Voice Therapy Research Articles

Vocal Hygiene Habits in College Students With and Without Self-Reported Symptoms of a Voice Problem

PurposeThe purpose of this study was to determine the prevalence of symptoms of a voice problem in college students and to assess if general health factors and vocal hygiene habits serve as risk factors for symptoms of a voice problem in this population. MethodsParticipants (n = 289) from a university in the United States completed an online survey that included demographic and general health questions, the Screen6 questionnaire, and a list of 23 vocal hygiene habits. Four participants were excluded due to receiving voice therapy and the remaining 285 participants were divided into two groups based on the results of the Screen6 questionnaire: those with two or more symptoms of a voice problem daily or weekly (n = 84) and those with fewer symptoms (n = 201). Results29.5% of the college students in this study experienced two or more symptoms weekly or daily. Throat clearing was the most commonly reported symptom. Risk factors included having a postnasal drip, experiencing severe seasonal allergies, and taking medication for depression or anxiety. The following vocal hygiene habits were reported to occur more frequently in those with symptoms of a voice problem: use your voice until it hurts, use extra muscular effort while talking, use extra respiratory effort while talking, use a pitch that you think is too high, and use a pitch that you think is too low. Non-use behaviors, such as water and caffeine consumption, did not vary significantly between groups. ConclusionsPeople with two or more symptoms of a voice problem daily or weekly report using their voice in a way that may contribute to experiencing these symptoms. Vocal hygiene education for this demographic may be more impactful if it is catered to how the voice is used rather than non-use voice care.

Intensive Voice Treatment following Botulinum Neurotoxin Injection for a Speaker with Abductor Laryngeal Dystonia: An Exploratory Case Study.

Abductor laryngeal dystonia (ABLD) is a rare neurological voice disorder which results in sporadic opening of the vocal folds during speech. Etiology is unknown, and to date there is no identified effective behavioral treatment for it. It is hypothesized that LSVT LOUD®, which was developed to treat dysphonia secondary to Parkinson's disease, may have application to speakers with ABLD to improve outcomes beyond that with botulinum neurotoxin (BoNT) treatment alone. The participant received one injection of BoNT in each vocal fold 2 to 3 months prior to initiating intensive voice therapy via teletherapy. Objective measures of vocal loudness (dB sound pressure level), maximum phonation time, and high/low pitch frequency (Hz) were recorded in all treatment sessions and follow-up sessions. Over the course of treatment, the participant showed steady gains in phonation time, volume, pitch range, and vocal quality with a substantial reduction in aphonic voice breaks by the end of the treatment program. Perceptual symptoms of ABLD were nearly undetectable by the participant and the clinicians up to 12 months posttreatment, with no additional BoNT injections. The results suggest that LSVT LOUD® following BoNT was effective, with long-lasting improvement in vocal function, for this speaker with ABLD.

Current approaches to gender-affirming vocal care.

This review addresses the challenges faced by transgender women in achieving congruence between gender identity and voice characteristics and emphasizes the importance of a multidisciplinary approach involving therapeutic and surgical interventions. Recent literature on gender-affirming vocal care emphasizes key themes such as assessment, voice feminization therapy, and various surgical techniques, including glottoplasty and its modifications. Recent publications focused on outcomes, duration, and impact on vocal quality and scrutinized complications associated with surgical interventions. Most publications in the last 18 months advocate for the integration of voice therapy and surgery for optimal outcomes. Utilising a combined approach is significantly more effective in terms of fundamental frequency gain compared to therapy alone. Modified Wendler's glottoplasty remains the preferred and most reliable surgical intervention. However, surgery is not without its complications and vocal trade-offs, in particular, its impact on vocal projection and the risk of long-term dysphonia. Postsurgery rehabilitation improves long-term outcomes. Recent publications on alternative surgical approaches, namely laser reduction glottoplasty and feminization laryngoplasty, show promise but the results are more difficult to generalise. Prospective multicentre studies with standardized protocols are needed to establish best evidence-based practices.

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

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

Gender-Diverse Patients' Awareness and Utilization of Gender-Affirming Laryngological Services.

Despite gender-affirming laryngological services (GALS; eg, voice therapy or surgery) being available nationwide, there is a discrepancy between the number of transgender and gender diverse (TGD) people with vocal incongruence and those who pursue services. Primary care is an important setting for accessing gender-affirming care, including learning about GALS. The purpose of this study was to understand the relationship between access to primary care and utilization of GALS. An anonymous cross-sectional online survey was developed in REDCap. Between June-November 2022, 187 TGD respondents answered all questions related to this analysis. We assessed the relationship between having a primary care provider (PCP) and use of GALS via logistic regression. Of the 167 individuals who reported having a PCP, 54% reported familiarity with GALS, compared to 45% of individuals without a PCP. Compared to the group without a PCP, a greater proportion of individuals with a PCP had received professional voice therapy (21% vs 5%) and voice surgery (3% vs 0%). Logistic regression models did not demonstrate a significant effect of primary care access on either familiarity with, or use of, GALS. Most respondents (89%) were linked to the medical community through a PCP. A greater proportion of respondents with a PCP had accessed professional voice therapy and voice surgery compared with respondents without a PCP, though this difference was not statistically significant. Increased communication between GALS providers and PCPs would raise awareness of available services and may strengthen the referral pipeline to increase access to vocal care. Level III.

Rehabilitasi Respirasi pada Pasca Operasi Angkat Pita Suara

Laryngectomy is a surgery that involves the removal of components of the larynx and vocal cords, with a permanent stoma created in the neck. Voice, breathing, and eating functions will be impaired in the long term. After laryngectomy, people lose not only their voice and ability to communicate but also part of their personality. Voice rehabilitation becomes essential in treatment, focusing on acceptable voice production and aspiration prevention and improving the quality of life of larynx-impaired patients post vocal cord removal. Rehabilitation of laryngectomized patients is a current therapeutic challenge. A therapeutic respiratory rehabilitation was designed to meet patient expectations better.

Talking Like a Teacher—A Study of Pre-Service Teachers’ Voice and Speech Characteristics in Learning and Teaching Situations

Voice and speech are educational tools and a medium of pedagogy for teachers. Teachers tend to modify their voice and speech to support learning. This study aimed to investigate whether pre-service teachers modify their speech and voice in teaching compared to peer learning speech and whether the changes can promote learning and be beneficial for the speakers. Nine pre-service physics teachers’ voices were recorded in three learning situations and in one teaching session with similar external circumstances. Duration of speech turns, pausing, speech rate, fundamental frequency (F0) and its variation, sound pressure level (SPL) and its range, and voice quality were analyzed. Results showed that the participants had longer speech turns, decreased speech rate, and increased pausing when teaching compared to speech in peer learning situations. F0 and SPL were higher in teaching, indicating that the teaching situation was more stressful than the peer learning situation. For F0, this was confirmed by correlation analysis. From the learning point, increased pausing and slower speech rate may be beneficial, but increased F0 and SPL may, on the other hand, be harmful to future teachers as they can increase the risk of vocal overloading. Voice training for future teachers is strongly recommended.

Vocal Approach to Transgender Individuals: The Journey Taken in Chile and Argentina

In recent years, there have been international references to the vocal approach for the specific group of transgender individuals, although the Latin American literature is still very timid on this matter. The purpose of this article is to identify the current norms, statistics, and vocal approach towards transgender individuals in Chile and Argentina, considering the experience of two speech and language pathologists with more than twenty years of experience on voice therapy. Reflections were made on the transgender reality in these countries, the limitations in the implementation of the depathologization of the transgender group were outlined, some current and unreliable statistics were presented, some innovative actions in the public system were highlighted, and the lack of knowledge about the benefits of vocal work for transgender men and women was discussed. The identified aspects could benefit from multicenter research that strengthens speech therapy actions with this group, contributing to depathologization and positive approach.

The Utah Gender Presentation Scale for Communication: Development and Validation of a Measure of Voice-Related Gender Incongruence.

The aim of the present study was to develop and validate a patient-reported outcome measure for gender incongruence specific to voice and communication parameters, including pitch, intonation, resonance, loudness, speech smoothness, speech clarity, word choice, facial expression, gesture, and posture. The Utah Gender Presentation Scale for Communication (U-GPS) includes 10 items, each on a 10-point scale from masculine to feminine. Items were selected based on literature review and patient focus groups. During test administration, respondents provide their current rating and goal rating for each item. The difference between these scores is used to calculate an overall incongruence score. Prospective data from transgender and gender-diverse (n = 155) and cisgender (n = 69) individuals were then used for a multiparametric psychometric evaluation of the measure. Findings demonstrate excellent levels of internal consistency (Cronbach's alpha for current scores: α = .943; Cronbach's alpha for goal scores: α = .970), test-retest reliability (intraclass correlation coefficient = .905), longitudinal validity (improvement in therapy for trans women: F = 293.0, p < .001; nonbinary folx: F = 80.9, p < .001), concurrent validity (correlation with the Trans Woman Voice Questionnaire: r = .51, p < .001), and known-group expectations (differences among five gender groups: F = 82.7, p < .001). The U-GPS is a meaningful measure of voice-related gender incongruence, which is clinically relevant for assessing goals in gender-affirming voice and communication therapy for individuals across the gender spectrum.

Transformational Voice Work: Using Theatre-Based Vocal Practice to Support Gender-Diverse Voices

As a voice coach and teacher, Jane MacFarlane guides actors to a greater understanding of how their voice works, to reveal a character that is rooted in truth and believability. The foundation of the work she does is based on Kristin Linklater’s Freeing the Natural Voice, which identifies habits and patterns of tension in the body that can limit the range of our voices and employs techniques to access the fullness and richness of the vocal qualities we are born possessing. A few years ago, MacFarlane was approached by a colleague who was transitioning and wanted to know if voice work could help her find a vocal quality that affirmed her gender. They began crafting a progression through the voice work that helped her find a voice that felt organic and true to who she really is. Through working with her on her journey, MacFarlane became associated with Skipping Stone, a transgender support organization in Calgary. Together, they began to offer online classes that were based on the work MacFarlane does with theatre practice and applied it to the needs of the transgender community. This article outlines the process of the eight-week progression for vocal feminization through Skipping Stone.

Voice Coaching at the Stratford Festival: A Vocation of Service

On Saturday, 22 October 2022, longtime Stratford voice and text coaches Paul de Jong, Cathy MacKinnon, and Janine Pearson discussed and reflected on the role of the voice coach at the Stratford Festival with Danielle Wilson. The Stratford festival is the only festival in Canada with a coaching team, and the coaches share their thoughts on the history, value, role, and purpose of voice coaches at the festival and in what ways they serve the work of the actor. The coaches also reflect on how voice work is evolving and how we might encourage the next generation of voice coaches to enter the profession.

The Use of the Voice Trainer App for Vocal Control in People with a Degenerative Ataxia: A Pilot Intervention Study.

Dysarthria is disabling in persons with degenerative ataxia. There is limited evidence for speech therapy interventions. In this pilot study, we used the Voice trainer app, which was originally developed for patients with Parkinson's disease, as a feedback tool for vocal control. We hypothesized that patients with ataxic dysarthria would benefit from the Voice trainer app to better control their loudness and pitch, resulting in a lower speaking rate and better intelligibility. This intervention study consisted of five therapy sessions of 30min within 3weeks using the principles of the Pitch Limiting Voice Treatment. Patients received real-time visual feedback on loudness and pitch during the exercises. Besides, they were encouraged to practice at home or to use the Voice trainer in daily life. We used observer-rated and patient-rated outcome measures. The primary outcome measure was intelligibility, as measured by the Dutch sentence intelligibility test. Twenty-one out of 25 included patients with degenerative ataxia completed the therapy. We found no statistically significant improvements in intelligibility (p = .56). However, after the intervention, patients were speaking slower (p = .03) and the pause durations were longer (p < .001). The patients were satisfied about using the app. At the group level, we found no evidence for an effect of the Voice trainer app on intelligibility in degenerative ataxia. Because of the heterogeneity of ataxic dysarthria, a more tailor-made rather than generic intervention seems warranted.

Unlocking tracheoesophageal speech from pharyngoesophageal spasm: preliminary results of a videofluoroscopic-guided botulinum toxin A injection technique.

The tracheoesophageal puncture for the voice prosthesis (VP) placement is the recognized gold standard in post-laryngectomy voice rehabilitation. Despite the development of specific intraoperative techniques, a subset of patients will suffer from poor functional outcomes due to pharyngoesophageal spasms (PES). This paper evaluates the functional outcomes after transcutaneous botulinum toxin type A (BTX-A) infiltration for PES with a videofluoroscopy-guided technique. Since 2022, eight consecutive patients with VP and affected by PES were treated with BTX-A injection by a standard videofluoroscopic guided technique at the European Institute of Oncology, IRCCS (IEO) in Milan. A lidocaine test was performed pre-operatively to evaluate the potential effect of chemical neurectomy. All patients with positive lidocaine tests were injected with 50IU of BTX-A (Allergan, Irvine, CA) according to the sites marked during the videofluoroscopy. Reported symptoms (VHI, SECEL), perceptual (INFVo), aerodynamic (MPT) and manometric parameters were collected before and after treatment. In all cases, BTX-A was performed as an outpatient procedure without complications. For seven patients, only one BTX-A injection was needed, while one patient required a re-injection. Subjective and perceptive improvement after BTX-A was significant for VHI, SECEL and INFVo. MPT showed significant improvement after a chemical neurectomy. After a mean follow-up of 6months, all patients maintained a good TES quality. The videofluoroscopic guided BTX-A injection of the pharyngoesophageal tract showed to be a feasible and reproducible technique in all cases. The pharyngoesophageal videofluoroscopy allows defining of patients' anatomical landmarks that help the surgeon to perform a homogeneous injection, empowered by post-injection massage.

Factors associated with successful electrolarynx use after total laryngectomy, a multi-institutional study.

To identify characteristics associated with successful electrolarynx (EL) use after total laryngectomy (TL). Records of 196 adults who underwent TL from 03/15/2012 to 03/15/2022 at the University of Washington and Puget Sound Veterans Affairs were reviewed. Characteristics included age, Charlson Comorbidity Index, social support, pre-operative radiation (RT) and chemoradiation (CRT), and 6-month post-TL swallow status. EL success was evaluated using pre-defined criteria of intelligibility, reliability, and independence with use. Poisson regressions and robust standard error estimates were used to estimate unadjusted risk ratios for each characteristic. Statistically significant characteristics were included in multivariate analysis (MVA) to estimate adjusted risk ratios. Median age was 64, median Charlson Comorbidity Index was 5, 170 (87%) were male, 159 (81%) had high social support, and 159 (81%) attained post-TL full-oral diet. Pre-operatively, 110 (56%) had RT, including 55 (28%) with CRT. Ninety-three (47%) met our criteria for EL success. Characteristics significantly associated with EL success included social support (p = .037) and post-TL full-oral diet (p = .037); both approached significance on MVA. EL success varied by pre-operative treatment on univariate (p = .005) and MVA (p = .014). Compared to no prior RT or CRT, the probability of EL success was 29% higher with prior RT and 29% lower with prior CRT in MVA, although these associations did not reach significance. In this retrospective review, EL success correlated with high social support, post-TL full-oral diet, and pre-operative treatment history. These results warrant validation in a larger prospective study to help guide the choice of voice rehabilitation modalities or intensified speech therapy. 4.

Efficacy of the voice therapy protocol (VTP) for adult patients with unilateral vocal fold mobility impairment; a feasibility study

Background: Unilateral vocal fold mobility impairment (UVFMI) causes dysphonia and/or dysphagia, which can significantly affect a patient’s ability to communicate and perform regular daily life activities as well as the quality of life. Voice therapy offers a less invasive and more preferential method for patients. However, there are limitations concerning the integration of multiple therapy approaches. Voice therapy exercises with clear methodologies are required to plan and conduct therapy systematically, and frequency would be required for each exercise. Therefore, this study was conducted by applying the protocols of voice therapy in adult patients with unilateral vocal fold mobility impairment. Objective: This feasibility study is a prospective cohort, pre-post single arm, designed to determine whether the voice therapy protocol (VTP) can enhance voice quality in adult patients with unilateral vocal fold mobility impairment (UVFMI) in a pilot study. Materials and methods: All subjects received 12 sessions of voice therapy protocol, with each session conducted weekly for 45 minutes. The voice therapy protocol applied in this study consisted of vocal hygiene education, abdominal breathing exercises, vocal function exercises, pushing exercises, muscle relaxation exercises, and applied resonance voice therapy. The outcomes of protocols for voice therapy were measured before and after treatment using subjective voice assessments (GIRBAS scale) and objective voice assessments (Dr. Speech program and electroglottography-EGG). Results: Cases 2, 7, 10, 11, and 13 improved after receiving VTP. As for other participants, there are still some voice parameters that need to be monitored. Overall, it was found that the participants’ voice parameters were changing within the acceptable range, with MPT, jitter, shimmer, and HNR values significantly different (p&lt;0.05). Conclusion: The findings of this study indicated that the voice therapy protocol was a worthwhile alternative and could be used to develop further treatment guidelines for adult patients with UVFMI at a speech clinic.

Objective evaluation of the pharyngoesophageal segment as a source of substitute phonation in patients after total laryngectomy

The study aimed to identify objective predictors of the successful voice rehabilitation after total laryngectomy to select the optimal method of voice restoration.Material and Methods. The study included 60 laryngectomized male patients who were stratified into 2 equal groups depending on the patient’s choice of voice restoration: tracheoesophageal puncture or esophageal voice. A comprehensive assessment of the qualitative and quantitative parameters of the pharyngoesophageal segment was carried out using the diagnostic procedures, such as: fiberoptic endoscopic evaluation of swallowing, high-speed video endoscopy, and high-resolution pharyngoesophageal manometry. The results of examination of the pharyngoesophageal segment were compared with the results of voice rehabilitation.Results. A significant difference in the resting pressure in the pharyngoesophageal segment between patients with successful and unsuccessful voice rehabilitation was found. The resting pressure in the pharyngoesophageal segment was higher in patients with unsuccessful voice rehabilitation than in patients with successful voice rehabilitation. Among patients with failed voice rehabilitation, 64 % had pseudodiverticula, 25 % had cicatricial strictures and 11 % had pharyngospasm. Pseudodiverticula were found only in patients who underwent vertical or apparatus pharyngeal closure. We described vibrating patterns of substitute phonation in laryngectomized patients and identified 5 different types of pseudoglottis. No significant differences between the methods of substitute phonation were found.Conclusion. The state of pharyngoesophageal segment is an objective predictor of successful substitute phonation and depends on the surgical technique of pharyngeal closure, the volume of cancer treatment and the course of the postoperative period. A comprehensive assessment of the qualitative and quantitative parameters of the pharyngoesophageal segment using fiberendoscopic, fuoroscopic studies and highresolution pharyngoesophageal manometry allows prediction of voice rehabilitation outcomes.

Trans Woman Voice Questionnaire Scores Highlight Specific Benefits of Adjunctive Glottoplasty With Voice Therapy in Treating Voice Feminization.

Treatment options to assist patients to produce a more perceptually feminine voice include voice therapy (VT) and surgeries to elevate pitch such as the Wendler glottoplasty (WG). The Trans Woman Voice Questionnaire (TWVQ) is a validated quality of life measure for trans women's self-reported perceptions of their voice and is frequently administered before and after such interventions. The 30 statements broadly pertain to how feminine a patient feels their voice is, how effortful it is to produce their voice, and how their voice impacts them psychosocially, making it a useful and specific outcome measure when treating trans females for voice concerns. To compare quality of life outcomes between VT and VT with adjunct WG (VT+WG) based on changes in ratings of individual statements on the TWVQ. A retrospective case series of 31 trans female patients treated was completed. A total of 17 patients underwent VT and 14 underwent VT with adjunctive WG. Ratings for each of the 30 TWVQ statements were compared before and after treatment for each group. Wilcoxon rank-sum tests were used to compare rating changes before and after treatment. Spearman rank-order correlation tests were used to assess the association between total TWVQ score and "current voice" rating. WG was associated with statistically significantly improved ratings for every statement on the TWVQ except one. In contrast, VT was associated with statistically significant improvements in 16 of the 30 statements, which largely pertained to patient emotions surrounding their voice rather than physical aspects such as pitch and dysphonia. Furthermore, while both WG+VT and VT improved the "current voice" rating significantly, WG improved the score by nearly 1 unit more. Lastly, we found a positive association between the total TWVQ score and current voice rating, indicating that lower scores were associated with more self-perceived feminine-sounding voices (P < 0.01). Both VT and VT+WG result in improvements in the TWVQ. The specific statements on the TWVQ offer insight into specific quality of life treatment outcomes, with VT associated with improvements in mostly psychosocial aspects of voice production and VT+WG with both psychosocial and physical aspects.

A Systematic Review of Speech-Language Pathology Interventions for Presbyphonia Using the Rehabilitation Treatment Specification System

BackgroundThe prevalence of voice disorders for people over the age of 65 is 4× higher than for the population at large. The most common cause of dysphonia in this group is presbyphonia, the preferred first-line treatment for which is voice therapy with a speech-language pathologist. This systematic review seeks to identify how voice therapy affects multidimensional voice outcomes in people with presbyphonia. MethodsA systematic search of CINAHL, Embase, Emcare, MEDLINE and Google Scholar was undertaken in March 2023. Comparative and non-comparative studies of voice therapy in participants over 50 years with presbyphonia were considered for inclusion. No limitations were placed on date or language of publication. Study quality and risk of bias were assessed with the Cochrane Risk of Bias 2 (RoB 2) tool and the Methodological Index for Non-Randomized Studies (MINORS). Subgroup analysis was used to compare studies based on participant sex, intervention duration, study design and intervention content. Interventions were specified using the Rehabilitation Treatment Specification System (RTSS) employing a consensus methodology among reviewers. Results were synthesized utilizing metanalysis when outcomes were adequately specified, and narrative analysis when they were not. Results23 studies were included with 1,050 subjects (mean age: 72.5 ± 8.6; 51% female). The most reported intervention was Vocal Function Exercises (VFEs). Per the RTSS, 14 interventions employed a predominantly Organ Functions approach and the 14 remaining interventions employed a Skills & Habits approach. Metanalysis confirmed post-therapy improvement in patient-related outcome measures (PROMs) of 0.93 standard mean difference (p<0.00001, 95% CI: 0.70-1.17); studies with predominantly males and with longer treatment periods were associated with larger improvements, while RCTs reported more modest improvements. Metanalysis also identified a mean post-therapy increase in maximum phonation time (MPT) of 5.37 seconds (p<0.00001, 95% CI: 3.52-7.22). Treatments with an Organ Functions focus resulted in greater gains in MPT than those with a Skills & Habits focus (7.52 s vs. 2.90 s). Finally, metanalysis identified reductions in acoustic perturbation measures (jitter: 0.62%, p<0.001, 95% CI: 0.26-0.97%; shimmer 1.05%, p<0.00001, 95% CI: 0.67-1.44%). Narrative synthesis further identified improvement in auditory-perceptual voice quality in all active treatment groups as well as improved glottal function in most studies which reported this. ConclusionsDespite the uncertainty around internal validity introduced by the inclusion of a wide range of study designs, there is convincing evidence that voice therapy for presbyphonia results in significant improvement in patient-reported, aerodynamic, acoustic, and expert-rated voice outcomes. Treatments with an Organ Functions focus may better address the underlying physiological deficits of presbyphonia, although future comparative studies with multidimensional voice assessment are warranted.

ВОКАЛЬНАЯ ФОНОПЕДИЯ ЧЕРЕЗ ПРИЗМУ ВОКАЛЬНОЙ ПЕДАГОГИКИ

In their study, the authors consider through the prism of some vocal-pedagogical settings such a relevant interdisciplinary section of medical speech therapy as voice therapy (phonopedic voice pedagogy), namely its subsection — vocal-voice therapy. Relying on serious scientific sources, the authors define the very process of singing phonation as a valuable rehabilitation and preventive resource for voice disorders. The article reveals the modern scientific approach to the interpretation of vocal breathing, in particular, in the context of a differentiated approach to it in relation to speech breathing, since traditionally the basis of voice therapy is the work on correction of phonation breathing. The inverse nature of vocal breathing carries significant correctional potential for the patient during the rehabilitation. The authors consider vocals as an important component of psychotherapeutic influence when working with a patient with impaired voice function. The article also describes two modern Western systems of vocal pedagogical voice training, “Estill Voice Training” (EVT) and “Complete Vocal Technique” (CVT), as a mechanism for rehabilitation effects on the voice. Some recent studies by colleagues in this direction are touched upon.

Neurectomy and Myomectomy for Treatment of Spasmodic Dysphonia.

Spasmodic dysphonia (SD) is a debilitating neurological disorder affecting the muscles of voice production. Sudden involuntary movements of the vocal folds lead to phonatory breaks and to forced, strained, and strangled voice quality in adductor SD, or breathy breaks in abductor SD. There is currently no cure for spasmodic dysphonia, and the gold standard for treatment is the injection of botulinum toxin in small amounts to the intrinsic laryngeal musculature.1 However, botulinum treatment requires periodic reinjection, produces vocal instability immediately after injection, lacks uniform results among patients, and patients can develop antibodies to botulinum toxin. Long-term or permanent symptom relief would be ideal. We present four patients with adductor and one patient with abductor spasmodic dysphonia who underwent neurectomy and myomectomy for treatment. The mean age was 64 years (age range 45-83). The mean duration of adductor spasmodic dysphonia was 11.8 years. The duration of abductor spasmodic was 4 years. All patients had previously been treated with voice therapy and botulinum toxin A. The mean duration of follow up was 1.7 years. Four patients had subjective and objective improvement after surgery. One patient had subjective improvement.