Outcomes of a Community of Practice on Quebec Speech Language Pathologists' Voice Assessment Practices and Professional Identity

In a context where different protocols for recommended practices in clinical voice assessment exist, while there are gaps in the literature regarding the evidence base supporting assessment procedures and measures, clinicians from regions where a strong community holding expertise in clinical and scientific voice practices lack can struggle to confidently develop their voice assessment practices. In an effort to improve voice assessment practices and strengthen professional identity among speech-language pathologists in Quebec, Canada, a community of practice (CoP) was established, with the aim of promoting knowledge sharing, implementing change in clinical practice, and improving professional identity. Thirty-nine participants took part in the CoP activities conducted over a four-month period, including virtual meetings and in-person workshops. Participants had a high rate of attendance (> 74% participation rate in virtual meetings), and were highly satisfied with their participation and intended to remain involved after the project's end. Statistically significant changes in voice assessment practices were observed post-CoP, regarding probability of performing assessments (p < .001), and perceived importance of assessment for evaluative purposes (p <.001), as well as improvements in assessment specific confidence, specifically for procedure of auditory-perceptual assessment (p < .001) and purpose of aerodynamic assessment (p = .05). Moreover, there was an increase in professional identity post-CoP (p < .001) and participants felt they made significant learnings. The present study highlighted the need to involve SLPs in future research to identify assessments that are relevant to the specific evaluative objectives of SLPs working with voice, and suggests CoPs are an efficient tool for that purpose.

En un contexto en el que existen diferentes protocolos para las prácticas recomendadas en la evaluación vocal clínica, y en el que se presentan vacíos en la literatura respecto a la base de evidencia que respalda los procedimientos y medidas de evaluación, los profesionales de regiones donde no hay una comunidad sólida con experiencia en prácticas vocales clínicas y científicas pueden enfrentar dificultades para desarrollar con confianza sus prácticas de evaluación vocal. Con el propósito de mejorar las prácticas de evaluación vocal y fortalecer la identidad profesional entre los logopedas de Quebec, Canadá, se estableció una comunidad de práctica (CdP). Esta tenía como objetivo fomentar el intercambio de conocimientos, implementar cambios en la práctica clínica y mejorar la identidad profesional. Un total de treinta y nueve participantes se involucraron en las actividades de la CdP, llevadas a cabo durante un período de cuatro meses, que incluyeron reuniones virtuales y talleres presenciales. Los participantes tuvieron una alta tasa de asistencia (> 74% de participación en las reuniones virtuales) y expresaron un alto grado de satisfacción con su participación, manifestando su intención de continuar involucrados después de la finalización del proyecto. Se observaron cambios estadísticamente significativos en las prácticas de evaluación vocal posterior a la CdP, en lo que respecta a la probabilidad de llevar a cabo evaluaciones (p < .001) y la percepción de la importancia de la evaluación con fines evaluativos (p < .001), así como mejoras en la confianza específica en la evaluación, particularmente en el procedimiento de evaluación auditivo-perceptual (p < .001) y el propósito de la evaluación aerodinámica (p = .05). Además, se registró un aumento en la identidad profesional posterior a la CdP (p < .001) y los participantes sintieron que obtuvieron aprendizajes significativos. El presente estudio destacó la necesidad de involucrar a los logopedas en investigaciones futuras, para identificar evaluaciones pertinentes a los objetivos evaluativos específicos de los logopedas que trabajan con la voz, y sugiere que las CdP son una herramienta eficiente con ese propósito.

Student's Self-Reported Experience of Soundscape: The Link between Noise, Psychological and Physical Well-Being.

Extensive research has shown that noise has detrimental effects on learning in classrooms, yet schools remain noisy environments. In addition, little is known about the students' insight into their subjective reaction to noise. Students' awareness of noise, as well as their perception of its effects on their affective and bodily states, remain unanswered. In the current study, the self-reported experience of noise and reaction towards noise, which was collected by way of a questionnaire, was assessed for 408 students in primary and secondary schools in Québec. Results suggest that about half of the students experience affective and bodily reactions to noise, and students who report having a negative affective reaction to noise are also more prone to report feeling this noise in their bodies. The results of this study offer a comprehensive picture of the students' subjective (affective and bodily) state in relation to noise in schools.

Enfin, a podcast in French on stuttering! - "Je je je suis un podcast": Impacts of accessing stuttering-related information in one's mother tongue.

PURPOSE: English-language podcasts on stuttering are numerous. However, stuttering-related podcasts in French are far more rare. In order to create a space to explore stuttering for a French-speaking population, the Association bégaiement communication (ABC), a French-Canadian stuttering organization, produced "Je je je suis un podcast". This study seeks to understand 1) how French, as the language of the podcast, has impacted accessibility to stuttering-related information in the Francophone stuttering community, and 2) how this information impacted listeners' experience with stuttering. METHOD: An anonymous online survey which included multiple choice, Likert scale and open-ended questions was conducted to better understand the impact, among listeners, of having access to a stuttering-related podcast in French. Answers were analyzed quantitatively and qualitatively. RESULTS: Eighty-seven people (40 people who stutter [PWS], 39 speech-language pathologists [SLP]/SLP students, eight parents/close persons to a person who stutters), who had listened to "Je je je suis un podcast" participated in the survey. All three populations reported a greater accessibility, and a sense of identification and connection facilitated because of French. SLPs reported seeing the podcast as a way to support their practice, to gain perspective from PWS, and as a lever for change in the SLP field. PWS reported that the podcast gives them a sense of belonging that encourages involvement, as well as knowledge that empowers and supports them in managing their stuttering. CONCLUSION: "Je je je suis un podcast" is a podcast about stuttering produced in French that increases accessibility to stuttering-related information and empowers PWS and SLPs.

Self-reported voice difficulties in educational professionals during COVID-19 in Quebec: a cross-sectional mixed-methods study.

Background: The health measures imposed by COVID-19 on workplaces created adverse communication settings. Our cross-sectional study aimed to document the nature and severity of the vocal difficulties experienced by educational professionals a few weeks after the implementation of health measures in schools and early childhood settings in Quebec, Canada while teaching in class.Methods: To this end, we conducted a self-report survey containing nine close-ended questions and one open-ended question regarding self-reported vocal difficulties and the implementation of health measures. The survey was answered by 194 educational professionals in October 2020.Results: Since the introduction of the health measures, respondents reported often or always: having difficulty making themselves heard (66.5%), needing to strain their voice (68.1%), having throat pain after work (38.1%), and being concerned about their vocal health (25.2%). 35.6% perceived that their voice changed moderately or a lot and 75.3% did not feel equipped to take care of their vocal health. Fisher's exact tests revealed the difficulties overall were more present in women (p < 0.05).Discussion: The qualitative analysis of open-ended question answers shows a circular process at play, where the vocal responses to the COVID-19-induced communication barriers contribute to creating more problematic communication settings, thus increasing the challenges for vocal health. Better equipping the professionals to take care of their vocal health by developing resources in their professional settings to help them face vocal challenges in both every day as well as extreme situations, should be a priority.

Participants' perspective on a COVID-19 online vocal group stimulation for people with Parkinson's disease.

The COVID-19 related confinement and social distancing had negative consequences on the health of individuals living with Parkinson's Disease (PD). In collaboration with a non-profit organization, we developed and implemented a daily online vocal stimulation group named "Musculation de la Voix" (MdlV) in April 2020. To better understand the potential of MdlV to diversify existing services available to people with PD experiencing vocal symptoms, this study aimed to explore participants' experience and perception of MdlV in terms of participation, motivations, feelings, perceived changes, and appreciation. The 45 individuals who registered to the Summer 2020 Semester of MdlV were invited to complete an online ten-question survey. Responses to the four close-ended questions were analyzed using descriptive statistics while statements provided in response to the six open-ended questions were subjected to an inductive qualitative content analysis. Thirty seven participants completed the survey. Results revealed that the sample of respondents was mostly constituted of individuals who were engaged in this activity since its very beginning (62,2%), participated daily (59,5%), intended to keep participating in the activity (97,3%), and had never received speech-language therapy (SLT) services before (72,97%). The qualitative analysis yielded one theme relating to prior services: "Previous SLT services are variable and perceived as beneficial but with limitations," and three themes pertaining to MdlV: "Seeking improvement and support as initial motivations to engage in MdlV," "Unanticipated benefits and desired gains catalyzing motivation to participate in MdlV," and "Perceived limitations of MdlV and persisting needs." Our study participants' engagement and motivation toward MdlV as well as the benefits they perceived in relation to this activity suggest that an online vocal stimulation group may be a promising complement to currently limited SLT services. As limitations and persisting needs were also identified, future studies are required to elucidate what aspect of MdlV works, for whom and how.

Vocal beauty: a mediating variable in the negative stereotyping of dysphonic speakers.

Context: A range of studies have consistently shown that listeners associate negative psychosocial characteristics to speakers with dysphonia. The reasons why have not formerly been explored. A better understanding of the mechanisms behind this negative stereotype could help to develop attitude-changing measures towards voice disorders.Aim: We want to explore if the negative psychosocial stereotype linked to dysphonia is due to dysphonia's negative impact on perceived vocal beauty.Methods: A group of naïve listeners was asked to listen to female voice samples with varying degrees of dysphonia according to the Grade (G) of the GRBAS scale, and then to rate the perceived degree of vocal beauty for each voice on a visual analogue scale. They were also asked to infer personal characteristics of each speaker on a set of 21 Bipolar semantic scales.Results: Mediation analyses showed that G significantly and negatively predicts perceptions of vocal beauty (p < .001) and that vocal beauty in its turn was significantly and positively predicting inferences of negative psychosocial characteristics in the speakers (p < .001). When vocal beauty was partialled out, the negative impact of G was diminished or even cancelled.Conclusion: Our results show that in female speakers, the negative impact of dysphonia on the attribution of speakers' personal characteristic is explained by the negative impact of dysphonia on perceived vocal beauty. Our results support the hypothesis that the beauty stereotype underlies the negative biases existing towards dysphonic speakers. We suggest that clinicians should be aware of this mechanism when promoting awareness about dysphonia.

Vocal symptoms in pediatric population: Validation of the Brazilian version of the Pediatric Vocal Symptoms Questionnaire. / Sintomas vocais na população pediátrica: Validação da versão brasileira do Questionário de Sintomas Vocais Pediátrico.

PURPOSE: To validate the Pediatric Vocal Symptoms Questionnaire (PVSQ) for Brazilian Portuguese. METHODS: The study was approved by the Ethics Committee (758,309). A total of 716 individuals participated in this research, of which 367 were children and adolescents, with and without vocal alteration, aged 6-18 years, and 349 were parents/guardians, who responded to the final version of the instrument. Among the interviewed of this version, 272 participated in the test-retest, and 32, of the sensitivity. Children and adolescents aged 6-18 years responded to the self-evaluation version of the PVSQ, and their parents/guardians to its parental version. RESULTS: The PVSQ showed acceptable reliability and reproducibility for the Brazilian population and sensitivity to vocal treatment. CONCLUSION: The PVSQ was validated for Brazilian Portuguese, being a good instrument of vocal self-evaluation, both in the parental version and in the self-evaluation version.

OBJETIVO: Validar o Questionário de Sintomas Vocais Pediátrico (QSV-P) para o português brasileiro. MÉTODO: Aprovado pelo Comitê de Ética (758.309). Participaram desta pesquisa 716 indivíduos, dos quais 367 eram crianças e adolescentes, com e sem alteração vocal, entre 6 e 18 anos, e 349 eram pais/responsáveis, que responderam à versão final do instrumento. Entre os respondentes dessa versão, 272 participaram do teste-reteste, e 32, da sensibilidade. As crianças e os adolescentes entre 6 e 18 anos responderam à versão de autoavaliação do QSV-P, e seus pais/responsáveis, à versão parental do QSV-P. RESULTADOS: O QSV-P apresentou confiabilidade e reprodutibilidade aceitáveis para a população brasileira e sensibilidade ao tratamento vocal. CONCLUSÃO: O QSV-P foi validado para o português brasileiro, sendo um bom instrumento de autoavaliação vocal, tanto na versão parental quanto na versão autoavaliativa.

Personality Traits of Children With Vocal Fold Nodules.

This is a case-control study investigating the personality profiles of children with vocal fold nodules (VFNs). Personality has been suggested as a contributing factor to VFN in adults and in children. However, previous studies in children have focused on psychopathologic traits and have reported contradictory findings. The aim of our study was to explore whether general, nonpathologic personality structure predicts the presence of VFN in children. Personality traits were measured in 34 children with VFN, aged 6.0-13.6, and 34 age- and sex-matched normophonic controls by means of a pediatric five-factor personality questionnaire. Children with VFN were found to be significantly more extroverted than controls (P = 0.022, d = 0.61), and a binary logistic regression showed that extraversion significantly predicted the presence of VFN in our population (P = 0.027). The clinical implications of the results are discussed.

Sintomas vocais na população pediátrica: Validação da versão brasileira do Questionário de Sintomas Vocais Pediátrico / Vocal symptoms in pediatric population: Validation of the Brazilian version of the Pediatric Vocal Symptoms Questionnaire

ResumoObjetivo: Validar o Questionário de Sintomas Vocais Pediátrico (QSV-P) para o português brasileiro. Método Aprovado pelo Comitê de Ética (758.309). Participaram desta pesquisa 716 indivíduos, dos quais 367 eram crianças e adolescentes, com e sem alteração vocal, entre 6 e 18 anos, e 349 eram pais/responsáveis, que responderam à versão final do instrumento. Entre os respondentes dessa versão, 272 participaram do teste-reteste, e 32, da sensibilidade. As crianças e os adolescentes entre 6 e 18 anos responderam à versão de autoavaliação do QSV-P, e seus pais/responsáveis, à versão parental do QSV-P. Resultados O QSV-P apresentou confiabilidade e reprodutibilidade aceitáveis para a população brasileira e sensibilidade ao tratamento vocal. Conclusão O QSV-P foi validado para o português brasileiro, sendo um bom instrumento de autoavaliação vocal, tanto na versão parental quanto na versão autoavaliativa.

Abstract Purpose To validate the Pediatric Vocal Symptoms Questionnaire (PVSQ) for Brazilian Portuguese. Methods The study was approved by the Ethics Committee (758,309). A total of 716 individuals participated in this research, of which 367 were children and adolescents, with and without vocal alteration, aged 6-18 years, and 349 were parents/guardians, who responded to the final version of the instrument. Among the interviewed of this version, 272 participated in the test-retest, and 32, of the sensitivity. Children and adolescents aged 6-18 years responded to the self-evaluation version of the PVSQ, and their parents/guardians to its parental version. Results The PVSQ showed acceptable reliability and reproducibility for the Brazilian population and sensitivity to vocal treatment. Conclusion The PVSQ was validated for Brazilian Portuguese, being a good instrument of vocal self-evaluation, both in the parental version and in the self-evaluation version.

Equivalência cultural da versão brasileira do Questionnaire des Symptômes Vocaux / Cross-cultural adaptation of the Brazilian version of the 'Questionnaire Des Symptômes Vocaux'

RESUMO Objetivo Realizar a equivalência cultural brasileira do Questionnaire des Symptômes Vocaux (QSV). Métodos O questionário foi traduzido para a língua portuguesa por duas fonoaudiólogas brasileiras bilíngues, cientes do objetivo da pesquisa. A retrotradução foi efetuada por uma terceira fonoaudióloga brasileira, bilíngue e professora de francês, não participante da etapa anterior. Depois da comparação das traduções e adequações necessárias nos termos e expressões, produziu-se uma única versão denominada Questionário de Sintomas Vocais Pediátrico (QSV-P), que foi aplicado a 32 indivíduos (16 crianças/adolescentes com queixa vocal e seus respectivos pais). Adotou-se como critério de inclusão a presença de queixa vocal (parental ou autorrelatada) e/ou a presença de desvio vocal na avaliação perceptivoauditiva da qualidade vocal. A opção “não aplicável” foi acrescentada na chave de resposta de todas as perguntas do QSV-P. Resultados No processo de tradução e adaptação cultural, não houve modificação e/ou eliminação de nenhuma das questões. O QSV-P reflete a versão original do francês, composto por 31 questões objetivas, aplicável a crianças/adolescentes entre 6 e 18 anos e a seus respectivos pais/responsáveis que visam investigar questões físicas, emocionais e sociofuncionais da alteração vocal. Conclusão O Questionnaire des Symptômes Vocaux apresentou equivalência cultural para o português brasileiro na versão intitulada Questionário de Sintomas Vocais Pediátrico. O processo de validação do QSV-P está em andamento.

ABSTRACT Purpose This article aims to present the cultural equivalence of the Brazilian version of the ‘Questionnaire des Symptômes Vocaux’ (QSV). Methods The questionnaire was translated into Portuguese by two Brazilian bilingual speech-language pathologists who were informed about the purpose of this research. The back translation was performed by a third bilingual Brazilian speech-language pathologist, who was also a French teacher and had not participated in the previous stage. After the comparison of translations, a final version of the questionnaire was produced and called ‘Questionário de Sintomas Vocais Pediátrico (QSV-P)’, which was administered to 32 individuals (16 children/adolescents with vocal complaints and their parents). The inclusion criterion was the vocal complaint and/or vocal quality altered on the perceptual auditory evaluation. The option “not applicable” was added to each item of the protocol. Results During the process of translation and cultural adaptation, no item was changed and/or eliminated from the questions. The QSV-P kept the same structure as the original French version with 31 questions, which can be responded by children/adolescents (6-18 years) and their parents, regarding the physical, emotional and social functioning of the vocal problem. Conclusion The cultural equivalence of the Brazilian version of the ‘Questionnaire des Symptômes Vocaux’, entitled ‘Questionário de Sintomas Vocais Pediátrico’, was demonstrated. The QSV-P validation is currently being done.

Cross-cultural adaptation of the Brazilian version of the 'Questionnaire Des Symptômes Vocaux'. / Equivalência cultural da versão brasileira do Questionnaire des Symptômes Vocaux.

PURPOSE: This article aims to present the cultural equivalence of the Brazilian version of the 'Questionnaire des Symptômes Vocaux' (QSV). METHODS: The questionnaire was translated into Portuguese by two Brazilian bilingual speech-language pathologists who were informed about the purpose of this research. The back translation was performed by a third bilingual Brazilian speech-language pathologist, who was also a French teacher and had not participated in the previous stage. After the comparison of translations, a final version of the questionnaire was produced and called 'Questionário de Sintomas Vocais Pediátrico (QSV-P)', which was administered to 32 individuals (16 children/adolescents with vocal complaints and their parents). The inclusion criterion was the vocal complaint and/or vocal quality altered on the perceptual auditory evaluation. The option "not applicable" was added to each item of the protocol. RESULTS: During the process of translation and cultural adaptation, no item was changed and/or eliminated from the questions. The QSV-P kept the same structure as the original French version with 31 questions, which can be responded by children/adolescents (6-18 years) and their parents, regarding the physical, emotional and social functioning of the vocal problem. CONCLUSION: The cultural equivalence of the Brazilian version of the 'Questionnaire des Symptômes Vocaux', entitled 'Questionário de Sintomas Vocais Pediátrico', was demonstrated. The QSV-P validation is currently being done.

On the accuracy of adults' auditory perception of normophonic and dysphonic children's personality.

We investigated the accuracy of auditory inferences of personality of Belgian children with vocal fold nodules (VFN). External judges (n = 57) were asked to infer the personality of normophonic (NP) children and children with VFN (n = 10) on the basis of vowels and sentences. The auditory inferred profiles were compared to the actual personality of NP and VFN children. Positive and partly accurate inferences of VFN children's personality were made on the basis of connected speech, while sustained vowels yielded negative and inaccurate inferences of personality traits of children with VFN. Dysphonic voice quality, as defined by the overall severity of vocal abnormality, conveyed inaccurate and low degrees of extraversion. This effect was counterbalanced in connected speech by faster speaking rate that accurately conveyed higher degrees of extraversion, a characteristic trait of VFN children's actual personality.

Voice-related complaints in the pediatric population.

Subjective evaluation of the voice by the patient is routinely assessed in the adult dysphonic population; this is, however, not the case in the pediatric population. There were three objectives of this study: the first goal was to study the ability of children aged 5-13 years to express themselves about physical, emotional, and sociofunctional aspects of their voice. The second goal was to explore if specific voice-related complaints were expressed by dysphonic children as compared with normophonic children. The third goal was to compare the dysphonic children's voice-related complaints with those of their mothers. The overall objective was to set the grounds for the elaboration of a standardized questionnaire in French concerning subjective evaluation of voice in children. Twenty-five dysphonic children with vocal complaint (15 nodules, one polyp, one microweb, eight unspecified) and 55 normophonic children aged 5-13 years were interviewed. The interviews were semistructured based on a canvas of voice-related questions. The dysphonic children's mothers were interviewed with the mean of a written questionnaire and were invited to discuss their answers orally with the examiner. The results were analyzed qualitatively and statistically. A Chi-square test and the Fisher's test were used to analyze the differences between the complaints expressed by the dysphonic and the normophonic children, and a binomial test was used to compare the children's answers with their mothers' answers. The qualitative analysis of the interviews suggests that children are capable of reflecting over their own voice and of giving autonomous information about different aspects of their voice. It also appeared that voice is a complex phenomenon and that it needs to be clearly and cautiously defined to the children. We identified 27 different complaints related to the voice, out of which 17 were significantly more expressed by dysphonic than by normophonic children (P<0.05). Three of the 27 identified complaints show significant discordances between the mothers and the dysphonic children. The results suggest that children are capable of making a subjective and autonomous evaluation of their voice and that dysphonic children experience significantly more voice-related discomfort than nondysphonic children. The complaints expressed by the dysphonic children and their mothers are not all in concordance. The main conclusion is that a standardized subjective evaluation of the voice, not only by the parents but also by the child him/herself, would be relevant in the assessment of pediatric dysphonia.

The Swedish version of the Voice Handicap Index adapted for singers.

This study evaluates a Swedish version of the Voice Handicap Index adapted for singers. A total of 96 healthy singers and 30 singer-patients completed the questionnaire. Validity and reliability, internal coherence, and group differences were assessed. The singer-patient group had significantly higher scores than the control group. Reliability was confirmed by high Cronbach's (>0.78) for test-retest scores, and for each of the sub-scales. Test-retest stability in both groups was confirmed by high correlation values alpha (>0.8). Overall scores compared closely to those from previous reports. The Swedish translation of the adapted VHI for singers (RHI-s) is valid and reliable and shows sensitivity to the singer's concerns. It can be considered a useful tool in the clinical assessment of Swedish healthy or pathological singers.

CO2 laser-assisted microsurgery for intracordal cysts: technique and results of 49 patients.

Microsurgery for intracordal cysts is a challenging procedure, because cysts are close to the vocal ligament and the risk of inducing a scar is high. In this retrospective study, our experience with the CO(2)-laser scanning system (Acublade(®)) is reported on 49 patients. There were 41% epidermoid cysts and 59% mucous retention cysts. A quarter of the patients presented with bilateral cystic lesions and 59% had a contralateral lesion other than a cyst. The cyst was removed after a minimicroflap. It was dissected away from the lamina propria and the epithelium. Collagen was injected intraoperatively if the glottal gap was considered important. The epithelium was redraped using Tissucol (Baxter, Vienna, Austria). The mean follow-up time was 160 days. We noted a statistically significant improvement in the grade of the dysphonia according to Hirano's perceptual scale (G pre = 2, G post = 1, p = 0.002); the Vocal Handicap Index (VHI pre = 51, VHI post = 28, p = 0.001) and the maximal phonation time in milliseconds (MPT pre = 11, 1 MPT post = 12.7, p = 0.033) in all the patients. In the professional voice subgroup (20/49 patients), there was a significant improvement in the frequency range (FR pre = 310 Hz, FR post = 434 Hz, p = 0.001). The CO(2)-laser scanning system is reliable in the treatment of intracordal cysts.

Relaxation thyroplasty for mutational falsetto treatment.

Mutational falsetto voice is considered to be a psychogenic disorder associated with the rejection of adulthood. The initial treatment must include speech therapy and psychotherapy. However, delayed treatment and denial of the problem can cause the disorder to become recalcitrant to behavioral treatment. Modified relaxation (type III) thyroplasty was proposed by Isshiki to shorten the vocal folds and release tension by incising and depressing the anterior segment of the thyroid cartilage. This procedure is called relaxation thyroplasty by a medial approach (anterior commissure retrusion) in the European Laryngological Society classification system. It results in a lowering of the vocal pitch. The surgery can be performed under local or general anesthesia. It should only be considered for cases not improved by speech therapy and psychological counseling. Our series included 7 male patients with a mean age of 21 years who underwent modified relaxation thyroplasty after failure of behavioral management. The assessment of outcomes was based on changes in the fundamental frequency of the voice and the Voice Handicap Index. The mean fundamental frequency was lowered from 187 Hz to 104 Hz (p < 0.001), and the mean Voice Handicap Index was improved from 70 to 21. There were no postoperative complications. The voice results were consistent over a mean follow-up of 17 months. Modified relaxation Isshiki (type III) thyroplasty is a successful treatment option for lowering vocal pitch in cases of mutational falsetto voice recalcitrant to conservative therapy.