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Traditional clinical voice evaluation focuses primarily on the severity of voice impairment, with little emphasis on the impact of voice disorders on the individual's quality of life. This study reports the development of a 28-item assessment tool that evaluates the perception of voice problem, activity limitation, and participation restriction using the International Classification of Impairments, Disabilities and Handicaps-2 Beta-1 concept (World Health Organization, 1997). The questionnaire was administered to 40 subjects with dysphonia and 40 control subjects with normal voices. Results showed that the dysphonic group reported significantly more severe voice problems, limitation in daily voice activities, and restricted participation in these activities than the control group. The study also showed that the perception of a voice problem by the dysphonic subjects correlated positively with the perception of limitation in voice activities and restricted participation. However, the self-perceived voice problem had little correlation with the degree of voice-quality impairment measured acoustically and perceptually by speech pathologists. The data also showed that the aggregate scores of activity limitation and participation restriction were positively correlated, and the extent of activity limitation and participation restriction was similar in all except the job area. These findings highlight the importance of identifying and quantifying the impact of dysphonia on the individual's quality of life in the clinical management of voice disorders. [ABSTRACT FROM AUTHOR]

Purpose: This study set out to investigate whether individuals with dysphonia, as determined by either self-assessment or clinician-based auditory-perceptual judgment, exhibited differences in perilaryngeal muscle activities using surface electromyography (sEMG) during various phonatory tasks. Additionally, the study aimed to assess the effectiveness of sEMG in identifying dysphonic cases., Method: A total of 77 adults (44 women, 33 men, M age = 30.4 years) participated in this study, with dysphonic cases identified separately using either a 10-item Voice Handicap Index (VHI-10) or clinician-based auditory-perceptual voice quality (APVQ) evaluation. sEMG activities were measured from the areas of suprahyoid and sternocleidomastoid muscles during prolonged vowel /i/ phonations at different pitch and loudness levels. Normalized root-mean-square value against the maximal voluntary contraction (RMS %MVC) of the sEMG signals was obtained for each phonation and compared between subject groups and across phonatory tasks. Additionally, binary logistic regression analysis was performed to determine how the sEMG measures could predict the VHI-10-based or APVQ-based dysphonic cases., Results: Participants who scored above the criteria on either the VHI-10 ( n = 29) or APVQ judgment ( n = 17) exhibited significantly higher RMS %MVC in the right suprahyoid muscles compared to the corresponding control groups. Although the RMS %MVC value from the right suprahyoid muscles alone was not a significant predictor of self-evaluated dysphonic cases, a combination of the RMS %MVC values from both the right and left suprahyoid muscles significantly predicted APVQ-based dysphonic cases with a 69.66% fair level., Conclusions: This study found that individuals with dysphonia, as determined by either self-assessment or APVQ judgment, displayed more imbalanced suprahyoid muscle activities in voice production compared to nondysphonic groups. The combination of the sEMG measures from both left and right suprahyoid muscles showed potential as a predictor of dysphonia with a fair level of confidence., Supplemental Material: https://doi.org/10.23641/asha.25112804.

Purpose: This study set out to quantify the fatigue-related changes in surface electromyographic (sEMG) activities of the perilaryngeal muscles following a vocal loading task., Method: Thirty-six young healthy participants ( M age = 22.4 years) with normal voice performed karaoke singing for at least 100 min. Before the singing task, all participants underwent the sEMG measure and completed a Perceived Vocal Fatigue Score (P-VFS) questionnaire. After the singing task, all participants were immediately measured with the P-VFS again. Half of the participants were then measured for their sEMG immediately after their karaoke singing task, and the other half were given 20 min of rest before undertaking the sEMG measure. The P-VFS and the median frequency (MDF) of the sEMG signals collected from the suprahyoid, infrahyoid, and sternocleidomastoid muscles before and after the singing task were compared using a linear mixed-effects model., Results: All participants reported a perceived vocal fatigue after singing, with a significantly increased P-VFS. Compared with the presinging baseline, the MDF of the sEMG signals in perilaryngeal muscles was significantly lower immediately after the singing task. Such a significant difference was also found after 20 min following the singing task., Conclusions: The MDF analysis of the sEMG signals could identify and quantify the performance vocal fatigue contributed by perilaryngeal muscles following a vocal loading task. The findings also showed that such fatigue in perilaryngeal muscles, as far as sEMG activities are concerned, can last for at least 20 min.

Purpose: This study's broad objective was to examine the effectiveness of surface electromyographic (EMG) biofeedback for motor learning in the voice production domain. The specific objective was to examine whether concurrent or terminal biofeedback would facilitate learning for a relaxed laryngeal musculature task during spoken reading., Method: Twenty-two healthy adult speakers were randomly assigned to 1 of 2 groups. One group received real-time EMG waveform displays of muscle activation from bilateral thyrohyoid sites during reading trials (concurrent feedback group). The other group received static terminal EMG waveform displays about activation levels for the same sites on completion of successive trials (terminal feedback group). All participants were instructed to minimize EMG amplitudes from the thyrohyoid sites during phonation in an oral reading task. Signals were also collected from control, orofacial sites, but participants received neither instructions nor feedback for those sites., Results: The pooled data (2 feedback groups x 2 electrode sites) showed that, overall, muscle activation levels did decrease across baseline, training, and no-feedback test phases. However, no clear evidence was seen of reliable changes in the targeted laryngeal muscle activation levels across the phases, for either the concurrent or the terminal feedback groups. Paradoxically, and entirely unanticipated, reliable decreases were seen in muscle activation for the orofacial, no-feedback control sites. Those decreases were equivalent across concurrent and terminal feedback groups., Conclusions: The unanticipated findings indicate that the provision of biofeedback for a target muscle group facilitated incidental learning in another, untargeted muscle group. Discussion focuses on the possible role of locus of attention in motor learning. Building on literature from other domains, the hypothesis is advanced that attention to muscular contractile force during training trials may suppress intentional learning for attended target sites but may benefit incidental learning for nearby, unattended sites.

Perceptual voice evaluation is a common clinical tool for rating the severity of vocal quality impairment. However, the evaluation process involves subjective judgment, and reliability is therefore a major issue that needs to be considered. When listeners are asked to judge the quality of a voice signal, they use their own internal standards as the references. These internal standards can be variable, as different individuals may have acquired different standards in prior situations. In order to improve the reliability of the perceptual voice evaluation process, external anchors and training are provided to counteract the effect of these internal standards. This study investigated to what extent the provision of anchors and a training program would improve the reliability of perceptual voice evaluation by naive listeners. The results show, in general, that anchors and training helped to improve the reliability of perceptual voice evaluation, especially in the rating of male voices. Furthermore, it was found that anchors made up of synthesized signals combined with training were more effective in improving reliability in judging perceptual roughness and breathiness than natural voice anchors.