Voice Therapy Research Articles

Geriatric Voice: Distinctive Clinical Profiles of Working Seniors in a Tertiary Laryngology Clinic

ObjectivesVoice disorders have been reported in up to 47% of the geriatric population. Few studies have assessed dysphonia in the elderly, with none examining vocal function in working seniors. This study aims to profile the clinical characteristics of individuals aged 65 years and older, comparing working and non-working seniors. Study DesignRetrospective cohort study. MethodsMedical charts were reviewed for patients aged 65 years and older referred to the McGill University Health Centre Laryngology Clinic (January 2018 to March 2020). Variables studied included sociodemographics, comorbidities, voice complaints, lifestyle factors, diagnoses, voice acoustics [maximum phonation time (MPT), S/Z ratio, F0], GRBAS scale, VHI-10, RSI, and treatment modalities. ResultsA total of 267 patients were included, with a mean (SD) age of 74.2 (6.6) years and 61% of female patients. Occupation information was available in 148 cases, of which 31.1% were still working and 12.8% were professional voice users. The predominant voice complaint was dysphonia/hoarseness (48.8%) and the most prevalent diagnosis was presbyphonia (31.8%). The mean (SD) VHI-10 and RSI scores were 19.8 (9.0) and 18.7 (9.4) points, respectively. Voice therapy was prescribed for 155 patients (58.7%): 124 attended at least one session with significant post-treatment improvements in the GRBAS and VHI-10 scores (P<0.01). In the univariate analysis, working seniors had a significantly more prevalent singing habit (P=0.04) and laryngopharyngeal reflux diagnosis (P=0.01), displaying a significantly longer MPT (P<0.001) and lower G-B-S scores (P<0.05). After adjusting mean differences, only MPT and the G-S scores were significantly different between both groups. ConclusionsThe predominant diagnosis in elders with voice complaints was presbyphonia. Voice therapy proved effective in improving the VHI-10 and GRBAS scores for geriatric patients. Almost one-third of seniors remained in the workforce, demonstrating superior vocal profiles, specifically in the MPT and the grade and strain of perceptual voice quality.

Voice Changes Without Laryngeal Nerve Alterations After Thyroidectomy: The Need For Prospective Trials - A Review Study.

Thyroidectomy is a commonly performed surgical procedure that is offered for different thyroid pathologies. The most frequent complication after total thyroidectomy is transient or permanent hypoparathyroidism followed by transient or permanent recurrent laryngeal nerve palsy. Patients may experience voice impairment despite intact laryngeal nerve function. These patients are of special interest because they experience subjective symptoms which are difficult to measure and therefore to treat. The Voice Handicap Index (VHI) and VHI-10 are the most commonly used subjective questionnaires. Their results correlate with objective findings. Female sex, in particular after menopause, is a dominant factor for developing voice impairment after thyroidectomy. The extent of neck surgery and the weight and volume of the removed thyroid correlates directly with both objective and subjective voice impairment after surgery. Videolaryngostroboscopy should be considered to examine vocal cord pathologies in this patient group. Surprisingly, there are no studies showing that speech and voice therapy are beneficial for patients with voice alterations but with intact laryngeal nerves. While recurrent laryngeal nerve (RLN) paralysis can be evaluated by objective exams postoperatively, we are still left with the issue of possible partial or complete external branch of superior laryngeal nerve (EBSLN) injury. It is therefore quite difficult to segregate neural (RLN and EBSLN) and non-neural voice change populations, regardless of the method of literature evaluation. Perhaps patients' perspectives on how they experience voice functionality should play a superior role in deciding which patients should be investigated further with laryngoscopy, acoustic or perceptual analysis, and which patients should be offered treatment.

Effectiveness and Feasibility of Telepractice on Voice Therapy for Female Teachers in Elementary Schools with Self-Reported Voice Disorders.

The purpose of this study is to explore the effectiveness of telepractice in voice intervention for female teachers in elementary schools with self-reported voice disorders. Thirty-five female elementary school teachers with self-reported voice disorders volunteered to participate in the study. They were divided into a telepractice voice intervention group (experimental group N=18) and a face-to-face voice intervention group (control group N=17) based on their employment setting. The exact same treatment protocol was applied to both groups of subjects, except that the intervention group was seen through telepractice, and the control group was seen face-to-face. The treatment protocol includes vocal hygiene education and resonant voice therapy twice a week for a total of eight sessions. Auditory perceptual analysis, acoustic assessment, aerodynamic assessment and self-assessment protocol were conducted before the intervention and one week after the last intervention, and the differences before and after interventions within each group and between groups were compared. There was no significant difference in baseline data including age, working years, and voice symptoms between the two groups. Both groups showed significant improvement (P<0.05) in all voice assessment before and after the treatment sessions, except for the Voice Handicap Index-10 (VHI-10) assessment. No statistical difference was found in other pre- and post-intervention voice assessment changes between the two study groups. The control group presented higher improvement in the total score, and the two subdomain assessments of physiology and emotion. Telepractice voice intervention can effectively improve the voice quality of female teachers in elementary schools, and telepractice therapy can be an effective alternative to face-to-face voice intervention.

КЛЮЧЕВЫЕ МОМЕНТЫ ПРИМЕНЕНИЯ ВОКАЛЬНОЙ ФОНОПЕДИИ ПРИ ДИЗАРТРИЧЕСКИХ РАССТРОЙСТВАХ

In their study, the authors consider such a relevant interdisciplinary section of medical speech therapy as voice therapy (vocal rehabilitation or phono pedagogy), namely its subsection — vocal-voice therapy (vocal rehabilitation), in the context of its effect on adults with mild dysarthric disorders, which is poorly covered in the Russian specialized speech therapy literature. The article outlines the features of violations of the components of voice and speech in dysarthria. In addition to vocal-voice therapy (vocal rehabilitation) techniques, the authors emphasize the importance of including the necessary speech therapy algorithms and multimodal intervention techniques in the work. The article outlines the general principles and some technical resources for the step-by-step vocal-voice therapy (vocal rehabilitation) of students diagnosed with a symptom of dysarthria, based both on personal successful experience of many years of work and on the experience of foreign colleagues. The stages of vocal-voice therapy (vocal rehabilitation) work described by the authors include: breathing exercises to music; special vocal and vocal-voice therapy (vocal rehabilitation) exercises using piano — SOVTe exercises; traditional vocal exercises (singing the notes of a scale with an open sound); work using vocalises; work on vocal composition with words.

Assessment of Voice Quality and Vocal Cord Paralysis After Endarterectomy.

Recurrent laryngeal nerve palsy is a rare but important complication after endarterectomy (CEA). The impact on voice quality after this procedure is also important. The aim of the study was to assess voice quality and vocal cord function after CEA. 200 patients were enrolled in the study. Inclusion criteria were indications for CEA and patient consent to the procedure. Endoscopic examination of the larynx was performed before the procedure, immediately after the procedure, on the 2nd day after the procedure, then 3 month and 6 months after the procedure. Voice was assessed by maximum phonation time (MPT), GRBAS scale, Voice Handicap Index (VHI) and the Voice-Related Quality of Life (V-RQOL) questionnaire. In the study group, the results on the GRBAS scale were significantly worse and the average MPT was shorter compared to the control group. In the V-RQOL assessment, patients rated their voice as fair or good, significantly more often noticed that they had difficulty speaking loudly and being heard, and that they felt short of air when speaking. In VHI-30, the total score was significantly higher in the study group compared to the control group. Voice disorders after the procedure were reported by 68 patients, while a disorder of the recurrent laryngeal nerve was observed immediately after the procedure in 32 patients. Most vocal cord disorders were transient. Ultimately, 3% of patients were diagnosed with vocal cord paralysis. Cranial nerves paralysis, including the recurrent laryngeal nerve, are a common complication after CEA. Majority the paralysis is transient, but requires appropriate diagnostic and therapeutic procedures. Vocal cord evaluation is a non-invasive and widely available examination and should be performed pre- and postoperatively after all neck surgeries. The incidence of voice disorders after CEA significantly affects the quality of life of patients and requires voice rehabilitation and patient care with psychological support.

Evolution of the quality of life of total laryngectomy patients using electrolarynx.

Therapy and vocal rehabilitation in laryngeal cancer impact patients' quality of life. The objective of this study was to evaluate the evolution of the quality of life of patients with laryngeal cancer submitted to total laryngectomy and using electrolarynx. This is an observational study with a cross-sectional design and a quantitative approach. It was conducted between April 2022 and January 2023 in a Brazilian cancer hospital. For data collection, a quality of life questionnaire, validated for patients with head and neck cancer at the University of Washington, was applied in two phases: from 7 days after total laryngectomy and, subsequently, from 70 days after surgery using electronic larynx for at least 60 days. The inclusion criteria were patients undergoing total laryngectomy included on the Aldenora Bello Cancer Hospital's election list to receive the electronic larynx. Patients who did not sign the informed consent form were not included. The sample consisted of 31 patients, of which approximately 84% were men and approximately 93% at the age of 50 years or older. When comparing the phases, it is possible to observe that the item speech had the greatest progress, while chewing had the least. Only the item recreation, swallowing, taste, and saliva did not show any statistical significance. The score for the general quality of life questions increased. Electronic larynx is a viable and useful method of voice rehabilitation. Our data suggest that the use of the electrolarynx as a postlaryngectomy method of verbal communication is responsible for positive effects on patients' quality of life.

Методы немедикаментозной терапии функциональных нарушений голосовой функции

The development of physical and rehabilitation medicine makes it possible to introduce nondrug methods of treatment more widely. Treatment of patients with hypofunctional dysphonia is aimed at improving the condition of the neuromuscular apparatus of the larynx. The number of such patients increased significantly during and after the Covid-19 pandemic. Neuromuscular electrophonopedic stimulation (NMEPS) is a modern method combining physiotherapeutic and voice therapy effects. Objectives. To study the effectiveness of various nondrug treatments methods for hypofunctional dysphonia. Materials and methods. 45 patients with hypofunctional dysphonia were examined. For the treatment of vocal function, 25 patients of the observation group used NMEPS of the larynx, and 20 patients of the comparison group used phonopedic correction. Each course consisted of 10 lessons. A point assessment of patient complaints, an analysis of videoendoscopic end videolaryngostroboscopic signs of hypofunctional dysphonia and the psychoemotional status of patients were performed. Results. Before treatment, there was no significant difference between the groups. After the course of treatment, the number of complaints from patients in the observation group decreased from 10.3±1.1 to 4.1±0.3 points, in the comparison group, from 10.5±0.8 to 6.8±0.4 points (p &lt; 0.05). When analyzing the videoendoscopic picture in the observation group, a significant improvement in most indicators was noted. Normal indicators of the videoendostroboscopic picture were diagnosed in 88% of patients in the observation group and 65% of patients in the comparison group (p &lt; 0.05). In both groups, an improvement in the psychoemotional status during treatment was revealed compared to the initial one. Conclusions. The data obtained confirm the effectiveness of the NMEРS in the treatment of patients with hypofunctional dysphonia.

Effectiveness of Semi-Occluded Vocal Tract Exercises (SOVTEs) in Patients with Dysphonia: A Systematic Review and Meta-Analysis.

Dysphonia is a disorder characterized by an alteration in the overall quality of the voice which reduces quality of life. Therefore, we assessed the effectiveness of SOVTEs in the management of dysfunctional and organic dysphonia for acoustic, perceptual-auditive, aerodynamic parameters and self-perception of the disease. a systematic review and meta-analysis were conducted. Findings were reported according to the PRISMA statement. Five databases were searched for RCTs and non- or quasi-RCTs. Studies were independently assessed using the Cochrane Risk of bias (RoB) and ROBINS-I tools. Effect sizes (ES) were calculated only at post-treatment. GRADE criteria were used to assess the quality of evidence. eight articles were included. Studies investigated several SOVTEs, alone or in combination. None of the study was completely judged at low RoB. The quality of evidence resulted very low for each analysis. SOVTEs revealed to be statistically more effective than control interventions in improving F0 (ES: -14.42; CI 95%: -27.16, -1.69); P=0.03), whereas shimmer did not change significantly (ES: -0.43; CI 95%:-02.02, 1.15; P=0.59). Not significant changes in favor of control groups were found for jitter (ES: 0.13; CI 95%: -0.14, 0.40; P=0.34) and overall gravity in the perceptual-auditory evaluation (ES: 0.13 CI 95%: -0.50, 0.77; P=0. 68). Among secondary outcomes, evidence suggested that SOVTEs are more effective than control interventions in Psub reduction (ES: -1.47; CI 95%: -2.84, -0.10; P=0.03); self-assessment resulted not significantly in favor of SOVTEs (VHI/VRQoL: ES -0.23; CI 95% -1.14, 0.69; P=0.63 and VTDS/VDSI: ES -4.85, CI 95% -25.13, 15.42; P=0.64). results obtained showed that voice therapy based on SOVTEs is not to consider significantly superior if compared to other treatments, even if a favorable trend was detected and should be taken into consideration. Further high-quality RCTs on specific SOVTEs are recommended to produce better-quality evidence.

Organik ve Fonksiyonel Disfonilerde Ses Terapisinin Etkinliği

Organik ve Fonksiyonel Disfonilerde Ses Terapisinin Etkinliği

Design and usability evaluation of a web-based pitch control training app for transgender women.

Transgender people often experience dysphoria because the way their voice is perceived does not match their gender identity. Such dysphoria negatively affects mental health and quality of life, and is particularly an issue in trans women. Dysphoria can be reduced via gender-affirming voice and communication training provided by human experts, but the accessibility of such training is often limited. As a supplement or alternative to human-guided training, our team has thus developed an early prototype of voice training software for transfeminine users (i.e., trans women and nonbinary users who were assigned male at birth). The software is accessible via a web browser and provides three vocal pitch exercises together with real-time feedback about the user's pitch relative to a desired target pitch curve. This paper presents the main technical features and results of a single-session usability evaluation with 5 transfeminine participants. We further present future plans for expansion to other exercises and voice aspects (particularly resonance) as well as plans for clinical trials.

Two Cases of Voice Training for Hyperfunctional Voice Disorder in TE Shunt Speech

Two Cases of Voice Training for Hyperfunctional Voice Disorder in TE Shunt Speech

무후두 음성에 대한 성문 역 여과 분석의 유용성

The purpose of this study was to present basic data for voice rehabilitation by acoustically analyzing the voices of subjects who lost their voice due to laryngeal excision and used esophageal vocalization as an alternative method. We aimed to investigate the usefulness of esophageal speech analysis using open source software that can automatically run glottic inverse filtration (GIF) analysis and analyze various parameter values. GIF analysis was performed on 20 normal adults and 20 people with negative esophageal vocalization. Analysis variables included open quotient, speed quotient, closure quotient, amplitude quotient, normalized amplitude quotient, and semi-open quotient. As a result of glottal inverse filtration analysis of normal voice and esophageal vocalization, the values of esophageal vocalization were lower in all variables compared to normal vocalization, and the average score of esophageal vocalization was found to be 1/4 of that of normal vocalization. In this study, objective values for the glottal waveform of normal adults were obtained, and these parameter values were applied to esophageal voice to determine the extent to which they differ from normal voice, and the GIF value was used to determine the degree of voice progress in esophageal voice rehabilitation. It is believed that it can be used for prediction.

Vocal Cool-Down In Voice Training: Method and Technical Considerations

Abstract In addition to the artistic aspect of professional voice performance, the sportive aspect is also important. The voices of professional voice actors, who are considered just like an athlete, should be strong, flexible and durable against long-term use. Also called vocal athletes, voice performers need processes such as muscle and skill development, voice warm up and cool down as in the applications expressed as periodization in sports medicine. Vocal training should aim to prepare the student for the stage not only with its artistic aspect but also with its sportive aspect. In the vocal training process, it is important to raise the awareness of the students from the very beginning of the education and to make the sportive discipline a behavior in the name of sustainable professional vocal use. It is unacceptable for a professional athlete to do some warm-up and cool-down movements with random movements or ignorance. The same is true for seeking vocal exercises for the singer.&#x0D; Exercise programs structured on a physiological basis both give predictable results, and the singer knows what to do and can ensure the performance. The most important components of the conscious training program that creates vocal periodization are vocal warming-up and cooling-down. Contrary to vocal warm-up exercises, studies on vocal cool-down are not sufficient both in the literature and in vocal training. It is an important necessity to apply vocal cool-down exercises in the same routine for the tissue recovery and to return to the speaking tone after the performance and to achieve tissue recovery under appropriate conditions. Vocal cool-down exercises are basically based on stretching and slowing down. In addition to metabolic effects such as blood flow changes, decreasing the muscle tonus, and removal of metabolites from the tissue; physiological effects such as providing a comfortable low larynx position and relaxation are targeted. Vocal cool-down techniques include semi-occluded vocal tract exercises, descending arpeggios, formant maneuvers, yawn&amp;sigh, and chewing approach. In this study, the literature on vocal cool-down exercises has been reviewed, and ideal cool-down conditions and exercises have been presented in parallel with sports physiology.&#x0D; Keywords: Voice Training, Vocal Warm-up Exercises, Vocal Cool-down Exercises, Voice Health, Vocal Performance

Vocal Pedagogy - Reflections on How to Teach Proper Speaking and Singing to Students

"The present study intends to dive into the world of technically appropriate human sound production. Whether it’s used in professional speech or singing, understanding the different elements that aid in the correct creation and emission of sound are prerequisites for all who intend to pursue a career that requires speaking or singing for an extended period of time. From the characteristics of sound to the anatomy of how sound is created, what does technical breathing mean but also what a voice trainer needs to pay attention to in terms of anatomy but also psychology when working with students, the following article presents the steps and methods a vocal coach needs to take into account when taking on a new student. Keywords: human voice, pedagogy, technical breathing, professional speech, singing, vocal coach, anatomy."

Prevalence of Occupational Voice Disorder Among Teachers of Kathmandu District, Nepal.

The objective of this research was to identify the prevalence of voice disorders among teachers in the Kathmandu District of Nepal, with an emphasis on identifying possible risk factors that may be associated with these disorders. A cross-sectional study design was used, with both quantitative and qualitative data-gathering techniques using a mixed-methods approach. Data were collected from 95 non-teachers and 194 participating teachers from different schools in Kathmandu Valley. The analysis covered self-reported voice problem prevalence, job details, and demographic data. We examined the relationships between several variables and voice issues, including gender, class size, length of instruction, and tobacco usage. Findings: Compared with nonteachers (33.7%), teachers had a considerably greater prevalence of voice issues (69.1%). Greater class size and more than ten years of teaching experience were shown to be risk factors, while female instructors reported a greater prevalence of voice issues. Additionally, it was shown that instructors' voice issues are also linked to tobacco usage. The results of this study highlight how critical it is to provide voice therapy to educators employed in the Kathmandu District, particularly those in at-risk categories such as female instructors, more experienced educators, and educators with larger class sizes. The outcomes demonstrated important impacts on teacher well-being, job satisfaction, and academic achievement. More research and intervention strategies are needed to minimize the effects of voice problems and promote a positive teaching andlearning environment.

Immediate Effects of Cervical Mobilization on Acoustic Properties and Performance in Voice Training Students

Objective: The aim of this study was investigation of immediate effects of cervical mobilization on acoustic properties and performance in voice training students. &#x0D; Material-Method: The research was conducted on 15 female volunteer students. Acoustic properties of the voice, performance and neck mobility were evaluated. Cervical mobilization was performed by an experienced physiotherapist. Then the assessments were repeated. &#x0D; Results: There was a significant change in cervical mobilization and performance after mobilization, no significant difference was found in the acoustic properties of the voice. &#x0D; Conclusion: It was observed that a single session of cervical mobilization positively affected performance and cervical mobility.

A Structured Pre- and Post-Operative Voice Therapy Program for Benign Vocal Fold Lesions

Benign vocal fold lesions (BVFLs) are acquired structural anomalies of the vocal folds, and these are primarily a result of vocal abuse or phonotrauma. Phonotraumatic lesions are not generally regarded as recurrent, provided that appropriate behavioral changes are made after resolution or surgical removal. Voice therapy plays a crucial role in this aspect. The aim of this article is to propose a structured pre- and post-operative voice therapy program for patients undergoing surgical intervention for BVFLs. Voice therapy post-surgery has been proven to reduce the rate of recurrence in BVFLs. Having a standard treatment protocol is a useful tool for the therapist, particularly one without extensive voice training.

Rehabilitation Treatment Specification System for Voice Therapy: Application to Everyday Clinical Care.

Rehabilitation intervention descriptions often do not explicitly identify active ingredients or how those ingredients lead to changes in patient functioning. The Rehabilitation Treatment Specification System (RTSS) provides guidance to identify the critical aspects of any rehabilitation therapy and supported the development of standardly named ingredients and targets in voice therapy (Rehabilitation Treatment Specification System for Voice Therapy [RTSS-Voice]). This study sought to test the content validity of the RTSS-Voice and determine if the RTSS-Voice can be used to identify commonalities and differences in treatment (criterion validity) across clinicians in everyday clinical practice. Five speech-language pathologists from different institutions videotaped one therapy session for 59 patients diagnosed with a voice or upper airway disorder. Specifications were created for each video, and iterative rounds of revisions were completed with the treating clinician and two RTSS experts until consensus was reached on each specification. All 59 sessions were specified without the addition of any targets or ingredients. There were two frequent targets: (a) increased volition and (b) decreased strained voice quality. There were three frequent ingredients: (a) information regarding the patient's capability and motivation to perform a therapeutic behavior, (b) knowledge of results feedback, and (c) opportunities to practice voicing with improved resonance and mean airflow. Across sessions treating vocal hyperfunction, there was large variability across clinicians regarding the types and number of treatment components introduced, types of feedback provided, and vocal practice within spontaneous speech and negative practice. The RTSS and the RTSS-Voice demonstrated strong content validity, as they comprehensively characterized 59 therapy sessions. They also demonstrated strong criterion validity, as commonalities and differences were identified in everyday voice therapy for vocal hyperfunction across multiple clinicians. Future work to translate RTSS principles and RTSS-Voice terms into clinical documentation can help to understand how clinician and patient variability impacts outcomes and bridge the research-practice gap. https://doi.org/10.23641/asha.24796875.

A comparative study of stretch-and-flow voice therapy versus Smith accent method in rehabilitation of hyperfunctional dysphonia: a randomized controlled trial

BackgroundThis work aims to compare between stretch-and-flow voice therapy and Smith accent method of voice therapy in treatment of hyperfunctional dysphonia in order to assess the benefit of using this new technique in its management. A randomized controlled trial was conducted at the Unit of Phoniatrics, Otorhinolaryngology Department, in the period from November 2020 to February 2023. A sample of 60 patients with hyperfunctional dysphonia was randomly divided into two groups; each group consisted of 30 patients: “group A” who received stretch-and-flow voice therapy (SnF) and “group B” who received Smith accent (SA) method of voice therapy. Assessment included auditory perceptual assessment (APA) using modified GRBAS scale and Arabic-voice handicap index (Arabic-VHI).ResultsThe study revealed significant improvement in grade of dysphonia, voice quality, and Arabic-VHI post-therapy for both groups. There was a significant improvement regarding voice pitch in SnF group only and in loudness of voice in SA group only.ConclusionSnF can be considered as an alternative approach for treating hyperfunctional dysphonia, offering a shorter duration, and potentially being a simpler alternative for patients who struggle with the more intricate rhythms of the Smith Aaccent voice therapy method.

VOICETAINER SEBAGAI PELUANG KERJA BAGI GENERASI MILENIAL DALAM BIDANG KOMUNIKASI DAN PUBLIC SPEAKING

The ability to communicate effectively and good public speaking skills, today is indispensable for various needs, including being used and exploited as job opportunities in the field of communication and public speaking. Against this background of the need for public speaking skills, especially for the millennial generation, a public speaking workshop was held that focused on introducing and practicing voice coaches. The implementation of the public speaking workshop has two main objectives, namely: (1) Get to know the Voicetainers; (2) Practicing Voicetainer. Methodologically, this public speaking workshop activity is carried out using service learning method. At the operational level, the service learning method in this activity is carried out by teaching participants about public speaking by combining academic approaches (voicetainer concepts and theory) and training practical skills (practicing voicetainer) of activity participants in the fields of communication and public speaking which can be used as job opportunities. Specifically, this activity has been carried out well and has achieved maximum results on the following two points: (1) Workshop participants can recognize and know about a voice coach, which is a public speaking skill that can support work in the field of communication; (2) Workshop participants can practically and applicatively practice public speaking skills which can be used as job opportunities in the field of communication.