Journal of Voice最新文献

Purpose: Numerous clinical findings support the idea that increased surface laryngeal hydration prevents and manages voice problems in professional voice users. However, empirical evidence for surface laryngeal hydration (nebulized saline solution) through multidimensional voice measures is lacking, especially in speech-language pathologists (SLPs). Hence, the present study investigated the effect of surface hydration using nebulized saline solution on voice quality using thermal, acoustic, and self-perceptual measures in SLPs.

Methods: The study involved 30 SLPs divided into three groups: group I had no voice usage, group II read aloud passage for 1 hour without surface hydration, and group III read aloud passage for 1 hour with surface hydration for 10 minutes. Multidimensional voice outcomes such as thermal (front, right, and left view of the throat), acoustic (Multidimensional Voice Program), and self-perceptual (perceived phonatory effort, perceived vocal tiredness) were measured for the pretest and post test condition in all the group.

Results: Pre-post comparison shows that thermal measures showed a significant increase in group II and a significant decrease in group III. Also, fundamental frequency, perturbation, and self-perceptual measures showed a significant increase in group II compared to group III. Further, the between-group post test comparisons revealed a significant decrease in many outcome measures in group III compared to group II. The above results support that surface hydration significantly influenced the voice quality during the vocal loading task.

Conclusion: The study confirms the benefits of surface hydration using saline solution in SLPs. Surface hydration preserves vocal quality compared to those not hydrated during vocal loading.

Aim: The study aimed to understand awareness, perceptions, and barriers to voice therapy among beginners, performers, and teachers of Carnatic music.

Method: Barriers from the literature were obtained, and the guide for the semistructured interview was developed. Twelve Carnatic singers (four each identified as beginners, performers, and teachers) were contacted and interviewed on an online platform. The interviews were audio recorded and transcribed verbatim. The transcriptions were loaded and coded in the Qualitative Data Analysis Miner Lite software. The codes were grouped according to beginners, performers, and teachers. The codes were analyzed using a deductive-inductive approach, and thematic analysis was performed to report the findings.

Results and discussion: Overall, three themes emerged during thematic analysis. Beginners were familiar with the signs and symptoms of voice problems related to singing. The performers and teachers were able to identify causes related to posture and lifestyle that impacted singing. The need for seeking help differed with expertise and personal experience. Beginners believed in home remedies as their first choice and considered them sufficient to resolve voice problems. Performers and teachers believed in modifying singing techniques as a remedy to voice problems and considered medical intervention only as a second option. Mixed perceptions about the outcomes of voice therapy and the anticipation of quick results from voice therapy/therapists were major deterrents to seeking professional voice care. Beginners' views on perceptions of medical intervention for voice problems were strongly influenced by their singing teachers. Beginners also expressed limited access to voice therapy due to several logistical reasons and financial constraints as barriers to attending therapy. Performers and teachers sought medical help as a final resort since the presence of voice problems affected their livelihoods and careers.

Conclusion: This qualitative study highlights socioculturally relevant information deeply rooted in the belief systems of Carnatic musicians. These opinions from beginners, performers, and teachers are important to be addressed during counseling and awareness sessions to support vocal health in this sophisticated but vulnerable professional voice group.

Objectives: Previous research has shown that instructed manipulation of the false vocal fold activity (FVFA), true vocal fold mass (TVFM), and larynx height (LH) impacted on voice quality. It is not known whether these manipulations have any effect on voice onset. Vocal Rise Time (VRT) is an objective acoustic measure of voice onset, which has potential as an assessment tool in clinical settings. The present study aimed to investigate the effects of instructed manipulation of FVFA, TVFM, and LH on VRT.

Study design: Retrospective, observational study.

Methods: Nine vocally trained participants (five females, four males) aged between 19 and 36years were instructed to perform differential manipulation of FVFA, TVFM, and LH while phonating the prolonged /ɑ/ vowel. Recorded voice samples were edited and analyzed using a novel Python-based application, the Voice Onset Analysis Tool (VOAT) to obtain VRT results. The VRT data were compared across conditions using repeated-measures analysis of variance, and were correlated against perceptual ratings of tone onset.

Results: Reliability analysis showed excellent intra- and inter-rater agreement in VRT measurements using VOAT. All laryngeal parameters (FVFA, TVFM, and LH) showed statistically significant main effects on VRT. There was a consistent trend for thin TVFM, constricted FVFA, and lower LH to increase VRT values. However, post hoc analysis showed some statistically insignificant results possibly due to the small sample size. There was a weak positive correlation between VRT and perceptual tone onset ratings.

Conclusion: VRT measurements using VOAT are highly reliable. All three laryngeal parameters were contributors to determining voice onset. Given the limited sample size, careful definition and standardization of VRT measurement protocol is needed for it to become a useful and reliable measure of voice onset in research and clinical settings.

Purpose: This study examined the contribution of voice to the self via implicit associations.

Method: An implicit association test (IAT) of the voice and the self was created and presented to vocal performers and community controls. One-hundred eleven participants completed this voice-self IAT, the Vocal Congruence Scale (VCS), and the Voice Handicap Index (VHI) via an in-person, monitored, and timed Qualtrics survey. Student t tests comparing timing differences between congruent and incongruent conditions revealed the presence of an implicit relationship.

Results: The findings demonstrated an implicit relationship between the voice and the self as measured using the IAT. Strength of implicit relationships between self and voice was significantly greater for community controls than vocal performers. Additionally, this IAT revealed divergent validity with the VCS, and the VHI using Spearman's correlation.

Conclusion: Implications suggest that even if overt declarations are absent, individuals with an implicit voice-self relationship rely on their voice to contribute to their sense of self. This implicit relationship is greater for community members than vocal performers.

Objective: This study aimed to evaluate the influence of voice therapy on maximum phonation time (MPT) and S:Z ratio in patients diagnosed with primary muscle tension dysphonia (pMTD). The goal was to investigate whether pMTD is associated with reduced S:Z ratio and prolonged MPT.

Study design: Prospective cohort study.

Methods: A comparative analysis was conducted on a cohort of patients diagnosed with pMTD. Prevoice and postvoice therapy assessments of MPT and S:Z ratio were performed. Data from these measurements were analyzed to determine the impact of voice therapy on the studied parameters. A paired t test was used to evaluate MPT and S:Z ratio pretherapy and post therapy.

Results: Fifty-two patients met the inclusion criteria for the study, having completed a laryngology evaluation with diagnosis of pMTD and agreeing to voice therapy between July 22, 2021, and April 4, 2023. Sixteen of these patients completed a full course of voice therapy. The Voice Handicap Index-10 (VHI-10), MPT, and S:Z ratio were measured during initial evaluation as part of a complete laryngeal function study. A statistically significant reduction in VHI-10 scores was observed, with values decreasing from 17.81 (±2.81) pretherapy to 8.81 (±1.8) post therapy (P < 0.001). However, no significant differences were detected in MPT or the S:Z ratio following the intervention.

Conclusions: There is a lack of correlation between subjective evaluations of voice (VHI-10) and objective assessments (MPT and S:Z ratio), indicating that these objective parameters may not accurately reflect changes in voice quality following therapy in the pMTD population.

Lay summary: MPT and S:Z ratio do not appear to be uniformly impacted in patients with pMTD. Moreover, these measures do not consistently improve following voice therapy for pMTD.

Background: Communication impairments significantly impact the quality of life for individuals with Parkinson's disease (PD), underscoring the need for effective interventions. Singing, by engaging shared neural networks and structural mechanisms involved in speech production, holds therapeutic potential for addressing speech disorders in this population. This study explores the effects of singing-based therapeutic intervention on voice in patients diagnosed with PD.

Methods: We systematically searched four electronic databases to find relevant studies. Data extraction and analysis involved calculating mean differences (MD) or standardized mean difference (SMD) for pre- and post-singing interventions, including their 95% confidence intervals (CI). Statistical significance was evaluated with a P-value threshold >0.05.

Results: Our systematic review and meta-analysis included 21 studies, encompassing 449 patients. Singing showed no significant effect on speaking fundamental frequency (MD 2.98, 95% CI: -6.79, 12.75, P = 0.55), jitter (MD -0.13, 95% CI: -0.47, 0.22, P = 0.47), shimmer (MD -0.71, 95% CI: -1.68, 0.26, P = 0.15), or health-related quality-of-life outcomes: Voice Handicap Index (MD -4.60, 95% CI: -9.29, 0.09, P = 0.05) and Voice-Related Quality of Life (SMD 0.08, 95% CI: -0.28, 0.44, P = 0.65). However, singing significantly improved vocal frequency range (MD 2.60, 95% CI: 1.17, 4.03, P = 0.0004), maximum expiratory pressure (MD 14.26, 95% CI: 9.57, 18.96, P < 0.00001), maximum inspiratory pressure (MD 6.22, 95% CI: 2.96, 9.48, P = 0.0002), and maximum phonation time (MD 1.83, 95% CI: 0.73, 2.92, P = 0.001). Vocal intensity showed no significant difference (MD 1.09, 95% CI: -0.71, 2.88, P = 0.24).

Conclusion: Our study found that singing interventions positively affect vocal frequency range and respiratory outcomes. However, significant changes were not observed in other speech metrics.

Objective: This study aimed to validate the French adaptation of the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V_f) for assessing voice disorders in France. The CAPE-V_f addresses limitations of the GRBAS by providing a more sensitive, standardized approach to evaluating six vocal parameters (overall severity, roughness, breathiness, strain, pitch, and loudness) on three tasks (sustained vowels, sentence reading, and spontaneous speech). The study focused on investigating the intra- and inter-rater reliability, as well as the convergent and discriminant validity of the CAPE-V_f.

Methods: Thirty-four dysphonic and seven euphonic native French speakers participated in the study. Thirteen speech-language pathologists from France evaluated the voice samples using both the CAPE-V_f and GRBAS tools at a one-week interval. Intra- and inter-rater reliability were calculated using intraclass correlation coefficients (ICC), while convergent and discriminant validity were measured by correlating CAPE-V_f with GRBAS and Voice Handicap Index (VHI) scores, respectively.

Results: The CAPE-V_f showed good intra-rater reliability for overall severity (mean ICC: 0.89), strain (ICC: 0.83), and pitch (ICC: 0.88), while roughness, breathiness, and loudness exhibited moderate reliability. Inter-rater reliability was low for most parameters, except overall severity, which demonstrated good reliability (mean ICC: 0.77). Strong correlations were observed between CAPE-V_f and GRBAS Grade (mean r: 0.84), supporting its convergent validity. Moderate correlations were found for roughness, breathiness, and strain. The CAPE-V_f's correlation with the VHI was moderate (mean r: 0.53), reflecting its discriminant validity.

Conclusion: The CAPE-V_f is a valid and reliable tool for perceptual assessment of voice disorders in French-speaking populations, with stronger psychometric properties than the GRBAS, particularly for intra-rater reliability and overall severity. While inter-rater reliability was lower, qualitative feedback suggested that improvements to the protocol, particularly for pitch and loudness ratings, could enhance its clinical applicability. The findings support the CAPE-V_f as a comprehensive tool for standardized clinical voice assessment.

Background: In voice clinics, vocal effort is a prevalent complaint, with around 25% of clinicians citing it as the primary issue.

Aim: This study had two objectives. First, it sought to establish the prevalence of vocal effort, both as the primary and the only symptom, among patients receiving treatment from clinicians specializing in voice disorders in various countries across South and North America. Second, this study aimed to distinguish key factors, including country of clinical practice, clinicians' experience, and the instruments employed to assess effort, associated with the identification of vocal effort.

Methods: This cross-sectional study surveyed speech-language pathologists (SLPs) from North and South America on vocal effort in patients. The survey covered SLP demographics, caseload composition, patient challenges, and measures of vocal effort that were used. Statistical analysis assessed relationships between SLP demographics, caseload, and vocal effort factors.

Results and conclusion: The results suggest significant geographical variations in SLPs' experiences with vocal effort. Colombian clinicians report significantly fewer voice cases and a lower proportion of vocal effort in their caseload, while Argentinian clinicians were more likely to report vocal effort in their voice cases. Years of experience were identified as a significant predictor of a higher likelihood of a voice-dominant caseload and higher rates of vocal effort among patients. Interestingly, using the Vocal Fatigue Index during the assessments increased the likelihood of reporting vocal effort in the clinicians' caseload. These findings suggest a potential association between experience, outcome measure selection, and vocal effort caseload. These lead to suggestions that opportunities for additional voice disorder training beyond that which SLPs find in school are valuable.

Objective: To investigate the correlation between anxiety, depression, and self-perceived vocal handicap in Lebanese patients with voice disorders.

Study design: Prospective cohort.

Methods: All patients who presented to the voice clinic of a tertiary referral center with hoarseness between November 2023 and June 2024 were invited to participate in this prospective study. All patients were asked to complete the Voice Handicap Index-10 (VHI-10), the Generalized Anxiety Disorder scale-7 (GAD-7), and the Patient Health Questionnaire-9 (PHQ-9).

Results: A total of 100 patients were enrolled in this study. The study group included 56 men and 44 women. The mean age of the participants was 46.03 ± 11.66 years. The mean VHI-10 score was 13.41 ± 6.39. Based on the GAD-7 score, 12 patients had minimal anxiety, 24 had mild anxiety, 43 had moderate anxiety, and 21 had severe anxiety. Patients with moderate or severe anxiety had a significantly higher VHI-10 score than those with minimal anxiety (P < 0.05). There was a mild positive correlation between level of anxiety and the VHI-10 score (r = 0.276). Based on the PHQ-9 score, 50 patients had minimal depression, 30 had mild depression, and 20 had moderate depression. Patients with moderate or mild depression had a significantly higher VHI-10 score than those with mild depression (P < 0.05). There was a mild positive correlation between level of depression and the VHI-10 score (r = 0.316).

Conclusions: Anxiety and depression are common in Lebanese patients with voice disorders. Self-perceived vocal handicap correlated positively with the level of anxiety and depression. A multidisciplinary approach is recommended to optimize treatment of patients with voice disorders and mental illnesses.