Journal of Voice最新文献

Behavioral voice therapy and voice training often rely on auditory perceptual prompts and oral sensations to communicate the intended voice production and voice quality. Due to the subjective nature, voice quality perception and sensations vary depending on listeners' experience and do not always allow precise communication of treatment plans and training goals in clinical voice care or voice training. A possible alternative is to describe voices using the underlying anatomical and physiological configurations that are used to produce them. This approach may provide a common, objective framework that allows precise communication of the target voice production and voice quality. The goal of this study is to evaluate how accurately laryngeal and epilaryngeal configurations can be perceived by listening to the voice in the framework of the Estill Voice Model. The results show that with training focused on both physiology and auditory perception of the voice, listeners are able to perceive laryngeal and epilaryngeal configurations with an accuracy much higher than the chance level. However, our results also show that some physiological combinations are more challenging to perceive than others, which implies either anatomical or physiological constraints or conflicting/redundant acoustic consequences.

Voice disorders are multidimensional phenomena involving anatomical and physiological features alongside emotional, behavioral, and psychological aspects. Although the literature acknowledges the relevance of psychological factors in voice disorders, the structured incorporation of psychological approaches into voice therapy remains limited. This article addresses that gap by presenting a preliminary framework for integrating acceptance and commitment therapy (ACT) principles into voice therapy. ACT is a well-established psychological approach with demonstrated adaptability across various professions and contexts. The six core processes of ACT are briefly outlined and contextualized, followed by practical suggestions and clinical examples illustrating their potential application in routine voice therapy. ACT is presented as a flexible, accessible, and theoretically coherent approach that may enhance the personalization and effectiveness of voice therapy. While these suggestions are grounded in conceptual reasoning and extensive clinical experience, further research is needed to systematically examine their application and outcomes. Moreover, training models for speech-language pathologists should be developed to provide clinicians with the tools and confidence to apply ACT principles as part of their professional scope. While this article is not intended to serve as a comprehensive manual for therapy, it offers an initial conceptual framework. This preliminary contribution aims to encourage clinicians and researchers to expand the therapeutic framework of voice therapy by incorporating psychological flexibility, acceptance, and values-based action.

Objectives: Flexible nasendoscopy (FNE) is a commonly undertaken procedure in Otolaryngology, enabling a dynamic evaluation of the structure and function of the upper aerodigestive tract. Despite FNE being performed routinely in clinical practice, studies investigating the associated complications are lacking. The aim of this prospective case series is to evaluate patient experience and complications associated with FNE.

Methods: This prospective consecutive case series evaluates the experience of 143 patients undergoing assessment for laryngeal pathology. A questionnaire was given to 181 consecutive patients prior to their outpatient appointment. The forms offered the patients the opportunity to evaluate apprehension prior to FNE, perceived pain during FNE, and decisional regret following FNE, by means of visual analog scale scores. Patient-reported complications were categorized into eight domains and collected prospectively. Responses were collected and the data analyzed using GraphPad Prism Version 10.4.1 (532).

Results: Out of 181 patients, 143 (79%) answered the questionnaire. Mean apprehension score was 24.8%, mean pain score 18% and mean decisional regret score 3.7%. Eighty-eight patients (62%) experienced no complications associated with FNE. Fifty-five patients experienced between 1 and 4 complications each. Forty patients (28%) experienced gag reflex activation, 24 patients (16.8%) experienced cough, and 10 (7%) reported sore throat as a result of FNE. One patient experienced epistaxis, and no patients had vasovagal syncope. Ten patients (7%) required a topical anaesthetic to tolerate the procedure, 2 patients (1.4%) required alternative examination with a rigid nasendoscope, and for 1 patient, the procedure was abandoned due to equipment malfunction.

Conclusions: FNE is a safe, commonly performed procedure. The rate of individual complications in this prospective case series is low. This study's findings have the potential to enhance the process of informed consent by enabling clinicians to refine their practice in offering a clearer understanding of the incidence of common complications of FNE.

Level of evidence: Uncontrolled prospective case series of consecutive patients: Level IV.

Purpose: This study examined whether visual spatial cues presented in immersive virtual reality (IVR)-room size and speaker-to-listener distance-are associated with changes in vocal production, and whether these effects differ between trained singers ("experts") and untrained speakers ("novices").

Methods: Eight participants (four experts, four novices) completed speech tasks across eight IVR conditions presented in randomized order, manipulating room size (small, large) and speaker-to-listener distance (1 m, 3 m, and 15 m), as well as their combined conditions. Voice recordings were analyzed to extract sound pressure level (SPL; dB) and mean speaking fundamental frequency (f₀) (mean f₀: Hz), which were then examined using linear mixed-effects models.

Results: For SPL, Listener Distance was significant and interacted with Group, indicating distance-dependent group differences. Experts showed significant within-group SPL differences across distance conditions, whereas novices demonstrated fewer significant distance-related contrasts. Room Size was not significant. For mean f₀, significant effects were observed for Group and Listener Distance, along with a Group × Listener Distance interaction. Follow-up contrasts indicated significant distance-related mean f₀ modulation within the expert group, whereas within-novice distance contrasts were not significant after Holm correction.

Conclusions: These preliminary findings indicate that visually specified speaker-to-listener distance influenced vocal intensity and mean f₀, whereas room size alone showed limited effects under acoustically controlled conditions. The results also suggest that vocal training may be associated with differential use of visual information, with experts demonstrating more flexible modulation across distance cues and novices showing comparatively limited adjustment. IVR was feasible for delivering controlled visual manipulations. Further work incorporating perceptual outcomes and more ecologically representative sensory feedback will help clarify underlying mechanisms and clinical significance.

Objective: The aim of this study was to evaluate the relationship between laryngopharyngeal reflux (LPR) and a new anthropometric indicator, the body roundness index (BRI).

Method: In this retrospective case-control study, adults with LPR (n = 89; reflux symptom index [RSI] > 13 and RFS>7) and controls (n = 94; RSI ≤ 13 and reflux finding score [RFS] ≤ 7) underwent anthropometry (body mass index [BMI]; BRI; body fat percentage [BF%]; visceral adipose tissue, [VAT]), patient-reported scales (Turkish voice handicap index-10, Turkish Eating Assessment Tool-10), and acoustic analysis (fundamental frequency, jitter%, shimmer%, harmonic-noise ratio, cepstral peak prominence smoothed [CPPS], acoustic voice quality index-3.0). Group differences were assessed with Mann-Whitney U. Multiple testing was controlled with Benjamini-Hochberg false discovery rate (FDR). Effect sizes were summarized by Hodges-Lehmann median difference and rank-biserial correlation (r_rb).

Results: The groups were similar in terms of age, gender, and BMI (P > 0.05). BRI showed no association with LPR (median 6.10 vs 5.20; P = 0.130; q = 0.239; r_rb = 0.13). VAT (percentage and total mass) likewise did not differ (all q ≥ 0.32). In contrast, BF% was higher in LPR overall (Δ = +2.55%; P = 0.006; q = 0.064; r_rb = 0.24), driven by men (P = 0.002; q = 0.004; r_rb = 0.40), while women showed no clear difference. Nominal acoustic differences (higher jitter%, lower CPPS) did not survive FDR correction and had small effect sizes (|r_rb|≤0.18).

Conclusion: BRI did not discriminate LPR, and VAT estimates were likewise uninformative. In contrast, directly measured BF%, particularly in men, showed a modest association with LPR status, suggesting that simple, direct adiposity assessment may be more clinically meaningful than shape indices when evaluating patients with suspected LPR. Prospective studies should test gender-specific thresholds and incorporate objective reflux monitoring to clarify causality.

Background: Music therapists are professional voice users who rely extensively on both singing and speech in clinical practice, putting them at risk for developing voice disorders. Although vocal health education has been shown to reduce the incidence of voice problems among other professional voice users such as educators and singers, there is limited evidence concerning their effectiveness for music therapists.

Objective: This study aims to evaluate the impact of a 4-week online vocal health education program for music therapists by examining changes in self-perceived knowledge, confidence, awareness, practice, and overall vocal health. It also explores participants' experiences of the program, including motivations, perceived benefits, and challenges.

Methods: A convergent parallel-mixed methods design was employed. Seven music therapists enrolled, and six completed all components of the program, which comprised 4 weekly 1-hour online sessions integrating theoretical content with practical exercises. Quantitative data was collected through pre- and post-program 14-item surveys and analyzed using descriptive and inferential statistics. Qualitative data from a post-program focus group was analyzed thematically.

Results: Mean scores increased on 12 of 14 survey items, indicating perceived improvements in vocal health knowledge, awareness, and confidence. The largest gains were in regular use of vocal warm-ups, understanding of vocal health strategies and recovery techniques, and confidence in managing fatigue. Slight increases in reported discomfort and fatigue were noted following the program. Thematic analysis revealed three overarching themes: (i) rationale for participation, (ii) program reflections and experiences, and (iii) recommendations for future program delivery.

Conclusion: Findings suggest that a brief online vocal health education program is well-received and beneficial in enhancing music therapists' awareness, confidence, and self-reported vocal health practices. Larger longitudinal studies are warranted to examine long-term effects on vocal health and to inform the development of specialized training within music therapy education and professional development.

Objective: The aim of this study was to compare the voice characteristics of obese and non-obese individuals using auditory-perceptual evaluation, self-assessment tools, traditional acoustic parameters, and multiparametric acoustic measures, and to examine the relationship between body mass index (BMI) and voice parameters in individuals with obesity (IwO).

Material and methods: This prospective cross-sectional comparative study included 86 participants (43 obese, 43 non-obese). Assessments comprised maximum phonation time (MPT), auditory-perceptual evaluation with the Grade, Roughness, Breathiness, Asthenia, and Strain (GRBAS) scale, acoustic analysis including fundamental frequency (F0), jitter, shimmer, harmonics-to-noise ratio (HNR), acoustic voice quality index (AVQI), acoustic breathiness index (ABI), and dysphonia severity index (DSI) using PRAAT software, as well as self-assessment tools including the voice-related quality of life (V-RQOL) scale and the vocal fatigue index (VFI).

Results: IwO showed significantly shorter MPT and lower HNR, as well as higher AVQI and ABI scores and lower DSI values compared with non-obese individuals (P < 0.005). In the study group, V-RQOL scores were lower, and VFI scores were higher (P < 0.001). GRBAS ratings revealed higher scores for GRBS in IwO (P < 0.05). In addition, BMI demonstrated moderate and significant correlations with several parameters, including GRB, MPT, F0, AVQI, ABI, DSI, V-RQOL, and VFI (P < 0.05).

Conclusions: Voice was adversely affected in IwO, and correlations with BMI showed that increasing obesity severity was linked to greater deterioration in voice parameters. Using multiparametric acoustic tools alongside traditional measures may enable a more comprehensive evaluation in this population.

Objective: The purpose of this scoping review was to determine the inclusion and exclusion criteria typically used for human participants when conducting occupational vocal function research.

Methods: A scoping review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines searching PubMed/MEDLINE (Ovid), APA PsychInfo, and Web of Science with a cover period between January 1, 2018 and September 15, 2023. Studies performed on human participants and published in English were included in this study. In addition, studies were required to use human participants (all ages and sexes) who were occupational voice users. Articles using the following study designs were included: experimental (randomized controlled trials, quasi-experimental) and nonexperimental (observational, cross-sectional). Review articles, case reports, editorials, meta-analysis, and opinion pieces were excluded from review, as well as studies that included participants with head and neck cancer.

Results: A total of 71 studies were included in this scoping review. Data extraction and analysis revealed that variables of sex and vocal health were consistently accounted for in research; however, inclusion/exclusion variables such as gender, hydration, and medication use were rarely included.

Conclusion: This scoping review highlights the need to consider more expansive inclusion/exclusion criteria as relates to factors that could impact objective measures of vocal function. Moreover, developing consistent inclusion and exclusion criteria across studies may help clinicians generalize findings to clinical populations.

Objectives: Altered respiratory kinematics are thought to contribute to primary muscle tension dysphonia (pMTD) symptoms such as vocal effort, fatigue, and discomfort. Although speech-language pathologists (SLPs) often comment on respiratory patterns during voice evaluations, it remains unclear which visual-perceptual cues they rely on for clinical decision-making and how accurate these patterns are for identifying patients with pMTD. As such, this study aimed to (1) identify the respiratory patterns SLPs perceive in pMTD and (2) evaluate their diagnostic accuracy in distinguishing pMTD from vocally healthy controls.

Methods: Forty-six participants (21 pMTD, 25 controls) performed voice tasks varying in intensity and articulatory complexity, while six synchronized cameras captured perilaryngeal-respiratory movements. Five blinded, fellowship-trained SLPs rated breathing normality, severity (0-10), presence of pMTD (Y/N), and confidence (0-10). Open-ended responses were analyzed using natural language processing (NLP) and reflexive content analysis (RCA).

Results: NLP analysis identified five visual-perceptual respiratory features: abdominal, anterior neck tension, clavicular, thoracic, and suboptimal breathing-none of which reliably distinguished pMTD from vocally healthy controls (average diagnostic accuracy = 60%; d' ≤ 1.04). RCA methods yielded three categories: Observable Features of Movement and Breathing, Perceived Patient Experiences, and Interpreting and Evaluating Data.

Conclusion: Observable respiratory patterns were inconsistently linked to diagnostic accuracy. Visual observation alone appears insufficient for reliably identifying pMTD, underscoring the need for multimodal physiological approaches to improve diagnostic specificity.

While binary discrimination between healthy and pathological voices provides initial screening capability, clinical utility requires accurate multi-class classification to distinguish between different pathology types. This paper presents a novel Auditory Feature Extraction (AFE) approach, inspired by auditory perception mechanisms, for a robust multi-class pathological voice recognition (PVR) system. The proposed approach uses a Gammachirp FilterBank (GCFB) to accurately simulate the spectral behavior of the cochlea. This FilterBank is considered an efficient auditory filter model and contains 128 Gammachirp auditory filters with center frequencies equally distributed according to the Equivalent Rectangular Bandwidth-rate scale. The GCFB output undergoes decimation, cubic-root amplitude compression, and then Discrete Cosine Transform to finally generate the AFE coefficients. We evaluated the performance of the proposed AFE approach for PVR using Hidden Markov Model Toolkit on two widely recognized datasets: the Saarbruecken Voice Database (SVD) and the Massachusetts Eye and Ear Infirmary (MEEI) dataset. Our AFE outperforms state-of-the-art approaches as revealed by assessment results compared to Human Factor Cepstral Coefficients (HFCC), Frequency Domain Linear Prediction (FDLP), and Mel-Frequency Cepstral Coefficients (MFCC). AFE approach achieves 99.75% balanced accuracy in binary voice classification (95.6%, 94.8%, and 93.85% for HFCC, FDLP, and MFCC, respectively) and 94.38% balanced accuracy in multi-class pathologic voice classification (72.93%, 69.66%, and 60.03% for HFCC, FDLP, and MFCC, respectively) on the SVD dataset, while accomplishing 100% balanced accuracy on the MEEI database. These findings suggest the AFE approach provides a robust and highly discriminative feature set that could lead to an improved voice pathology classification, then a better clinical screening of voice disorders.