Introduction: A series of recent studies using the Public Opinion Survey of Human Attributes-Stuttering (POSHA-S) have documented an extreme case of regression to the mean (RTM) or a "crossover" effect in public attitudes toward stuttering. Respondents were previously sorted according to changes in their attitudes. The "crossover" effect revealed that respondents with the highest pre-test scores had the lowest post-test scores, those with the lowest pre-test scores had the highest post-test scores, and those with intermediate scores changed minimally. Method: In this study, RTM was evaluated in four different measures from two USA samples: Bipolar Adjective Scale (BAS), Emotional Intelligence Scale (EIS), Attitudes Toward Disabled Persons (ATDP) scale, and Metacognitive Awareness Inventory (MAI). Results: The "crossover" effect was observed in three of these scales as well as in one of two POSHA-S scores. Due to lower-than-expected test-retest correlations, correction for regression to the mean diminished or eliminated the "crossover" effect in some of the measures. Conclusions: Overall, the study showed that the "crossover" effect can be observed in widely different pre- versus post-test measures.
This paper proposes a clinical-functional framework of vocal behaviour based on a distinction between operations-controllable physiological parameters-and phenomena-emergent acoustic outcomes arising from their nonlinear interaction. Because the vocal organ functions as a nonlinear biological-acoustic system, qualities such as resonance, projection, and phonatory stability cannot be directly targeted; they emerge from coordinated operational conditions. Functional voice disorders are accordingly reinterpreted as emergent consequences of suboptimal operational configurations, reorienting clinical practice from symptom description toward identification of underlying system disorders. A diagnostic model maps symptoms to operational deficiencies, supported by measurable indices including subglottal pressure estimation, cepstral peak prominence (CPP), H1-H2, and SPL/effort ratio. Three illustrative case models-hyperfunctional phonation with restricted high-range projection, hypofunctional instability with breathy phonation, and register discontinuity at passaggio-each trace presenting symptoms to operational causes and specify intervention targets. The framework provides a theoretical basis for established voice habilitation techniques as operational interventions. Four empirically testable predictions define a coherent research agenda for voice science and clinical practice.
INTRODUCTION:The auditory system helps control voice production, and the present case study illustrates this relationship and reveals how severe to profound post-lingual Hearing Loss (HL) impacts voice quality and dynamics and how uni- and bi-lateral cochlear implantation (CI) improves performance in spontaneous speech. The purpose of this study was to analyse acoustic and auditory perceptual measures of spontaneous speech produced by an adult with HL before CI, after unilateral CI and after bilateral CI. METHOD:The study is a longitudinal, retrospective case report and explored voice quality and dynamics in producing spontaneous speech samples through Long-Term Average Spectra (LTAS), Cepstral Peak Prominence (CPP) and fundamental frequency (fo) analysis, auditory-perceptual evaluation by experienced speech and language therapists based on the Vocal Profile Analysis Scheme for Brazilian Portuguese (BP-VPAS). RESULTS:Outcomes of the LTAS, CPP and BP-VPAS analyses were sensitive to changes in spontaneous speech samples before CI, after unilateral CI and after bilateral CI in an adult Brazilian Portuguese speaker with post lingual HL, contributing to a voice assessment process in a more natural context than a reading task. CONCLUSIONS:The results showed a positive impact of CI on voice quality and dynamics, and that bilateral CI improved prosodic adjustments in spontaneous speech, highlighting the integration between voice, speech and hearing.
OBJECTIVES:Reduced laryngeal sensitivity increases the risk of silent penetration and/or aspiration (SPA) and reduces the effectiveness of dysphagia screening tests. The aim of this study was to evaluate the diagnostic value of several Cough Reflex test (CRT) modalities for screening SPA in patients over 75 years of age. METHOD:This prospective study included 37 patients over the age of 75 who were hospitalised for acute conditions. Fiberoptic Endoscopic Evaluation of Swallowing (FEES) was used to compare the presence of SPA with the results of CRT obtained using citric acid at concentrations of 0.1 mol/L, 0.2 mol/L and 0.4 mol/L. During CRT, the presence of C2 (2 or more coughs) and C5 (5 or more coughs) were noted. RESULTS AND DISCUSSION:Only the 0.1 mol/L concentration proved to be discriminatory: absence of C2 distinguished patients with SPA from healthy individuals (p = 0.009; Se: 81.25%; Sp: 71.43%). Absence of C5 discriminated patients with SPA from those with detected penetrations and/or aspirations (DPA) (i.e. aspiration triggering cough) (p = 0.026; Se: 81.25%; Sp: 71.43%). This test does not require specific expertise in dysphagia management, is non-invasive and is sensitive for detecting SPA. CONCLUSIONS:The CRT using citric acid at 0.1 mol/L is a clinically valuable, non-invasive and sensitive tool for detecting SPA in an acute-care geriatric population.
BACKGROUND:Speech and language therapists' (SLT) practice with cultural and linguistic diverse (CALD) populations with acquired and congenital neurogenic communication disorders in Denmark and Sweden is becoming more urgent due to demographic changes. AIM:To investigate SLTs training, clinical practice, and issues regarding services to children and adults from CALD backgrounds with neurogenic communication disorders, in Denmark and Sweden. METHODS AND PROCEDURES:A survey with 19 questions about training, assessment, intervention, and counselling related to CALD was administered to SLTs working with children and adults with neurogenic communication disorders in Denmark and Sweden. RESULTS:296 SLTs from Denmark and Sweden participated. About half of the respondents had received training in working with people from a different linguistic background and fewer in working with people from a different cultural background. The majority reported that they did not feel very well prepared to work with these populations. A mismatch between the SLTs language proficiencies and the languages of the served CALD population was reported. Large variations in recommendation and practice related to practice with CALD populations. However, professional interpreters were used to some extent. CONCLUSIONS AND IMPLICATIONS:The results indicate that the SLTs in the area of neurogenic communication disorders face challenges and have a need for more training and other support about how to provide appropriate services for a CALD population.
Non-word repetition (NWR) is a frequently used task in speech and language assessments. This study investigated NWR performance in children with childhood apraxia of speech (CAS) and speech motor delay (SMD), examining its relation to auditory discrimination (AD) and oral motor performance. Participants were 54 children with persistent speech-sound disorders (SSD) (31 with CAS and 23 with SMD) and 39 children with typical speech development (TSD) aged 6-16 years. Assessments of word naming, NWR, AD, and oral-motor performance were conducted. Percentage consonants correct (PCC), and percentage vowels correct (PVC) were calculated from phonetic transcriptions. The results revealed a difference between children with SSD and children with TSD on all variables and also revealed some differences between children with CAS and children with SMD. Children with CAS had a lower PCC and PVC score on NWR and a lower AD score than those with SMD. More parents of children with CAS reported difficulties with reading and writing. A large proportion of both children with SMD and children with CAS were found to have orofacial dysfunction. Our findings suggest that assessing AD skills and oral-motor skills is important for understanding the underlying difficulties of motor speech disorders in children. Our results indicate differences related to motor planning and motor execution, underscoring the importance of broad assessment approaches to facilitate accurate diagnoses and tailored interventions.
OBJECTIVE:To adapt the Self-Evaluation of Communication Experiences after Laryngectomy (SECEL) scale into Turkish (TR-SECEL) and to examine its validity and reliability in Turkish-speaking individuals following laryngectomy. STUDY DESIGN:Prospective, descriptive validity and reliability study. METHODS:The adaptation process involved forward- and back-translation and expert review. A total of 104 individuals with laryngectomy (94 men and 10 women; mean age = 63.65 ± 8.61 years) were included in the study and completed the TR-SECEL, EORTC QLQ-H&N35, and the Voice-Related Quality of Life Scale (V-RQOL). Psychometric evaluation included content validity, internal consistency (Cronbach's alpha), test-retest reliability, exploratory factor analysis, and convergent validity. RESULTS:TR-SECEL showed excellent internal consistency for the total scale (α = .95), high reliability for the environmental (α = .93) and attitudinal (α = .92) subscales, and moderate reliability for the general subscale (α = .61). Test-retest reliability was very high (r = .99, p < .001). TR-SECEL scores were significantly correlated with the V-RQOL and the subscales of EORTC QLQ-H&N35. Factor analysis indicated a three-factor structure explaining 53.4% of the total variance. CONCLUSIONS:The findings of this study suggest that the TR-SECEL has satisfactory psychometric properties for assessing communication experiences in Turkish-speaking individuals after laryngectomy. The scale may be a useful tool in clinical and research settings for evaluating communication-related outcomes and monitoring rehabilitation processes.
Voice assessment is crucial in the diagnosis and management of voice disorders, yet clinical practice often diverges from standardized protocols due to contextual constraints. This qualitative study explored facilitators, barriers, and protocol variability in Quebec French-speaking Speech and Language Therapists' (SLTs) voice assessment practices. Semi-structured interviews were conducted with 11 SLTs specializing in voice therapy, and transcripts were analyzed thematically. Findings revealed strong facilitators such as interdisciplinary collaboration with Ear, Nose and Throat (ENT) specialists, access to imaging, professional peer networks, and continuing education. Barriers included limited access to specialized services, insufficient standardization, inconsistent acoustic measures, and gaps in training. Protocols were highly variable and flexibly adapted across pediatric, adult, and geriatric populations, as well as according to patient needs and local resources. Rather than deviations, these adaptations reflected clinical reasoning and patient-centred care in real-world contexts. The study highlights the need for co-designed, modular protocols that balance standardization with flexibility, improved interdisciplinary collaboration, equitable access to equipment, and linguistically adapted tools. Such an approach could bridge the gap between guidelines and practice, ensuring protocols remain both scientifically robust and clinically feasible.
PURPOSE:Aging affects speech motor performance, particularly articulatory skills, often measured through oral diadochokinetic (ODDK) rates. The purpose of this was to examine the effects of age and gender on two tasks, namely alternating and sequential motion rates (SMRs) in healthy elderly Kannada speakers, and compared performances across tasks. METHODS:Sixty native Kannada speakers aged 61-80 performed rapid repetition tasks (/pa/, /ta/, /ka/ for alternating motion rate (AMR); /pataka/ for SMR). ODDK rates were recorded and analyzed using the Motor Speech Profile. RESULTS:Age had no significant effect on ODDK rates. However, a significant two-way interaction emerged between the type of task and gender. Subsequent analyses of the interaction effects demonstrated that the SMR was 16.52% and 14.73% faster than the AMRs in males and females, respectively. With regard to gender, the diadochokinetic (DDK) rates of the elderly male participants were significantly higher than those of the female participants for stimuli /pa/ (5.52 syllables/s and 4.90 syllables/s), /ta/ (5.06 syllables/s and 4.22 syllables/s), and /pataka/ (6.17 syllables/s and 5.43 syllables/s), with the exception of the syllable /ka/ (4.86 syllables/s and 4.77 syllables/s). CONCLUSIONS:The study findings highlighted that the decline in DDK rates may be language-specific. While disagreeing with some of the recent study findings on age-related decline in DDK rate, current findings underscore the need to use gender-specific reference values while assessing the articulatory motor integrity in the Kannada-speaking elderly population.
In this comment, I advocate for embracing a true multilingual approach in the assessment of acquired language difficulties-by allowing people to use their complete linguistic repertoire-rather than the traditional binary approach, which assesses each language separately. I first briefly review the shift that has occurred in the fields of neurolinguistics and psycholinguistics of bilingualism from binary to non-binary views of both the processing of multiple languages in the brain and in the study of multilingual individuals. I then address assessment challenges in multilingual individuals with aphasia and suggest that, when appropriate, multilingual people could be evaluated and treated in a context that allows them to employ their complete linguistic repertoire rather than in a context in which they have to select one target language and inhibit the other(s). This new assessment practice can then alleviate added cognitive and affective demands associated with language selection and inhibition, and can provide ecologically valid information about the communication abilities of the individual. This new approach is suitable for multilingual people who tend to use their multiple languages with their interlocutors, and may be less relevant for those multilingual people who use their languages in a diglossic manner. Customizing services in accordance with multilingualism-related variables may enhance best practices and well-being.
BACKGROUND:This study aimed to compare speech intelligibility and articulation-phonological skills of children with congenital severe-to-profound sensorineural hearing loss who received cochlear implantation at one of three implantation-age ranges (12-17, 18-23, and 24-29 months) with those of age-matched peers with typical hearing. METHODS:The study included 45 children (32 males and 13 females) who received cochlear implants at 12-17, 18-23, or 24-29 months and were 5-7 years old at data collection. Each implantation-age subgroup consisted of n = 15 children. A control group of 15 children (7 males and 8 females) with typical hearing, aged 5-7, was also included. The Turkish Articulation and Phonology Test (SST) were used to assess articulation and phonological skills. The Intelligibility in Context Scale (ICS) was used to assess speech intelligibility. RESULTS:Children implanted at 12-17 months demonstrated significantly more advanced articulation and phonological skills compared with those implanted at later ages. Nonetheless, even early-implanted children did not attain articulation, phonological skills or speech intelligibility levels observed in age-matched peers with typical hearing. CONCLUSIONS:These findings underscore the importance of early cochlear implantation during infancy. While early implantation is associated with improved speech outcomes, children with cochlear implants may continue to exhibit speech sound disorders affecting their articulation, phonological skills, and intelligibility. This suggests a need for ongoing, speech-focused intervention, in addition to general language support, with continuous monitoring and active family involvement.
OBJECTIVES:This study aimed to develop and validate machine learning (ML) models for automated prediction of perceptual dysphonia severity, as indexed by the Grade (G) parameter of the GRBAS scale, using acoustic analyses of sustained vowels. The overarching goal was to enhance objectivity, reproducibility, and efficiency in clinical voice assessment. METHODS:A total of 524 sustained/a/samples were collected from three databases. The evaluations of all recordings by ten raters using the GRBAS scale, that achieved excellent interrater reliability (Krippendorff's α = 0.96), were modelled. Forty-seven acoustic features spanning spectral, cepstral, perturbation, and noise-based indices were extracted using Parselmouth (Praat). Five ML classifiers-Decision Tree (DT), Random Forest (RF), Extreme Gradient Boosting (XGBoost), Light Gradient Boosting Machine (LightGBM), and Categorical Boosting (CatBoost)-were trained using 5-fold cross-validation (80/20 split) and evaluated by accuracy, F1-score, and quadratic weighted kappa (QWK). RESULTS:Gradient boosting algorithms outperformed traditional tree-based models. LightGBM achieved the highest QWK (0.945), followed by CatBoost (QWK = 0.941) and XGBoost (QWK = 0.935). Feature-importance analyses identified cepstral measures-particularly Smoothed Cepstral Peak Prominence (CPPS), Cepstral Spectral Index of Dysphonia (CSID), Acoustic Voice Quality Index (AVQI), Harmonics-to-Noise Ratio (HNR) as the most influential predictors of perceptual Grade (G), while jitter and shimmer parameters contributed minimally. Correlation analyses confirmed strong associations between Grade and AVQI (r = 0.854), HNR (r = -0.853), and cepstral indices (r = -0.835 to -0.832). CONCLUSIONS:Gradient boosting methods, particularly LightGBM, produced near-expert agreement with perceptual ratings, supporting their potential as objective, interpretable tools for clinical dysphonia assessment.
AIM:The use of a stethoscope for cervical auscultation (CA) has been reported to be useful in detecting potential swallowing ailments. Nevertheless, stethoscopic CA suffers several constraints including poor signal-to-noise ratio. The current study examined the signal characteristics of CA using Doppler ultrasound obtained when swallowing liquids of different consistencies by both older and younger healthy individuals. METHOD:Thirty healthy younger and older adults participated in the study. Doppler ultrasound CA was carried out when they swallowed 5-mL liquids of different consistencies according to IDDSI levels 0-4: (1) thin, (2) slightly thick, (3) mildly thick, (4) moderately thick, and (5) extremely thick using a portable Doppler ultrasound device. Parameters including the duration of swallow CA signal (T), time to onset of the second peak (TP2), and the intensity and frequency of the first and second peaks (IP1, IP2, FP1, FP2) were obtained from the ultrasound CA signals. RESULTS:From the ultrasound CA signals of swallowing, durational measures including T and TP2 generally increased with age but not bolus consistency. However, intensity and frequency measures appeared to be similar between young and older healthy adults, even when swallowing liquids of different consistencies. CONCLUSIONS:Doppler ultrasound CA signals revealed that older adults were associated with a longer swallowing duration than the younger counterparts, but not across bolus consistencies. Frequency and intensity measures appeared to be insensitive to the effects of age and bolus consistency. The findings support that ultrasound CA could be used to clinically evaluate swallow proficiency.
Purpose: Swallowing and voice share anatomical and physiological mechanisms, yet their relationship in healthy individuals remains underexplored.Methods: This study examined associations among voice assessments and self-perceived swallowing in 110 healthy Shanghai adults.Results: Correlation analysis showed that the results of Dysphagia Handicap Index, which captures subjective perceptions of swallowing impairment, correlated negatively with Maximum Phonation Time, the Dysphonia Severity Index, Diadochokinesis rate, four Laryngeal Diadochokinesis tasks, the Voice-Related Quality of Life Measure, and the Vocal Fatigue Index (VFI) Factor 3, and positively with Jitter, Noise-to-Harmonics Ratio, Lowest Intensity, and VFI Factors 1 and 2, with correlations generally in the weak-to-moderate range. A regression model indicated that voice parameters, particularly measures of vocal stability such as Jitter and fatigue recovery as measured by VFI Factor 3, together with age, accounted for over half of the variance in self-reported swallowing handicap.Conclusions: These findings suggest that multidimensional voice evaluation may offer exploratory, non-invasive insights into swallowing-related function, and could contribute to future approaches for early detection of subclinical swallowing difficulties in aging populations.
AIMS:Autologous fascia lata (AFL) is a therapeutic option in the management of unilateral vocal fold paralysis (UVFP). However, the effect of platelet-rich plasma (PRP) administered with AFL is unknown. The aim of this study was to investigate the long-term effects of the combination of minced AFL and PRP in the treatment of UVFP. METHODS:Between January 2015 and January 2021, a retrospective evaluation was made of 14 participants diagnosed with UVFP treated with minced AFL+PRP injection. Pre-treatment and postoperative 1-year evaluations were performed with videolaryngostroboscopy, the GRBAS scale, Turkish Voice Handicap Index (T-VHI-10), maximum phonation time (MPT), and acoustic analysis (%Jitter, %Shimmer, fundamental frequency (fo)). FINDINGS:Half of the participants were males, with with a mean age of 42.0 ± 12.1 years. One-year post-intervention, the T-VHI-10 scores decreased significantly (32.1 to 13.8; p = 0.001), mean MPT increased significantly (from 6.57 s to 16.14 s; p = 0.001), and significant improvements were observed in %Jitter (0.8 to 0.3; p = 0.030) and %Shimmer (5.18 to 2.16; p = 0.001) values. No postoperative complications or donor site morbidity were reported in any participant. CONCLUSIONS:Combining PRP with minced AFL is a safe, long-acting option for treating UVFP with significant improvement in voice quality. The regenerative effects of PRP may contribute to permanent vocal improvement by increasing fascia fertility. This method can be considered a less invasive alternative to thyroplasty and may provide additional advantages in terms of the use of autologous material and permanence.
Belting is a vocal technique used in musical theater and pop singing. In contrast to classical female singing, it de-emphasizes energy in the fundamental frequency and emphasizes energy in the second to fourth harmonics. The spectrum often resembles that of a trumpet on notes around C5 (523 Hz). This study aimed to investigate spectral trends in five female belters using three different vowels on two slightly different pitches. The trumpet-like spectra are not produced by tuning resonances to harmonics, but rather by distributing supraglottal inertive reactance across the 500–3000 Hz range with a short (17 cm) mini-trumpet airway shape. Vowels produced are highly modified from normal speaking vowels. The results provide helpful information to both singers and vocal pedagogues in aiding belting strategies.
In typically developing (TD) children, early gestures emerge before first words and predict spoken language. Language development in children with cochlear implants (CI) vary due to factors such as implantation age and exposure to spoken language, but variation is largely unexplained. Little is known about gestures in children with CI and how this is related to vocabulary. In this study, spontaneous use of gestures during assessment of receptive and expressive vocabulary was examined and related to vocabulary test results in ten children with CI, aged 25-39 months. The results were compared to those of individually age and sex matched TD children with normal hearing. All children were tested with the vocabulary test, the Picture Naming Game (PiNG). The test situation was video recorded to capture the children's use of deictic, iconic, and conventional gestures. Children with CI had lower vocabulary scores and used fewer gestures than TD children. Observable but statistically non-significant relationships between gestures and vocabulary were found in children with CI, as well as between vocabulary score and implantation age. The findings indicate that gestures should be included in the assessment and intervention of young children with challenges in their development of spoken language.
PURPOSE:To investigate whether there is a difference in olfactory functions among individuals who use different voice restoration methods after total laryngectomy. METHOD:The study group for this research comprised individuals who had undergone total laryngectomy and aged 44 to 75 years; 10 participants using oesophageal speech, 10 participants using tracheoesophageal speech, and 10 participants using electrolarynx were included. The control group comprised 10 individuals with normal olfactory function of similar age and gender to the individuals in the study group. The participants' olfactory functions were evaluated using the Sniffin Sticks Extended Test. European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire - H&N-35 was used as a subjective scale. RESULT:All laryngectomised patients exhibited olfactory impairment, with 73.3% diagnosed with anosmia and 26.7% with hyposmia. Regarding Sniffin Sticks Test combined scores; the mean values of voice prosthesis users, electrolarynx and oesophageal speech group were 8.4, 10.1 and 21.6 respectively, while in the control group it was 38.2. In terms of Sniffin Sticks Test composite scores, the oesophageal speech group had significantly higher scores than the voice prosthesis and electrolarynx groups (p < 0.001). CONCLUSION:While all laryngectomised patients showed olfactory dysfunction, those using oesophageal speech - a somewhat overlooked rehabilitation method - exhibited statistically significant preservation of olfactory function compared to other voice restoration techniques. These findings suggest that oesophageal speech may offer distinct advantages for maintaining post-laryngectomy olfactory capacity, warranting further consideration in clinical practise.
IntroductionThis study investigates the relationship between the morphological characteristics of the pharyngoesophageal segment (PES), communication experiences, and the acoustic parameters of the tracheoesophageal (TE) voice.MethodsA total of 55 patients who had undergone total laryngectomy were enrolled in this study between July 2020 and October 2023 in a Department of Otorhinolaryngology at a University Hospital in Croatia. High-speed videoendoscopy (HSV) images of the PES mucosa, an objective assessment of the voice, and a self-assessment questionnaire were analysed.ResultsHSV-based visualisation of PES was clearer in individuals who both self-rated their voice more positively and were rated similarly by a Speech and Language Therapist. The most common shape of PES during the open phase was split side-to-side. The Self-Evaluation of Communication Experiences after Laryngectomy (SECEL:HR) questionnaire showed that the majority of patients were well rehabilitated and satisfied with their voice. A significant correlation was found between the fundamental frequency (fo), jitter and shimmer and the SECEL:HR questionnaire. The visibility and shape of the PES as well as the amount of saliva could be associated with the reported fo and the quality of the TE voice.ConclusionA better insight into the phonatory movement of the PES mucosa in laryngectomised patients could allow us to better assess the patient's abilities and adjust the duration of voice therapy for each patient. However, due to the high variability of anatomical and morphological variations as well as acoustic measurements limiting the final results, further analyses are needed to clarify the different questions raised.
Necrobiotic xanthogranuloma (NXG) is a rare non-Langerhans cell histiocytosis with exceptionally uncommon laryngeal involvement. We report a 45-year-old male presenting with hoarseness and airway obstruction due to a supraglottic mass. Surgical excision via microlaryngoscopy was complicated by recurrent bleeding, which was ultimately managed with superior thyroid artery ligation. Histopathological evaluation confirmed NXG, showing necrobiosis, giant cells, cholesterol clefts, and CD138 positivity. The patient recovered uneventfully, with symptom resolution and a patent airway at follow-up. This case emphasizes the need to consider NXG in the differential diagnosis of laryngeal masses and highlights the importance of multidisciplinary evaluation and surgical preparedness for hemorrhagic complications.
