OBJECTIVE: To map the phonatory tasks and the result measures used to evaluate vocal fatigue in vocally healthy individuals.
METHODS: This is a scoping review based on the following research question: What are the phonatory tasks and outcome measures used for the evaluation of vocal fatigue in vocally healthy individuals? The construction of the search strategy followed the PCC strategy; population: vocally healthy adult individuals; concept: phonatory tasks and vocal evaluation measures; and context: vocal fatigue. The search was performed electronically in the databases Medline (PubMed), LILACS (BVS), SCOPUS (Elsevier), Web of Science (Clarivate), EMBASE, and COCHRANE. A manual search in the references of the selected articles and in the journal with the highest number of publications was also performed. The selection of articles was based on reading the titles, abstracts, and full text, applying the eligibility criteria. The selected articles were related to the evaluation of vocal fatigue in healthy individuals from a predetermined vocal load task. Data regarding the characteristics of the publication, sample, phonatory tasks, and outcomes were extracted. The results were presented in a descriptive format, due to a frequency distribution analysis.
RESULTS: In total, 3756 studies were identified during the search, of which 60 were selected. The most used vocal load activity was the reading task, with duration ranging from 46 to 120 minutes. The (1) sustained vowel /a/ and (2) the reading of texts and phrases, both in usual intensity and frequency without the interference of the researcher, were the most used evaluation tasks. The most used outcome measures are the following: (1) acoustic parameters-fundamental frequency [fo] (mean, variance), sound pressure level (mean), local jitter (%), local shimmer (%), cepstral peak prominence (mean); (2) vocal self-assessment by the validated instruments-Perceived Phonatory Effort Scale, Visual Analog Scale, Borg-CR-10 Scale.
CONCLUSIONS: There is a diversity of phonatory tasks and outcome measures recurrently used in scientific articles to evaluate the signs of vocal fatigue in vocally healthy individuals. The most used vocal sample to evaluate vocal fatigue was the sustained vowel /a/ in habitual intensity and frequency without the interference of the researcher. The most frequently reported outcome measures for the assessment of immediate vocal fatigue effects were the acoustic analysis and vocal self-assessment.

This systematic review represents an update to previous reviews of the literature addressing behavioral management of respiratory/phonatory dysfunction in individuals with dysarthria due to neurodegenerative disease.
Multiple electronic database searches and hand searches of prominent speech-language pathology journals were conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards.
The search yielded 1,525 articles, from which 88 met inclusion criteria and were reviewed by two blinded co-investigators. A large range of therapeutic approaches have been added to the evidence base since the last review, including expiratory muscle strength training, singing, and computer- and device-driven programs, as well as a variety of treatment modalities, including teletherapy. Evidence for treatment in several different population groups-including cerebellar ataxia, myotonic dystrophy, autosomal recessive spastic ataxia of Charlevoix-Saguenay, Huntington\'s disease, multiple system atrophy, and Lewy body dementia-were added to the current review. Synthesis of evidence quality provided strong evidence in support of only one behavioral intervention: Lee Silverman Voice Treatment Program (LSVT LOUD) in people with Parkinson\'s disease. No other treatment approach or population included in this review demonstrated more than limited evidence, reflecting that these approaches/populations require urgent further examination.
Suggestions about where future research efforts could be significantly strengthened and how clinicians can apply research findings to their practice are provided.
https://doi.org/10.23641/asha.24964473.

OBJECTIVE: To map the volitional and non-volitional devices used by speech and language pathologists (SLPs) in voice training and therapy and characterize their use in research on voice interventions.
METHODS: This scoping review is the first part of a larger study. The electronic search was carried out by mapping the references in PubMed/Medline, LILACS/BVS, Scopus, Web of Science, EMBASE, and the Cochrane Library, and the manual search was carried out in the grey literature. Two blind independent reviewers selected and extracted data; divergences were solved by consensus. The data extracted in this part of the study were the authorship and year of publication, country, study design, sample characteristics, intervention modality, ingredient, target, mechanism of action, dosage, and outcome measures. They were addressed with descriptive analysis.
RESULTS: Publications that use devices as ingredients are mostly from the last two decades, mainly carried out in the United States of America and Brazil, in adults of both sexes with behavioral dysphonia. Forty-two types of devices were used, many of them with similar approaches but different nomenclatures. Most devices were used voluntarily, focusing on vocal function, and aiming to increase source and filter interaction. Most studies used silicone tubes. The most reported technical specification to apply the ingredient was surface electrodes on the neck. Device dosage was time-controlled, and the most used outcomes were self-assessment and acoustic analysis.
CONCLUSIONS: Devices are currently used as ingredients in vocal interventions, with a greater focus on increasing the source and filter interaction, associated with silicone tubes (the most used devices in these studies), which have been dosed with performance time. Outcomes were measured with self-assessment instruments.

OBJECTIVE: Dysphonia is a common symptom due to the coronavirus disease of the 2019 (COVID-19) infection. Nonetheless, it is often underestimated for its impact on human\'s health. We conducted this first study to investigate the global prevalence of COVID-related dysphonia as well as related clinical factors during acute COVID-19 infection, and after a mid- to long-term follow-up following the recovery.
METHODS: Five electronic databases including PubMed, Embase, ScienceDirect, the Cochrane Library, and Web of Science were systematically searched for relevant articles until Dec, 2022, and the reference of the enrolled studies were also reviewed. Dysphonia prevalence during and after COVID-19 infection, and voice-related clinical factors were analyzed; the random-effects model was adopted for meta-analysis. The one-study-removal method was used for sensitivity analysis. Publication bias was determined with funnel plots and Egger\'s tests.
RESULTS: Twenty-one articles comprising 13,948 patients were identified. The weighted prevalence of COVID-related dysphonia during infection was 25.1 % (95 % CI: 14.9 to 39.0 %), and male was significantly associated with lower dysphonia prevalence (coefficients: -0.116, 95 % CI: -0.196 to -0.036; P = .004) during this period. Besides, after recovery, the weighted prevalence of COVID-related dysphonia declined to 17.1 % (95 % CI: 11.0 to 25.8 %). 20.1 % (95 % CI: 8.6 to 40.2 %) of the total patients experienced long-COVID dysphonia.
CONCLUSIONS: A quarter of the COVID-19 patients, especially female, suffered from voice impairment during infection, and approximately 70 % of these dysphonic patients kept experiencing long-lasting voice sequelae, which should be noticed by global physicians.

This study aimed to critically appraise recent peer-reviewed scientific evidence on the effect of vocal hygiene education on voice quality and function directly and indirectly measured by auditory-perceptual, acoustic, and self-report measures in professional voice users.
A systematic review was conducted utilizing the Preferred Reporting Items for Systematic review and Meta-Analyses Protocols (PRISMA-P) guidelines. Five databases were searched using the keywords \"vocal hygiene,\" \"vocal hygiene education,\" \"vocal health,\" \"vocal quality,\" and \"voice quality\" with Boolean phrases \"AND\" and \"OR.\" Twenty-three studies that met the eligibility criteria were included. Scoring was based on the American Speech-Language-Hearing Association\'s levels of evidence and quality indicators, as well as the Newcastle-Ottawa Scale for assessing the risk of bias.
Four studies (17%) linked low awareness of vocal hygiene or insufficient vocal hygiene education to self-reported acute and chronic voice symptoms, as well as a greater perception of voice handicap among professional voice users. Numerous studies (n = 10; 43%) showed that adequate voice training or vocal hygiene education was linked to positive voice outcomes. Six studies (6.26%), however, demonstrated that vocal hygiene education is more effective when combined with direct voice therapy. When vocal hygiene education is presented in isolation, the superiority of a direct voice therapy approach, with or without vocal hygiene education, is seen over a vocal hygiene education program alone (indirect treatment).
Recent literature demonstrates mixed results obtained through auditory-perceptual, acoustic, and self-rating measures on the effects of vocal hygiene instruction on vocal quality and function in professional voice users. However, the compelling positive outcomes presented do warrant implementation of vocal hygiene education programs in combination with direct voice therapy for professional voice users.

BACKGROUND: Voice training has been proposed as an intervention to improve swallowing function in patients with dysphagia. However, little is known about the effects of voice training on swallowing physiology.
OBJECTIVE: This systematic review investigates the effect of voice training on the swallowing function of patients with oropharyngeal dysphagia and provides the theoretical basis for improving the swallowing function and life quality of patients with oropharyngeal dysphagia.
METHODS: A systematic review using a narrative synthesis approach of all published studies was sought with no date restrictions. Five electronic databases (EMBASE, PubMed, CINAHL, Web of Science, and The Cochrane Library) were searched from inception to April 2022.
METHODS: Eight studies were included. Two researchers screened the literature according to inclusion and exclusion criteria, extracted data, and carried out quality control according to the Cochrane handbook5.1.0. Data were analyzed narratively and descriptively.
CONCLUSIONS: In general, statistically significant positive therapy effects were found. Voice training improves the oral and pharyngeal stages of swallowing in patients with neurological causes of dysphagia, such as stroke, and in patients with non-neurological causes of dysphagia, such as head and neck cancer. However, the current literature is limited and further primary research is required to provide more evidence to support voice training intervention in dysphagia.  Future studies could  further refine the content of voice training interventions, increase the number of patients enrolled, assess the long-term effects of voice training interventions and add associated assessments of the quality of life after treatment.

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Vocal fold nodules (VFNs) are the main cause of paediatric dysphonia. Voice therapy is recommended as the preferable treatment option for VFNs in children.
The aim of this systematic review is to provide an overview of the existing literature concerning the effects of voice therapy in children with VFNs.
This systematic literature review was developed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (via PubMed) and Embase were searched and the grey literature was checked. The search strategy was based on three concepts: VFNs, voice therapy and children. Two examiners independently determined article eligibility and extracted all relevant data from the included studies. The methodological quality of the included study was assessed using the QualSyst tool.
By identifying, evaluating and summarizing the results of all relevant studies about voice therapy in paediatric VFNs, this systematic review makes the available evidence more accessible to voice therapists, otolaryngologists and other relevant stakeholders.
24 studies were included in this systematic review. Eight studies (8/24) reported a significant improvement for at least one outcome parameter after voice therapy. However, five papers (5/24) could not demonstrate significant changes after voice therapy. All studies that did not test for significance (11/24) found improvements for one or more outcome parameters. The overall quality of the included studies is adequate (55%). In sum, there is some evidence that voice therapy is effective in children with VFNs, but further well-designed research, especially randomized controlled trials, is necessary to confirm these results.
What is already known on the subject Voice therapy is preferable in children with VFNs because of the phonotraumatic nature of the nodules and the associated high recurrence rate after phonosurgery. Most voice therapists in clinical practice offer an eclectic voice therapy programme, consisting of direct and indirect voice therapy techniques. What this study adds to existing knowledge This systematic review provides a clear overview of the available evidence concerning the effects of voice therapy in paediatric VFNs. There is some evidence that voice therapy is an effective treatment option in children with VFNs, but well-designed research is scarce on this subject. What are the potential or actual clinical implications of this work? This review shows that effectiveness studies with strong designs are very scarce in children with VFNs. Clinicians should be aware that few therapy techniques have been thoroughly investigated in this population. However, this review may guide voice therapists when creating a treatment plan for a child with VFNs because it identifies, evaluates and summarizes the results of all relevant individual studies about voice therapy in paediatric VFNs. Voice therapy seems to be effective in treating paediatric patients with VFNs, given the fact that a considerable number of included studies report significant improvements after voice therapy. Both direct and indirect therapy approaches appear to have a positive effect on the phonation of children with VFNs.

OBJECTIVE: The purpose of this scoping review was to summarize key findings in the voice therapy adherence literature for individuals with phonotraumatic lesions. The particular focus was to identify how adherence has been defined and measured (operationalization and criteria for successful adherence) and to describe variables which were found to have a positive, neutral, or negative relationship with adherence to voice therapy.
METHODS: Data were identified and charted using the PRISMA-ScR protocol via searches of CINAHL, PsycINFO, Pubmed, SCOPUS, and Web of Science.
RESULTS: Literature mining revealed that adherence is rarely defined but is usually operationalized. \"Successful completion of therapy\" was the most common operationalization. Most variables studied in this field have been found to have no relationship with adherence. An incidental finding was that, most frequently, researchers have repeatedly studied variables which have already been documented to have no relationship with adherence.
CONCLUSIONS: Research into voice therapy adherence is still emerging, and few if any variables have been identified which are strongly associated with adherence to voice therapy for people with phonotraumatic lesions. Inspiration for future research may be drawn from other disciplines, which point to relationship variables as central to the adherence process. Examination of such variables is currently underrepresented in the voice therapy literature; we suggest this and other gaps for pursuit in future research.

OBJECTIVE: The body of literature discussing the acoustic, aerodynamic, perceptual, and morphometric changes that occur during and after semi-occluded vocal tract exercise (SOVTE) has dramatically expanded within the past 20 years. The current study integrates the literature on SOVTE from the 1990s onward, reviewing the technique\'s clinically relevant effects in vocally untrained adults both with and without dysphonia. The study aims to give clinicians actionable information on how SOVTEs alter vocal function in both normal and pathological states.
METHODS: The author queried the MEDLINE database for combinations of search terms related to semi-occluded vocal tract exercise. To improve article identification, the author also performed iterative citation webbing in which the reference lists of each article selected for full-text screening were cross-referenced against the articles returned in the initial MEDLINE search. Articles identified by iterative citation webbing that did not appear in the initial MEDLINE search were then screened individually. The second author independently verified adherence to the review\'s inclusion and exclusion criteria in both the initial search and data extraction phases.
RESULTS: The initial MEDLINE search returned 869 articles, 111 of which passed the title and abstract screening phase. Iterative citation webbing returned an additional 20 studies, resulting in a total of 131 articles that qualified for full-text screening. 53 articles passed full-text screening and were included in the current review.
CONCLUSIONS: Semi-occluded vocal tract exercise increases the inertive reactance of the glottis, vocal tract, and air column, as well as introducing flow resistance at the level of the lips or velopharyngeal port. Each of these mechanisms yields downstream acoustic, aerodynamic, morphometric, and perceptual changes, including reductions in phonation threshold pressure and perceived phonatory effort, improved spectral characteristics of the acoustic signal, attenuation of vocal fold impact stress as indexed by various metrics such as maximum area declination rate, and alterations to the physical dimensions of the vocal tract. Although few studies examined the duration of these changes post exercise, several RCTs support the assertion that SOVTE\'s effects can be sustained with regular practice over weeks or months, regardless of current vocal health status.