Voice Disorders

Singing voice is a special subgroup within the field of voice. In addition to the differences in physiology between singing and speaking voice, singer patients are often regarded as a challenge for the otolaryngologist. The reason for this is probably that the field of voice has not received as much attention as others in our speciality. Moreover, in the case of singers, empathy is vital in the doctor-patient relationship, and, as in many other cases, it forms part of the therapeutic effect. In order to achieve this, the physician has to know what singers are and which are the main pathologies they suffer, how they are formed and how they are expressed. This review offers an overlook of the pathological-physiology of singing voice from a double point of view, scientific and artistic, which in the case of singing are inevitably linked.

We quantified the recovery of voice following a 2-hour vocal loading exercise (oral reading). Eighty-six adult participants tracked their voice recovery using short vocal tasks and perceptual ratings after an initial vocal loading exercise and for the following 2 days. Short-term recovery was apparent, with 90% recovery within 4 to 6 hours and full recovery at 12 to 18 hours. Recovery was shown to be similar to a dermal wound healing trajectory. The new recovery trajectory highlighted by the vocal loading exercise in the current study is called a vocal recovery trajectory. By comparing vocal fatigue to dermal wound healing, this trajectory is parallel to a chronic wound healing trajectory (as opposed to an acute wound healing trajectory). This parallel suggests that vocal fatigue from the daily use of the voice could be treated as a chronic wound, with the healing and repair mechanisms in a state of constant repair. In addition, there is likely a vocal fatigue threshold at which poi...

The introduction, in the late 70s, of the first digital spectrograph (DSP Sonograph) by Kay Elemetrics has improved the possibilities of spectroacoustic voice analysis in the clinical field. Thanks to the marketing, in 1993, of the Multi Dimensional Voice Program (MDVP) advanced system, it is now possible to analyse 33 quantitative voice parameters which, in turn, allow evaluation of fundamental frequency, amplitude and spectral energy balance and the presence of any sonority gap and diplophony. Despite its potentials, the above-mentioned system is not widely used yet, partly on account of the lack of a standard procedure. Indeed, there are still only a few case reports in the literature taking into consideration prescriptive aspects related both to procedure and analysis. This study aims to provide the results of amplitude perturbation parameter analysis in euphonic adult patients. In our opinion, these are the most significant parameters in determining the severity of a phonation ...

Purpose To determine what research evidence exists to support the use of voice measures in the clinical assessment of patients with voice disorders. Method The American Speech-Language-Hearing Association (ASHA) National Center for Evidence-Based Practice in Communication Disorders staff searched 29 databases for peer-reviewed English-language articles between January 1930 and April 2009 that included key words pertaining to objective and subjective voice measures, voice disorders, and diagnostic accuracy. The identified articles were systematically assessed by an ASHA-appointed committee employing a modification of the critical appraisal of diagnostic evidence rating system. Results One hundred articles met the search criteria. The majority of studies investigated acoustic measures (60%) and focused on how well a test method identified the presence or absence of a voice disorder (78%). Only 17 of the 100 articles were judged to contain adequate evidence for the measures studied to ...

Introduction: Vocal hygiene sensitization programs help in propagating the information about conservation of voice in a swift manner to a target population. Nurses being bridge between patients and doctors help patients understand or convey important information. Hence, nursing trainees formed the target group for the sensitization program on voice conservation and care. Materials and Methods: Ninety‑two nursing trainees and their faculty participated in a one‑day sensitization program on vocal hygiene. The program consisted of two lectures on the anatomy and physiology of voice and vocal hygiene for voice conservation and voice care. Participants’ familiarity of the topic was assessed using a questionnaire before and after the lectures. Results: There was a significant increase in percent correct response from 77.41% to 91.46% after the program. Out of 10 questions, eight had increase in scores, one had decreased score, and one question remained the same. Conclusion: Improved percent correct response scores of the participants in the post test implied better awareness about the voice production mechanism and conservation of voice and its care. The results could imply that such programs could improve dissemination of information pertaining to voice use, conservation of voice, and helping in reducing the occurrence of voice problems in different groups of professional voice users.

A review of the records of the Voice, Swallowing and Sinus Center of St. Luke’s Medical Center—Quezon City had produced data on the population of patients referred both for assessment and intervention, particularly those with dysphagia.  These data will be presented in a concise manner followed by a discussion of the possible factors that influenced the changes in the referral flow and patient followup.  The recommendations that will conclude this study may serve as reference for similar centers that may be set up in various institutions in the future.

This paper reviews a 12-year experience in more than 900 patients with spasmodic dysphonia who have been treated with botulinum toxin. This is a retrospective analysis of patients with adductor spasmodic dysphonia (strain-strangled voice), abductor spasmodic dysphonia (whispering voice), and adductor breathing dystonia (paradoxical vocal fold motion), all of whom have been treated with botulinum toxin injections for relief of symptom. All of the patients were studied with a complete head and neck and neurologic examination; fiberoptic laryngostroboscopy; acoustic and aerodynamic measures; and a speech evaluation including the Universal spasmodic dysphonia rating scale. Some were given electromyography. All patients received botulinum toxin injections into the affected muscles under electromyographic guidance. The adductor patients had an average benefit of 90% of normal function lasting an average of 15.1 weeks. The abductor patients had an average benefit of 66.7% of normal function lasting an average of 10.5 weeks. Adverse effects included mild breathiness and coughing on fluids in the adductor patients, and mild stridor in a few of the abductor patients. Botulinum toxin A injection of the laryngeal hyperfunctional muscles has been found over the past 12 years to be the treatment of choice to control the dystonic symptoms in most patients with spasmodic dysphonia.

Purpose: This study investigated which acoustic features of the voices of transgender (trans) women correlate with self- and listener ratings of voice femininity and with listener perceptions of gender. Differences between trans- and cisgender (cis) voices on these acoustic variables were also explored.
Methods: Speech samples were collected from 12 trans women and 10 cis control subjects. The acoustic variables of speaking fundamental frequency (SFF), SFF variation, intensity, vowel formants, and correlates of breathiness were collected for each speaker. Speakers completed a self-evaluation of voice femininity on a five-point scale drawn from the Transsexual Voice Questionnaire for Male-to-Female Transsexuals. Excerpts of these speech samples were presented to blind listeners, who also evaluated the femininity of each voice and classified each speaker within a binary gender system. Correlations between the acoustic variables and self- and listener ratings of voice femininity and listener perceptions of gender were measured using Spearman’s rank-order coefficient.
Results: Moderate-to-strong correlations were found between ratings of voice femininity and mean and maximum SFF, SFF variation, and mean intensity. These same four acoustic variables were moderately correlated with listener perceptions of gender. There were no consistent or significant correlations between voice femininity ratings or gender perceptions and minimum SFF, vowel formants, and breathiness measures. The analysis of differences between trans and cis speakers was limited by sample size. Results suggest SFF, SFF variation, and intensity—or pitch, intonation, and loudness—are appropriate targets for evidence-based voice training of trans women.

El estudio de la voz está integrado por numerosos factores que determinan el resultado final. A la hora de abordar el estudio de la voz es conveniente contemplar el cuerpo humano como una fuente inagotable de recursos que potencian y facilitan la expresión, la interpretación y la comunicación a través de la voz. Para ello, es necesario conocerlo y descubrir sus posibilidades. En el siguiente artículo se analiza la interacción existente entre la voz y el cuerpo, tanto en la voz hablada como cantada.

Body awareness as an essential basic in vocie education.
Voice studies are made up of various factors that determine the final result. When looking at voice studies it is convenient to contemplate the human body as a limitless source of resources that promote and facilitate expression, interpretation and communication trough the voice. Therefore we need to know about it so as to find out its possibilities. In the following article we analyse the existent interaction between the voice and body as much in the spoken voice as in singing.

The role of the speech-language pathologist (SLP) has developed considerably over the last 10 years given the medical and technological advances in life-sustaining procedures. Over time, children born with congenital, surgical, or "medically fragile" conditions have become mainstreamed into regular school-based settings, thus extending the traditional role of the SLP and multidisciplinary team. Understanding the impact of these voice disorders on the child’s educational performance has been a struggle for many clinicians because the eligibility decisions for students in school-based settings must be made within the framework of federal legislation and regulations governing the provision of services for students with disabilities. This article discusses how to identify children with voice disorders under the Individuals With Disabilities Education Act (IDEA) definition, the role of the SLP in assigning priority in various voice management scenarios, and how models of therap...

Purpose: The purpose of this study was to investigate current practices of speech-language pathologists (SLPs)
in the management of pediatric vocal health, with specific analysis of the influence of clinical specialty and workplace setting on management approaches.
Method: American Speech-Language-Hearing Association– certified clinicians providing services within the United States (1%–100% voice caseload) completed an anonymous online survey detailing clinician demographics; employment location and service delivery models; approaches to continuing professional development; and specifics of case management, including assessment, treatment, and discharge procedures.
Results: Current practice patterns were analyzed for
100 SLPs (0–42 years of experience; 77 self-identifying as voice specialists) providing services in 34 U.S. states across a range of metropolitan and nonmetropolitan workplace settings. In general, SLPs favored a multidisciplinary approachto management; included perceptual, instrumental, and quality of life measures during evaluation; and tailored intervention to the individual using a combination of therapy approaches. In contrast with current practice guidelines, only half reported requiring an otolaryngology evaluation prior to initiating treatment. Both clinical specialty and workplace setting were found to affect practice patterns. SLPs in school settings were significantly less likely to consider themselves voice specialists compared with all other work environments. Those SLPs who considered themselves voice specialists were significantly more likely to utilize voice-specific assessment and treatment approaches.
Conclusion: SLP practice largely mirrors current professional practice guidelines; however, potential exists to further enhance client care. To ensure that SLPs are best able to support children in successful communication, further research, education, and advocacy are required.

To develop and validate a score that can serve as a screening index for voice disorders in teachers. The subjects of this study were 252 female teachers, with and without voice disorders (WVD and WOVD) from the public school system of São Paulo, Brazil. All subjects underwent medical and vocal evaluations and completed a questionnaire about experienced vocal symptoms. They were then randomly divided into samples A and B. Sample A was used to develop and sample B to validate a screening index for voice disorder (SIVD). The development was done using a factorial analysis, and a cutoff point to predict the risk of having a voice disorder was defined using a receiver operating characteristic curve. The validation was done by calculating sensitivity and specificity values for the cutoff, comparing mean scores of subjects WVD and WOVD, calculating correlation between SIVD and Voice Handicap Index (VHI), and the association between the risk and presence of voice disorder. The SIVD comprise...

ENT/phoniatrics specialists are frequently the primary reference persons for patients who have problems with the professional use of their voice. Singers show the highest risk factors for voice disorders among all professional voice users. The treatment and care of singers requires specific knowledge and competence of the physician, as well as a treatment setting adapted to the needs of this special group of patients, whose existence depends on the use of their voice. To some extent, evidence based concepts can be taken into account when treating professional singers. In cases for which no concepts have yet been developed and evaluated, recourse to clinical experience is necessary. In the present paper, current concepts for the treatment of singers are discussed on the basis of scientific publications and on long-standing experience of consultations in musician's medicine and ENT, under the aspects of diagnosis, therapy as well as prevention, taking into account the most frequen...

Presbylaryngis, or aging of the larynx, can adversely affect vocal function and quality of life in the elderly. This preliminary investigation examined the effects of vocal function exercises, a physiologic voice therapy approach, as a primary treatment for presbylaryngis. Nine consecutive elderly patients with presbylaryngis (2 female, 7 male) underwent a 6-week course of voice therapy employing vocal function exercises. Pretherapy-versus-posttherapy comparisons were made of self-ratings of voice handicap and phonatory effort level, as well as auditory-perceptual voice assessments, acoustic analyses, and visual-perceptual evaluations of laryngeal images. After treatment, patients reported significant reductions on Voice Handicap Index scores, phonatory effort levels, and voice disorder severity. Blinded listeners rated the posttreatment voices as significantly less breathy and strained. However, comparison of pretreatment and posttreatment maximum phonation times, acoustic measures...

Occupational voice disorders are characterized by rich symptomatology, which is dominated by symptoms by the vocal tract discomfort. Therefore, in the management it is important to consider these subjective complaints. The aim of the study was to assess the usefulness of using the vocal tract discomfort scale (VTD) in evaluating the effects of rehabilitation concerning occupational dysphonia. The study included 55 teachers (mean age: 47.2) with occupational dysphonia diagnosed by means of videostroboscopy. The test battery covered also: voice self-assessment according to voice handicap index (VHI), perceptual GRBAS scale and the new VTD scale. Each subject underwent intensive rehabilitation, including voice training and voice hygiene education. The post-therapy examination was conducted using the above-mentioned methods. Comparing the results obtained in the preliminary and the control test a significant post-therapy improvement (p = 0.000) was discovered in relation to the general ...