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The measure H1–H2, the difference in amplitude between the first and second harmonics, is frequently used to distinguish phonation types and to characterize differences across voices and genders. While H1–H2 can differentiate voices and is used by listeners to perceive changes in voice quality, its relation to voice articulation is less straightforward. Its calculation also involves practical issues with error propagation. This paper highlights some developments in the use of H1–H2 and proposes a new measure that we call “residual H1.” In residual H1, the amplitude of the first harmonic is normalized against the overall sound energy (as measured by root mean square energy) instead of against H2. Residual H1 may mitigate some of the issues with using H1–H2. The current study tests the correlation between residual H1 and electroglottographic contact quotient (CQ) and compares the ability of residual H1 vs H1–H2 to differentiate statistically across phonation types in !Xóõ and utterance-level changes in phonatory quality in Mandarin. The results show that residual H1 has a stronger correlation with CQ and differentiates contrastive and allophonic phonatory quality better than H1–H2, particularly for more constricted phonation types.

There is growing interest in research on the non-modal voice quality, creaky voice; however, its identification often relies on time-consuming manual annotation, leading to a recent focus on automatic creak detection methods. Various automatic methods have been proposed, which rely on varying types and combinations of acoustic cues for creak detection. In this paper, we compare the performance of three automatic tools, the AntiMode method, the Creak Detector algorithm, and the Roughness algorithm, against manual annotation of creak using data from 80 Australian English speakers. We explore the possibility that tools used in combination may yield more accurate creak detection than individual tools used alone. Based on method comparisons, we present options for researchers, including an “out-of-the-box” approach, which supports combining automatic tools, and propose additional steps to further improve creak detection. We found restricting analysis to sonorant segments significantly improves automatic creak detection, and tools performed consistently better on female speech than male speech. Findings support previous work showing detection may be optimised by performing a creak probability threshold sweep on a subset of data prior to applying the Creak Detector algorithm on new datasets. Results provide promising solutions for advancing efficient large-scale research on creaky voice.

Feminization Laryngoplasty evolved from the aim to change a voice from a male quality to a female quality. Larynx and pharynx in a male have undergone enlargement during puberty and as there is no endocrine method for shrinking structures, a surgery that reduces the size of male structures toward the size of female structures might appropriately alter the voice. A smaller larynx and pharynx might raise both the fundamental frequency of the voice and the resonant frequency of the vocal tract. The surgery is used for transgender individuals who desire a female voice, for individuals who fail speech therapy and for complications of tracheal shave procedures whereby the vocal cords have been loosened.

Summary Objective Past literature indicates that vibrato measurements of singers objectively changed (i.e., vibrato rate decreased and vibrato extent increased) from 1900 to the present day; however, historical audio recording technology may distort acoustic measurements of the voice output signal, including vibrato. As such, the listener's perception of historical singing may be influenced by the limitations of historical technology. This study attempts to show how the wax cylinder phonograph system—the oldest form of mass-produced audio recording technology—alters the recorded voice output signal of modern-day singers and, thus, provides an objective lens through which to study the effect(s) of historical audio recording technology on vibrato measurements. Methods Twenty professional Western opera singers sang a messa di voce on the vowel [a] and on the pitch C4 for male singers and C5 for female singers, three times into a flat-response omnidirectional microphone and onto an Edison Home Phonograph simultaneously. The middle 1–3 seconds (6–10 vibrato cycles) of each sample was analyzed for vibrato rate, vibrato extent, jitter (ddp), shimmer (dda), and fundamental frequency for each recording condition (wax cylinder phonograph or microphone). Steady-state and frequency-modulating sinewave test signals were also recorded under the multiple recording conditions. Results Results indicated no significant effect of recording condition on vibrato rate (mean [standard deviation], cylinder: 5.3 Hz [0.5], microphone: 5.3 Hz [0.5]) and no significant difference was found for mean fundamental frequency (cylinder: 389 Hz [137], microphone: 390 Hz [137]). A significant main effect of recording condition was found for vibrato extent (cylinder: ±103 cents [30], microphone: ±100 cents [31]). Additionally, mean jitter (ddp) (cylinder: 1.22% [1.09], microphone: 0.24% [0.12]) and mean shimmer (dda) (cylinder: 9.40% [4.90], microphone: 1.92% [0.94]) were significantly higher for the cylinder recording condition, indicating more cycle-to-cycle variability in the wax cylinder recorded signal. Analysis of test signals revealed similar patterns based on recording condition. Discussion This study validates past scholarly inquiry about vibrato measurements as extracted from digitized wax cylinder phonograph recordings by demonstrating that measured vibrato rate remains constant during both recording conditions. In other words, vibrato rate as measured from historical recordings can be viewed as an accurate representation of the historical singer being studied. Furthermore, it suggests that the value of prior vibrato extent measurements from these acoustic recordings may be slightly overestimated from the original voice output signals produced by singers near the beginning of the 20th century (i.e., a narrow vibrato extent might have been numerically smaller on average). Increased jitter and shimmer in the wax cylinder recording conditions may be indicative of nonlinearities in the phonograph recording or playback systems

Summary Objective To verify the immediate effects of voiced gargling on the electrical activity of extrinsic laryngeal muscles and vocal self-assessment. Methods A sample of 20 individuals of both sexes, mean age of 31.95 (±11.57) years, were equally divided in two groups according to the presence or absence of vocal complaint. Both groups were evaluated by surface electromyography of the suprahyoid (SH) and infrahyoid (IH) muscle areas during rest, phonation of the sustained vowel [Ɛ] in habitual and strong intensities; phonation of rising and falling glissando; and counting from 1 to 10. Surface electromyography was assessed before and after the voiced gargling exercise, which lasted 1 minute. All participants self-rated their voice and phonatory comfort after the exercise. Wilcoxon and Mann-Whitney tests were applied, as well as Fisher's exact test and linear-to-linear test. The level of significance was 5%. Results The percentage of electrical activity of the SH muscle area decreased in the glissando and counting tasks in the group with vocal complaint, as well as in phonation of sustained vowel in strong intensity in the group without complaint. Decrease was also observed in the right IH muscle area at rest and during sustained vowel phonation at habitual and strong intensities. Percentage of muscular electrical activity was lower in the group with complaint in the following situations: IH muscle area on both sides, at rest and during habitual phonation of sustained vowel and glissando before and after the exercise; right IH muscle area, during counting and strong phonation of sustained vowel before and after exercise; left IH muscle area, in the counting task, just after intervention. Most participants noticed improvement in voice (70%) and phonatory comfort (65%). Conclusions Voiced gargling during 1 minute promotes immediate effects on the electrical activity of the extrinsic laryngeal muscles in individuals with or without vocal complaint. Most individuals reported improved voice and phonatory comfort after exercise.

This study replicates and extends the recent findings of Lee, Keating, and Kreiman [J. Acoust. Soc. Am. 146(3), 1568–1579 (2019)] on acoustic voice variation in read speech, which showed remarkably similar acoustic voice spaces for groups of female and male talkers and the individual talkers within these groups. Principal component analysis was applied to acoustic indices of voice quality measured from phone conversations for 99/100 of the same talkers studied previously. The acoustic voice spaces derived from spontaneous speech are highly similar to those based on read speech, except that unlike read speech, variability in fundamental frequency accounted for significant acoustic variability. Implications of these findings for prototype models of speaker recognition and discrimination are considered.

Purpose: The prognosis of glottic T1a laryngeal squamous cell carcinoma (LSCC) is excellent with both transoral laser surgery (TLS) and radiation therapy (RT). Our aim was to compare TLS and RT treatment results in a randomized study. Methods and Materials: Of 56 male patients with glottic T1a LSCC, 31 were randomized for TLS and 25 for RT. Survival and larynx preservation data were collected from medical records. Results: Five-year overall survival (OS) was 87%, disease-specific survival (DSS) was 97%, and recurrence-free survival (RFS) was 81% in patients treated with TLS. Five-year OS was 92%, DSS was 100%, and RFS was 88% in patients treated with RT. The primary treatment method was not associated with OS, RFS, or DSS in a log-rank test. The larynx preservation rate was similar in both groups (TLS, 97%; RT, 92%; P = .575). Conclusions: In a prospective randomized setting oncological outcomes of both treatment modalities (TLS or RT) for T1a LSCC were similar. (C) 2022 Elsevier Inc. All rights reserved.

AIM To determine which acoustic parameters may be associated with vocal fatigue among college professors in Bogota-Colombia. METHOD This was a cross-sectional study including 27 voice samples of college professors. RESULTS A gender analysis showed that mean fundamental frequency increased significantly among men and women who reported vocal fatigue compared with the those without fatigue (138.2Hz vs 122.3Hz for males; and 228.7Hz vs 188.9Hz for females; Mann-Whitney U test P value

To discover patterns of phonotraumatic lesions in singers and investigate factors that differentiate those who underwent surgery from those who did not. We hypothesized that 1) lesion type distribution differs by age, sex, singer classification (professional/amateur), and history of formal voice training; 2) the likelihood of surgery is associated with singer classification and voice training.Retrospective.Retrospective review of 438 singers with phonotraumatic lesions over a 9-year period. Lesion type distribution was analyzed with respect to sex, age, singer classification, and voice training. The association of eventual surgery with these factors was also analyzed.Nodules accounted for over half of the cohort (58%), followed by pseudocysts (20%), polyps (14%), and cysts (4%). Nearly two of every three injured female singers, but fewer than one out of every three injured male singers, had nodules. In contrast, over half of the injured males had polyps, whereas only 6% of injured females had polyps. In females, polyps occurred at a later age, and in males, nodules occurred at a younger age compared to other lesion types. Only 14% of the total cohort eventually underwent surgery. Professional singers without formal voice training were almost eight times more likely to have undergone surgery than amateur singers with voice training.Professional singers were more likely to undergo surgery than amateurs, and formal voice training was associated with a lower likelihood of surgery. The observation that polyps tended to occur in older women may have implications for the pathogenesis of vocal fold polyps.4 Laryngoscope, 132:2180-2186, 2022.

Summary Objective Several techniques have been practiced in the field of voice therapy to balance glottal pressures and improve glottal adduction. As such, Semioccluded Vocal Tract Exercises using narrow diameter straws have shown promise as a technique to increase glottal contact as reflected by Closed Quotients (CQ) measured from electroglottograph (EGG). This study explored the effect of nasal resistance (NR) technique, a manually induced NR approach, on glottal adduction in phononormal subjects as a possible new therapeutic technique to assist in glottal closure. Subjects Thirty-four vocally healthy adult females qualified for this study. All subjects were reportedly and perceptually normal. Methods Subjects were instructed to perform tasks including (a) steady modal phonation, (b) straw phonation, (c) humming, and (d) NR technique in a random order. EGG measures included calculation of the CQ and jitter during the mid-section of each stimuli for a minimum of 10 EGG cycles. One-way repeated measures ANOVAs and Bonferroni post-hoc comparisons were calculated to determine differences between each phonatory task for the outcome measures of CQ and jitter. Results Analyses revealed that the mean CQ was significantly different in all the tasks performed with humming (33.99%) at the lowest and NR technique at highest (43.88%). Though the CQ of straw phonation (40.53%) was higher than modal steady phonation (36.65%), jitter was found to be significantly lower for NR technique (0.23%). Jitter during straw phonation (0.43%) did not differ significantly from modal phonation (0.44%). Conclusion These results provide preliminary evidence that NR technique can increase CQ with lower levels of jitter compared to straw phonation using a narrow diameter of 2 mm. Future studies should expand enrollment to men, larger age ranges, and patients with hypofunctional symptoms (eg, Parkinson disease) to evaluate the potential benefits of NR as a therapeutic technique.

Introduction: Despite its clinical significance, few studies have explored the applicability of the validated Arabic version of the Voice Handicap Index (VHI-Arab) in professional voice users, especially singers. The correlation between VHI-Arab scores and acoustic measures in this targeted group remains unclear. The aim of this study was to explore Arab Kuwaiti prospective professional singers’ perception of voice handicap using the validated VHI-Arab. Additionally, we examined the association between VHI-Arab scores and acoustic measures such as fundamental frequency (F0), shimmer, jitter, and signal-to-noise ratio. Methods: VHI-Arab scores and acoustic measures of 100 adult prospective professional singers (50 females and 50 males) were compared with those of 100 adult controls (50 females and 50 males). Results: Female prospective professional singers differed significantly from female controls in terms of functional and physical subscale scores, total VHI-Arab scores, and shimmer and jitter values. Male prospective professional singers showed significant differences neither in VHI-Arab scores nor in acoustic measures; however, their shimmer values showed significant a difference. There was no correlation between VHI-Arab scores and acoustic measures. Conclusion: Kuwaiti prospective professional singers did not perceive their voice as handicapped. Female prospective professional singers had a better perception of their voice compared with female controls. The results of the current study suggest that the perception of voice handicap and acoustic measures are different attributes that do not correlate.

Summary Objectives This paper aims to study the effect of room acoustics and phonemes on the perception of loudness of one's own voice ( autophonic loudness) for a group of trained singers. Methods For a set of five phonemes, 20 singers vocalized over several autophonic loudness ratios, while maintaining pitch constancy over extreme voice levels, within five simulated rooms. Results There were statistically significant differences in the slope of the autophonic loudness function (logarithm of autophonic loudness as a function of voice sound pressure level) for the five phonemes, with slopes ranging from 1.3 (/a:/) to 2.0 (/z/). There was no significant variation in the autophonic loudness function slopes with variations in room acoustics. The autophonic room response , which represents a systematic decrease in voice levels with increasing levels of room reflections, was also studied, with some evidence found in support. Overall, the average slope of the autophonic room response for the three corner vowels (/a:/, /i:/, and /u:/) was −1.4 for medium autophonic loudness. Conclusions The findings relating to the slope of the autophonic loudness function are in agreement with the findings of previous studies where the sensorimotor mechanisms in regulating voice were shown to be more important in the perception of autophonic loudness than hearing of room acoustics. However, the role of room acoustics, in terms of the autophonic room response, is shown to be more complicated, requiring further inquiry. Overall, it is shown that autophonic loudness grows at more than twice the rate of loudness growth for sounds created outside the human body.

Background Long-term dysphonia may persist after thyroid surgery even in the absence of overt nerve injury. Therefore, we evaluated long-term dysphonia after thyroidectomy using a validated survey. Methods Patients undergoing thyroidectomy at a single institution from 1990 to 2018 were surveyed via telephone to complete the Voice Handicap Index-10 Survey. Individuals with documented nerve injury were excluded. Results In total, 308 patients completed the survey (mean age 51 ± 14 years, 78% female). Median time since surgery was 10.7 (interquartile range 2.3–17.5) years. The mean Voice Handicap Index-10 Survey score was 2.6 ± 5.2. Of the 113 (37%) patients who reported subjective dysphonia, the mean Voice Handicap Index-10 Survey score was 7.1 ± 6.5. Twenty-two (7.1%) patients had a Voice Handicap Index-10 Survey score above the empiric normative cutoff of 11, with a mean score of 17.6 ± 6.8. The most frequent complaints included “The clarity of my voice is unpredictable” (N = 71, 23%), “People have difficulty understanding me in a noisy room” (N = 70, 23%), and “I feel as though I have to strain to produce voice” (N = 65, 21%). Conclusion Long-term follow-up of patients after thyroidectomy suggests that more than 30% without nerve injury report dysphonia. Research to further assess the etiology and impact of these changes on quality of life is needed.

OBJECTIVE To assess long-term outcomes of ALA-PDT in treating recalcitrant laryngeal leukoplakia. STUDY DESIGN Retrospective Case-Control. METHODS We reviewed all laryngeal leukoplakia patients treated with ALA-PDT compared with angiolytic laser treatment alone (585 nm PDL or 532 nm KTP laser) from 2000 to 2019. Patients with laryngeal cancer (or a history of laryngeal cancer), leukoplakia previously treated with radiation and no pathologic report were excluded. Patient demographics, procedure details and outcomes were examined including histopathologic diagnosis, procedures performed, ALA usage, recurrence of leukoplakia and the development of cancer. RESULTS We identified 132 patients with laryngeal leukoplakia: 42 were treated with ALA-PDT and 90 were treated with an angiolytic laser alone (Laser group). The proportion of cases of high-grade dysplasia was 57.1% in the ALA-PDT group compared to 32.2% in the Laser group. In high-grade dysplasia cases, there was a statistically significant better recurrence-free survival (RFS) at 12 months and 60 months in those who underwent ALA-PDT 71.4% and 7.1% vs Laser 25% and 0% (p = .01). However, for overall groups, there was no difference in RFS (p = .25). Voice outcomes (patient subjective report) improved or were stable in 75% of subjects with no serious side effects reported. CONCLUSION ALA-PDT for recalcitrant and high-grade dysplasia is highly effective with improved recurrence-free survival compared to laser alone. ALA-PDT may be an appropriate therapy in patients who have failed prior angiolytic laser alone.

Purpose The purpose of this study was to investigate the relationships among subjective auditory-perceptual ratings of vocal quality, objective acoustic and aerodynamic measures of vocal function, and patient-perceived severity of their vocal complaint. Method This study was a retrospective chart review of adult patients evaluated at a single outpatient center over a 1.5-year time period. Twenty-two clinical objective and subjective measures of voice were extracted from 676 charts (310 males, 366 females). To identify the underlying concepts addressed in an initial voice assessment, principal component analyses were conducted for males and females to account for sex differences. Linear regression models were conducted to examine the relationship between the principal components and patient perceived severity. Results Seven principal components were identified for both sexes and accounted for 75% and 71% of the variance in the clinical measures, respectively. Of these seven principal components, only two predicted male patient perceived severity, which accounted for 22% of the variance. In contrast, four principal components predicted female patient perceived severity of their voice disorder and accounted for 19% of the variance. Conclusions The results highlight the underlying aspects of vocal quality and functioning that are evaluated during an initial assessment. Male and female patients differ in which of these components may contribute self-perceived severity of a voice disorder. Identifying these underlying components may support clinical decision making when developing a clinical protocol and highlights the overlap between patient concerns and clinical measures. Supplemental Material https://doi.org/10.23641/asha.16879603

PurposeThe ongoing literature suggests that COVID-19 may have a potential impact on voice characteristics during the infection period. In the current study, we explored how the disease deteriorates different vocal parameters in patients who recovered from COVID-19.MethodsA total of 80 participants, 40 patients with a prior history of COVID-19 (20 male, 20 female) with a mean age of 39.9 ± 8.8 (range, 21–53) and 40 gender and age-matched healthy individuals (mean age, 37.3 ± 8.8; range, 21–54) were included to this study. The data of acoustic voice analyses, durational measurements, patient-reported outcomes, and auditory-perceptual evaluations were compared between the study group and the control group. Correlation analyses were conducted to examine the association between the clinical characteristics of the recovering patients and measured outcomes.ResultsMaximum phonation time (MPT) and the scores of both Voice Handicap Index-10 (VHI-10) and Voice-Related Quality of Life (V-RQOL) questionnaires significantly differed between the groups, which was more evident in female participants. The overall severity score of dysphonia was found to be higher in the study group than the control group (p = 0.023), but gender-based comparisons reached significance only in males (p = 0.032). VHI-10 and V-RQOL revealed significant correlations with the symptom scores of the disease.ConclusionsPatients with a prior history of COVID-19 had significantly lower MPT, increased VHI-10 scores, decreased voice-related quality of life based on the V-RQOL questionnaire, and higher overall severity scores in the auditory-perceptual evaluation. Self-reported voice complaints disclosed close relationships with the symptom scores of COVID-19 disease.

OBJECTIVE The goal of this study is to analyze the voice in patients with thyroid pathology through two objective indexes with great diagnostic accuracy. Overall vocal quality was evaluated with the Acoustic Voice Quality Index (AVQI v.03.01) and the breathy voice with the Acoustic Breathiness Index (ABI). DESIGN Observational case-control study. SETTING Hospital Universitario Nuestra Senora de Candelaria. PARTICIPANTS Fifty-eight subjects, 29 controls and 29 thyroidectomy candidates. MAIN OUTCOME MEASURES All participants with thyroid pathology completed the Spanish version of Voice Handicap Index-10. Also, patient complaints relating to possible laryngeal dysfunction were assessed through closed questions. A sustained vowel and three phonetically balanced sentences were recorded for each subject (118 samples). AVQI v.03.01 and ABI were assessed using the Praat program. Two raters perceptually evaluated each voice sample by using the Grade parameter of GRABS scale. RESULTS Acoustic analysis shows that 55.17% of subjects present values above the pathological threshold of the AVQI, and 58.62% above that of the ABI. Results of the Student's test comparisons of the AVQI and ABI values between the control group and the thyroid group show significantly higher values of AVQI (t[56] = -3.85, p

Classical singers use nasal consonants as “resonance exercises,” and experimental results have shown that singers may use some velopharyngeal opening (VPO), most often in [a:] and more seldom in [i:] or [u:]. In particular, male singers have been found to increase VPO as pitch rises toward register change frequencies (passaggi). Laryngoscopic findings have shown that some VPO stabilizes vocal fold vibration; the effect is related to positive reactance. This study investigates the effects of VPO on vocal tract (VT) reactance over the range of fundamental frequencies (f0) used in singing using a computerized tomography-based finite element model of the VT and nose of a female. According to the results, by raising the lowest VT resonances, the VPO increased the VT reactance in the frequency ranges 207–359 Hz for [i:], 265–411 Hz for [u:], and 500–611 Hz for [a:], depending on the VPO size (full or half VPO). These frequency ranges are close to the first and second passaggio of a female singer. The change may have an especially practical stabilizing effect for [a:], which is otherwise characterized by very large changes in VT reactance and negative reactance at the second passaggio.

Introduction The objective of this study was to assess the impact of surgical resection and free flap reconstruction of soft palate cancer on speech, swallowing and quality of life, and to identify the factors influencing functional outcomes and quality of life. Material and methods Patients treated with surgical resection of squamous cell carcinoma and free-flap reconstruction of the soft palate were reviewed at least 12 months after surgery. Speech was assessed using the Hirose intelligibility scoring system, nasalance scoring, GRBAS scoring and the Voice Handicap Index 30 (VHI30) questionnaire. Swallowing was assessed by fiberoptic endoscopy and the Deglutition Handicap Index (DHI). Quality of life was assessed using EORTC QLQ-C30 and QLQ-H&N35 questionnaires. Results 29 patients were included. Speech outcomes were satisfactory, demonstrating normal or slightly below normal speech intelligibility in 75.9% of the patients, moderate or no rhinolalia in 72.4% of the patients and mean overall VHI30 scores indicative of slight or no handicap in 86.2% of the patients. Swallowing outcomes were satisfactory, with mean overall DHI scores indicative of slight or no handicap in 82.8% of the patients. Patient quality of life was preserved as demonstrated by mean quality of life and functioning scales scores all superior to 80%. Conclusion The sequelae arising from surgical resection and free-flap reconstruction of soft palate cancer are tolerable, involving slight handicap in terms of speech and swallowing and relatively little impact on quality of life.

Professional voice users form an increasing part of our population. Physical fitness instructors listed as professional voice users are at risk for voice problem as they perform vigorous exercises, instruct at the same time and compete vocally with loud background music. Hence, there is a dire need to study the voice problems in this population. The current study was aimed at investigating the phonatory and respiratory functions in physical fitness instructors in comparison to a control group.Cross-sectional study design MATERIALS AND METHODS: Fifty physical fitness instructors (48 males and two females) and 50 controls (45 males and five females) with the age range of 18-40 years were initially enrolled in the study. The phonatory function measures (perceptual, physiological, and acoustic) and respiratory function measures (aerodynamics) were obtained.Following the data analysis only for male participants, the majority of the perceptual parameters such as grade, roughness, breathiness, and strain showed significant increase in the clinical group compared to controls (P0.05). Similarly, few acoustic parameters such as fundamental frequency (FFew perceptual and acoustic parameters are sensitive in differentiating the voice problems in physical fitness instructors from the controls. The significant perceptual and acoustic parameters implied that they are at risk for developing voice problems. Hence, early identification and prevention of voice problems in this population is warranted.

Summary Objectives The objective of this study was to present a novel surgical technique involving the use of a “bipedicled vocal fold mucosal flap” to repair a mucosal defect and to evaluate the outcomes of patients in whom it was used. Material and methods This was a retrospective study of 6 clinical cases. All patients underwent surgery between November 2000 and July 2018, and all procedures were performed by the same surgeon. For the auditory-perceptual assessment, the Grade-Roughness-Breathiness-Asthenia-Strain hoarseness scale was used. We based the stroboscopic evaluation on the European Laryngological Society protocol, analyzing the parameters glottal closure, mucosal wave, and phase symmetry. Results Ages at the time of surgery ranged from 10 to 52 years, and all of the patients were male. Preexisting vocal fold lesions included polyps, cysts, a sulcus, and mucosal bridges. Among the stroboscopic parameters, only the mucosal wave differed significantly between the preoperative and postoperative periods (P = 0.046). There were also significant postoperative improvements in the overall grade of dysphonia (P = 0.025) and in the degree of breathiness (P = 0.025). Conclusions The use of a bipedicled vocal fold mucosal flap appears to promote significant improvements in the mucosal wave and in voice quality. In the patients evaluated here, the technique was used without preoperative planning. However, it proved to be a safe and appropriate means of repairing mucosal defects in the vocal folds, with the potential to preserve rheological properties and promote healing with less chance of fibrosis.

Objective: Patients with recurrent respiratory papillomatosis (RRP) have significant vocal dysfunction which affects their performance at work. This study aimed to evaluate voice-related work productivity before and after ablative treatment for RRP. Methods: This is a prospective case series conducted at 2 academic laryngology outpatient clinics. Adult employed patients with RRP completed the Work Productivity & Activity Impairment instrument (WPAI), Voice Handicap Index (VHI-10), WorkHoarse, Hospital Anxiety and Depression Scale (HADS), and a demographics questionnaire immediately before and 1 month after ablative treatment of papilloma. The primary outcome measure was the change in work productivity impairment domain of the WPAI, and changes in ratings before and after ablation were compared using a Wilcoxon Signed-Rank test. Results: The 32 participants (mean age 45, 84% male) had a median (interquartile range) voice-related work productivity impairment score of 48.8% (30.0) at baseline which was improved to 5.0% (10.0) at 1 month after surgical ablation of papillomata (difference 30.0% (30.0) improvement). For the secondary outcome measures, there were significant improvements in VHI-10 ( P Conclusion: Patients with RRP experience significant voice-related work productivity impairment, and ablation of papillomata significantly improves work productivity.

Purpose This study aims to investigate the effects of a 10-min vocal exertion task on voice and respiratory measures, to determine whether restorative strategies can mitigate these effects after cessation of exertion, and to assess whether these strategies continue to reduce these detrimental effects when vocal exertion is resumed. Method A prospective, repeated-measures design was used. On consecutive days, 20 participants (equal men and women) completed two vocal exertion tasks separated by 10 min of restoration strategies: vocal rest or controlled phonation (low-level tissue mobilization using straw phonation). Voice and respiratory data were collected at baseline, following the first exertion task, after restoration strategies, and after the second exertion task. Outcome measures included (a) vocal effort, (b) phonation threshold pressure, (c) maximum and minimum fundamental frequencies, (d) cepstral peak prominence of connected speech, (e) lung volume initiation and termination, (f) percent vital capacity expended per syllable, and (g) number of syllables per breath group. Results A worsening of phonation threshold pressure ( p < .001), vocal effort ( p < .001), and increase of minimum fundamental frequency ( p = .007) were observed after vocal exertion. Lung volume initiation ( p < .001) and lung volume termination ( p < .001) increased. These changes were largely reversed by restoration strategies, but only controlled phonation prevented exertion-induced changes in respiratory kinematic measures on a subsequent vocal exertion task. Conclusions Exertion-induced voice changes occur rapidly and may be mitigated by either controlled phonation or vocal rest. Controlled phonation is recommended as a superior strategy due to evidence of a protective effect on a successive vocal exertion task.

Introduction Vibratory asymmetry and neuromuscular compensation are often seen in laryngeal neuromuscular pathology. However, the ramifications of these findings on voice quality are unclear. This study investigated the effects of varying levels of vibratory asymmetry and neuromuscular compensation on cepstral peak prominence (CPP), an analog of voice quality. Study design In vivo canine phonation model. Methods Varying degrees of vocal fold vibratory asymmetry were achieved by stimulating one recurrent laryngeal nerve (RLN) over 11 levels from threshold to maximal muscle activation. For each of these levels, phonation was induced at systematically varied combinations of neuromuscular compensation: three levels each of contralateral RLN stimulation (80%, 90%, and 100% of maximal), superior laryngeal nerve (SLN) activation (0%, 50%, and 100% of maximal), and airflow levels (500, 700, and 900 mL/s). Vocal fold symmetry was determined by assessing the opening phase of the vibratory cycle in high-speed video recordings. Voice quality was estimated acoustically by calculating CPP for each voice sample. Results Eight hundred twenty-two phonatory conditions with varying degrees of vibratory asymmetry were evaluated. CPP was highest at vibratory symmetry. Increasing levels of asymmetry resulted in significant decreases in CPP. CPP increased significantly with increasing contralateral RLN activation. CPP was significantly higher at 50% SLN activation than 0% or 100% SLN activation. Conclusion Voice quality, as approximated by CPP, is best at vibratory symmetry and deteriorates with increasing degrees of asymmetry. Voice quality may be improved with neuromuscular compensation by increased adduction of the contralateral vocal fold or increased vocal fold tension at mid-levels of SLN activation. Level of evidence N/A, Basic Science Laryngoscope, 2021.

Summary Objective The primary goal of the study was to evaluate the influence of cosmetic and functional rhinoplasty on quality of life and voice performance preservation in opera singers. Materials and methods This study was conducted in the ENT Department of Claros Clinic and included 18 opera singers: 16 women (8 sopranos, 5 mezzos, 2 contralto, and 1 unclassified) and 2 men (1 tenor and 1 baritone). Patients underwent either cosmetic or functional rhinoplasty. We excluded patients with previous nasal surgery, allergic or vasomotor rhinitis, laryngeal pathology, nasal pathology except septal deviation, hormonal or psychiatric disorders, psychic lability, or younger than 18 years of age. We evaluated the fundamental frequency, jitter, shimmer, maximal phonation time, Voice Handicap Index-10, and subjective perception of the patient before and 6 months after surgery. Results Rhinoplasty was indicated for aesthetic reasons in 12 cases. Six patients also associated nasal obstruction due to septal deviation. The fundamental frequency presented no variation and jitter, shimmer and the maximal time phonation improved slightly. Voice Handicap Index-10 scores decreased after the intervention (5.3 vs 5) and the overall perception of the surgical intervention was considered positive both aesthetically and vocally. Conclusions Singers evaluated long-term influence of rhinoplasty as positive. Over 88.8% admitted a beneficial effect on vocal emission and function while 11.1% perceived no change regarding their previous voice.

Summary Objectives Excessive or disharmonious activity of internal and external laryngeal muscles causes a type of dysphonia known as muscle tension dysphonia (MTD). MTD is often diagnosed based on laryngoscopic findings and clinical history. Several diagnostic and classification systems have so far been proposed based on increased supraglottic activity to determine MTD. Various studies have shown that increased supraglottic activity may also be observed in those with normal voice. The present study aimed to precisely examine the incidence of abnormal muscle tension pattern (aMTP) in those with normal voice in comparison with those with MTD. The secondary goal of this study was comparative examination of acoustic parameters and maximum phonation time (MPT) in the group with MTD and normal individuals. Material and Methods Participants were 75 people with MTD (41 women and 34 men) and 50 individuals with normal voice and no history of dysphonia (20 women and 30 men). Laryngoscopic evaluation was performed for all participants by considering four types of aMTP. Acoustic analyses, including cepstral peak prominence, jitter, shimmer and NHR, as well as MPT examination were performed. Results A significant difference between the MTD group and control group was observed in all MTPs except for MTP 2 (lateral-to-medial approximation of the false vocal folds) (P = 0.367, χ2(1) = 0.81). In other MTPs, a significant difference existed between the control and MTD groups in terms of aMTP incidence (P Conclusion On the four aMTPs, results revealed that one must exercise caution in diagnosing MTD based on MTP 2 (medial compression of ventricular folds), and this must not be the sole criterion for diagnosis. Moreover, cepstral peak prominence and MPT analyses are of high clinical significance.

High-speed videoendoscopy is an important tool to study laryngeal dynamics, to quantify vocal fold oscillations, to diagnose voice impairments at laryngeal level and to monitor treatment progress. However, there is a significant lack of an open source, expandable research tool that features latest hardware and data analysis. In this work, we propose an open research platform termed OpenHSV that is based on state-of-the-art, commercially available equipment and features a fully automatic data analysis pipeline. A publicly available, user-friendly graphical user interface implemented in Python is used to interface the hardware. Video and audio data are recorded in synchrony and are subsequently fully automatically analyzed. Video segmentation of the glottal area is performed using efficient deep neural networks to derive glottal area waveform and glottal midline. Established quantitative, clinically relevant video and audio parameters were implemented and computed. In a preliminary clinical study, we recorded video and audio data from 28 healthy subjects. Analyzing these data in terms of image quality and derived quantitative parameters, we show the applicability, performance and usefulness of OpenHSV. Therefore, OpenHSV provides a valid, standardized access to high-speed videoendoscopy data acquisition and analysis for voice scientists, highlighting its use as a valuable research tool in understanding voice physiology. We envision that OpenHSV serves as basis for the next generation of clinical HSV systems.

To analyze the association of autonomic dysfunction symptoms with stress in Brazilian university professors of the Speech Language-Pathology course during the Covid-19 pandemic.Fifty-five Brazilian university professors participated in the study, with a mean age of 42 years and 10 months old (±8.75), 49 female and six male subjects. The evaluated outcomes were the symptoms of stress and self-assessment of autonomic dysfunction symptoms. The results were inferentially analyzed using binary logistic regression and chi-squared tests (In 54.54% of the university professors presented stress, with a predominance of psychological symptoms and a higher frequency resistance phase. Stress was a risk factor for the high occurrence of autonomic dysfunction symptoms related (OR 5.841) and unrelated (OR 29.750) to voice. There was an association between the predominance of psychological symptoms and the higher occurrence of autonomic dysfunction symptoms related to voice (There was an association between autonomic dysfunction symptoms and stress in Brazilian university professors during the Covid-19 pandemic.