Effects Of Voice Therapy Research Articles

Voice Therapy Method for Post-Thyroidectomy Syndrome

Objectives: This study aimed to demonstrate the effectiveness of Voice Therapy for Post- Thyroidectomy Syndrome (VT-PTS). The primary cause of PTS is the impairment of vertical movement in the larynx due to adhesion of the infrahyoid muscles or laryngeal-tracheal structures. Methods: The study included 12 participants (2 males and 10 females) diagnosed with PTS by a laryngologist. All participants reported subjective voice problems and were recommended for voice therapy by a speech-language pathologist. Participants were randomly assigned to the study. The VT-PTS program consisted of VT-1 (direct voice therapy conducted by a speech-language pathologist) and VT-2 (self-practice at home). Voice assessments included acoustic analyses (F0, jitter, shimmer, NHR, maximum pitch, minimum pitch, and pitch range) and subjective voice evaluations (K-VHI-10, K-VFI, and TVQ). Results: Acoustic analyses indicated significant increases in F0 (<i>p</i>=.014), maximum pitch (<i>p</i><.001), and pitch range (<i>p</i><.001) following VT-1 and VT-2. According to the Bonferroni correction, jitter (<i>p</i>=.046) and shimmer (<i>p</i>=.017) were not statistically significantly reduced. The K-VHI-10 (<i>p</i>=.003), K-VFI (<i>p</i>=.014), and TVQ (<i>p</i>=.002) also demonstrated significant decreases after VT-2. Conclusion: VT-PTS showed significant improvements in both objective and subjective voice evaluations, demonstrating its effectiveness in addressing voice problems in PTS. Notably, it was highly effective in addressing pitch-related problems, which are the primary voice problems in PTS. This study is valuable as it provides evidence- based support for speech-language pathologists in treating PTS in clinical fields. Future research should try non-face-to-face voice therapy and the development of applications to support post-surgical self-practice.

Effects of the Change in Respiratory Kinematics on the Singing Voice: Re-Visiting the Benefits of Diaphragmatic-Abdominal Breathing in Professional Singers with Problems in Pitch.

Objectives: To assess the effect of voice therapy on pitch in professional singers with faulty respiratory kinematics. Methodology: In this prospective interventional study, professional singers with easy voice fatigability and inability to reach higher pitches, following appropriate selection criteria, were subjected to a 1-month structured voice therapy that transformed their predominant breathing pattern from thoracic to diaphragmatic-abdominal. Acoustic parameters (pitch range and its extreme values before/after therapy, and difference in pitch range) were analyzed using Praat software and compared using standard statistical methods (paired t-test). The singers' age and career duration were also correlated with the pitch parameters (Pearson's correlation coefficient). Results: The singers (n = 60; 55% men, 45% women; respective mean age: 34.24, 35.92 years; average singing career: 12.56 years) had thoracic breathing before treatment [average pitch-range: 92.8 Hz; 85.84 Hz (men), 101.29 Hz (women)] that turned to abdominal type post-therapy [average pitch-range: 189.21 Hz; 178.54 Hz (men), 202.25 Hz (women)]. The decrease in the mean lowest pitch was significant by paired t-test in both men and women (t = 7.96 and 7.87, respectively; .0001 significant level of test), as also the increase in mean highest pitch (t = 23.85 and 17.45, respectively; .0001 significant level of test) and change in pitch range (t = 19.45 and 17.37, respectively; .0001 significant level of test). Correlations between age/career duration with pitch range before and after therapy and its difference varied from very poor to fair [respectively, for men and women, age with pitch range: r = -.54, r = .03 (pre-therapy); r = .045, r = -.39 (post-therapy); age with difference in pitch range: r = .21, r = -.30; singing career with pitch-range: r = -.36, r = .25 (pre-therapy); r = .3, r = -.5 (post-therapy); singing career with difference in pitch range: r = .29, r = -.51]. Conclusions: Voice therapy directed to change respiratory kinematics from thoracic to diaphragmatic-abdominal was significant in the restoration of acoustic voice parameters in professional singers. Their age and duration of singing career had limited roles as adjuncts to voice therapy in the process.

Personal and Clinical Predictors of Voice Therapy Outcomes: A Machine Learning Analysis Using the Voice Handicap Index

In this study, we examine the predictive factors influencing the outcomes of voice treatment in patients with voice-related disorders, using the voice handicap index (VHI) as a key assessment tool. By analyzing various personal habits and clinical variables, we identify the primary factors associated with changes when comparing VHI scores before and after voice treatment. For this research, we employed binomial logistic regression, random forest (RF), and a multilayer perceptron (MLP) model to evaluate the effectiveness of voice treatment. The findings reveal that gender (with female patients showing greater improvements in VHI scores compared to male patients), surgical history, voice use status, and voice training status are significant predictors of therapy outcomes. The MLP model demonstrated high accuracy, sensitivity, and specificity, with an area under the curve (AUC) value of 0.87 indicating its potential as a valuable clinical predictive tool; however, the model’s relatively low specificity suggests the need for further refinement to enhance its predictive accuracy. The results of this study provide valuable insights for clinicians and speech–language pathologists in developing personalized treatment strategies to optimize the effectiveness of voice therapy. Future research should prioritize the validation of these findings in larger and more diverse population samples. Furthermore, it is essential to explore additional predictive variables in order to enhance the model’s accuracy across different types of voice disorders.

Effects of Voice Therapy on Maximum Phonation Time and S:Z Ratio in Patients With Primary Muscle Tension Dysphonia

ObjectiveThis study aimed to evaluate the influence of voice therapy on maximum phonation time (MPT) and S:Z ratio in patients diagnosed with primary muscle tension dysphonia (pMTD). The goal was to investigate whether pMTD is associated with reduced S:Z ratio and prolonged MPT. Study DesignProspective cohort study. MethodsA comparative analysis was conducted on a cohort of patients diagnosed with pMTD. Prevoice and postvoice therapy assessments of MPT and S:Z ratio were performed. Data from these measurements were analyzed to determine the impact of voice therapy on the studied parameters. A paired t test was used to evaluate MPT and S:Z ratio pretherapy and post therapy. ResultsFifty-two patients met the inclusion criteria for the study, having completed a laryngology evaluation with diagnosis of pMTD and agreeing to voice therapy between July 22, 2021, and April 4, 2023. Sixteen of these patients completed a full course of voice therapy. The Voice Handicap Index-10 (VHI-10), MPT, and S:Z ratio were measured during initial evaluation as part of a complete laryngeal function study. A statistically significant reduction in VHI-10 scores was observed, with values decreasing from 17.81 (±2.81) pretherapy to 8.81 (±1.8) post therapy (P < 0.001). However, no significant differences were detected in MPT or the S:Z ratio following the intervention. ConclusionsThere is a lack of correlation between subjective evaluations of voice (VHI-10) and objective assessments (MPT and S:Z ratio), indicating that these objective parameters may not accurately reflect changes in voice quality following therapy in the pMTD population. Lay SummaryMPT and S:Z ratio do not appear to be uniformly impacted in patients with pMTD. Moreover, these measures do not consistently improve following voice therapy for pMTD.

Clinical Effects of Voice Therapy on Vocal Outcomes in Unilateral Vocal Fold Paralysis: Proof-of-Concept Study for Two SOVT-Based Treatment Protocols

BackgroundStudies on treatment efficacy in unilateral vocal fold paralysis (UVFP) often lack a predetermined treatment protocol, and little is known about the effects of specific vocal techniques on vocal outcomes and quality of life in UVFP patients. The purpose of this preliminary proof of concept study is to investigate the effects and feasibility of two intensive treatment protocols based on water-resistance therapy (WRT) and vocal function exercises (VFE). MethodsTen participants with acute or chronic UVFP/paresis were recruited in the study and randomly assigned to the WRT or VFE group. Three of these participants presented with aphonia and could not complete the program as prescribed. The remaining participants completed an intensive therapy program with the assigned vocal technique. Before, during, and after the program, a multidimensional voice assessment was performed. Maximum phonation time, acoustic, perceptual, and patient-reported outcome measures were obtained. ResultsWRT and VFE had positive clinical effects on instrumental and auditory-perceptual voice quality, glottal closure, and patient-reported outcome measures, but inter-individual variability was high. Studies with larger sample sizes are necessary to confirm or refute these findings. ConclusionThe WRT- and VFE-based therapy programs are both feasible and seem to elicit positive clinical changes in UVFP patients. Suggestions on how to improve the programs are provided, as well as considerations for implementation in clinical practice. Follow-up research is needed to examine the efficacy of both programs on group level.

Effectiveness of Voice Therapy in Telepractice with Patients with Hyperfunctional Voice Disorder: A Pilot Study.

Background: The need for telepractice and digital treatment has increased due to issues this revision.regarding medical access and the COVID-19 pandemic. However, in many countries, telepractice is rarely performed. The purpose of this pilot study was to describe the detailed process of telepractice in patients with hyperfunctional voice disorder and investigate its effects. Methods: The three subjects who were enrolled in this pilot study had hyperfunctional voice disorders. The evaluation was performed face to face. Auditory perceptual evaluation, acoustic evaluation, aerodynamic evaluation, patient self-evaluation, and interviews were conducted. Treatment was delivered by telepractice using a smartphone application. Results: In quantitative analysis of auditory perceptual evaluation, acoustic evaluation, aerodynamic evaluation, and patient self-evaluation, all subjects showed improved voice after treatment. In-depth analysis of telepractice was performed through the interview. Conclusions: Telepractice was effective in patients with voice disorders, and the patients were satisfied with this approach. In addition to this pilot study, further large-scale studies are required, but telemedicine may improve treatment outcomes and patient satisfaction in cases where medical access is limited or during outbreaks of respiratory infections like COVID-19.

Effects of Voice Therapy using Semi-Occluded Ventilation Mask and Speech Tasks on Adults with Vocal Fatigue

Objectives: This study aimed to investigate the vocal changes in adults experiencing subjective vocal fatigue through a three-week intervention employing a semi-occluded ventilation mask (SOVM), which is a type of semi-occluded vocal tract exercise (SOVTE), and Korean speech materials. Methods: We implemented a three-week intervention program using an SOVM and a protocol based on Korean speech materials for 22 Korean adults (5 males and 17 females, aged 25.81 ± 7.31 years) reporting subjective vocal fatigue. The SOVM was fabricated by establishing a semi-occluded environment using a silicone plug with a central hole, which was inserted into the front opening of an air-cushion mask, typically used in medical context. Participants were also instructed to perform home training sessions twice a day until the subsequent intervention. The outcomes of multi-dimensional voice evaluations were compared pre- and post-intervention to assess vocal changes. Results: Post-intervention, significant improvements were observed in specific acoustic measurements (jitter percent, shimmer percent, noise-to-harmonic ratio, and cepstral peak prominence of vowel phonation) and the severity indices derived from those acoustic parameters. Additionally, a significant reduction in patient-reported outcome measures was noted following the intervention. Conclusion: The findings suggest that voice intervention using the SOVM and Korean speech materials has the potential to alleviate vocal fatigue and enhance vocal quality in individuals with vocal fatigue complaints.

Effectiveness of voice therapy combining various voice rehabilitation techniques in patients with muscle tension dysphonia

&lt;b&gt;&lt;br&gt;Introduction:&lt;/b&gt; Voice disorders associated with excessive muscle tension are most frequently diagnosed by phoniatrists. Voice therapy constitutes an essential part of the management of patients with voice disorders.&lt;/br&gt; &lt;b&gt;&lt;br&gt;Aim:&lt;/b&gt; The aim of this study consisted in the assessment of the effectiveness of voice therapy combining various rehabilitation techniques in patients with muscle tension dysphonia along with the analysis of patient-assessed rehabilitation quality results.&lt;/br&gt; &lt;b&gt;&lt;br&gt;Material and methods:&lt;/b&gt; The study was carried out in a group of 16 patients (4 male and 12 female) aged 33–91 years. The mean age of the subjects was 53.8 years (Me = 51; SD 15.21). Organic lesions were excluded in all patients. Voice therapy was carried out using various rehabilitation techniques, and the study methodology included basic scales and questionnaires used in patients with voice disorders as well as a custom questionnaire on rehabilitation quality as assessed by the patients themselves.&lt;/br&gt; &lt;b&gt;&lt;br&gt;Results:&lt;/b&gt; The study results confirm the effectiveness of the therapy.&lt;/br&gt; &lt;b&gt;&lt;br&gt;Conclusions:&lt;/b&gt; The study confirms the effectiveness of voice therapy combining various rehabilitation techniques.&lt;/br&gt;

Organik ve Fonksiyonel Disfonilerde Ses Terapisinin Etkinliği

Organik ve Fonksiyonel Disfonilerde Ses Terapisinin Etkinliği

Investigation of the Clinical Effectiveness and Prognostic Factors of Voice Therapy in Voice Disorders: A Pilot Study

Examining the relationship between the prognostic factors and the effectiveness of voice therapy is a crucial step in developing personalized treatment strategies for individuals with voice disorders. This study recommends using the multilayer perceptron model (MLP) to comprehensively analyze the prognostic factors, with various parameters, including personal habits and acoustic parameters, that can influence the effectiveness of before-and-after voice therapy in individuals with speech disorders. Various methods, including the assessment of personal characteristics, acoustic analysis, statistical analysis, binomial logistic regression analysis, and MLP, are implemented in this experiment. Accuracies of 87.5% and 85.71% are shown for the combination of optimal input parameters for female and male voices, respectively, through the MLP model. This fact validates the selection of input parameters when building our model. Good prognostic indicators for the clinical effectiveness of voice therapy in voice disorders are jitter (post-treatment) for females and MPT (pre-treatment) for males. The results are expected to provide a foundation for modeling research utilizing artificial intelligence in voice therapy for voice disorders. In terms of follow-up studies, it will be necessary to conduct research that utilizes big data to analyze the optimal parameters for predicting the clinical effectiveness of voice disorders.

Formant change and individual variation in male-to-female transgender speakers during voice therapy

Increased fundamental frequency (F0), resonance frequency (F2), and vowel formant frequency (F1, F2, F3) are linked to be perceived as feminine, making them desired outcomes of successful gender-affirmative voice therapy for male-to-female transwomen (MTF). However, treatment often only targets pitch, reporting F0 as an acoustic outcome measure. Vowel formants are measured less often and show inconsistent results. We retrospectively explored the effect of voice therapy on formants of Australian English /i:/. 44 MTF speakers were treated with Sob Voice Therapy using the Optimal Phonation Task, Sob Voice Quality, and Sob Variant therapy components in consecutive order. Speakers were recorded at baseline and after mastering each therapy component. F1, F2, and F3 were extracted at /i:/ target in maximally three words per component. Formant values were analyzed using linear mixed models with therapy component and therapy length as fixed effects and patient as random effect. We found no statistically significant effect of therapy component nor session on formant values at p = 0.05. Graphic inspection of the data suggests between-speaker variation, indicating that some patients may respond to treatment despite the lack of group effect. Future research may explore other acoustic outcome measures for the efficacy of gender-affirmative voice therapy.

Introduction of Voice Type Component (VTC) as an Effective Acoustic Voice Analysis Method in Tele-evaluation

Telepractice in voice healthcare and evaluation services has attracted much attention in recent years. Multiple studies have proven the effectiveness of voice therapy with telepractice. However, voice evaluations are still mostly conducted in person due to the lack of sensitive acoustic analysis methods. This study examined various acoustic analysis methods for voice evaluation in telepractice. Eighteen female elementary school teachers with self-reported voice disorders volunteered to participate in the study. Speech samples were collected before and after the interventions using two voice sampling methods concurrently. One set of data was collected using the traditional voice sample collection method by the therapist in person. The second set of data was collected on the same speech samples using the clients' own smartphones, and the collected voice samples were later sent to the researcher for further acoustic analysis. The voice type component (VTC) measurement represented the proportion of different VTCs in a voice by measuring the chaos and intrinsic dimension. Voice analyses were conducted on both sets of data, and the correlation between the two sampling procedures was analyzed. It appears that the VTC could be a more reliable method for producing acoustic analysis results with voice samples collected from smartphones compared to other objective voice assessment procedures. This reliability has been demonstrated via statistical analysis, including correlation coefficient, pairwise t test, d-prime,and area under the curve. The results of this study highlighted the VTC as an effective and accurate acoustic analysis method in tele-evaluation. This feasible voice sampling method, which utilizes participants' own smartphones, will reduce barriers to accessing limited voice specialists due to distance and will decrease the cost of care by minimizing expenses associated with travel and additional equipment for voice sampling. Ultimately, this approach will enhance the effectiveness of voice care delivered through telepractice to patients in remote and underserved areas.

Voice Outcomes Following Serial Office-Based Steroid Injections and Voice Therapy for Vocal Fold Scar

Previous studies indicate that certain voice outcomes can improve following a single office-based steroid injection with voice therapy for vocal fold scar. We evaluated voice outcomes after a series of three timed office-based steroid injections with voice therapy. Retrospective case series with chart review. Academic medical center. We evaluated pre-and postprocedural patient-reported, perceptual, acoustic, aerodynamic, and videostroboscopic parameters. We evaluated 23 patients who underwent three office-based dexamethasone injections into the superficial lamina propria one month apart. All patients pursued voice therapy. Voice Handicap Index (n=19; P= .030) decreased after injection series. Total GRBAS score (grade, roughness, breathiness, asthenia, strain) decreased (n=23; P=0.001). Dysphonia severity index score improved (n=20; P=0.041). Phonation threshold pressure did not decrease significantly (n=22; P=0.536). Videostroboscopic parameters of vocal fold edge (P=0.023), right mucosal wave (P=0.023) improved or normalized after injection series. Glottic closure (P=0.134) did not improve. Series of three office-based steroid injections combined with voice therapy for vocal fold scar does not appear to provide further benefit than one injection. Despite lack of improvements of PTP and other parameters, injection series is likewise unlikely to worsen dysphonia. A partially negative study provides value in investigation of less invasive treatment alternatives for a disorder that is challenging to treat. Future studies exploring effects of voice therapy alone without other intervention and consideration of sham injection versus steroid injection are warranted.

Efficacy of voice therapy in the treatment of mutational falsetto

Objectives: This study aimed to evaluate the effectiveness of voice therapy in patients with mutational falsetto with objective and subjective methods. Patients and Methods: In this retrospective study, 18 male patients (mean age: 17.2±3.7 years; range, 14 to 26 years) diagnosed with mutational falsetto underwent acoustical analysis between May 2020 and January 2023 using Praat software. For objective acoustic analyses, fundamental frequency, jitter, shimmer, and maximum phonation time parameters were used. For subjective analyses, the GRBAS (Grade, Roughness, Breathiness, Asthenia and Strain) scale and the voice handicap index were used. Pre- and post-voice therapy subjective and objective parameters were compared. Results: The mean pre-voice therapy fundamental frequency value of the patients was 183.63±22.18 Hz, while the post-therapy value was 125.03±15.52 Hz. The mean pre-voice therapy voice handicap index score of the patients was 30.33±3.67, whereas the post-therapy score was 9.77±2.48. While the GRBAS scale value of the patients was 7.38±1.24, post therapy score was 1.55±1.29. As a result of the comparison of the objective and subjective values before and after the therapy, a statistically significant difference was found (p&lt;0.001). Conclusion: Mutational falsetto can be treated with the use of inexpensive sound analysis programs that do not require special hardware in clinical practice and with sound therapy methods.

Increasing the speech intelligibility by the use of voice therapy in patients with profound hearing loss

Objective: The purpose of this study is to evaluate changes in the acoustic properties of voice in patients with profound sensorineural hearing loss to determine the effectiveness of voice therapy. Material-Method: Our study consisted of 15 individuals from the 20-25 years of age with bilateral symmetrical hearing loss (Group A), and 15 individuals in the 26-65 age group with post lingual cochlear implants (Group B). The control group (Group C) included 15 adults with the normal hearing range from the age group of 20-30. Prospective analysis methods was utilized for this research. In order to quantitatively measure the psychosocial consequences of voice-related disorders the Voice Handicap Index (VHI) was given, and, to determine the acoustic measures of the voice quality, the /ah/ sound was digitally recorded with the Multidimensional Voice Program (Kay Elemetrics) in all groups. Conclusion: Average Fundamental frequency (F0), jitter percentage (jitter), shimmer, noise-harmonic ratio (NHR), voice turbulence index (VTI), soft phonation index (SPI), PPQ and APQ parameters were analyzed through acoustic sound analysis program. When the data in Group A are compared with Group B, the acoustic parameters show a statistically significant higher value. Discussion: Speech intelligibility increased in individuals with profound hearing loss who received sound therapy and who used cochlear implants. According to the results of the VHI, individuals with cochlear implants benefit from voice therapy.

Factors Associated With Treatment-Related Changes in Voice Volume in People With Multiple Sclerosis.

Vocal disorders are frequent in people with multiple sclerosis (MS). Cognitive impairment, fatigue, depression, and other clinical characteristics can be associated with treatment effectiveness in rehabilitation. Finding baseline characteristics that identify those who are responding to treatment can help the clinical decision-making process, which can then help improve the effectiveness of voice treatment. We developed a model to identify factors associated with treatment-related improvement on voice intensity in people with MS. Data are from a randomized controlled trial of the effects of voice therapy. Forty-four people with MS were enrolled and randomized to receive Lee Silverman Voice Treatment LOUD, specifically addressing voice intensity, or conventional speech-therapy group. Voice intensity (dB) was measured during monologue before and after treatment and was used to differentiate those who responded (posttreatment voice intensity > 60 dB) from those who did not. Possible associated factors were cognitive impairment, fatigue, depression, disability, and disease duration. Associations were assessed by univariate logistic regression and univariate and multivariate linear regressions. Mean ± SD monologue voice intensity is improved in the whole sample (before rehabilitation: 51.8 ± 4.2 dB; and after rehabilitation 57.0 ± 6.5 dB; P < .001), and 11 people with MS (27.5%) responded to treatment. Specificity of treatment was associated with the return to normal voice intensity (OR, 14.28; 95% CI, 12.17-309.56) and we found a linear association between voice improvement and the specificity of treatment (6.65 [SE = 1.54] dB; P < .05). Moreover, the analysis revealed a nonlinear association between improvement and fatigue, suggesting increased benefits for people with MS with moderate fatigue. Other factors were not significantly associated with treatment effectiveness. Moderate fatigue and the specificity of the intervention seem to be key factors associated with clinically relevant improvement in voice intensity even in people with MS with a high level of disability and long disease duration.

Pediatric Voice Handicap Index (pVHI): A Tool for Evaluating the Reliability and Validity of Voice Therapy in Children With Benign Vocal Fold Nodules

benign vocal fold lesions (BVFLs) represent the most common etiology of voice disorders in paediatric population, cause of dysphonia by preventing full vocal fold closure and modifying vibratory characteristics. Of those pathologies, vocal fold nodules represent almost 63% of the cases in children between 0-14 years. Management may include a combination of phonosurgery, voice therapy and pharmacological treatment, but almost 95% of otolaryngologists recommend voice therapy as primary treatment. The Pediatric Voice Handicap Index (pVHI) is nowadays widely used and accepted in the evaluation and monitoring of paediatric patients with dysphonia. The aim of our study was to demonstrate the reliability and validity of PVHI in the evaluation of the effects of voice therapy as treatment of vocal fold nodules in the paediatric population. in this retrospective chart review twenty-seven (27) dysphonic patients with bilateral vocal fold nodules were treated with behavioral voice therapy approaches, and the PVHI surveys was administered to each patient parent's before and after therapy. The age of the patients ranged from 4 to 14 years (mean age 8.7 y-o); 17 (63%) were male and 10 (37%) females. according to our results, behavioral voice therapy effectively improved pVHI scores from pre- to post-treatment in paediatric patients with bilateral vocal fold nodules.

Voice Therapy Improves Acoustic and Auditory-Perceptual Outcomes in Children.

This study employed acoustic measures as well as auditory-perceptual assessments to examine the effects of voice therapy in children presenting with benign vocal fold lesions. A retrospective, observational cohort design was employed. Sustained vowels produced by 129 children diagnosed with benign vocal fold lesions were analyzed, as well as connected speech samples produced by 47 children. Treatment outcome measures included Consensus of Auditory-Perceptual Evaluation of Voice (CAPE-V), jitter, shimmer, Noise-to-Harmonic Ratio (NHR), cepstral peak prominence (CPP), and Low-to-High Ratio (LHR) on sustained vowels, and CPP and LHR on connected speech. Following voice therapy, significant improvements in CAPE-V ratings (p < 0.001) were observed. Additionally, jitter (p=0.041), NHR (p=0.019), and CPP (p < 0.01) on sustained vowels, and CPP (p=0.002), and LHR (p=0.008) on connected speech significantly improved following voice therapy. CPP increased with age in males but did not change in females. CAPE-V ratings and perturbation measures indicated that dysphonia was more severe in younger children pre and post-therapy. Auditory-perceptual and acoustic measures demonstrated improved voice quality following voice therapy in children with dysphonia. CPP effectively quantified voice therapy gains and allowed for analysis of connected speech, in addition to sustained vowels. These findings demonstrate the value of CPP as a tool in assessing therapy outcomes and support the efficacy of voice therapy for children presenting with vocal fold lesions. 4 Laryngoscope, 133:977-983, 2023.

Effect of Voice Therapy as a Supplement After Reinnervation Surgery for Breathy Dysphonia Due to Unilateral Vocal Fold Paralysis

To evaluate whether vocal function exercises (VFE) could be an adjunct treatment for patients with unilateral vocal fold paralysis (UVFP) who were not satisfied with their postoperative voices after reinnervation surgeries. Retrospective. Medical records of the patients with UVFP who underwent laryngeal reinnervation between October 2011 and October 2014 were reviewed. Patients were classified into two groups: one received VFE according to patients' desire (VFE group) and the other did not have voice therapy (control group). Effects of VFE were assessed by vocal fold vibration (regularity, amplitude and glottal gap), aerodynamic measurements (maximum phonation time (MPT) and mean airflow rate (MFR)), GRBAS scale, acoustic parameters (pitch range, pitch perturbation and amplitude perturbation quotients (PPQ, APQ), and noise-to-harmonics ratio (NHR)) and subjective evaluation by patients (Voice Handicap Index-10 (VHI-10)). Phonatory function was also compared between the two groups at three time points: before reinnervation surgery, before VFE, and after VFE. Thirty patients were enrolled (11 men, 19 women). The VFE group included eight patients, and 22 patients served as controls. In the VFE group, several parameters (amplitude, MPT, MFR, pitch range, APQ, and NHR) did not improve significantly after surgery, while all parameters examined improved significantly in the control group. After VFE, amplitude, glottal gap, MFR, B score, pitch range, and PPQ showed significant improvement, while the control group did not show a significant improvement except in VHI-10, during the corresponding period. Significant differences in G and B scores and VHI-10 between the two groups were observed at the third time point. VFE may be used as an adjunct treatment for patients with UVFP who are not satisfied with their voices after reinnervation surgery. However, phonatory function after VFE may not reach the same level as for those who are satisfied with their voices after reinnervation surgery.

Self-regulation in children with vocal fold nodules: A multilevel analysis

Introduction: Vocal fold nodules (VNs) represent the most common cause of voice disorders in children. Phonotrauma related to chronic, repetitive, intense vocal activity is often cited as the proximate cause of VNs. However, diminished self-regulation (SR) may predispose some children toward extreme phonotraumatic voice use, thereby contributing secondarily to their development. This case-control study examined the association between features of SR and VNs in children. Method: Parents of children with VNs (N = 40, Age Mean = 7.5, SD = 2.03 years) and vocally normal, medical controls (VNCs; N = 40, Age Mean = 7.6, SD = 1.54 years) completed the Behavior Rating Inventory of Executive Function, Second Edition (BRIEF2; Gioia, Isquith, Guy & Kenworthy, 2015), an inventory that evaluates components of SR in children. Results: Children with VNs, as compared with the vocally normal control group, were described as (i) impulsive (i.e., scoring significantly worse on the Behavior Regulation Index, BRI; P < 0.001, Cohen's d = 0.86), and (ii) emotionally dysregulated (i.e., scoring significantly worse on the Emotional Regulation Index, ERI; P < 0.001, Cohen's d = 0.81). Conclusions: Diminished SR in some children with VNs may contribute to phonotraumatic vocal behaviors and potentially attenuate the effectiveness of voice therapy.