Hyperfunctional Voice Disorders Research Articles

Eclectic Voice Therapy Program in Hyperfunctional Voice Disorders: Evidence from Multidimensional Vocal Profiling

PurposeHyperfunctional Voice Disorder is a disorder of multifactorial origin. It can be speculated that an eclectic voice therapy program that uses combinatory approaches could bring about better efficiency of voice in these individuals. Nevertheless, very less attempts have been made to examine the efficacy of eclectic voice therapy using multidimensional voice outcome measures in the treatment of HFVD. Method10 individuals with HFVD in the age range of 20-55 years attended Comprehensive Voice Habilitation Program (CVHP), an eclectic voice therapy approach for 15 sessions spread across 3 weeks. A stroboscopy examination was performed at the baseline and post-therapy to track the changes in laryngeal functions. Further, perceptual voice analysis, Acoustic Voice Quality Index (AVQI), and Voice Handicap Index in Kannada (VHI-K) were obtained at the baseline, post-therapy, and two follow-ups to report the therapy outcomes. Related- samples Friedman’s Two-way Analysis of Variance by Ranks and Wilcoxn Signed Rank Test were used to note the pre-post and follow-up changes in voice outcomes. ResultsStroboscopy findings revealed significant improvement in movement patterns of the vocal folds and a reduction in ventricular hyperadduction. Perceptual ratings and AVQI scores decreased in post-therapy and follow-up evaluations indicating a decrease in dysphonia severity over time. In addition, a significant decrease in VHI-K scores indicated the alleviation of self-perceived disability/handicap. ConclusionThe current study provided preliminary evidence to support the efficacy of Eclectic voice therapy in HFVD by documenting significant changes in the voice-related outcome measures.

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

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. Therefore, the objectives of this study were to (1) quantify vocal fold adduction, applying a previously validated method developed for patients with vocal fold paralysis, and (2) correlate these measures with acoustic vocal quality and self-perceived measures of vocal effort severity. A deep learning program, Automated Glottic Action Tracking using artificial Intelligence, was used to track glottic angle configurations and vocal fold adduction velocities on laryngoscopic videos across 60 laryngoscopies (20 primary muscle tension dysphonia [pMTD], 20 phonotraumatic lesions, and 20 healthy controls). Voice samples were also acquired, and cepstral peak prominence (CPP) and H1-H2 acoustic measures were used to quantify vocal quality. Participants were also asked to rate their vocal effort on a 100mm visual analog scale. There were no significant group differences in glottic angle configurations or vocal fold adduction velocities, although there were trends toward increased peak vocal fold adduction velocities in patients with hyperfunctional voice disorders compared to controls. Vocal effort was significantly higher in the two hyperfunctional groups compared to controls. CPP was significantly lower in the pMTD group, but there were no group differences in acoustic parameters between any of the other groups or for H1-H2 values. Despite significantly more vocal effort reported in patients with hyperfunctional voice disorders, there were no significant group differences in vocal fold adduction patterns. These findings suggest other physiologic mechanisms may also be responsible for the symptoms and genesis of pMTD and benign vocal fold lesions.

Auditory-Motor Function Pre- and Post-Therapy in Hyperfunctional Voice Disorders: A Case Series

Behavioral voice therapy is the most common treatment for hyperfunctional voice disorders (HVDs) but has limited long-term effectiveness since the comprehensive mechanisms underlying HVDs remain unclear. Recent work has implicated disordered sensorimotor integration during speech in some speakers with HVDs and suggests that auditory processing is a key factor to consider in HVD assessment and therapy. The purpose of this case-series study was to assess whether current voice therapy approaches for HVDs resulted in improvements to auditory-motor function. Longitudinal (pre-post) study. Pre and postvoice therapy for HVDs, 11 speakers underwent an assessment of auditory-motor function via auditory discrimination of vocal pitch, responses to unanticipated auditory perturbations, and responses to predictable auditory perturbations of vocal pitch. At the post-therapy session, 10 out of 11 participants demonstrated voice therapy success (via self-reported voice problems and/or auditory-perceptual judgements of voice by a clinician) and eight of the 11 participants demonstrated improvements in at least one measure of auditory discrimination and/or auditory-motor control. Specifically, three speakers demonstrated improvements in auditory discrimination, five speakers demonstrated improved (within typical cutoffs) responses to predictable perturbations, and two speakers demonstrated improvements in both auditory discrimination and auditory-motor measures. Together, these findings support that voice therapy in individuals with HVDs may impact auditory-motor control and highlight the potential benefit of systematically addressing auditory function in voice therapy and assessment for HVDs.

Quantification of False Vocal Fold Hyperfunction During Quiet Breathing in Muscle Tension Dysphonia.

False vocal fold (FVF) hyperfunction during phonation is thought to be a diagnostic sign of primary muscle tension dysphonia (pMTD). However, hyperfunctional patterns with phonation are also observed in typical speakers. This study tested the hypothesis that FVF posturing during quiet breathing, as measured by the curvature of FVF, could differentiate patients with pMTD from typical speakers. Laryngoscopic images were collected prospectively in 30 subjects with pMTD and 33 typical speakers. Images were acquired at the end of expiration and maximal inspiration during quiet breathing, during sustained /i/, and during loud phonation before and after a 30-min vocal loading task. The FVF curvature (degree of concavity/convexity) was quantified using a novel curvature index (CI, >0 for hyperfunctional/convex, <0 for "relaxed"/concave) and compared between the two groups. At end-expiration, the pMTD group adopted a convex FVF contour, whereas the control group adopted a concave FVF contour (mean CI 0.123 [SEM 0.046] vs. -0.093 [SEM 0.030], p = 0.0002) before vocal loading. At maximal inspiration, the pMTD group had a neutral/straight FVF contour, whereas the control group had a concave FVF contour (mean CI 0.012 [SEM 0.038] vs. -0.155 [SEM 0.018], p = 0.0002). There were no statistically significant differences in FVF curvature between groups in either the sustained voiced or loud conditions. Vocal loading did not change any of these relationships. A hyperfunctional posture of the FVFs during quiet breathing especially at end-expiration may be more indicative of a hyperfunctional voice disorder than supraglottic constriction during voicing. 3 Laryngoscope, 133:3449-3454, 2023.

Impact of Face Masks on Acoustic Measures in Patients with Hyperfunctional Voice Disorders and Normal Speakers

Purpose: Wearing face masks during the COVID-19 pandemic has become a very important hygiene measure to block or prevent respiratory droplets and infections. The purpose of this study is to explore the effect of wearing face masks on the acoustical measurement of voice and speech in patients with hyperfunctional voice disorders, and to present guidelines for wearing a mask when evaluating voice and speech.Methods: A total of 20 patients with hyperfunctional voice disorders who diagnosed with vocal nodules, muscle tension dysphonia, and adductor spasmodic dysphonia (14 females, 6 males, age=30.55±8.24) and age-and gender-matched 20 healthy adults (15 females, 5 males, age=27.31±7.52) were enrolled. All participants completed three speech tasks (sustained /a/vowel, CAPEV-3 all voiced sentence, and the ‘Kaeul’ standard passage- 2nd sentence) with their habitual pitch and loudness among the different mask conditions (No mask, surgical, and KF94). Acoustic analysis including perturbation and cepstral &amp; spectral parameters was conducted with MDVP and ADSV.Results: For the healthy speakers, there were significantly lower in jitter (%), shimmer (%), and noise-to-harmonic (NHR) in no mask condition than in mask conditions, while there was no significantly different in perturbation measures (F0, jitter (%), shimmer (%), and NHR for patients. Vocal intensity was significantly reduced in mask-wearing conditions either surgical or KF94 mask with all speech tasks except sustained /a/ vowel phonation for patients. Cepstral peak prominence (CPP) was not significantly different among the different mask conditions in sustained /a/ vowel phonation and 3rd CAPEV sentence (all voiced sentence) in all groups. Both healthy speakers and patients showed significantly lower L/H ratio values in the no mask condition.Conclusions: Overall, in current study, wearing a mask or the type of face mask did not change time-based and cepstral acoustic parameters, while a spectral measure such as L/H ratio was significantly increased in mask-wearing conditions in patients with hyperfunctional voice disorders. These findings suggest that wearing either surgical or KF 94 masks could be a safe and relevant choice for acoustic perturbation and cepstral measures with /a/ vowel in hyperfunctional dysphonia.

Is Thyrohyoid Space Palpation a Reliable and Useful Clinical Tool Within Diagnostic Protocol for Voice Disorders?

Palpation of the extrinsic laryngeal muscles is a common part of examination performed by otolaryngologists and speech-language pathologists on individuals presenting with voice complaints, thought to aid in diagnosis and treatment planning. While research has identified a significant relationship between thyrohyoid tension and hyperfunctional voice disorders, we are not aware of any studies exploring correlations between thyrohyoid posture during palpation and the full spectrum of voice disorders. This study aims to identify whether patterns in thyrohyoid posture at rest and during phonation can be related to stroboscopic findings and voice disorder diagnoses. A multidisciplinary team ofthree laryngologists and three speech-language pathologists participated in data collection during 47 new patient visits for voice complaints. Each patient underwent neck palpation and evaluation of thyrohyoid space at rest and during phonation by two independent raters. Clinicians then used stroboscopy to rate glottal closure and supraglottic activity as part of determining primary diagnosis. Strong inter-rater agreement was found for ratings of thyrohyoid space posture both at rest (κ=0.93) and during phonation (κ=0.80). Findings revealed no significant correlations between patterns of thyrohyoid posture and laryngoscopic findings or primary diagnoses. Findings suggest that the presented method of laryngeal palpation is a reliable measure for assessing thyrohyoid posture at rest and during phonation. Lack of significant correlation between palpation ratings and other collected measures suggests that this method of palpation is not a useful tool for predicting laryngoscopic findings or voice diagnoses. Laryngeal palpation may still be useful in predicting extrinsic laryngeal muscle tension and guiding treatment planning; however, further research exploring the validity of laryngeal palpation as a measure of extrinsic laryngeal muscle tension is needed, as well as studies that include patient-reported measures and repeated measurements of thyrohyoid posture over time to explore whether thyrohyoid posture is impacted by other factors.

The role of patient perceptions and hyperfunctional voice disorders in predicting voice therapy attendance

Objectives/hypothesisAttendance is essential to voice therapy's effectiveness in the treatment of voice and laryngeal disorders. With such high rates of drop-out and non-attendance, it is important to understand the factors that influence this behavior. This study sought to identify potential predictors of attendance to voice therapy at an interdisciplinary voice clinic. Study designSingle-institution retrospective cohort study. MethodsIn this retrospective cohort study, patients evaluated at an interdisciplinary voice clinic who received a referral for voice therapy were identified. Age, gender, voice-related diagnoses, Voice Handicap Index-10 scores, Reflux Symptom Index scores, and measures of patient perceptions (self-rated severity, importance of voice in one's life, and “feelings about voice therapy”) were recorded to evaluate associations with attendance to at least one therapy session. Standard statistical analysis and logistic regressions were performed. ResultsOf 168 subjects included, 111 (66.1 %) attended at least one session of voice therapy. Patients diagnosed with primary hyperfunctional voice disorders had a significantly higher attendance rate than other groups. Attenders had higher self-ratings of severity and more positive “feelings about voice therapy” compared to non-attenders. Regression models found three significant predictors of therapy attendance: primary diagnosis of hyperfunctional voice disorder, self-rated severity, and “feelings about voice therapy.” ConclusionIn this cohort, patients with more positive feelings about voice therapy, higher self-rated severity, and a diagnosis of primary hyperfunctional voice disorder were more likely to attend voice therapy. Level of evidence3.

Speech and language therapy for children with phonotrauma

Introduction. Proper voice production requires coordinated, synchronous and efficient functioning of the larynx, respiratory, resonance and articulation mechanisms. Phonotrauma is trauma to the laryngeal mechanism and includes any behavior that results in injury to the vocal folds. The aim of this research was to identify and describe the characteristics of voice disorders in children that occur as a result of phonotrauma, approach?es and techniques in speech and language therapy of these speech disorders, and the effects of their application. The characteristics of phonotrauma in children reflect the characteristics of hyperfunctional voice disorders, as they usually arise as a result of voice abuse. Speech and language therapy of children with phonotrauma includes identification and reduction, i.e. elimination of the vocal behavior that had caused the voice disorder. In addition, treatment focuses on a vocal hygiene program and the use of various direct treatment techniques to achieve appropriate voice production. Effects of applying direct and indirect treatment techniques is demonstrated by the reduction of the size of the lesion, the degree of dysphonia and voice disorders, hoarseness, breathiness in the voice, the absence of recurrence, and the achievement of optimal values of the acoustic parameters of the voice. Conclusion. In most cases, children can master the correct way of producing speech after a short period of speech and language therapy. However, in order to achieve this goal, it is necessary to actively involve children, their parents, and other people from the immediate and wider social environment.

Effects of Cognitive Stress on Voice Acoustics in Individuals With Hyperfunctional Voice Disorders.

Autonomic nervous system dysfunction has been implicated in the development and persistence of hyperfunctional voice disorders (HVDs). The purpose of this study was to determine the effects of cognitive stress, which is known to arouse the autonomic nervous system, on voice acoustics in female speakers with and without HVDs. Adult female speakers-66 with HVDs, 66 without-were recorded while speaking with and without a cognitive stressor. Root-mean-square (RMS) of amplitude, fundamental frequency (f o), low-to-high spectral energy ratio (L/H ratio), cepstral peak prominence (CPP), and relative f o (RFF) were measured for each speaker and cognitive stress condition. Mixed-model analyses of variance and post hoc t tests were conducted to determine if cognitive stress affected voice acoustics and whether voice changes were greater for those with HVDs. All measures differed significantly under cognitive stress for speakers with and without HVDs. RMS and CPP increased whereas f o, CPP, and RFF decreased under cognitive stress. Changes in these measures were not greater in those with HVDs. Cognitive stress and presumed autonomic arousal affect voice similarly in female speakers with and without HVDs.

Correlation between Severity of Laryngeal Hypertension and Subjective Voice Evaluation

Objectives: This study aims to investigate the usefulness of subjective voice disorder evaluation as a method of laryngeal hypertension evaluations. The Vocal Fatigue Index (VFI) was compared according to the severity of laryngeal hypertension, and a correlation analysis was performed between the severity of laryngeal hypertension and the VFI score. Methods: The subjects of this study were 67 patients diagnosed with hyperfunctional voice disorder. The author classified the larynx into four parts and palpated it for evaluation of laryngeal hypertension. And according to the results, the patients were classified into ‘none, mild, moderate, and severe’. The voice measurements were based on the K-VFI results. Results: The results of comparing VFI scores according to the severity of laryngeal hypertension, K-VFI-total (F = 4.155, p = .009), K-VFI-fatigue (F = 15.628 p = .000), physical (F = 6.959, p = .000) and rest (F = 10.673, p = .000) showed significant differences between groups. In multiple comparisons, the three groups with hypertension each had higher scores in K-VFI-total, physical, and rest than the group without hypertension. In the K-VFI-fatigue, the moderate and severe hypertension groups scored higher than the non-hypertension group. In addition, the severity of laryngeal hypertension showed a significant positive correlation with K-VFI-total (r = .530, p = .000), K-VFI-fatigue (r = .375, p = .000), K-VFI-physical (r = .592, p = .000) and K-VFI-rest (r = .425, p = .000). Conclusion: These results suggest that patients can recognize laryngeal hypertension as evaluated by an SLP’s palpation. In addition, it indicates that the VFI which includes items about physical discomfort as a subjective voice evaluation can be usefully performed for the evaluation of laryngeal hypertension.

What Can Altered Auditory Feedback Paradigms Tell Us About Vocal Motor Control in Individuals With Voice Disorders?

The goal of this review article is to provide a summary of the progression of altered auditory feedback (AAF) as a method to understand the pathophysiology of voice disorders. This review article focuses on populations with voice disorders that have thus far been studied using AAF, including individuals with Parkinson's disease, cerebellar degeneration, hyperfunctional voice disorders, vocal fold paralysis, and laryngeal dystonia. Studies using AAF have found that individuals with Parkinson's disease, cerebellar degeneration, and laryngeal dystonia have hyperactive auditory feedback responses due to differing underlying causes. In persons with PD, the hyperactivity may be a compensatory mechanism for atypically weak feedforward motor control. In individuals with cerebellar degeneration and laryngeal dystonia, the reasons for hyperactivity remain unknown. Individuals with hyperfunctional voice disorders may have auditory-motor integration deficits, suggesting atypical updating of feedforward motor control. These findings have the potential to provide critical insights to clinicians in selecting the most effective therapy techniques for individuals with voice disorders. Future collaboration between clinicians and researchers with the shared objective of improving AAF as an ecologically feasible and valid tool for clinical assessment may provide more personalized therapy targets for individuals with voice disorders.

Usefulness of Vocal Fatigue Index for Hypertension of Extrinsic Laryngeal Muscles

Background and Objectives This study compares Vocal Fatigue Index (VFI) scores according to the presence or absence of external laryngeal tension in hyperfunctional voice disorder. And through this, it is to confirm the usefulness of VFI to hypertension of extrinsic laryngeal muscles.Materials and Method The subjects were 61 female diagnosed with hyperfunctional voice disorder (hypertension group 41, non-hypertension group 20). The author palpated extrinsic laryngeal muscles for evaluation of hypertension and classified them as the presence or absence. The voice measurements were jitter, shimmer, Korean-Voice Handicap Index-10 (K-VHI-10), and Korean-Vocal Fatigue Index (K-VFI). The voice compared were according to the diagnosis and presence of hypertension only for patients with hyperfunctional voice disorder.Results As a result of comparing the voice measurement according to the presence or absence of hypertension, there was no significant difference in the acoustic variables, K-VHI-10 and K-VFI-Total, K-VFI-Fatigue. Whereas, K-VFI-Physical (p=0.006) and K-VFI-Rest (p=0.022) were significantly higher in the hypertension group.Conclusion These results indicate that the hypertension group has more physical discomfort and less voice recovery than the group without hypertension. It means that K-VFI can measure the physical discomfort and limitations of voice recovery due to hypertension of the external laryngeal muscle. The VFI can be used as one of the methods to evaluate the hypertension of the external laryngeal muscle in Hyperfunctional voice disorder.

Neurogenic Laryngeal Disorders

The larynx is critical to performing complex tasks of airway protection, phonation, respiration, and deglutition. Various focal and systemic neurologic disorders impact the larynx, causing deficits that lead to dysfunction in voice, speech, breathing, and swallowing function. The most common hyperfunctional neurolaryngeal disorders include spasmodic dysphonia (laryngeal dystonia), essential vocal tremor, and muscle tension dysphonia. Some hypofunctional neurolaryngeal disorders include parkinsonian disorders, neuromuscular junction diseases, and myopathies. A multidisciplinary approach involving evaluation by neurologists, voice-trained otolaryngologists and speech-language pathologists is often key to diagnosis and treatment of these challenging and sometimes lifelong disorders. Botulinum toxin injection into the laryngeal musculature is currently the gold-standard treatment for both spasmodic dysphonia and vocal tremor. However, much research is being conducted to advance less invasive and more definitive medical and surgical treatment interventions. This review contains 3 figures, 11 videos, 6 tables and 29 references Keywords: laryngeal neurophysiology, laryngeal dystonia, adductor spasmodic dysphonia, abductor spasmodic dysphonia, essential vocal tremor, hyperfunctional voice disorders, hypofunctional voice disorders, botulinum toxin injection

An eclectic Voice Therapy Program for the Treatment of Hyperfunctional Voice Disorders (HFVD)

An eclectic voice therapy program includes sequenced and structured set of exercises combining direct and indirect intervention methods. Tailor-made exercise prescription with specific cultural adaptations are needed to provide a holistic change to voice quality.1 This study detailed the construction of an exercise prescription for participants with hyperfunctional voice disorder [HFVD] in the Indian context. The exercise program was developed based on literature related to vocal therapy approaches and delivery methods. Adaptations were introduced to a selected set of exercises. Five voice experts verified the exercises and their prescription for content and feasibility of use in the Indian context. Modification suggested by the experts were included for framing the final version of the exercise program. This structured therapy program was planned for 6 weeks (30 minutes duration/session offered individually twice per week, with a gap of two days between sessions in a week) with the goals to improve voice quality, flexibility, and endurance while speaking. Five participants with HFVD partook in the study for pilot testing. Stroboscopy, perceptual voice analysis, Dysphonia Severity Index (DSI) and Vocal Fatigue Index in Tamil (VFI-T) were used to report the therapy outcomes. Participants' report on the learning process and generalization of the program were documented. Wilcoxon-signed rank test was used to test the pre-post outcome measures. An eclectic voice therapy program, i.e., Comprehensive Voice Habilitation Program [CVHP] was constructed and it included vocal hygiene instructions, warm-up & cool-down, easy onset, resonant voice, and carry over exercises. Participants completed the program in 14-18 sessions (over 7 to 9 weeks of therapy). All participants showed significant changes in vocal fold movement patterns, reduction in ventricular hyperadduction, overall grade of voice quality, DSI and VFI-T. Participants reported that pictorial illustrations, feedback, and monitoring sheets were useful in learning the exercises. CVHP showed significant change in the voice-related outcome measures and was a viable program for treating HFVD.

Impaired auditory discrimination and auditory-motor integration in hyperfunctional voice disorders

Hyperfunctional voice disorders (HVDs) are the most common class of voice disorders, consisting of diagnoses such as vocal fold nodules and muscle tension dysphonia. These speech production disorders result in effort, fatigue, pain, and even complete loss of voice. The mechanisms underlying HVDs are largely unknown. Here, the auditory-motor control of voice fundamental frequency (fo) was examined in 62 speakers with and 62 speakers without HVDs. Due to the high prevalence of HVDs in singers, and the known impacts of singing experience on auditory-motor function, groups were matched for singing experience. Speakers completed three tasks, yielding: (1) auditory discrimination of voice fo; (2) reflexive responses to sudden fo shifts; and (3) adaptive responses to sustained fo shifts. Compared to controls, and regardless of singing experience, individuals with HVDs showed: (1) worse auditory discrimination; (2) comparable reflexive responses; and (3) a greater frequency of atypical adaptive responses. Atypical adaptive responses were associated with poorer auditory discrimination, directly implicating auditory function in this motor disorder. These findings motivate a paradigm shift for understanding development and treatment of HVDs.

Computational simulations of respiratory-laryngeal interactions and their effects on lung volume termination during phonation: Considerations for hyperfunctional voice disorders.

Glottal resistance plays an important role in airflow conservation, especially in the context of high vocal demands. However, it remains unclear if laryngeal strategies most effective in controlling airflow during phonation are consistent with clinical manifestations of vocal hyperfunction. This study used a previously validated three-dimensional computational model of the vocal folds coupled with a respiratory model to investigate which laryngeal strategies were the best predictors of lung volume termination (LVT) and how these strategies' effects were modulated by respiratory parameters. Results indicated that the initial glottal angle and vertical thickness of the vocal folds were the best predictors of LVT regardless of subglottal pressure, lung volume initiation, and breath group duration. The effect of vertical thickness on LVT increased with the subglottal pressure-highlighting the importance of monitoring loudness during voice therapy to avoid laryngeal compensation-and decreased with increasing vocal fold stiffness. A positive initial glottal angle required an increase in vertical thickness to complete a target utterance, especially when the respiratory system was taxed. Overall, findings support the hypothesis that laryngeal strategies consistent with hyperfunctional voice disorders are effective in increasing LVT, and that conservation of airflow and respiratory effort may represent underlying mechanisms in those disorders.

Patient-Reported Factors Associated with the Onset of Hyperfunctional Voice Disorders.

Prevention, diagnosis, and treatment of hyperfunctional voice disorders would be improved by better understanding their etiological contributing factors. Therefore, this study estimated the prevalence of etiological factors using self-reported data about disorder onset from a large cohort of patients with Phonotraumatic Vocal Hyperfunction (PVH) and Non-Phonotraumatic Vocal Hyperfunction (NPVH). Retrospective chart review extracted the self-reported rate (gradual, sudden) and events associated (voice use, anxiety/stress, upper respiratory infection [URI]) with disorder onset from 1,577 patients with PVH and 979 patients with NPVH. Both patient groups reported a gradual onset more than a sudden onset. Voice use was the most frequently reported event for PVH and the NPVH group self-reported all three events at equal frequency. The largest PVH subgroups were associated with voice use while the NPVH subgroups were associated with only voice use, only URI, or only anxiety/stress. The results support the general clinical view that PVH is most strongly related to the gradual accumulated effects of phonotrauma, while NPVH has a more heterogeneous etiology. The identified PVH and NPVH subgroups may have clinical relevance and future work could investigate differences in treatment and outcomes among these subgroups.

Cepstral Measures to Analyze Vocal Fatigue in Individuals With Hyperfunctional Voice Disorder

Cepstral measures are sensitive to slightest deviance in voice quality. Vocal fatigue is an initial symptom of a voice disorder. This study aimed (1) to assess the correlation of vocal fatigue and cepstral measures and (2) to identify a measure for analyzing voice change due to vocal fatigue in individuals with hyperfunctional voice disorders. Cross-sectional. A total of 100 subjects participated in the study, that is Group I (50 cases) and Group II (50 controls). Vocal Fatigue Index (VFI-T) in Tamil was administered to identify the presence of fatigue. Voice samples (sustained vowel and conversational speech) were recorded using the Computerized Speech Lab (Model 4150). Mic to mouth distance was maintained at 10 cm. Extraction of cepstral peak prominence (CPP) and smoothened cepstral peak prominence (CPPS) for a vowel (v) and connected speech (cs) was done using Praat software (version 6.0.39, Boersma & Weenink, 2018). Independent t test was used to compare the cepstral measures between cases and controls. Individuals with vocal fatigue (cases) showed significantly lower cepstral values and higher VFI scores compared to the controls. Spearman's rho revealed moderate to strong negative correlation between factors of VFI and cepstral measures. On stepwise multiple linear regression, CPPcs was retained as a sensitive measure to analyze vocal fatigue in individuals with hyperfunctional voice disorder. Cepstral measures can be applied to analyze vocal fatigue.

Voice Onset Time in Individuals With Hyperfunctional Voice Disorders: Evidence for Disordered Vocal Motor Control

Purpose This study examined vocal hyperfunction (VH) using voice onset time (VOT). We hypothesized that speakers with VH would produce shorter VOTs, indicating increased laryngeal tension, and more variable VOTs, indicating disordered vocal motor control. Method We enrolled 32 adult women with VH (aged 20-74 years) and 32 age- and sex-matched controls. All were speakers of American English. Participants produced vowel-consonant-vowel combinations that varied by vowel (ɑ/u) and plosive (p/b, t/d, k/g). VOT-measured at the release of the plosive to the initiation of voicing-was averaged over three repetitions of each vowel-consonant-vowel combination. The coefficient of variation (CoV), a measure of VOT variability, was also computed for each combination. Results The mean VOTs were not significantly different between the two groups; however, the CoVs were significantly greater in speakers with VH compared to controls. Voiceless CoV values were moderately correlated with clinical ratings of dysphonia (r = .58) in speakers with VH. Conclusion Speakers with VH exhibited greater variability in phonemic voicing targets compared to vocally healthy speakers, supporting the hypothesis for disordered vocal motor control in VH. We suggest future work incorporate VOT measures when assessing auditory discrimination and auditory-motor integration deficits in VH.

Application of Speech Range Profile in Hindi in Hyperfunctional Voice Disorders: A Case-controlled Observational Study

Application of Speech Range Profile in Hindi in Hyperfunctional Voice Disorders: A Case-controlled Observational Study