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Objective: Vocal tremor (VT) poses treatment challenges due to uncertain pathophysiology. VT is typically classified into two phenotypes: isolated vocal tremor (iVT) and essential tremor-related voice tremor (ETvt). The impact of phenotypes on upper aerodigestive tract physiology during swallowing remains unclear. Qualitative and quantitative measures were employed to characterize tremor phenotypes and investigate the effects on swallowing physiology., Methods: Eleven ETvt participants (1 Male, 10 Female; x̄ age = 74) and 8 iVT participants (1 Male, 7 Female; x̄ age = 71) swallowed 20 mL boluses in cued and uncued conditions under standardized fluoroscopic visualization. Sustained/a/productions were captured to assess the rate and extent of fundamental frequency (F0) modulation. Penetration and Aspiration Scale (PAS) scores were obtained and swallowing biomechanics were captured using Swallowtail™ software. Participants also completed the Swallowing Quality of Life (SWAL-QOL) questionnaire., Results: Hypopharyngeal transit was faster in both VT phenotypes compared with Swallowtail™ normative reference data. Total pharyngeal transit times, however, were only faster in patients with iVT, relative to reference data. No significant differences were observed on the SWAL-QOL or PAS between tremor phenotypes. SWAL-QOL scores revealed that these patients rarely reported dysphagia symptoms., Conclusions: Subtle differences in swallowing patterns were observed across VT phenotypes, possibly related to adaptive mechanisms resulting in quicker pharyngeal bolus transit. Most patients did not report swallowing issues or dysphagia symptoms. This study is foundational for larger studies on this challenging population., Level of Evidence: 4 Laryngoscope, 134:4599-4603, 2024., (© 2024 The American Laryngological, Rhinological and Otological Society, Inc.)

Objectives: This study examined the effects of a combination corticosteroid plus long-acting beta 2 -adrenergic agonist inhaler (IC) on rabbit phonation., Methods: White New Zealand male rabbits were assigned randomly to experimental and control groups (n = 11 per group). The experimental group received twice-daily doses of Advair HFA™ (fluticasone propionate 45 mcg and salmeterol 21 mcg) via a veterinary facemask with 1-way valve and spacer; the control group received aerosolized saline. After 8 weeks, animals were euthanized, larynges excised, frozen, and subsequently thawed and mounted on a standard bench apparatus. Phonation was elicited during 15 successive trials, and phonation threshold pressure (PTP; cmH 2 O) and flow (PTF; L/min) were quantified., Results: Repeated measures analysis of variance indicated significant differences between the experimental and control groups (p < 0.05). Mean PTP and PTF values were higher (worse) for rabbits that received Advair HFA™., Conclusion: Following 8-week exposure to ICs, rabbit larynges required greater air pressure and flow to initiate phonation. Because even modest phonation onset differences can have a meaningful clinical impact on voice function, these findings suggest that LABA ICs may put patients at risk for voice disorders. Furthermore, these voice disorders may occur within a relatively short timeframe. The results from this study have important clinical implications for voice care in those who use ICs., Level of Evidence: NA Laryngoscope, 133:2680-2686, 2023., (© 2023 The American Laryngological, Rhinological and Otological Society, Inc.)

The PhenX Toolkit (https://www.phenxtoolkit.org/) is an online catalog of recommended measurement protocols to facilitate cross-study analyses for biomedical research. An expert review panel (ERP) reviewed and updated the PhenX Toolkit Speech and Hearing domain to improve the precision and consistency of speech, language, and hearing disorder phenotypes. A three-member ERP convened in August 2018 to review the measurement protocols in the PhenX Speech and Hearing domain. Aided by three additional experts in voice assessment, vertigo, and stuttering, the ERP updated the 28 protocols to reflect the latest science and technology. ERP recommendations include six new protocols, five updated protocols (from the same source), and one retired protocol. New additions include two voice-related, three hearing-related, and two speech-related protocols. Additions reflect new phone/tablet applications for hearing and language, and clinical evaluations of voice. "Language" was added to the domain name, which is now "Speech, Language, and Hearing," to represent language-related protocols. These protocols can facilitate the assessment of speech, language, and hearing in clinical and population research. Common data elements (i.e., use of the same variables across studies) used by geneticists, otolaryngologists, audiologists, speech-language pathologists, and in other disciplines can lead to cross-study data integration and increased statistical power when studies are combined., (© 2021 Research Triangle Institute. Annals of Human Genetics published by University College London (UCL) and John Wiley & Sons Ltd.)

Purpose Clinical trials have demonstrated that standardized voice treatment programs are effective for some patients, but identifying the unique individual treatment ingredients specifically responsible for observed improvements remains elusive. To address this problem, the authors used a taxonomy of voice therapy, the Rehabilitation Treatment Specification System (RTSS), and a Delphi process to develop the RTSS-Voice (expert consensus categories of measurable and unique voice treatment ingredients and targets). Method Initial targets and ingredients were derived from a taxonomy of voice therapy. Through six Delphi Rounds, 10 vocal rehabilitation experts rated the measurability and uniqueness of individual treatment targets and ingredients. After each round, revisions (guided by the experts' feedback) were finalized among a primary reader (a voice therapy expert) and two external readers (rehabilitation experts outside the field of voice). Consensus was established when the label and definition of an ingredient or target reached a supramajority threshold (≥ 8 of 10 expert agreement). Results Thirty-five target and 19 ingredient categories were agreed to be measurable, unique, and accurate reflections of the rules and terminology of the RTSS. Operational definitions for each category included differences in the way ingredients are delivered and the way individual targets are modified by those ingredients. Conclusions The consensus labels and operationalized ingredients and targets making up the RTSS-Voice have potential to improve voice therapy research, practice, and education/training. The methods used to develop these lists may be useful for other speech, language, and hearing treatment specifications. Supplemental Material https://doi.org/10.23641/asha.15243357.

Objective: To delineate research priorities for improving clinical management of laryngeal dystonia, the NIH convened a multidisciplinary panel of experts for a 1-day workshop to examine the current progress in understanding its etiopathophysiology and clinical care., Methods: The participants reviewed the current terminology of disorder and discussed advances in understanding its pathophysiology since a similar workshop was held in 2005. Clinical and research gaps were identified, and recommendations for future directions were delineated., Results: The panel unanimously agreed to adopt the term "laryngeal dystonia" instead of "spasmodic dysphonia" to reflect the current progress in characterizations of this disorder. Laryngeal dystonia was recognized as a multifactorial, phenotypically heterogeneous form of isolated dystonia. Its etiology remains unknown, whereas the pathophysiology likely involves large-scale functional and structural brain network disorganization. Current challenges include the lack of clinically validated diagnostic markers and outcome measures and the paucity of therapies that address the disorder pathophysiology., Conclusion: Research priorities should be guided by challenges in clinical management of laryngeal dystonia. Identification of disorder-specific biomarkers would allow the development of novel diagnostic tools and unified measures of treatment outcome. Elucidation of the critical nodes within neural networks that cause or modulate symptoms would allow the development of targeted therapies that address the underlying pathophysiology. Given the rarity of laryngeal dystonia, future rapid research progress may be facilitated by multicenter, national and international collaborations., (© 2021 American Academy of Neurology.)

Refractory chronic cough (RCC) and unexplained chronic cough (UCC) are common problems seen in primary care and subspecialty clinics. The role of cough hypersensitivity and laryngeal dysfunction in contributing to the persistence of cough in RCC/UCC is not well recognised. Data of patients with RCC and UCC evaluated in 2019 by an interdisciplinary cough clinic led by a pulmonologist and speech-language pathology team was reviewed. Patients completed validated questionnaires including the Leicester cough questionnaire (LCQ), voice handicap index (VHI) and dyspnoea index (DI) questionnaire at initial encounter. Presence of cough hypersensitivity was based upon a history of allotussia and hypertussia. Laryngeal dysfunction was diagnosed in those with a history of laryngeal paresthesias, throat clearing, voice abnormalities, upper airway dyspnoea and documentation of functional or anatomic laryngeal abnormalities on nasoendoscopy. Of the 60 UCC/RCC patients analysed, 75% of patients were female and 85% were over 40 years of age. Cough hypersensitivity was documented in all patients and multiple cough triggers occurred in 75% of patients. 95%, 50% and 25% of patients reported laryngeal paresthesias, voice abnormalities and upper airway dyspnoea, respectively. Significant associations between LCQ and VHI and DI scores occurred when adjusting for age, sex, ethnicity and body mass index. Laryngeal functional abnormalities were documented on 44 out of 60 patients on nasoendoscopy. Hypertussia, allotussia and laryngeal dysfunction are common in patients with RCC and UCC. Evaluation of UCC and RCC can delineate laryngeal hypersensitivity and allows appropriate treatment to be directed at this phenotype., Competing Interests: Conflict of interest: K.M. Sundar attended one advisory board for Merck in August 2020 ($1175.00), was a site principal investigator (PI) for a study on iVAPS validation of an expiratory positive airway pressure algorithm funded by Resmed Inc., received nonfinancial support for a study on sham continuous positive airway pressure in chronic cough from Respironics Inc., and was a site PI for VOLCANO-2 funded by NeRRe Therapeutics Inc., outside the submitted work. Conflict of interest: A.C. Stark has nothing to disclose. Conflict of interest: N. Hu has nothing to disclose. Conflict of interest: J. Barkmeier-Kraemer has nothing to disclose., (©The authors 2021.)

Objectives: To report the updated psychometric properties of a child feeding questionnaire and to report the psychometric properties of a screening tool developed from this questionnaire. A secondary objective was to consider if items from a behavior checklist embedded within the Infant and Child Feeding Questionnaire may be useful in making referrals for feeding problems., Study Design: Caregivers of children younger than the age of 4 years with pediatric feeding disorders (as defined by International Classification of Diseases, Ninth Revision, criteria) were recruited from 2 outpatient clinics. A comparison group with no feeding problems was recruited during well child checks from community clinics. Caregivers completed a demographic questionnaire and a child feeding questionnaire. Exploratory and confirmatory analyses identified questionnaire items that differentiated groups. Remaining items were summed and area under the curve, sensitivity, and specificity values were calculated to describe the resulting screening tool. ORs of behaviors from the embedded behavior checklist were calculated to determine whether specific behaviors could be useful for referrals., Results: Responses of 989 caregivers (pediatric feeding disorders, n = 331; no feeding problems, n = 650) were obtained. Six questions of the child feeding questionnaire differentiated groups accounting for 60% of variance. Sensitivity (73%) and specificity (93%) were greater when any 2 or more of these 6 items was endorsed. Three items of the embedded feeding behaviors checklist show promise for referrals to specific provider disciplines., Conclusions: A pediatric feeding disorders screening tool consisting of 6 questions from a child feeding questionnaire is psychometrically sound. Use of this tool may expedite referrals for treatment. Further study of the embedded behavior checklist may be useful for clinical referrals., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Purpose This study compared auditory-perceptual measures of presence/absence and severity of vocal tremor to acoustic markers of vocal tremor. The validity (both concurrent and diagnostic) of various acoustic markers of vocal tremor was also assessed. Method Fifty-six midvowel sustained [a:] recordings were selected to yield a representative convenience sample of vocal tremor. After training with 10 synthesized samples, 4 female audiologists rated these samples on "voice tremor severity" on a continuous 10-cm scale. Afterward, 15 randomly selected recordings were presented a 2nd time for intrarater reliability assessment. Customized audio signal processing in Praat yielded 12 acoustic measures of rate, extent and perturbation of fundamental frequency ( f 0 ), and intensity level (IL) modulation. Enter-type multiple linear regression analysis was applied to weight and combine these acoustic variables into an acoustic model of vocal tremor severity. Results After removing the vocal tremor severity ratings of 1 of the audiologists because of insufficient intra- and interrater reliability, mean single-measures consistency-type intraclass correlation coefficients equaled .83 within raters and .72 between raters. Correlation between mean ratings and the 12 acoustic markers ranged from .76 for median extent of f 0 modulation to .11 for rate of IL modulation. Correlation between mean ratings and the acoustic model was .89. Analysis of this model's receiver operating characteristics yielded an area under receiver operating characteristic curve of .93, denoting sensitivity of .87 and specificity of .91. Conclusions This study demonstrated that auditory-perceptual ratings of vocal tremor severity are guided primarily by f 0 and IL modulation extent, less by modulation perturbation, and least by modulation rate. The acoustic model covering all these modulation properties yielded acceptable results in terms of both concurrent and diagnostic validity. However, external cross-validation of this model is warranted before applying it in clinical voice/speech assessment.

Purpose: The aim of this study was to recommend protocols for instrumental assessment of voice production in the areas of laryngeal endoscopic imaging, acoustic analyses, and aerodynamic procedures, which will (a) improve the evidence for voice assessment measures, (b) enable valid comparisons of assessment results within and across clients and facilities, and (c) facilitate the evaluation of treatment efficacy., Method: Existing evidence was combined with expert consensus in areas with a lack of evidence. In addition, a survey of clinicians and a peer review of an initial version of the protocol via VoiceServe and the American Speech-Language-Hearing Association's Special Interest Group 3 (Voice and Voice Disorders) Community were used to create the recommendations for the final protocols., Results: The protocols include recommendations regarding technical specifications for data acquisition, voice and speech tasks, analysis methods, and reporting of results for instrumental evaluation of voice production in the areas of laryngeal endoscopic imaging, acoustics, and aerodynamics., Conclusion: The recommended protocols for instrumental assessment of voice using laryngeal endoscopic imaging, acoustic, and aerodynamic methods will enable clinicians and researchers to collect a uniform set of valid and reliable measures that can be compared across assessments, clients, and facilities.

Background: Iranian vibrato (tahrir) is a common feature of traditional Iranian singing. A unique feature of tahrir is a modulated voice quality perceived as a rhythmic falsetto voice break associated with upward pitch inflections. Laryngeal discomfort and impaired voice quality can occur in singers when they perform Iranian tahrir using an improper technique., Aim: A case series research design was used to explore voice treatment outcomes using laryngeal manual therapy (LMT) for treating voice problems associated with tahrir singing., Method: Four professional Iranian singers of the traditional style (3 men and 1 woman) were studied. All subjects reported difficulty executing tahrir during performances. They were assessed by a speech-language pathologist (SLP) specializing in the administration of LMT for voice disorders. Multidimensional assessments were made of the participants' vocal function using acoustic and auditory-perceptual evaluation, self-reports of the singers, and LMT assessments by the SLP before and after treatment. The therapeutic program implemented LMT techniques to release laryngeal joints and reduce muscular tension., Results: Pretreatment examination of the larynx and anterior neck musculature using palpation showed that the difficulties in producing tahrir vibrato were associated with a decreased thyrohyoid space and tension in the submental complex and sternocleidomastoid. Posttreatment examination showed an increased thyrohyoid space and reduced tension in the submental complex and sternocleidomastoid, associated with the singers' perception of reduced effort producing tahrir vibrato during singing., Conclusion: Tahrir vibrato requires specific training to prevent excessive tension in laryngeal and neck muscles. In the absence of such training, or in the context of excessive singing associated with fatigue, LMT may facilitate more efficient vocal production in tahrir singers., (© 2015 S. Karger AG, Basel.)

Objectives/hypothesis: This article describes a case study of physiologic and acoustic patterns of essential vocal tremor (EVT). Simulations of vocal tremor were used to test hypotheses regarding measured acoustic patterns and expected physiologic sources., Study Design: This is a case study of EVT using an analysis by synthesis approach., Methods: Oscillations of vocal tract and laryngeal structures were identified using rigid videostroboscopic examination. Acoustical analyses of sustained phonation were completed using the methods previously described in the literature and custom-written MATLAB functions. Simulations of the client's vocal tremor were created using a computational model., Results: The client exhibited vocal fold length changes and oscillation within the laryngeal vestibule during sustained phonation at a comfortable pitch and loudness. Despite the involvement of vocal fold length changes, a low average extent of fundamental frequency (F0) modulation (ie, 5.3%) and high average extent of intensity modulation (ie, 23.0%) were measured. Simulations of vocal tremor involving modulation of F0 demonstrated that this source of tremor contributes to frequency-induced intensity modulation, although there was a greater extent of F0 modulation than intensity modulation., Conclusions: The greater extent of intensity than F0 modulation in one client with EVT exhibiting predominant vocal fold length changes contrasted with the lower extent of intensity than F0 modulation in simulated vocal tremor involving F0 modulation. These findings demonstrate that other potential sources of intensity modulation outside the larynx should be determined during the evaluation of clients with vocal tremor., (Copyright © 2013 The Voice Foundation. Published by Mosby, Inc. All rights reserved.)

Objective: Thyroidectomy may be performed for clinical indications that include malignancy, benign nodules or cysts, suspicious findings on fine needle aspiration biopsy, dysphagia from cervical esophageal compression, or dyspnea from airway compression. About 1 in 10 patients experience temporary laryngeal nerve injury after surgery, with longer lasting voice problems in up to 1 in 25. Reduced quality of life after thyroid surgery is multifactorial and may include the need for lifelong medication, thyroid suppression, radioactive scanning/treatment, temporary and permanent hypoparathyroidism, temporary or permanent dysphonia postoperatively, and dysphagia. This clinical practice guideline provides evidence-based recommendations for management of the patient's voice when undergoing thyroid surgery during the preoperative, intraoperative, and postoperative period., Purpose: The purpose of this guideline is to optimize voice outcomes for adult patients aged 18 years or older after thyroid surgery. The target audience is any clinician involved in managing such patients, which includes but may not be limited to otolaryngologists, general surgeons, endocrinologists, internists, speech-language pathologists, family physicians and other primary care providers, anesthesiologists, nurses, and others who manage patients with thyroid/voice issues. The guideline applies to any setting in which clinicians may interact with patients before, during, or after thyroid surgery. Children under age 18 years are specifically excluded from the target population; however, the panel understands that many of the findings may be applicable to this population. Also excluded are patients undergoing concurrent laryngectomy. Although this guideline is limited to thyroidectomy, some of the recommendations may extrapolate to parathyroidectomy as well., Results: The guideline development group made a strong recommendation that the surgeon should identify the recurrent laryngeal nerve(s) during thyroid surgery. The group made recommendations that the clinician or surgeon should (1) document assessment of the patient's voice once a decision has been made to proceed with thyroid surgery; (2) examine vocal fold mobility, or refer the patient to a clinician who can examine vocal fold mobility, if the patient's voice is impaired and a decision has been made to proceed with thyroid surgery; (3) examine vocal fold mobility, or refer the patient to a clinician who can examine vocal fold mobility, once a decision has been made to proceed with thyroid surgery if the patient's voice is normal and the patient has (a) thyroid cancer with suspected extrathyroidal extension, or (b) prior neck surgery that increases the risk of laryngeal nerve injury (carotid endarterectomy, anterior approach to the cervical spine, cervical esophagectomy, and prior thyroid or parathyroid surgery), or (c) both; (4) educate the patient about the potential impact of thyroid surgery on voice once a decision has been made to proceed with thyroid surgery; (5) inform the anesthesiologist of the results of abnormal preoperative laryngeal assessment in patients who have had laryngoscopy prior to thyroid surgery; (6) take steps to preserve the external branch of the surperior laryngeal nerve(s) when performing thyroid surgery; (7) document whether there has been a change in voice between 2 weeks and 2 months following thyroid surgery; (8) examine vocal fold mobility or refer the patient for examination of vocal fold mobility in patients with a change in voice following thyroid surgery; (9) refer a patient to an otolaryngologist when abnormal vocal fold mobility is identified after thyroid surgery; (10) counsel patients with voice change or abnormal vocal fold mobility after thyroid surgery on options for voice rehabilitation. The group made an option that the surgeon or his or her designee may monitor laryngeal electromyography during thyroid surgery. The group made no recommendation regarding the impact of a single intraoperative dose of intravenous corticosteroid on voice outcomes in patients undergoing thyroid surgery.

The recurrent laryngeal nerve (RLN) branches from the vagus cranial nerve to innervate structures important for voicing and swallowing. Damage to this nerve, commonly associated with surgery or idiopathic etiologies that largely occur with aging, results in impaired voicing and swallowing (Myssiorek, 2004). Sunderland proposed a model of peripheral nerve damage whereby a nerve's ability to resist damage from stretch and compression is determined by the quantity and composition of its epineurial connective tissues (Sunderland, 1951). Thus, it would be expected that epineurium differs depending upon the forces imposed on a nerve within its anatomical setting. The purpose of this study was to investigate RLN epineurium quantity and composition with development. A porcine model (piglet vs. juvenile) was used because of the similarity between porcine and human laryngeal innervation, anatomy and function. The entire RLN was excised bilaterally, and stereological methods were used to quantify the composition of epineurial connective tissues. Compared with the piglet, the juvenile pig RLN was double the diameter. While the piglet had no differences in the percentage of epineurial collagen and adipose between proximal and distal segments of both sides of the RLN, the juvenile pig had a greater percentage of collagen in the proximal segment of both sides of the RLN and a greater percentage of adipose in the distal segment of the left RLN compared with the proximal segment. In addition, unlike the piglet, the juvenile pig had a greater number of fascicles in the proximal than distal segment of the RLN, regardless of nerve side. These findings are consistent with predicted patterns associated with the different anatomical settings of the left and right RLN, show that the RLN changes with age, and support Sunderland's model., (© 2013 Anatomical Society.)

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 be formally considered for inclusion in clinical voice assessment., Conclusion: Results provide evidence for selected acoustic, laryngeal imaging-based, auditory-perceptual, functional, and aerodynamic measures to be used as effective components in a clinical voice evaluation. However, there is clearly a pressing need for further high-quality research to produce sufficient evidence on which to recommend a comprehensive set of methods for a standard clinical voice evaluation.

Objectives/hypothesis: Vocal tremor is an acoustical phenomenon characterized by relatively periodic modulations in fundamental frequency and intensity. Although vocal tremor is considered easier to perceive during sustained phonation than during connected speech, systematic comparison between these speech contexts has not been investigated. This investigation compared vocal tremor perception during sustained phonation and connected speech contexts., Study Design: This is a prospective, controlled study with randomized conditions., Methods: Audio recordings from five speakers diagnosed with essential vocal tremor were used for this study. Twenty-four naive adult listeners rated the overall severity (ie, aberrance) of the voice and the degree of shakiness (ie, tremor) during sustained phonation of /i/. A different group of 21 naive adult listeners rated sentence stimuli consisting of two different sentences, one loaded with voiced and the other with voiceless speech sounds., Results: All speakers were rated by listeners to have similar levels of shakiness and overall severity during sustained phonation. However, significantly higher levels of shakiness and overall severity were perceived during sustained phonation than during sentence context. A nonsignificant trend was shown for higher average ratings for shakiness and overall severity on voice-loaded compared with voiceless-loaded sentences., Conclusions: This study demonstrated that vocal tremor is perceived as significantly more severe during sustained phonation than during connected speech. More importantly, individual speakers differed in their ability to reduce vocal tremor perception during connected speech. Thus, sustained phonation does not necessarily offer a valid estimation of the impact of a vocal tremor on an individual's connected speech., (Copyright © 2012 The Voice Foundation. Published by Mosby, Inc. All rights reserved.)

Sequential swallowing is the act of swallowing multiple times, without pausing. Because sequential swallowing requires breath-holding, it seems likely that it could increase the drive to breathe. This study was designed to determine if sequential swallowing is accompanied by an increased drive to breathe in young, healthy adults. We predicted that sequential swallowing would be accompanied by prolonged breath-holding in most cases, and that this would be followed by a recovery phase during which ventilation would increase for a brief period. Results showed that not only did healthy participants increase ventilation after sequential swallowing, they also experienced breathing discomfort (dyspnea) despite the fact that they usually continued to breathe during the swallowing sequence. Given that these effects are observable in young, healthy adults, it seems reasonable to assume that individuals with respiratory and/or neurological compromise would also have an increased drive to breathe during sequential swallowing.

Vocal tremor is characterized by involuntary rhythmic modulations of pitch and loudness and is best perceived during sustained phonation of vowels. It is most often present in individuals affected by neurogenic disorders such as Parkinson's disease, amyotrophic lateral sclerosis, spinal muscular dystrophy, spasmodic dysphonia, and essential tremor. Vocal tremor does not appear to be responsive to systemic pharmaceutical management but may benefit from injection of botulinum toxin (i.e., Botox) into affected musculature. However, many individuals do not tolerate the potential side effects of severe breathiness and difficulty swallowing associated with Botox injections. In this article, we summarize the speech evaluation and treatment methods successfully used with an individual with essential vocal tremor. Methods used for characterizing the individual's vocal tremor patterns and the ensuing rationale for behavioral intervention is provided. The outcomes of this case example motivated consideration of speech treatment as a beneficial strategy for some individuals with vocal tremor., (© Thieme Medical Publishers.)

Purpose: This article presents the development of the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) following a consensus conference on perceptual voice quality measurement sponsored by the American Speech-Language-Hearing Association's Special Interest Division 3, Voice and Voice Disorders. The CAPE-V protocol and recording form were designed to promote a standardized approach to evaluating and documenting auditory-perceptual judgments of vocal quality., Method: A summary of the consensus conference proceedings and the factors considered by the authors in developing this instrument are included., Conclusion: The CAPE-V form and instructions, included as appendices to this article, enable clinicians to document perceived voice quality deviations following a standard (i.e., consistent and specified) protocol.