Can perpetrators discern survivors from voice?

Background: Research has shown that potential perpetrators and individuals high in psychopathic traits tend to body language cues to target a potential new victim. However, whether targeting occurs also by tending to vocal cues has not been examined. Thus, the role of voice in interpersonal violence merits investigation.Objective: In two studies, we examined whether perpetrators could differentiate female speakers with and without sexual and physical assault histories (presented as rating the degree of 'vulnerability' to victimization).Methods: Two samples of male listeners (sample one N = 105, sample two, N = 109) participated. Each sample rated 18 voices (9 survivors and 9 controls). Listener sample one heard spontaneous speech, and listener sample two heard the second sentence of a standardized passage. Listeners' self-reported psychopathic traits and history of previous perpetration were measured.Results: Across both samples, history of perpetration (but not psychopathy) predicted accuracy in distinguishing survivors of assault.Conclusions: These findings highlight the potential role of voice in prevention and intervention. Gaining a further understanding of what voice cues are associated with accuracy in discerning survivors can also help us understand whether or not specialized voice training could have a role in self-defense practices.

We examined whether listeners with history of perpetration could differentiate female speakers with and without assault histories (presented as rating the degree of 'vulnerability' to victimization).Listeners' higher history of perpetration was associated with higher accuracy in differentiating survivors of assault from non-survivors.These findings highlight that voice could have a crucial role in prevention and intervention.

Vocal Pedagogues Training Dysphonic Voices: Treatment Seeking Approaches and Practices.

OBJECTIVE: This study examined the practices of current professional voice teachers' management of voice disorders. TYPE OF STUDY: Survey. METHODS: An online survey was developed and made available to vocal educators who had membership in organizations within the field of voice. Respondents rated their comfort with management of voice disorders, criteria for accepting a dysphonic student, and their approach within the multidisciplinary environment. RESULTS: Of 786 responses from professional vocal educators, 48% had worked with a vocalist recovering from dysphonia, vocal surgery, or a vocal pathology. Two-thirds reported management of nodules, polyps, or cysts. The majority of respondents working with injured voices had advanced degrees in vocal performance, but few had cross-training as an speech-language pathologist. Pedagogues focused on breathing strategies while speech-language pathologist pedagogues focused on resonance and reduction of phonotrauma. Pedagogues sought information on voice science and medicine from scholarly journals, attending conferences, and medical professionals. CONCLUSIONS: Vocal pedagogues were interested members of the interdisciplinary team with a desire to seek knowledge beyond their initial career training, even though additional continuing education or licensure is not mandated for vocal educators. Findings show a need for vocal degree programs to include anatomy and physiology and multidisciplinary management of voice disorders.

Intubation-Related Laryngeal Deficiency and Vocal Fold Immobility in Pediatric Premature Patients.

OBJECTIVES/HYPOTHESIS: We report a posterior laryngeal rating system and measures of voice disability in pediatric patients undergoing phonosurgery for vocal fold paralysis. Posterior glottic deficiency may account for persistent voice disability. STUDY DESIGN: Retrospective Study. METHODS: Retrospective analyses of 66 subjects with primary unilateral vocal fold paralysis were reviewed for the status of posterior glottis and voice disability (Pediatric Voice Handicap Index [pVHI]). Gestation age (GA), weight, and medical/surgical history were reviewed. The width, length, and depth of the larynx were analyzed to create a reproducible rating scale. RESULTS: Mean GA was 29 weeks, with an intubation history for all subjects, with 90% having a left vocal fold immobility. Cardiac surgery was performed in 92% of subjects. A progressive rating (type 0-3) Benjamin Defect Severity Scale (BDSS) was developed to rate the absence or presence of a posterior abnormality. BDSS-2 and BDSS-3 subjects were more likely to have low birth weight. Extremely preterm GA was more likely to be associated with BDSS-1 (mild) or BDSS-2. History of multiple and prolonged intubations were seen more frequently in BDSS-2 or BDSS-3. Post-op pVHI reduced an average of 15 points for BDSS-0 to BDSS-2, but only 3 points for BDSS-3. Post-op pVHI matched normal values for preintervention dysphonic children. CONCLUSIONS: The presence of a persistent breathy voice after intervention for unilateral vocal fold immobility is potentially associated with posterior glottic defects. Low birth weight with multiple/prolonged intubation is more likely to be present with higher-grade BDs, whereas low GA is more likely to be associated with BDSS-1 to BDSS-2. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:2550-2557, 2021.

Pediatric laryngopharyngeal reflux: Perceptual, acoustic, and laryngeal findings.

OBJECTIVES: Describe acoustic and laryngeal findings in pediatric patients with subjective dysphonia attributed to laryngopharyngeal reflux (LPR). Determine the impact of LPR on perceived voice quality using the pediatric Voice Handicap Index (pVHI). Compare these findings with age-matched normative values as well as data on pediatric patients with dysphonia due to other etiologies. METHODS: Retrospective case series of pediatric patients (age 2-17 years) evaluated at a specialty pediatric voice clinic at a tertiary care children's hospital from January 1 2007 to December 31 2017 in whom LPR in whom LPR was deemed to be the most significant contributing factor for dysphonia based on physical examination and history. Patients with structural laryngeal abnormalities unrelated to LPR, such as raised lesions, stenosis, papillomatosis, or vocal fold immobility were excluded. RESULTS: 163 out of 1195 evaluable patients met inclusion criteria. Of these, 87% had pVHI and 83% had acoustic data available from their first appointment for analysis. Mean total pVHI score was 24 (range: 0-81). Perturbation measures were elevated in both females (jitter 1.38%, shimmer 4.16%) and males (jitter 2.01%, shimmer 5.62%). Laryngologic assessment revealed: vocal fold changes including erythema and/or pre-nodules in 72% of patients. Cobblestoning of any portion of the pharynx was present in 67% with hypopharyngeal cobblestoning the most common, present in 64% of patients. CONCLUSION: Pediatric patients with clinically diagnosed LPR have pVHI, jitter, and shimmer scores that are comparable to previously reported patients with raised lesions, scar and immobility, and values that are significantly higher than published normative data. Dysphonic children should be assessed for LPR and treated when indicated. LEVEL OF EVIDENCE: 4.

Recurrent laryngeal nerve reinnervation for management of aspiration in a subset of children.

Pediatric aspiration is a multifactorial process that is often complex to manage. Recurrent laryngeal nerve (RLN) injury can cause glottic insufficiency and aspiration. We describe three cases of unilateral vocal fold paralysis resulting in aspiration and the successful use of the RLN reinnervation for its treatment. The theory for utilizing the reinnervation procedure is that when glottic closure improves and a less breathy vocalization occurs, then the larynx is better equipped to protect the lower airway and avoid aspiration. Our cases demonstrate stronger voice and improved swallow function, with normalization of modified barium swallow evaluation, at approximately 6-months post reinnervation.

A Vocal Health Survey Among Amateur and Professional Voice Users.

An international survey was conducted to provide insights into current practices related to vocal health among amateur and professional voice users. Vocalists of various genres completed an online survey related to their practice in seeking medical care for vocal health concerns, and their preferences for the type of medical help they seek. Specific vocal symptoms or conditions which the subjects feel would warrant evaluation was also queried, as well as their preference for voice use and management should laryngeal pathology be diagnosed during a medical examination. Participants were knowledgeable in both traditional and alternative medical approaches but showed a preference for those options most readily available, as opposed to those best suited for a vocal issue. Ideally, a combination of traditional and alternative management would appear to be the best long-term strategy for professional and amateur voice users.

What's in a singer's voice: The effect of attachment, emotions and trauma.

Research shows that negative experiences in childhood have a long-lasting impact on one's psychological outcomes and one's physiology. The voice is a crucial means of expression, and its complex physiology is believed to be reflective of emotional and mental states. Parenting practices (particularly those contributing to insecure attachment) and traumatic experiences in childhood may thus also influence vocal characteristics. Except for literature on psychogenic voice disorders, the relationship between such experiences and the 'normal' voice is generally unexplored; we propose that a potential relationship is most likely to emerge in singers, for whom the voice is a more central part of their sense of self. In this paper, we test the hypothesis that vocal characteristics relate to attachment and trauma history. Study 1: 25 singers (age 18-35) completed an attachment history questionnaire (ECR-R) and the Singing Voice Handicap Index. Voice range profile and perturbation measures were recorded and analyzed for voice quality assessment. Study 2: 26 singers (age 19-33) completed the attachment history questionnaire, the Childhood Trauma Questionnaire, and the State and Trait Anxiety Inventory. They were also administered the Test of Self-Conscious Affect to assess shame and guilt proneness. Voice range profile, perturbation, and spectrogram measures were recorded and analyzed. The results indicated that anxious attachment, shame, and emotional neglect can predict vocal acoustic measures of intensity and, to some extent, perturbation. This suggests the need to address attachment, shame, and trauma history patterns in the aspiring performer.

Frequency Characteristics in Animal Species Typically Used in Laryngeal Research: An Exploratory Investigation.

OBJECTIVES: Laryngeal research is typically conducted on animal species that have similar features to the human larynx, yet little is known of the frequency characteristics of those animals. This study examines frequency characteristics of dog, cat, pig, and sheep across emotional communication events. STUDY DESIGN: Prospective study. METHODS: Acoustic data were gathered in domestic environment, with fundamental frequency (fo) computation of vocalization during happy, distress, and food request activities. RESULTS: Dogs demonstrated reduced fo range and reduced vocalization as a factor of age (18 semitones for adult male dog, three semitones for aged male dog). When two barks were present, the second bark was typically shorter in length and had a higher fo. Male cat was observed to be more talkative and exhibited a much higher purr fo than his female housemate. Cat purr was varied by sex between the typical 25 Hz and a significantly higher fo, consistent with literature on use of cry-purr by some cats. Lambs exhibited phonation breaks, and an overall frequency range of 28 semitones in lambs compared with 49 semitones for mature sheep. Piglets exhibited fo range of 44 semitones with higher fo with distress and lowest fo for grunting. CONCLUSIONS: Aged animals followed similar phonatory patterns of humans, with change of fo for communication need. The male cat was found to purr differently from female cats. Pigs and cats may have nonlaryngeal source signal coupling. Animal phonation changes with emotion. Observed fo patterns may improve interpretation of phonation among laboratory animals in laryngeal research.

Recurrent laryngeal nerve reinnervation in children: Acoustic and endoscopic characteristics pre-intervention and post-intervention. A comparison of treatment options.

OBJECTIVES/HYPOTHESIS: To establish the benefit of ansa cervicalis-recurrent laryngeal nerve reinnervation (ANSA-RLN) for the management of dysphonia secondary to unilateral vocal cord paralysis (UVCP) in children. Children treated with ANSA-RLN for the management of dysphonia secondary to unilateral vocal fold immobility will have superior acoustic, perceptual, and stroboscopic outcomes compared to injection laryngoplasty and observation. STUDY DESIGN: Retrospective case-series chart review. METHODS: Laryngeal, perceptual, and acoustic analysis of dysphonia was performed in 33 children (age 2-16 years) diagnosed with UVCP. Comparison of pre-post function for treatment groups (no treatment, injection laryngoplasty, ANSA-RLN) with additional comparison between gestational ages, age at initial evaluation, and gender were examined. Perceptual measures included Pediatric Voice Handicap Index (pVHI) and Grade, Roughness, Breathiness, Asthenia, Strain (GBRAS) perceptual rating. Objective measures included semitone (ST) range, jitter%, shimmer%, noise-to-harmonic ratio, voicing, and maximum phonation time. RESULTS: Post-treatment, pVHI, jitter%, and ST were significantly improved for ANSA-RLN subjects compared to injection subjects. Improved function (laryngeal diadochokinesis, pVHI, GRBAS, and/or acoustic) was observed in all ANSA-RLN subjects who had vocal fold paralysis as the only laryngeal diagnosis. CONCLUSIONS: This study presents one of the largest studies of pediatric vocal fold paralysis diagnosis and treatment. The study looks at the spectrum of function in patients with UVCP and looks at the outcomes of options: no treatment, injection laryngoplasty, and ANSA-RLN. Although surgical outcomes vary, both injection laryngoplasty and ANSA-RLN show benefit in laryngeal function, voice stability, voice capacity, perceptual rating, and pVHI scores. Both injection laryngoplasty and ANSA-RLN showed improvements post-treatment, and should be considered for management of pediatric UVCP. However, the ANSA-RLN group showed better and longer-lasting perceptual and acoustic parameters in comparison with the injection and control groups. Reinnervation, even long term after the onset of vocal fold paralysis, should be considered a viable permanent treatment for pediatric UVCP.

Aerodynamic measures and biofeedback as management in persistent paradoxical vocal fold motion and reverse phonation.

OBJECTIVES: Paradoxical vocal fold motion (PVFM) and reverse phonation are characterized by aberrant vocal fold adduction. To date, there have been no studies examining the aerodynamic events during reverse phonation. We present an unusual case of persistent reverse phonation secondary to respiratory distress associated with PVFM. STUDY DESIGN: Case report. METHODS: We present the case of a 42-year-old female with sudden onset of respiratory distress associated with PVFM and persistent reverse phonation. She underwent baseline aerodynamic measurements followed by trial therapy. Through the use of instrumental and tactile aerodynamic biofeedback, the patient was able to coordinate exhalatory breath pressure flow during phonation, which resulted in immediately improved voice quality from highly dysphonic to nearly normal voice quality. CONCLUSIONS: Patients with reverse phonation seldom undergo aerodynamic testing as part of the initial diagnostic and management program. Our case study demonstrates the effectiveness of aerodynamic technology to enable a patient with aberrant glottic function to recognize inspiratory phonation events and to reestablish consistent expiratory flow/pressure egress in speech tasks. Instrumental and tactile biofeedback is effective for reinforcement of normal flow patterns during speech tasks.

Severity of voice handicap in children diagnosed with elevated lesions.

OBJECTIVE: This study sought to determine the impact of voice disability on children with elevated vocal fold lesions (nodules, cysts, polyps). The Pediatric Voice Handicap Index (pVHI) was used to assess the impact on functional, physical, and emotional aspects of voice and oral communication. The degree of talkativeness and overall severity of dysphonia were also determined. STUDY DESIGN: Case series with chart review of children evaluated at a voice clinic from 2007 to 2011. SETTING: Tertiary specialized children's hospital. SUBJECTS AND METHODS: Medical records of 33 children (11 girls, 22 boys) diagnosed with an elevated vocal fold lesion by a pediatric laryngologist were reviewed for voice disability using the pVHI. The pVHI is a parental proxy of perceived voice handicap in functional, physical, and emotional aspects and includes a talkativeness rating scale and visual analog overall severity rating of voice (VAS). Data were examined for young children (age 2-5 years), children (age 6-10 years), and adolescents (age 11-17 years). RESULTS: The VAS was significantly correlated with pVHI-total. There was no significant difference between age groups for overall pVHI (mean, 29.3) or talkativeness, but all groups had significantly higher functional disability (mean, 16) compared with physical (mean, 8.2) or emotional (mean, 5.1) disability. CONCLUSIONS: Children across all age groups with elevated vocal fold lesions have significant voice disability, greatest for functional aspects of voice. Voice care team professionals must recognize the functional impact of dysphonia on the pediatric patient.

Collaboration and conquest: MTD as viewed by voice teacher (singing voice specialist) and speech-language pathologist.

This study was designed as a qualitative case study to demonstrate the process of diagnosis and treatment between a voice team to manage a singer diagnosed with muscular tension dysphonia (MTD). Traditionally, literature suggests that MTD is challenging to treat and little in the literature directly addresses singers with MTD. Data collected included initial medical screening with laryngologist, referral to speech-language pathologist (SLP) specializing in voice disorders among singers, and adjunctive voice training with voice teacher trained in vocology (singing voice specialist or SVS). Initial target goals with SLP included reducing extrinsic laryngeal tension, using a relaxed laryngeal posture, and effective abdominal-diaphragmatic support for all phonation events. Balance of respiratory forces, laryngeal coordination, and use of optimum filtering of the source signal through resonance and articulatory awareness was emphasized. Further work with SVS included three main goals including a lowered breathing pattern to aid in decreasing subglottic air pressure, vertical laryngeal position to lower to allow for a relaxed laryngeal position, and a top-down singing approach to encourage an easier, more balanced registration, and better resonance. Initial results also emphasize the retraining of subject toward a sensory rather than auditory mode of monitoring. Other areas of consideration include singers' training and vocal use, the psychological effects of MTD, the personalities potentially associated with it, and its relationship with stress. Finally, the results emphasize that a positive rapport with the subject and collaboration between all professionals involved in a singer's care are essential for recovery.