Adam D. Rubin

Introduction. Auditory feedback allows individuals to monitor their vocal characteristics and adjust to maintain optimal voice quality. One type of auditory stimulation for conversational voice training/therapy is pure tone stimulation. This technique presents binaural auditory stimuli consisting of pure tones separated by half-step intervals to modify the fundamental frequency of the speaking voice and expand the vocal range. Objectives. This study aimed to characterize detectable changes in voice production following the application of pure tone stimulation (PTS) among speakers with and without voice disorders. Methods. Data from thirty-nine participants (28 individuals with voice disorders and 11 individuals with normal voices) were analyzed for this study. All participants engaged in binaural PTS exercises. Participants recorded a sustained vowel /a/ before and after the PTS exercises. Multiple acoustic voice parameters were extracted from the sustained vowel samples (fundamental frequency, pitch strength, harmonics-to-noise ratio, and smoothed cepstral peak prominence). Additionally, a visual analogue scale (VAS) interpretation of narrowband (NB) spectrograms was conducted to assess voice quality. Results. Statistically significant increases in fundamental frequency were found after the PTS exercises, except for males in the normal voices group. Pitch strength increased after the PTS, regardless of gender. Participants also demonstrated an increase in the harmonics-to-noise ratio. VAS ratings of NB spectrograms indicated improvement in voice quality following the program. Conclusions. Voice changes after performing PTS suggest voice quality improvement, as measured by acoustic analysis of vowel production and qualitative assessment of NB spectrograms among participants with and without voice disorders.

Objective: Benign phonotraumatic lesions of the vocal folds (BVFLs) are typically seen in younger female patients with high vocal loads. Hemorrhagic polyps (HPs) do not fit the classic paradigm of most BVFLs, as they tend to occur in an older population, have a male predominance, and report to result from a vocal accident. We present one of the largest cohorts of HPs, to reexamine their etiology and clinical features.Methods: Retrospective cohort study, inclusive of all patients with HP managed by the senior authors between the years 2016 through 2023. Demographic data, management, phonotraumatic risk factors, pre‐ and post‐treatment VHI‐10 were reviewed. We examined patient videostroboscopy, categorized the size of the lesion, and identified any concurrent mucosal abnormality.Results: One hundred and eleven patients had confirmed HP, 84 males (75.7%). Thirty‐five patients were size category 1; pinpoint (28.9%), 57 were category 2; less than 1/3rd the vocal fold (45.5%), and 26 were category 3; greater than 1/3rd the vocal fold (21.5%). Ten patients (9%) had bilateral HPs. Thirty‐five patients had an additional 40 mucosal lesions in addition to the HP(s). The onset of symptoms was gradual in 60% of patients. The mean pretreatment VHI‐10 was 18.0 (SD 10.7), compared to 6.0 (SD 10.5) post‐treatment, (p < .001). 57/111 patients reported high voice demand professions or recreational activities. The average self‐reported talkative scale score was 7.6/10. Patients were managed with operative microdirect laryngoscopy and microflap excision (53.1%), in‐office clinic potassium titanyl phosphate (KTP) laser (24.3%), voice therapy alone (7.2%), and KTP in the operating room (6.3%).Conclusions: In our cohort, most patients were male, had high vocal demands, reported gradual symptom onset, and almost a third of patients had additional BVFLs.Level of evidence: Level 3: Retrospective cohort study.

Background: While several acoustic voice metrics are available for clinical voice assessment, there remains a significant need for reliable and ecologically valid tools. The Acoustic Voice Quality Index version 03.01 (AVQI-3) and Acoustic Breathiness Index (ABI) hold potential due to their comprehensive assessment approach, incorporating diverse voice aspects. However, these tools still need to be validated in English-speaking populations. Methods: This study assessed the discriminatory accuracy and validity of AVQI-3 and ABI in 197 participants, including 148 with voice disorders. Voice samples were collected, followed by AVQI-3 and ABI calculations. Additionally, auditory-perceptual assessments were conducted by a panel of speech-language pathologists. Results: AVQI-3 and ABI effectively identified disordered voice quality, evidenced by high accuracy (AUCs: 0.84, 0.89), sensitivity, and specificity (thresholds: AVQI-3 = 1.17, ABI = 2.35). Strong positive correlations were observed with subjective voice quality assessments (rs = 0.72, rs = 0.77, p < 0.001). Conclusions: The study highlights AVQI-3 and ABI as promising instruments for clinically assessing voice disorders in U.S. English speakers, underscoring their utility in clinical practice and voice research.

The field of voice disorders lost a true pioneer with the passing of Dr. Cristina Jackson-Menaldi (June 21, 1950 - November 20, 2020). A renowned voice pathologist and singing voice specialist, Dr. Jackson-Menaldi made significant contributions to our understanding and treatment of voice disorders. She was also a passionate advocate for voice education and disorder prevention.

Objectives/Hypothesis To investigate the relationship of throat pain and dysphonia. Study Design Prospective cohort study. Methods Forty‐five subjects presenting with hyoid bone syndrome (HBS) and dysphonia were asked to rate their pain on a numerical rating scale and complete the 10‐item Voice‐Related Quality of Life (V‐RQOL) questionnaire prior to and at 1‐week follow‐up after treatment with triamcinolone injection into the attachments to the affected greater cornu(s). Wilcoxon signed‐rank tests were applied to evaluate if the overall V‐RQOL scores, the physical functioning (PF) and social–emotional (SE) domain scores, and pain scores changed significantly after treatment. To evaluate how change in perceived pain affected V‐RQOL, the differences in the V‐RQOL, PF, and SE domain scores, and in pain scores were calculated for each subject. Three linear models were fit to the response variables, ΔV‐RQOL, ΔPF, and ΔSE, using ΔPain as a predicting variable. Results V‐RQOL, PF, and SE domain scores, and pain scores all improved significantly with treatment. A bigger decrease in the pain score led to a bigger increase in V‐RQOL and domain scores, with slopes varying between −1.1 and −1.4. The PF domain scores showed the greatest improvement with decrease in pain scores. Conclusions Effective treatment of HBS led to improvement in patients' voice complaints, suggesting that throat pain may have a direct effect on voice. This may be related to compensatory perilaryngeal adjustments patients make when speaking with a “guarding” effect when they have throat pain. Level of Evidence IV (Cohort study) Laryngoscope, 2021