Voice Disorders

Palatopharyngeal dysfunction may take place when palatopharyngeal valve is unable to perform its own closing due to a lack of tissue (palatopharyngeal insufficiency) or lack of proper movement (palatopharyngeal incompetence). Palatopharyngeal insufficiency induces nasal regurgitation of liquids, hypernasal speech, nasal escape, disarticulations and impaired speech intelligibility. Prosthetic management of palatopharyngeal insufficiency requires a close co-operation between an otolaryngologist and a speech pathologist. As a result, the patient can be socially and physically rehabilitated with the improved speech quality as well as prevention of leakage of liquids.

El programa de rehabilitación vocal debe basarse en un diagnóstico funcional siendo indispensable la información que la estroboscopia proporciona para diseñar un programa de terapia específico. Los equipos de Foniatría y Logopedia colaboran en este diseño e intervención, lo que reduce la duración del tratamiento con un mejor rendimiento y menor coste para el sistema sanitario. Para verificar la eficacia de la rehabilitación con 10 sesiones de tratamiento, se realiza un estudio con pacientes tratados por un equipo formado por un Foniatra y dos Logopedas. Se realiza una evaluación pre y post-tratamiento con herramientas subjetivas y objetivas: cuestionario de confort vocal, examen perceptual de la voz y análisis acústico. Los resultados avalan la eficacia del tratamiento realizado en tan solo diez sesiones.

The study aimed at measuring the effect of vocal loading (loud reading) on fundamental frequency (F0), throat temperature along with self-rating questionnaire before and after loud reading task. Methods: 50 (25 men and 25 women) normo-phonic adults participated in the study. Phonation sample of vowel /a/ for 6 seconds, thrice, measurement of throat temperature and a self-rating questionnaire was collected as baseline. Participants were provided with an English novel and were instructed to read at 70-80 dB SPL for 45 minutes. Fundamental frequency, throat temperature and scores from the self-rating questionnaire were compared between pre-reading and post-reading conditions. Entire experiment was carried out in an air-conditioned room at 25 ℃. Results: Statistically significant difference was observed within groups for fundamental frequency, throat temperature and scores of self-rating questionnaire. However, statistical significance was seen only in fundamental frequency and self-rating questionnaire. This study describes the potential use of thermal imaging to be used alongside other measures (acoustics) in assessing vocal load.

Vocal cord paresis or paralysis occurs due to lesion in the vagus nerve. Vocal cord paralysis can lead to dysphonia as well as dysphagia which lead the patient to frustration and emotional problems. The literature available on the etiology and the problems faced by them in Indian population is very scanty. Hence a prospective study was done on 41 Patients with vocal cord palsy who were referred to the Department of ENT for voice assessment and management from March 1st 2012 till 1st August 2012. The medical and surgical reports were examined. They were evaluated by an otorhinolaryngologist, and a Speech Language Pathologist. Diagnosis was made based on video stroboscopic findings. We also examined voice-related quality of life (V-RQOL) outcomes in these patients. In this study, endo-tracheal intubation (15/41; 36.5%) was the major cause of vocal cord palsy. The second major cause for vocal cord palsy in our study was surgical trauma (iatrogenic) which constituted 26.8% (11/41), out of which thyroidectomy contributed to 81.81% (9/11) and cardiac surgery (Coronary Artery Bypass Grafting (CABG) contributed to 18.18% (2/11). Neurological problems caused 14.63% (6/41) of the total cases. Non-surgical trauma constituted 9.75% (4/41) of the total patients. Left recurrent laryngeal nerve paralysis was found as a complication of heart disease in 7.3%(3/41). Tuberculosis of lungs and cancer of lungs accounted to be the rarest causes. Hoarseness of voice was the most common symptom with associated dysphagia in a few. The voice related quality of life of these patients was found to be poor. They were found to have problems in the social-emotional domain and physical functioning domain.

Researchers estimate that 89% of people with Parkinson's disease (PD) have a speech or voice disorder including disorders of laryngeal, respiratory, and articulatory function. Despite the high incidence of speech and voice impairment, studies suggest that only 3-4% of people with PD receive speech treatment. The authors review the literature on the characteristics and features of speech and voice disorders in people with PD, the types of treatment techniques available, including medical, surgical, and behavioral therapies, and provide recommendations for the current efficacy of treatment interventions and directions of future research.

A chance encounter that would evolve into a lifelong collaboration.
Their paths first crossed at Indiana University, Bloomington.
“That initial encounter marked the beginning of a lasting connection,” recalls Paglin, now retired from the stage and co-founder of New Voice Studio Brilla-Paglin.
“...Lisa went on to become a promising new soprano at the Vienna Staatsoper, but like myself, she began to sense that something in her vocal technique was amiss, that the voice was not responding as it should.”

"...We immersed ourselves in historic recordings, consulted specialists ... studied treatises by the great masters..."

Each year, a diverse array of singers, ranging from fresh out of the conservatory to artists commanding five-figure fees per performance, arrive here, predominantly from the world of opera but also from other genres including pop and jazz.
“Our pedagogical foundation rests on three principles: freedom, spontaneity, and beauty,” Paglin explains. “Contemporary vocal practice is excessively regimented, natural singing is neglected, and there is an unhealthy obsession with power and volume that results in massive muscular tension.”


https://elpais.com/cultura/2025-09-03/el-taller-de-un-pueblo-de-italia-donde-dos-sopranos-retiradas-reparan-las-voces-rotas-de-la-opera.html?fbclid=IwY2xjawMlazRleHRuA2FlbQIxMQABHswNpmqYr7udubcrRcKBfRge7se_ty5IsStAlqVc1I0pf5Ea4b732xA8Mfbb_aem_QZyDbrVz7LULb8cPtbjm7A

A chance encounter that would evolve into a lifelong collaboration.
Their paths first crossed at Indiana University, Bloomington.
“That initial encounter marked the beginning of a lasting connection,” recalls Paglin, now retired from the stage and co-founder of New Voice Studio Brilla-Paglin.
“...Lisa went on to become a promising new soprano at the Vienna Staatsoper, but like myself, she began to sense that something in her vocal technique was amiss, that the voice was not responding as it should.”

"...We immersed ourselves in historic recordings, consulted specialists ... studied treatises by the great masters..."

Each year, a diverse array of singers, ranging from fresh out of the conservatory to artists commanding five-figure fees per performance, arrive here, predominantly from the world of opera but also from other genres including pop and jazz.
“Our pedagogical foundation rests on three principles: freedom, spontaneity, and beauty,” Paglin explains. “Contemporary vocal practice is excessively regimented, natural singing is neglected, and there is an unhealthy obsession with power and volume that results in massive muscular tension.”


https://elpais.com/cultura/2025-09-03/el-taller-de-un-pueblo-de-italia-donde-dos-sopranos-retiradas-reparan-las-voces-rotas-de-la-opera.html?fbclid=IwY2xjawMlazRleHRuA2FlbQIxMQABHswNpmqYr7udubcrRcKBfRge7se_ty5IsStAlqVc1I0pf5Ea4b732xA8Mfbb_aem_QZyDbrVz7LULb8cPtbjm7A

Durante o período pré-menstrual é comum a ocorrência de disfonia, e são poucas as mulheres que se dão conta dessa variação da voz dentro do ciclo menstrual (Quinteiro, 1989). OBJETIVO: Verificar se há diferença no padrão vocal de mulheres no período de ovulação em relação ao primeiro dia do ciclo menstrual, utilizando-se da análise perceptivo-auditiva, da espectrografia, dos parâmetros acústicos e quando esta diferença está presente, se é percebida pelas mulheres. FORMA DE ESTUDO: Caso-controle. MATERIAL E MÉTODO: A amostra coletada foi de 30 estudantes de Fonoaudiologia, na faixa etária de 18 a 25 anos, não-fumantes, com ciclo menstrual regular e sem o uso de contraceptivo oral. As vozes foram gravadas no primeiro dia de menstruação e no décimo-terceiro dia pós-menstruação (ovulação), para posterior comparação. RESULTADOS: Observou-se durante o período menstrual que as vozes estão rouco-soprosa de grau leve a moderado, instáveis, sem a presença de quebra de sonoridade, com pitch e ...

OBJECTIVE: To evaluate the consequences of lifetime, severe and untreated isolated growth hormone deficiency (IGHD) on vocal and laryngeal function. STUDY DESIGN: Cross-sectional. SUBJECTS AND METHODS: A total of 23 IGHD adult subjects and 22 controls were administered a questionnaire about vocal complaints and harmful voice habits, and underwent videolaryngostroboscopic examination, voice evaluation by perceptual-auditory analysis with GRBAS scale including grade of dysphonia, roughness, breathiness, asthenia and strain items, objective voice evaluation by maximum phonation time (MPT), and acoustic analysis. RESULTS: There was no difference in vocal complaints between IGHD subjects and controls. Vocal abuse and smoking were more frequent in IGHD subjects. IGHD subjects presented higher values for roughness, breathiness, and strain. Laryngopharyngeal reflux (LPR) signs and laryngeal constriction were more frequent in IGHD individuals. MPT was similar in the two groups. Fundamental f...

Investigar a importância dada ao bem-estar vocal do professor durante a graduação, pelos coordenadores dos cursos de Educação do Estado de São Paulo. Métodos: Estudo de natureza qualitativa e exploratória, desenvolvido a partir de entrevistas semi estruturadas áudio gravadas com oito coordenadores de Pedagogia do Estado de São Paulo, após assinatura de termo de consentimento livre e esclarecido. As seguintes perguntas foram feitas: 1-O que signifi ca saúde vocal para o/a senhor/a?; 2-Existem ações em prol da saúde vocal do professor na instituição que o/a senhor/a coordena? Quais?; e 3-Como o/a senhor/a vê a atuação do fonoaudiólogo junto à saúde vocal do professor? Os dados foram transcritos e classifi cados por similitude de freqüência e conteúdo, agrupados em eixos temáticos. Resultados: Segundo os participantes, na maioria das instituições não há programas contínuos de prevenção, destinados ao bem-estar vocal do professor. Alguns consideram necessário ter, no espaço da universidade, um fonoaudiólogo para assessorar o professor, por meio de orientação, ou encaminhamento a uma ação terapêutica quando um distúrbio vocal estiver instalado. Foi comentada a inserção de uma disciplina sobre o tema no currículo de formação de professores. Conclusões: Embora os coordenadores tenham ressaltado a importância do bem-estar vocal, nos currículos dos cursos, por eles coordenados, esse aspecto não é questionado.

Objetivo: Verificar a resposta de adolescentes a um site sobre voz, em que esta foi apresentada não apenas como produto mecânico, mas também como instrumento de comunicação. Método: A partir de questionários veiculados em site voltado a adolescentes, em dois momentos (antes e após a navegação), foram coletados dados pessoais e questões relacionadas à voz quanto a sua produção, cuidados e como instrumento de comunicação. Posteriormente, os dados foram categorizados e submetidos à análise estatística. Resultados: O grupo constituiu-se por indivíduos de ambos os gêneros (M=139; F=173), predominantemente na faixa etária 18-19 anos (41,3%). O significado de voz mais atribuído pelos adolescentes foi um som, um produto mecânico do corpo (62,8%), ampliado, após acesso ao site, para instrumento de comunicação. Tanto o número de citações dos hábitos nocivos (802→1201) como dos benéficos (736→1121) obtiveram um aumento após a intervenção. Os dados sobre a voz como instrumento de comunicação mostraram que a maioria (59,9%) remeteu-se a sensações agradáveis ao se comunicar e 75,8% atribuíram termos positivos a sua voz, embora os rapazes tenham citado mais termos negativos, especificamente, relacionados à instabilidade vocal (p<0,001). Conclusão: A Fonoaudiologia pode tomar a Internet: como um meio pelo qual a informação de saúde seja melhor disseminada; como espaço de intercâmbio profissional; como recurso para a pesquisa e também como uma ferramenta para promover a educação em saúde, principalmente para os adolescentes, por serem eles uma população bastante presentes nesse meio de comunicação.

Background: Evaluating the incidence of postoperative vocal cord dysfunction after pulmonary resections and the impact of timing for vocal cord medialization on preventing postoperative pulmonary complications for these patients. : Patients developing vocal cord dysfunction (VCD)/unilateral vocal cord paralysis (UVCP) after pulmonary resection were examined retrospectively, in terms of postoperative pulmonary complication (PPC) rates and hospital length of stay. Total of 2740 patients underwent anatomical pulmonary resection for malignancy. Eleven patients were referred to otolaryngology team with pre-diagnosis of VCD following the operation. UVCP diagnosis was confirmed with indirect laryngoscopic examination. Results: UVCP diagnosis was confirmed in 8 (0.3%) with indirect laryngoscopic examination. Performed resections were left upper lobectomy in 3 and left pneumonectomy in 5 patients. Atelectasis necessitating bronchoscopy and pneumonia were the PPC, seen in 3 (37.5%) patients. Calcium hydroxyapatite injection for 6 patients and polytetrafluoroethylene graft implantation for 2 patients was performed. Mean duration between pulmonary resection and medialization was 5.3 days in patients developing PPC and 3.6 days in patients with no PPC (p = 0.011). All patients were discharged within an average of 8.1 (6-13) days, uneventfully. One patient required re-injection of calcium hydroxyapatite on 5th month. Throughout a mean follow-up duration of 14.8 months, all patients had stable vocal cord position. Vocal cord medialization can be performed safely for postthoracotomy UVCP. In order to minimize phonetic and respiratory complications, this procedure must be applied on early postoperative period.

The purpose of this study was to compare nasalance values in tracheoesophageal (TE) voice prosthesis and laryngeal speakers. Nasalance measures were obtained from 10 age-matched male TE speakers and 10 healthy male laryngeal speakers reading the Zoo Passage and Nasal Sentences. All TE speakers were rated as good to excellent in terms of speech proficiency and intelligibility. Nasalance scores were compared across groups. The findings revealed there were no significant differences in average nasalance values between the two groups. Clinical implications and future research needs are discussed.

Disturbances of aphasic patients in the planning of spoken utterances have hitherto mainly been investigated through patterns of paraphasic errors, the scope of these errors usually not involving more extensive units than the word. In contrast, comparatively little is known about disturbances at the level of larger planning units. In the present study we focus on respiratory activity, asking how normals and one apraxic aphasic link the linguistic-phonetic demands of an utterance in terms of length, loudness, and tempo to appropriate patterns of respiratory motor activity. We further wished to determine the extent to which covert speech may take account of the airflow requirements of the planned utterance and speculated that inclusion of this experimental condition could help to throw more precise light on the levels of the speech production system where planning deficiences can occur in apraxic speakers.

Airway injury is one of the common complications after endotracheal intubation under general anesthesia. According to the US Closed Claims Database, the larynx is the most common site of airway injury during endotracheal intubation, accounting for one-third of all airway injuries. Common laryngeal injuries include traumatic granuloma, hematoma, and vocal cord paralysis, but only 20% of cases are related to intubation difficulties [1]. Granuloma or hematoma can often be detected using visual equipment for a definitive diagnosis. Vocal fold paralysis is not easily identified during extubation and often causes upper respiratory tract obstruction or even aspiration pneumonia [2,3]. In severe cases, it can be life-threatening. Vocal fold paralysis is mainly manifested as a disorder of vocal fold adduction or abduction. In patients with complete vocal fold paralysis, the vocal fold is often fixed in the paramedian position. The causes of vocal fold paralysis can be roughly divided into three categories: recurrent laryngeal nerve injury, cricoarytenoid joint dislocation, and glottic edema [4]. This article reviews the literature on vocal cord paralysis after surgery in a patient with preoperative recurrent laryngeal nerve injury, analyzes the causes of its occurrence, and explores the diagnosis and prevention procedures for similar cases.

Essential tremor (ET) still remains a clinical diagnosis. Nonetheless, it is misdiagnosed in 30 to 50% of cases. There are a number of areas of diagnostic uncertainty. One of these is isolated head tremor, on which published data are limited and at variance. We studied the prevalence of isolated head (i.e., neck) tremor in ET in two population‐based studies (Turkey and New York) and a large clinical sample (New York); these 583 ET cases all received the same detailed tremor examination. Head tremor with mild arm tremor occurred in a very small percentage of cases in each sample (1.9–3.1%, overall 2.7%). Nearly all of them were women. Head tremor in the complete absence of arm tremor was not observed in any cases (0.0%). These clinical data may be of value to clinicians in practice settings and researchers in phenotyping efforts in the emerging field of ET genetics. © 2009 Movement Disorder Society

The identified risk factors or determinant of voice disorders were subdivided into different categories based on best evidence quality namely medical and health related factors, socioeconomic factors, environmental factors and demographic factors. Further good quality research is required to identify the strong correlation between determinants of voice disorder and professional users. Introduction: Voice is a crucial part of our life which helps us to express our emotion and views in words. The disorders or issues with voice in professional user affect their daily functions and tasks. Voice abnormalities are deviations of a specific sound in relation to tone, intensity, volume, or variability of speech from of the voices of people of common gender, age, and ethnic groups. It is found that voice problems contribute to psychiatric illnesses such as depression, fatigue, and insecurity. It also adversely affects professional performance, engagement and attitude, contributing to lowered quality and higher incidence of absenteeism. Methods: The computer assisted Ebscohost-All database, Medline, PubMed and Google scholar from 2009 to 2020 have been used to identify the determinants of voice disorders in professional users. Altogether, 10 articles were found to summaries the results following the best evidence synthesis. Results: Ten studies were identified for inclusion which reflects the lack of literature in this topic. Types of occupation, loud speech use, psychological stresses, and recurring issues of upper tract infections, thyroid problems, and gastrointestinal acid reflux and background noises were found to be strongly related to voice issues. Further age, sex, gender, smoking and alcohol were weakly identified as risk factors for voice disorder in professional users. Conclusion: Due to the identification of few conflicting correlations between risk factors and voice disorders, it is recommended to perform comprehensive cohort study among professional users. Further, limited good quality evidence exists to identify the socioeconomic factors as a determinant of voice disorder in professional users.

Editor-Weiner et al conclude that "results from [their] systematic review, together with data on safety and cost effectiveness, support the use of intranasal corticosteroids over oral antihistamines as first line treatment for allergic rhinitis." 1 They also state that "intranasal corticosteroids are considered safe [and] studies have failed to show significant effects on serum markers of bone metabolism and short term bone growth," referring to two studies, those by Martinati et al and Wolthers et al. They make no reference to two more recent studies, both of a larger number of subjects over longer periods, which established a significant reduction in paediatric bone growth. 2 3 The issue of adverse effects was also addressed in a report by the Committee on Safety of Medicines and Medicines Control Agency, which concluded that intranasal corticosteroids can cause "clinically important systemic adverse effects at licensed doses." 4 The United Kingdom datasheet for Beconase aqueous nasal spray (beclomethasone dipropionate) recognises the potential for children to develop growth retardation at licensed doses and the need to refer patients to paediatric specialists while they are being prescribed intranasal corticosteroids (Allen and Hanburys, Sept 1998). I question the omission of such key data from Weiner et al's systematic review; it may well tip the risk:benefit ratio away from the use of intranasal corticosteroids in children and, hence, affect the validity of the review's conclusions.

PURPOSE: To investigate the correlation among velopharyngeal closure, hypernasality, audible nasal air emission (NAE) and nasal rustle (NR), in individuals with repaired cleft palate. METHODS: One hundred patients with repaired cleft palate and lip, submitted to pressure-flow study for measurement of velopharyngeal orifice area (velopharyngeal area) and speech sample recordings. Velopharyngeal area was estimated during the production of the sound /p/ inserted in a sentence, and the velopharyngeal closure was classified as adequate, borderline or inadequate. Hypernasality was rated using a 4-point scale, NAE and NR were rated as absent or present, by three speech language pathologists, using recorded speech samples. Inter and intra-judge agreements were established. Statistical analysis was performed using the Spearman correlation coefficient considering p&lt;0.05. An ordinal logistic regression model was developed to investigate whether the characteristics of speech can predict velo...

This study examined changes in voice and speech production in a patient with Parkinson disease as he increased vocal intensity following 1 month of intensive voice treatment. Phonatory function and articulatory acoustic measures were made before and after treatment as well as 6 and 12 months later. Pre- to post-treatment increases were documented in sound pressure level in sustained phonation, syllable repetition, reading, and monologue. Consistent with mechanisms of intensity change reported in normal speakers, corresponding improvements were measured in estimated subglottal pressure, maximum flow declination rate, laryngeal airway resistance, open quotient, EGGW-25, harmonic-spectral slope, and maximum vowel duration. Measures of phonatory stability in sustained phonation and semitone standard deviation in reading and speaking showed changes accompanying increased vocal intensity. In addition, changes were measured in articulatory acoustic parameters (vowel and whole word duration...

Objective: To define the effects of Lee Silverman Voice Treatment (LSVT ® ) on swallowing and voice in eight patients with idiopathic Parkinson's disease. Methods: Each patient received a modified barium swallow (MBS) in addition to voice recording before and after 1 month of LSVT ® . Swallowing motility disorders were defined and temporal measures of the swallow were completed from the MBS. Voice evaluation included measures of vocal intensity, fundamental frequency, and the patient's perception of speech change. Results: before LSVT ® , the most prevalent swallowing motility disorders were oral phase problems including reduced tongue control and strength. Reduced tongue base retraction resulting in residue in the vallecula was the most common disorder in the pharyngeal stage of the swallow. Oral transit time (OTT) and pharyngeal transit time (PTT) were prolonged. After LSVT ® , there was an overall 51% reduction in the number of swallowing motility disorders. Some temporal measures of swallowing were also significantly reduced as was the approximate amount of oral residue after 3 ml and 5 ml liquid swallows. Voice changes after LSVT ® included a significant increase in vocal intensity during sustained vowel phonation as well as during reading. Conclusions: LSVT ® seemingly improved neuromuscular control of the entire upper aerodigestive tract, improving oral tongue and tongue base function during the oral and pharyngeal phases of swallowing as well as improving vocal intensity.

Purpose The present study examined vocal SPL, voice handicap, and speech characteristics in Parkinson’s disease (PD) following an extended version of the Lee Silverman Voice Treatment (LSVT), to help determine whether current treatment dosages can be altered without compromising clinical outcomes. Method Twelve participants with idiopathic PD received the extended treatment version (LSVT-X), similar to LSVT except that it was administered twice a week in 1-hr sessions over 8 weeks and required substantially more home practice. Recordings were made in a sound-treated booth immediately before and after treatment, and again 6 months later. Vocal SPL was measured for 4 different tasks and compared with data from a previous study, in which participants with PD received traditional LSVT 4 times a week for 4 weeks. Listener ratings were conducted with audio samples from both studies, using sentence pairs from a standard passage. LSVT-X participants completed the Voice Handicap Index (VHI) ...

Setting: University cancer referral center. Patients: Two cohorts of consecutive patients willing to participate after treatment for primary T1a midcord glottic carcinoma with laser surgery (18 of 23 eligible) or radiotherapy (16 of 18 eligible). Main Outcome Measures: Posttreatment voice quality was evaluated according to a multidimensional voice protocol based on validated European Laryngological Society recommendations, including perceptual, acoustic, aerodynamic, and stroboscopic analyses, together with patient self-assessment using the Voice Handicap Index. Results: Approximately half of the patients had mild to moderate voice dysfunction in the perceptual analysis (53% [8 of 15] in the radiotherapy group and 61% [11 of 18] in the laser surgery group) and on the Voice Handicap Index (44% [7 of 16] in the radiotherapy group and 56% [10 of 18] in the laser surgery group). The voice profile in the laser surgery group was mainly breathy; in the radiotherapy group, it was equally breathy and rough, with a trend for more jitter in the acoustic analysis. There was no statistical difference in the severity of voice dysfunction between the groups in any of the variables. Conclusions: Endoscopic laser surgery offers overall voice quality equivalent to that of radiotherapy for patients with T1a midcord glottic carcinoma, although specific voice profiles may ultimately be different for the 2 modalities. We believe that endoscopic laser surgery is the preferred treatment in these patients because it provides oncologic control similar to that of radiotherapy and the additional benefits of lower costs, shorter treatment time, and the possibility of successive procedures.

High-frequency subglottic jet ventilation was used in 142 consecutive adults with grade I airways treated with suspension microlaryngoscopy. All cases were managed by the senior anesthesiologist (AP) and the large majority by the senior surgeon (JR), between 2000 and 2002. The laser was used in 30% of cases. There were few complications, none serious, associated with this technique in this series. The subglottic catheter never proved impossible to insert and only needed to be replaced by the supraglottic catheter in two patients because of limitation of visualization of the posterior glottis. The technique was used in a wide variety of surgical pathology from benign hyperfunction-related laryngeal pathology through paralytic vocal fold conditions through papilloma. Advantages and disadvantages over traditional intubation techniques and supraglottic jet ventilation are reviewed, including such issues as ease of intubation/ventilation, surgical exposure/control, maintenance of O 2 and CO 2 levels, and use in the limited/borderline airway.

Background/Aim. An excessive use or misuse of voice by vocal professionals may result in symptoms such are husky voice, hoarse voice, total loss of voice, or even organic changes taking place on vocal folds - minimal pathological lesions - MAPLs. The purpose of this study was to identify the type of MAPLs which affects vocal professionals, as well as to identify the risk factors that bring about these changes. Methods. There were 94 vocal professionals who were examined altogether, out of whom 46 were affected by MAPLs, whereas 48 of them were diagnosed with no MAPLs, so that they served as the control group. All these patients were clinically examined (anamnesis, clinical examination, bacteoriological examination of nose and pharynx, radiography of paranasal cavities, allergological processing, phoniatric examination, endo-video-stroboscopic examination, as well as gastroenterologic examination, and finally endocrinological and pulmological analyses). Results. The changes that occu...

Background/Aim. Spasmodic dysphonia (DS) is a disabling speech disturbance appearing as the consequence of dystonic vocal folds contraction. Its intermittent appearance in the laryngeal muscles causes vocal function discontinuation. The quality of life of these patients is significantly disturbed. Surgical and a medical therapy appear to be inadequate and unsuccessful ones of no steady improvement. It is the botulinum toxin therapy that proved to be highly efficacious one, with the established improvement in 80?100% of patients. The aim of our study was to evaluate the efficacy of botulinum toxin therapy in patients with SD and to show our preliminary results. Methods. The study included 10 patients with adductor spasmodic dysphonia. After diagnostic procedures, botulinum toxin was applied either in one or both vocal folds, in doses of 12?16 units each. In our study we applied indirect technique originally developed by Hocevar and Pirtosek. Perceptive voice and speech analysis was p...

We tested the applicability of the Goettinger Hoarseness Diagram (GHD) for quantitative evaluation of voice disorders after severe traumatic brain injury (TBI) and compared the obtained data with those from established voice analysis systems such as the Multi-Dimensional Voice Program (MDVP), electroglottography (EGG) and perceptual ratings using sustained vowel productions from 10 patients with TBI dysarthrophonia at late stages postinjury and of 10 healthy control speakers. Statistical analyses revealed significant intergroup differences with respect to various acoustic and perceptual measures, i.e., irregularity component, noise component, noise-to-harmonic ratio, shimmer, jitter, roughness, creakiness, strained-strangledness, hypernasality. By contrast, the considered EGG estimates, i.e., open quotient and speed quotient, did not allow for separation of patients and controls. In addition, the two GHD components exhibited close correlations to perceived roughness and creakiness, ...

The purpose of this study was to present our experience with combined use of CO 2 laser and cold instrumentation for Reinke's edema surgery and to evaluate 1year follow-up results of the technique in a series of professional voice users. Fifteen patients with Reinke's edema who underwent microlaryngoscopic surgery were included. Videolaryngostroboscopy, perceptual and acoustic voice analyses were performed before and after surgery. During the 1-year follow-up, no recurrence of Reinke's edema was encountered. SigniWcant postoperative improvement was obtained in the quality of voice, in terms of GRBAS scores, Fo, jitter, shimmer and NHR. No evidence of laryngeal cancer was found on the histological examinations. Combined use of CO 2 laser and cold instrumentation provides a reliable and safe method for Reinke's edema surgery, and cessation of smoking, voice rest and control of the laryngopharyngeal reXux contribute to the success of surgery. We consider that the removal of redundant mucosa of the vocal fold reduces the risk of the recurrence of Reinke's edema and provides better quality of voice. However, it does not imply that our method is superior to others', but this procedure constitutes an eVective treatment of choice for Reinke's edema patients, including professional voice users.

Schools, and to analyze the levels of noise in classrooms and intelligibility of the teacher's voices in the same schools. Methods: the present study was performed in five all-day schools and half-day schools in the city of Petrolina/PE, Brazil. Three classrooms in each school were evaluated (n=15) in the morning and in the afternoon shifts. Eighteen teachers participated in the study and the following instruments were used: Quality of Life in Voice Protocol (QVV) and a semi-structured interview script. In order to verify noise, a decibel meter and a dosimeter were used. Results: Teachers had lower vocal quality of life in the total and physical domains, while most reported feeling vocal alterations. On the other hand, the environmental analysis indicated high levels of noise and a possible interference in the intelligibility of the teacher's speeches. Conclusion: The data demonstrate the need for more studies regarding the topic, and more care with the voices of the teachers.

In Finland there is a rather big public concern about indoor air quality and it's effect on health especially in buildings with suspected dampness. Many employees complain about voice problems and respiratory symptoms in such environments. Methacholine is widely used as a nonspecific irritant for airways in diagnosing asthma. In spirometry the inspiratory curves reflect mainly laryngeal dimensions. There is a common interest among pulmonologists on laryngeal reactions. It appears that a significant proportion of asthma diagnosis are false and may be implications of laryngeal constriction under variable exposures, some even to poor indoor air quality. Methods: Participants in the present study were 32 volunteers (female n=26, male n=6, mean age 44 years, range 22-60 years) who have suffered voice or respiratory symptoms due to exposure to poor air quality in a building with water damage. Participants went through a methacholine challenge test (MCT) with expirograms and inspirograms and a phoniatric videolaryngostroboscopy was done. Voice samples were recorded before and after MCT with a head-mounted condenser microphone and the laryngoscopy was done separately. The Acoustic Voice Quality Index 02.02 (Praat) and the inverse filtering (Aparat) analyses were executed. The participants were divided into two groups depending on their results of the inspirograms and/or whether they got hoarse after MCT. Results: Twenty of the participants had 25% or more and twelve had less than 25% deterioration in their inspirogram after MCT. The groups differed significantly from each other before MCT for the inverse filtering parameter Open Quotient (p<0.05). After MCT the groups differed significantly for acoustic parameters AVQI 02.02, CPPS and HNR (p<0.05). The phoniatric finding of the degree of the muscle tension dysphonia (MTD) and the inverse filtering parameter QOQ had low significant negative correlation with each other (Spearman's rho -0.41, p=0.05). Also the phoniatric finding of the forward pending corniculate arytenoid cartilages during forced breathing had low but significant correlation with the inverse filtering parameters QOQ (Spearman's rho -0.36, p=0.05) and NAQ (Spearman's rho -0.36, p=0.05). The results of this preliminary study indicate that the acoustic and the inverse filtering analyses of voice material could be one of the diagnostic tools detecting laryngeal problems among patients suffering from poor indoor air quality. A larger study group is needed in the future to confirm the results of the present preliminary study.

We investigated the evolution of the neurological and neuropsychological characteristics in a right-handed woman who was 53-years-old at the onset and who showed personality changes and behavioral disorders accompanied by progressive dysarthria. She had hypernasality and a slow rate of speech with distorted consonants and vowels, which progressed as motor disturbances affecting her speech apparatus increased; finally, she became mute two years post onset. Her dysarthria due to bilateral voluntary facio-velo-linguo-pharyngeal paralysis accompanied with automatic-voluntary dissociation fit the description of anterior opercular syndrome. She showed personality changes and behavioral abnormalities from the initial stage of the disease, as is generally observed in frontotemporal degeneration (FTD), and her magnetic resonance image showed progressive atrophy in the frontotemporal lobes; thus, she was clinically diagnosed with FTLD. This patient’s symptoms suggest that FTLD, including bila...

In pattern recognition, observations are often represented by the so called static features, that is, numeric values that represent some kind of attribute from observations, which are assumed constant with respect to an associated dimension or dimensions (e.g. time, space, and so on). Nevertheless, we can represent the objects to be classified by means of another kind of measurements that do change over some associated dimension: these are called dynamic features. A dynamic feature can be represented by either a vector or a matrix for each observation. The advantage of using such an extended form is the inclusion of new information that gives abetter representation of the object. The main goal in this work is to extend traditional Principal Component Analysis (normally applied on static features) to a classification task using a dynamic representation. The method was applied to detect the presence of pathology in the speech using two different voice disorders databases, obtaining hi...

This paper presents an assessment of vocal impairment for separating healthy persons from patients with Parkinson's disease (PD). We have recently shown that deterioration of speech performances in PD speakers is notable from an early stage of the disease, even before starting pharmacotherapy. In this study, we present the potential of the simple Bayes rule to reveal changes in degradable speech performance in the course of PD-related dysarthria. The various speech data were recorded from 23 speakers with recently diagnosed PD and 23 healthy speakers. It has been found that 19 various acoustic measurements are able to differentiate PD significantly from healthy speakers. Subsequently, the Bayes theorem was applied to each of these measurements. As a result, the 21 PD patients and 21 healthy people were correctly classified according to their group. The Bayes theorem thus confirms its feasibility for identifying the features of the impaired voice.

Gastroesophageal re ux (GER) is associated with a variety of laryngopharyngeal signs and symptoms. Injury of the laryngopharynx as a result of GER can be refractory to conventional antire ux therapy. This prospective study was undertaken to evaluate the prevalence of laryngopharyngeal signs and symptoms in patients with documented GER and to assess the response to a high-dose combination antire ux therapy consisting of cisapride and pantoprazole. Twenty-two patients with symptoms of GER were enrolled. After baseline evaluation using a history questionnaire for symptoms, laryngeal endoscopy and vocal acoustic analysis, patients were started on treatment consisting of pantoprazole 40 mg b.d. and cisapride 20 mg twice daily. Repeat history and otolaryngologic evaluation was performed at 4 weeks. Laryngopharyngeal symptoms were frequent in most patients, with throat clearing and globus being the most prevalent symptoms followed by vocal fatigue and excess mucus production. Almost 90% of the patients had abnormal endoscopic laryngeal ndings but the acoustic parameters did not show any abnormal results except for mild elevation in the shimmer. After treatment, all symptoms and endoscopic abnormalities improved signi cantly except for intermittent dysphonia and laryngeal mucosal redness. Acoustic abnormalities did not change signi cantly following therapy. Laryngeal symptoms and voice abnormalities are highly prevalent in patients with GER. Combination antire ux therapy with a proton pump inhibitor and a prokinetic agent results in rapid symptomatic and endoscopic response in the majority of patients.

The dysphonia cases are common in professions that use the voice continuously. Out of these, we find the preachers who are submitted to several vocal alterations for the abusive use of the voice. To analyze the occurrence of laryngeal symptoms in the preachers of the Seventh-Day Adventist Churches in the city of Belém and to alert for the problem. We carried out a prospective, individualized and transversal study through the completing of a research-owned questionnaire. We evaluated 56 preachers, according to acceptance. The 56 preachers were male with mean age of 35.8 years. As for the occupation, only 8 (14%) exerted other activities that also demanded the occupational use of the voice. This study showed that the activity time average of the preachers was of 10.2 years. As for the vocal cares, only 29 (51.7%) practiced vocal cares, of whom 13 (7.2%) carried out vocal warm-up before their activities. The triad of clinical symptoms of major frequency was: Clearing of the throat, observed in 44 preachers (78.5%), hoarseness, in 32 (57.1%) and pain/irritation, in 29 (51.8%). As for the habits and lifestyle only one (1.8%) preacher reported he had the habit of smoking, one (1.8%) informed he used marijuana and two (3.7%) mentioned they drank alcoholics. We observed a high prevalence of vocal complaints in the preachers studied. Clearing of the throat was the most frequent (78.5%), followed by hoarseness (57.1%) and laryngeal pain/irritation (51.8%). These professionals' instruction and training as for the cares regarding the vocal health could reduce the high prevalence o such complaints.

The aim of this study is to explain to the scientific community what Vocal Anthropophysiology is and how it differs from common singing methods. Unlike singing "methods," which often lack scientific precision (BRIXEN; SADOLIN; KJELIN, 2013) and comprehensive research (SUNDBERG, 2018), Vocal Anthropophysiology provides a scientifically grounded theoretical-methodological framework, establishing itself as a scientifically supported "methodology" for the study and investigation of singing voice. Thus, it differs from traditional singing teaching methods of singing instruction. A "method" refers to the way of achieving an objective or solving a problem, while a "methodology" is the broader study of methods (TOMITCH & TUMOLO, 2011). While conventional singing methods are based on concepts and techniques described in treaties and closed-methods, such as Belcanto, Speech Level Singing, and Belting, Vocal Anthropophysiology offers a contemporary approach that unifies knowledge from the Sciences of Voice. It aims to legitimize and enable Contemporary Singing in all its nuances and shades, as well as to decode and describe the anatomical and biomechanical characteristics of vocal phenomena in the singing voice. Comprehensive descriptions of the systematization of laryngeal biomechanics through Vocal Anthropophysiology can be found in Coelho (2014) and Güths, Rolim, and Coelho (2021). Therefore, Vocal Anthropophysiology constitutes a scientific approach and research of the human voice, providing a solid foundation for studying and investigating in this field, especially regarding vocal arts such as singing in its various cultural manifestations, dubbing, ventriloquism, among others.

This pilot study reports on acoustic and perceptual profiles of two American female speakers' productions of six American English social affective expressions: Authority, Declaration, Irritation, Sincerity, Uncertainty and walking on eggs (WOEG) as spoken in the linguistic sentence frame, Mary was dancing. The acoustic profile describes the prosodic characteristics (F0, intensity, duration, voice quality and tonal targets) of the utterances as a whole, as well as the voice quality characteristics of the nuclear stress syllable in the utterances. The perceptual profiles describe (1) listeners' 3-dimensional VAD emotional ratings, i.e., Valence, Arousal, and Dominance, of the utterances and (2) listeners' auditory impressions of the nuclear stress syllable. Multifactorial Analyses (MFA) were applied to examine the relation between the prosodic characteristics and the VAD scales, and also the relationship between voice quality measurements on the nuclear stress vowel and auditory perceptions. The prosodic MFA results indicate that for these two American English speakers, a soft / noisy voice, with weak harmonics and irregular rhythm with pauses and hesitations, as in the expressions of Uncertainty and WOEG, is perceived by listeners as accommodating (not Dominant) and not positive (negative Valence). Loud, tense voices with energy in the upper frequencies, as in the expression of Irritation, are perceived as Aroused. Expressions of Authority, Declaration, and Sincerity tend to have comparatively regular rhythm and relatively flat intonation. The MFA analysis of voice quality measurements and auditory perceptions suggests that Normalized Amplitude Quotient (NAQ) may indeed be a good estimate for tense voice due to glottal closing behavior, Cepstral Peak Prominence (CPP), a good estimation for strong non-noisy harmonics, Peak Slope, a good estimate of spectral related tense voice, and Hammarberg Index, for distribution of spectral energy, i.e., strong or weak energy in the upper frequencies. But these measures do not completely account for the auditory judgments of voice quality. An interpretation of the acoustic and perceptual profiles of the social affective expressions is discussed in terms of theoretical codes (Frequency Code and Effort Code) proposed for explaining symbolic relations between vocal characteristics and pragmatic affective processing in spoken human communication.

Background-Mitochondrial alterations occur in skeletal muscle fibers throughout the normal aging process, resulting from increased accumulation of reactive oxide species (ROS). These result in respiratory chain abnormalities which decrease the oxidative capacity of muscle fibers, leading to decreased contractile force, sarcopenia, or fiber necrosis. Intrinsic laryngeal muscles are a cranial muscle group which possess some distinctive genotypic, phenotypic and physiologic properties. Their susceptibility to mitochondrial alterations resulting from biological processes that increase levels of oxidative stress may be one of these distinctive characteristics. Objectives-The incidence of COX deficiency (COX -) was determined in human posterior cricoarytenoid (PCA) muscle, in comparison to the human thyrohyoid (TH) muscle, an extrinsic laryngeal muscle that served as "control" muscle. Ten PCA and 10 TH muscles were harvested post laryngectomy from 10 subjects ranging in age from 55-86 years. Differences in COX -were compared within and between muscle types using tissue section staining and standard morphometric analysis. Results and Conclusions-COX -fibers were identified in both the PCA and TH muscle. The PCA muscle had ten times as may affected fibers as the TH muscle, with significant differences in COX -found between muscle type and fiber type (p = .003). Almost all of this effect was the result of elevated levels of COX deficiency in type I fibers from the PCA muscle (p = .002) that showed a strong positive correlation with increased age. These results suggest that increased mitochondrial alterations may occur in the PCA muscle during normal aging.

Forty adult patients diagnosed with chronic rhinosinusitis who underwent functional endoscopic sinus surgery (FESS), were analyzed with respect to postoperative resonatory voice changes. For evaluation the patients were asked about their subjective impression of voice changes using a questionnaire. An objective assessment was performed by determining the so-called nasalance using the Nasometer ® (Kay Elemetrics), preoperatively, on the immediate postoperative follow-up (2 days after surgery), and approximately 1 month after surgery. The mean nasalance values increased significantly one month after FESS whereas the immediate postoperative control (2 days after surgery) showed a decrease of nasalance. Although FESS is a minimally invasive procedure, it can change the acoustic characteristics of the vocal tract in the long term and produce a significant increase in nasality. The authors strongly recommend that clinicians inform all patients, in particular voice professionals, about the possible effects of endonasal sinus surgery on voice quality.

This study evaluated the relationship between voice complaint and deviant vocal fold status with special regard to presbylarynx, in patients aged more than 60 years, with pharyngeal-laryngeal complaint. The material consisted of clinical histories and images obtained by laryngoscopies from protocols from the Larynx Institute-INLAR, Sa ˜o Paulo, Brazil, of 210 patients, 88 men and 122 women, aged more than 60 years, who had sought otorhinolaryngologic treatment. Indicative glottic characteristics of the presbylarynx, such as vocal fold bowing, prominence of vocal processes, and spindleshaped glottic chink, were analyzed. The increase in mass, leukoplakia, and other vocal fold alterations, distinct from these two, grouped as miscellaneous, as well as the presence or absence of voice complaint were also analyzed. Vocal fold bowing, prominence of vocal processes, and spindle-shaped glottic chink showed a strong correlation among each other. The presence of presbylarynx was accompanied by less voice complaint than the presence of vocal fold mucosa alterations, which in turn are more common where an absence of presbylarynx exists.

The objective is to investigate the presence of dysphonic symptoms in multiple sclerosis (MS) patients and to compare quantitative acoustic parameters in multiple sclerosis patients and normal individuals. The method of study was an 8-month controlled cross-sectional that was carried out with 106 individuals (30 MS, 76 controls). Both groups included males and females from 20 to 55 years. Exclusion criteria were prior vocal disorder, laryngeal microsurgery, recent endotracheal intubation, tumors, laryngeal, lung or mediastinal metastases, respiratory disease, and other associated neurological diagnoses. For dysphonic symptoms (qualitative variables), associations were assessed using Mantel-Haenszel's χ 2 test, with Yates correction or the Fisher exact test when necessary. Statistical significance was set at p р 0.05. Dysphonia was observed in 70% of MS individuals versus 33% of controls (p ϭ 0.01). Association was found between MS and dysphonia (OR: 2.2, CI 95%: 1.13-4.25). Fundamental frequency was higher among MS patients (p ϭ 0.01). Fundamental frequency deviation was significantly higher in MS women (but not men) than controls (p ϭ 0.00). Jitter was higher in MS men than in all other groups (p ϭ 0.00). Results suggest that evaluation and treatment of MS patients should be revised, evaluating voice alterations in relation to other signs. MS seems to intensify gender effect on fundamental frequency deviation, noise, and jitter, with MS women presenting fewer voice variations than men.

This study aimed to verify whether the resonant voice based on Lessac's Y-Buzz can be perceived by listeners as resonant and different from habitual voice and to compare them to determine whether this sound exploration improves the vocal production. Nine newly graduated actors, six men and three women without voice complaints, were the subjects. They received a session of Lessac's Y-Buzz training from the primary investigator. Before training, they were asked to sustain the vowel /i/ at comfortable frequency and habitual loudness. After training, they were requested to sustain the Y-Buzz they had learned at a comfortable frequency and habitual loudness. Three speech-language pathologists (SLP) trained in voice developed an auditory-perceptive analysis. The pre-and posttraining voice samples were randomly spliced together, edited, and presented in pairs to perceptual judges who were asked to identify the most resonant of the pair. The voice samples were also acoustically compared through the Hoarseness Diagram and acoustic measures using the VoxMetria Software (CTS, version 2.0s, Brazil). The Y-Buzz trials were identified as resonant voice in 74% of the comparisons. The acoustic measures showed a statistically significant decrease of irregularity (P 5 0.002) and shimmer (P 5 0.38). The Hoarseness Diagram demonstrated how the resonant voice moved toward the normality for irregularity and noise components. The results showed that the resonant voice based on the Y-Buzz can be identified as resonant and different from normal voicing in the same subject, and it apparently implies a better vocal production demonstrating a significant decrease of shimmer and irregularity through the Hoarseness Diagram evaluation.

To analyze the phonatory and laryngopharyngeal symptoms reported by call center operators; and quantify the impact of these symptoms on quality of life, and the association between these issues and professional performance, number of monthly calls, and number of missed workdays. Methods. Call center operators (n ¼ 157) from a billing call center completed the Vocal Signs and Symptoms Questionnaire and the Brazilian version of the Voice Activity and Participation Profile (VAPP). The company provided data regarding professional performance, average number of monthly calls, and number of missed workdays for each employee. Results. The mean number of current symptoms (6.8) was greater in the operators than data for the general population (1.7). On average, 4.2 symptoms were attributed to occupational factors. The average number of symptoms did not correlate with professional performance (P ¼ 0.571). However, fewer symptoms correlated with decreased missed workdays and higher mean monthly call figures. The VAPP scores were relatively low, suggesting little impact of voice difficulties on call center operator's quality of life. However, subjects with elevated VAPP scores also had poorer professional performance. Conclusions. The presence of vocal symptoms does not necessarily relate to decreased professional performance. However, an association between higher vocal activity limitation and participation scores and poorer professional performance was observed.

This article presents the current state of knowledge regarding vocal hygiene for the voice professional. Research regarding vocal hygiene has primarily focused on two areas: vocal hygiene as a preventive strategy, and vocal hygiene as a management technique for individuals with voice disorders. It is difficult to assess the effectiveness of vocal hygiene as a preventive tool as programs are often expensive leading to limited data. Vocal hygiene as a sole strategy for the treatment of voice disorders has shown minimal, but favorable results. As a component of a comprehensive therapeutic program, it is difficult to isolate the influence of vocal hygiene. However, limited components of vocal hygiene including hydration and vocal rest have been associated with improved therapeutic outcomes. In addition, the current literature proposes a paradigm shift away from more restrictive therapy approaches to a holistic approach to vocal well being. Summary Vocal hygiene should be considered only as a component of a broad vocal rehabilitation program. The role of vocal hygiene as a means to prevent voice disorders remains unproven. Additionally, some of the findings may be applied to both dysphonic and healthy individuals in order to facilitate vocal well being.

Art hritis may affect the larynx and produce symptoms such as hoarseness and vocal fatigue. Objective: This paper aimed to evaluate the laryngeal manifestations of rheumatoid arthritis. Methods: This is prospective study assessed 27 patients with rheumatoid arthritis with the aid of videolaryngostroboscopy, auditory-perceptual analysis of the speech using the GIRBAS scale, acoustic analysis and the Voice Handicap Index questionnaire. Results: Nineteen patients had laryngeal complaints, the main ones being intermittent dysphonia and sensation of a foreign body in the throat. The most frequent laryngoscopical finding was overlapping arytenoids. Three patients had low pitch, nine patients had mild dysphonia and roughness. Median acoustic measures were: F0, 198.39 Hz; Jitter, 0.815; Shimmer, 4.915; and NHR, 0.144. Regarding the Voice Handicap Index, the median score was zero in all domains. There was a statistically significant correlation between voice complaints and the domains of this index. Functional classes were significantly correlated to: overlapping arytenoids (p = 0.001), PPQ (p = 0.0257), Shimmer (p = 0.0295), APQ (p = 0.0195), and the VHI physical (p = 0.0227) and total domains (p = 0.0425). Laryngeal complaints were reported by 70.4% of the patients and laryngoscopical alterations were observed in 48% of the subjects. Voice acoustic evaluation and self-perception were altered.

Background: Parkinson's disease is a common movement disorder affecting approximately 127,000 people in the UK, with an estimated two thirds having speech-related problems. Currently there is no preferred approach to speech and language therapy within the NHS and there is little evidence for the effectiveness of standard NHS therapy or Lee Silverman voice treatment. This trial aims to investigate the feasibility and acceptability of randomizing people with Parkinson's disease-related speech or voice problems to Lee Silverman voice treatment or standard speech and language therapy compared to a no-intervention control. Methods/Design: The PD COMM pilot is a three arm, assessor-blinded, randomized controlled trial. Randomization will be computer-generated with participants randomized at a ratio of 1:1:1. Participants randomized to intervention arms will be immediately referred to the appropriate speech and language therapist. The target population are patients with a confirmed diagnosis of idiopathic Parkinson's disease who have problems with their speech or voice. The Lee Silverman voice treatment intervention group will receive the standard regime of 16 sessions between 50 and 60 minutes in length over four weeks, with extra home practice. The standard speech and language therapy intervention group will receive a dose determined by patients' individual needs, but not exceeding eight weeks of treatment. The control group will receive standard care with no speech and language therapy input for at least six months post-randomization. Outcomes will be assessed at baseline (pre-randomization) and post-randomization at three, six, and 12 months. The outcome measures include patient-reported voice measures, quality of life, resource use, and assessor-rated speech recordings. The recruitment aim is at least 60 participants over 21 months from 11 sites, equating to at least 20 participants in each arm of the trial. This trial is ongoing and recruitment commenced in May 2012. Discussion: This study will provide information on the feasibility and acceptability of randomizing participants to different speech and language therapies or control/deferred treatment. The findings relating to recruitment, treatment compliance, outcome measures, and effect size will inform a future phase III randomized controlled trial. Trial registration: International Standard Randomised Controlled Trial Number Register: ISRCTN75223808 registered

Objective: To define the effects of Lee Silverman Voice Treatment (LSVT ® ) on swallowing and voice in eight patients with idiopathic Parkinson's disease. Methods: Each patient received a modified barium swallow (MBS) in addition to voice recording before and after 1 month of LSVT ® . Swallowing motility disorders were defined and temporal measures of the swallow were completed from the MBS. Voice evaluation included measures of vocal intensity, fundamental frequency, and the patient's perception of speech change. Results: before LSVT ® , the most prevalent swallowing motility disorders were oral phase problems including reduced tongue control and strength. Reduced tongue base retraction resulting in residue in the vallecula was the most common disorder in the pharyngeal stage of the swallow. Oral transit time (OTT) and pharyngeal transit time (PTT) were prolonged. After LSVT ® , there was an overall 51% reduction in the number of swallowing motility disorders. Some temporal measures of swallowing were also significantly reduced as was the approximate amount of oral residue after 3 ml and 5 ml liquid swallows. Voice changes after LSVT ® included a significant increase in vocal intensity during sustained vowel phonation as well as during reading. Conclusions: LSVT ® seemingly improved neuromuscular control of the entire upper aerodigestive tract, improving oral tongue and tongue base function during the oral and pharyngeal phases of swallowing as well as improving vocal intensity.

Thank you for the opportunity to review the article, "Lee Silverman Voice Treatment versus standard speech and language therapy versus control in Parkinson's disease: a pilot randomised controlled trial (PD COMM pilot)". This is an important topic for discussion, as in order to provide and receive the best rehabilitative care, it is essential for therapists and patients to have information that can guide the decisions they make regarding selection of therapeutic methods that have been proven to be effective via research. This paper is intended to be a pilot report of the feasibility of implementation of a larger study, and based on information collected in this pilot study, to determine which types of outcome measures to include in a larger study. In order to determine the feasibility for implementation of a larger study, and to determine which outcome measures should be used in a future study, it is essential that the pilot study be conducted in a way that controls for possible confounds and implements methods that will result in reliable and valid data. While this study has demonstrated the feasibility of this type of a project from a recruitment standpoint, the information currently provided regarding implementation, and the methods for assessment and data collection, are not reported in a way to determine the validity and reliability of the data. Thank you for your comments but we disagree with this statement, the study was multi centre and the data completeness was excellent, it was independently analysed and the researchers were blind to allocation. It has to be emphasised that this is not an efficacy study but a feasibility study. Additionally, the current study has note-worthy potential for confounds. It is not possible to determine from the information presented whether or not the items that will be described as confounds in this review, and the methods that are lacking were actually applied, but just not reported, or if they were not included in the original study design. Thus, if it is a case of the former (information is available but wasn't reported), then it would be important that significant and substantial revisions are made to the paper to include this information. If the comments cannot be addressed and information cannot be added to affirm the fidelity of treatment and validity/reliability of information provided, then these would be significant design flaws, the data would not be able to be interpreted as reliable or valid, and it would not be recommended that the study be published.