The clinical voice laboratory: Clinical application of voice research

In the past decade the number of voice laboratories has increased dramatically. Their primary mission is to enhance patient care by the application of knowledge gained from basic research. They also are dedicated to further improvement of diagnostic and therapeutic resources. The strength of the voice laboratory lies in collaboration between the clinician and the scientist.     

G. Paul Moore lecture: Rational thought: The impact of voice science upon voice care

Recent evolution in scientific knowledge and technology has led to monumental improvement in the standard of care for patients with voice disorders. New concepts in anatomy, physiology, measurement, and analysis have provided voice care professionals with not merely better understanding, but moreover an extensive vocabulary with which to think about voice function and dysfunction. Previously, we had to depend too much upon anecdote and “the art of medicine.” Thanks to scientific advances, we now have the tools we need for rational thought about the human voice. This is the fundamental change responsible for recent great advances in voice care.     

The accent method of voice therapy: Effect of accentuations on FO, SPL, and airflow

The effect of the increased flow rate (ΔU) in response to the Accent Method exercises on fundamental frequency (FO) and sound pressure level (SPL) was studied in three subjects (professionally trained, trained, and untrained in this method). In all the subjects, the rhythmic accentuated exercises produced a variable degree of increase in FO (ΔFO) and SPL (ΔSPL). The professionally trained subject showed greater ΔFO and ΔSPL in response to the ΔU in the fastest tempo, which requires higher skills. Both trained subjects showed a greater correlation between ΔU and both ΔSPL and ΔFO, as well as between ΔFO and ΔSPL, as compared to the untrained subject. The effects of the accentuated exercises on FO and SPL in response to the increased airflow rate (ΔU) thus appear to demonstrate the treating effectiveness of the Accent Method.     

Correlation of VHI-10 to Voice Laboratory Measurements Across Five Common Voice Disorders

ObjectiveTo correlate change in Voice Handicap Index (VHI)-10 scores with corresponding voice laboratory measures across five voice disorders.Study DesignRetrospective study.MethodsOne hundred fifty patients aged >18 years with primary diagnosis of vocal fold lesions, primary muscle tension dysphonia-1, atrophy, unilateral vocal fold paralysis (UVFP), and scar. For each group, participants with the largest change in VHI-10 between two periods (T_A and T_B) were selected. The dates of the VHI-10 values were linked to corresponding acoustic/aerodynamic and audio-perceptual measures. Change in voice laboratory values were analyzed for correlation with each other and with VHI-10.ResultsVHI-10 scores were greater for patients with UVFP than other disorders. The only disorder-specific correlation between voice laboratory measure and VHI-10 was average phonatory airflow in speech for patients with UVFP. Average airflow in repeated phonemes was strongly correlated with average airflow in speech (r = 0.75). Acoustic measures did not significantly change between time points.ConclusionsThe lack of correlations between the VHI-10 change scores and voice laboratory measures may be due to differing constructs of each measure; namely, handicap versus physiological function. Presuming corroboration between these measures may be faulty. Average airflow in speech may be the most ecologically valid measure for patients with UVFP. Although aerodynamic measures changed between the time points, acoustic measures did not. Correlations to VHI-10 and change between time points may be found with other acoustic measures.     

Impact and Prevention of Voice Problems in the Teaching Profession: Embracing the Consumers'' View

Teachers are vulnerable to developing voice problems due to their specific occupational demands during teaching. Information on how the teaching profession is impacted by voice problems and what the profession perceives to be useful information for preventing voice problems is important for health care service providers. A total of 122 subjects from the teaching profession (55 practicing teachers and 67 prospective teachers) were therefore surveyed to ascertain their perception of their voice condition and the impact of voice problems on their communication, social life, personal emotions, and occupation. The results showed that the practicing teachers perceived their voice to be significantly worse than the prospective teachers. In addition, the teachers also faced significantly more difficulties in their daily communication than the prospective teachers. These two groups of subjects believed that information on breathing exercises and specific vocal hygiene strategies would help them prevent voice problems.     

Common Practices of Voice Therapists in the Evaluation of Patients

This study surveys voice therapists regarding common diagnostic practices in patients referred for therapy with the diagnosis of muscle tension dysphonia (broadly defined as the "hyperfunctional" component of the dysphonia). Through postings on the e-mail list of the ASHA special interest division on voice, speech pathologists with at least 3 years' experience in stroboscopy and acoustic instrumentation were invited to complete the survey. Results from 53 completed surveys demonstrated that voice quality and patient self-perception are the sole assessments performed by all therapists. Voice quality, observation of body posture and movement, and probing the patient's ability to alter voice production are each significantly more likely to be performed than the more objective stroboscopic, acoustic, aerodynamic, and EGG assessments. Further, the tasks of defining specific therapy session goals and helping the patient to achieve a particular target skill are considered best served by measures of vocal quality, observation of body position and movement, and judging the patient's ability to alter voice production. For definition of the overall therapy goal, stroboscopy and patient perception scales are added to all of the subjective assessment measures as being important. Acoustic data are considered most important for patient reinforcement and outcomes assessment. Implications of these findings are discussed, and topics for further exploration are identified.     

Voice Perceptions and Quality of Life of Transgender People

Despite the plethora of research documenting that the voice and quality of life (QoL) are related, the exact nature of this relationship is vague. Studies have not addressed people who consider their voice to influence their life and identity, but would not be considered to have a voice “disorder” (e.g., transgender individuals). Individuals seeking vocal feminization may or may not have vocal pathology and often have concerns not addressed on the standard psychosocial measures of voice impact. Recent development of a voice-related QoL measure specific to the needs of transgender care (Transgender Self-Evaluation Questionnaire [TSEQ]) affords opportunity to explore relationships between self-perceived QoL and perceptions of femininity and likability associated with transgender voice. Twenty male-to-female transgender individuals living as a female 100% of the time completed the TSEQ and contributed a speech sample describing Norman Rockwell’s “The Waiting Room” picture. Twenty-five undergraduate listeners rated voice femininity and voice likability after audio-only presentation of each speech sample. Speakers also self-rated their voices on these parameters. For male-to-female transgender clients, QoL is moderately correlated with how others perceive their voice. QoL ratings correlate more strongly with speaker’s self-rated perception of voice compared with others’ perceptions, more so for likability than femininity. This study complements previous research reports that subjective measures from clients and listeners may be valuable for evaluating the effectiveness of treatment in terms of how treatment influences voice-related QoL issues for transgender people.     

The Voice Handicap Index: Correlation Between Subjective Patient Response and Quantitative Assessment of Voice

The aim of this prospective study is to elucidate the relationship between the Voice Handicap Index (VHI) and several voice laboratory measurements in the network of the multidimensional voice assessment. Fifty-eight patients were included. Each patient replies to the questionnaire and performs a voice assessment during the same time. The following parameters were measured: minimum frequency, maximum frequency, range, minimum intensity, subglottic pressure, mean flow, maximum phonation time, jitter, and dysphonia severity index. Regarding the relationship with the scores of the VHI, poor correlations with the minimal frequency for all the scores except the emotional one (total and subscales) and with the range for only the physical one are found. Seventeen questions correlate with the voice laboratory measurements we performed, with a decreased distribution between physical, functional, and emotional subscales. We observe that acoustic parameter is correlated with the emotional subscale, the parameters of the profile range are more often involved in the emotional subscale, as is the minimal frequency, but never with the physical subscale, and all the subscales are interesting despite the smaller number of differences with the emotional one. The VHI and the laboratory measurements give independent informations in practice.