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Park Y, Stepp CE. Test-Retest Reliability of Relative Fundamental Frequency and Conventional Acoustic, Aerodynamic, and Perceptual Measures in Individuals With Healthy Voices. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2019; 62:1707-1718. [PMID: 31181173 PMCID: PMC6808369 DOI: 10.1044/2019_jslhr-s-18-0507] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 02/14/2019] [Accepted: 02/18/2019] [Indexed: 05/31/2023]
Abstract
Purpose Recent studies have shown that an acoustic measure, relative fundamental frequency (RFF), has potential for the assessment of excessive laryngeal tension and vocal effort associated with functional and neurological voice disorders. This study presents an analysis of the test-retest reliability of RFF in individuals with healthy voices and a comparison of reliability between RFF and conventional measures of voice. Method Acoustic and aerodynamic measurements and Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) were performed on 28 individuals with healthy voices on 5 consecutive days. Participants produced RFF stimuli, a sustained /ɑ/, and a reading passage to allow for extraction of acoustic measures and CAPE-V ratings; /pa/ trains were produced to allow for extraction of aerodynamic measures. Results Moderate reliabilities (intraclass correlation coefficient [ICC] = .64-.71) were found for RFF values. Mean vocal fundamental frequency, smoothed cepstral peak prominence, shimmer, harmonics-to-noise ratio, and mean airflow rate exhibited good-to-excellent reliabilities (ICC = .76-.99). ICCs for jitter and phonation threshold pressure were moderately reliable (ICC = .67-.74). ICCs for subglottal pressure estimates and all CAPE-V parameters showed poor reliabilities (ICC = .31-.58). Conclusion RFF has comparable reliability to conventional measures of voice. This expands the potential for clinical application of RFF. Supplemental Material https://doi.org/10.23641/asha.8233376.
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Affiliation(s)
- Yeonggwang Park
- Department of Speech, Language, and Hearing Sciences, Boston University, MA
| | - Cara E. Stepp
- Department of Speech, Language, and Hearing Sciences, Boston University, MA
- Department of Biomedical Engineering, Boston University, MA
- Department of Otolaryngology–Head and Neck Surgery, Boston University School of Medicine, MA
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Uygun MN, Esen Aydınlı F, Aksoy S, Özcebe E. Turkish Standardized Reading Passage for the Evaluation of Hard Glottal Attack Occurrence Frequency. J Voice 2018; 32:51-56. [DOI: 10.1016/j.jvoice.2017.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 03/07/2017] [Accepted: 03/08/2017] [Indexed: 10/19/2022]
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Iwahashi T, Ogawa M, Hosokawa K, Kato C, Inohara H. The Effects of Humming on the Prephonatory Vocal Fold Motions Under High-Speed Digital Imaging in Nondysphonic Speakers. J Voice 2017; 31:291-299. [DOI: 10.1016/j.jvoice.2016.09.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Revised: 09/04/2016] [Accepted: 09/08/2016] [Indexed: 10/20/2022]
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Teresa GR, Díaz-Román TM. Vocal Hyperfunction in Parents of Children With Attention Deficit Hyperactivity Disorder. J Voice 2015; 30:315-21. [PMID: 25979790 DOI: 10.1016/j.jvoice.2015.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 04/14/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the presence of habits and symptoms of vocal hyperfunction in the parents of children with attention deficit hyperactivity disorder (ADHD). METHODS Parents of 24 children with ADHD and 30 children of a control group completed a specific questionnaire to detect the hyperfunctional use of the voice (excessive talking, excessive loudness, talking too fast, and shouting), hoarseness, vocal fatigue, mental and physical fatigue, and the degree of parental concern for the vocal health of their child. RESULTS Parents of children with ADHD spoke more often, faster, and stronger than the parents of the control group; in addition, they also used a louder volume than they usually used when they spoke to their children. The parents manifested more vocal, mental, and physical fatigue than the parents of the control group. There was a significant correlation between the "concern" for the vocal health of their children with respect to vocal symptoms of the children, the habits of vocal hyperfunctioning, and the symptoms suffered by the parents. CONCLUSIONS These results suggest that the parents of children with ADHD change their vocal attitude when communicating with their children. Most likely, the increased concern of parents with ADHD children and their respective level of stress lead to hyperfunctional vocal usage. This subsequently leads to symptoms of vocal, physical, and mental fatigue at the end of the day.
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Affiliation(s)
- Garcia-Real Teresa
- Department of Philosophy and Research Method in Education, Faculty of Education Science, University of La Coruña, A Coruña, Spain.
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Guzman M, Barros M, Espinoza F, Herrera A, Parra D, Muñoz D, Lloyd A. Laryngoscopic, Acoustic, Perceptual, and Functional Assessment of Voice in Rock Singers. Folia Phoniatr Logop 2014; 65:248-56. [DOI: 10.1159/000357707] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Mayerhoff RM, Guzman M, Jackson-Menaldi C, Munoz D, Dowdall J, Maki A, Johns MM, Smith LJ, Rubin AD. Analysis of supraglottic activity during vocalization in healthy singers. Laryngoscope 2013; 124:504-9. [DOI: 10.1002/lary.24310] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 06/28/2013] [Accepted: 06/28/2013] [Indexed: 11/09/2022]
Affiliation(s)
- Ross M. Mayerhoff
- Department of Otolaryngology-Head and Neck Surgery; Wayne State University; Detroit Michigan U.S.A
| | - Marco Guzman
- School of Communication Sciences; University of Chile and Voice Center, Las Condes Clinic; Santiago Chile
| | - Cristina Jackson-Menaldi
- Department of Otolaryngology-Head and Neck Surgery; Wayne State University; Detroit Michigan U.S.A
- Lakeshore Professional Voice Center; Lakeshore Ear, Nose, and Throat Center; St. Clair Shores Michigan U.S.A
| | - Daniel Munoz
- Department of Network Management; Barros Luco-Trudeau Hospital; Santiago Chile
| | - Jayme Dowdall
- Department of Otolaryngology, Harvard Medical School, and Department of Otology and Laryngology; Massachusetts Eye and Ear Infirmary, Brigham and Women's Hospital; Boston Massachusetts U.S.A
| | - Ahmed Maki
- McLaren Oakland, Pontiac, and Michigan State University; East Lansing Michigan U.S.A
| | - Michael M. Johns
- Department of Otolaryngology-Head and Neck Surgery; Emory University School of Medicine, and Emory Voice Center; Atlanta Georgia U.S.A
| | - Libby J. Smith
- Department of Otolaryngology-Head and Neck Surgery; University of Pittsburgh Medical Center; Pittsburgh Pennsylvania U.S.A
| | - Adam D. Rubin
- Lakeshore Professional Voice Center; Lakeshore Ear, Nose, and Throat Center; St. Clair Shores Michigan U.S.A
- Department of Otolaryngology-Head and Neck Surgery; University of Michigan Medical Center,; Ann Arbor Michigan U.S.A
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Guzman M, Castro C, Testart A, Muñoz D, Gerhard J. Laryngeal and pharyngeal activity during semioccluded vocal tract postures in subjects diagnosed with hyperfunctional dysphonia. J Voice 2013; 27:709-16. [PMID: 24075912 DOI: 10.1016/j.jvoice.2013.05.007] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 05/17/2013] [Indexed: 10/26/2022]
Abstract
High vertical laryngeal position (VLP), pharyngeal constriction, and laryngeal compression are common features associated with hyperfunctional voice disorders. The present study aimed to observe the effect on these variables of different semioccluded vocal tract postures in 20 subjects diagnosed with hyperfunctional dysphonia. During observation with flexible endoscope, each participant was asked to produce eight different semioccluded exercises: lip trills, hand-over-mouth technique, phonation into four different tubes, and tube phonation into water using two different depth levels. Participants were required to produce each exercise at three loudness levels: habitual, soft, and loud. To determine the VLP, anterior-to-posterior (A-P) compression, and pharyngeal width, a human evaluation test with three blinded laryngologists was conducted. Judges rated the three endoscopic variables using a five-point Likert scale. An intraclass correlation coefficient to assess intrarater and interrater agreement was performed. A multivariate linear regression model considering VLP, pharyngeal width, and A-P laryngeal compression as outcomes and phonatory tasks and intensity levels as predictive variables were carried out. Correlation analysis between variables was also conducted. Results indicate that all variables differ significantly. Therefore, VLP, A-P constriction, and pharyngeal width changed differently throughout the eight semioccluded postures. All semioccluded techniques produced a lower VLP, narrower aryepiglottic opening, and a wider pharynx than resting position. More prominent changes were obtained with a tube into the water and narrow tube into the air. VLP significantly correlated with pharyngeal width and A-P laryngeal compression. Moreover, pharyngeal width significantly correlated with A-P laryngeal compression.
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Affiliation(s)
- Marco Guzman
- School of Communication Sciences, University of Chile, Santiago, Chile.
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Stepp CE, Heaton JT, Stadelman-Cohen TK, Braden MN, Jetté ME, Hillman RE. Characteristics of phonatory function in singers and nonsingers with vocal fold nodules. J Voice 2011; 25:714-24. [PMID: 21216129 DOI: 10.1016/j.jvoice.2010.06.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2010] [Accepted: 06/09/2010] [Indexed: 12/01/2022]
Abstract
PURPOSE The goals of this study were to determine if there were significant differences between singers and nonsingers in the morphology of vocal nodules and the associated impact on vocal function. METHOD Participants were 10 professionally trained singers with nodules, eight nonsingers with nodules, and 10 individuals with healthy normal voice (controls). Surface electromyography (sEMG) from three anterior neck locations and acoustic rise times for vowels /a/ and /i/ were measured in all the participants. In individuals with nodules, dB SPL/cm H(2)O, glottal airflow, and nodule location and size were also measured. RESULTS There were no significant differences between singers and nonsingers with nodules in terms of airflow, dB SPL/cm H(2)O, nodule size, or nodule location. In nonsingers with nodules, airflow and nodule size were significantly correlated, but were not significantly correlated in singers. Vowel rise times and sEMG during vocal tasks did not differentiate among nodule and control groups. Sternocleidomastoid sEMG during initiation of the vowel /a/ was statistically significantly stronger in nonsingers with nodules relative to singers with nodules and controls. CONCLUSIONS Nodule morphology did not differ between singers and nonsingers, although some behavioral aspects of phonation differed between the groups.
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Affiliation(s)
- Cara E Stepp
- Harvard-MIT Division of Health Science & Technology, Cambridge, Massachusetts, USA.
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Stepp CE, Hillman RE, Heaton JT. A virtual trajectory model predicts differences in vocal fold kinematics in individuals with vocal hyperfunction. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2010; 127:3166-76. [PMID: 21117765 PMCID: PMC2882670 DOI: 10.1121/1.3365257] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
A simple, one degree of freedom virtual trajectory model of vocal fold kinematics was developed to investigate whether kinematic features of vocal fold movement confirm increased muscle stiffness. Model simulations verified that increases in stiffness were associated with changes in kinematic parameters, suggesting that increases in gesture rate would affect kinematic features to a lesser degree in vocal hyperfunction patients given the increased levels of muscle tension they typically employ to phonate. This hypothesis was tested experimentally in individuals with muscle tension dysphonia (MTD; N = 10) and vocal nodules (N = 10) relative to controls with healthy normal voice (N = 10) who were examined with trans-nasal endoscopy during a simple vocal fold abductory-adductory task. Kinematic measures in MTD patients were less affected by increased gesture rate, consistent with the hypothesis that these individuals have elevated typical laryngeal muscle tension. Group comparisons of the difference between medium and fast gesture rates (Mann-Whitney, one-tailed) showed statistically significant differences between the control and MTD individuals on the two kinematic features examined (p<0.05). Results in nodules participants were mixed and are discussed independently. The findings support the potential use of vocal fold kinematics as an objective clinical assay of vocal hyperfunction.
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Affiliation(s)
- Cara E Stepp
- Harvard-MIT Division of Health Sciences and Technology, Cambridge, Massachusetts 02139, USA.
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Stepp CE, Hillman RE, Heaton JT. Use of neck strap muscle intermuscular coherence as an indicator of vocal hyperfunction. IEEE Trans Neural Syst Rehabil Eng 2010; 18:329-35. [PMID: 20083462 DOI: 10.1109/tnsre.2009.2039605] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Intermuscular coherence in the beta band was explored as a possible indicator of vocal hyperfunction, a common condition associated with many voice disorders. Surface electromyography (sEMG) was measured from two electrodes on the anterior neck surface of 18 individuals with vocal nodules and 18 individuals with healthy normal voice. Coherence was calculated from sEMG activity gathered while participants produced both read and spontaneous speech. There was no significant effect of speech type on average coherence. Individuals with vocal nodules showed significantly lower mean coherence in the beta band (15-35 Hz) when compared to controls. Results suggest that bilateral EMG-EMG beta coherence in neck strap muscle during speech production shows promise as an indicator of vocal hyperfunction.
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Affiliation(s)
- Cara E Stepp
- Harvard-MIT Division of Health Sciences and Technology, Cambridge, MA 02139, USA.
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Sellars C, Dunnet CP. Comparisons between therapists' and patients' views of dysphonia: a survey study. LOGOP PHONIATR VOCO 2003; 27:124-31. [PMID: 12498353 DOI: 10.1080/140154302760834859] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Speech and language therapists (SLTs) recognise the need to involve patients in the design and implementation of services. The present study describes the results of a questionnaire survey undertaken among SLTs working with patients with voice disorders to determine whether patients' and therapists' views on issues around dysphonia were in harmony. The SLTs' views of patients' disabilities and handicaps associated with dysphonia are reported and compared with those of an earlier survey of patient-reported difficulties (Scott et al. Clin Otolaryngol 1997; 22: 37-40). A close, but incomplete, match of therapists' and patients' views of dysphonia is reported and discussed.
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Affiliation(s)
- Cameron Sellars
- Department of Speech & Language Therapy, Walton Building, Glasgow Royal Infirmary, Glasgow, G4 0SF, Scotland.
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Carding P, Carlson E, Epstein R, Mathieson L, Shewell C. Formal perceptual evaluation of voice quality in the United Kingdom. LOGOP PHONIATR VOCO 2001; 25:133-8. [PMID: 11086805 DOI: 10.1080/14015430050175860] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
This document is a position statement on the formal perceptual evaluation of voice quality in the United Kingdom (UK). It addresses a number of clinical issues pertaining to the complexity of voice quality analysis. There is also a brief description of the three formal perceptual protocols most commonly used in the UK: The Vocal Profile Analysis (VPA), GRBAS and The Buffalo III Voice Profile. Potential clinical problems with perceptual voice quality evaluation are highlighted. Problems associated with the lack of defined terminology, limitless variety of voice quality, general lack of reliability data and difficulties in determining specificity and sensitivity are discussed. A practical guide for selecting an evaluation scheme is described. The conclusion is that the GRBAS scheme should be recommended as the absolute minimum standard for practising UK voice clinicians. However, there is a clear need to develop a more satisfactory perceptual rating scheme that is clinically realistic, theoretically sound, internationally acceptable and has proven reliability.
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Affiliation(s)
- P Carding
- Department of Surgery, University of Newcastle, Freeman Hospital, Newcastle upon Tyne, UK
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Carding PN, Horsley IA, Docherty GJ. A study of the effectiveness of voice therapy in the treatment of 45 patients with nonorganic dysphonia. J Voice 1999; 13:72-104. [PMID: 10223677 DOI: 10.1016/s0892-1997(99)80063-0] [Citation(s) in RCA: 141] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Forty-five patients diagnosed as having nonorganic dysphonia were assigned in rotation to 1 of 3 groups. Patients in group 1 received no treatment and acted as a control group. Patients in groups 2 and 3 received a program of indirect therapy and direct with indirect therapy, respectively. A range of qualitative and quantitative measures were carried out on all patients before and after treatment to evaluate change in voice quality over time. Results revealed a significant difference between the 3 treatment groups in the amount of change for the voice severity, electrolaryngograph, and shimmer measurements and on ratings provided by a patient questionnaire (P<0.05). However, other measures failed to show significant differences between the 3 groups. Most of the patients (86%) in group 1 showed no significant change on any of the measures. Some patients in treatment group 2 (46%) showed significant change in voice quality. Fourteen out of 15 patients (93%) in treatment group showed significant changes in voice quality.
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Affiliation(s)
- P N Carding
- Department of Speech and Voice Therapy, Freeman Hospital, University of Newcastle Upon Tyne, England
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Ramig LO, Verdolini K. Treatment efficacy: voice disorders. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 1998; 41:S101-16. [PMID: 9493749 DOI: 10.1044/jslhr.4101.s101] [Citation(s) in RCA: 157] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
This article reviews the literature on the efficacy of treatment for voice disorders primarily using studies published in peer-reviewed journals. Voice disorders are defined, their frequency of occurrence across the life span is reported, and their impact on the lives of individuals with voice disorders is documented. The goal of voice treatment is to maximize vocal effectiveness given the existing disorder and to reduce the handicapping effect of the voice problem. Voice treatment may be (a) the preferred treatment to resolve the voice disorder when medical (surgical or pharmacological) treatments are not indicated; (b) the initial treatment in cases where medical treatment appears indicated; it may obviate the need for medical treatment; (c) completed before and after surgical treatment to maximize long-term post-surgical voice; and (d) a preventative treatment to preserve vocal health. Experimental and clinical data are reviewed that support these roles applied to various disorder types: (a) vocal misuse, hyperfunction and muscular imbalance (frequently resulting in edema, vocal nodules, polyps or contact ulcers); (b) medical or physical conditions (e.g., laryngeal nerve trauma, Parkinson disease); and (c) psychogenic disorders (e.g., conversion reactions, personality disorders). Directions for future research are suggested which maximize clinical outcomes and scientific rigor to enhance knowledge on the efficacy of voice treatment.
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Chan RW. Does the voice improve with vocal hygiene education? A study of some instrumental voice measures in a group of kindergarten teachers. J Voice 1994; 8:279-91. [PMID: 7987431 DOI: 10.1016/s0892-1997(05)80300-5] [Citation(s) in RCA: 91] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
This study investigated the efficacy of a program of vocal hygiene education designed for an occupational group at risk for dysphonia, namely, kindergarten teachers. Twelve female teachers explored concepts and knowledge of vocal abuse and vocal hygiene in a workshop session and attempted to practice vocal hygiene for 2 months. They showed significant voice improvement as assessed instrumentally in terms of three acoustic and electroglottographic parameters. There was no significant change of voice in a control group of 13 teachers. The results suggest that teachers were able to improve their voices if they significantly reduced vocal abuses in daily life and practiced specific strategies to maintain classroom order and reduce the use of voice in teaching.
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Affiliation(s)
- R W Chan
- Department of Speech and Hearing Sciences, University of Hong Kong, Prince Philip Dental Hospital
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Abstract
There are many concepts about voice therapy that are at best, misleading and at worst, incorrect. Through this review, it is hoped that some of these misconceptions will be resolved. Issues reviewed include developmental factors, iatrogenic voice disorders, breathing habits, optimum pitch, palate training, and etiology based on perceptual cues.
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