ABSTRACT
OBJECTIVES: The purpose of this study was to identify common clinical practices and experiences of voice therapists regarding the treatment of pediatric vocal fold nodules (VFNs) in Flanders, Belgium. STUDY DESIGN: Observational survey study. METHODS: A 38-item online survey was completed by 35 voice therapists (32 females, 3 males) with experience in treating pediatric VFNs. Demographic characteristics, occupational characteristics, educational characteristics, therapy content, therapy delivery model, and experience of the voice therapist were explored. Experiences of voice therapists were measured using visual analog scales (score 0-100). An extensive descriptive analysis was performed using IBM SPSS version 28. RESULTS: The majority of voice therapists (93.9%) provide a combination of direct and indirect therapy techniques when treating children with VFNs. The most commonly used direct techniques are breathing exercises (84.4%), semioccluded vocal tract exercises (71.9%) with a clear preference for resonance tube in water and resonant voice therapy, and relaxation exercises (65.6%). On average, Flemish voice therapists provide 24.80 (SD: 11.5, range: 10-50) half-hour sessions, usually at a frequency of once a week. No respondents had experience with intensive therapy or group therapy in the treatment of pediatric VFNs. Regarding the experience of voice therapists with treating VFNs in children, respondents give a mean score of 77.28 (SD: 13.7, range: 50-100) on a scale of 0 (negative experience) to 100 (positive experience). Furthermore, 96.2% of voice therapists experience difficulties during treatment and 40% feel there are not enough targeted training opportunities on the topic of pediatric VFNs. CONCLUSION: Flemish voice therapists generally feel comfortable treating pediatric VFNs. They usually provide a combination of direct and indirect therapy and use a wide range of different direct therapy techniques. However, there is still some need to organize more focused and tailor-made training initiatives.
ABSTRACT
OBJECTIVES: One role of a speech-language pathologist (SLP) is to help transgender clients in developing a healthy, gender-congruent communication. Transgender women frequently approach SLPs to train their voices to sound more feminine, however, long-term acoustic effects of the training needs to be rigorously examined in effectiveness studies. The aim of this study was to investigate the long-term effects (follow-up 1: 3months and follow-up 2: 1year after last session) of gender-affirming voice training for transgender women, in terms of acoustic parameters. STUDY DESIGN: This study was a randomized sham-controlled trial with a cross-over design. METHODS: Twenty-six transgender women were included for follow-up 1 and 18 for follow-up 2. All participants received 14weeks of gender-affirming voice training (4weeks sham training, 10weeks of voice feminization training: 5weeks pitch elevation training and 5weeks articulation-resonance training), but in a different order. Speech samples were recorded with Praat at four different time points (pre, post, follow-up 1, follow-up 2). Acoustic analysis included fo of sustained vowel /a:/, reading and spontaneous speech. Formant frequencies (F1-F2-F3) of vowels /a/, /i/, and /u/ were determined and vowel space was calculated. A linear mixed model was used to compare the acoustic voice measurements between measurements (pre - post, pre - follow-up 1, pre - follow-up 2, post - follow-up 1, post - follow-up 2, follow-up 1 - follow-up 2). RESULTS: Most of the fo measurements and formant frequencies that increased immediately after the intervention, were stable at both follow-up measurements. The median fo during the sustained vowel, reading and spontaneous speech stayed increased at both follow-ups compared to the pre-measurement. However, a decrease of 16 Hz/1.7 ST (reading) and 12 Hz/1.5 ST (spontaneous speech) was detected between the post-measurement (169 Hz for reading, 144 Hz for spontaneous speech) and 1year after the last session (153 Hz and 132 Hz, respectively). The lower limit of fo did not change during reading and spontaneous speech, both directly after the intervention and during both follow-ups. F1-2 of vowel /a/ and the vowel space increased after the intervention and both follow-ups. Individual analyses showed that more aspects should be controlled after the intervention, such as exercises that were performed at home, or the duration of extra gender-affirming voice training sessions. CONCLUSIONS: After 10 sessions of voice feminization training and follow-up measurements after 3months and 1year, stable increases were found for some formant frequencies and fo measurements, but not all of them. More time should be spent on increasing the fifth percentile of fo, as the lower limit of fo also contributes to the perception of more feminine voice.