he was diagnosed with coronavirus disease 2019 on the basis of the results of a standard laboratory test, namely real-time polymerase chain reaction. Treatment was provided in ten sessions. Pre- and post-treatment audio recordings of sustained vowels, selected sentences, and connected speech samples were submitted for auditory perceptual and acoustic analysis to assess the effects of the treatment program. Also, videolaryngostroboscopy voice quality perceptions by the patient, both before and after therapy, were assessed. The reduction in all features of the Consensus Auditory-Perceptual Evaluation of Voice was observed. The results of acoustic assessment showed that jitter (35.13%) and shimmer (20.48%) decreased; moreover, the harmonics-to-noise ratio (1.17%), cepstral peak prominence smoothed (28.53%) and maximum phonation time (15.5%) increased after treatment sessions. The scores of four parameters of Stroboscopy Examination Rating Form (SERF) form changed after cricothyroid visor maneuver therapy. Also, the visual analog scales score at the pre-treatment assessment was 40, and increased to 90 at the post-treatment assessment.ConclusionsThe effectiveness of cricothyroid visor maneuver therapy on dysphonia associated with coronavirus disease 2019 was investigated in the current study. This case study has highlighted chronic dysphonia after coronavirus disease 2019 infection, and suggests that the cricothyroid visor maneuver therapy approach may have positive outcomes for patients with muscle tension dysphonia with this background.

Indirect Vocal Therapy as a Treatment Program for Behavioral Dysphonia: A Pilot Study

Introduction: Indirect vocal therapy (IVT) has tools that aim to modify an individual’s behavior, emotional factors, and physical environment for restoring vocal quality. Then, vocal health guidance may promote the desire for caring about the voice and prevent or treat behavioral dysphonia. However, studies that used parts of IVT have shown conflicting results. Hence, the main objective of this study was to introduce an IVT program based on the taxonomy of Van Stan et al. [Am J Speech Lang Pathol. 2015;24(2):101–25]. The second objective of this study was to analyze the preliminary effects of the IVT program on vocal comfort through the self-assessment of vocal fatigue, vocal symptoms, vocal handicap, and vocal quality in patients diagnosed with behavioral dysphonia. Method: This is an experimental, analytical, and prospective pilot study. Nine participants (five women; four men) aged between 18 and 50 years with behavioral dysphonia participated in this study. They underwent the IVT program with guidance about vocal health, general health, emotional factors, and motivation. The therapy was implemented twice per week, totalizing eight sessions, each lasting 35 min. Participants were assessed before therapy started (M1), after it ended (M2), and 1 month after as a follow-up (M3). As assessment, participants filled in the Vocal Fatigue Index (VFI), Voice Symptoms Scale (VoiSS), and Vocal Handicap Index-30 (VHI-30). Additionally, they had their voices recorded for acoustic measures (i.e., cepstral peak prominence-smoothed, alpha ratio, and L1-L0) and auditory-perceptual analysis using the GRBASI scale. Results: The acoustic measures and auditory-perceptual analysis showed no significant differences between the assessment moments. The auditory-perceptual analysis showed a mild deviation in participants’ vocal quality. The participants’ scores of the VFI, VoiSS, and VHI were lower in M2 and remained lower in M3. Conclusion: The IVT program had positive results in voice-related self-assessment and vocal comfort. However, further studies are necessary to elucidate its effects on the vocal quality of participants with behavioral dysphonia.