AIMS:To characterize prescribing practices, counseling approaches, and perceptions of testosterone-associated voice change among prescribing providers and examine voice clinician experiences managing presumed testosterone-associated voice changes. METHODS:Cross-sectional study using anonymous REDCap-based surveys distributed through professional society platforms, online forums, and direct outreach to testosterone-prescribing medical providers and voice clinicians (laryngologists and speech-language pathologists [SLPs]). RESULTS:Among 72 medical providers, 55 (76%) prescribed testosterone therapy to cisgender women. Respondents primarily practiced in obstetrics-gynecology (64%), followed by primary care (11%) and endocrinology (10%). Testosterone was largely prescribed during menopause (91%), typically for hypoactive sexual desire disorder (93%). Most providers reported detailed (53%) or brief (37%) voice risk counseling. Management for voice changes included testosterone discontinuation (53%), dose reduction (41%), and specialist referral (12%). Reported barriers from qualitative responses included limited evidence in literature evaluating associations between androgen use and voice risk, patient misinformation from social media, and lack of female-specific testosterone formulations. Among 87 voice clinician respondents, 71% of laryngologists and 83% of SLPs reported treating women with presumed testosterone-associated voice changes. Laryngologists typically relied on clinical judgment (58%) or abnormal laryngeal function studies (eg, videostroboscopy, acoustic and/or aerodynamic voice analysis) (38%) when establishing a diagnosis. Vocal fold thickening (67%) and edema (38%) were the most common laryngeal exam findings, while pitch deepening and loss of vocal range were the most frequent presenting complaints. 83% of laryngologists and 86% of SLPs believed testosterone-associated voice changes are underrecognized. CONCLUSIONS:Our study suggests that prescribing providers and voice clinicians alike recognize voice change as an increasingly common androgenic effect of testosterone therapy, though counseling and management varied. Laryngologists often relied on clinical judgment, including a temporal relationship between testosterone exposure and subsequent voice change, reflecting the absence of standardized diagnostic criteria. These findings underscore the need for voice‑related testosterone research in cisgender women and collaboration between prescribing providers and voice clinicians for informed counseling and timely referral when voice changes occur.
This study aimed to map distance-learning speech-language-hearing interventions designed to promote teachers' vocal well-being and synthesize their main characteristics and reported outcomes. This integrative literature review searched five scientific databases (SciELO, LILACS, PubMed, Scopus, and Google Scholar), using the descriptors Faculty OR Teachers AND Voice OR Voice Disorders AND Distance Education. It included publications in English, Spanish, and Portuguese, without restriction on the publication date. The search retrieved 209 articles, nine of which were included after careful analysis. Overall, the empirical studies reported favorable outcomes in some vocal self-assessment, auditory-perceptual, acoustic, and aerodynamic measures. However, these findings should be interpreted cautiously because not all studies assessed the same outcomes, few included comparison groups, and some publications did not provide empirical post-intervention data.
Healthy individuals carry a risk of developing voice disorders from vocal abuse, prompting the development of preventive measures. We hypothesized that resonant voice exercises, typically prescribed for individuals with vocal problems, might positively affect phonatory performance in those without existing voice disorders. Here, 39 healthy female university students participated in an experimental session featuring an introductory Lessac-Madsen Resonant Voice Therapy (LMRVT). The LMRVT consisted of vocal musculature relaxation exercises and the repetition of words initiated by the nasal consonant /m/. For assessment, we recorded maximum phonation time (MPT), sustained single-vowel phonation, and a passage-reading task before and after the LMRVT intervention. The results demonstrated a significant prolongation of MPT following the intervention, whereas no acoustic feature showed a significant group-level change after correction for multiple comparisons. In multiple regression analyses, we tested whether acoustic changes were associated with individual differences in ΔMPT. These analyses consistently identified a reduction in the Hammarberg Index, reflecting increased high-frequency regional resonance, as a significant correlate of ΔMPT in both sustained-vowel phonation and passage-reading tasks. The multiple regression analysis for the passage-reading task also showed a trend for a decrease in vowel-space area. An exploratory Bayesian structural equation modeling (BSEM) was then conducted to characterize the shared variation among ΔMPT and the acoustic measures, assuming "vocal economy" as a latent factor related to the intervention-associated change. The ΔHammarberg Index showed the strongest negative loading on the vocal economy factor, which was consistently associated with ΔMPT across tasks. These findings suggest that introductory resonant voice exercises may improve MPT in healthy individuals and that the Hammarberg Index may be a candidate acoustic correlate of individual differences in MPT improvement.
OBJECTIVES:To examine and compare clinical outcomes for cisgender women with voice complaints and a history of exogenous testosterone supplementation to an age-matched nondysphonic control group. METHODS:Thirty cisgender women who presented to a multidisciplinary voice center with self-reported voice changes and a history of testosterone therapy were identified via retrospective chart review. Auditory-perceptual ratings, laryngeal imaging, and patient-reported outcomes (Voice Handicap Index-10 (VHI-10), Singing VHI-10 (SVHI-10)) were obtained. Acoustic and aerodynamic measures were collected and compared to those of an age-matched, hormone-naive, nondysphonic, cisgender group of women (n = 20). RESULTS:Twenty-seven patients (90%) were occupational voice users. Most patients received testosterone subcutaneous pellets (60%) followed by intramuscular injections (30%), topical formulations (6.67%), or a combination of administration routes (3.33%). Mean VHI-10 was 19.12, with 93.3% exceeding the clinical significance threshold of 11. Among those reporting as singers, all patients exceeded the SVHI-10 clinical threshold, with a mean of 34.43. The patient and control groups were significantly different (P < 0.05) for fundamental frequency (F0) of the vowel /a/ and connected speech (Rainbow Passage reading), F0 standard deviation (SD) during speech, cepstral peak prominence SD, subglottal pressure, phonation threshold pressure, and airflow rate for the Rainbow Passage. CONCLUSIONS:Current evidence on the effects of testosterone on the voice remains limited and excludes domains of a comprehensive voice assessment. Cisgender women on testosterone reporting to a multidisciplinary voice center demonstrate statistically significant findings in acoustic and aerodynamic parameters compared with age-matched, hormone-naive controls. Those using subcutaneous pellets or intramuscular injections may be at a higher risk for dysphonia than other formulations. The emerging clinical presentation of vocal dysfunction in cisgender women following testosterone therapy suggests further investigation is warranted.
Water resistance therapy (WRT) exercises are a common tool that aims to relax and free the voice by increased impedance and the massage effects of pressure modulations of low-frequency bubbles. It has been hypothesized that such exercises could have a direct effect on vocal vibrato due to relaxation effects or sensorimotor feedback loops. Since the bubbling frequency is often slightly faster than vibrato in trained singers, it has been hypothesized that vibrato rate could be increased after WRT. To assess this topic, the phonations of eight Western-classically trained singers (three male, five female) with intended vocal non-vibrato and vibrato were recorded through simultaneous high-speed videolaryngoscopy (20,000 fps), electroglottography (EGG), audio recordings, and a Rothenberg mask. The task of sustained phonations on vowel [i] was performed before and after a 10-minute water resistance exercise, as well as 10 minutes later. Calculated outcome parameters were Vibrato Extent (VE), Vibrato Rate (VR), their Coefficients of Variation (CV), Sound Pressure Level (SPL), Cepstral Peak Prominence (CPP), Open Quotients, Closing Quotient and Nasalance. The level for statistical significance was set to α = 0.05 and adjusted to αadj = 0.0167 due to Bonferroni correction for multiple comparisons. VE showed a tendency of decrease (P = 0.019), and CPP was found to be significantly raised (P = 0.003) directly after WRT. The other parameters did not reach statistical significance. In seven cases, nasalance varied at the same rate as the vibrato, possibly either due to an acoustic compliance of the soft palate during phonation or a physiological chain reaction to vertical larynx movements associated with vibrato. This observation was independent of the WRT. It is concluded that WRT does not influence vibrato parameters to a great amount in trained singers.
OBJECTIVES:Laryngopharyngeal reflux (LPR) has been described as a chronic inflammatory condition with a substantial negative impact on quality of life. The Reflux Symptom Score (RSS) provided a more comprehensive assessment than other questionnaires, as it systematically assessed 22 items across ear, nose, throat (ENT), digestive, and respiratory domains. This study aimed to translate the RSS into Dutch and to evaluate its reliability and validity in a clinical setting. METHODS:The RSS was translated through a forward-backward translation method. Forty participants were enrolled: 20 patients with suspected LPR and 20 healthy controls. Reliability was assessed through internal consistency (Cronbach's alpha) and test-retest reliability (14-day interval). External validity was evaluated by correlating RSS scores with the RSI and Voice Handicap Index-Throat (VHI-T). Criterion validity was tested by comparing scores between the patient and control groups. RESULTS:The Dutch RSS demonstrated high internal consistency (Cronbach's alpha = 0.870) and excellent test-retest reliability (ICC = 0.858). Patients scored significantly higher than controls on total RSS and on Quality of Life (QoL) impact RSS subset (P < 0.001). Multivariable analysis confirmed that the diagnostic power remained sufficient regardless of age and sex. Receiver Operating Characteristic (ROC) analysis identified an optimal clinical cutoff of 31 points, yielding both 90% sensitivity and specificity. CONCLUSION:The Dutch RSS was shown to be a reliable and valid instrument for assessing and monitoring symptoms of LPR. The comprehensive nature and high discriminative power of the RSS supported implementation in daily clinical practice for Dutch-speaking patients.
OBJECTIVES:Vocal fold cysts have been traditionally treated with microsurgical excision under general anesthesia. Awake in-office laser-assisted drainage and marsupialization are an alternative treatment approach to address vocal fold mucous retention cysts in select patients to avoid the risks of general anesthesia.1 While short-term efficacy of the approach has been described, longer-term voice outcomes and rates of recurrence are unknown. METHODS:A multi-institutional retrospective chart review was conducted of patients with vocal fold mucous retention cysts treated with in-office laser-assisted marsupialization and had follow-up data beyond 6 months. Data abstracted included demographics, pre- and postprocedural Voice Handicap Index (VHI)-10 scores, cyst recurrence, and videostroboscopic findings. RESULTS:Six patients (mean age 70.7 years, 50% male) with unilateral vocal fold mucous retention cysts were included. Mean VHI-10 scores improved from 21 to 5.5. Follow-up ranged from 9 months to 33 months (mean 19 months). Mucosal pliability was completely preserved in four patients. Two patients demonstrated a very mild reduction in mucosal pliability on laryngeal stroboscopy but reported overall favorable postprocedural voice quality. One patient recurred at 14 months and required microlaryngeal surgery for excision of the cyst. CONCLUSION:In-office awake laser-assisted drainage and marsupialization of vocal fold mucous retention cysts can be an effective treatment paradigm in select patients, with favorable and durable long-term outcomes. However, small risks of postoperative scarring and cyst recurrence need to be balanced against benefits such as avoiding general anesthesia. LEVEL OF EVIDENCE: 4:
OBJECTIVE:To investigate the vocal characteristics of female patients with RE while accounting for menopause status as a confounding factor. STUDY DESIGN:Retrospective chart review METHODOLOGY: The medical records of female patients diagnosed with Reinke's edema who presented to the Voice and Swallowing Unit between February 2020 and March 2026 were reviewed. Demographic data included menopause status, disease laterality, severity, and treatment. The outcome measures included the Voice Handicap Index-10 (VHI-10), fundamental frequency (F0), habitual pitch (HP), jitter, shimmer, noise-to-harmonic ratio (NHR), voice turbulence index (VTI), and maximum phonation time (MPT). RESULTS:A total of 52 patients were included in the study. The mean age of the study group was 55.77 ± 10.43 years. Thirty-four women were postmenopausal (65.4%). There was no statistically significant difference in the mean VHI-10 scores across subgroups with different disease severity (P = 0.958). Similar results were noted in the subgroups with and without menopause. There was a statistically significant difference in the mean F0 across subgroups with different disease severity (P = 0.002). However, subgroup analysis of postmenopausal patients showed no significant difference in F0 between the three subgroups. Only in the subgroup of non-menopausal patients was the difference statistically significant (P = 0.001). With respect to HP, only in the subgroup of non-menopausal patients, those with type 1 and 2 disease had a significantly higher mean HP (157.88 ± 32.70) compared to those with type 3 (119.37 ± 21.98) (P = 0.011). Both NHR (0.136 ± 0.058 vs 0.235 ± 0.053, P = 0.003) and VTI (0.034 ± 0.016 vs 0.070 ± 0.024, P = 0.008) were significantly higher in non-menopausal women with type 3 disease compared to those with type 1 and 2 disease. CONCLUSION:The results of this investigation suggest that menopause status may influence the relationship between disease severity and vocal pitch in female patients with RE. Further research on the impact of menopause on voice in a larger cohort of patients with RE is needed to establish strong persuasiveness.
OBJECTIVES:Dysphonia significantly alters voice quality, necessitating objective and cost-effective clinical assessment tools. However, acoustic metrics often vary based on preprocessing pipelines and dataset composition. This study aims to provide a robust characterization of healthy and dysphonic voices using a highly reproducible signal-processing framework applied to a large-scale database. METHODS:Acoustic features (F0, RAP, APQ, NHR, and CPP) were extracted from a standardized 0.4-second stable segment of sustained vowels using a high sampling rate (50 kHz). Group differences were assessed through non-parametric statistics and effect sizes. Diagnostic discrimination was quantified via sex-stratified ROC analysis, including 95% confidence intervals estimated by bootstrapping. RESULTS:Significant sex-specific patterns emerged: F0 provided moderate discrimination in females (AUC = 0.688), while CPP emerged as the most robust biomarker in males (AUC = 0.744). Perturbation (RAP, APQ) and noise (NHR) metrics showed consistent elevations in dysphonic groups, yielding stable diagnostic cutoffs (eg, RAP: 0.27-0.33%; NHR: 0.007-0.010) with good specificity. The absence of zero-padding and high-resolution sampling improved measurement stability across all clinical subtypes. CONCLUSIONS:Standardized preprocessing without temporal interpolation enhances the reliability of acoustic biomarkers. The established sex-specific normative values and objective diagnostic thresholds provide a robust benchmark for automated voice screening and clinical monitoring, effectively addressing the inherent heterogeneity of clinical databases.
OBJECTIVE:To investigate the correlation between Diabetes Mellitus type 2 (DMT2) and patient tolerance to office-based laryngeal surgery (OBLS). STUDY DESIGN:Retrospective chart review METHODS: A retrospective review of all adult patients who underwent OBLS between November 2021 and June 2026 was conducted. Patients diagnosed with DMT2 based on ICD-10 coding and who had filled the Iowa Satisfaction with Anesthesia Scale (IOWA) and VAS score for tolerance were included. A control group that also underwent OBLS was matched by age, gender, smoking status, and history of reflux disease. Additional clinical data included glucose levels and HbA1c. RESULTS:The study included 59 diabetic and 59 non-diabetic patients. The mean IOWA score was 1.99 ± 1.15 for diabetics and 2.15 ± 1.05 for controls (P = 0.518). The mean VAS score for tolerance was 7.68 ± 2.30 and 7.47 ± 2.32 for controls (P = 0.591). A weak negative non-significant correlation was observed between IOWA scores and disease duration (r = -0.196, P = 0.318) and between VAS scores and disease duration (r = -0.319, P = 0.098). There was a weak positive non-significant correlation between VAS scores and HbA1c (r = 0.103, P = 0.581). CONCLUSION:The results showed no significant difference in tolerance score between those with diabetes vs those without diabetes. A study on a larger study group with a longer duration of disease is warranted.
BACKGROUND:Tracheoesophageal prosthesis (TEP), a one-way prosthetic valve, is considered the most effective method of voice restoration following total laryngectomy (TL) but requires specialized training, close follow-up management, and practice to achieve satisfactory speech and maximize longevity of the device. Because alternative communication methods (eg, writing, esophageal speech) remain available to patients with TEP, prosthesis abandonment (removal or discontinuing use for speech) is a well-known outcome. Considering the multifactorial nature of successful TEP speech, we examined correlations between TEP abandonment and social determinants of health at an urban, safety-net hospital. OBJECTIVES:This study aims to determine the frequency of TEP abandonment in an underserved patient population, compare this to what has been reported in the literature, and to explore whether there are socioeconomic factors associated with abandonment. METHODS:A retrospective cohort study was conducted at our institution. All patients having undergone TL for laryngeal cancer or dysfunction or who were followed at our hospital following TL from June 1, 2015 to June 30, 2024 were identified. Six variables were selected for multiple binary logistic regression analysis using SPSS Version 29.0.2.0 with an α = 0.05 level of significance. RESULTS:Forty-one patients with TEP were included. Pre-TL radiation therapy (P = 0.018), greater distance from hospital (P = 0.017), and homelessness or incarceration (P = 0.043) were significantly associated with TEP abandonment. Insurance coverage of supplies, state area deprivation index, and substance and/or alcohol use disorder were not significant predictors. CONCLUSION:Housing instability/incarceration, pre-TL radiation, and geographic distance are associated with TEP abandonment, highlighting the need for further research to investigate these associations. These findings also highlight a need to improve access to long-term TE vocal rehabilitation in vulnerable populations.
OBJECTIVE:This study aims to investigate the Vertical Laryngeal Position (VLP) used by professional Classical Turkish Music (CTM) and Classical Western European Opera (CWEO) singers during singing using endoscopic imaging techniques, and to determine whether there is a significant difference in VLP between these two vocal disciplines. METHODS:The study included a total of 13 professional singers (7 from CTM, 6 from CWEO) with at least 10 years of experience. Participants were asked to perform various vocal exercises (staccato/legato in low, medium, and high ranges) as well as a repertoire piece reflecting the stylistic characteristics of their genre during video-laryngostroboscopy (VLS). The obtained video recordings were viewed in a blinded manner by three Otorhinolaryngology (ENT) professors specializing in laryngology, who independently scored VLP levels on a scale of 1 to 5. Data were analyzed comparatively using statistical methods. RESULTS:Comparative analysis revealed statistically significant differences in VLP between the two groups. It was determined that the laryngeal positions of the CTM group were significantly higher compared to the CWEO (Opera) group during repertoire performance ($P = 0.048$), low-range staccato exercises ($P = 0.039$), and low-range legato exercises ($P = 0.028$) ($P < 0.05$). No significant difference was observed between the groups in medium and high-frequency exercises ($P > 0.05$). CONCLUSION:This study presents objective data on the VLP characteristics of CTM performers. The findings indicate that CTM singers use a significantly higher laryngeal position compared to CWEO singers, particularly during repertoire performance and in low tones. However, it is noteworthy that this difference disappears at high frequencies. While this divergence in low tones can be explained by genre-specific timbral preferences, the similarity in high tones is thought to stem from the combined effect of the obligatory nature of laryngeal physiology and the Western-based voice training curriculum implemented in conservatories in Türkiye. These data emphasize the importance of genre-specific approaches in voice pedagogy and therapy processes.
Objective To investigate the presence of vocal fatigue in transmasculine and transfeminine individuals, compare these groups, and identify associated factors. Methods This cross-sectional, observational study was conducted online in Brazil with convenience sampling. Transmasculine and transfeminine individuals participated by completing a characterization questionnaire including questions on age, gender, hormone therapy, implementation of vocal adjustments in communication, and the number of contexts in which these adjustments are performed, as well as the Vocal Fatigue Index (VFI) and the global self-assessment item of the Trans Woman Voice Questionnaire (TWVQ). Variables were analyzed descriptively, and the transmasculine (TMG) and transfeminine (TFG) groups were analyzed comparatively. Associations between variables were investigated using linear regression, with the total VFI score as the outcome measure. Results The study sample comprised 34 individuals in the TMG and 24 in the TFG. Mean VFI scores were outside the reference values for Brazilian Portuguese. The TMG presented a significantly higher total VFI score than TFG. Linear regression analysis revealed a significant association between the total VFI score and the number of contexts in which individuals make vocal adjustments: for every 1-unit increase in the number of contexts, the total VFI score increased by an average of 4.11 points. Conclusion Transgender individuals presented symptoms of vocal fatigue, which were more pronounced in transmasculine compared to transfeminine individuals. Additionally, the number of contexts in which vocal adjustments are made to express gender identity was associated with increased vocal fatigue symptoms.
OBJECTIVE:To investigate the prevalence and findings of esophageal manometric abnormalities underlying dysphagia in laryngopharyngeal reflux disease (LPRD). METHODS:Three independent investigators conducted a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) systematic literature search in PubMed, Scopus, and Cochrane databases for studies reporting manometry and high-resolution manometry (HRM) findings in LPRD patients. Methodological bias analysis was conducted with two validated bias tools. RESULTS:Twenty-four papers met the inclusion criteria (2337 patients). The LPRD diagnosis was based on objective testing in 3/24 (12.5%) studies, with one study using hypopharyngeal-esophageal impedance-pH testing. Manometric studies consistently suggested increased upper esophageal sphincter baseline and residual pressures, whereas lower esophageal sphincter baseline and relaxation pressures were decreased in LPRD patients. Esophageal body motility was characterized by a high prevalence of ineffective swallows, and impaired bolus clearance. Reflex mechanisms were also altered. There was substantial heterogeneity across studies for LPRD diagnosis, exclusion criteria, and manometric parameters, which were reported with the Chicago classification 3.0/4.0 in 10/24 (42%) studies. The mean MINORS was 7.5 ± 2.4, highlighting an overall low quality of studies. CONCLUSION:This systematic review suggests a trend toward ineffective esophageal motility, esophageal sphincter hypotension, or impaired dynamics in patients with swallowing, voice, and breathing LPRD-related symptoms and findings. Further prospective controlled studies including patients with a demonstrated LPRD are needed to establish the prevalence of esophageal abnormalities in LPRD.
Acoustic analysis is a fundamental step in the multidimensional assessment of dysphonia. However, conventional perturbation measures require nearly periodic signals for valid computation. Visual signal typing classifies voice signals into discrete types based on a narrowband spectrogram and serves as a critical gatekeeper for selecting appropriate analytical methods for a valid assessment. Two main frameworks exist: the Titze/Sprecher system for laryngeal voice and the van As-Brooks system for tracheoesophageal speech. Despite three decades of development, no systematic review had synthesized the conceptual and empirical evidence on the utility of visual signal typing. This systematic review followed PRISMA 2020 guidelines. PubMed, Scopus, Web of Science, and Google Scholar were searched from inception to early 2026. Studies were included if they used visual or acoustic signal typing as a primary or one of the methods with reported reliability, validity, classification accuracy, or clinical utility. Two independent reviewers performed screening, data extraction, and quality appraisal. Twenty-one studies (1995-2025) met inclusion criteria. The Titze/Sprecher laryngeal framework predominated in 15 studies, while the van As-Brooks framework was used in six tracheoesophageal (TE) studies. Inter-rater reliability ranged from κ = 0.45 to 0.95, with higher agreement in laryngeal studies (typically κ ≥ 0.72 with training) compared with TE studies (κ = 0.55-0.84). Two studies reported numeric perceptual coefficients (r = 0.746 and r = -0.93); the remaining studies reported moderate-to-strong directional associations. Automated approaches achieved 82-96% accuracy in classification of these signals. Interestingly, the signal typing process identified >50% of dysphonic samples as unsuitable for conventional perturbation analysis. Visual signal typing demonstrates moderate-certainty reliability and low-to-moderate-certainty validity as a clinical gatekeeper, particularly within the Titze/Sprecher laryngeal framework. Evidence is strongest for laryngeal voice with structured rater training. Significant gaps persist in clinical utility, deep learning automation, neurological voice disorders, connected speech, telemedicine, and international standardization.
OBJECTIVE:Asymmetric vocal fold vibration caused by unilateral biomechanical alteration is common in laryngeal disorders and presents a challenge for functional reconstruction. This study aimed to investigate phonatory and vibratory outcomes in asymmetric glottic configurations reconstructed with materials of different stiffness. METHODS:Two asymmetric curved-surface (CS) vocal fold models were developed. A silicone-based single-layer model (Si-CS) and a titanium-based bi-layer model (Ti-CS) were constructed and compared with symmetric controls. Twenty-four excised canine larynges were used to establish the Si-CS model. In addition, 20 beagle larynges were harvested following unilateral vocal fold resection and healing after type I thyroplasty with titanium implantation. Phonation threshold pressure (PTP), phonation threshold flow (PTF), phonation threshold power (PTW), acoustic parameters, and high-speed imaging were analyzed. RESULTS:In the Si-CS model, PTP and PTW were significantly increased compared with controls (P < 0.05), whereas acoustic parameters and vibratory amplitude remained comparable. In the Ti-CS model, both PTP and PTW were significantly elevated (P < 0.05). Fundamental frequency, jitter, and shimmer showed no significant differences, while harmonic-to-noise ratio (HNR) decreased significantly (P < 0.05). High-speed imaging demonstrated reduced vibratory amplitude in the anterior and midfold regions, with relatively preserved posterior vibration. CONCLUSION:Curved-surface reconstruction with increased stiffness can preserve near-normal phonatory characteristics despite elevated aerodynamic thresholds. Titanium-based asymmetric reconstruction following vocal fold resection maintains vibratory periodicity but alters regional vibratory dynamics and acoustic harmonic structure.
Objectives This study serves as an investigation into the treatment approaches of speech-language pathologists who work with patients diagnosed with vocal fold paresis. This study tests the hypotheses that: 1) there is a wide range of practice patterns among speech-language pathologists when treating vocal fold paresis; 2) there is low consensus among speech-language pathologists regarding the most effective therapeutic techniques for vocal fold paresis; and 3) a variety of these techniques are employed with limited perceived confidence in their efficacy. Methods A questionnaire consisting of 18 multiple-choice and open-text questions was developed using the Qualtrics platform. Questions included information on participants’ confidence in treating vocal fold paresis, treatment frequency, and which therapeutic techniques they regularly employ. A total of 46 participants completed the survey. Participants were recruited via professional social media groups and word of mouth. Results Participants’ treatment techniques were wide-ranging, but certain exercises were consistently chosen, including SOVTs and resonant voice therapy. Less than 20% of participants reported feeling that their treatment is extremely effective, though a majority reported feeling confident in their treatment. Conclusions There is high consensus regarding which few therapy techniques to employ first, yet participants reported using a wide range of therapeutic techniques throughout the treatment process. There was also a lack of consensus on which specific techniques are most effective. These findings suggest there are multiple tools to choose from, but no objective mode to evaluate which will be best for a specific patient beyond trial and error. This suggests the need for better diagnostics to align patients’ symptoms with certain treatment tools that will be more effective for the specific patient, and to better understand the benefits and nuances of each tool. Level of Evidence V
The article discusses the relevance of introducing intercultural approaches to vocal training in the context of the globalization of art education. The purpose of this article is to analyze intercultural approaches to teaching vocal art, to make a comparative review of methods of teaching musical repertoires of the world, and to identify effective pedagogical strategies that contribute to the formation of intercultural competence of future vocalists. The methodology is based on an interdisciplinary approach that combines musicological analysis, cultural aspects, and pedagogical practices. Case studies, questionnaires, interviews, and control vocal auditions were used. The study was conducted within the framework of the experimental course "Vocal Traditions of the World", which included modules on the study of European, African American, Eastern, Latin American, and Ukrainian vocal traditions. The results demonstrated a statistically significant improvement in the students' vocal adaptability, interpretative creativity, accuracy of pronunciation in the source language, and understanding of the cultural context, compared with the control group. These results indicate improved intercultural vocal competence and greater awareness of stylistic and cultural characteristics, rather than mastery of the relevant vocal traditions. The qualitative analysis confirmed the increase in students' emotional expressiveness, tolerance, openness to cultural diversity, as well as the development of their ability to creatively interpret unusual material. It is proposed to integrate intercultural modules into curricula, expand methodological support, use digital resources to access authentic samples, and improve the qualifications of teachers in the field of intercultural music education. The results should be interpreted in light of the study's limitations, including the fact that it was conducted at a single institution, the relatively small sample size, the quasi-experimental design, and the limited duration of the intervention, which may restrict the generalizability of the results.
The rapid integration of artificial intelligence into clinical voice research has created promising opportunities for the early identification of mental health concerns, particularly among individuals with communication impairments. In their recent study, Wang and Sambamoorthi (2026) developed an interpretable and fairness-aware Random Forest model that predicts mental health disorders using acoustic features derived from the Bridge2AI-Voice dataset. By organizing these features into clinician-friendly domains of voice stability, speech prosody, and voice clarity, the authors achieved solid predictive performance, with area under the receiver operating characteristic curve values of approximately 0.83 to 0.84. The model revealed etiology-specific acoustic patterns and employed SHapley Additive Explanations and partial dependence plots to enhance transparency. Furthermore, the demonstration of strong gender fairness, including perfect counterfactual prediction invariance, represents a commendable step toward responsible artificial intelligence in voice science. These contributions position the study as a significant advancement in the development of ethical and clinically relevant voice-based screening tools.
OBJECTIVE:Treatment of benign vocal fold lesions (BVFLs) in professional voice users (PVUs) requires a balance between safety and restoration of phonatory function. Photoangiolytic lasers allow selective ablation of vascular structures, resulting in lesion involution. Prior studies support their safety and efficacy in the general population, but evidence supporting their use in PVUs is limited. The aim of this scoping review is to evaluate the safety and efficacy of photoangiolytic laser treatment of BVFLs in PVUs. DATA SOURCE:Using PRISMA-ScR guidelines, research databases (PubMed, Web of Science, Embase, CINAHL) were queried through July 2025. REVIEW METHODS:Records were screened in two rounds by two independent reviewers. Conflicts were resolved by a third reviewer (senior author). Data on study design, laser type, sample size, and outcomes were extracted and summarized. RESULTS:A total of 1013 studies were identified, and 22 studies were included after full-text review. The most studied laser was KTP (36.3%), followed by PDL (18.2%) and TruBlue (9.1%), with 31.8% of studies comparing KTP and PDL. Vocal fold polyps were the most frequently studied lesion type (22.7%). Across studies, subjective (VHI, SVHI, GRBAS) and objective acoustic outcomes consistently improved. All complications (rate 5-10%) were minor and temporary: transient hoarseness, edema, or self-limited bleeding. CONCLUSION:Professional voice users with BVFLs require treatment to restore high-level phonatory function while maintaining safety and preventing long-term complications. This scoping review provides evidence of the safety and efficacy of photoangiolytic laser treatment of BVFLs in PVUs.
