Journal of Voice最新文献

Objective/hypothesis: This study sought to determine any differences in presenting complaints of dysphonia, diagnoses found, and the selected management in a group of 100 pediatric performers compared to a group of 100 pediatric non-performers.

Study design: Retrospective descriptive study with chart review of 200 children evaluated at a pediatric Voice Clinic for primary report of dysphonia.

Subjects and methods: Medical records of 200 children (100 consecutive performers, 100 consecutive non-performers) with a chief complaint of dysphonia were reviewed for history, diagnosis, and management.

Results: Singers' performing levels included avocational, professional, solo performer, choral, musical theatre classical, and pop/commercial. The age range for singer patients was 8-20 years, while the age range for non-singer patients was 4 months to 21 years. Females dominated the singer group (27 males,73 females) while males dominated the non-singer group (58 males, 42 females). Organized sports involvement was similar for both groups. Voice disability (pediatric voice handicap index) was rated significantly higher for non-singers (non-singers 37.9, singers 21.5). The most common diagnoses for singers were reflux, allergic rhinitis, muscle tension dysphonia, and vocal fold mass. The most common diagnoses for non-singers were vocal fold mass, reflux, vocal fold paralysis, and tonsillar hypertrophy. Non-singers were referred for phono-surgery and tonsillectomy at a significantly higher incidence compared to the singer group. Referrals to gastroenterologist and referrals to allergist were similar between groups.

Conclusions: Laryngologists need to recognize the complexity of performance demands on the pediatric performer, as well as recognizing their concerns, as well as those of their support team, while still addressing common childhood diagnoses. Reflux laryngitis was a common diagnosis in both groups, but at a significantly higher incidence for singers. Vocal fold mass was a common diagnosis in both groups, but at a significantly higher incidence for non-singers.

Aim and objectives: Voice therapy is often described as a "black box," with insufficient detail on the active therapeutic components driving change. This study aimed to qualitatively analyze the structure, techniques, and pedagogical features of complete vocal technique-voice therapy (CVT-VT) for the treatment of primary muscle tension dysphonia (pMTD), using thematic analysis and the rehabilitation treatment specification system (RTSS).

Study design: Qualitative continuation of a preregistered feasibility and acceptability trial.

Methods: Fourteen adults with pMTD were recruited at a National Health Service voice clinic; eleven completed the CVT-VT protocol (average 4.2 sessions) and attended the follow-up research clinic. Fifty-four recorded therapy sessions were transcribed and analyzed through reflexive thematic analysis, followed by consensus classification according to the RTSS framework. Triangulation was achieved using session transcripts, practitioner patient journal notes, and multi-investigator analysis incorporating perspectives of speech-language pathology, singing voice rehabilitation, and vocal pedagogy.

Results: Thematic analysis identified five overarching themes: (1) demystifying voice physiology, (2) (re)coordinating breath and phonation, (3) working toward a clear sound, (4) avoiding uncontrolled constrictions, and (5) designing one's own sound. RTSS consensus analysis specified 10 treatment targets (eg, increased clear voice, improved stamina, patient empowerment, and achieving healthy loudness) and their ingredients, highlighting both functional exercises (eg, voiced fricatives, SOVTEs, epilaryngeal narrowing, and metallic voice production) and pedagogical strategies (eg, structured feedback, motivational scaffolding, promoting growth mindset, and self-efficacy building). CVT-VT emphasized coordinated control of respiratory, phonatory, and resonatory subsystems, with deliberate progression from therapist guidance to patient independence.

Conclusion: CVT-VT represents a functionally oriented, patient-centered intervention for pMTD that integrates explicit pedagogy with deliberate therapeutic practice. Findings highlight the value of qualitative inquiry to examine not only what therapy is delivered, but how it is pedagogically delivered. The findings participate in opening the "black box" of therapy, detailing active components and mechanisms of action, and suggest potential for reduced treatment duration compared with traditional voice therapy. Further evaluation in randomized controlled trials with extended follow-up is warranted.

Trial registration: Clinicaltrials.gov website (NCT05365126 Unique Protocol ID: 19ET004). Registered 06 May 2022.

Maximum phonation time (MPT) is commonly used as an indication of phonatory function. However, MPT varies considerably depending on several factors, for instance, laryngeal valving, ie, the completeness of glottal closure. This parameter is closely related to phonation type, which can vary along the continuum between weak and firm glottal adduction, resulting in an abundant and reduced glottal airflow, respectively, ie, Breathy and Pressed phonation. This investigation analyzes the effects of both phonation type and flow rate on MPT, hypothesizing that Pressed and Breathy phonations produce extremes of MPT variation. Audio and lung volume were recorded in 14 singers experienced in performing different singing genres. They sustained the vowel /a/ as long as they could, after a maximum inhalation, a task repeated in Breathy, Flow, Neutral, and Pressed phonations. Real-time visual feedback of sound level and fundamental frequency was provided by means of the FonaDyn software, helping participants to keep these parameters constant across different degrees of vocal fold adduction. The relationship between flow rate, phonation, and MPT was analyzed using multilevel Bayesian models. Such models offer a better quantification of uncertainty, full probability distributions, and the ability to integrate the results of previous experiments into current analyses as compared to equivalent frequentist models. The results suggested that MPT varies with both flow rate and phonation type: the former is a stronger standalone predictor of MPT than the latter. The implication of such a finding is that, when access to flow data is not available, MPT is still a useful metric, provided that control for phonation type is considered. Indeed, much of the variation of published MPT data may reflect phonation type differences. Thus, future investigations should control for phonation type when MPT data are compared.

Objective: Diagnosing laryngopharyngeal reflux (LPR) is challenging due to the overlap of its symptoms with those of other conditions. The Reflux Symptom Score-12 (RSS-12) is a condensed version of the RSS questionnaire to facilitate LPR assessment in clinical practice. This study aimed to validate the German version of the RSS-12 (G-RSS-12) and evaluate its reliability, clinical validity, and responsiveness.

Study design: A prospective, controlled, cross-sectional study.

Methods: This single-center study included 73 patients with LPR symptoms and 50 healthy controls. The participants underwent clinical examination, neck sonography, and 24-hour pH monitoring to confirm LPR. Participants completed the G-RSS-12 and the German version of the Reflux Symptom Index (G-RSI). Thirty-seven patients with confirmed LPR underwent 12-week treatment with pantoprazole 20 mg twice a day. Responsiveness to treatment and the G-RSS-12 cutoff for determining the presence or absence of LPR were examined.

Results: The G-RSS-12 demonstrated high internal consistency (Cronbach's α = 0.809, N = 123) and excellent test-retest reliability (ICC = 0.98, N = 37). Construct validity was supported by significant differences in scores between patients and controls (P < 0.001). G-RSS-12 showed high criterion validity, correlating strongly with the G-RSI (rho = 0.895, P < 0.001, N = 123). Responsiveness was evident, with significant improvements in scores after treatment (P < 0.001, N = 37). A G-RSS-12 cutoff value of 12 indicated LPR with high sensitivity (97.30%) and specificity (91.70%).

Conclusions: G-RSS-12 demonstrated superior discriminative properties compared with G-RSI. G-RSS-12 proved to be a highly reliable, valid, and responsive tool for assessing LPR symptoms and monitoring treatment outcomes in German-speaking populations.

Objective: Adductor laryngeal dystonia (AdLD) is a task-specific focal dystonia characterized by involuntary vocal fold hyperadduction and impaired voice quality. While reduced cortical inhibition is a hallmark of AdLD, its relationship to acoustic measures of voice dysfunction remains unclear. This study investigated whether intracortical inhibition, as measured by the cortical silent period (cSP) from the laryngeal motor cortex (LMC), is associated with cepstral peak prominence (CPP), a quantitative acoustic marker of voice harmonic periodicity.

Methods: Thirty-two participants (17 AdLD, 15 controls) underwent transcranial magnetic stimulation with fine-wire electromyography targeting the LMC to measure cSP. Acoustic recordings of sustained vowels and connected speech were used to derive CPP. Linear models were used to assess the relationship between cSP, CPP, and perceptual voice severity (Consensus auditory-perceptual evaluation of voice overall severity ratings).

Results: Participants with AdLD exhibited significantly shorter cSP durations and lower CPP values than controls (P < 0.05). Across all participants, longer cSP durations were significantly associated with higher CPP values (β = 0.075, P = 0.03), indicating that greater cortical inhibition is associated with better harmonic periodicity in the voice. However, cSP did not independently predict perceptual voice severity after adjusting for age and CPP.

Conclusion: These findings link impaired cortical inhibition in the LMC to less harmonic periodicity in AdLD, supporting a mechanistic role for disinhibition in dysphonic voice production. While cSP did not improve the prediction of perceptual severity, it may serve as a physiological correlate of acoustic dysphonia and a potential biomarker for future neuromodulatory interventions.

Objectives: This study investigated the effects of four common semioccluded vocal tract exercises (SOVTEs)-tongue trill, lip trill, straw phonation, and water resistance therapy (WRT)-in primary muscle tension dysphonia (MTD).

Study design: Double-blind randomized controlled trial.

Methods: The participants who included 30 females with primary MTD were randomly assigned to one of four experimental SOVTE groups and a vocal hygiene (control) group. Each participant underwent four voice therapy sessions, conducted twice weekly. Aerodynamic, acoustic, auditory-perceptual, and self-assessments were performed before and after the interventions.

Results: Within-group comparisons indicated a significant improvement in maximum phonation time (MPT) following lip trill, straw phonation, and WRT (P < 0.05). No significant changes were observed for acoustic measures in SOVTE groups (P > 0.05). The overall severity of dysphonia significantly decreased after tongue trill and straw phonation. Frequency and severity of vocal tract discomfort (VTD) and the voice handicap index (VHI) showed significant improvements after straw phonation and WRT (p< 0.05). In the control group, only acoustic measures and VHI changed significantly (P < 0.05). Between-group comparisons revealed significant improvement only in the MPT and VTD. Post hoc analyses demonstrated that MPT improvement was significantly greater in the straw phonation compared with other groups (P < 0.05; η² ≥ 0.14). Additionally, significant differences were observed between trills, tongue trill and WRT, and WRT and vocal hygiene for the VTD (P > 0.05; η² ≥ 0.14).

Conclusion: All SOVTEs were effective in primary MTD. Although certain SOVTEs demonstrated significant improvements in MPT and VTD, no single exercise was identified as the most beneficial. Future studies with larger sample size and objective measures are recommended.

Objectives: A systematic investigation of the posterior glottal gaps, opening and closing vibratory patterns, and mucosal wave amplitude in children with nodules compared to vocally healthy controls.

Methods: High-speed videoendoscopy (HSV) recordings were obtained from 20 children with vocal fold nodules (10 boys, 10 girls). Sustained phonation on vowel /i:/ was elicited. The posterior glottal gap, the mucosal wave amplitude, and the opening and closing phase anterior-posterior (AP) vibratory patterns along the entire vocal folds (VFs) and at the nodule location were rated by two raters, using a custom visualization tool. Similarly, data obtained from vocally healthy adults and children from a previous study were used as control. Between groups, differences were assessed using Pearson's chi-square, followed by post hoc Mann-Whitney U tests.

Results: Posterior glottal gaps were more frequent in girls with nodules, compared with specific vocally healthy control groups, particularly adult men (P < 0.001), who showed fewer and smaller gaps. Opening patterns initiating posteriorly were common across pediatric groups; however, boys with nodules exhibited mostly opening patterns initiating at the ends (P < 0.001). Children with nodules, especially girls, demonstrated mostly the middle progressing toward both ends or simultaneous closure, while control girls (P < 0.05) and women (P < 0.01) mostly showed an anterior-to-posterior pattern. The male groups showed less differences. In the vibratory patterns at the nodule location, no statistically significant influence of sex was visible. Opening at the nodule most frequently occurred later relative to other locations, while simultaneous closing was the most frequent closing pattern.

Conclusion: This study identified sex- and pathology-related differences in pediatric VF vibration, particularly in glottal gap configuration, AP vibratory coordination, and mucosal wave amplitude. The findings offer valuable benchmarks for visual-perceptual assessment and highlight the diagnostic potential of HSV in differentiating healthy pediatric voice production from pathology.

Musicians are a high-risk population susceptible to various occupation-related health issues. Conservatorium singing students' risk of vocal injury increases as more time is spent practising and performing. Singers are particularly vulnerable to the negative effects of social and recreational voice use. Conservatorium singing students have demonstrated little awareness on vocal health and well-being. Understanding the barriers to good vocal health will allow for targeted strategies to minimize the development and continuation of negative vocal health habits. The aim of this study is to investigate students' current vocal health behaviors. A qualitative design was used. Vocal teachers, voice students, and independent accredited practising speech pathologists who specialized in voice participated in iterative semi-structured interviews. Data were transcribed verbatim, analyzed thematically, and interpreted through the Capability, Opportunity, Motivation, Behavior (COM-B) Model for Behavior Change. Students' limited knowledge in vocal anatomy and physiology hindered their engagement in vocal hygiene practices and articulate their concerns. This contributed to hesitation in seeking professional help and passive vocal health behaviors. Voice teachers were committed to student well-being but struggled to make vocal health concepts accessible in their teaching. Both voice teachers and students reported that more formal support is needed within conservatoria to aid students in accessing relevant health professionals. This study provided the foundation for a collaborative, multidisciplinary approach to vocal health education from health professionals and vocal teachers. Results will inform the design of a vocal health education program for conservatorium singers to provide students with the skills to manage their vocal health.