Improve Voice Quality Research Articles

The sound of education: Exploring Filipino students' perceptions of teachers' vocal quality in the classroom

Every teacher needs to develop their vocal skills through continual practice and voice quality improvement. Students will draw judgments and assumptions about the teacher's attitude toward them, as well as the knowledge and concepts that he or she is imparting, based on the tones of the teacher's voice. The purpose of this study was to explore students’ perception on teachers’ vocal quality in a classroom setting. With a qualitative research design, the current study employed an interpretative phenomenological analysis approach. The participants of the study are composed of 26 students (9 males) (17 females) under the College of Business and Entrepreneurship. The collection of data was done through a face-to-face, semi-structured interview with audio recording. With the help of thematic analysis, the researchers come up with these themes: (1) the instructional tone or manner and emotional expression of the teachers; (2) teachers’ emphasis and motivation on teaching; (3) engagement and voice characteristics of teachers; (4) teachers’ effectiveness and students’ engagement in the classroom; (5) challenges faced by students; (6) comprehensibility and academic performance of students; and (7) learning and knowledge acquisition of students. The findings revealed that the vocal quality of teachers have an impact on how engaged their students are in the learning process, which in turn helps them achieve academically.

What Is the Effect of Maxillary Impaction Orthognathic Surgery on Voice Characteristics? A Quasi-Experimental Study.

Regarding the impact of orthognathic surgery on the airway and voice, this study was carried out to investigate the effects of maxillary impaction surgery on patients' voices through acoustic analysis and articulation assessment. This quasi-experimental, before-and-after, double-blind study aimed at examining the effects of maxillary impaction surgery on the voice of orthognathic surgery patients. Before the surgery, a speech therapist conducted acoustic analysis, which included fundament frequency (F0), Jitter, Shimmer, and the harmonic-to-noise ratio (HNR), as well as first, second, and third formants (F1, F2, and F3). The patient's age, sex, degree of maxillary deformity, and impaction were documented in a checklist. Voice analysis was repeated during follow-up appointments at one and six months after the surgery in a blinded manner. The data were statistically analyzed using SPSS 23, and the significance level was set at 0.05. Twenty two patients (18 females, 4 males) were examined, with ages ranging from 18 to 40 years and an average age of 25.54 years. F2, F3, HNR, and Shimmer demonstrated a significant increase over the investigation period compared to the initial phase of the study (P <0.001 for each). Conversely, the Jitter variable exhibited a significant decrease during the follow-up assessments in comparison to the initial phase of the study (P< 0.001). Following maxillary impaction surgery, improvements in voice quality were observed compared to the preoperative condition. However, further studies with larger samples are needed to confirm the relevancy.

Effect of Intralesional Steroid Injection in Bilateral Benign Vocal Fold Lesions

Abstract Background Corticosteroids are one of the most potent inhibitors of inflammation and wound repair. Local injection of steroid gives the option of administration of a potent drug locally, thereby avoiding the systemic side effects of them. They have been used in the last decade in managing benign vocal fold lesions as intralesional steroid injection has the advantages of rapid subsidence of the inflammation and edema with rapid improvement of voice postoperatively Ailil of the work This study is designed to show clinical ancl encloscopic voice Iinprovelnent of microlaryngeal surgery alone versus microlaryngeal surgery of the prilnary lesion combined with steroid injection in the opposing lesion in patients with bilateral vocal fold benign lesions. Patients and methods 40 patients with bilateral benign vocal fold lesions with Inoclerate to severe dysphonia are divided into two groups, one group underwent microlaryngo-surgery with excision of the primary lesion and injection of steroids into the contralateral lesions. The second group underwent microlaryngo-surgery with excision of the primary lesion only. Each subject was evaluated, preoperatively and postoperatively through a protocol including auditory perceptual assessment, laryngoscopic picture and self-rating by the patient using VHI. Results Comparing pre and post therapy results for each group, there was statistically significant improvcmcnt (reduction) in the size of thc contralatcral lesion and significant improvement in the quality of voice quality resulting in overall improvement in VHI. Conclusion Intralesional steroid injection in the contralateral lesion in bilateral benign vocal fold lesions is effective in improving voice quality postoperatively

Individualized Dynamic Prediction Model for Patient-Reported Voice Quality in Early-Stage Glottic Cancer.

Early-stage glottic cancer (ESGC) is a malignancy of the head and neck. Besides disease control, preservation and improvement of voice quality are essential. To enable expectation management and well-informed decision-making, patients should be sufficiently counseled with individualized information on expected voice quality. This study aims to develop an individualized dynamic prediction model for patient-reported voice quality. This model should be able to provide individualized predictions at every time point from intake to the end of follow-up. Longitudinal cohort study. Tertiary cancer center. Patients treated for ESGC were included in this study (N = 294). The Voice Handicap Index was obtained prospectively. The framework of mixed and joint models was used. The prognostic factors used are treatment, age, gender, comorbidity, performance score, smoking, T-stage, and involvement of the anterior commissure. The overall performance of these models was assessed during an internal cross-validation procedure and presentation of absolute errors using box plots. The mean age in this cohort was 67 years and 81.3% are male. Patients were treated with transoral CO2 laser microsurgery (57.8%), single vocal cord irradiation up to (24.5), or local radiotherapy (17.5%). The mean follow-up was 43.4 months (SD 21.5). Including more measurements during prediction improves predictive performance. Including more clinical and demographic variables did not provide better predictions. Little differences in predictive performance between models were found. We developed a dynamic individualized prediction model for patient-reported voice quality. This model has the potential to empower patients and professionals in making well-informed decisions and enables tailor-made counseling.

ПСИХО-ФИЗИЧЕСКИ ПОДХОДИ КЪМ ГЛАСОВОТО ОБУЧЕНИЕ: ПОДОБРЯВАНЕ НА ВОКАЛНОТО ЗДРАВЕ НА УЧИТЕЛИ В НАЧАЛНИЯ ЕТАП

Contemporary pedagogy is an ever-changing field that is constantly searching new ways to develop and update teachers’ skills. The challenges before the teachers in the elementary stage are numerous and varied, but among them one of the main ones are the management and protection of vocal health. Modern scientific research emphasizes the importance of psycho-physical approaches to voice training to improve the vocal health of teachers. The presentation will look at the structure of the vocal apparatus, how sound is produced, the role of the tongue, the importance of proper breathing and how to train and improve voice quality through specific exercises and techniques.

Causal speech enhancement using dynamical-weighted loss and attention encoder-decoder recurrent neural network.

Speech enhancement (SE) reduces background noise signals in target speech and is applied at the front end in various real-world applications, including robust ASRs and real-time processing in mobile phone communications. SE systems are commonly integrated into mobile phones to increase quality and intelligibility. As a result, a low-latency system is required to operate in real-world applications. On the other hand, these systems need efficient optimization. This research focuses on the single-microphone SE operating in real-time systems with better optimization. We propose a causal data-driven model that uses attention encoder-decoder long short-term memory (LSTM) to estimate the time-frequency mask from a noisy speech in order to make a clean speech for real-time applications that need low-latency causal processing. The encoder-decoder LSTM and a causal attention mechanism are used in the proposed model. Furthermore, a dynamical-weighted (DW) loss function is proposed to improve model learning by varying the weight loss values. Experiments demonstrated that the proposed model consistently improves voice quality, intelligibility, and noise suppression. In the causal processing mode, the LSTM-based estimated suppression time-frequency mask outperforms the baseline model for unseen noise types. The proposed SE improved the STOI by 2.64% (baseline LSTM-IRM), 6.6% (LSTM-KF), 4.18% (DeepXi-KF), and 3.58% (DeepResGRU-KF). In addition, we examine word error rates (WERs) using Google's Automatic Speech Recognition (ASR). The ASR results show that error rates decreased from 46.33% (noisy signals) to 13.11% (proposed) 15.73% (LSTM), and 14.97% (LSTM-KF).

Efficacy of straw phonation exercises with breathing exercises and indirect approaches for dysphonic adults with benign vocal fold lesions

Background: The voice is essential to a people’s daily life, especially in occupational voice users who are at risk for benign vocal fold lesions. It is important to use the proper vocal therapy techniques on a dysphonic patient who has benign vocal fold lesions in order to reduce behaviors that will aggravate the voice disorder and enhance behaviors that help improve voice quality. Objectives: The purpose of this study was to evaluate the efficacy of straw phonation exercises with breathing exercises and indirect approaches in dysphonic adults with benign vocal fold lesions, including vocal nodules; vocal polyps, and vocal cysts. Materials and methods: This study was a pilot study. Twelve participants who had benign vocal fold lesions received vocal hygiene guidance, abdominal breathing exercises, muscle relaxation, and straw phonation voice therapy. All participants received 8 weekly therapy sessions: 30 minutes per session. The vocal assessment data was collected before the first voice therapy session, and immediately after the eighth session, by subjective vocal assessment, and objective vocal assessment with Dr. Speech software version 5. Results: The results after therapy showed significant improvements against the GIRBAS scales in terms of the subjective vocal assessment, in the values of SD F0, jitter, NNE, and MPT of the objective vocal assessment. Conclusion: This result indicates straw phonation with breathing exercises and indirect approaches as being a worthwhile alternative method for voice therapy in dysphonic patients with benign vocal fold lesions.

Efficacy of straw phonation exercises with breathing exercises and indirect approaches for dysphonic adults with benign vocal fold lesions

Background: The voice is essential to a people’s daily life, especially in occupational voice users who are at risk for benign vocal fold lesions. It is important to use the proper vocal therapy techniques on a dysphonic patient who has benign vocal fold lesions in order to reduce behaviors that will aggravate the voice disorder and enhance behaviors that help improve voice quality. Objectives: The purpose of this study was to evaluate the efficacy of straw phonation exercises with breathing exercises and indirect approaches in dysphonic adults with benign vocal fold lesions, including vocal nodules; vocal polyps, and vocal cysts. Materials and methods: This study was a pilot study. Twelve participants who had benign vocal fold lesions received vocal hygiene guidance, abdominal breathing exercises, muscle relaxation, and straw phonation voice therapy. All participants received 8 weekly therapy sessions: 30 minutes per session. The vocal assessment data was collected before the first voice therapy session, and immediately after the eighth session, by subjective vocal assessment, and objective vocal assessment with Dr. Speech software version 5. Results: The results after therapy showed significant improvements against the GIRBAS scales in terms of the subjective vocal assessment, in the values of SD F0, jitter, NNE, and MPT of the objective vocal assessment. Conclusion: This result indicates straw phonation with breathing exercises and indirect approaches as being a worthwhile alternative method for voice therapy in dysphonic patients with benign vocal fold lesions.

Tissue-engineered vocal fold replacement in swine: Methods for functional and structural analysis.

We have developed a cell-based outer vocal fold replacement (COVR) as a potential therapy to improve voice quality after vocal fold (VF) injury, radiation, or tumor resection. The COVR consists of multipotent human adipose-derived stem cells (hASC) embedded within a three-dimensional fibrin scaffold that resembles vocal fold epithelium and lamina propria layers. Previous work has shown improved wound healing in rabbit studies. In this pilot study in pigs, we sought to develop methods for large animal implantation and phonatory assessment. Feasibility, safety, and structural and functional outcomes of the COVR implant are described. Of eight pigs studied, six animals underwent COVR implantation with harvest between 2 weeks and 6 months. Recovery of laryngeal tissue structure was assessed by vibratory and histologic analyses. Recovery of voice function was assessed by investigating acoustic parameters that were derived specifically for pigs. Results showed improved lamina propria qualities relative to an injured control animal at 6 months. Acoustic parameters reflected voice worsening immediately after surgery as expected; acoustics displayed clear voice recovery in the animal followed for 6 months after COVR. These methods form the basis for a larger-scale long-term pre-clinical safety and efficacy study.

Efficacy of Fiberoptic Laryngeal Surgery in Benign VocalCord Lesions in Comparision with Microlaryngeal Surgery.

The use of operating microscope and rigid telescope in laryngeal surgery represents one of the most exciting advances. Both systems provide good illumination, magnification and relative ease of operation. Microlaryngeal surgery (MLS) with suspension laryngoscope is currently considered the gold standard for surgical approach to the larynx for excision of benign lesions of vocal folds. The limitation of this technique is intubation, general anesthesia (GA) related and in difficult exposure of larynx. The development of ideal anesthetic system has not been successful in satisfying both the surgeon and the anesthesiologist. Fiberoptic Laryngeal Surgery (FLS) is convenient as it avoids GA, is an outpatient procedure with less morbidity and reduced costs. FLS is preferable for the patients who have medical contraindications for general GA. To compare the efficacy of MLS and FLS surgical procedures in terms of functional outcome. This is a comparative clinical study done on 42 patients who were diagnosed to have benign vocal fold pathology. Pre and post-operative speech evaluation was done for all the patients by the same examiner, which included GRABS scale, Maximum Phonation Time, voiced consonants, voiceless consonants, s/z ratio along with stroboscopy. In Group A, MLS was the treatment modality, done under GA, while in Group B, FLS was the treatment modality done under Local Anesthesia (LA). After one-month, post-operative evaluation of voice was done. When the Maximum Phonation Time, S/Z ratio and stroboscopic parameters (mucosal wave) were compared between the two study groups there appeared no statistically significant difference between the two groups. Our study shows that when benign vocal cord pathologies were treated by MLS or FLS the voice Quality improvement remains the same. FLS is the procedure of choice when MLS under general anesthesia is contraindicated.

Voice Improvement after Voice Therapy in Female Patients with Unilateral Vocal Fold Paralysis after Thyroid Surgery

Introduction: Dysphonic voice is present in patients with unilateral vocal fold paralysis (UVFP). The aim of this study was to present outcomes following rehabilitation of patients with UVFP, performed according to a voice therapy protocol. Methods: This prospective study comprised 27 women with UVFP who underwent pre- and post-voice therapy assessment. The mean age of patients was 53.19 ± 10.06 years. The protocol included the following: (1) multidimensional assessment of voice quality before treatment; (2) digital laryngeal manipulation voice therapy; (3) voice therapy evaluation which implied repeated multidimensional assessment of voice. Results: The results showed improvement in voice quality following voice therapy with regard to the parameters of the objective voice analysis (maximum fundamental frequency of voice, minimum intensity of voice, jitter, shimmer, harmonics-to-noise ratio, and signal-to-noise ratio, p ˂ 0.05), maximum phonation time, subjective analysis of voice, as well as self-assessment of voice quality on all the subscales and overall score (p ˂ 0.001). Conclusion: Implementing a protocol provides clear guidelines at each stage of the treatment. Voice therapy performed using digital laryngeal manipulation improves the majority of the acoustic and perceptual characteristics of the voice.

The Role of Primary Repair of the Recurrent Laryngeal Nerve during Thyroid/Parathyroid Surgery in Vocal Outcomes-A Systematic Review.

Recurrent laryngeal nerve (RLN) injury is a well and long-known complication of thyroid and parathyroid surgery that significantly affects the quality of life of patients. Despite the advances in surgical techniques and technology, it still occurs in clinical practice either as temporary paresis or as permanent paralysis of the corresponding vocal cord. The purpose of the current systematic review is to examine the value of intraoperative repair of the RLN in voice restoration. A systematic review of the existing literature was conducted using PubMed, Scopus, Cochrane Library, and Google Scholar databases according to the PRISMA guidelines. The systematic review resulted in 18 studies, which met the inclusion criteria. An improvement in phonatory function and voice quality was observed in all these studies after immediate RLN reconstruction (not always statistically significant). This improvement appears to be comparable to or even higher than that achieved with other methods of repair, and in some cases, the improvement approaches levels found in normal subjects. Intraoperative RLN reconstruction is not widely used in clinical practice, but the evidence so far makes it a viable and safe alternative to traditional techniques with better long-term results, as it prevents the occurrence of atrophy of the vocal cord and should be considered in the operating room if possible.

Age-dependent treatment effect of vocal fold steroid injection for benign vocal fold lesions.

Benign vocal fold lesions (BVFLs) cause voice disorders and impair social life. Recently, office-based vocal fold steroid injection (VFSI) has gained attention as a minimally invasive treatment for BVFLs. This study aimed to analyze the age-dependent treatment effect of VFSI and to clarify the indications for treatment. In this retrospective cohort study, a total of 83 patients with BVFLs were treated with a similar regimen of VFSI. Three or four months after the injection, age-dependent phonological functions were evaluated. The differences between pre- and post-treatment findings were analyzed using the Wilcoxon matched-pair signed-rank test, and the correlation between patient age and improvement rates were determined by Pearson's correlation coefficient. Improvement in voice handicap index (VHI), which was the primary endpoint, was observed. Subjective and objective voice quality measurements also showed significant improvements. Subgroup analyses revealed that there was no age-related difference in the improvement of voice quality and that there was no improvement in aerodynamic effect in patients over 45 years of age. This study clarified the age-dependent treatment effect of VFSI and provided the important suggestion of establishing indication criteria for BVFLs. The study results provided clarity on the indication criteria of VFSI and served as an important indicator for tailoring treatment to patients' needs. 4.

Комплексное лечение хронической патологии гортани при болезни Шегрена

Issues of voice quality and health, as the main means of communication, are becoming increasingly relevant. One of the causes of dysphonia is Sjögren’s disease. Progressive dryness of the mucous membrane of the upper respiratory tract, autoimmune disorders lead to the development of chronic pathology of the vocal apparatus. Treatment methods traditionally used for chronic pathology of the larynx do not achieve high and lasting improvement in voice quality in patients with Sjögren’s disease. The purpose of this study was to evaluate the effectiveness of the developed method of complex treatment of chronic laryngeal pathology in Sjögren’s disease. 46 patients with voice disorders associated with Sjögren’s disease were examined and treated. The patients were divided into two groups. Group I (20 patients) received treatment traditionally used for chronic laryngitis. In group II (26 patients), complex treatment was supplemented by three-stage aerosol therapy of the mucous membrane of the upper respiratory tract with saline solution sounded by low-intensity ultrasound, intranasal application of a drug containing hyaluronic acid, and light therapy to the larynx area. Based on an assessment of the dynamics of patient complaints, data from videolaryngostroboscopy, acoustic analysis of the voice, and the results of a questionnaire using a visual analogue scale for the severity of dryness of the mucous membrane of the upper respiratory tract, a comparative analysis of the results of therapy demonstrated a more striking and lasting improvement in the clinical and functional state of the larynx in patients of group II. Thus, the developed method of complex treatment of chronic pathology of the larynx in Sjögren’s disease, including three-stage aerosol therapy of the mucous membrane of the upper respiratory tract with saline solution sounded by low-intensity ultrasound, light therapy to the larynx area, and a topical preparation containing hyaluronic acid, allows achieving a pronounced positive effect with an aftereffect for 5 months.

Comparison of Short and Long-Term Results after Injection Laryngoplasty with Radiesse® Voice and Thyroplasty Type I in Unilateral Vocal Fold Palsy.

Unilateral vocal fold palsy independently of etiology results in glottic insufficiency leading to unfavorable short or long-term impact on voice quality. Our aim was to evaluate the effect of injection laryngoplasty using Radiesse® Voice and thyroplasty type I on glottic closure, voice quality and aerodynamics by comparing preoperative, short- and long-term results. Data of 32 consent patients were reviewed between 2012 and 2023. All patients underwent either injection laryngoplasty (14 patients) or thyroplasty type I (18 patients) under local anesthesia. Maximum phonation time, glottic closure based on videolaryngostroboscopy, VHI-30 values and GRBAS scale were recorded prior, short-term (3 month) and long-term (12 months) after procedures for statistical comparison. Friedman test, Mann-Whitney test and Wilcoxon signed rank tests were used for statistical analysis. In injection laryngoplasty group, we found significant improvement in maximum phonation time (p = 0.002), grade of hoarseness (p = 0.002) and breathiness (p = 0.000) when comparing results before and short-term after procedure. In thyroplasty type I group we saw significant improvement of maximum phonation time (p = 0.000), glottic insufficiency (p = 0.000), all three VHI-30 components (p = 0.000), as well as grade of hoarseness, breathiness (both p = 0.000) and roughness (p = 0.011) of GRBAS scale when comparing voice outcome before and short-term after procedure. There was no significant difference in voice outcome results neither between short and long-term results nor between the two groups in any parameter. These results demonstrate both short and long-term efficiency of injection laryngoplasty and thyroplasty type I in the improvement of voice quality and glottic closure.

Muscle Tension Dysphonia in Singers and Professional Speakers with Ankyloglossia: Impact of Treatment with Lingual Frenuloplasty and Orofacial Myofunctional Therapy

Introduction: Muscle tension dysphonia (MTD) describes a condition affecting the feeling or quality of the voice due to increased muscle tension in and/or around the neck and larynx. Ankyloglossia is a condition of restricted tongue mobility that has been shown to be associated with increased muscle tension. This case series explores outcomes for voice users with MTD who have been treated for ankyloglossia. Methods: Twelve professional or recreational voice users diagnosed with ankyloglossia were surveyed on their symptoms of MTD before and after treatment with lingual frenuloplasty and pre- and post-operative orofacial myofunctional therapy (OMT), a multidisciplinary approach known as functional frenuloplasty. Two investigators independently compiled a list of themes reported by participants and agreed upon common themes. Results: Eleven out of twelve patients (91.6%) reported clinical improvement in the use of their voice after functional frenuloplasty; one patient reported no change. Five primary themes were noted: improved voice quality, improved ease of singing and/or speaking, increased stamina, increased pitch range, and improved breath support. Discussion: OMT with lingual frenuloplasty can be an effective adjunctive intervention for treatment of symptoms of vocal tension and fatigue for singers and professional speakers with ankyloglossia. These findings suggest a possible association between MTD and restricted tongue mobility presumably due to underlying myofascial tension.

Effects of Intraoperative Nerve Monitoring Techniques on Voice and Swallowing Disorders after Uncomplicated Thyroidectomy: Preliminary Report of a Bi-Institutional Prospective Study.

Background: Voice and swallowing problems are frequently associated with thyroidectomy. Intermittent nerve monitoring (i-IONM) seems to provide a positive effect in reducing its prevalence. The aim of this study was to test the hypothesis that continuous intraoperative nerve monitoring (c-IONM) may reduce the prevalence of these disorders even further than i-IONM. Methods: This 3-arm prospective bi-institutional study compared 179 consecutive patients that underwent thyroidectomy: 56 without IONM, 55 with i-IONM and 67 with c-IONM. Neck dissections and laryngeal nerve palsies were excluded. Two questionnaires (VHI-10 for voice disorders and EAT-10 for swallowing disorders; both validated for Italian language use) were administered before and 1 month after surgery. Statistical significance was analyzed by the chi-squared test. Results: After thyroidectomy, no statistically significant differences were found in the three groups concerning EAT-10. although these symptoms seemed to be influenced by gastro-esophageal reflux. VHI-10 worsened in the “no-IONM” group compared with both i-IONM (p < 0.09, not quite statistically significant) and c-IONM (p < 0.04). Conclusion: Both i- and c-IONM improve voice quality independently of laryngeal nerve integrity. Reduced dissection and particularly restrained manipulation could explain these results, being particularly favorable for c-IONM.

Voice quality changes after functional endoscopic sinus surgery in patients with nasal polyps

Nasal polyps are associated with hyponasality. The effect of functional endoscopic sinus surgery (FESS) on voice quality has not been adequately investigated; therefore, this study developed objective and subjective measurements to compare nasal polyp patients pre- and postsurgery. An observational prospective study was conducted at Srinagarind Hospital, Khon Kaen University, Thailand. Bilateral nasal polyposis patients who underwent FESS between August 1, 2015 and August 1, 2017, were recruited. All participants were assessed for nasal polyp grade, nasometry, acoustic parameters, acoustic perception, and patient satisfaction before surgery and at the 1-, 3- and 6-month follow-ups. Forty-six patients, 29 males and 17 females (mean age 48.2years ± 16.2years), were enrolled. Mean nasometry scores were significantly improved at 1, 3 and 6months after surgery (p < 0.05), whereas the acoustic parameters were not significantly different after surgery (p > 0.05). Overall acoustic perception, assessed with a set of words and sentences, showed significant improvement in hyponasality voice after surgery (p < 0.05), whereas GIRBAS showed no significant change after surgery in each parameter of perception (p > 0.05). Patient satisfaction with voice changes after surgery was high, with significantly increased mean scores between the 1- and 6-month follow-ups (p < 0.05). The results showed that FESS for nasal polyposis patients improved voice quality and patients' voice satisfaction ratings. Trial registration: This trial was registered at the Thai Clinical Trial Registry (TCTR20210324004).

Effect of Controlled Muscle Activation in a Unilateral Vocal Fold Polyp Setting on Vocal Fold Vibration

Unilateral vocal fold polyps can lead to incomplete glottal closure and irregular vocal fold vibration. Depending on polyp size and resulting dysphonia severity, voice therapy or surgery may be recommended. As part of voice therapy, patients may learn how to optimize intrinsic and extrinsic laryngeal muscle use to mitigate benign lesion effects, increase vocal efficiency, and improve voice quality. In this study, we used a low-dimensional mass model with a simulated unilateral vocal fold polyp and varied intra-laryngeal muscle activity to simulate vocal fold vibration across varied conditions. Differing muscle activation has different effects on frequency, periodicity, and intensity. Accordingly, learning how to optimize muscle activity in a unilateral polyp setting may help patients achieve the best possible periodic and most efficiently produced voice in the context of abnormal vocal fold morphology.

Meta-Therapy Applications for the Voice Evaluation

Purpose: Meta-therapy is conceptualized as the conversation between clinician and patient that guides treatment. Because the area of meta-therapy and behavioral change is so broad, the focus of this clinical focus article is on laying the patient's foundation for therapy during the initial voice evaluation. Conclusions: In 2012, the American Speech-Language-Hearing Association developed evidence-based recommendations for a complete physiologic voice assessment. While the standard goal of this voice evaluation is to obtain a diagnosis, it behooves clinicians to apply meta-therapy techniques even in that early diagnostic space, for instance, to assess and facilitate readiness for change. Therefore, we present stimulability testing (assessment of an individual's ability to modify a behavior when provided with models or cues) as a critical additional component of the voice evaluation. In this light, during the voice evaluation, the patient understands that voice functions physiologically like a moving instrument rather than a static organ, that the production is a learned skill that can be optimized any time, and that the patient has potential for voice change. The evaluation should also be used to assess the patient's individual voice goal, the importance of the goal, and level of self-efficacy to pursue the goal in therapy. The patient is introduced to both the “what” of therapy—the specific exercises designed to improve voice quality—and also the “how,” the dialogue about treatment rationale and expectations for ongoing voice change and ultimate therapeutic success.