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Lam D, Xu K, Mirza N. Is Postoperative Voice Rest Unnecessary? A Systematic Review and Meta-analysis of Voice Rest Recommendation Outcomes. J Voice 2024:S0892-1997(24)00304-7. [PMID: 39343652 DOI: 10.1016/j.jvoice.2024.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 09/07/2024] [Accepted: 09/09/2024] [Indexed: 10/01/2024]
Abstract
BACKGROUND Voice rest (VR) is widely recommended after microlaryngeal surgery to facilitate recovery and improve voice outcomes. Our study is the first systematic review and meta-analysis summarizing the impact of postoperative absolute voice rest (AVR) and no voice rest (NVR) instructions on voice outcomes. METHODS PubMed, Embase, and Cochrane Library databases were searched using "voice rest laryngeal surgery" and "postoperative voice rest" for articles published before December 2022. Risk of bias was assessed using ROBINS-I and RoB2 tools. Meta-analysis using a random effects model was performed for studies comparing Voice Handicap Index (VHI-10) outcomes between NVR and AVR. Analysis was performed in R Studio. RESULTS In total, 255 articles were reviewed, 24 underwent full-text screening, and nine met inclusion criteria. Four randomized control trials (RCT) and one retrospective review compared AVR durations (range: 2-10days). Four studies (two cohort, one cross-sectional, and one RCT) compared AVR to NVR. All studies had risk of bias (ROBINS-I: two moderate, two serious; RoB2: five with concerns). Comparing AVR durations, two found no difference between short and long duration, while two reported improved outcomes for the short cohort. In studies comparing AVR to NVR, all concluded no significant difference in outcomes. Pooled analysis of three studies (355 patients) comparing NVR and AVR demonstrated no significant differences in pre- and postoperative VHI-10 change (mean difference=-0.87; 95% CI, -2.51 to 0.77; P = 0.27). CONCLUSION Systematic review findings indicate postoperative VR may not lead to improved voice outcomes, and a meta-analysis demonstrated no difference in VHI-10 outcomes between AVR and NVR. LEVEL OF EVIDENCE: 2
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Affiliation(s)
- Doreen Lam
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Katherine Xu
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Natasha Mirza
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Otorhinolaryngology - Head and Neck Surgery at the Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Division of Otolaryngology, Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania.
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2
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Zuim AF, Stewart CF, Titze IR. Vocal Demands of Musical Theatre Rehearsals: A Dosimetry Study. J Voice 2023:S0892-1997(23)00344-2. [PMID: 37951817 DOI: 10.1016/j.jvoice.2023.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/14/2023] [Accepted: 10/16/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVE To investigate singers' vocal load by documenting three types of vocal doses (time, cycle, and distance doses) and sound pressure levels during the four phases of rehearsal and how the vocal doses vary between singers across rehearsals in the musical Nine, written by Maury Yeston. METHODS/DESIGN Five student-singers participating in the musical Nine gave informed consent to participate in the study. All five participants were assigned female at birth and female-identifying individuals. They attached a KayPENTAX APM 3300 dosimeter sensor to their lower neck and wore the accelerometer during four three-hour rehearsals throughout the rehearsal process (the music learning phase, the choreography learning phase, the blocking learning phase, and the dress rehearsal) of the musical. The dosimeter records neck vibrations at a rate of 20 samples per second. but it does not record linguistic content. RESULTS A dosimetric analysis of five student singers identified variability in voice production throughout the rehearsal process. According to the dosimetry findings, singers employed extensive low-frequency voicing below the first passaggio, with belting and mixed vocal strategies as the predominant stylistic choices when performing in Nine. Additionally, the singers used an occasional head voice effect at specific moments. The roles of Carla, Saraghina, La Fleur, and Ensemble One and Two required specific vocal ranges due to the musical score. CONCLUSIONS Researchers have yet to establish a safe baseline vocal dose for singers. The vocal dose is affected by many factors, such as duration of phonation, frequency range, SPL, and styles of vocalism required by the score. Louder and heavier vocalization produces larger distance doses, representing the cumulative load placed on vibrating tissue. The cycle dose, distance dose, and SPL reported in this study varied within and between singers. The phonation density graphs show this variability and the low tessitura required by the score. Time doses ranged from 4% to 7% of rehearsal time; this short dose suggests that the rehearsals provided healthy conditions for the successful rehearsal process with efficient attention to the vocalization of a score that requires heavy vocal styles, including belting. While the rehearsal pace was not alarming, the demands of the score alone may prove to be much greater than the vocal dose reported through the rehearsal. Further studies are needed to establish the overall dose of each Broadway role to serve as parameters for vocal pacing and voice care.
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Affiliation(s)
- Ana F Zuim
- Steinhardt School, Department of Music and Performing Arts Professions, New York University, New York City, New York.
| | - Celia F Stewart
- Steinhardt School, Department of Communicative Sciences and Disorders, New York University, New York City, New York
| | - Ingo R Titze
- National Center for Voice and Speech, The University of Utah, Salt Lake City, Utah
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White AC, Awad R, Carding P. Pre and Post-operative Voice Therapy Intervention for Benign Vocal Fold Lesions: A Systematic Review. J Voice 2023; 37:857-874. [PMID: 34272141 DOI: 10.1016/j.jvoice.2021.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 06/01/2021] [Accepted: 06/06/2021] [Indexed: 01/16/2023]
Abstract
Benign vocal fold lesions cause dysphonia by preventing vocal fold closure, causing irregular vibration and increasing compensatory muscle tension. Voice therapy delivered in addition to phonosurgery may improve voice and quality of life outcomes but the evidence base is lacking and what constitutes voice therapy for this population is not defined. The purpose of this systematic review is to critically evaluate the evidence for pre and post-operative voice therapy to inform the development of an evidence based intervention. STUDY DESIGN Systematic Review. METHODS Electronic databases were searched using key terms including dysphonia, phonosurgery, voice therapy and outcomes. Eligible articles were extracted and reviewed by the authors for risk of bias and for information regarding the content, timing and intensity of any pre and post-operative voice therapy intervention. RESULTS Of the 432 articles identified, 35 met the inclusion criteria and were included in the review. 5 were RCTs, 2 were individual cohort studies, 1 was a case control study and 26 were case series. There was considerable heterogeneity in participant characteristics. Information was frequently lacking regarding the content timing and intensity of the reported voice therapy intervention, and where present, interventions were highly variable. CONCLUSION Reporting in relevant literature is limited in all aspects of content, timing and intensity of intervention. Further intervention development work is required to develop a robust voice therapy treatment intervention for this population, before effectiveness work can commence.
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Affiliation(s)
- Anna C White
- Division of Rehabilitation, Wellbeing and Ageing, University of Nottingham, Nottingham NG7 2UH; Nottingham University Hospitals NHS Trust, Nottingham, NG72UH.
| | - Rehab Awad
- Lewisham and Greenwich NHS Trust, University Hospital Lewisham Hospital, Lewisham High Street, London, SE13 6LH; Kasr Alaini Hospital, Cairo University, Al-Saray Street, El Manial, Cairo, 11956, Egypt
| | - Paul Carding
- Health & Life Sciences, Oxford Institute of Nursing, Midwifery & Allied Health Research, Jack Straws Lane, Oxford, OX3 0FL, England
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Bottalico P, Nudelman CJ. Do-It-Yourself Voice Dosimeter Device: A Tutorial and Performance Results. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023:1-15. [PMID: 37263017 DOI: 10.1044/2023_jslhr-23-00060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE Voice dosimeters gather voice production data in the daily lives of individuals with voice disorders. Additionally, voice dosimeters aid in understanding the pathophysiology of voice disorders. Previously, several voice dosimeters were commercially available. However, these devices have been discontinued and are not available to clinicians and researchers alike. In this tutorial, instructions for a low-cost, easy-to-assemble voice dosimeter are provided. This do-it-yourself (DIY) voice dosimeter is further validated based on performance results. METHOD Ten vocally healthy participants wore the DIY voice dosimeter. They produced a sustained /a/ vowel and read a text with three different vocal efforts. These tasks were recorded by the DIY voice dosimeter and a reference microphone simultaneously. The expanded uncertainty of the mean error in the estimation of four voice acoustic parameters as measured by the DIY dosimeter was performed by comparing the signals acquired through the reference microphone and the dosimeter. RESULTS For measures of sound pressure level, the DIY voice dosimeter had a mean error of -0.68 dB with an uncertainty of 0.56 dB. For fundamental frequency, the mean error was 1.56 Hz for female participants and 1.11 Hz for male participants, with an uncertainty of 0.62 Hz and 0.34 Hz for female and male participants, respectively. Cepstral peak prominence smoothed and L1 minus L2 had mean errors (uncertainty) of -0.06 dB (0.27 dB) and 2.20 dB (0.72 dB). CONCLUSION The mean error and uncertainties for the DIY voice dosimeter are comparable to those for the most accurate voice dosimeters that were previously on the market.
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Affiliation(s)
- Pasquale Bottalico
- Department of Speech and Hearing Science, University of Illinois at Urbana-Champaign
| | - Charles J Nudelman
- Department of Speech and Hearing Science, University of Illinois at Urbana-Champaign
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Dueppen A, Joshi A, Roy N, Yiu Y, Procter T, Goodwin M, Thekdi A. Exploring Personality and Perceived Present Control as Factors in Postsurgical Voice Rest: A Case Comparison. J Voice 2023:S0892-1997(22)00415-5. [PMID: 36639311 PMCID: PMC10333449 DOI: 10.1016/j.jvoice.2022.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 12/14/2022] [Accepted: 12/15/2022] [Indexed: 01/13/2023]
Abstract
OBJECTIVE This case comparison explored the relation between personality, perceived present control, and postoperative voice rest (as estimated by self-report and objective voice use) following surgery for benign vocal fold lesions. METHOD Two participants were included. Both participants were diagnosed with benign vocal fold pathology, underwent phonosurgery, and were assigned to either complete voice rest (CVR) or relative voice rest (RVR) postoperatively. During voice rest (VR), a visual analog scale (VAS) and a dosimeter (the Vocalog2) were used daily to estimate self-perceived and objective voice use, respectively. The participants also completed questionnaires on voice-related demographics, the Voice Handicap Index (VHI), Ten-Item Personality Inventory (TIPI), and Perceived Present Control (PPC). After 7 days of CVR or RVR, participants completed a postoperative questionnaire and a final VAS for overall voice use. RESULTS A wide discrepancy was observed in one of two participant's subjective perception of voice use (using the VAS) versus objective dosimetry data wherein she reported significantly more voice use than was observed objectively. Differences in personality and PPC between the participants did not appear to affect their voice use following the VR protocols. CONCLUSION The amount of voice use in both VR protocols for these two participants suggests that personality and PPC did not affect their adherence to recommendations of VR. Patients may perceive their voice use differently across time, which might play a role in their adherence to voice rest recommendations: voice use measured as instances versus a unit of time (seconds).
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Affiliation(s)
- Abigail Dueppen
- Department of Communication Sciences and Disorders, University of Houston, Houston, Texas; Department of Otolaryngology - Head & Neck Surgery, Houston Methodist Hospital, Houston, Texas
| | - Ashwini Joshi
- Department of Communication Sciences and Disorders, University of Houston, Houston, Texas; Department of Otolaryngology - Head & Neck Surgery, Houston Methodist Hospital, Houston, Texas.
| | - Nelson Roy
- Department of Communication Sciences and Disorders, University of Utah, Salt Lake City, Utah
| | - Yin Yiu
- Department of Otolaryngology - Head & Neck Surgery, Houston Methodist Hospital, Houston, Texas
| | - Teresa Procter
- Department of Otolaryngology - Head & Neck Surgery, Houston Methodist Hospital, Houston, Texas
| | - Maurice Goodwin
- Department of Otolaryngology - Head & Neck Surgery, Houston Methodist Hospital, Houston, Texas
| | - Apurva Thekdi
- Department of Otolaryngology - Head & Neck Surgery, Houston Methodist Hospital, Houston, Texas
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Chi HW, Cho HC, Yang AY, Chen YC, Chen JW. Effects of Different Voice Rest on Vocal Function After Microlaryngeal Surgery: A Systematic Review and Meta-Analysis. Laryngoscope 2023; 133:154-161. [PMID: 35218027 DOI: 10.1002/lary.30082] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 02/06/2022] [Accepted: 02/14/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To compare the results of a voice handicap index (VHI) scale and acoustic parameters in patients who underwent microlaryngeal surgery followed by either short-duration (voice rest for <7 days) or long-duration (≥7 days) voice rest. STUDY DESIGN Systematic review and meta-analysis. METHODS The PubMed, Embase, and Cochrane Library databases were systematically searched for articles published before March 1, 2021. Randomized controlled trials (RCTs) that measured the voice outcomes of patients after different durations and extents of postoperative voice restriction were included in the meta-analysis. RESULTS Four RCTs comprising 112 patients were included in the quantitative meta-analysis. Compared with the long-duration voice rest group, the short-duration group exhibited comparable VHI scores (mean difference [MD], -7.01; 95% CI, -16.12 to 2.09; p = 0.13), maximum phonation time (MD, -2.58; 95% CI, -5.42 to 0.26; p = 0.07), and acoustic variables of jitter (MD, -1.25; 95% CI, -3.43 to 0.94; p = 0.26) and shimmer (MD, -0.79; 95% CI, -2.08 to 0.51; p = 0.24). Subgroup analysis for benign pathology and cold instruments studies demonstrated significantly better VHI scores (MD, -14.45; 95% CI, -26.19 to -2.72; p = 0.02 and MD, -15.98; 95% CI, -28.52 to -3.44; p = 0.01, respectively) in the short-duration group. CONCLUSIONS The limited evidence does not demonstrate benefit in voice outcomes from long-duration voice rest and suggests potential unfavorable effects on compliance and quality of life, providing a rationale for short-duration voice rest after microlaryngeal surgery. More studies are required to determine the optimal duration and extent of postoperative voice rest. LEVEL OF EVIDENCE 1 Laryngoscope, 133:154-161, 2023.
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Affiliation(s)
- Hua-Wei Chi
- Department of Otolaryngology-Head and Neck Surgery, Yonghe Cardinal Tien Hospital, New Taipei City, Taiwan
| | - Hsiao-Chien Cho
- Department of Otolaryngology-Head and Neck Surgery, Cardinal Tien Hospital, New Taipei City, Taiwan.,Department of Otolaryngology-Head and Neck Surgery, National Taiwan University Hospital, Taipei City, Taiwan
| | - An-Yun Yang
- Master Program of Big Data in Biomedicine, School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Yong-Chen Chen
- College of Medicine, School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Jeng-Wen Chen
- Department of Otolaryngology-Head and Neck Surgery, Cardinal Tien Hospital, New Taipei City, Taiwan.,Department of Otolaryngology-Head and Neck Surgery, National Taiwan University Hospital, Taipei City, Taiwan.,Master Program of Big Data in Biomedicine, School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.,College of Medicine, School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.,Department of Medical Research and Education, Cardinal Tien Hospital, New Taipei City, Taiwan
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Llorente-Ortega M, Podhorski A, Fernandez S. Introducing a New Dosimeter for the Assessment and Monitoring of Vocal Risk Situations and Voice Disorders. J Voice 2022:S0892-1997(22)00239-9. [PMID: 36210222 DOI: 10.1016/j.jvoice.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 08/01/2022] [Accepted: 08/03/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE There are many physiological parameters recorded by devices that are becoming more affordable, precise and accurate. However, the lack of development in the recording of voice parameters from the physiological or medical point of view is striking, given that it is a fundamental tool for the work of many people and given the high incidence and prevalence of voice pathologies that affect people's communication. In this paper we perform a complete literature review on the dosimeters used in voice research and to present a prototype dosimeter with a pilot study to show its capabilities. METHOD We conducted a literature review using the keywords [MONITORING], [PHONATION], [ACCUMULATOR], [PORTABLE], [DOSIMETRY], [VOICE] searching in PubMed, Trip Database, HONcode, and SciELO search engines. From our review of dosimeter designs, we created our own prototype consisting of two main components: a Knowles Electronics BU-7135-0000 accelerometer mounted on a neck brace; and the ultra-low power MSP430FR5994 microcontroller. The selected sampling frequency was 2048 Hz. The device calculates the F0 every 250 ms and the amplitude and phonation activity every 31.25 ms. A pilot study was conducted using 2 subjects: one male during 11 days and one female during 14 days. RESULTS This work includes devices that have been created during the last 45 years as tools for the diagnosis and monitoring of the treatment of cases of vocal pathology and for the detection of phonatory patterns or risk situations for developing voice disorders or vocal pathologies. We also present recordings with our new device on the pattern of daily talk time, the fundamental frequency and the relative intensity of two subjects on different days. CONCLUSIONS Interesting work has been done in the development of voice dosimeters with different approaches. In our experience it is not possible to access them for research and they are not yet in clinical use. It is possible that a joint approach with voice and voice disorders professionals and engineers working closely together could take advantage of current technology to develop a fully portable, useful, and efficient system.
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Affiliation(s)
| | - Adam Podhorski
- Biomedical Engineering and Sciences Department, TECNUN, School of Engineering, University of Navarra, San Sebastian, Spain
| | - Secundino Fernandez
- Medical Engineering Laboratory, School of Medicine, University of Navarra, Spain; Voice Laboratory, Department of Otorhinolaryngology, School of Medicine. University of Navarra, Spain
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Bartlett RS, Carpenter AM, Chapman LK. A Systematic Review of Adherence Strategies for Adult Populations in Speech-Language Pathology Treatment. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:1501-1516. [PMID: 35320678 DOI: 10.1044/2022_ajslp-21-00255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE Speech-language pathologists (SLPs) often advise adult patients to complete at-home programs in order to improve outcomes. Despite this widespread practice, relatively little is known about treatment adherence. The purposes of this systematic review were to identify adherence strategies and adherence tracking methods used by adult populations that are commonly treated by SLPs (i.e., dysphagia, aphasia, traumatic brain injury, dysphonia, dysarthria), and to identify the efficacy of these strategies. METHOD The systematic review was conducted in accordance with A Measurement Tool to Assess Systematic Reviews guidelines. A comprehensive literature search was performed in three databases (CINAHL, PubMed, and Web of Science). RESULTS Of the 679 articles found, 18 were selected for analysis. Two thirds of the included articles received the second highest rating on the 5-point JAMA Quality Rating Scheme. Interventions designed to alter treatment adherence included (most to least frequent) computer programs, portable devices/phone apps, alarm reminders, instructional DVDs, check-ins from a clinician/volunteer, and wearable device. Adherence reporting methods included (most to least frequent) self-report diaries, computer program/app-aided collection, wearable device, and clinician/volunteer observation. Of the articles that reported practice frequency, 58% found that adherence strategies improved practice frequency as compared to control. Of the articles that reported treatment outcomes, 66% found that adherence strategies were associated with improved treatment outcomes as compared to control. CONCLUSIONS The paucity of publications reviewed suggests that treatment adherence is considerably understudied in speech-language pathology. A clearer understanding of how to improve the design of adherence strategies could yield highly valuable clinical outcomes. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.19393793.
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King RE, Novaleski CK, Rousseau B. Voice Handicap Index Changes After Microflap Surgery for Benign Vocal Fold Lesions Are Not Associated With Recommended Absolute Voice Rest Duration. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:912-922. [PMID: 35179998 PMCID: PMC9150674 DOI: 10.1044/2021_ajslp-21-00115] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/27/2021] [Accepted: 11/14/2021] [Indexed: 06/01/2023]
Abstract
PURPOSE Voice rest is frequently prescribed after phonosurgery, but optimal type and duration for voice outcomes have not been demonstrated. Studies to date have been characterized by heterogeneity in surgical procedures and laryngeal diagnoses. We sought to analyze the effect of recommended absolute voice rest duration on outcomes of microflap surgery for benign vocal fold lesions. A secondary purpose was to identify patient factors associated with postoperative voice outcomes. METHOD Forty-three patients were included in this retrospective review of patients aged 18 years and above who underwent direct microlaryngoscopy with microflap for vocal fold polyp or cyst over a 5-year period at a multidisciplinary voice center. Duration of recommended postoperative absolute voice rest was classified as less than 7 days, 7 days, and more than 7 days. Demographic and vocal hygiene data and voice treatment history were collected. Outcome measures consisted of one pre- and two postoperative Voice Handicap Index (VHI) scores. Effects of recommended voice rest on outcomes were analyzed using mixed models for repeated measures. Effects of patient factors on outcomes were analyzed as exploratory measures. Stroboscopy ratings were analyzed descriptively. RESULTS Thirteen patients were recommended 7 days of absolute voice rest, 15 were recommended less than 7 days, and 15 were recommended more than 7 days. Postoperatively, VHI scores significantly improved for all patients. Voice rest as a continuous variable was associated with the Functional subscale score in the short term, but there was no effect on VHI total score and no longer term effect of voice rest on any outcome. Age, sex, and preoperative voice therapy were associated with at least one VHI subscale score on at least one time point. CONCLUSION VHI outcomes of microflap surgery for polyps and cysts do not differ by duration of recommended absolute postoperative voice rest. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.19178459.
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Affiliation(s)
- Renee E. King
- Department of Surgery, University of Wisconsin–Madison
- Department of Communication Sciences and Disorders, University of Wisconsin–Madison
- Department of Hearing and Speech Sciences, Vanderbilt University, Nashville, TN
| | - Carolyn K. Novaleski
- Department of Hearing and Speech Sciences, Vanderbilt University, Nashville, TN
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing
| | - Bernard Rousseau
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, TN
- Department of Communication Sciences and Disorders, University of Pittsburgh, PA
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King RE, Dailey SH, Thibeault SL. Role of Voice Therapy in Adherence to Voice Rest After Office-Based Vocal Fold Procedures. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:2542-2553. [PMID: 34520225 PMCID: PMC9132023 DOI: 10.1044/2021_ajslp-21-00082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 05/03/2021] [Accepted: 06/07/2021] [Indexed: 06/13/2023]
Abstract
Purpose Patients undergoing vocal fold procedures significantly reduce but often do not cease voice use during absolute postprocedure voice rest. We hypothesized that patients who completed preprocedure voice therapy would increase adherence to postprocedure voice rest. Method Eighty-six participants completed this prospective cohort study. Patients scheduled for office-based vocal fold procedures, 1-3 days of absolute postprocedure voice rest, and preprocedure speech-language pathology (SLP) care were recruited. SLP care consisted of either (a) multiple voice therapy sessions, (b) one counseling/therapy session, or (c) voice evaluation only. Participants reported talking and other specific voice behaviors on 100-mm visual analog scales for up to 3 days pre- and postprocedure as well as changes in overall voice use at follow-up at least 1 week postprocedure. Results Talking decreased postprocedure by 63% in the therapy group and 65% in the counseling group, both significantly more than the 35% decrease measured in the evaluation group. There were group differences in talking at baseline but not during voice rest. Coughing and throat clearing were highest in the voice evaluation group and decreased less than talking during voice rest. At follow-up, 84% of participants reported that they completed voice rest for at least as long as recommended and 39.5% reported that they never used their voices during voice rest. Participants estimated a 98% overall reduction in voice use during voice rest at follow-up. Conclusions Voice use before and after vocal fold procedures varies by participation in preprocedure voice therapy. Patients significantly decrease talking during postprocedure voice rest but are not perfectly adherent. Communicative voice use decreases more than noncommunicative voice use during voice rest. Patients may overestimate adherence to voice rest at follow-up. Supplemental Material https://doi.org/10.23641/asha.16589864.
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Affiliation(s)
- Renee E. King
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, University of Wisconsin–Madison
- Department of Communication Sciences and Disorders, University of Wisconsin–Madison
| | - Seth H. Dailey
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, University of Wisconsin–Madison
| | - Susan L. Thibeault
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, University of Wisconsin–Madison
- Department of Communication Sciences and Disorders, University of Wisconsin–Madison
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Souza EVS, Bassi IB, Gama ACC. Voice amplifier: effects on dose and vocal intensity of teachers without dysphonia. Codas 2021; 33:e20200091. [PMID: 34431858 DOI: 10.1590/2317-1782/20202020091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 09/06/2020] [Indexed: 11/22/2022] Open
Abstract
PURPOSE Analyze the interference of using the voice amplifier in vocal dose of non-dysphonic teachers. METHODS This is an experimental study comparing people from the same ambience compound for 20 teachers from municipal elementary school in Belo Horizonte/MG. After consent, the participants were requested to answer the vocal symptom scale questionnaire (ESV) and later participated in two different moments of the study, for which they randomly selected. In the first moment, the participants used only the vocal dosimeter and in the second, they used the vocal dosimeter and the voice amplifier. The measurements were recorded by the device for 1h40m, in the classroom that the teachers taught. The time between the two measurements was one week, with the same room, the same time and the same discipline being taught, at both times. RESULTS The intensity parameter was the only one that showed difference with the use of the voice amplifier. CONCLUSION Use voice amplification while non-dysphonic teachers are teaching doesn't affect the fundamental frequency and vocal dose measure in the acoustics parameters. The vocal intensity is smaller when teacher uses the vocal amplification.
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Affiliation(s)
- Evelyn Vanessa Silva Souza
- Programa de Pós-graduação em Ciências Fonoaudiológicas, Departamento de Fonoaudiologia, Faculdade de Medicina, Universidade Federal de Minas Gerais - UFMG - Belo Horizonte (MG), Brasil
| | | | - Ana Cristina Côrtes Gama
- Departamento de Fonoaudiologia, Faculdade de Medicina, Universidade Federal de Minas Gerais - UFMG - Belo Horizonte, MG, Brasil
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Adherence of Patients With Dysphonia to Voice Therapy: Systematic Review. J Voice 2020; 34:808.e15-808.e23. [DOI: 10.1016/j.jvoice.2019.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 04/15/2019] [Accepted: 04/16/2019] [Indexed: 11/20/2022]
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Dhaliwal SS, Doyle PC, Failla S, Hawkins S, Fung K. Role of voice rest following laser resection of vocal fold lesions: A randomized controlled trial. Laryngoscope 2019; 130:1750-1755. [PMID: 31498467 DOI: 10.1002/lary.28287] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 07/17/2019] [Accepted: 08/19/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVES/HYPOTHESIS Voice rest is often prescribed following phonosurgery by most surgeons despite limited empiric evidence to support its practice. This study assessed the effect of postphonosurgery voice rest on vocal outcomes. STUDY DESIGN Prospective, randomized controlled trial. METHODS Patients with unilateral vocal fold lesions undergoing CO2 laser excision were recruited in a prospective manner and randomized into one of two groups: 1) an experimental arm consisting of 7 days of absolute voice rest, or 2) a control arm consisting of no voice rest. The primary outcome measure was the Voice Handicap Index-10 (VHI-10) questionnaire. Secondary outcomes included aerodynamic measurements (maximum phonation time), acoustic measures (fundamental frequency, jitter, shimmer, and harmonic-to-noise ratio), and auditory-perceptual measures. Primary and secondary outcomes were assessed preoperatively and reassessed postoperatively at the 1- and 3-month follow-up. Patient compliance to voice rest instructions were controlled for using subjective and objective parameters. RESULTS Thirty patients were enrolled with 15 randomized to each arm of the study. Statistical analysis for the entire cohort showed a significant improvement in the mean preoperative VHI-10 compared to postoperative assessments at 1-month (19.0 vs. 7.3, P < .05) and 3-month (19.0 vs. 6.2, P < .05) follow-up. However, between-group comparisons showed no significant difference in postoperative VHI-10 at either time point. Similarly, secondary outcome measures yielded no significant difference in between-group comparisons. CONCLUSIONS Our study shows no significant benefit to voice rest on postoperative voice outcomes as determined by patient self-perception, acoustic variables, and auditory-perceptual analysis. LEVEL OF EVIDENCE 1b CLINICAL TRIAL NUMBER: NCT02788435 (clinicaltrials.gov) Laryngoscope, 130:1750-1755, 2020.
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Affiliation(s)
- Sandeep S Dhaliwal
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Philip C Doyle
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada.,Voice Production and Perception Laboratory, and Department of Health and Rehabilitation Sciences, Western University, London, Ontario, Canada
| | - Sebastiano Failla
- Voice Production and Perception Laboratory, and Department of Health and Rehabilitation Sciences, Western University, London, Ontario, Canada
| | - Sarah Hawkins
- Department of Speech-Language Pathology, London Health Sciences Centre, London, Ontario, Canada
| | - Kevin Fung
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
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Application of Ambulatory Phonation Monitoring (APM) in the measurement of daily speaking-time and voice intensity before and after cochlear implant in deaf adult patients. Auris Nasus Larynx 2019; 46:844-852. [PMID: 31005362 DOI: 10.1016/j.anl.2019.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 03/12/2019] [Accepted: 03/28/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVE to evaluate the changes in daily voice production, analysed through the Ambulatory Phonation Monitoring (APM), and their relationship with Quality of Life (QOL) measurements in a group of profound deaf patients treated with Cochlear Implant (CI). METHODS A total of 12 consecutive post-lingual deaf patients (8 females and 4 males) treated with CI for bilateral severe-to-profound hearing loss were enrolled. Each patient was evaluated before and after 6 months of CI use. In particular, the daily voice production evaluation was performed using the APM, while QOL information were gathered from the Italian version of the Nijmegen Cochlear Implant Questionnaire (I-NCIQ). RESULTS Significant differences in the APM results obtained before and after CI were found. In particular, a significant decrease of the mean amplitude and a significant increase of the daily phonation time and percentage of phonation time were demonstrated after CI use in all the patients. A significant improvement in the I-NCIQ scores was demonstrated after CI use and significant correlations among I-NCIQ scores and the APM parameters were found. CONCLUSIONS The APM could be useful in the evaluation of the benefits of cochlear implantation and may represents an indicator of deaf patient participation. In addition, the daily voice production's modifications after CI and their significant relations with the changes in QOL measurements could be useful in treatment planning as well as during pre- and post-operative counselling.
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Amir O, Shapira Y, Mick L, Yaruss JS. The Speech Efficiency Score (SES): A time-domain measure of speech fluency. JOURNAL OF FLUENCY DISORDERS 2018; 58:61-69. [PMID: 30119862 DOI: 10.1016/j.jfludis.2018.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 07/01/2018] [Accepted: 08/07/2018] [Indexed: 06/08/2023]
Abstract
PURPOSE This study is a preliminary attempt to evaluate a new speech fluency measure, the Speech Efficiency Score (SES), in comparison with subjective stuttering severity rating scales and stuttered syllable counts (%SS). METHODS 277 listeners (92 naïve, 39 speech-language pathology (SLP) students, 124 practicing SLPs, and 22 SLPs who specialize in stuttering) evaluated short recordings of speech on an 11-point scale. Recordings were obtained from 56 adults, of whom 20 were people who stutter, 16 were people who stutter who were using fluency-shaping techniques, and 20 were speakers who do not stutter. In addition, %SS and the SES measure were obtained for each recording. RESULTS The four listener groups rated stuttering severity similarly, with no statistically significant between-group differences. Listeners' responses on the stuttering severity rating scales and the SES yielded significant differences between all three speaker groups. The %SS measure yielded a significant difference only between the stuttering group and the other two groups but not between the fluency-shaping and the control groups. A very strong positive correlation was found between the SES and the subjective stuttering-severity rating scales (r = 0.92). The correlation between %SS and the perceptual evaluation, as well as the correlation between %SS and the SES, were lower, though they still reached significance. CONCLUSIONS Results suggest that speech efficiency scores, which are based on a time-domain analysis, closely match subjective stuttering severity ratings and could ultimately provide a more objective way to measure speech fluency.
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Affiliation(s)
- Ofer Amir
- Department of Communication Disorder, The Stanley Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Israel.
| | | | | | - J Scott Yaruss
- Department of Communicative Sciences & Disorders, College of Communication Arts and Sciences, Michigan State University, East Lansing, MI, Israel
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Searl J, Knollhoff S. Sense of Effort and Fatigue Associated With Talking After Total Laryngectomy. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2018; 27:1434-1444. [PMID: 30286222 DOI: 10.1044/2018_ajslp-17-0218] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 05/18/2018] [Indexed: 06/08/2023]
Abstract
PURPOSE Sense of effort and fatigue associated with talking was compared in individuals with and without a total laryngectomy. METHOD An online survey of individuals using tracheoesophageal speech (TES; n = 222), electrolaryngeal speech (ELS; n = 132), esophageal speech (n = 41), and laryngeal speech (LS; n = 112) asked about 3 domains of effort when talking: frequency of occurrence, withdrawal from talking, and location in the body. Three aspects of fatigue were explored: frequency of occurrence, fatigue type, and duration of talking before fatigue. RESULTS Alaryngeal groups reported significantly more talking-related effort and fatigue than the LS group. Sixty-three percent of all respondents indicated that effort caused them to talk less, with no group differences on this item. Significantly more effort was localized to the lips and tongue by ELS compared with TES and LS groups. Both the ELS and TES groups had higher shoulder/arm effort when talking compared with the esophageal speech and LS groups. ELS respondents reported less fatigue than the TES group. When fatigue was present, the TES group had more physical and less mental fatigue than the ELS group. The duration of talking before experiencing fatigue was significantly shorter for the alaryngeal groups compared with the LS group. CONCLUSIONS Effort and fatigue associated with talking are a common report for individuals using alaryngeal speech. The location of effort within the body and the type of fatigue experienced vary to some extent across alaryngeal speaking methods.
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Affiliation(s)
- Jeff Searl
- University of Kansas Medical Center, Kansas City
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Whitling S, Lyberg-Åhlander V, Rydell R. Absolute or relative voice rest after phonosurgery: a blind randomized prospective clinical trial. LOGOP PHONIATR VOCO 2018; 43:143-154. [PMID: 30183437 DOI: 10.1080/14015439.2018.1504985] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVES The first aim, was to compare participant compliance with postoperative voice rest advice in two groups. The second aim was to compare vocal function and recovery in the short-term, seven days post-surgery and in the long-term, 3-6 months post-surgery. DESIGN Preliminary randomized prospective blind clinical trial. METHODS Twenty patients scheduled for surgery for benign vocal fold lesions were randomized into seven days of absolute or relative voice rest. Compliance with voice rest advice was monitored with a voice accumulator for seven days following surgery. Vocal recovery was tracked through (a) self-perceived vocal function, (b) perceptual assessments of voice recordings and (c) visual assessment of high resolution and high speed digital imaging (d) vocal stamina and reaction to vocal loading, explored with a vocal loading task. RESULTS The absolute voice rest group phonated significantly less than the relative voice rest group during seven days post-surgery, but they were not silent. The absolute voice rest group self-reported more difficulty with compliance than the relative voice rest group. The relative voice rest group coped with significantly more vocal loading at long-term check-up. In the short-term the absolute voice rest group improved morphological recovery to a significant degree, however relative voice rest renders superior long-term recovery. CONCLUSIONS Absolute voice rest is difficult to comply with. Neither short-term, nor long-term vocal recovery differed significantly between groups. Within-group comparisons showed significant improvements in vocal stamina, immediate recovery from vocal loading and self-assessments of voice problems only for the group with recommended relative voice rest.
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Affiliation(s)
- Susanna Whitling
- a Department of Logopedics Phoniatrics and Audiology , Lund University , Lund , Sweden
| | | | - Roland Rydell
- a Department of Logopedics Phoniatrics and Audiology , Lund University , Lund , Sweden.,b Ear, Nose and Throat Disease Clinic , Skåne University Hospital , Lund , Sweden
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Assad JP, Magalhães MDC, Santos JN, Gama ACC. Dose Vocal: uma revisão integrativa da literatura. REVISTA CEFAC 2017. [DOI: 10.1590/1982-021620171932617] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO O objetivo da pesquisa foi realizar uma revisão da literatura referente aos tipos de dose vocal e aos resultados destas medidas em diferentes situações comunicativas. Houve levantamento da literatura nacional e internacional, publicada nos idiomas Inglês, Espanhol ou Português, utilizando-se as bases de dados MEDLINE, LILACS, IBECS e ISI (Web of Science), dos últimos 21 anos, cujos artigos estavam disponíveis na íntegra. Quinze estudos contemplaram os critérios propostos. A maioria dos artigos estudou professores, visto que são mais vulneráveis para a ocorrência de disfonia. Os tipos de dose encontrados foram porcentagem de fonação, dose temporal, dose cíclica, dose de distância, dose de energia radiada e dose de energia dissipada. O aumento da dose vocal está associado ao uso excessivo e prolongado da voz na atividade docente, principalmente entre os professores da educação infantil e os de canto. As altas doses vocais correlacionam-se também à presença de disfonia, ao maior nível de ruído ambiental, à grande variação prosódica na fala e à autopercepção de fadiga vocal. Pacientes com disfonia comportamental (nódulos e pólipos) apresentam maiores doses vocais que pacientes com outros quadros disfônicos. Fatores como repouso de voz e uso do amplificador vocal indicam a diminuição da dose da voz.
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Mehta DD, Cheyne HA, Wehner A, Heaton JT, Hillman RE. Accuracy of Self-Reported Estimates of Daily Voice Use in Adults With Normal and Disordered Voices. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2016; 25:634-641. [PMID: 27788279 PMCID: PMC5373697 DOI: 10.1044/2016_ajslp-15-0105] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 01/27/2016] [Accepted: 04/18/2016] [Indexed: 05/25/2023]
Abstract
PURPOSE Accurate estimation of daily patterns of vocal behavior is essential to understanding the role of voice use in voice disorders. Given that clinicians currently rely on patient self-report to assess daily vocal behaviors, this study sought to assess the accuracy with which adults with and without voice disorders can estimate their amount of daily voice use in terms of phonation time. METHOD Eighteen subjects (6 patients, 6 matched members of a control group without voice disorders, 6 low voice users) wore the accelerometer-based Ambulatory Phonation Monitor (APM; model 3200, KayPENTAX, Montvale, NJ) for at least 5 workdays. Subjects were instructed to provide hourly self-reports of time spent talking using a visual analog scale. Spearman correlation coefficients and errors between self-reported and APM-based estimates of phonation time revealed subject- and group-specific characteristics. RESULTS A majority of subjects exhibited a significant bias toward overestimating their phonation times, with an average absolute error of 113%. Correlation coefficients between self-reported and APM-based estimates of phonation time ranged from statistically nonsignificant to .91, reflecting large intersubject variability. CONCLUSIONS Subjects in all 3 groups were moderately accurate at estimating their hourly voice use, with a consistent bias toward overestimation. The results support the potential role that ambulatory monitoring could play in improving the clinical assessment of voice disorders.
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Affiliation(s)
- Daryush D. Mehta
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, MA
- Institute of Health Professions, Massachusetts General Hospital, Boston
| | - Harold A. Cheyne
- Bioacoustic Research Program, Lab of Ornithology, Cornell University, Ithaca, NY
| | - Asa Wehner
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston
| | - James T. Heaton
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, MA
- Institute of Health Professions, Massachusetts General Hospital, Boston
| | - Robert E. Hillman
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, MA
- Institute of Health Professions, Massachusetts General Hospital, Boston
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Effect of Noise on Vocal Loudness and Pitch in Natural Environments: An Accelerometer (Ambulatory Phonation Monitor) Study. J Voice 2016; 30:389-93. [DOI: 10.1016/j.jvoice.2015.05.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Accepted: 05/22/2015] [Indexed: 11/22/2022]
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