Victoria Sue McKenna

Transgender and gender diverse people (hereafter abbreviated as trans people) often experience voice dysphoria (also called voice-gender incongruence): distress because their voice does not match t...

Objectives: To investigate the reliability of high‐speed videoendoscopy (HSV) methodology for quantifying laryngeal swallowing behaviors. Methods: Twenty‐two healthy adults completed a dry volitional swallow under HSV at 500 frames per second (fps) with a lower‐than‐standard scope position located in the laryngeal vestibule. After reaching consensus among five raters on specified behaviors and definitions, all raters used a custom MATLAB graphical user interface (GUI) to annotate the laryngeal behaviors during the pharyngeal phase of the swallow and rated their confidence in visualizing laryngeal anatomy and movements. Inter‐ and intra‐rater reliability for timing of the onsets, offsets, and durations of each laryngeal behavior was calculated using intraclass correlation coefficients (ICCs), and presence/absence agreement of each behavior was quantified by Fleiss's kappa and supplemented with percent agreement. Results: Raters reported confidence visualizing the vocal folds (87%) and the arytenoids (80%). Full arytenoid closure was present in 84%, while full anterior–posterior compression had the highest inability‐to‐visualize rate (41%). Inter‐rater reliability was good to excellent for onset (ICC range, 0.82–0.99), excellent for offset (0.91–0.99), and poor to moderate for duration (0.08–0.63). Percent agreement for presence/absence exceeded 80% across all behaviors. Intra‐rater reliability was good to excellent for onset (0.85–0.99), excellent for offset (0.91–0.99), and poor to moderate for duration (0.14–0.60). Conclusion: HSV, with a standardized low‐scope protocol and analysis using a custom GUI with clear definitions, is a promising, feasible, and reliable tool for investigating onset and offset timings of specific laryngeal patterns during the pharyngeal swallow. Level of Evidence: 4.

A transgender woman underwent anterior (Wendler) glottoplasty and was followed for 1‐year. We found desired pitch improvements, but also undesired changes to intensity, vocal efficiency, laryngeal vibratory kinematics, and vocal effort. This case highlights the importance of considering multimodal assessment in clinical follow‐up and outcome analysis for these patients.

Background: Transgender people often experience distress due to a mismatch between their gender and the way their voice is perceived (eg, transgender women with low pitch), which significantly reduces their mental health and quality of life. This is especially a problem for transfeminine people and can be reduced with gender-affirming voice training (GAVT), but such training is often inaccessible due to factors such as price and geographical constraints. Objective: We aim to improve the limited availability of GAVT by developing and testing a free web-based software platform (named TruVox; University of Cincinnati) that would combine real-time feedback about the user’s voice with structured vocal pitch exercises for transfeminine people. Methods: The current publicly accessible TruVox prototype focuses on vocal pitch training with 5 structured exercises that provide real-time pitch visualizations as well as supporting videos and text. It was tested in 2 evaluation stages: initial remote usability evaluations and a later single-session in-person evaluation with 21 transfeminine participants under the supervision of 2 researchers. In remote evaluations, participants reported bugs and usability issues that were iteratively addressed. In the in-person evaluation, participants tested the final software prototype and filled out the System Usability Scale, then performed 10 repetitions of different exercises to gauge performance improvement with practice. They also filled out the Intrinsic Motivation Inventory for each exercise. Results: The System Usability Scale score had a mean of 79.8 (SD 12.8) on a 100-point scale, Intrinsic Motivation Inventory scores were high (eg, interest/enjoyment over 11/14), and exercise performance significantly improved in all but 1 exercise (P values ranging from below .001 to .095). As qualitative feedback, participants requested to be able to use the software without much preparation and suggested several desirable future features, such as performance tracking and goal-setting. Conclusions: While the pitch training module should not be considered a complete GAVT package, TruVox represents a promising foundation for further GAVT software because it was perceived as usable and motivating and allowed participants to improve their exercise performance. To our knowledge, TruVox is the first GAVT software that combines real-time voice visualization with structured exercises, and this study represents the first quantitative human subjects evaluation of GAVT software. In the future, TruVox will be expanded with additional modules such as resonance training, then tested in longer-term trials.

Objectives: To compare self‐reported voice, cough, and dyspnea symptom impacts, aerodynamics, and laryngeal kinematics in young adults who do and do not use electronic cigarettes. Methods: A total of 26 electronic cigarette users ( EC group; 10 male, 16 female) and 39 nonusers (control group; 10 male, 29 female) completed the study. Standardized questionnaires related to voice, dyspnea, and cough symptoms were completed. Aerodynamic measures of peak expiratory flow and volume for cough, subglottal pressure, and vital capacity were obtained. Laryngeal kinematics were evaluated during tasks of sustained /i:/ and /hi‐hi/ from high‐speed videoendoscopy. Comparisons between EC and controls were examined, and regression analyses were calculated to evaluate how characteristics of use (e.g., duration, frequency, co‐use with marijuana) were related to outcome measures. Results: The EC group reported significantly greater voice and cough symptoms on standardized questionnaires compared to controls, with a longer duration of use significantly related to greater symptoms. Use of marijuana was related to greater cough symptoms as well. The EC group also exhibited significantly smaller vocal fold adductory velocities during /hi‐hi/ productions as well as significantly lower amplitude quotient variability and phase asymmetry. Conclusion: This study provides preliminary evidence of the negative effects of daily electronic cigarette use in young adults, with users reporting more voice/cough symptoms, along with subtle changes to laryngeal kinematics. However, voice and cough aerodynamics were not affected. Future studies should investigate how factors of duration and use of marijuana influence voice and cough in electronic cigarette users. Level of Evidence: III.

BACKGROUND Transgender people often experience distress due to a mismatch between their gender and the way their voice is perceived (eg, transgender women with low pitch), which significantly reduces their mental health and quality of life. This is especially a problem for transfeminine people and can be reduced with gender-affirming voice training (GAVT), but such training is often inaccessible due to factors such as price and geographical constraints. OBJECTIVE We aim to improve the limited availability of GAVT by developing and testing a free web-based software platform (named TruVox; University of Cincinnati) that would combine real-time feedback about the user’s voice with structured vocal pitch exercises for transfeminine people. METHODS The current publicly accessible TruVox prototype focuses on vocal pitch training with 5 structured exercises that provide real-time pitch visualizations as well as supporting videos and text. It was tested in 2 evaluation stages: initial remote usability evaluations and a later single-session in-person evaluation with 21 transfeminine participants under the supervision of 2 researchers. In remote evaluations, participants reported bugs and usability issues that were iteratively addressed. In the in-person evaluation, participants tested the final software prototype and filled out the System Usability Scale, then performed 10 repetitions of different exercises to gauge performance improvement with practice. They also filled out the Intrinsic Motivation Inventory for each exercise. RESULTS The System Usability Scale score had a mean of 79.8 (SD 12.8) on a 100-point scale, Intrinsic Motivation Inventory scores were high (eg, interest/enjoyment over 11/14), and exercise performance significantly improved in all but 1 exercise (P values ranging from below .001 to .095). As qualitative feedback, participants requested to be able to use the software without much preparation and suggested several desirable future features, such as performance tracking and goal-setting. CONCLUSIONS While the pitch training module should not be considered a complete GAVT package, TruVox represents a promising foundation for further GAVT software because it was perceived as usable and motivating and allowed participants to improve their exercise performance. To our knowledge, TruVox is the first GAVT software that combines real-time voice visualization with structured exercises, and this study represents the first quantitative human subjects evaluation of GAVT software. In the future, TruVox will be expanded with additional modules such as resonance training, then tested in longer-term trials.

Objective: This pilot study was designed to test the tolerability of a lower scope position and feasibility of custom‐designed MATLAB graphical user interface (GUI) used to analyze playback review of laryngeal high‐speed videoendoscopy (laryngeal HSV) during healthy volitional dry swallows. We hypothesized this method would conceptually provide time resolution for glottic closure events compared with standard (30 frames per second, fps), and enable a means to measure timing, sequence, and duration of laryngeal movements during swallowing not otherwise visualized. Methods: A total of 14 healthy adults (4 male, 22–80 years) participated. We performed laryngeal HSV at 500fps. Measurements included: (i) feasibility and tolerability of the procedure; (ii) identification of a swallowing segment of interest (SOI) for the peak of the swallow; and (iii) description of laryngeal swallowing movements using a GUI. Results: Fourteen subjects tolerated the procedure without discomfort and swallow images were able to be analyzed in 12. Using our GUI, mean SOI was 260 ms, yielding 130 frames for analysis (compared with seven in standard laryngoscopy). Vocal fold adduction, vocal fold medialization, and anterior–posterior arytenoid compression to the epiglottis prior to whiteout could be identified and sequenced. Conclusion: Participants tolerated a low position of the endoscope during dry volitional swallows. The output of our GUI demonstrated a novel technique for identifying, describing, and sequencing a swallowing SOI. Future studies should investigate laryngeal closure and arytenoid positioning with a bolus and in a range of ages, genders, and etiologies in both healthy and abnormal populations to better understand swallowing physiology. Level of Evidence: NA Laryngoscope , 135:1737–1743, 2025

Purpose: Voice and swallowing are distinct functions that share anatomical and physiological properties; however, research investigating their intersection is limited. The purpose of this scoping review was to explore the literature surrounding the relationship between voice and swallowing measures in healthy adults and those with non-degenerative disorders. Specifically, we aimed to elucidate whether objective voice measures could be used as correlates of swallowing function. Method: We systematically searched four databases (Embase, PubMed, CINAHL, and Web of Science) for relevant literature using a combination of key words and controlled vocabulary generated from the Yale Mesh Analyzer. The inclusion criteria consisted of peer-reviewed studies in the English language that reported on healthy adults and/or patients with non-degenerative neurological disorders and pulmonary diseases and contained instrumental and/or objective voice and swallowing measures. Two raters completed the abstract screening process followed by independent full-text reviews. Case studies, review studies, gray literature, or abstract-only studies were excluded. Results: Among 5,485 screened studies, 182 were fully reviewed, with only 11 studies meeting the inclusion criteria. Eight studies found an association between voice and swallowing objective measures, whereas the other three did not. Significant voice measures that were related to swallowing safety and/or physiology included maximum fundamental frequency ( F 0), F 0 range, maximum phonation time, biomechanics of effortful pitch glides, and voice onset time. Conclusions: Although there was heterogeneity in the measures used, specific objective voice measures showed promise in clinical practice as a screening tool for dysphagia. Further investigations are needed to validate the clinical utility of these measures across diverse patient populations.