OBJECTIVE: The terminology used by speech-language pathologists (SLPs) during voice therapy is important for treatment outcomes because it can impact both patient self-efficacy and adherence. However, little is known about what factors influence the terminology that SLPs choose to use. Understanding this gap is important to ultimately optimize voice therapy outcomes. Therefore, the primary aims of this study were to (1) assess the relationship between reported clinician-perceived positivity and (2) assess the relationship between clinician-perceived positivity and clinical endorsement for use. We hypothesized that clinician-perceived positivity would be one important factor driving how frequently clinicians use or avoid specific terms, and if they think the term should be used by other SLPs in clinical practice.
METHODS: This prospective study was conducted as an online survey of SLPs and SLP clinical fellows who evaluate and treat adult voice patients. The survey presented respondents with a total of 46 voice-related terms and prompted respondents to rate: (1) how frequently they use a specific voice-related term (\"frequency of use\"); (2) how positive or negative they perceive a specific voice-related term to be (\"perceived positivity\"); and (3) if they feel a specific voice-related term should versus should not be used in clinical practice (\"clinical endorsement\"). Inferential statistics were used to examine the relationship between perceived positivity and frequency of use, and perceived positivity and clinical endorsement. Summary statistics were used to describe frequency of use across all terms.
RESULTS: One hundred twelve respondents completed the survey. Clinician-perceived positivity of voice-related terminology was significantly related to its reported self-reported frequency of use (β = 1.946; 95% CI: 1.701-2.191; P < 0.0005) and clinical endorsement of use by others (β = 4.103; 95% CI: 3.750-4.456; P < 0.0005). Both of these relationships exhibited relatively large effect sizes.
CONCLUSIONS: This study was an important first step at identifying factors that influence SLP\'s use of specific terminology in voice therapy. Specifically, an SLP\'s perceived positivity of clinical terminology strongly influenced the frequency with which they reported using that term in voice therapy and whether or not they thought that term should be used with patients by other SLPs in voice therapy. Future work should investigate clinician characteristics that might affect terminology use, include more diverse sampling, utilize self-selected terminology or audio recordings of therapy interactions, and assess direct effects of terminology use on patient outcomes.

UNASSIGNED: Voice disorders in occupations connected with excessive voice use can be attributed to the inappropriate use of voice and poor vocal hygiene. Therefore, it is essential for persons in such occupations to be aware of vocal abuse, vocal hygiene, practices and their influence on maintaining healthy voice.
UNASSIGNED: To assess knowledge, attitude and practice on vocal abuse and vocal hygiene among diverse occupational voice users in Jodhpur.
UNASSIGNED: A cross-sectional study was conducted in Jodhpur district, Rajasthan. Data was collected from 424 participants (106 Doctors, 106 Teachers, 106 Advocates, 106 Vendors) from May 2023 to July 2023 by administrating a pretested semi structured questionnaire. Microsoft Excel and IBM SPSS (V. 23) statistical software were used for descriptive and inferential statistical analysis.
UNASSIGNED: Majority (92%) of the participants felt that their quality of voice was good. About 55% participants were not aware about the term vocal abuse (Doctors 17.9%, Teachers 39.6%, Advocates 79.2%, Vendors 44.3%). Around 56% participants (Doctors 63.3%, Teachers 66.0%, Advocates 32.1%, Vendors 61%) had negative attitude towards vocal hygiene practices. About 47% of the participants preferred home remedies and 44.3% (Doctors 72.6%, Teachers 48.1%, Advocates 41.5%, Vendors 15.1%) preferred to consult ENT specialist for their voice related problem. Perception of vocal abuse on vocal health and hygiene practices was found to statistically significant (p = 0.001) among the different category of occupations.
UNASSIGNED: In this perception-based, cross-sectional study it was found that majority of the participants were neither aware about term vocal abuse nor followed vocal hygiene practices. In view of the above findings it is strongly recommended that excessive voice users should be made aware of vocal hygiene practices & repeated reinforcement of the same is required to prevent voice related problem.

OBJECTIVE: Many series have compared voice quality after radiotherapy or surgery for cT1 glottic carcinoma. Different meta-analyses identify better results for radiotherapy while others do not identify any difference, some finally find a superiority of surgery. The purpose of this study was to compare the voice quality in the long term of patients who underwent transoral surgery versus exclusive irradiation for the treatment of cT1 glottic carcinoma.
METHODS: The VOQUAL study was a pilot comparative multicenter cross-sectional study. The primary endpoint was the Voice Handicap Index comparison between two groups (radiotherapy or surgery). The voice assessment also consisted in the heteroevaluation of voice quality by the Grade, Roughness, Breathness, Asthenia, and Strain rating scale reported by Hirano.
RESULTS: The study included 41 adult patients with cT1 carcinoma of the vocal cord treated by cordectomy or exclusive radiation in two oncologic centers. The median Voice Handicap Index value was 20 [8; 32.5] in the surgery group and 10 [4; 18.5] in the radiotherapy group. There was no statistically significant difference between the median values and the various components F, P and E of the questionnaire (P=0.1585). The median value of the numeric dysphonia Grade, Roughness, Breathness, Asthenia, and Strain scale was 2 [0; 5] in the surgery group and 2 [0.25; 3.75] in the radiotherapy group. There was no statistically significant difference between these values (P=0.78).
CONCLUSIONS: Our study did not show any significant difference on the primary endpoints of Voice Handicap Index and Grade, Roughness, Breathness, Asthenia, and Strain scores.
METHODS: III.
BACKGROUND: The VOQUAL study was registered on the ClinicalTrials.gov platform under the number NCT04447456, in July 2020.

OBJECTIVE: To verify possible complaints, voice and aerodigestive symptoms, singing voice handicap, and knowledge of vocal health and hygiene in Candomblé religious leaders in Brazil.
METHODS: The study comprised 112 individuals who filled out a questionnaire with their identification and characterization, the stratified classification of their professional activities, and their self-perception of voice. Three self-assessment protocols - VoiSS, QSHV, and MSHI - were also used.
RESULTS: The self-assessment of voice ranged from average to good. VoiSS mean total score was 23.04, which is above the cutoff. QSHV mean score was 23.54 points, which is near the cutoff. MSHI mean score (the perception of singing voice handicap) was 25.66 points. There was a substantially strong positive correlation between VoiSS and MSHI total scores (0.789; p<0.001). Women had higher limitation scores (p=0.012) and total scores (p=0.012) in VoiSS and higher handicap scores (p=0.038) in MSHI. Level I professionals - vocal elite (singers and actors) - had significantly higher QSHV scores than those in levels IV (p=0.010) and V (p=0.008). Most respondents had not visited an otorhinolaryngologist (89.29%) within the last year and had not been submitted to speech therapy (83.04%) for voice complaints.
CONCLUSIONS: Candomblé leaders, particularly women, perceived voice symptoms and singing voice handicaps, with no relationship with their knowledge of vocal health and hygiene. Despite the complaints, most subjects reported not having visited health professionals responsible for voice care within the last year.
OBJECTIVE: Verificar a autopercepção de sintomas vocais e aerodigestivos, desvantagem vocal no canto e o conhecimento em saúde e higiene vocal em líderes religiosos do Candomblé do Brasil.
UNASSIGNED: Participaram deste estudo 112 indivíduos, que preencheram virtualmente um questionário de identificação, caracterização, classificação das atividades profissionais em níveis e autoavaliação vocal no momento atual, além de três protocolos de autoavaliação: Escala de Sinais e Sintomas (ESV), Questionário de Saúde e Higiene Vocal (QSHV) e Índice de Desvantagem para o Canto Moderno (IDCM). Foram utilizados os testes de correlação de Spearman, teste de Mann-Whitney e teste de Kruskal-Wallis.
RESULTS: A autoavaliação vocal no momento atual variou de razoável a boa. A média do escore total na ESV foi de 23,04, acima da nota de corte. O QSHV apresentou valor médio de 23,54 pontos, próximo à nota de corte. O Índice de Desvantagem para o Canto Moderno (IDCM) mostrou média de 25,66 pontos. Houve correlação positiva de força substancial entre os escores totais da ESV e IDCM (0,789). Mulheres apresentaram maiores escores no ESV total e ESV limitação, além de maior escore no IDCM desvantagem. Profissionais do nível I - elite vocal (cantores e atores) apresentaram escores significativamente maiores para o QSHV que os profissionais do grupo IV (usuário não profissional não-vocal) e os do nível V (pessoas que estão fora do mercado de trabalho). A maioria dos respondentes não consultou Otorrinolaringologista (89,29%) no último ano e nem realizou fonoterapia (83,04%) por queixas vocais.
UNASSIGNED: Líderes do Candomblé apresentaram percepção de sintomas vocais e desvantagem vocal no canto, mais evidente nas mulheres, não havendo relação com o conhecimento de saúde e higiene vocal. Apesar da identificação de sintomas vocais, a maior parte dos sujeitos relatou não ter acessado profissionais de saúde responsáveis por esses cuidados com a voz no último ano.

OBJECTIVE: We investigated the reliability and validity of the Turkish version of the Screening Index for Voice Disorder (SIVD-TR).
METHODS: The original SIVD1 translated into Turkish, followed by a translation back into English by a linguist. The text was finalized by an evaluation committee. This translated version was then administered to a cohort of 223 teachers in Ankara, Turkey, encompassing both those with and without voice disorders (WVD and WOVD). After a duration of 7-14days, a random selection of 53 teachers underwent the questionnaire once more. Statistical analyses were conducted to evaluate the reliability and validity of the index. Cronbach\'s alpha and test-retest methods were used to scale the reliability. A cutoff point was determined to decide the risk of a voice disorder, by using a Receiver Operating Characteristic curve. The validation process is concluded by computing sensitivity and specificity values, comparing mean scores between WVD and WOVD subjects, and finally examining correlations between SIVD-TR and the Turkish version of the Voice Handicap Index (VHI-10).
RESULTS: The internal consistency reliability exhibited high significance, with Cronbach\'s alpha measuring at 0.872. The test-retest correlation coefficient for the total scores was 0.80. The SIVD-TR consists of 12 symptoms, each accounting for 1 point on the scale. The identified cutoff for identifying the risk of a voice disorder is 4 (four) symptoms, with a sensitivity of 55.2%. A correlation of 69% was observed between SIVD-TR and VHI-TR. A significant association was noted between the risk of having a voice disorder and the actual presence of a voice disorder. Subjects with a voice disorder exhibited higher mean SIVD scores, providing further evidence of the questionnaire\'s discriminative validity.
CONCLUSIONS: The Turkish adaptation of SIVD demonstrated both reliability and validity, establishing itself as a robust tool for identifying voice disorders.

UNASSIGNED: Hemihypertrophy (HH) is a rare congenital malformation usually recognized at birth. It is often diagnosed due to impaired aesthetics and mobility caused by asymmetry of the face, body, or limbs. Some patients are diagnosed due to the presence of tumors and mental abnormalities.
UNASSIGNED: A 14-year-old boy with hoarseness since infancy and progressively increasing with age. Laryngoscopy and CT of the larynx suggested bilateral asymmetry of the laryngeal structures, and voice analysis suggested severe voice disorders. The boy had no history of trauma or other medical conditions, but had physical asymmetry since birth, which coincided with the laryngeal asymmetry. After a detailed examination and evaluation, we considered that his voice disorders were unexpectedly caused by crossed idiopathic HH. Since the boy in his growth spurts is not a candidate for surgery, we implemented individualized voice correction therapy. After practicing, the boy\'s voice disorders were significantly relieved.
UNASSIGNED: Congenital HH can cause asymmetrical development of the larynx, which leads to voice disorders. Voice correction therapy is an effective treatment for patients unsuitable for surgery.

BACKGROUND: The predominant alterations in voice of patients with multiple sclerosis (MS) are phonatory instability, vocal asthenia and roughness, shortness of breath, hypophonia, and hypernasality. However, research on alterations of acoustic parameters has few studies and disparate results. The objective of this study was to investigate voice disturbances in patients with MS, both with objective measures (analysis of biomechanical) and subjective measures (scales and questionnaires).
METHODS: This is an experimental study with a total of 20 participants with MS. Voice samples were collected, and biomechanical correlates were analyzed through the Clinical Voice Systems program, Online Lab App. The VHI-30 (Voice Handicap Index) questionnaire, the GRBAS (grade, roughness, breathiness, asthenia, strain) scale, and the Hospital Anxiety and Depression Scale were used as subjective measures.
RESULTS: Ninety-five percentages of participants feel and describe dysphonic difficulties. Self-perception of vocal disability correlated with auditory vocal perceptual analysis in the sample of women.
CONCLUSIONS: The biomechanical parameters showed alterations in the strength of the glottic closure, the efficiency index, and the structural imbalance index.

OBJECTIVE: To analyze the reliability, measurement error, and responsiveness of the Voice Handicap Index (VHI) for measuring voice handicap in individuals with voice disorders.
METHODS: This systematic review followed the recommendations of the COnsensus-based Standards for the Selection of Health Measurement INstruments. Studies that validated the VHI, analyzed the measurement properties of reliability, measurement error, or responsiveness, and had dysphonic individuals as the study population were included. The following electronic databases were searched: Cochrane Library, EMBASE, LILACS, PubMed, Scopus, and Web of Science. The manual search was carried out on gray literature in the Biblioteca Digital Brasileira de Teses e Dissertações and ProQuest Dissertation & Theses, in addition to mapping citations and consulting an expert in the field. Evidence selection, data extraction, risk of bias analysis, certainty of evidence, and good psychometric measurements were performed by two blinded and independent reviewers. A meta-analysis was performed using Fisher\'s transformed r-to-z correlation coefficient and standardized mean difference. Heterogeneity was calculated using Tau² and I² statistical tests in JAMOVI 2.3.2 software.
RESULTS: Eighty studies were included in the meta-analysis. When assessing the risk of bias, most studies were classified as inadequate during the reliability and measurement error stages. In the responsiveness stage, they were classified as doubtful in the sensitivity and specificity sub-boxes and good in the comparison sub-box with a gold standard instrument. For psychometric properties, most studies were classified as indeterminate in terms of both reliability and responsiveness. In test-retest reliability and responsiveness, the average outcome differed significantly from zero, indicating agreement between the test and retest moments and a significant reduction in the VHI score after intervention. Considering certainty of the evidence, the level of evidence was very low in both the reliability and responsiveness stages. The analyzed studies did not evaluate observational errors, and hence, they were not considered in this review.
CONCLUSIONS: The VHI proved to be reliable and responsive in measuring voice handicap. However, it should be used with caution, as there is heterogeneity, a risk of bias, and no adherence to the analysis of observational error.

UNASSIGNED: Vocal fatigue-related symptoms, frequent in patients with voice disorders, are reliably quantifiable with the Vocal Fatigue Index (VFI) in several languages. The main aim of this work was to investigate the content and construct validity of the German Vocal Fatigue Index (VFI-D) by comparison with the German Voice Handicap Index 9 international (VHI9i) and the Vocal Tract Discomfort Scale (VTD). Moreover, the scale and retest reliability were investigated.
UNASSIGNED: In a prospective cohort study at two tertiary care hospitals, 93 adults with all types of voice complaints filled out the VFI-D, the VHI-9i, and the VTD. Eighty-one adults (Mage = 53.5 years, SD = 15.7) completed them one time, and additional 12 patients (Mage = 53.8 years, SD = 15.6) did a test-retest, completed them twice at an interval of 1 week. The validity was assessed by Spearman\'s rho and Mokken scaling and the reliability by a factor analysis and a two-tailed t test.
UNASSIGNED: Mokken scaling has proven the VFI-D as one-dimensional questionnaire (one cluster, r = .95). All VFI-D items could be assigned to one of three factors according to principal component and principal axis factor analysis. Although Factor 1 related best to the VHI9i (∅ rs = .76) and Factor 2 to the VTD (∅ rs = .74), Factor 3 correlated moderately with the VHI9i (rs = .34) and weakly with the VTD (rs = .25). Results from the first and second VFI-D completion agreed strongly (t = -1.78, p = .10).
UNASSIGNED: In this study, the content and construct validity of the VFI-D were confirmed. Also, both scale reliability with identical factors as those in the original study and retest reliability were verified. The VHI9i and VTD were highly indicative of VFI-D Factors 1 and 2, respectively. No correlation between Factor 3 and the other questionnaires was determined. Future research should evaluate which characteristics are specific to vocal fatigue versus general voice disorder-related symptoms.

OBJECTIVE: To compare the effects of telerehabilitation (TR) and face-to-face rehabilitation (FTF) methods on the outcomes of adults with voice disorders and to analyze the effectiveness of TR.
METHODS: Following Boolean Logic, a search strategy was devised, combining subject terms and keywords based on the interventions and populations outlined in the inclusion criteria. We searched PubMed, Cochrane Library, Embase, Web of Science, Scopus, CNKI, Wanfang, CQVIP databases, and manually screened academic conference papers, journal articles, and gray literature to identify eligible randomized controlled trials (RCTs) on remote voice therapy. Two researchers assessed the risk of bias in the included studies using the risk of bias assessment tool for RCTs outlined in the Cochrane Handbook for Systematic Reviews of Interventions version 5.1.0.
RESULTS: Five trials with a total of 233 patients with voice disorders were included in the study after screening. The results revealed a significant difference in Jitter change values (mean difference [MD]=-0.12, 95%CI [-0.23,-0.01], P = 0.04) between TR and FTF, maximum phonation time (MD=0.76, 95%CI [-0.60,2.13], P = 0.27), Shimmer (MD=-0.04, 95%CI [-0.11,0.03], P = 0.27), voice handicap index (MD=0.87, 95%CI [-1.77,3.50], P = 0.52), and GRBAS(G) (MD=-0.00, 95%CI [-0.01,0.01], P = 0.99) had no significant difference.
CONCLUSIONS: TR demonstrates comparable efficacy to FTF in voice treatment and is associated with higher levels of patient satisfaction, making it a viable and effective therapeutic modality. However, given the limited sample size analyzed in this study, further validation of this conclusion necessitates additional RCTs with larger sample sizes. Furthermore, researchers should remain cognizant of the constraints associated with TR and consistently refine treatment protocols to enhance the efficacy of voice therapy.