Experiences of Patients with Unilateral Vocal Fold Paralysis: A Mixed-Methods Study of the Insider's Perspective.

OBJECTIVE: Unilateral vocal fold paralysis (UVFP) is often characterized by severe dysphonia and has a significant impact on a patient's communication in daily and vocational situations. Having a better understanding of how UVFP influences quality of life and patient experiences can help improve patient-centered care in this population. Therefore, the purpose of this study was to explore the lived experiences of patients with UVFP. METHODS: Twenty-five adults with UVFP (age range: 39-84years) participated in the study. Quantitative data were collected from 22 participants, using the Voice Handicap Index (VHI), Dysphonia Severity Index (DSI), and Acoustic Voice Quality Index (AVQI). Qualitative data were collected from 25 individual semistructured interviews, which were recorded, transcribed, and analyzed with the software program NVivo. The interviews were coded using an inductive thematic approach. RESULTS: Quantitative results showed a mean DSI of - 1.6, mean AVQI of 3.80, and mean VHI of 45.8 in the participant group. A statistically significant, moderate (positive) correlation was found between VHI and time after onset (in years). From the qualitative analysis of the interviews, four main themes were identified: emotional impact, psychosocial impact, physical complaints, and coping strategies. Voice problems caused by UVFP generally had a negative impact on patients' emotional and psychological well-being, with considerable effects on participation, self-identity, and professional activity. Participants demonstrated a combination of problem-focused and emotion-focused coping strategies to accommodate to these issues. Half of the participant group also showed avoidance as a coping style. VHI scores were significantly higher in participants who reported experiencing current emotional and participation problems due to UVFP, and who had not yet accepted their new voice. CONCLUSION: The themes from this study emphasize the importance of focused anamnesis and emotive counseling in practice, with specific attention to the psychosocial and emotional impact of UVFP.

Clinical Experiences of Speech-Language Pathologists in the Rehabilitation of Unilateral Vocal Fold Paralysis.

PURPOSE: Unilateral vocal fold paralysis (UVFP) is a neurological voice disorder that is often first treated by a speech-language pathologist (SLP). In literature, little consensus is found regarding voice therapy onset, duration, frequency, and content. The aim of the current study is to investigate the clinical practice of SLPs for treatment of UVFP regarding diagnostics and treatment characteristics. Additionally, the study examined the personal experiences of SLPs regarding UVFP care. METHOD: An online survey was completed by 37 respondents, all SLPs with experience in treating UVFP. Demographic characteristics, experiences with voice assessments and treatment modalities were examined. Lastly, experiences and opinions of SLPs on evidence-based practice and their own clinical practice were surveyed. RESULTS: Almost all respondents used a multidimensional voice assessment with findings from laryngovideostroboscopy to assess UVFP. Laryngeal electromyography is not yet integrated in regular clinical practices. The most commonly used vocal techniques were resonant voice exercises, laryngeal manipulation, semioccluded vocal tract exercises (SOVTEs), vocal hygiene, and Vocal Function Exercises, with SOVTEs most often considered effective. A total of 75% of the respondents feel confident treating UVFP, and 87.6% believe it is important to stay updated on evidence-based practice. Variation in therapy timing and dosage was observed, and 48.4% of SLPs usually started early voice therapy within 4 weeks after UVFP onset. CONCLUSION: Flemish SLPs generally feel confident treating UVFP patients and show interest in improving evidence-based practice. Initiatives to train clinicians further in UVFP care and encouraging SLPs to provide practice-based evidence will enhance the knowledge base for evidence-based practice in UFVP.

Immediate effects of a semi-occluded water-resistance ventilation mask on vocal outcomes in women with dysphonia.

INTRODUCTION: Semi-occluded vocal tract exercises (SOVTEs) are frequently used exercises in voice therapy. An important shortcoming to most SOVTEs is the inability to include continuous speech in these exercises. A variation of water-resistance therapy (WRT), during which a patient phonates through a resonance tube ending in water, was developed to include continuous speech: the semi-occluded water resistance ventilation mask (SOVM-WR). The current study investigated the immediate effects of this innovative technique on vocal outcomes of women with dysphonia. METHODS: A pretest-posttest randomized controlled trial was performed. Twenty female participants were randomly assigned to the experimental SOVM-WR group or the WRT (control) group. A blinded multidimensional voice assessment was conducted before and after a 30-minute therapy session with the assigned technique. RESULTS: No significant changes were found in acoustic or auditory-perceptual vocal outcomes in either of the groups, except for a significant increase in lowest frequency in both groups. Patient-reported outcomes (PROMs) showed significant improvements of vocal comfort, vocal effort, and voice quality in both groups, and participants indicated that they would use the techniques at home. CONCLUSIONS: The similar results of the SOVM-WR to WRT and promising PROMs confirm its suitability as an alternative to the latter technique. Potential reasons for a lack of improvement of objective and auditory-perceptual vocal outcomes are vocal fatigue, tube dimensions and immersion, and the small sample size. Large-scale and longitudinal research is needed to examine whether the SOVM-WR has a higher transfer to spontaneous speech than WRT after a full therapy program.

Immediate effects of straw phonation in air or water on the laryngeal function and configuration of female speech-language pathology students visualised with strobovideolaryngoscopy: A randomised controlled trial.

BACKGROUND: A promising way to obtain vocal economy and efficiency is by semi-occluding the vocal tract while phonating. Current knowledge about the immediate effects of semi-occluded vocal tract (SOVT) phonation on the laryngeal function and configuration is based mainly on computer modelling or excised larynges studies. In in vivo SOVT studies, electroglottography (EGG) has been the most commonly used laryngeal outcome, showing contradictory results between studies. Therefore, exploring these aspects by direct visualisation of the human larynx during SOVT phonation using strobovideolaryngoscopy (SVL) is needed. AIMS: The aim of this study was to investigate and compare the immediate effects of straw phonation (SP) in air, SP in 2 cm water, and SP in 5 cm water (with stirring straws), on the laryngeal function and configuration of a homogeneous group of vocally healthy female speech-language pathology students, visualised with flexible SVL. METHODS & PROCEDURE: A randomised controlled trial was used. Fifty-two female speech-language pathology students (mean age: 18.7 years, SD: 0.6) were assigned randomly to one of three experimental groups or a control group: (1) SP in air, (2) SP in 2 cm water, (3) SP in 5 cm water or (4) [u] phonation with similar soft onset and slightly pursed lips as in SP but without a straw (control group). The participants underwent flexible SVL during habitual [u] phonation, followed by the specific SOVT exercise of their group assignment. All video samples were evaluated randomly and blindly by two experienced investigators using the Voice-Vibratory Assessment with Laryngeal Imaging (VALI) rating form, first independently and then by consensus. OUTCOME & RESULTS: Compared to habitual phonation, the vibrational amplitude decreased during SP in 5 cm water and SP in 2 cm water, being more prominent in the first, more flow-resistant exercise. The mucosal wave also decreased during SP in 5 cm water. The anteroposterior (AP) supraglottic compression similarly increased during SP in air, SP in 2 cm water, and SP in 5 cm water. Further, a rise in mediolateral (ML) compression and a decrease in phase symmetry and regularity were found during SP in 2 cm water. A similar decrease in regularity was observed during SP in 5 cm water. CONCLUSIONS & IMPLICATIONS: Both SP in air and SP in water cause positive immediate laryngeal effects for voice training opportunities. More AP supraglottic activity found during each SP exercise might indicate epilarynx narrowing, an economic phenomenon associated with SOVT. Immersing the straw in water additionally diminished the vibrational amplitude, lowering vocal fold impact stress and risk for phonotrauma during the exercise. The decreased regularity of the vibrational cycles during SP in water might be due to the varying back pressure created by the water bubbling. The impact of SP in water on ML supraglottic compression needs further investigation. WHAT THIS PAPER ADDS: What is already known on the subject A promising way to obtain vocal economy and efficiency is by semi-occluding the vocal tract while phonating. Current knowledge about the immediate effects of semi-occluded vocal tract (SOVT) phonation on the laryngeal function and configuration is based mainly on computer modelling or excised larynges studies. In in vivo SOVT studies, electroglottography (EGG) has been the most commonly used laryngeal outcome, showing contradictory results between studies. Therefore, exploring these aspects by direct visualisation of the human larynx during SOVT phonation using strobovideolaryngoscopy (SVL) is needed. What this paper adds to existing knowledge Group results of the current study generally support earlier computer modelling and in vivo studies, strengthening the current SOVT knowledge. Both SP in air and SP in water cause positive immediate laryngeal effects for voice training opportunities. More anteroposterior (AP) supraglottic activity found during each SP exercise might indicate epilarynx narrowing, an economic phenomenon associated with SOVT. Immersing the straw in water additionally diminished the vibrational amplitude, lowering vocal fold impact stress and risk for phonotrauma during the exercise. The decreased regularity of the vibrational cycles during SP in water might be due to the varying back pressure created by the water bubbling. The impact of SP in water on ML supraglottic compression needs further investigation. What are the potential or actual clinical implications of this work? Current results support that both SP in air and SP in water can be useful exercises in voice training. SP in water has shown the additional gain of lowering the vibrational amplitude during the exercise, hence supporting its appropriateness for vocal warm-ups by minimising vocal fold impact stress and the risk of phonotrauma. In the future, large-scale randomised controlled trials in other subgroups of voice users, including dysphonic patients, are needed to support evidence-based practice. SVL can facilitate the search for individualised training and therapy approaches.

Longitudinal Vocal Outcomes and Voice-Related Quality of Life After Selective Bilateral Laryngeal Reinnervation: A Case Study.

PURPOSE: Bilateral vocal fold paralysis (BVFP) is a severe disorder that can result in respiratory, swallowing, and voice-related problems. Most surgical treatments do not restore laryngeal function and often need to compromise voice quality to preserve respiratory function. Laryngeal reinnervation (LR) may offer a solution to this problem, but literature on longitudinal outcomes of this procedure is scarce. This study aims to report the longitudinal vocal outcomes of BVFP after LR and subsequent voice therapy. METHOD: The case of a 23-year-old man with BVFP after a traumatic dissection of both recurrent laryngeal nerves is described. Selective bilateral LR of both adductors and abductors was performed 5 months after the onset of BVFP. Voice therapy was provided after the LR procedure. Multidimensional voice assessments, including acoustic, perceptual, and patient-reported outcome measures (PROMs), were conducted 2, 5, 6.5, 8, and 31 months after LR. RESULTS: An improvement of vocal capabilities and voice quality was noticed 6.5 months after LR, after 4.5 months of voice therapy, with normative values after 2.5 years. PROMs showed an improvement of voice-related quality of life, but some limitations to activities of daily living were still present. Inspiratory arytenoid abduction was not observed on laryngeal videostroboscopic findings in this patient, but tracheostomy was not required. CONCLUSIONS: Voice therapy after LR helps establish healthy and efficient voice use without increasing compensatory hyperfunctional behavior. More research is needed to examine potential merits of voice therapy in the rehabilitation of vocal and respiratory functions after LR.

Peer attitudes towards adolescents with speech disorders due to cleft lip and palate.

BACKGROUND AND AIMS: Individuals with speech disorders are often judged more negatively than peers without speech disorders. A limited number of studies examined the attitudes of adolescents toward peers with speech disorders due to a cleft lip with or without a cleft of the palate (CL ± P). Therefore, the aim of the present study was to investigate the attitudes of peers toward the speech of adolescents with CL ± P. METHOD: Seventy-eight typically developing adolescents (15-18 years, 26 boys, 52 girls) judged audio and audiovisual samples of two adolescents with CL ± P based on three attitude components, i.e., cognitive, affective, and behavioral. The degree of speech intelligibility was also scored by their peers. The study investigated whether the three attitudes were determined by speech intelligibility or appearance of an individual with CL ± P. Furthermore, the influence of knowing someone with a cleft, the age, and gender of the listeners on their attitudes were explored. RESULTS: A significantly positive correlation was found between the speech intelligibility percentage and the three different attitude components: more positive attitudes were observed when the speech intelligibility of the speaker was higher. A different appearance due to a cleft lip does not lead to more negative attitudes. Furthermore, boys seem to have more negative attitudes toward individuals with CL ± P compared to girls. CONCLUSION: This study provided additional evidence that peers show more negative attitudes toward adolescents with less intelligible speech due to CL ± P. Intervention should focus on changing the cognitive, affective, and behavioral attitudes of peers in a more positive direction and remove the stigma of patients with a cleft. Further research is needed to verify these results.

Normative Speech Data in Professional Opera Singers- A Retrospective Study.

The term "singer" refers to a population of individuals who perform musical songs or related artistic material using their voices. Research has indicated that, as a population, singers' voice parameters differ from the non-singer population. Given the fact that diagnosed voice pathologies are more prevalent in the singer population, normative speech data in singers are necessary for diagnosis and for outcome analysis. OBJECTIVES: The purpose of this study was to compare objective voice parameters for the professional opera singer population with KAYPENTAX CSL normative values. METHODOLOGY: Medical records of students at an elite opera conservatory who came into the senior author's (RTS) office for a baseline evaluation were reviewed retrospectively. All subjects had no voice complaint and had not undergone voice surgery. Subjects with vocal fold mass and scar were excluded. All subjects had undergone objective voice measurements by one of three board certified speech-language pathologists using the KAYPENTAX CSL (computerized Speech Lab) protocol. Mean, standard deviation, median and range were compared with normative values provided by KAYPENTAX CSL. RESULTS: Twenty-seven elite opera conservatory students (11 females and 16 males, ages 21-29 years) were included in the study. There were significant differences between singers and normative values of KAYPENTAX CSL. Among men, the jitter, relative average perturbation and noise- to- harmonic ratio among singers were significantly lower than KAYPENTAX CSL normative values. Among the females, the shimmer percent of singers was significantly higher than KAYPENTAX CSL normative values. CONCLUSION: Our findings indicate that singers may have different normative voice parameters. However, further research is needed to confirm or refute these findings, and similar studies are needed for singers in other genres.

Voice Quality of Choir Singers and the Effect of a Performance on the Voice.

BACKGROUND: The voice use of choir singers is understudied despite the imbalance of high vocal demands versus low vocal education, and consequently increased risk for voice problems. Also, there is a lack of information on the effects of a performance on choristers' voices. Available studies included performances of at least one hour. To date, no studies investigated the effects of a choir performance with a duration resembling vocal warm-ups. PURPOSE: The first purpose of this study was to determine the voice quality, capacities, symptoms and voice-related quality of life of choir singers. Secondly, the effect of a short choir performance, resembling warm-up duration (15 minutes), on the choristers' voices was investigated. METHODS: A randomized controlled trial was used. Thirty adult choir singers (25 women, 5 men; mean age: 32 years) were assigned randomly to an experimental group or a control group. Participants in the experimental group sung in choir for 15 minutes immediately after their pre voice assessment, whereas the control group was instructed to have standard voice use (one-on-one conversation with the investigator, no singing) across that time span. A second voice assessment was repeated afterwards. RESULTS: The choir singers showed excellent voice quality and capacities with mean scores on the Dysphonia Severity Index and Acoustic Voice Quality Index of 7.5 and 2.0, respectively. Auditory-perceptually, the mean grade score was 5/100 corresponding with a normal to mildly deviant voice quality. Patient-reported outcome measures showed mean deviant scores, indicating a considerable singing voice handicap. The choir singers seem vulnerable for stress with a high occurrence rate of 76.7% (23/30). Compared with the control group, the Dysphonia Severity Index significantly improved, whereas the self-perceived presence of vocal fatigue and complaints increased after 15 minutes of choir singing. Fundamental frequency increased in both groups, being more outspoken in the experimental group. CONCLUSIONS: Choir singers show excellent voice quality and capacities, that further improve after a short choir performance of 15 minutes. Vocal fatigue and complaints, on the other hand, already increased after that short time span. Realizing that vocal load is much higher in real-life rehearsals, competitions and performances, choristers deserve and need a qualitative voice training and a strict follow-up. Future research should focus on effective vocal warm-up and cool-down programs for this population.

Listeners' attitudes towards voice disorders: An interaction between auditory and visual stimuli.

OBJECTIVE: People with dysphonia are judged more negatively than peers with normal vocal quality. This preliminary study aims to (1) investigate correlations between both auditory-perceptual and objective measures of vocal quality of dysphonic and non-dysphonic speakers and attitudes of listeners, and (2) discover whether these attitudes towards people with dysphonia vary for different types of stimuli: auditory (A) stimuli and combined auditory-visual (AV) stimuli. Visual (V) stimuli were included as a control condition. METHOD: Ten judges with no experience in the evaluation of dysphonia were asked to rate A, AV and V stimuli of 14 different speakers (10 dysphonic and 4 non-dysphonic speakers) Cognitive attitudes, evaluation of voice characteristics and behavioral attitudes were examined. Pearson and Spearman correlation coefficients were calculated to examine correlations between both Dysphonia Severity Index (DSI) values and perceptual vocal quality as assessed by a speech-language pathologist (PVQSLP) or perceptual vocal quality as assessed by the judges (PVQjudge). Linear mixed model (LMM) analyses were conducted to investigate differences between speakers and stimuli conditions. RESULTS: Statistically significant correlations were found between both perceptual and objective measures of vocal quality and mean attitude scores for A and AV stimuli, indicating increasingly negative attitudes with increasing dysphonia severity. Fewer statistically significant correlations were found for the combined AV stimuli than for A stimuli, and no significant correlations were found for V stimuli. LMM analyses revealed significant group effects for several cognitive attitudes. CONCLUSION: Generally, people with dysphonia are judged more negatively by listeners than peers without dysphonia. However, the findings of this study suggest a positive influence of visual cues on the judges' cognitive and behavioral attitudes towards dysphonic speakers. Further research is needed to investigate the significance of this influence.

Vocal Quality, Symptoms, and Habits in Musical Theater Actors.

PURPOSE: The purpose of this study was to measure and compare the voice characteristics and vocal complaints and habits of musical theater actors and musical theater students. METHOD: Thirty participants were included in the study, 18 musical theater students and 12 professional musical theater actors. Vocal quality was measured by the multiparameter indices Dysphonia Severity Index (DSI) and Acoustic Voice Quality Index (AVQI). A perceptual evaluation of the speaking voice was performed using the GRBASI scale. All participants completed the Voice Handicap Index (VHI), the VHI adapted to the singing voice, the Vocal Tract Discomfort (VTD) Scale and the Corporal Pain Scale. RESULTS: Excellent scores for DSI (resp. 7.3, 7.1) and AVQI (resp. 2.6, 2.5) were found in the musical theater actors and students. All participants reported at least two symptoms of VTD and the mean scores for the VHI adapted to the singing voice were located in the clinical zone. Musical theater students reported significantly more VTD and pain symptoms compared to the professionals. No significant differences in perceptual and objective voice characteristics were found between musical theater actors and students. A higher presence of vocal misuse and stress in the students was observed. CONCLUSION: Musical theater students and actors are elite vocal performers with comparable excellent objective vocal measures (DSI, AVQI). In both groups, an increased number of VTD and complaints of the singing voice were reported. Especially students were vulnerable for stress, vocal misuse, VTD, and pain symptoms. The findings suggest that musical theater actors are a risk group for developing voice disorders requiring multidimensional voice assessment and voice care.

Articulation skills in bilingual children with a migration background: a comparison between bilingual Turkish-Dutch, Arabic-Dutch and monolingual Dutch children.

BACKGROUND/AIMS: There is a lack of studies investigating articulation skills in bilingual children with a migration background. Therefore, the present study compared articulation skills in bilingual Turkish-Dutch/Moroccan Arabic-Dutch children with migration background and monolingual Dutch children without migration background. Moreover, possible factors influencing articulation skills were determined. METHODS: 15 bilingual Turkish-Dutch, 15 bilingual Moroccan Arabic-Dutch and an age and gender matched group consisting of 15 monolingual Dutch children, all aged between 6 and 7 years and living in Flanders, were included in the present study. Articulation was evaluated using a picture naming test. Speech samples were transcribed phonetically and articulatory analysis, including a phonetic inventory and phonetic and phonological analyses, was performed. The phonetic analysis made a distinction between distortions, substitutions, additions, and omissions. For the phonological analysis, a distinction between syllable structure processes, substitution processes and assimilation processes was made. Moreover, parents were administered a self-report questionnaire to determine possible factors influencing articulation skills. RESULTS: A statistically significant difference in additions was found when comparing the three groups. Interestingly, both the Turkish-Dutch and Moroccan Arabic-Dutch groups used additions that were not present in the Dutch group (i.e. respectively addition of the [ə] and [ər]). Concerning phonological analysis, it was found that deletions of final consonants were more present in the bilingual groups compared to the monolingual group. Moreover, statistically significant effects of origin, home language, and language preference of the child were found on presence of both phonetic errors and phonological disorders. CONCLUSION: Findings of the present study showed that some phonetic errors and phonological processes were more present in the group of bilingual children with migration background compared to the group of monolingual children without migration background. Interestingly, phonetic errors and phonological processes were more present when (1) the child had a Turkish origin, or (2) when the dominant language at the home environment was Turkish, or (3) when the preferred language of the child was Turkish. Given the increased attention to migration, findings of the present study are highly important for speech-language pathologists, teachers, and more generally, all professionals working with bilingual populations with a Moroccan Arabic or Turkish migration background.

Reliability results of perceptual ratings of resonance, nasal airflow and speech acceptability in patients with cleft palate by Ugandan speech-language pathologists following a two-day workshop.

INTRODUCTION: To meet the scarcity of training and/or educational initiatives in Uganda regarding state-of-the-art speech diagnosis and treatment in patients with cleft palate, a workshop was organized for all interested speech-language pathologists and health care workers. OBJECTIVE: To evaluate and compare the inter- and intra-rater reliability of the perceptual evaluation of hypernasality, hyponasality, nasal emission, nasal turbulence and speech acceptability before and after a two-day workshop in Ugandan speech-language pathologists. METHODS: On the first day, perceptual speech evaluation was discussed and practiced. Perceptual exercises included individual ratings of a specific speech variable followed by a group discussion and consensus listening exercises in listener pairs. The second day focused on speech treatment. Ten Ugandan speech-language pathologists rated speech samples of Ugandan patients with a CP ± L before and immediately following the two-day workshop. Inter- and intra-rater reliability of the perceptual ratings of hypernasality, hyponasality, nasal emission, nasal turbulence and speech acceptability were determined by means of the absolute percentage of agreement. The Wilcoxon signed-rank test was used to compare results at both time points. RESULTS: Overall inter- and intra-rater reliability improved when observing the absolute percentage agreement. However, median agreement results only showed enhanced reliability for hypernasality, hyponasality and nasal turbulence whereas (limited) deteriorated reliability was observed for nasal emission and speech acceptability. Regarding inter-rater reliability only the median percentage agreement for hyponasality exceeded 50% (median: 56.3%). Overall, better results were found for intra-rater reliability, with only weak results for speech acceptability. DISCUSSION AND CONCLUSION: Training positively affected reliability results. Nonetheless, this improvement was not achieved for each speech variable and reliability improvements were modest. Findings indicate the need for continued training and the search for the most effective training paradigm and feedback techniques, whilst taking into account clinical relevance and practical considerations.

A cleft care workshop for speech and language pathologists in resource-limited countries: The participants' experiences about cleft care in Uganda and satisfaction with the training effect.

OBJECTIVES: workshops and specialized training programs are often inaccessible for speech and language pathologists (SLPs) based in resource-limited countries given the lack of supply, the long travel distances and the excessive participation fees. To stimulate life-long learning opportunities for all, this study described and measured the effect of a free, two-day cleft care workshop for SLPs in Uganda. The workshop included different topics related to the assessment and treatment of children with a cleft of the palate with or without a cleft of the lip (CP ± L). METHODS: The participants who presented during the two-day course were asked to complete a pre- and post-workshop questionnaire to evaluate their satisfaction. The pre-workshop form also included some questions concerning cleft care in Uganda. Both the pre- and post-workshop forms included three visual analogue scales to investigate the evolution of the participants' estimation of their knowledge regarding speech in patients with a CP ± L and to assess the changes in their self-confidence in the diagnosis and treatment of this population. RESULTS: seventeen SLPs completed the pre- and post-workshop questionnaires. In general, the participants were highly satisfied with the different themes covered in the program. After the training course, the participants rated their general knowledge about CP ± L and their self-confidence in the diagnosis and treatment of children with a CP ± L significantly higher than before the workshop. CONCLUSION: the vast majority of the SLPs reported that cleft care was not easily accessible in Uganda. The most commonly reported obstacle for cleft care was a lack of knowledge about this matter in the SLPs themselves highlighting the importance of the organization of additional education opportunities. The participants reported a significantly higher level of self-confidence in diagnosing and treating children with a CP ± L after the workshop. The content of this workshop can form the basis for future learning opportunities for SLPs based in resource-limited countries.

Immediate Effects of a Semi-Occluded Water Resistance Ventilation Mask on Objective and Subjective Vocal Outcomes in Musical Theater Students.

Background Traditional semi-occluded vocal tract exercises (SOVTEs) are restricted to single-phoneme tasks due to the semi-occlusion at the mouth, which hinders full articulation, continuous speech, and singing. Innovative SOVTEs should overcome this limitation by creating the semi-occlusion outside the oral cavity. Purpose The purpose of this study was to investigate the immediate effects of a semi-occluded water resistance ventilation mask, which allows for continuous speech and singing, on objective (voice range, multiparametric voice quality indices) and subjective (auditory-perceptual, self-report) vocal outcomes in musical theater students. Method A pre-/posttest randomized controlled trial was used. Twenty-four musical theater students (16 women and eight men, with a mean age of 21 years) were randomly assigned into a study group and a control group. The study group received a vocal warm-up session with the innovative water resistance ventilation mask (tube attached to the mask "outside" the mouth), whereas the control group received the traditional water resistance approach (tube "inside" the mouth). Both sessions lasted 30 min and were similar with respect to vocal demand tasks. A multidimensional voice assessment including objective and subjective outcomes was performed pre- and posttraining by an assessor blinded to group allocation. Results The Dysphonia Severity Index significantly and similarly increased (improved) in both the study and control groups, whereas the Acoustic Voice Quality Index solely decreased (improved) in the control group. The intensity range significantly decreased (worsened) and the semitone range significantly increased (improved) in the study group, whereas no differences in voice range profile were found in the control group. Auditory-perceptually, a more strenuous speaking voice was noticed after the use of the traditional water resistance approach. The subjects perceived both SOVTEs as comfortable vocal warm-up exercises that decrease the amount of effort during speaking and singing, with a slight preference for the water resistance ventilation mask. Conclusions Both the innovative water resistance ventilation mask and the traditional water resistance exercise seem effective vocal warm-up exercises for musical theater students. The additional articulatory freedom of the mask might increase the phonatory comfort and the practical implementation of SOVTEs in the daily vocal warm-up of (future) elite vocal performers. The hypothesis of a higher transfer to continuous speech or singing in the mask condition has not been supported by the current study. Larger scale investigation and longer term follow-up studies are needed to confirm these preliminary results. Supplemental Material https://doi.org/10.23641/asha.11991549.