Speech Emotion Recognition in People at High Risk of Dementia.

Background and Purpose: The emotions of people at various stages of dementia need to be effectively utilized for prevention, early intervention, and care planning. With technology available for understanding and addressing the emotional needs of people, this study aims to develop speech emotion recognition (SER) technology to classify emotions for people at high risk of dementia. Methods: Speech samples from people at high risk of dementia were categorized into distinct emotions via human auditory assessment, the outcomes of which were annotated for guided deep-learning method. The architecture incorporated convolutional neural network, long short-term memory, attention layers, and Wav2Vec2, a novel feature extractor to develop automated speech-emotion recognition. Results: Twenty-seven kinds of Emotions were found in the speech of the participants. These emotions were grouped into 6 detailed emotions: happiness, interest, sadness, frustration, anger, and neutrality, and further into 3 basic emotions: positive, negative, and neutral. To improve algorithmic performance, multiple learning approaches were applied using different data sources-voice and text-and varying the number of emotions. Ultimately, a 2-stage algorithm-initial text-based classification followed by voice-based analysis-achieved the highest accuracy, reaching 70%. Conclusions: The diverse emotions identified in this study were attributed to the characteristics of the participants and the method of data collection. The speech of people at high risk of dementia to companion robots also explains the relatively low performance of the SER algorithm. Accordingly, this study suggests the systematic and comprehensive construction of a dataset from people with dementia.

Update of Vocal Fold Shortening With Retrodisplacement of Anterior Commissure for Voice Feminization.

OBJECTIVES: To assess the efficacy and long-term durability of the enhanced technique of Type II Vocal Fold Shortening and Retrodisplacement of the Anterior Commissure (VFSRAC) for voice feminization compared with the preceding Type I method. METHODS: A retrospective analysis encompassed 506 patients drawn from a cohort of 1025 MtF transgender women who underwent VFSRAC between 2003 and 2021. The study period included cases from 2015 to 2021, during which the Type II update technique was implemented, involving a modification to the suture technique. Subjective and perceptual evaluations, aerodynamic and acoustic assessments, real-time pitch analysis, and videostroboscopic reviews were conducted pre- and postoperatively in the MtF transgender women cohort. Comparative statistical analyses were performed to discern differences between the earlier Type I method (2003-2014) and the more recent Type II method (2015-2021). RESULTS: The preoperative mean speech fundamental frequency (sF0) for Type II VFSRAC was 134.5 Hz. Postoperatively, the mean sF0 increased to 196.7 Hz, 212.3 Hz, and 207.5 Hz at 3 months, 6 months, and beyond 1 year, respectively, exceeding outcomes observed with the Type I method. Postoperative subjective and objective assessments indicated an augmentation in voice femininity. Acoustic and aerodynamic indices were within the normal range, and the regularity of the vocal fold mucosal wave was preserved within normal parameters. These results suggest that patients achieved a natural phonation pattern after surgery. CONCLUSIONS: The application of our updated type II VFSRAC has demonstrated feasibility and consistently yielded favorable results for individuals desiring a naturally feminine voice. LEVEL OF EVIDENCE: 3 Laryngoscope, 2024.

Case Report: Benefits of LSVT LOUD in a multilingual patient with hypokinetic-hyperkinetic dysarthria and suspected progressive supranuclear palsy.

Purpose: This case study measured how well the Lee Silverman Voice Treatment (LSVT) improved vocal features, intelligibility, and communicative effectiveness for a multilingual participant with hypokinetic-hyperkinetic dysarthria secondary to suspected progressive supranuclear palsy. LSVT treatment was chosen for the participant due to the strengths and deficits he presented with prior to treatment, and for the anticipated challenges in treatment that may arise from the presence of multilingualism and impaired cognitive functioning. Methods: A multilingual patient in their 60's (English, Spanish, and French) with hypokinetic-hyperkinetic dysarthria secondary to suspected progressive supranuclear palsy completed the standard treatment sessions for LSVT. Assessment measures were taken at baseline, immediately post-treatment, and three-months post-treatment. Results: Improvements were measured in vocal quality, vocal loudness, intelligibility, and communicative effectiveness immediately post-treatment. Three months post-treatment, improvements in vocal quality and intelligibility were maintained. Conclusion: This case study illustrates that LSVT may be a beneficial treatment for complex clients who are multilingual and present with complex comorbidities and cognitive deficits. LSVT resulted in some meaningful changes in vocal quality, intelligibility, and communicative effectiveness for this individual. Clinicians who work with complex patients may wish to consider the theoretical underpinnings of LSVT, client profile, areas of client need, and ability and desire to complete an intensive treatment program to determine if trialing LSVT is appropriate. The use of LSVT with complex clients may yield positive outcomes.

Evaluation of Subjective and Objective Voice Characteristics in Patients With Bulimia Nervosa.

OBJECTIVE: The present study aims to examine subjectively and objectively the voice changes in bulimia nervosa (BN) patients at different stages of treatment. METHOD: The study was conducted with a study group including 10 patients followed up with a diagnosis of BN and a control group consisting of 10 healthy participants of a similar age group without eating disorders. The Reflux Symptom Index (RFS) was used for stroboscopic evaluation. The fundamental frequency (F0), jitter, shimmer, and noise-to-harmonics ratio were determined during acoustic voice analysis. Maximum phonation time was analyzed. A subjective evaluation was performed using the Voice Handicap Index-10 (VHI-10). RESULTS: Jitter, shimmer, VHI-10 score, and RFS values showed a statistically significant difference in the patient and control groups (P < 0.05). The mean values of jitter, shimmer, VHI-10 score, and RFS were higher in the patient group than in the control group. Maximum phonation time did not differ between groups (P > 0.05) Age and F0 (Hz) values showed no statistically significant difference in the patient and control groups (P > 0.05). CONCLUSIONS: In BN patients, the laryngopharyngeal reflux mechanism causes negative effects on vocal cord examination and acoustic sound analysis parameters, leading to subjective dissatisfaction.

A Quality Improvement Study to Identify Deterrents and Improve Voice Patient Compliance with Follow-Up.

OBJECTIVE: Evaluation and treatment for voice disorders may optimally involve multiple treatment modalities. However, even in multispecialty clinics, patients may be less likely to comply with follow-up compared to patients seen for other otolaryngologic complaints. We investigated the factors contributing to noncompliance and then implemented quality improvement metrics aimed at improving our clinical noncompliance rates. METHODS: Noncompliant patients were identified as those who had been seen in our multispecialty voice care clinic and instructed to follow-up but had not returned within 6months. Patients were telephoned for a brief survey. Surveys were completed in two rounds, pre- and post-quality improvement efforts. RESULTS: On the initial round of surveys, the most frequently cited reason for discontinuing care was financial (38.5%), some (30.8%) did not like the clinic location, and some felt follow-up would not be helpful (46.2%). The clinic location was subsequently moved outside of the downtown metropolitan area, and multidisciplinary care team approaches were implemented within this same, larger office space. A second round of surveys was then administered, wherein significantly fewer patients endorsed financial concerns as a reason for care discontinuation of care (Chi2 =8.689, P = 0.003). While fewer patients (22.6%) disliked the clinic location, this difference was not significant. A significantly greater number of patients endorsed feeling better as their reason for not following up (Chi2 =5.551, P = 0.018). CONCLUSIONS: This study reports quality improvement efforts aimed at identifying and addressing factors that contribute to voice care noncompliance. Ease of clinic access and affordability appear to be substantial factors. Optimizing clinic location, emphasizing the importance of continuity of care, and offering comprehensive approaches may improve patient adherence to voice care recommendations. LEVEL OF EVIDENCE: 2b.

The Immediate Effect of Straw Phonation in Children With Repaired Cleft Palate.

OBJECTIVE: This study aims to investigate the immediate effect of straw phonation on the phonation of Persian-speaking children with repaired cleft palate. STUDY DESIGN: Quasi-experimental preintervention and postintervention. METHODS: Seventeen children with repaired cleft palate and velopharyngeal dysfunction were investigated. A control group was established comprising children without a cleft palate (control group), carefully matched in terms of age and gender. All participants underwent straw phonation and assessment. The assessments were made two times: at baseline and immediately after straw phonation. Each participant performs straw phonation (a short straw measuring 3 mm in inner diameter and 20 cm in length) once for 3 minutes. The acoustic analysis including parameters, such as jitter, shimmer, harmonics-to-noise ratio (HNR), cepstral peak prominence (CPP) parameters, as well as the electroglottography (closed quotient [CQ]) analysis were performed at pretreatment and immediately after treatment. RESULTS: Compared with the pretreatment values, after-treatment observation demonstrated a significant reduction in Jitter % and Shimmer %, and a significant enhancement in HNR and CPP among children with repaired cleft palate. There is no significant difference in intragroup data in the CPP and CQ in pretreatment. CONCLUSIONS: The proposed straw phonation technique results in an immediate positive change in the quality of voice in both groups. Moreover, assessments in the clinical group showed a significant decrease in shimmer and jitter perturbation, alongside elevated levels of HNR and CPP subsequent to straw phonation, irrespective of the phonatory task.

Close approximations to the sound of a cochlear implant.

Cochlear implant (CI) systems differ in terms of electrode design and signal processing. It is likely that patients fit with different implant systems will experience different percepts when presented speech via their implant. The sound quality of speech can be evaluated by asking single-sided-deaf (SSD) listeners fit with a cochlear implant (CI) to modify clean signals presented to their typically hearing ear to match the sound quality of signals presented to their CI ear. In this paper, we describe very close matches to CI sound quality, i.e., similarity ratings of 9.5 to 10 on a 10-point scale, by ten patients fit with a 28 mm electrode array and MED EL signal processing. The modifications required to make close approximations to CI sound quality fell into two groups: One consisted of a restricted frequency bandwidth and spectral smearing while a second was characterized by a wide bandwidth and no spectral smearing. Both sets of modifications were different from those found for patients with shorter electrode arrays who chose upshifts in voice pitch and formant frequencies to match CI sound quality. The data from matching-based metrics of CI sound quality document that speech sound-quality differs for patients fit with different CIs and among patients fit with the same CI.

Adopting a stance of vulnerability in healthcare evaluation: Amplifying the patient voice.

This paper argues that one aspect of re-imagining evaluation in health planning and management is for leaders and clinicians to develop comfort with vulnerability when engaging in service evaluations. Starting with an exploration of how the service user voice is traditionally expressed in healthcare evaluation, the paper then proceeds to explore the particular role and challenges faced by clinician-evaluators, including their role as 'privileged interlocutors' in conversations with service users. The tensions in reconciling the role of the clinician as an expert, with the related but different skills needed for effective discourse in qualitative evaluation are explored, and it is asserted that it is important for clinicians and leaders to be comfortable in showing and working with vulnerability when evaluating healthcare interventions. Clinicians are already skilled in holding discourse with service users, and extending the communication repertoire to include the management of emotion and expression of vulnerability is achievable and rewarding. The paper concludes that the ability to hold a vulnerable stance when conducting evaluation can have benefits in reducing defensiveness, encouraging a truer sense of enquiry and amplifying the service user voice.

Is tetrodotoxin intoxication the cause of "zombi voice" in Haiti?

OBJECTIVE: Zombification, a magical and religious process in Haiti, has been scientifically studied and remains relevant. Originating from the convergence of African, Caribbean, and Christian rites, it involves a comatose trance, transforming individuals into living dead through Voodoo practices. Haitian zombies consistently exhibit a preserved expression marked by a nasal voice, a result of nasalization-using nasal cavities as resonators during phonation. The aim of this study was to ascertain the mechanisms through which zombification could impact the voices of the subjects. METHODS: A comprehensive investigation was conducted using both primary and secondary sources. Primary sources involved direct or reported testimonies of individuals undergoing zombification, with audio or video recordings available from the collections of the Laboratory of Anthropology, Archaeology, and Biology (UVSQ/Paris-Saclay University), as well as on the internet. Secondary sources encompassed the entirety of existing literature regarding zombification in Haiti on one hand, alterations in the voices of subjects when mentioned on the other hand, and toxicological hypotheses or evidence available on PubMed/Medline and Google Scholar. RESULTS: Few post-zombification observations exist, but 20th-century studies clarified the physio pathological process, confirming its reality. Wade Davis demonstrated in 1983 that zombification results from poisoning, with effects ranging from reversible to fatal, implicating substances like tetrodotoxin and datura. Nasalization can be natural or pathological, affecting various phonemes. No mutilating acts or surgery have been reported related to Haitian zombification. CONCLUSION: The pharmacological characteristics of tetrodotoxin, coupled with testimonials, present a medical hypothesis elucidating the biological mechanism underlying nasalization in this context. Given that tetrodotoxin induces flaccid paralysis as a neurotropic poison, its neurological impact could account for soft palate paralysis or spasms. Additionally, the severe hypotension induced by tetrodotoxin may elucidate oral and pharyngeal necrosis.

Music as an Evolved Tool for Socio-Affective Fiction.

The question of why music evolved has been contemplated and debated for centuries across multiple disciplines. While many theories have been posited, they still do not fully answer the question of why humans began making music. Adding to the effort to solve this mystery, we propose the socio-affective fiction (SAF) hypothesis. Humans have a unique biological need for emotion regulation strengthening. Simulated emotional situations, like dreams, can help address that need. Immersion is key for such simulations to successfully exercise people's emotions. Therefore, we propose that music evolved as a signal for SAF to increase the immersive potential of storytelling and thereby better exercise people's emotions. In this review, we outline the SAF hypothesis and present cross-disciplinary evidence.

Reliability and Validity of the Turkish Version of the Screening Index for Voice Disorder (SIVD-TR).

OBJECTIVES: We investigated the reliability and validity of the Turkish version of the Screening Index for Voice Disorder (SIVD-TR). METHODS: The original SIVD1 translated into Turkish, followed by a translation back into English by a linguist. The text was finalized by an evaluation committee. This translated version was then administered to a cohort of 223 teachers in Ankara, Turkey, encompassing both those with and without voice disorders (WVD and WOVD). After a duration of 7-14days, a random selection of 53 teachers underwent the questionnaire once more. Statistical analyses were conducted to evaluate the reliability and validity of the index. Cronbach's alpha and test-retest methods were used to scale the reliability. A cutoff point was determined to decide the risk of a voice disorder, by using a Receiver Operating Characteristic curve. The validation process is concluded by computing sensitivity and specificity values, comparing mean scores between WVD and WOVD subjects, and finally examining correlations between SIVD-TR and the Turkish version of the Voice Handicap Index (VHI-10). RESULTS: The internal consistency reliability exhibited high significance, with Cronbach's alpha measuring at 0.872. The test-retest correlation coefficient for the total scores was 0.80. The SIVD-TR consists of 12 symptoms, each accounting for 1 point on the scale. The identified cutoff for identifying the risk of a voice disorder is 4 (four) symptoms, with a sensitivity of 55.2%. A correlation of 69% was observed between SIVD-TR and VHI-TR. A significant association was noted between the risk of having a voice disorder and the actual presence of a voice disorder. Subjects with a voice disorder exhibited higher mean SIVD scores, providing further evidence of the questionnaire's discriminative validity. CONCLUSION: The Turkish adaptation of SIVD demonstrated both reliability and validity, establishing itself as a robust tool for identifying voice disorders.

Does Vocalization Increase the Positive Valence of Emotion?

PURPOSE: This study aims to determine if the act of voicing can have an effect on mood. DESIGN: A within-participant reversal paradigm, where each participant served as their own control. METHODS: Following a baseline condition, 40 participants (8 male, 32 female, none disclosed as other) underwent three experimental conditions: breathing, articulating, and voicing. After each condition, participants underwent a picture-viewing emotion-induction paradigm using the International Affective Picture System followed by rating their current mood and arousal. RESULTS: Immediately following the articulating condition, aversive pictures were rated as less unpleasant compared with the other conditions. Additionally, arousal levels were rated lower immediately following the articulating and voicing conditions in response to the positive pictures. CONCLUSIONS: The findings showed that the act of making speech sounds, not simply voicing by itself, may influence the way we process emotions.

Long-Term Outcomes of Pediatric Laryngeal Reinnervation.

OBJECTIVE: Pediatric nonselective laryngeal reinnervation (NSLR) has gained popularity in recent years; however, long-term outcomes have not been reported. METHODS: Patients greater than 1 year post reinnervation were recruited. Families were asked to report Pediatric Voice-Related Quality of Life (PVRQOL) and provide an audio recording of connected speech. PVRQOL and voice measures were compared with preoperative and early postoperative outcomes (<12 months) using analysis of variance (ANOVA) for repeated measures and post hoc tests for linear trend. RESULTS: Sixty-six patient families were contacted. Twelve patients responded with PVRQOL; six (50%) were female. Median age at surgery was 6.4 (range 1.9-15) and at follow-up 13.5 (range 10-18), with a median of 6.8 years (range 3-9.1) since surgery at follow-up. Mean preoperative PVRQOL was 68.1 (95% CI 52.3-84.0), early postoperative 86.5 (73.2-99.7), and long-term 90 (82.7-97.3). ANOVA showed no significant difference between values (p = 0.1228), but post hoc testing showed improving outcomes over time (p-for-trend 0.0304). PVRQOL was stable between early postoperative and long-term values (p = 0.3399). Four voice samples were adequate for analysis. Mean preoperative cepstral peak prominence (CPP) was 5.2 (95% CI 3.4-7.0), early postoperative 8.5 (5.5-11.5), and long-term 6.8 (2.77-10.89, p = 0.3340, p-for-trend 0.2988) Low-to-high spectral ratio was 22.3 preoperatively (14.0-30.5), 23.0 early postoperative (17.4-28.7), and 28.8 long-term (17.4-40.2, p = 0.1174, p-for-trend 0.0364). Cepstral spectral index of dysphonia (CSID) was 83.0 preoperatively (44.1-121.8), 39.4 early postoperative (20.4-58.3), and 45.53 long-term (-0.05-91.1, p = 0.4457, p-for-trend 0.1464). CONCLUSIONS: Years after NSLR, PVRQOL, low-to-high spectral ratio, and CSID show no evidence of degradation over time. LEVEL OF EVIDENCE: 4 Laryngoscope, 2024.

Comparing five-factor personality traits and psychological distress between dysphonic patients and individuals with vocally healthy voices.

INTRODUCTION: It was reported that voice can carry information about personality and psychological distress. In the current study, the relationship between five-factor personality traits and psychological distress with voice was enlightened from diverse aspects. METHODS: A total of 119 participants (55 with and 64 without dysphonia) sustained vowels /a/ and /i/, read six standard sentences, and answered a question. Three raters auditory-perceptually evaluated the vocal samples using the Persian version of CAPE-V. The participants were distributed into four groups (vocally healthy, mild, moderate, and severe dysphonia). They completed two questionnaires: NEO Five-Factor Inventory (NEO-FFI) and Depression, Anxiety, and Stress Scale-21. RESULTS: Results showed that the conscientiousness (U = 1146.500, z = -3.27, p = .001) in the dysphonia group was significantly less than the vocally healthy group. Depression (U = 1381.000, z = -2.03, p = .042) and anxiety (U = 1181.000, z = -3.10, p = .002) in the dysphonia group were significantly higher than in the vocally healthy group. In comparing different abnormal overall voice qualities, the mild dysphonia group revealed significantly lower conscientiousness (p = .001) and significantly higher anxiety (p = .002) relative to the vocally healthy group. CONCLUSIONS: Findings indicated that the conscientiousness trait could play an influential role in persons with dysphonia and its psychological status. The voice care team should consider conscientiousness and psychological distress during the assessment and treatment of dysphonic patients.

Longitudinal Coadaptation of Older Adults With Wearables and Voice-Activated Virtual Assistants: Scoping Review.

BACKGROUND: The integration of smart technologies, including wearables and voice-activated devices, is increasingly recognized for enhancing the independence and well-being of older adults. However, the long-term dynamics of their use and the coadaptation process with older adults remain poorly understood. This scoping review explores how interactions between older adults and smart technologies evolve over time to improve both user experience and technology utility. OBJECTIVE: This review synthesizes existing research on the coadaptation between older adults and smart technologies, focusing on longitudinal changes in use patterns, the effectiveness of technological adaptations, and the implications for future technology development and deployment to improve user experiences. METHODS: Following the Joanna Briggs Institute Reviewer's Manual and PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines, this scoping review examined peer-reviewed papers from databases including Ovid MEDLINE, Ovid Embase, PEDro, Ovid PsycINFO, and EBSCO CINAHL from the year 2000 to August 28, 2023, and included forward and backward searches. The search was updated on March 1, 2024. Empirical studies were included if they involved (1) individuals aged 55 years or older living independently and (2) focused on interactions and adaptations between older adults and wearables and voice-activated virtual assistants in interventions for a minimum period of 8 weeks. Data extraction was informed by the selection and optimization with compensation framework and the sex- and gender-based analysis plus theoretical framework and used a directed content analysis approach. RESULTS: The search yielded 16,143 papers. Following title and abstract screening and a full-text review, 5 papers met the inclusion criteria. Study populations were mostly female participants and aged 73-83 years from the United States and engaged with voice-activated virtual assistants accessed through smart speakers and wearables. Users frequently used simple commands related to music and weather, integrating devices into daily routines. However, communication barriers often led to frustration due to devices' inability to recognize cues or provide personalized responses. The findings suggest that while older adults can integrate smart technologies into their lives, a lack of customization and user-friendly interfaces hinder long-term adoption and satisfaction. The studies highlight the need for technology to be further developed so they can better meet this demographic's evolving needs and call for research addressing small sample sizes and limited diversity. CONCLUSIONS: Our findings highlight a critical need for continued research into the dynamic and reciprocal relationship between smart technologies and older adults over time. Future studies should focus on more diverse populations and extend monitoring periods to provide deeper insights into the coadaptation process. Insights gained from this review are vital for informing the development of more intuitive, user-centric smart technology solutions to better support the aging population in maintaining independence and enhancing their quality of life. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/51129.

Exploring the barriers to feminine healthcare access among marginalized women in Bangladesh and facilitating access through a voice bot.

In today's digital age, ensuring high-quality healthcare services is paramount for both physical and mental well-being. This is particularly challenging in developing countries like Bangladesh, where marginalized individuals, especially women, face barriers to accessing essential healthcare. Financial constraints and limited awareness often hinder their ability to avail themselves of private or public healthcare services. Besides, women have distinct healthcare difficulties compared to men, and they are also more likely to catch certain illnesses and diseases. However, there is a noticeable gap in the existing literature, with insufficient research specifically dedicated to addressing the healthcare challenges faced by this underprivileged group of women in developing countries. In this study, we delve deeper into the healthcare challenges faced by underprivileged women in Bangladesh, including issues related to menstruation and gynecological disorders through a field study in a slum area. Drawing valuable insights from this field study, we propose leveraging voice bots in the telecommunications sector as an innovative solution to provide accessible and targeted healthcare support for marginalized women. We present the prototype of such a voice bot to be available 24/7 with detailed workflow and performance evaluation. We expect that our study will contribute to the ICTD scholarship by informing future interventions for economically disadvantaged communities as well as informing policymakers grappling with the healthcare challenges faced by underprivileged women.

Practicing voice: student voice experiences, democratic school culture and students' attitudes towards voice.

The abilities of citizens to make themselves heard and listen to each other are essential for the functioning of democratic societies. Schools are practice grounds for these citizenship competences. This study investigates whether students' experiences with voice in school are related to their attitudes towards voice (contributing and listening democratically), and how a democratic school culture affects this relation. Overall, 5297 students, from 240 classrooms, in 81 Dutch secondary schools, participated in the study. Results of multilevel analyses revealed that students' voice experiences at school, their own and those of their classmates, are positively related to students' attitudes towards contributing and listening democratically. This relation is not affected by a democratic school culture. These findings underline the relevance of opportunities to practice voice at school for all students and of the social nature of practicing voice. More generally, this study illustrates the importance of understanding schools as practice grounds for citizenship.

Assessing the Effectiveness of Voice Therapy Techniques in Treating Dysphonia: An Otolaryngological Review.

Dysphonia is a prevalent condition that can impact individuals across all age groups. It occurs when normal voice quality is altered, caused by structural and/or functional issues. Evaluation and assessment from clinicians are warranted if dysphonia persists for more than four weeks and/or is coupled with risk factors or other concerning clinical manifestations. Additionally, voice disorders can increase the risk of depression and anxiety disorders, as well as raise stress levels and lower self-reported health indicators. Dysphonia can have a substantial influence on interpersonal interactions and lower overall quality of life since effective communication relies significantly on spoken language. Hence, managing dysphonia is essential for enhancing communication abilities, improving quality of life, maintaining vocational functioning, promoting psychological well-being, and addressing underlying health concerns. Speech and language therapy, medical management, surgery, or a combination of the aforementioned are all possible treatments for dysphonia. Speech and language therapy is often the first-line treatment option for dysphonia patients who do not meet the criteria for surgical intervention. Voice therapy is often beneficial and remains the first line of treatment, even when patients approach with benign vocal fold nodules. A well-designed voice therapy program improves both the quality of life and vocal performance. The majority of the studies in the existing literature advocate for and report beneficial outcomes associated with voice therapy; however, more research is needed to provide evidence-based findings to guide clinical practice and achieve optimal outcomes. This comprehensive review elaborately highlights the utilization and efficacy of various voice therapeutic modalities utilized for the management of dysphonia in light of current literature.

Total tracheoesophageal puncture failure: A scoping review of patient characteristics and etiologies.

OBJECTIVES: Tracheoesophageal prosthesis (TEP) is a common method for post-laryngectomy speech rehabilitation. Despite its common use, some patients ultimately fail TEP rehabilitation. TEP dysfunction negatively affects quality of life due to poor voice quality and need for repeated interventions to restore TEP function. Occasionally, voice rehabilitation with TEP is completely unsuccessful. We performed a scoping review to characterize the main reasons for total TEP failure, in hopes of guiding selection of optimal TEP candidates. STUDY DESIGN: Scoping review using PubMed of all English language articles from 1990 to 2020 addressing causes of TEP failure. METHODS: This scoping review followed the population, intervention, comparison, outcome and study (PICOS) guidelines. Total TEP failure was defined as complete loss or abandonment of TEP voice or tract. A comprehensive search strategy using PubMed's MeSH subject headings and keywords was created. Causes and rates of failure were reviewed. RESULTS: Among 544 peer-reviewed journal articles reviewed for inclusion. Seventy articles met inclusion criteria, resulting in a total of 4928 TEP voice restoration patients for analysis. 15.2% of these patients had total TEP failure. The most common reasons for failure were dissatisfaction with voice (26.3%), leakage (17.9%), inadequate patient motivation (14.7%), comorbidities (14.2%), stoma problems (11.6%), and abandonment of TEP after dislodgement (10.6%). CONCLUSION: Common reasons for TEP failure included voice dissatisfaction, leakage, lack of patient motivation, patient comorbidities, and stoma problems. These factors should be considered when selecting candidates for TEP voice restoration.