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Yuen CWN, Ma EPM. Systematic Review: Singing-Based Interventions to Improve Physical Functions Related to Aging Voice in Older Adults. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2024; 67:2139-2158. [PMID: 38875480 DOI: 10.1044/2024_jslhr-23-00641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2024]
Abstract
PURPOSE This systematic review aimed to evaluate the effects of singing as an intervention for aging voice. METHOD Quantitative studies of interventions for older adults with any medical condition that involves singing as training were reviewed, measured by respiration, phonation, and posture, which are the physical functions related to the aging voice. English and Chinese studies published until April 2024 were searched using 31 electronic databases, and seven studies were included. The included articles were assessed according to the Grading of Recommendations, Assessment, Development, and Evaluations rubric. RESULTS Seven studies were included. These studies reported outcome measures that were related to respiratory functions only. For the intervention effect, statistically significant improvements were observed in five of the included studies, among which three studies had large effect sizes. The overall level of evidence of the included studies was not high, with three studies having moderate levels and the rest having lower levels. The intervention activities included trainings other than singing. These non-singing training items may have caused co-intervention bias in the study results. CONCLUSIONS This systematic review suggests that singing as an intervention for older adults with respiratory and cognitive problems could improve respiration and respiratory-phonatory control. However, none of the included studies covers the other two of the physical functions related to aging voice (phonatory and postural functions). The overall level of evidence of the included studies was not high either. There is a need for more research evidence in singing-based intervention specifically for patient with aging voice.
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Affiliation(s)
- Crystal W-N Yuen
- Voice Research Laboratory, Faculty of Education, The University of Hong Kong
| | - Estella P-M Ma
- Voice Research Laboratory, Faculty of Education, The University of Hong Kong
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Contreras-Ruston F, Castillo-Allendes A, Saavedra-Garrido J, Ochoa-Muñoz AF, Hunter EJ, Kotz SA, Navarra J. Voice self-assessment in individuals with Parkinson's Disease as compared to general voice disorders. Parkinsonism Relat Disord 2024; 123:106944. [PMID: 38552350 DOI: 10.1016/j.parkreldis.2024.106944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 03/18/2024] [Accepted: 03/20/2024] [Indexed: 06/04/2024]
Abstract
BACKGROUND Individuals with Parkinson's Disease (IwPD) often fail to adjust their voice in different situations, without awareness of this limitation. Clinicians use self-report questionnaires that are typically designed for individuals with General Voice Disorders (GVD) in the vocal assessment of IwPD. However, these instruments may not consider that IwPD have a reduced self-perception of their vocal deficits. This study aimed to compare self-reported vocal symptoms and voice loudness between IwPD and GVD. METHODS 28 IwPD and 26 with GVD completed the Voice Symptom Scale (VoiSS) questionnaire to evaluate their voice self-perception. Vocal loudness (dB) was also assessed. Univariate and multivariate analyses were used to compare the outcomes from these measures between the two groups. Principal Component Analysis and Hierarchical Clustering Analysis were applied to explore data patterns related to voice symptoms. RESULTS IwPD reported significantly fewer vocal symptoms than those with GVD in all VoiSS questionnaire domains. Multivariate principal component analysis found no significant correlations between VoiSS scores and participant similarities in voice measures. Despite experiencing hypophonia, IwPD scored lower in all VoiSS domains but still fell in the healthy voice range. Hierarchical Clustering Analysis grouped participants into three distinct categories, primarily based on age, vocal loudness, and VoiSS domain scores, distinguishing between PD and GVD individuals. CONCLUSIONS IwPD reported fewer vocal symptoms than GVD. The voice self-assessment seems to be unreliable to assess vocal symptoms in IwPD, at least regarding loudness. New self-report instruments tailored to PD individuals are needed due to their particular voice characteristics.
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Affiliation(s)
- Francisco Contreras-Ruston
- Department of Cognition, Development and Educational Psychology, University of Barcelona, Barcelona, Spain; Faculty of Psychology and Neuroscience, Department of Neuropsychology & Psychopharmacology, Maastricht University, 6229 ER, Maastricht, the Netherlands; Speech-Language Pathology and Audiology Department - Universidad de Valparaíso, San Felipe, Chile.
| | - Adrián Castillo-Allendes
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing, MI, USA; Department of Communication Sciences and Disorders, University of Iowa, Iowa City, IA, USA
| | - Jorge Saavedra-Garrido
- Institute of Statistics, University of Valparaíso, Faculty of Science, Valparaíso, Chile; Department of Meteorology, University of Valparaíso, Valparaíso, Chile
| | - Andrés Felipe Ochoa-Muñoz
- Institute of Statistics, University of Valparaíso, Faculty of Science, Valparaíso, Chile; School of Statistics, Universidad del Valle, Cali, Colombia
| | - Eric J Hunter
- Department of Communication Sciences and Disorders, University of Iowa, Iowa City, IA, USA
| | - Sonja A Kotz
- Faculty of Psychology and Neuroscience, Department of Neuropsychology & Psychopharmacology, Maastricht University, 6229 ER, Maastricht, the Netherlands
| | - Jordi Navarra
- Department of Cognition, Development and Educational Psychology, University of Barcelona, Barcelona, Spain
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Sund LT, Cameron B, Johns MM, Gao WZ, O'Dell K, Hapner ER. Laryngologists' Reported Decision-Making in Presbyphonia Treatment. J Voice 2024; 38:723-730. [PMID: 34819238 DOI: 10.1016/j.jvoice.2021.10.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 10/10/2021] [Accepted: 10/11/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Decision-making regarding behavioral versus procedural intervention in the treatment of presbyphonia has not been well defined. The study objective was to survey laryngologists' reported practice patterns and decision-making in presbyphonia. METHODS All laryngology faculty in U.S. academic medical centers with residency programs were recruited to complete an anonymous 29-item survey regarding decision-making in presbyphonia treatment. The survey included 5 sections: demographics, first-line treatment distribution, factors that drive decision-making toward procedural intervention, treatment progression if first-line treatment is insufficient, durable treatment. RESULTS Of 153 laryngologists surveyed, 89 responded (58%). Voice therapy (VT) was the most often reported first-line treatment, with 57% of respondents indicating the majority of their patients receive VT initially. Most respondents (83%) indicated they occasionally use procedural intervention as first-line treatment. Factors driving first-line procedural intervention were severe glottal insufficiency (87%), high occupational/social voice demands (76%), voice not stimulable for change (73%), difficulty attending VT (70%), severe dysphonia (65%), and dysphagia (61%). The majority of respondents indicated the following do not affect their decision to pursue procedural intervention: patient age (88%); medical comorbidities (63%); patient's desire for a "quick fix" (55%); patient-reported outcome measures (51%). Most respondents (81%) use trial injection augmentation before durable treatment. Of durable treatments, bilateral thyroplasty was preferred (71%), followed by CaHA (15%) and lipoinjection (11%). CONCLUSIONS This study is the first to our knowledge to examine factors that influence decision-making in presbyphonia treatment. While VT remains the most frequent first-line treatment, study results better inform decision-making regarding first-line procedural intervention.
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Affiliation(s)
- Lauren Timmons Sund
- USC Voice Center, USC Caruso Department of Otolaryngology - Head and Neck Surgery, Keck Medicine of USC, Los Angeles, California
| | - Brian Cameron
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Texas - Houston, Cameron, Houston, Texas
| | - Michael M Johns
- USC Voice Center, USC Caruso Department of Otolaryngology - Head and Neck Surgery, Keck Medicine of USC, Los Angeles, California
| | - William Z Gao
- Department of Otolaryngology-Head & Neck Surgery, Georgetown University Medical Center, Gao, Washington, DC
| | - Karla O'Dell
- Department of Otolaryngology-Head & Neck Surgery, Georgetown University Medical Center, Gao, Washington, DC
| | - Edie R Hapner
- UAB Voice Center, Department of Otolaryngology, University of Alabama at Birmingham, Hapner, Birmingham, Alabama.
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Slavych BK, Zraick RI, Ruleman A. A Systematic Review of Voice-Related Patient-Reported Outcome Measures for Use with Adults. J Voice 2024; 38:544.e1-544.e14. [PMID: 34782227 DOI: 10.1016/j.jvoice.2021.09.032] [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: 05/31/2021] [Revised: 09/22/2021] [Accepted: 09/23/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE This paper's purpose is to provide a resource for clinicians and researchers of select voice-related patient-reported outcome measures (PROMs) available in the English language. METHOD A systematic search for voice-related PROMs was conducted between September 2020 and July 17, 2021. Databases included APA PsychInfo, Nursing and Allied Health Source, MEDLINE via the EBSCO interface, and Science Direct. Reference lists for PROMs-related articles were mined for reference to PROMs protocols. RESULTS Thirty voice-related PROMs were identified and categorized as either developed primarily for use in the clinic (n = 12), developed primarily for use in a specific research study (n = 6), or translated into English for publication (n = 12). Twelve PROMs were summarized: Aging Voice Index, Disease Specific Self-Efficacy in Spasmodic Dysphonia, Evaluation of the Ability to Sing Easily, Evaluating Voice Disability - Quality of Life Questionnaire, Glottal Function Index, Linear Analog Scale of Assessment of Voice Quality, Quality of Life in Recurrent Respiratory Papillomatosis, Speech Disability Questionnaire, Trans Woman Voice Questionnaire, Vocal Cord Dysfunction Questionnaire, Vocal Fatigue Index, and the Vocal Tract Discomfort Scale. CONCLUSION The PROMs can be categorized into English-language voice-related PROMs developed primarily for clinical use, English-language PROMs developed primarily for research use, and English-language PROMs translated into English. The extent of reliability and validity testing completed varies in the PROMs developed primarily for clinical use. A PROM's psychometric properties as well as the language in which the PROM was tested, should guide clinicians and researchers as they consider which instrument(s) to use.
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Affiliation(s)
- Bonnie K Slavych
- Communication Disorders program, University of Central Missouri, Warrensburg, Missouri, USA.
| | - Richard I Zraick
- School of Communication Sciences and Disorders, University of Central Florida, Orlando, Florida, USA
| | - Alice Ruleman
- Communication Disorders program, University of Central Missouri, Warrensburg, Missouri, USA
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Gartling GJ, van Mersbergen M, Crow K, Lewandowski A, Smith LJ, Gartner-Schmidt JL. The Patient Experience: The Relationship Between Vocal Handicap, Congruency, Perceived Present Control, and Mood Across Four Voice Disorders. J Voice 2024; 38:244.e15-244.e27. [PMID: 34615615 DOI: 10.1016/j.jvoice.2021.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 08/19/2021] [Accepted: 08/25/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The potential for negative sequalae in psychosocial well-being presents clinical importance to the assessment of voice disorders. Despite the impairment voice disorders cause in the psychosocial domain, the clinical assessment of these disorders relies heavily on visual perceptual judgments of the larynx, audio-perceptual, as well as acoustic and aerodynamic measures. While these measures aid in accurate diagnosis and are necessary for standard of care, they present little insight into the patient experience of having a voice disorder. DESIGN Retrospective between-subject, non-experimental design. METHODS Data from 335 patients from the University of Pittsburgh Voice Center were collected from scores of the Voice Handicap Index-10 (VHI-10) and two recent questionnaires, the Voice Present Perceived Control scale (VPPC), and the Vocal Congruency Scale (VCS). Examining how these voice-specific scales related to three mental health screeners for stress (Perceived Stress Scale-4), anxiety (Generalized Anxiety Disorder-7) and depression (Patient Health Questionnaire-9) were also examined. Patient diagnoses included primary muscle tension dysphonia (pMTD), unilateral vocal fold paralysis (UVFP), vocal fold atrophy, and mid membranous vocal fold lesions. RESULTS There were significant differences in scores from the voice-specific scales between diagnostic groups with UVFP being the highest (worst) in VHI-10 and UVFP being the lowest (worst) in VCS compared to healthy controls. There was no significant difference in VPPC scores between diagnostic groups. Results showed statistically significant inverse relationships between the VHI-10 and the VPPC and between the VHI-10 and VCS for all diagnostic groups. A significant direct relationship was found between the VPPC and the VCS for patients diagnosed with MTD, UVFP and Lesions. In sum, patients with UVFP presented with the most frequent and sometimes strongest relationships between voice and mental health measures. DISCUSSION This study marks an initial investigation into the nuanced patient experience of having a voice disorder. Three theoretically unrelated voice constructs: handicap, perceived control, and sense of self, were measured via self-report. Results from this study describe the patient experience correlating to these constructs with weak correlations to stress, anxiety, and depression. Findings also clearly suggest that patient experience varies among diagnostic groups, as well as varying constructs. Measures of multiple constructs of patient perception provide valuable insight into a patient's experience of their voice disorder, guidance on the direction of voice treatment, and justification for such treatments.
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Affiliation(s)
- Gary J Gartling
- Communication Science and Disorders, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Miriam van Mersbergen
- School of Communication Sciences and Disorders, The University of Memphis, Memphis, Tennessee
| | - Karen Crow
- Louisville Center for Voice Care, Louisville, Kentucky
| | - Ali Lewandowski
- University of Pittsburgh Voice Center, Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Libby J Smith
- University of Pittsburgh Voice Center, Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Jackie L Gartner-Schmidt
- Communication Science and Disorders, University of Pittsburgh, Pittsburgh, Pennsylvania; University of Pittsburgh Voice Center, Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
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Tsai LYJ, Chan RW, Shen C, Chen Z, Zhuang P, Chiang YN, Tai SK, Xue K. A 4-Week Straw Phonation in Water Exercise Program for Aging-Related Vocal Fold Atrophy. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:2581-2599. [PMID: 37459605 DOI: 10.1044/2023_jslhr-23-00071] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Abstract
PURPOSE This study evaluated the efficacy of a 4-week straw phonation in water (SPW) exercise program on aging-related vocal fold atrophy (VFA), with a secondary objective to examine the immediate effects of SPW exercises. METHOD Thirty-eight older adults aged 60 years and above formally diagnosed with aging-related VFA were randomly assigned into an experimental group undergoing SPW exercises with an 8-cm depth of straw submersion into water for 4 weeks plus vocal hygiene practice (n = 20), and a control group with only vocal hygiene practice (n = 18). Outcome measures included laryngeal endoscopic measures of glottal gap, auditory-perceptual ratings of voice quality, acoustic measures, aerodynamic measures, and standardized self-assessment questionnaire scores. An additional round of acoustic and aerodynamic assessment following 20 min of SPW exercises was conducted to examine the immediate effects. RESULTS Significant improvements in normalized glottal gap area, perceptual rating of breathiness, smoothed cepstral peak prominence, harmonics-to-noise ratio (HNR), mean oral airflow, subglottal pressure and laryngeal airway resistance at comfortable loudness, Voice-related Quality of Life scores, and Chinese Vocal Fatigue Index Factor 3 scores were observed in the experimental group relative to the control group. There were also significant immediate effects for HNR, mean oral airflow, subglottal pressure, and laryngeal airway resistance. CONCLUSIONS These findings suggested significant immediate improvements in vocal function following SPW exercises, with additional significant improvements in vocal function as well as significant improvements in quality of life following the 4-week SPW exercise program. Further studies with more long-term follow-up are recommended to better understand the efficacy of SPW exercises with deep levels of straw submersion into water as an effective clinical option for the management of hypofunctional dysphonia associated with aging-related VFA.
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Affiliation(s)
- Lydia Yueh-Ju Tsai
- Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taiwan
| | - Roger W Chan
- Geriatric Care Research Center, Xiamen Medical College, Xiamen, Fujian, China
- Department of Voice Medicine, Zhongshan Hospital Xiamen University, Xiamen, Fujian, China
| | - Cuiling Shen
- Geriatric Care Research Center, Xiamen Medical College, Xiamen, Fujian, China
| | - Zusen Chen
- Geriatric Care Research Center, Xiamen Medical College, Xiamen, Fujian, China
| | - Peiyun Zhuang
- Department of Voice Medicine, Zhongshan Hospital Xiamen University, Xiamen, Fujian, China
| | - Yu-Ning Chiang
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan
| | - Shyh-Kuan Tai
- Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taiwan
| | - Keying Xue
- Institute of Respiratory Diseases, Xiamen Medical College, China
- Department of Respiratory Medicine, Second Affiliated Hospital, Xiamen Medical College, Xiamen, Fujian, China
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Liao C, Chan RW, Zhuang P, Wang C, Lin F, Chen Y, Yu H. Mandarin Chinese version of the Aging Voice Index. Laryngoscope Investig Otolaryngol 2023; 8:980-988. [PMID: 37621265 PMCID: PMC10446271 DOI: 10.1002/lio2.1117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 06/18/2023] [Accepted: 07/08/2023] [Indexed: 08/26/2023] Open
Abstract
Objectives This study developed the Mandarin Chinese version of the Aging Voice Index (AVI), with preliminary validation of the scale for potential clinical applications. Study Design Scale development. Methods The experimental procedure involved: (1) cross-cultural adaptation of the original AVI into the Mandarin Chinese version (CAVI); (2) evaluation by expert panel; (3) back translation; (4) pilot testing; (5) development of the final CAVI; (6) scale validation with 68 older adults of 60-89 years old (29 females and 39 males), 34 with voice disorders and 34 age-matched with normal voice. Internal consistency reliability, test-retest reliability, content validity, criterion-related validity, and discriminatory ability (diagnostic accuracy) of the CAVI were evaluated. Results There were high internal consistency (Cronbach's alpha = 0.9733), high test-retest reliability (intraclass correlation coefficient = 0.9578, p < 0.01), high content validity (content validity index = 0.9710), high criterion-related validity (Pearson's r = 0.9439, p < 0.01 between CAVI and Voice Handicap Index-10; r = 0.8070, p < 0.01 between CAVI and voice-related quality of life [V-RQOL]), and significant difference in CAVI scores between the two groups with huge effect size (t(34.69) = -11.59, Cohen's d = 2.81, p < 0.001). Receiver operating characteristic analysis revealed a high diagnostic accuracy of the CAVI, with an area under the curve of 0.9974 (p < 0.001) and a cut-off score of 12.0 with 100% sensitivity and 97.1% specificity. Conclusion Our findings suggested that the CAVI could be a reliable and valid standardized self-assessment questionnaire tool for clinical evaluation of the impact of voice problems specifically for Mandarin-speaking older adults. Further studies should explore a full-scale validation of the CAVI for being a standard clinical tool, including for older adults in Mainland China. Level of evidence 3b (case-control study).
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Affiliation(s)
| | - Roger W. Chan
- Geriatric Care Research CenterXiamen Medical CollegeXiamenFujianChina
- Department of Voice MedicineZhongshan Hospital Xiamen UniversityXiamenFujianChina
| | - Peiyun Zhuang
- Department of Voice MedicineZhongshan Hospital Xiamen UniversityXiamenFujianChina
| | - Chi‐Te Wang
- Department of Otolaryngology Head and Neck SurgeryFar Eastern Memorial HospitalNew Taipei CityTaiwan
| | - Feng‐Chuan Lin
- Department of Otolaryngology Head and Neck SurgeryFar Eastern Memorial HospitalNew Taipei CityTaiwan
| | - Ying Chen
- Geriatric Care Research CenterXiamen Medical CollegeXiamenFujianChina
| | - Huiqin Yu
- Geriatric Care Research CenterXiamen Medical CollegeXiamenFujianChina
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Presbyphonia as an Individual Process of Voice Change. J Voice 2023; 37:303.e1-303.e14. [PMID: 33495034 DOI: 10.1016/j.jvoice.2020.12.046] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 12/16/2020] [Accepted: 12/17/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of the study was to determine the individual variability of the severity of dysphonia in the population of older women and men using the initial perceptual voice assessment (GRBAS) and objective diagnosis of the clinical form of Presbyphonia with laryngeal visualization technique (High-Speed Digital Imaging [HSDI]) and acoustic voice analysis (Diagnoscope Specjalista). METHODS The study included 302 elderly women and men. Application of perceptual GRBAS scale allowed to extract 230 subjects with voice disorders (Group I). Remaining 72 elderly subjects without the symptoms of dysphonia consisted Group II. Group III included 50 subjects with euphonic voice. In the assessment of dysphonia, visualization technique (HSDI) as well as acoustic method (Diagnoscope Specjalista). The observation of real vibration of vocal folds using HSDI technique and HS camera allowed to examine symmetricity (Shaw-Deliyski scale), periodicity and amplitude of vibration, Mucosal Wave (MW) morphology, Glottal Closure Type, and value of Open Quotient (OQ). Acoustic analysis allowed to assess value of Fundamental Frequency (F0), Maximum Phonation Time (MPT) as well as Jitter, Shimmer, Noise-to-Harmonics Ratio (NHR) parameters. Narrowband Spectrography was performed. RESULTS HSDI technique allowed to register in elderly women with voice disorders a mild asymmetry and aperiodicity of vibrations, MW reduction, amplitude increase and glottal insufficiency in the posterior segment of glottis which indicated edematous changes in the larynx. In 90% of men in this group, moderate asymmetry and aperiodicity were observed as well as amplitude decrease, significant limitation of MW and glottal insufficiency in the middle segment of the glottis which indicated atrophic changes in the larynx. In remaining 10% of men, amplitude of vibration was increased which indicated the existence of hypofunctional dysphonia. Objective confirmation of glottal insufficiency in women with edematous changes was high value of OQ in posterior segment of the glottis registered with HSDI technique. In men with larynx atrophy, the value of OQ was the highest in the middle segment of the glottis. Glottal insufficiency, especially in the middle segment, coexisted with the increase of NHR parameter observed in acoustic examination and with numerous nonharmonic components in the scope of high frequencies revealed in narrowband spectrography, especially in men with larynx atrophy. What is more, in men, the increase of F0 and reduction of MPT was registered. In women with edematous changes of the larynx, acoustic analysis revealed decrease of F0 value, increase of Jitter, Shimmer, NHR as well as reduction of MPT. Narrowband sopectrography revealed not only harmonic components but also nonharmonics in the range of low, medium, and high frequencies. CONCLUSIONS The course of Presbyphonia varies individually in the elderly. In many subjects, the process of aging does not influence the quality of voice. Crucial importance in the diagnosis of Presbyphonia is assigned to High-Speed Digital Imaging technique which confirms the existence of edematous changes in the larynx in women as well as atrophy and hypofunctional dysphonia in men. The acoustic examination of voice confirmed the individual variability of the severity of Presbyphonia in the elderly depending on the clinical form of dysphonia determined by the gender of the diagnosed person.
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Morawska J, Niebudek-Bogusz E, Pietruszewska W. Linguistic and Cultural Adaptation and Validation of the Vocal Fatigue Index into Polish. J Voice 2022:S0892-1997(22)00284-3. [PMID: 36220739 DOI: 10.1016/j.jvoice.2022.09.012] [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: 07/11/2022] [Revised: 09/13/2022] [Accepted: 09/13/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The purpose of the present study was the cross-cultural and linguistic adaptation and validation of the Vocal Fatigue Index (VFI) in the Polish language. METHODS The Vocal Fatigue Index was adapted into Polish and was administered to 323 subjects (216 with voice disorders, and 107 without voice disorders). One hundred and four participants with voice disorders completed the VFI a second time to evaluate test-retest reliability. VFI was assessed for internal consistency, test-retest reliability, discriminant validity, criterion validity, and sensitivity and specificity. RESULTS The Polish VFI exhibited satisfactory psychometric properties. A high Cronbach's alpha coefficient for the three factors (α=0.971 for Factor 1, α=0.929 for Factor 2, α=0.930 for Factor 3) was obtained. Significantly higher scores were revealed in subjects with voice disorders (48.88±11.73 [mean±SD]) in comparison with vocally healthy subjects (12.25±6.75 [mean±SD]) in the total VFI score as well as in the three factors (all P-values < 0.01). The best cut-off for VFI Total Score was set at a 32.5 score with sensitivity of 0.931 and specificity of 0.991. CONCLUSIONS The translated version of the VFI is a valid and reliable tool for identifying vocal fatigue symptoms in the Polish-speaking population.
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Affiliation(s)
- Joanna Morawska
- Department of Otolaryngology, Head and Neck Oncology, Medical University of Lodz, Lodz, Poland.
| | - Ewa Niebudek-Bogusz
- Department of Otolaryngology, Head and Neck Oncology, Medical University of Lodz, Lodz, Poland
| | - Wioletta Pietruszewska
- Department of Otolaryngology, Head and Neck Oncology, Medical University of Lodz, Lodz, Poland
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10
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Johnson AM, Pukin F, Krishna V, Phansikar M, Mullen SP. Feasibility and Preliminary Efficacy of Two Technology-assisted Vocal Interventions for Older Adults Living in a Residential Facility. J Voice 2022:S0892-1997(22)00221-1. [PMID: 35985896 DOI: 10.1016/j.jvoice.2022.07.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 07/19/2022] [Accepted: 07/20/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVES/HYPOTHESIS An increasing number of older adults are seeking behavioral voice therapy to manage their voice problems. Poor adherence to voice therapy is a known problem across all treatment-seeking populations. Given age-related physical and cognitive impairments and multiple chronic conditions, older adults are more susceptible to low adherence to behavioral therapies. The purpose of this study was to test the feasibility of an at-home, vocal training intervention for older adults without a known voice disorder living in a senior living community, as well as compare the effects of two modes of mobile health (mHealth) technology-assisted vocal training targeting vocal function and adherence in older adults. STUDY DESIGN Cohort Study (Prospective Observational Study). METHODS Twenty-three individuals were recruited from a single residential retirement community and randomly allocated into two experimental groups. Both groups were asked to practice the Vocal Function Exercises with increasing frequency over an 8-week period. Tablets with instructions for performing the exercises were provided to all participants. The feedback group's tablets also contained an application providing real-time feedback on pitch, loudness, and duration. Acoustic and aerodynamic measures of vocal function and cognitive measures were obtained before and after the intervention. Self-reported measures of practice frequency, perceived vocal progress and changes, and motivation were obtained weekly. RESULTS The feedback control group adhered to the requested practice sessions more in the latter half of the intervention (weeks 5 and 8). Vocal function measures remained stable. Overall, a pattern reflecting self-reported vocal progress and a general improvement in working memory and global cognitive functioning was observed in the feedback group. CONCLUSIONS This study demonstrated that an 8-week mHealth intervention is viable to facilitate vocal practice in older adults. Although vocal ability did not improve with training, results indicated that vocal performance remained stable and age-related vocal changes did not progress. Future research on implementation of mHealth applications in conjunction with behavioral voice therapy is warranted to assess adherence and improvements in vocal function in individuals with age-related voice problems.
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Affiliation(s)
- Aaron M Johnson
- Otolaryngology-Head and Neck Surgery, New York University Grossman School of Medicine. New York, New York, United States.
| | - Farrah Pukin
- Department of Communicative Disorders, Steinhardt School of Culture, Education, and Human Development, New York University, New York, New York, United States
| | - Vaishnavi Krishna
- Department of Speech and Hearing Sciences, University of Illinois at Urbana-Champaign, Urbana, Illinois
| | - Madhura Phansikar
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois
| | - Sean P Mullen
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois; Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, Illinois; Center for Social & Behavioral Science, University of Illinois at Urbana-Champaign, Urbana, Illinois; Illinois Informatics Institute, University of Illinois at Urbana-Champaign, Champaign, Illinois
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11
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Bottalico P, Piper RN, Legner B. Lombard effect, intelligibility, ambient noise, and willingness to spend time and money in a restaurant amongst older adults. Sci Rep 2022; 12:6549. [PMID: 35449186 PMCID: PMC9023576 DOI: 10.1038/s41598-022-10414-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 04/01/2022] [Indexed: 12/01/2022] Open
Abstract
Dining establishments are an essential part of the social experience. However, they are often characterized by high levels of background noise, which represents a barrier to effective communication. This particularly affects people suffering from hearing problems. Moreover, noise level exceeding normal conversational levels causes a phenomenon called the Lombard Effect, an involuntary tendency to increase the amount of vocal effort when talking in the presence of noise. Adults over 60 years represent the second largest population in the US and the majority of them suffer from some degree of hearing loss. The primary aim of the current study was to understand the effect of noise on vocal effort and speech intelligibility in a restaurant setting for adults over 60 years old with and without hearing loss. The secondary aim was to evaluate their perception of disturbance in communication and their willingness to spend time and money in a restaurant was affected by the varying levels of background noise. The results of this study showed background noise levels lower than 50 dB(A) will allow senior customers to minimize their vocal effort and to maximize their understanding of conversations, even for those with moderate to severe hearing loss. By setting a limit, it will also keep perceived disturbance low and willingness to spend time and money high among dining patrons.
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Affiliation(s)
- Pasquale Bottalico
- Department of Speech and Hearing Science, University of Illinois, 901 S. 6th St., Urbana-Champaign, IL, 61820, USA.
| | - Rachael N Piper
- Department of Speech and Hearing Science, University of Illinois, 901 S. 6th St., Urbana-Champaign, IL, 61820, USA
| | - Brianna Legner
- Department of Speech and Hearing Science, University of Illinois, 901 S. 6th St., Urbana-Champaign, IL, 61820, USA
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12
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Rao SJ, Nickel JC, Kiell EP, Madden LL. Readability of Commonly Used Patient-Reported Outcome Measures in Laryngology. Laryngoscope 2021; 132:1069-1074. [PMID: 34498753 DOI: 10.1002/lary.29849] [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: 06/16/2021] [Revised: 08/19/2021] [Accepted: 08/21/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Patient-reported outcome measures (PROMs) are used to evaluate patients' symptoms and clinical improvement after an intervention. Advocacy efforts and increased provider awareness regarding health literacy have helped to improve the readability of PROMs. Recent studies in otolaryngology in rhinology, pediatric otolaryngology, and head and neck reported PROM readability scores above the sixth-grade level. However, there is limited data regarding the readability of laryngology PROMs. Thus, this study aims to report the readability levels of PROMs in laryngology by assessing different readability indices and describing the relationship of readability levels to equitable healthcare. METHODS This is a bibliometric study that received approval from institutional review board (IRB) review as a nonhuman subject research study. Recent and widely utilized laryngology PROMs were selected from a publicly available literature search by reviewing laryngology systematic reviews, PubMed, and Google Scholar. Laryngology PROMs were selected from voice, dysphagia, airway, and other PROMs including voice questionnaires administered to patients seeking gender affirming voice care from systematic reviews and expert opinion. There were 37 PROMs included in this study. PROMs were analyzed via Gunning Fog, Simple Measure of Gobbledygook (SMOG), FORCAST, and Flesch Reading Ease Score. RESULTS All laryngology PROMs had readabilities above the recommended sixth-grade level. The mean and standard deviation (SD) of Gunning Fog was 7.30 (2.59), SMOG was 8.70 (1.51), FORCAST was 10.05 (1.51), and Flesch Reading Ease Score was 8.08 (2.76). CONCLUSION Laryngology PROMs are above the recommended middle school reading level. To further promote health equity, readability should be considered when developing future PROMs. LEVEL OF EVIDENCE N/A Laryngoscope, 2021.
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Affiliation(s)
- Shambavi J Rao
- Wake Forest School of Medicine, Wake Forest Baptist Health, Winston-Salem, North Carolina, U.S.A
| | - Joseph C Nickel
- Wake Forest School of Medicine, Wake Forest Baptist Health, Winston-Salem, North Carolina, U.S.A
| | - Eleanor P Kiell
- Department of Otolaryngology-Head and Neck Surgery, Wake Forest School of Medicine, Wake Forest Baptist Health, Winston-Salem, North Carolina, U.S.A
| | - Lyndsay L Madden
- Department of Otolaryngology-Head and Neck Surgery, Wake Forest School of Medicine, Wake Forest Baptist Health, Winston-Salem, North Carolina, U.S.A
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13
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Belsky MA, Shelly S, Rothenberger SD, Ziegler A, Hoffman B, Hapner ER, Gartner-Schmidt JL, Gillespie AI. Phonation Resistance Training Exercises (PhoRTE) With and Without Expiratory Muscle Strength Training (EMST) For Patients With Presbyphonia: A Noninferiority Randomized Clinical Trial. J Voice 2021; 37:398-409. [PMID: 33741235 DOI: 10.1016/j.jvoice.2021.02.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 02/10/2021] [Accepted: 02/11/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Presbyphonia negatively impacts quality of life in patients with age-related voice changes. A proof-of-concept study showed promise for high vocal intensity exercise to treat presbyphonia, which became the basis for a novel intervention for age-related voice changes known as Phonation Resistance Training Exercises (PhoRTE). Expiratory Muscle Strength Training (EMST) has also been proposed as an additional intervention to target and strengthen the aging respiratory system; however, EMST has undergone limited evaluation as an adjunct treatment for elderly patients undergoing voice therapy for presbyphonia. This study determined if the addition of EMST to PhoRTE voice therapy (PhoRTE + EMST) is at least as effective at voice improvement as PhoRTE alone. STUDY DESIGN Prospective, randomized, controlled, single-blinded, non-inferiority. MATERIALS AND METHODS Participants aged 55 years or older with a diagnosis of vocal fold atrophy were randomized to complete PhoRTE therapy or PhoRTE + EMST. The primary outcome was change in Voice Handicap Index-10 (VHI-10). Secondary outcomes included the Aging Voice Index, maximum expiratory pressure, and acoustic and aerodynamic measures of voice. Repeated measures linear mixed models were constructed to analyze outcomes at a significance level of α = 0.10. RESULTS Twenty-six participants were recruited for the study, and 24 participants were randomized to either treatment arm. Sixteen participants completed the entire study. Both treatment arms showed statistically significant and clinically meaningful improvements in VHI-10 (PhoRTE mean [M] = -8.20, P < 0.001; PhoRTE + EMST M = -9.58, P < 0.001), and PhoRTE + EMST was noninferior to PhoRTE alone (P = 0.069). Both groups experienced a statistically significant pre-post treatment decrease (improvement) in AVI scores (PhoRTE M = -18.40, P = 0.004; PhoRTE + EMST M = -16.28, P = 0.005). PhoRTE+EMST had statistically significantly greater changes in maximum expiratory pressure compared to PhoRTE alone (PhoRTE M = 8.24 cm H2O, PhoRTE + EMST M = 32.63 cm H2O; P= 0.015). Some secondary acoustic and aerodynamic outcomes displayed trends toward improvement. CONCLUSION This study demonstrates that voice therapy targeting high vocal intensity exercise (eg, PhoRTE) and EMST can play a role in improving voice outcomes for patients with presbyphonia.
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Affiliation(s)
| | - Sandeep Shelly
- Emory University, Department of Otolaryngology, Emory University Hospital Midtown, Atlanta, GA
| | - Scott D Rothenberger
- University of Pittsburgh School of Medicine, Division of Internal Medicine, Pittsburgh, PA
| | - Aaron Ziegler
- The Wellness Group for Voice, Speech, and Swallowing, LLC, Portland, OR
| | - Bari Hoffman
- School of Communication Sciences and Disorders, University of Central Florida, Orlando, FL
| | - Edie R Hapner
- Department of Otolaryngology, University of Alabama at Birmingham, Birmingham, AL
| | | | - Amanda I Gillespie
- Emory University, Department of Otolaryngology, Emory University Hospital Midtown, Atlanta, GA.
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14
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Stefu J, Slavych BK, Zraick RI. Patient-Reported Outcome Measures in Voice: An Updated Readability Analysis. J Voice 2021; 37:465.e27-465.e34. [PMID: 33736929 DOI: 10.1016/j.jvoice.2021.01.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/17/2021] [Accepted: 01/21/2021] [Indexed: 12/27/2022]
Abstract
PURPOSE The purpose of this study was to investigate whether voice-related patient-reported outcome measures (PROMs) developed and validated since 2011 meet the recommendation by health literacy experts that such materials be written at a fifth-to-sixth grade reading level. METHOD A readability analysis of eight voice-related PROMs was conducted. Readability formulas utilized were the Coleman-Liau index, Flesch-Kincaid reading ease, FORCAST, simple measure of Gobbledygook index, and Gunning-Fog score. RESULT Three-fourths of the PROMs exceeded the recommended fifth- to sixth-grade reading level. CONCLUSION Although awareness of health literacy has grown, voice-related PROMs continue to be developed without full consideration of their reading grade level. Researchers should consider revising or developing PROMs with consideration to reading grade level as well as other features to enhance readability.
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Affiliation(s)
- Julia Stefu
- University of Central Florida, Orlando, Florida
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15
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McGarey PO, Bitar R, Hughes CK, Hodson N, Harris EA, Dominguez LM, Dion GR, Simpson CB. Correlation of Glottic Gap and Voice Impairment in Presbyphonia. Laryngoscope 2020; 131:1594-1598. [PMID: 32902880 DOI: 10.1002/lary.29068] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 07/10/2020] [Accepted: 08/04/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE/HYPOTHESIS The objective of this study was to investigate the glottic gap area as a significant marker for the severity of presbyphonia as it relates to patient-reported outcome measures (Voice Handicap Index-10 [VHI-10]) and stroboscopic findings. STUDY DESIGN Retrospective case-control study conducted in an academic tertiary voice center. METHODS Patients seen at a tertiary voice clinic who were diagnosed with presbyphonia without other organic laryngeal pathology from January 2014 to December 2017 were included. Clinical data and laryngeal videostroboscopy videos were collected. Still images at the point of vocal process approximation during adduction were captured, and the glottic gap area was measured using ImageJ. These were compared to a control cohort. Correlations were made using Wilcoxon rank sum test, Mann-Whitney U test, and Pearson correlation coefficients. RESULTS Thirty-three patients were included. Inter-rater reliability of glottic area measurement was strong (intraclass correlation coefficient = 0.73, P < .001). Compared to controls, presbyphonia patients had a larger glottic gap area (P < .001) and greater open-phase quotient on laryngeal videostroboscopy (P < .001). Larger glottic gap area did not correlate with patient-reported vocal function as measured by VHI-10 (P = .79) and did not correlate with presence of secondary muscle tension dysphonia (P = .99). In the presbyphonia cohort, the glottic gap area did not correlate with age (P = .29). CONCLUSIONS Glottic gap area at the point of vocal process approximation during phonation can be reliably measured. Patients with presbyphonia have a larger glottic gap area and greater open-phase quotient on stroboscopy, but these do not correlate with patient-reported voice impairment or the presence of secondary muscle tension dysphonia (MTD). These data suggest that dysphonia severity in presbyphonia is not fully explained by a glottic gap or secondary MTD alone. LEVEL OF EVIDENCE 4 Laryngoscope, 131:1594-1598, 2021.
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Affiliation(s)
- Patrick O McGarey
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia, U.S.A
| | - Ryan Bitar
- Long School of Medicine, University of Texas Health Science Center, San Antonio, Texas, U.S.A
| | - Charlotte K Hughes
- Department of Otolaryngology-Head and Neck Surgery, Brooke Army Medical Center, Fort Sam Houston, Texas, U.S.A
| | - Noah Hodson
- Long School of Medicine, University of Texas Health Science Center, San Antonio, Texas, U.S.A
| | - Edward A Harris
- Long School of Medicine, University of Texas Health Science Center, San Antonio, Texas, U.S.A
| | - Laura M Dominguez
- Department of Otolaryngology, UT Health Science Center San Antonio, San Antonio, Texas, U.S.A
| | - Gregory R Dion
- Dental and Craniofacial Trauma Research Department, U.S. Army Institute of Surgical Research, JBSA Fort Sam Houston, San Antonio, Texas, U.S.A
| | - C Blake Simpson
- Department of Otolaryngology-Head and Neck Surgery, Birmingham, Alabama, U.S.A
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16
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Siqueira LTD, Silverio KCA, Berretin-FÉlix G, Genaro KF, Fukushiro AP, Brasolotto AG. Influence of vocal and aerodynamics aspects on the voice-related quality of life of older adults. J Appl Oral Sci 2020; 28:e20200052. [PMID: 32813841 PMCID: PMC7433863 DOI: 10.1590/1678-7757-2020-0052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 06/29/2020] [Indexed: 11/21/2022] Open
Abstract
The pursuit for quality of life urged a better understanding of aspects involved in ageing to minimize its consequences. Although many studies investigated older adults’ voice, aspects affecting this population voice-related quality of life have not yet been explored.
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Affiliation(s)
| | - Kelly Cristina Alves Silverio
- Departament of Speech-Language Pathology, Faculdade de Odontologia de Bauru, Universidade de São Paulo, Bauru, São Paulo, Brasil
| | - Giédre Berretin-FÉlix
- Departament of Speech-Language Pathology, Faculdade de Odontologia de Bauru, Universidade de São Paulo, Bauru, São Paulo, Brasil
| | - Kátia Flores Genaro
- Departament of Speech-Language Pathology, Faculdade de Odontologia de Bauru, Universidade de São Paulo, Bauru, São Paulo, Brasil
| | - Ana Paula Fukushiro
- Departament of Speech-Language Pathology, Faculdade de Odontologia de Bauru, Universidade de São Paulo, Bauru, São Paulo, Brasil
| | - Alcione Ghedini Brasolotto
- Departament of Speech-Language Pathology, Faculdade de Odontologia de Bauru, Universidade de São Paulo, Bauru, São Paulo, Brasil
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17
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Stager SV, Sparks AD, Bielamowicz SA, Edgar JD. The Role of Choral Singing in Speaking Voice Preservation of Aging Adults. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2020; 63:2099-2114. [PMID: 32569498 DOI: 10.1044/2020_jslhr-19-00347] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Purpose This descriptive cohort pilot study, using a convenience sample, examined whether evidence from vocal function measures, auditory-perceptual ratings, and/or endoscopic signs of aging supported singing in senior chorales as a possible intervention to preserve the speaking voice in aging adults. Method Thirteen singers and five nonsinging controls, all over 65 years of age, participated. They were assessed at two visits, 15-20 months apart. Vocal function measures and auditory-perceptual ratings of estimated age and the presence of voice disorders were compared across singing status and visit. Changes in the presence and degree of laryngeal signs of aging between visits were compared across singing status. Results Using an alpha of .2, deemed acceptable for pilot studies, vocal function measures supported choral singing as an intervention to preserve the speaking voice as less noise energy between 2 and 3 kHz (p = .01) and lower phonation threshold pressures (PTPs) were present (p = .09) for singers compared to nonsinging controls. Greater flows at comfortable pitch (p = .04) and high pitch (p = .06) as well as lower cepstral peak prominence smoothed (CPPS) for the vowel /a/ (p < .01) were found at Visit 2 for both groups, but singers demonstrated lower flows at Visit 2 than nonsinging controls at comfortable pitch (p = .06). Auditory-perceptual ratings did not support preservation of speaking voice, although a larger percentage of listeners rated nonsinging controls as voice disordered at Visit 2. Endoscopic ratings supported preservation, as singers were more likely than nonsinging controls to be rated as having laryngeal signs of aging absent at both visits (p = .02). Conclusion The findings from this pilot study provide evidence that regular singing in senior chorales may assist in preserving older adults' speaking voices.
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Affiliation(s)
- Sheila V Stager
- Medical Faculty Associates Voice Treatment Center, Department of Surgery, Division of Otolaryngology, The George Washington University School of Medicine, Washington, DC
| | - Andrew D Sparks
- Department of Surgery, The George Washington University School of Medicine, Washington, DC
| | - Steven A Bielamowicz
- Medical Faculty Associates Voice Treatment Center, Department of Surgery, Division of Otolaryngology, The George Washington University School of Medicine, Washington, DC
| | - Julia D Edgar
- Department of Communication Disorders, Truman State University, Kirksville, MO
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18
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Wu CH, Chan RW. Effects of a 6-Week Straw Phonation in Water Exercise Program on the Aging Voice. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2020; 63:1018-1032. [PMID: 32302246 DOI: 10.1044/2020_jslhr-19-00124] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Purpose Semi-occluded vocal tract (SOVT) exercises with tubes or straws have been widely used for a variety of voice disorders. Yet, the effects of longer periods of SOVT exercises (lasting for weeks) on the aging voice are not well understood. This study investigated the effects of a 6-week straw phonation in water (SPW) exercise program. Method Thirty-seven elderly subjects with self-perceived voice problems were assigned into two groups: (a) SPW exercises with six weekly sessions and home practice (experimental group) and (b) vocal hygiene education (control group). Before and after intervention (2 weeks after the completion of the exercise program), acoustic analysis, auditory-perceptual evaluation, and self-assessment of vocal impairment were conducted. Results Analysis of covariance revealed significant differences between the two groups in smoothed cepstral peak prominence measures, harmonics-to-noise ratio, the auditory-perceptual parameter of breathiness, and Voice Handicap Index-10 scores postintervention. No significant differences between the two groups were found for other measures. Conclusions Our results supported the positive effects of SOVT exercises for the aging voice, with a 6-week SPW exercise program being a clinical option. Future studies should involve long-term follow-up and additional outcome measures to better understand the efficacy of SOVT exercises, particularly SPW exercises, for the aging voice.
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Affiliation(s)
- Chia-Hsin Wu
- Department of Speech Language Pathology and Audiology, National Taipei University of Nursing and Health Sciences, Taiwan
| | - Roger W Chan
- Department of Speech Language Pathology and Audiology, National Taipei University of Nursing and Health Sciences, Taiwan
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