Voice Therapy Research Articles

Tracheoesophageal Puncture Outcomes at a Safety Net Hospital.

Tracheoesophageal puncture (TEP) is the gold standard for voice rehabilitation after total laryngectomy (TL). Retrospective analysis was performed of TEP outcomes in patients between 2013 and 2020 at a single tertiary hospital. TEP was performed primarily in 79%, secondarily in 6%, and not placed in 15% of 226 patients. Within the study population, 53.4% utilized their TEP, including 52% of primary and 71.4% of secondary TEPs. TEP-related complication occurred in 50.8%, including 50.8% of primary and 50% of secondary TEPs. Secondary TEP was less likely in Black versus White patients, and more likely in patients undergoing pharyngectomy. Older patients and those with TEP complications were less likely to utilize TEP. Our study, performed in a TL population of predominantly lower socioeconomic status, showed high complication rates and low rates of utilization overall. Our findings suggest secondary TEP may be favorable to allow increased pre-operatively counseling and patient healing prior to procedure.

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.

Methods of Voice Restoration following Laryngectomy

In Germany, approximately 950-1200 laryngectomies are performed annually due to extensive hypopharyngeal and laryngeal carcinomas. The removal of the larynx results in significant life changing functional losses, particularly in voice production and communication, resulting in psychological issues and social withdrawal. Rehabilitation requires a multidisciplinary team focusing on restoring communication skills. Methods include pseudowhispering, esophageal speech, external mechanical and electromechanical aids, and tracheoesophageal speech prostheses. Pseudowhispering uses air from the mouth and pharynx, while esophageal speech requires controlled release of esophageal air to produce sound. External aids include devices like the Electrolarynx. Tracheoesophageal speech prostheses, the current gold standard, offer superior phonation time and clarity but require frequent visits to the healthcare system to address complications due to the limited lifespan of the prosthesis. Despite high success rates with transoesophageal prostheses, some patients may face significant challenges. In conclusion, voice rehabilitation post-laryngectomy is crucial for social reintegration. Comprehensive patient education on the benefits and challenges of different methods is essential for making an informed decision tailored to their lifestyle.

Introduction of voice therapy

Voice disorders, resulting from structural and functional abnormalities in the larynx, significantly impact communication, daily activities, and emotional expression, ultimately lowering quality of life. Voice therapy is a key non-invasive intervention for managing voice disorders that arise from structural, functional, or neurological abnormalities in the larynx. Voice therapy includes techniques such as phonation exercises, breath control, resonance training, muscle relaxation, and posture adjustments, all aimed at restoring optimal vocal function. Indications for voice therapy cover a broad range of conditions, including vocal fold nodules, polyps, paralysis, spasmodic dysphonia, and aging-related vocal atrophy. Various voice therapy methods, such as vocal function exercises, resonance voice therapy, and Lee Silverman Voice Treatment, demonstrate improved outcomes in vocal quality, endurance, and overall vocal health. Recent trends in self-managed voice programs, facilitated by smartphone apps and social media resources, are expanding the accessibility of voice therapy. The integration of behavioral, medical, and technological interventions supports a multidisciplinary approach to meet diverse needs in managing voice disorders. This review underscores voice treatment approaches, highlighting their efficacy in addressing various voice disorders and supporting a multidisciplinary framework for optimizing therapeutic outcomes.

Options to enhance voice quality during and after thyroidectomy

Quality of voice after thyroidectomy remains the main concerns both for surgeons and patients. Injury of the recurrent laryngeal nerve or the external branch of the superior laryngeal nerve may lead to serious voice alteration and dysphonia. On the other hand, patients may complain of voice problems without direct injury to the nerve, which may be considered as a post-thyroidectomy syndrome. Regarding nerve injury during thyroidectomy, intraoperative neuromonitoring is helpful to identify, preserve and prognosticate the nerve function. In cases when the nerve is sacrificed (or resected), reinnervation may help to improve postoperative vocal function. If postoperative vocal fold paralysis is identified, early identification and management is mandatory. Injection laryngoplasty and laryngeal framework surgery may be required as appropriate. Early rehabilitation and voice therapy has demonstrated better post-thyroidectomy vocal outcomes. Feasibility of innovative strategies of managing nerve injury include nerve guiding conduit, bioengineering scaffold, neurostimulation and cell/gene therapy. In this review article, up-to-date options to enhance post-thyroidectomy vocal outcomes will be summarized.

Management strategies for suspected nerve injury during thyroid surgery: a comprehensive review

Thyroid surgery, such as thyroidectomy and lobectomy, is commonly performed to treat thyroid disorders. Nerve injury, especially to the recurrent laryngeal and superior laryngeal nerves, is a major complication, leading to vocal cord paralysis, dysphagia, and reduced quality of life. This review explores strategies for managing suspected nerve injury during thyroid surgery, including preventive measures, intraoperative neuromonitoring, surgical techniques for nerve preservation, and postoperative rehabilitation. Techniques like electromyography, electroglottography, and direct nerve stimulation help detect nerve damage early. Immediate responses, including microsurgical repair, are crucial. Postoperative care involves voice therapy, pharmacological treatment, and psychosocial support. Technological advancements, such as high-definition nerve imaging, robotic-assisted surgery, and artificial intelligence, improve nerve preservation. Effective management requires a multifaceted, multidisciplinary approach to minimize nerve injury and improve patient outcomes. Future research in regenerative medicine and personalized surgical planning holds promise for further advancements.

Summary of the best evidence for vocal rehabilitation training in adults with unilateral vocal fold paralysis.

To search, evaluate, and summarize the relevant evidence of voice rehabilitation training in adults with unilateral vocal fold paralysis (UVFP). Using the '6S' model, the database of UpToDate, BMJ Best Practice, domestic and foreign guidelines, and voice rehabilitation training for adults with UVFP were systematically searched. The search includes clinical decisions, guidelines, systematic reviews, randomized controlled trials, and expert consensus. Data search since the establishment of the database to 27 November 2023. The quality evaluation of the literature methodology and the extraction and integration of evidence were carried out independently by two researchers. A total of 12 literature were included, including 2 systematic reviews, 2 expert consensus, 4 guidelines, 2 clinical decisions, and 2 randomized controlled trials. Four categories of 16 pieces of evidence were summarized: evaluation of vocal cord paralysis, voice rehabilitation training, health education, joint decision-making, and multidisciplinary cooperation. This study summarized the best evidence of voice rehabilitation training for adults with UVFP and provided evidence-based summary for clinical staff to carry out relevant interventions.

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.

Dysphonia in children

Abstract Dysphonia is a frequent symptom in paediatric patients and it has a prevalence between 6 - 24%. In young patients, dysphonia has a direct importance because it impairs their communicative behaviour, their psychological status and also their social life. The most diagnosed voice pathologies in children are vocal nodules followed by vocal cord cysts, infectious and inflammatory causes, sulcus vocalis, laryngeal membranes, iatrogenic vocal cord paralysis, neurological causes, psychogenic factors, traumatic or irritative factors or, less commonly, laryngeal neoplasms. A correct diagnosis of dysphonia in paediatric patients is important for learning, voice training and their psychological development. Children with dysphonia have to be assessed with adequate equipment. It is recommended to use tools that are appropriate to the tolerance and cooperation of the patients and allow to have a good visualization of the vocal folds. Suitable preventive methods, early diagnosis, appropriate treatment of voice disorders should be taken into consideration in these cases. In this article, some of the most frequent causes of dysphonia in paediatric patients and their treatment options in order to achieve a proper voice are reviewed.

The Outcomes of the Voice Use Reduction Program on Voice Quality and Vocal Fatigue in Occupational Voice Users

The study aimed to describe the outcomes of the voice use reduction (VUR) program on voice quality and vocal fatigue (VF) in occupational voice users (OVUs). A within-subject, quasi-experimental, pre-test, post-test research design was performed on 30 OVUs. Perceptual and acoustic outcome measures were employed pre-and post-implementation of the VUR, including the GRBASI 4-point rating scale, jitter, shimmer, fundamental frequency ( F0), harmonic-to-noise ratio (HNR), maximum phonation time (MPT), frequency min and max, intensity min and max, the dysphonia severity index (DSI), and the vocal fatigue index (VFI). The pre-and post-test outcomes revealed significant ( p < .001) decreases in perceptual G (Grade of hoarseness), R (Roughness), A (Asthenia), S (Strain), and I (Instability). Perceptual normality in these areas increased significantly ( p < .001). Acoustic measures revealed significant ( p < .05) decreases in Jitter%, Intensity (dB) Min, and DSI scores as well as significant ( p < .05) increases in MPT /a/, /s/, and /z/, Frequency (Hz) Max, and F0 (Hz) Max, indicating improved voice quality at post-test. The VUR program positively affected and improved OVUs’ perception of VF in the areas of tiredness of voice and physical discomfort. OVUs strongly perceive improvement of VF symptoms with rest regardless of the current level of VF they are experiencing. When approaching OVUs, clinicians are encouraged to use a combination of direct voice therapy and vocal hygiene accompanied by VUR to help develop healthier use of the voice, facilitate healing, and prevent further/future injury or disorder.

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

Measuring patient motivation for voice therapy is an important component of determining prognosis and estimating compliance. Voice stimulability testing is assumed to influence the patient's motivation by improving their perception of the sound and/or feel of the voice. The purpose of this study was to validate a Voice Therapy Motivation and Voice Perception Inventory and to determine whether stimulability testing elicits improvements in motivation and patient-perceived voice status. Seventy-five patients who underwent initial voice therapy evaluation completed a four-item inventory that queried their commitment to voice therapy, confidence that they could change their voice through voice therapy, perception of their voice severity, and ratings of their vocal effort. Inventories were completed shortly before and after stimulability testing. A psychometric analysis of the survey was conducted, including the internal consistency of each construct of the inventory along with content, predictive, and concurrent validity. Paired-samples statistical analyses were conducted to determine differences before and after stimulability testing, and Spearman correlations between voice and motivation ratings were conducted to determine relationships between the patient's perception of their voice and their motivation for voice therapy. Internal consistency reliability was acceptable to good for each construct, particularly after stimulability testing. Motivation scales were predictive of returning for voice therapy sessions, subjective improvement of voice by the first therapy session, and likelihood of the patient practicing the home practice program. Patient ratings of voice severity and effort were positively correlated with clinician ratings of overall severity. Motivation and voice impairment perception improved following stimulability testing. Reduction in vocal effort was related to improved motivation, but change in voice severity was not. Voice stimulability testing can influence patient motivation for voice therapy and patient-perceived voice improvements. It should be considered a critical part of the voice evaluation.

Effect of Socioeconomic and Patient-Related Factors on Abidance and Adherence to Voice Therapy in Lebanese Patients With Voice Disorders

ObjectiveTo examine the rate of abidance and adherence to voice therapy (VT) in a group of Lebanese patients with voice disorders, and to analyze the correlation between the rate of abidance, adherence, and socioeconomic factors in addition to patient- and disease-related factors. Study DesignRetrospective chart review. MethodsThe medical records of patients with voice disorders who presented to the voice unit in a tertiary referral center between January 2022 and December 2023 were reviewed. All patients referred to voice therapy selected were included in this study. Patients were stratified into those who abided to voice therapy and those who did not. Patients who abided to voice therapy were further divided into two subgroups: those who adhered to VT and those who did not. ResultsA total of 236 patients with voice disorders were referred to VT, with only 51 attending VT, resulting in a 21.6% abidance rate. Of the 51 patients who attended VT, only 25 completed the therapy sessions, yielding a 55.6% adherence rate. Younger age and higher education level were positively correlated with adherence (r = 0.382, P = 0.01 and r = 0.506, P < 0.001, respectively). Disease-related factors showed a moderate negative correlation between high Voice Handicap Index-10 (VHI-10) scores and adherence (r = −0.687, P < 0.001). Functional voice disorders were associated with higher adherence rates compared with structural or neurologic voice disorders (P = 0.014). ConclusionThe results of this study indicate that the rate of abidance to VT in a group of Lebanese patients with dysphonia is low. Otolaryngologists referring dysphonic patients to VT should take into account the main factors affecting this low rate and account for alternative treatment plan in case one or more of these deterring factors are present.

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.

Barriers to Voice Therapy: A Report From Beginners, Performers, and Teachers of Carnatic Music

AimThe study aimed to understand awareness, perceptions, and barriers to voice therapy among beginners, performers, and teachers of Carnatic music. MethodBarriers from the literature were obtained, and the guide for the semistructured interview was developed. Twelve Carnatic singers (four each identified as beginners, performers, and teachers) were contacted and interviewed on an online platform. The interviews were audio recorded and transcribed verbatim. The transcriptions were loaded and coded in the Qualitative Data Analysis Miner Lite software. The codes were grouped according to beginners, performers, and teachers. The codes were analyzed using a deductive-inductive approach, and thematic analysis was performed to report the findings. Results and DiscussionOverall, three themes emerged during thematic analysis. Beginners were familiar with the signs and symptoms of voice problems related to singing. The performers and teachers were able to identify causes related to posture and lifestyle that impacted singing. The need for seeking help differed with expertise and personal experience. Beginners believed in home remedies as their first choice and considered them sufficient to resolve voice problems. Performers and teachers believed in modifying singing techniques as a remedy to voice problems and considered medical intervention only as a second option. Mixed perceptions about the outcomes of voice therapy and the anticipation of quick results from voice therapy/therapists were major deterrents to seeking professional voice care. Beginners’ views on perceptions of medical intervention for voice problems were strongly influenced by their singing teachers. Beginners also expressed limited access to voice therapy due to several logistical reasons and financial constraints as barriers to attending therapy. Performers and teachers sought medical help as a final resort since the presence of voice problems affected their livelihoods and careers. ConclusionThis qualitative study highlights socioculturally relevant information deeply rooted in the belief systems of Carnatic musicians. These opinions from beginners, performers, and teachers are important to be addressed during counseling and awareness sessions to support vocal health in this sophisticated but vulnerable professional voice group.

Patient Perception of Mental Effort in Voice Therapy

ObjectiveOne challenge in voice therapy is that mastering new vocal techniques is inherently cognitively effortful. While effort is critical for learning, it can also lead to frustration and reduced patient engagement. The purpose of this study was to investigate the relationship between patient-perception of voice handicap and mental effort in voice therapy, and to determine if different therapy approaches and stimuli elicit different perceptions of mental effort. MethodsA non-experimental, prospective investigation was conducted with adult patients receiving voice therapy. Prior to therapy initiation, patients completed the Voice Handicap Index-10 (VHI-10) to quantify perceived severity of their voice disorders. To assess mental effort, a Borg mental effort scale and the NASA Task Load Index (NASA-TLX) were administered following each therapy session. Therapy type and treatment stimulus/level of treatment hierarchy was documented for each session. Kruskal-Wallis H-test was used to compare differences in baseline VHI-10 and mental effort among voice disorder diagnoses. Pairwise comparisons, linear random-intercept mixed-effects model, and generalized estimating equation method were used to determine correlation between VHI-10 and mental effort, and therapy type, stimulus, and effort. ResultsTwenty-seven participants (89% female, 60% white) completed the study. There was no significant difference in VHI-10 or baseline perceptions of mental effort between races or among voice disorder diagnoses. There was a significant positive correlation between VHI-10 scores and session 1 mental effort. There was no significant difference in effort ratings among therapy types, but effort was rated as significantly greater for therapy stimuli that involved connected speech practice than other stimuli. Perceived mental effort significantly decreased over time. DiscussionVoice therapy imposes a cognitive load on the patient, and is particularly challenging for individuals with more severely perceived voice disorders. Further, patients think voice treatment approaches that utilize connected speech stimuli are more effortful than those that use simple stimuli, regardless of treatment target (e.g. resonance, flow).

A Case of Tracheogastric Puncture Using Transnasal Esophagoscopy After Total Laryngopharyngoesophagectomy and Gastric Pull-Up Reconstruction

Voice rehabilitation after total laryngopharyngoesophagectomy is a significant challenge, especially when accompanied by gastric pull-up reconstruction. In 2021, a study revealed that tracheoesophageal puncture is also safe and feasible option for voice rehabilitation in patients who underwent gastric pull-up surgery. Here, we report for the first time in South Korea a case that represents an instance of voice prosthesis insertion after gastric pull-up surgery. The case demonstrates the feasibility and safety of voice prosthesis insertion in patients who undergo total laryngopharyngoesophagectomy and gastric pull-up surgery, providing evidence that voice prosthesis insertion is achievable and can be performed in the outpatient setting using transnasal esophagoscopy.

Investigation of Acoustic Voice Characteristics of Individuals Diagnosed with Muscle Tension Dysphonia.

Muscle tension dysphonia (MTD) is a functional voice condition that causes irregular and imbalanced laryngeal and paralaryngeal muscle activation. Our study aimed to examine the acoustic characteristics of patients with MTD and reveal the differences between genders. The study retrospectively reviewed the acoustic examination findings from the files of patients diagnosed with MTD during evaluations in the laryngology outpatient clinic at a tertiary reference hospital between 2015 and 2022. The parameters assessed in prolonged vowel phonation analysis were fundamental frequency (F0), jitter, shimmer, noise-to-harmonic-to-ratio, and soft phonation index; in the counting task analysis, they were intensity, frequency, and semitone. Gender differences in acoustic measurements obtained during prolonged vowel phonation and counting tasks were also examined. The study included 80 individuals diagnosed with MTD. Although all parameters in the acoustic analysis of/a/ phonation were increased, differences were statistically significant only in the F0 and jitter parameters between females and males (p≤0.05). In the analysis of the counting task, the mean and minimum F0 parameters were significantly higher in females than in males (p=0.000). The mean dB level was decreased, particularly in the counting task, but the results for the intensity parameter did not differ significantly between genders (p>0.05). The values in the acoustic voice analysis parameters of patients with MTD were determined. These acoustic parameters are thought to guide the clinician in evaluating voice and determining voice therapy goals for MTD patients.

Comparative Study of Two Semi-Occluded Vocal Tract Protocols: A Randomized Clinical Trial.

Semi-occluded vocal tract exercises (SOVTEs) are widely used as a therapeutic tool to create flow resistance in the upper airway. The current study was a randomized controlled clinical trial to establish the efficacy of two SOVTE protocols, flow-resistant tube (FRT) and Lessac-Madsen Resonant Voice Therapy (LMRVT). Exploratory investigations included a noninferiority analysis of FRT to the widely adopted therapy protocol (LMRVT), as well as examining the dosing required to improve acoustic measures and subjective ratings. Sixty-seven participants with voice disorder were randomized into one of five groups: 4-week FRT (n = 14), 8-week FRT (n = 19), 4-week LMRVT (n = 15), 8-week LMRVT (n = 5), and control (n = 14). Voice Handicap Index (VHI) and Vocal Fatigue Index scores were collected pre- and posttreatment. Acoustic analysis using the Acoustic Voice Quality Index was completed. We compared VHI between controls and 8-week FRT and LMRVT, adjusting for pre-VHI using linear regression. We examined the efficacy of 4-week protocols relative to controls and conducted a noninferiority comparison of FRT (4 and 8 weeks) to LMRVT (4 and 8 weeks) using 5- and 10-point margins. Finally, we compared the 4- versus 8-week sessions for both therapies. A statistically significant reduction of VHI in both 8-week FRT relative to controls (-10.60, 95% CI [-19.80, -1.40], p = .025) and 8-week LMRVT (-15.74, 95% CI [-29.40, -2.08], p = .025) was found. We also found an improvement in 4-week FRT relative to controls (-10.11, 95% CI [-20.03, -0.20], p = .046), but the 4-week LMRVT result was not statistically significant (p = .057). FRT was found to be noninferior to LMRVT in terms of VHI using a 10-point margin (FRT - LMRVT: 0.69, 95% CI [-5.76, 7.15], p = .01), but not using a 5-point margin (p = .054). There were no statistically significant differences in VHI scores between 4- and 8-week sessions for either therapy. Both FRT and LMRVT improved VHI scores relative to controls. FRT was noninferior to LMRVT in terms of VHI scores. There were no statistically significant differences in VHI scores between 4- and 8-week therapy sessions.

Relationship between voice impairment and stress coping styles in professionally active teachers.

The cause of voice problems in teachers are excessive voice strain, improper voice emission, and wrong emotional responses to occupational stress. The aim of the study was to analyze the relationship between subjective voice assessment of professionally active teachers treated for voice disorders and their stress-coping styles. The study included 174 female teachers participating in a 24-day voice rehabilitation program at a sanatorium hospital. The Voice Handicap Index (VHI) self-assessment questionnaire was used to subjectively assess voice impairment. The Coping Inventory for Stressful Situations (CISS) questionnaire was used to assess coping styles. The VHI and CISS questionnaires were administered to the teachers at the beginning of the rehabilitation stay. Emotion-focused coping was shown to be associated with the subjective assessment of voice dysfunction as assessed by the VHI questionnaire for the total score and all of its dimensions (p = 0.04). In addition to proper voice emission, the prevention and rehabilitation of occupational voice disorders in teachers should also include stress management techniques, as this can help reduce the incidence of functional voice disorders in this occupational group.

Prevalence of Voice Problems and Associated Risk Factors in Islamic Religious Orators

Islamic leadership is a diverse profession and previous research has highlighted the increased risk of voice problems among Islamic leaders. The prevalence and risk factors for voice problems among Malayalam-speaking Islamic religious orators have not been adequately investigated. This study aimed to assess the prevalence of self-reported voice problems among Islamic religious orators who recite the Adhaan and those who do not and to examine the impact of age and associated risk factors. This study employed a non-experimental research design using survey research. The current findings report a high prevalence of voice problems among Islamic Adhaan reciters and suggest that age-related differences may influence the risk factors associated with voice problems in this population. Only two participants from the older group of Adhaan reciters had received voice therapy, suggesting that the majority of Islamic religious reciters lack knowledge about voice care and voice therapy. A limitation of the study is the lack of otorhinolaryngological examination, particularly laryngoscopy and voice analysis of Islamic religious orators. Further studies can investigate the effect of vocal hygiene training or similar voice management programs on Islamic religious orators' voices.