Meike Brockmann-Bauser

Purpose of review: This narrative review explores evidence- and simulation-based teaching strategies for tracheostomy management (TTM) and dysphagia in adult patients, focusing on immersive technologies and instructional approaches within speech and language education. Recent findings: Increasing clinical complexity and multimorbidity demand advanced competencies, yet many high-risk skills cannot be practiced safely in real-world settings. Simulation-based learning environments, including extended reality (XR) technologies such as virtual reality (VR), augmented reality (AR), and mixed reality (MR), provide safe, repeatable, and scalable opportunities for clinical reasoning, psychomotor skill development, and interprofessional communication. Evidence shows that VR-based TTM training improves knowledge acquisition, skill retention, and confidence. Competency-oriented instructional frameworks, including 4C/ID and ADDIE, with structured feedback and debriefing, support staged skill development. However, standardization of clinical workflows, guidelines, and outcome measures remains limited, particularly in speech and language therapy-specific scenarios. Summary: XR-based teaching enhances clinical, communication, and interdisciplinary skills in TTM. To fully realize its potential, standardized clinical guidelines, workflows, and evidence-based teaching standards are needed. Integrating VR within structured instructional models ensures pedagogical rigor and safe transfer of learning to clinical practice.

Objective: To discuss the current clinical application and usefulness, shortcomings and future directions of traditional and artificial intelligence (AI)‐driven acoustic assessment techniques to detect voice dysfunction. Data Sources: Literature review. Conclusion: AI‐based acoustic voice analysis techniques have huge potential to improve the early recognition, diagnosis, and tracking of treatment success in patients with voice disorders or diseases affecting voice function. Through smartphones, wearable devices, and server‐based solutions, acoustic voice assessment techniques have become widely available and may be extended to workplace and private settings. However, the transformative potential is thwarted by several limitations including a lack of (a) consistent data collection and reporting standards, leading to heterogeneity of current databases and literature; (b) characterization what acoustic analysis techniques including AI can detect or track reliably, and whether the derived outcomes serve as a reliable marker of dysfunction, pathology, or an improvement thereof; (c) clinical validation studies in unselected patients; and (d) ethical and legal controversies. Thus, substantial effort to research, define and establish guidelines for the collection, storage, and processing of acoustic data and valid clinical applications is warranted to design sensible strategies for analysis and use.

Purpose: 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. Method: 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 ( M _age = 53.5 years, SD = 15.7) completed them one time, and additional 12 patients ( M _age = 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. Results: 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 (∅ r _s = .76) and Factor 2 to the VTD (∅ r _s = .74), Factor 3 correlated moderately with the VHI9i ( r _s = .34) and weakly with the VTD ( r _s = .25). Results from the first and second VFI-D completion agreed strongly ( t = −1.78, p = .10). Conclusions: 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.

Purpose: Literature suggests a dependency of the acoustic metrics, smoothed cepstral peak prominence (CPPS) and harmonics-to-noise ratio (HNR), on human voice loudness and fundamental frequency ( F 0). Even though this has been explained with different oscillatory patterns of the vocal folds, so far, it has not been specifically investigated. In the present work, the influence of three elicitation levels, calibrated sound pressure level (SPL), F 0 and vowel on the electroglottographic (EGG) and time-differentiated EGG (dEGG) metrics hybrid open quotient (OQ), dEGG OQ and peak dEGG, as well as on the acoustic metrics CPPS and HNR, was examined, and their suitability for voice assessment was evaluated. Method: In a retrospective study, 29 women with a mean age of 25 years (± 8.9, range: 18–53) diagnosed with structural vocal fold pathologies were examined before and after voice therapy or phonosurgery. Both acoustic and EGG signals were recorded simultaneously during the phonation of the sustained vowels /ɑ/, /i/, and /u/ at three elicited levels of loudness (soft/comfortable/loud) and unconstrained F 0 conditions. Results: A linear mixed-model analysis showed a significant effect of elicitation effort levels on peak dEGG, HNR, and CPPS (all p < .01). Calibrated SPL significantly influenced HNR and CPPS (both p < .01). Furthermore, F 0 had a significant effect on peak dEGG and CPPS ( p < .0001). All metrics showed significant changes with regard to vowel (all p < .05). However, the treatment had no effect on the examined metrics, regardless of the treatment type (surgery vs. voice therapy). Conclusions: The value of the investigated metrics for voice assessment purposes when sampled without sufficient control of SPL and F 0 is limited, in that they are significantly influenced by the phonatory context, be it speech or elicited sustained vowels. Future studies should explore the diagnostic value of new data collation approaches such as voice mapping, which take SPL and F 0 effects into account.

The main aim of the present work was to investigate whether vocal hyperfunction (VH), perceptual voice quality (VQ), gender, and phonetic environment influence Voice Onset Time (VOT). The investigated group consisted of 30 adults, including 19 women (X = 46.1 ± 13.7 years) and 11 men (X = 47.5 ± 11.0 years), who had either phonotraumatic vocal hyperfunction (PVH) and non-phonotraumatic vocal hyperfunction (NPVH). VQ was judged considering the overall severity of dysphonia (OS) and the subcharacteristics of roughness, breathiness, and strain. Phonetic variables such as vowel stress, syllable stress, and mode of speech task were analyzed. Four samples of syllables with [p] plus vowel or diphthong were retrieved from CAPE-V sentences recordings. Acoustic analysis with Praat comprised VOT, mean fundamental frequency (fo), intensity (SPL dB(A)), and coefficient of variation of fundamental frequency (CV_fo %). VOT was significantly influenced by OS (p ≤ 0.001) but not by vocal VH condition (PVH versus NPVH) (p = 0.90). However, CV_fo was affected by the VH condition (p = 0.02). Gender effects were only found for mean fo (p ≤ 0.001) and SPL (p = 0.01). All VQ sub characteristics (OS, roughness, breathiness, and strain) correlated with VOT (p ≤ 0.001) and SPL (p ≤ 0.001) but not with fo. In summary, VOT was affected by voice quality, while it was not affected by vocal hyperfunction conditions. Therefore, VOT has the potential to objectively describe the onset of voicing in voice diagnostics, and may be one underlying objective characteristic of perceptual vocal quality.

Instrumental acoustic measurements of the human voice have enormous potential to objectively describe pathology and, thereby, to assist clinical treatment decisions. Despite the increasing application and accessibility of technical knowledge and equipment, recent research has highlighted a lack of understanding of physiologic, speech/language-, and culture-related influencing factors. This article presents a critical review of the current state of the art in the clinical application of instrumental acoustic voice quality measurements and points out future directions for improving its applications and dissemination in less privileged populations. The main barriers to this research relate to (a) standardization and reporting of acoustic analysis techniques; (b) understanding of the relation between perceptual and instrumental acoustic results; (c) the necessity to account for natural speech-related covariables, such as differences in speaking voice sound pressure level (SPL) and fundamental frequency f₀; (d) the need for a much larger database to understand normal variability within and between voice-disordered and vocally healthy individuals related to age, training, and physiologic factors; and (e) affordable equipment, including mobile communication devices, accessible in various settings. This calls for further research into technical developments and optimal assessment procedures for pathology-specific patient groups.