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Abstract Objectives The success of type 2 thyroplasty (TP2) for adductor spasmodic dysphonia (AdSD) depends on the selection of optimally sized titanium bridges, which requires accurate assessment of intraoperative vocal changes. While this procedure has traditionally been performed according to the laryngologist's experience, the most appropriate method for voice monitoring and selection of titanium bridge size remains to be determined. This study aimed to investigate evaluation parameters useful for voice monitoring, as these may allow less experienced surgeons to perform TP2 properly. Methods In this prospective study, voice monitoring was performed in 18 patients with AdSD patients undergoing TP2. Evaluations were performed preoperatively, intraoperatively, 13 weeks postoperatively, and 52 weeks postoperatively using GRBAS (grade, roughness, breathiness, asthenia, and strain), as well as perceptual judgment and acoustic analyses. Results Preoperative and intraoperative assessments of the G, R, B, and S parameters, perceptual judgment, and harmonic‐to‐noise ratio (HNR) were in moderate or better agreement. Intraoperative and 13‐ or 52‐week postoperative measurements of the R, B, and G parameters and strangulation, tremor, and HNR were also in high agreement. When two different sizes of titanium bridges were compared (unselected vs. selected), ratings for G, R, S, strangulation, tremor, jitter, shimmer, HNR, standard deviation of F0, and degree of voice breaks were better for the selected width than the unselected width. Conclusion The candidate items for intraoperative voice monitoring during TP2 for AdSD are G, R, strangulation, tremor, and HNR. The use of these items may help to ensure successful TP2 and contribute to the advancement of laryngeal framework surgery. Level of evidence Level 4.

Objectives: The success of type 2 thyroplasty (TP2) for adductor spasmodic dysphonia (AdSD) depends on the selection of optimally sized titanium bridges, which requires accurate assessment of intraoperative vocal changes. While this procedure has traditionally been performed according to the laryngologist's experience, the most appropriate method for voice monitoring and selection of titanium bridge size remains to be determined. This study aimed to investigate evaluation parameters useful for voice monitoring, as these may allow less experienced surgeons to perform TP2 properly. Methods: In this prospective study, voice monitoring was performed in 18 patients with AdSD patients undergoing TP2. Evaluations were performed preoperatively, intraoperatively, 13 weeks postoperatively, and 52 weeks postoperatively using GRBAS (grade, roughness, breathiness, asthenia, and strain), as well as perceptual judgment and acoustic analyses. Results: Preoperative and intraoperative assessments of the G, R, B, and S parameters, perceptual judgment, and harmonic‐to‐noise ratio (HNR) were in moderate or better agreement. Intraoperative and 13‐ or 52‐week postoperative measurements of the R, B, and G parameters and strangulation, tremor, and HNR were also in high agreement. When two different sizes of titanium bridges were compared (unselected vs. selected), ratings for G, R, S, strangulation, tremor, jitter, shimmer, HNR, standard deviation of F0, and degree of voice breaks were better for the selected width than the unselected width. Conclusion: The candidate items for intraoperative voice monitoring during TP2 for AdSD are G, R, strangulation, tremor, and HNR. The use of these items may help to ensure successful TP2 and contribute to the advancement of laryngeal framework surgery. Level of evidence: Level 4. [ABSTRACT FROM AUTHOR]

Background: Neck surface accelerometer (NSA) wearable devices have been developed for voice and upper airway health monitoring. As opposed to acoustic sounds, NSA senses mechanical vibrations propagated from the vocal tract to neck skin, which are indicative of a person's voice and airway conditions. NSA signals do not carry identifiable speech information and a speaker's privacy is thus protected, which is important and necessary for continuous wearable monitoring. Our device was already tested for its durable endurance and signal processing algorithms in controlled laboratory conditions. Objective: This study aims to further evaluate both instrument and analysis validity in a group of occupational vocal users, namely, voice actors, who use their voices extensively at work in an ecologically valid setting. Methods: A total of 16 professional voice actors (age range 21-50 years; 11 females and 5 males) participated in this study. All participants were mounted with an NSA on their sternal notches during the voice acting and voice assessment sessions. The voice acting session was 4-hour long, directed by a voice director in a professional sound studio. Voice assessment sessions were conducted before, during, and 48 hours after the acting session. The assessment included phonation tasks of passage reading, sustained vowels, maximum vowel phonation, and pitch glides. Clinical acoustic metrics (eg, fundamental frequency, cepstral measures) and a vocal dose measure (ie, accumulated distance dose from acting) were computed from NSA signals. A commonly used online questionnaire (Self-Administered Voice Rating questionnaire) was also implemented to track participants' perception of vocal fatigue. Results: The NSA wearables stayed in place for all participants despite active body movements during the acting. The ensued body noise did not interfere with the NSA signal quality. All planned acoustic metrics were successfully derived from NSA signals and their numerical values were comparable with literature data. For a 4-hour long voice acting, the averaged distance dose was about 8354 m with no gender differences. Participants perceived vocal fatigue as early as 2 hours after the start of voice acting, with recovery 24-48 hours after the acting session. Among all acoustic metrics across phonation tasks, cepstral peak prominence and spectral tilt from the passage reading most closely mirrored trends in perceived fatigue. Conclusions: The ecological validity of an in-house NSA wearable was vetted in a workplace setting. One key application of this wearable is to prompt occupational voice users when their vocal safety limits are reached for duly protection. Signal processing algorithms can thus be further developed for near real-time estimation of clinically relevant metrics, such as accumulated distance dose, cepstral peak prominence, and spectral tilt. This functionality will enable continuous self-awareness of vocal behavior and protection of vocal safety in occupational voice users. [ABSTRACT FROM AUTHOR]

Purpose: Voice feminization for transgender women remains a challenge. The fundamental frequency of the voice (fo) is one of the main parameters contributing to the perception of gender. One of the aims of voice therapy is to help transgender women acquire a new vocal motor behavior to increase their fo. We hypothesized that ambulatory biofeedback could help extend the new vocal behavior to daily life. Materials and methods: This prospective case study assessed the impact of two weeks of ambulatory vibrotactile biofeedback (VTBF) applied to one transgender woman, following two weeks of voice therapy (three 60-minute sessions). The VTBF was activated when the participant's voice was lower than 150 Hz for more than 500 ms and was accompanied by two 60-minute counseling sessions. Results: The results showed that mean fo monitored in daily activities tended to increase following the two weeks of voice therapy (Δ = 8 Hz or 1 semitone) and then increased significantly immediately after the two weeks of VTBF (Δ = 13 Hz or 1.5 semitones). The increase in mean fo from day to day and the decrease in the activation percentage from the first to the second week of VTBF (Δ = 6%) indicated a gradual integration of the motor behavior, making it possible to achieve the targeted female frequency. Conclusions: The results suggest that ambulatory VTBF helped the participant to generalize the techniques acquired during the voice therapy sessions to real-life communication situations. These results are promising for therapeutic programs that integrate tools that can be used outside the clinical context. Design: Prospective case study. [ABSTRACT FROM AUTHOR]

Optical fiber sensing is a novel sensing technology with the advantages of anti-electromagnetic interference, anti-corrosion and high sensitivity suiting for many special applications. In this paper, a Michelson optical fiber voice monitoring system is introduced and a novel sound extraction algorithm is proposed to improve the noise stability of it. The voice demodulated by a traditional algorithm based on $3\times 3$ fiber coupler has unstable background noise intensity with the change of the working point of the interferometer. The unstable noise comes from the shot noise of photodetectors. The sound extraction method proposed in this paper uses the relation between shot noise and light intensity to smooth the unstable noise and does not affect the quality of voice monitoring. Voice monitoring systems using this algorithm have stable monitoring quality without any working point control technology. The fluctuation range of noise intensity in 300~3500 Hz decrease from 10 dB to less than 2 dB compared with the traditional demodulation algorithm. Such a method and system can be widely used in many special voice monitoring application fields such as prison, underground utility tunnel.

Purpose: To identify the factors affecting teachers' vocal acoustic parameters, with the aim of detecting individuals at risk of phonotrauma. Method: The voicing time, voice sound pressure level [SPL] and fundamental frequency [fo] of 87 teachers were measured during one workweek using a voice dosimeter. We retrospectively investigated the impact of 10 factors (gender, age, teaching experience, teaching level, tobacco, gastro-esophageal problems, nonoccupational voice activity, voice education, past voice problems, and biopsychosocial impact of voice problems measured using the Voice Handicap Index [VHI]) on each voice parameter. Results: None of the above factors affected voicing time or SPL. fo depended significantly on gender, teaching level, nonoccupational voice activity and VHI score. Specifically, fo was higher in women (Δ = 69 Hz), in individuals without nonoccupational voice activities (Δ = 11 Hz), and in individuals with a lower VHI score (increase of 0.7 Hz for each additional point). For females, post hoc comparisons revealed a substantial impact of teaching level on fo: university instructors had deeper voices than kindergarten (Δ = 66 Hz), elementary (Δ = 52 Hz), or secondary teachers (Δ = 41 Hz). Conclusions: Since higher fo increases the mechanical stress related to vocal fold vibration, the screening and prevention of phonotrauma should focus primarily on women, particularly those who teach at lower levels, and teachers with more self-rated voice problems. The lower fo of teachers who engage in nonprofessional voice activities may suggest acute inflammation or muscle fatigue due to voice overload. [ABSTRACT FROM AUTHOR]

In questo studio sono riportati gli esiti del monitoraggio della voce di 27 insegnanti elementari e della relazione tra i parametri acustici di voce e aula. A seguito della validazione metrologica di un nuovo analizzatore vocale, in termini di incertezza tipo ed errore massimo ammissibile, è stata avviata la campagna di monitoraggio della voce occupazionale. Lo sforzo vocale medio, è risultato pari a 71,2 dB. È stato osservato l’effetto Lombard ad un tasso di 0,53 dB/dB ed un tempo di riverberazione ottimale di 0,7 s in grado di minimizzare il livello di voce. Per la sicurezza occupazionale è necessario avviare strategie di controllo vocale in campo, accurate e prolungate nel tempo. ------ In this study, the results of the voice monitoring of 27 teachers and the relationships between voice and classroom acoustics parameters are given. After metrologically validating a new vocal analyzer in terms of standard uncertainty and maximum admitted error, the occupational voice use monitoring campaign was started. The average vocal effort resulted to be of 71.2 dB. A Lombard effect was observed at a rate of 0.53 dB/dB and an optimal reverberation time of 0.7 s was found that minimizes the voice level. To guarantee occupational safety it is thus needed to start voice control strategies in field, that are accurate and prolonged in time.

Background: Occupational voice problems constitute a serious public health issue with substantial financial and human consequences for society. Modern mobile technologies such as smartphones have the potential to enhance approaches to prevention and management of voice problems. This paper addresses an important aspect of smartphone‐assisted voice care: the reliability of smartphone‐based acoustic analysis for voice health state monitoring. Aim: To assess the reliability of acoustic parameter extraction for a range of commonly used smartphones by comparison with studio recording equipment. Methods & Procedures: Twenty‐two vocally healthy speakers (12 female, 10 male) were recorded producing sustained vowels and connected speech under studio conditions using a high‐quality studio microphone and an array of smartphones. For both types of utterance, Bland–Altman analysis was used to assess overall reliability for mean F0, cepstral peak prominence (CPPS), Jitter (RAP) and Shimmer %. Outcomes & Results: Analysis of the systematic and random error indicated significant bias for CPPS across both sustained vowels and passage reading. Analysis of the random error of the devices indicated that that mean F0 and CPPS showed acceptable random error size, while jitter and shimmer random error was judged as problematic. Conclusions & Implications: Confidence in the feasibility of smartphone‐based voice assessment is increased by the experimental finding of high levels of reliability for some clinically relevant acoustic parameters, while the use of other parameters is discouraged. We also challenge the practice of using statistical tests (e.g., t‐tests) for measurement reliability assessment. [ABSTRACT FROM AUTHOR]

Classroom acoustics was one of the main research themes of Murray Hodgson, which I had the chance to know in Rome, at the ICA Conference in 2001, when I was at the beginning of my working path, and to further have as scientific converser in many other occasions. In Ferrara, in 2003, he concluded his presentation of a course on classroom acoustics with the hint that the teachers' voice problems should have been object of future studies. I have been working on this matter for seven years and this work summarizes the results and the perspectives related to the assessment of teachers' vocal behavior. In particular, teachers' voice monitoring during daily working activities has been recently based on wearable vocal analyzers equipped with contact sensors, which allow for measuring parameters related to vocal effort, vocal load, vocal intonation and health. Results obtained during experimental campaigns that took place in the last years in schools of different grade are presented in this work. The relationships with classroom acoustics, both in terms of noise and too low or excessive reverberation, and the subjective outcomes of the teachers, are also discussed. [ABSTRACT FROM AUTHOR]

Many common voice disorders are chronic or recurring conditions that are likely to result from inefficient and/or abusive patterns of vocal behavior, referred to as vocal hyperfunction. The clinical management of hyperfunctional voice disorders would be greatly enhanced by the ability to monitor and quantify detrimental vocal behaviors during an individual’s activities of daily life. This paper provides an update on ongoing work that uses a miniature accelerometer on the neck surface below the larynx to collect a large set of ambulatory data on patients with hyperfunctional voice disorders (before and after treatment) and matched control subjects. Three types of analysis approaches are being employed in an effort to identify the best set of measures for differentiating among hyperfunctional and normal patterns of vocal behavior: 1) ambulatory measures of voice use that include vocal dose and voice quality correlates, 2) aerodynamic measures based on glottal airflow estimates extracted from the accelerometer signal using subject-specific vocal system models, and 3) classification based on machine learning and pattern recognition approaches that have been used successfully in analyzing long-term recordings of other physiological signals. Preliminary results demonstrate the potential for ambulatory voice monitoring to improve the diagnosis and treatment of common hyperfunctional voice disorders.

Professional voice has become an important issue in the field of occupational health. Similarly, voice diseases related to occupations gain interest in insurance medicine, particularly within the frame of specific insurance systems for occupational diseases. Technological developments have made possible dosimetry of voice loading in the work-place, as well as long-term monitoring of relevant voice parameters during professional activities. A critical review is given, with focus on the specificity of occupational voice use and on the point of view of insurance medicine. Remaining questions and suggestions for future research are proposed. [ABSTRACT FROM PUBLISHER]

Previous studies on voice disorders among teachers have reported that this multidimensional phenomenon is associated with individual factors, external factors related with the audience and with the type of task and the occupation. This work deals with the long-term monitoring (1 to 4 days) of 31 primary school teachers and with the determination of the relationship between conversational and occupational voice parameters. Statistical analysis was performed to investigate the relationships between voice parameters and room acoustics-related factors. [ABSTRACT FROM AUTHOR]

Summary Purpose The objective of this study was to investigate the effect of cumulative vocal demands on the voices of music students majoring in voice throughout an academic semester. Method Acoustic and aerodynamic voice parameters captured across an academic semester were analyzed. This study was designed as a time-course investigation, in which all participants were tested individually at three separate times distributed equally over an academic semester. General effects were verified with the application of one-way within-participants analysis of variances with repeated measures. The equipment used for monitoring vocal behavior consisted of the Computerized Speech Lab, the Phonatory Aerodynamic System, and the Ambulatory Phonation Monitor, computer-based systems for the assessment of voice. Self-reported data regarding voice usage were also collected. Results In this study, comparisons of voice parameters of student singers repeatedly measured throughout an extended period of time did not lead to statistically significant differences. Self-reported information suggested a reasonable level of knowledge and awareness regarding voice concerns in this population. Conclusions The results of this study indicated consistent stability of voice acoustic and aerodynamic parameters in this group throughout an academic semester. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: This investigation compared voice performance of student teachers across an academic semester in order to examine the effect of increasing demands on their voice. Method: A repeated measures design was applied to the data analysis: all participants were tested three separate times throughout the semester. The equipments used for monitoring vocal behavior were the Ambulatory Phonation Monitor (APM), the Computerized Speech Lab (CSL), and the Phonatory Aerodynamic System (PAS), which are computer-based systems for acoustic and aerodynamic assessment of voice. Additionally, participants completed surveys related to voice usage. Results: In this study, most voice parameters of student teachers measured in a natural setting and in a controlled environment indicated changes that revealed progressive instability and noise in the course of an academic semester. Additional comparisons demonstrated differences between voice usage in the school environment and voice produced in the voice lab. Self-reported information demonstrated overall reduced awareness regarding preventive methods for voice disorders. Conclusions: Based on the results of this study, increased teaching-related voice demands associated with reduced awareness of voice production and preventive measures of voice disorders may have a detrimental impact on voice performance, leading to a risk of developing voice disorders. Learning outcomes: Participants will recognize the importance of clarifying and quantifying the relationship of vocal demands and voice performance among student teachers. [Copyright &y& Elsevier]

Background: Neck surface accelerometer (NSA) wearable devices have been developed for voice and upper airway health monitoring. As opposed to acoustic sounds, NSA senses mechanical vibrations propagated from the vocal tract to neck skin, which are indicative of a person's voice and airway conditions. NSA signals do not carry identifiable speech information and a speaker's privacy is thus protected, which is important and necessary for continuous wearable monitoring. Our device was already tested for its durable endurance and signal processing algorithms in controlled laboratory conditions., Objective: This study aims to further evaluate both instrument and analysis validity in a group of occupational vocal users, namely, voice actors, who use their voices extensively at work in an ecologically valid setting., Methods: A total of 16 professional voice actors (age range 21-50 years; 11 females and 5 males) participated in this study. All participants were mounted with an NSA on their sternal notches during the voice acting and voice assessment sessions. The voice acting session was 4-hour long, directed by a voice director in a professional sound studio. Voice assessment sessions were conducted before, during, and 48 hours after the acting session. The assessment included phonation tasks of passage reading, sustained vowels, maximum vowel phonation, and pitch glides. Clinical acoustic metrics (eg, fundamental frequency, cepstral measures) and a vocal dose measure (ie, accumulated distance dose from acting) were computed from NSA signals. A commonly used online questionnaire (Self-Administered Voice Rating questionnaire) was also implemented to track participants' perception of vocal fatigue., Results: The NSA wearables stayed in place for all participants despite active body movements during the acting. The ensued body noise did not interfere with the NSA signal quality. All planned acoustic metrics were successfully derived from NSA signals and their numerical values were comparable with literature data. For a 4-hour long voice acting, the averaged distance dose was about 8354 m with no gender differences. Participants perceived vocal fatigue as early as 2 hours after the start of voice acting, with recovery 24-48 hours after the acting session. Among all acoustic metrics across phonation tasks, cepstral peak prominence and spectral tilt from the passage reading most closely mirrored trends in perceived fatigue., Conclusions: The ecological validity of an in-house NSA wearable was vetted in a workplace setting. One key application of this wearable is to prompt occupational voice users when their vocal safety limits are reached for duly protection. Signal processing algorithms can thus be further developed for near real-time estimation of clinically relevant metrics, such as accumulated distance dose, cepstral peak prominence, and spectral tilt. This functionality will enable continuous self-awareness of vocal behavior and protection of vocal safety in occupational voice users., (©Zhengdong Lei, Lisa Martignetti, Chelsea Ridgway, Simon Peacock, Jon T Sakata, Nicole Y K Li-Jessen. Originally published in JMIR Formative Research (https://formative.jmir.org), 05.08.2022.)

Many common voice disorders are chronic or recurring conditions that are likely to result from inefficient and/or abusive patterns of vocal behavior, referred to as vocal hyperfunction. The clinical management of hyperfunctional voice disorders would be greatly enhanced by the ability to monitor and quantify detrimental vocal behaviors during an individual's activities of daily life. This paper provides an update on ongoing work that uses a miniature accelerometer on the neck surface below the larynx to collect a large set of ambulatory data on patients with hyperfunctional voice disorders (before and after treatment) and matched-control subjects. Three types of analysis approaches are being employed in an effort to identify the best set of measures for differentiating among hyperfunctional and normal patterns of vocal behavior: (1) ambulatory measures of voice use that include vocal dose and voice quality correlates, (2) aerodynamic measures based on glottal airflow estimates extracted from the accelerometer signal using subject-specific vocal system models, and (3) classification based on machine learning and pattern recognition approaches that have been used successfully in analyzing long-term recordings of other physiological signals. Preliminary results demonstrate the potential for ambulatory voice monitoring to improve the diagnosis and treatment of common hyperfunctional voice disorders.