Vocal fatigue（VF） is the common clinical symptom of voice diseases. It can also be a separate symptom and is considered to be a signal for the body to rest and to avoid pathological damage to the vocal cords. Therefore, the early identification and evaluation of vocal fatigue is of great value to the early prevention and treatment of vocal diseases. In recent years, there are many researches on the evaluation methods of vocalization fatigue. We searched the relevant literature and summarized the application status of vocal fatigue assessment methods, in order to provide reference for the selection and development of vocal fatigue assessment tools in clinical practice.
Humans ; Voice Quality ; Voice Disorders/diagnosis* ; Vocal Cords ; Surveys and Questionnaires ; Dysphonia/diagnosis*

Rationale/Objective: The Voice Handicap Index (VHI) is a selfassessment tool that evaluates the patient’s reaction and perception to a vocal disorder. This study aimed to establish, validate and assess the reliability of the Filipino translation of the Voice Handicap Index 10 (FVHI-10). Methods: The VHI-10 was translated and adapted to the Filipino language and culture with the help of the Sentro ng Wikang Filipino- University of the Philippines Manila. A self-assessment of voice quality and FVHI-10 were performed by the patients and their GRBAS scale scoring was rated by a speech language pathologist. The Spearman’s correlation between the FVHI-10 and the self-assessment and GRBAS scale scores was obtained to test for validity. To evaluate the reliability of the FVHI-10, testing through determining internal consistency was conducted through the use of Chronbach α coefficient, inter-item correlation, item-total correlation and Cronbach α coefficient if tool item was deleted. Results: Fifty five individuals participated in the study (29 males, 26 females, age range: 30-55 years) with the diagnosis of voice disorder based on complaints of hoarseness or dysphonia and laryngoscopic findings. Convergent validity was confirmed with moderate to strong correlation between the FVHI-10 and self-assessment (r=-.893, p<.05) and GRBAS scale scores (r=.427, p<.05). Reliability as measured through internal consistency was confirmed (Cronbach α=.874) (average ρ<.5) (corrected item-total correlation>0.3) (average interitem correlation=.15-.85). Conclusion The FVHI-10 was determined to be a valid and reliable instrument that can be utilized in the assessment of Filipino patients with voice disorders.
Dysphonia ; Voice Disorders ; Quality of Life

Objective:To determine the effectiveness of individualized voice therapy in persistent pediatric voice disorders. Methods:Thirty-eight children who were admitted to the Department of Pediatric Otolaryngology Shenzhen Hospital, Southern Medical University due to persistent voice disorder from November 2021 to October 2022 were included. All children were evaluated by dynamic laryngoscopy before voice therapy. Two voice doctors performed GRBAS score and acoustic analysis on the children's voice samples to obtain the relevant parameters including F0, Jitter, Shimmer, and MPT; All children were given personalized voice therapy for 8 weeks. Results:Among 38 children with voice disorders, 75.8%（29 cases） were diagnosed with vocal nodules, 20.6%（8 cases） were vocal polyps, and 3.4%（1 case） were vocal cysts. And in all children. And 51.7%（20 cases） had the sign of supraglottic extrusion under dynamic laryngoscopy. GRBAS scores decreased from 1.93 ± 0.62, 1.82 ± 0.55, 0.98 ± 0.54, 0.65 ± 0.48, 1.05 ± 0.52 to 0.62 ± 0.60, 0.58 ± 0.53, 0.32 ± 0.40, 0.22 ± 0.36, 0.37 ± 0.36. F0, Jitter, Shimmer decreased from（243.11±39.73） Hz, （0.85±0.99）%, （9.96±3.78）% to（225.43±43.20） Hz, （0.33±0.57）%, （7.72±4.32）%, respectively MPT was prolonged from（5.82±2.30） s to（7.87±3.21） s after treatment. All parameters changes had statistical significance. Conclusion:Voice therapy can solve children's voice problems, improve their voice quality and effectively treat children's voice disorders.
Humans ; Child ; Voice Disorders/diagnosis* ; Voice ; Voice Quality ; Acoustics ; Speech Acoustics ; Vocal Cords/surgery*

Parkinson’s disease (PD) is a chronic, neurodegenerative condition resulting in various motor impairments, including speech disorders. However, at the height of the coronavirus disease 2019 pandemic, a patient with PD could not access traditional in-person neurorehabilitation care. This case report highlights the feasibility of telerehabilitation to deliver speech therapy over a distance using available resources in a developing country. We describe a Filipino elderly woman, public speaker, and marriage counselor, seeking teleconsultation for her voice problems (slow and soft) attributed to PD. At that time, most center-based outpatient rehabilitation centers in Manila were closed due to the pandemic, and the patient preferred to stay at home for safety reasons. Hence, she was evaluated and managed remotely by an interdisciplinary team (neurologist, physiatrist, speech-language pathologist) through video calls. Since the ideal rehabilitation set up (in-person evaluation and therapy; use of Lee Silverman Voice Therapy) could not be done, the clinicians had to find practical alternatives, such as remotely administering subjective perceptual voice assessments, objective speech analysis using the Praat™ computer application, and speech teletherapy through synchronous (videocalls, phone calls) and asynchronous (e-mails, text messages, pre-recorded exercise videos) techniques. Notable speech improvements were observed by the clinicians, patient, and patient’s frequent communicative partners after at least four teletherapy sessions. However, the carry-over of the improvements was affected by the patient’s lack of compliance with the prescribed home exercise program. Telerehabilitation using synchronous and asynchronous techniques for speech disorders due to PD was found feasible, beneficial, safe, and practical amid social distancing and low resources in a developing country
Speech Therapy ; Telerehabilitation ; Parkinson Disease ; Voice Disorders ; COVID-19

Purpose: Filipino speech-language pathologists (SLPs) face challenges in applying evidence-based practice (EBP) due to lack of training, exposure, and experience. Without EBP being embedded in the educational curricula and clinical practice guidelines (CPGs), SLPs will continue to face barriers in providing evidencebased services. This study aimed to map the practice patterns of SLPs on voice disorders and benchmark these practices with international evidence-based practice guidelines. Methodology: A cross-sectional descriptive survey design was used. Seventeen out of 61 (28%) Filipino SLPs with clinical experience in voice disorders responded to an online survey form. The form was composed of these sections: (1) Practice Profile, (2) Etiologies of Voice Disorders, (3) Case Study, and (4) Clinical Practice Perspectives. The quantitative and qualitative data sets were analyzed to obtain the practice profiles of SLPs and identify gaps in relation to established evidence-based practice patterns. Results: The study revealed that 70% (n=12) of clinicians fall within five years of practice and work at hospitals. Majority of their clients are adults between 26 to 80 years old. On average, clinicians see one to two clients with voice disorders every week and hold around seven to nine voice therapy sessions prior to discharge. Structural pathologies were the most frequent etiology reported. Content analysis revealed that clinicians rely on the use of clinical experience and patient values for assessment and intervention of voice disorders. Conclusion The findings suggest that Filipino SLPs managing voice disorders predominantly rely on clinical experience and patient values for clinical decision-making. They sparsely use external evidence in assessment, differential diagnosis, and intervention which might compromise the quality of care. To ensure the best patient care, EBP needs to be incorporated in undergraduate education, professional development, and regulatory requirements of the Philippine Association of Speech Pathologists.
Practice Patterns, Physicians' ; ; Voice Disorders

BACKGROUND AND OBJECTIVES: Voice disorder is recognized as a major problem because it negatively affects the elderly's social participation and quality of life. The purpose of this study was to examine the validity and reliability of Korean aging voice index (KAVI), which assesses the quality of life related to the voice of the elderly. MATERIALS AND METHOD: This study was conducted on 211 elderly people aged 65 years or older : 111 patients with voice disorder (mean age 69.8, range 65–80 years) and 100 nomorphonic participants (mean age 70.6, range 65–82 years). Aging voice index was translated into Korean and used and Korean voice-related quality of life (KVQOL) was conducted to verify KAVI. The validity (item validity, concurrent validity, and construct validity) and reliability (test-retest reliability and internal consistency reliability) of KAVI. RESULTS: The item validity (ICC=0.895) and construct validity (r=0.765) showed a high correlation, respectively. And concurrent validity (r=0.748), test-retest reliability (0.851), and internal consistency reliability (α=0.832) were statistically significant in voice disorder group. In addition, there was a significant difference between the voice disorder and the nomorphonic group in AVI total score. CONCLUSION: KAVI is a validated and reliable quality of life tool that will be useful for assessing the presence and effectiveness of interventions in clinical settings.
Aged ; Aging ; Humans ; Methods ; Quality of Life ; Reproducibility of Results ; Social Participation ; Voice Disorders ; Voice

Functional dysphonia (FD) is a disease entity which includes various voice disorders in the absence of structural or neurologic laryngeal pathology. Muscle tension dysphonia (MTD), psychogenic dysphonia are representative FD with completely different pathogenesis. Therefore there is no standard treatment modality for FD, the first step of treatment of FD is differentiating patient's voice symptoms from other organic voice disorders and other functional voice problems. MTD is a functional voice disorder caused by hyperfunction of intrinsic and extrinsic laryngeal musculature. Symptoms include increased vocal effort, roughness, fatigue and odynophonia. First line for MTD is indirect or direct voice therapy. Unfortunately, many patients with MTD improve with voice therapy alone. For these patients, various modalities tried; lidocaine application, surgical excision of the false vocal folds, and botulinum toxin injection, etc. Botulinum toxin injections are widely used in the field of otolaryngology, especially for spasmodic dysphonia. However, its use in FD or MTD has only been described in few case reports. The aim of this lecture is to evaluate the feasibility of botulinum toxin injection for FD, especially MTD.
Botulinum Toxins ; Dysphonia ; Fatigue ; Humans ; Lidocaine ; Muscle Tonus ; Otolaryngology ; Pathology ; Vocal Cords ; Voice ; Voice Disorders

Botulinum toxin (BTX) has been widely used to treat muscle spasms in many voice disorders. Most commercially available forms of BTX require reconstitution before use, which may increase the risk of contamination and requires careful titration. Recently, a liquid-type BTX type A (BTX-A) has been developed, which should simplify the procedure and enhance its efficacy. In this session, I will discuss about the differences of BTX-A from existing types and the practical issues associated with it.
Botulinum Toxins ; Dysphonia ; Spasm ; Voice Disorders

Parkinson's disease (PD) is a widespread degenerative syndrome that affects the nervous system. Its early appearing symptoms include tremor, rigidity, and vocal impairment (dysphonia). Consequently, speech indicators are important in the identification of PD based on dysphonic signs. In this regard, computer-aided-diagnosis systems based on machine learning can be useful in assisting clinicians in identifying PD patients. In this work, we evaluate the performance of machine learning based techniques for PD diagnosis based on dysphonia symptoms. Several machine learning techniques were considered and trained with a set of twenty-two voice disorder measurements to classify healthy and PD patients. These machine learning methods included linear discriminant analysis (LDA), k nearest-neighbors (k-NN), naïve Bayes (NB), regression trees (RT), radial basis function neural networks (RBFNN), support vector machine (SVM), and Mahalanobis distance classifier. We evaluated the performance of these methods by means of a tenfold cross validation protocol. Experimental results show that the SVM classifier achieved higher average performance than all other classifiers in terms of overall accuracy, G-mean, and area under the curve of the receiver operating characteristic plot. The SVM classifier achieved higher performance measures than the majority of the other classifiers also in terms of sensitivity, specificity, and F-measure statistics. The LDA, k-NN and RT achieved the highest average precision. The RBFNN method yielded the highest F-measure.; however, it performed poorly in terms of other performance metrics. Finally, t tests were performed to evaluate statistical significance of the results, confirming that the SVM outperformed most of the other classifiers on the majority of performance measures. SVM is a promising method for identifying PD patients based on classification of dysphonia measurements.
Bays ; Classification ; Diagnosis ; Dysphonia ; Humans ; Machine Learning ; Methods ; Nervous System ; Parkinson Disease ; ROC Curve ; Sensitivity and Specificity ; Support Vector Machine ; Trees ; Tremor ; Voice Disorders

OBJECTIVE: To identify the relationship between maximum phonation time (MPT) and swallowing function, as well as the elements of swallowing, in order to provide a rationale for speech therapy in patients with Parkinsonism manifesting dysphagia. METHODS: Thirty patients with Parkinsonism who underwent speech evaluation and videofluoroscopic swallowing study (VFSS) were recruited. The MPT, the longest periods of sustained pronunciation of /aa/, was evaluated. The VFSS was evaluated using Penetration Aspiration Scale (PAS), National Institutes of Health-Swallowing Safety Scale (NIH-SSS), and Videofluoroscopic Dysphagia Scale (VDS). The relationship between dysphagia scales and MPT was analyzed using Pearson correlation. The difference in VDS variables between subgroups (Parkinson disease or Parkinsonian syndrome, independent or dependent ambulation, and normal or abnormal MPT) and the difference in MPT between subgroups based on the VDS variables were analyzed using the independent t-test. RESULTS: Bolus formation and laryngeal elevation functions were significantly higher in the normal MPT group compared with the impaired group. In the VDS variables, patients with intact bolus formation, oral transit time, pharyngeal swallow triggering, and laryngeal elevation showed significantly longer MPTs compared with the impaired groups. In addition, MPT was significantly correlated with the VDS and modestly correlated with the NIH-SSS, but not the PAS, suggesting that phonatory function is related to the oropharyngeal swallowing function, but not directly to the aspiration itself. CONCLUSION: The correlation between MPT and several swallowing-related elements was identified, indicating an interactive correlation between swallowing and phonation. This result justifies voice therapy as a treatment for dysphagia in patients with Parkinsonism.
Academies and Institutes ; Deglutition Disorders ; Deglutition* ; Dependent Ambulation ; Humans ; Parkinson Disease ; Parkinsonian Disorders* ; Phonation* ; Speech Therapy ; Voice ; Weights and Measures