Purpose: To determine what research evidence exists to support the use of voice measures in the clinical assessment of patients with voice disorders. Method: The American Speech‐Language‐Hearing Association (ASHA) National Center for Evidence‐Based Practice in Communication Disorders staff searched 29 databases for peer‐reviewed English‐language articles between January 1930 and April 2009 that included key words pertaining to objective and subjective voice measures, voice disorders, and diagnostic accuracy. The identified articles were systematically assessed by an ASHA‐appointed committee employing a modification of the critical appraisal of diagnostic evidence rating system. Results: One hundred articles met the search criteria. The majority of studies investigated acoustic measures (60%) and focused on how well a test method identified the presence or absence of a voice disorder (78%). Only 17 of the 100 articles were judged to contain adequate evidence for the measures studied to be formally considered for inclusion in clinical voice assessment. Conclusion: Results provide evidence for selected acoustic, laryngeal imaging–based, auditory–perceptual, functional, and aerodynamic measures to be used as effective components in a clinical voice evaluation. However, there is clearly a pressing need for further high‐quality research to produce sufficient evidence on which to recommend a comprehensive set of methods for a standard clinical voice evaluation.

Purpose: The goal of this study was to employ frequently used analysis methods and tasks to identify values for cepstral peak prominence (CPP) that can aid clinical voice evaluation. Experiment 1 identified CPP values to distinguish speakers with and without voice disorders. Experiment 2 was an initial attempt to estimate auditory-perceptual ratings of overall dysphonia severity using CPP values. Method: CPP was computed using the Analysis of Dysphonia in Speech and Voice (ADSV) program and Praat. Experiment 1 included recordings from 295 patients with medically diagnosed voice disorders and 50 vocally healthy control speakers. Speakers produced sustained /a/ vowels and the English language Rainbow Passage. CPP cutoff values that best distinguished patient and control speakers were identified. Experiment 2 analyzed recordings from 32 English speakers with varying dysphonia severity and provided preliminary validation of the Experiment 1 cutoffs. Speakers sustained the /a/ vowel and read four sentences from the Consensus Auditory-Perceptual Evaluation of Voice protocol. Trained listeners provided auditory-perceptual ratings of overall dysphonia for the recordings, which were estimated using CPP values in a linear regression model whose performance was evaluated using the coefficient of determination ( r ² ). Results: Experiment 1 identified CPP cutoff values of 11.46 dB (ADSV) and 14.45 dB (Praat) for the sustained /a/ vowels and 6.11 dB (ADSV) and 9.33 dB (Praat) for the Rainbow Passage. CPP values below those thresholds indicated the presence of a voice disorder with up to 94.5% accuracy. In Experiment 2, CPP values estimated ratings of overall dysphonia with r ² values up to .74. Conclusions: The CPP cutoff values identified in Experiment 1 provide normative reference points for clinical voice evaluation based on sustained /a/ vowels and the Rainbow Passage. Experiment 2 provides an initial predictive framework that can be used to relate CPP values to the auditory perception of overall dysphonia severity based on sustained /a/ vowels and Consensus Auditory-Perceptual Evaluation of Voice sentences.

Many common voice disorders are chronic or recurring conditions that are likely to result from faulty and/or abusive patterns of vocal behavior, referred to generically as vocal hyperfunction. An ongoing goal in clinical voice assessment is the development and use of noninvasively derived measures to quantify and track the daily status of vocal hyperfunction so that the diagnosis and treatment of such behaviorally based voice disorders can be improved. This paper reports on the development of a new, versatile, and cost-effective clinical tool for mobile voice monitoring that acquires the high-bandwidth signal from an accelerometer sensor placed on the neck skin above the collarbone. Using a smartphone as the data acquisition platform, the prototype device provides a user-friendly interface for voice use monitoring, daily sensor calibration, and periodic alert capabilities. Pilot data are reported from three vocally normal speakers and three subjects with voice disorders to demonstrate the potential of the device to yield standard measures of fundamental frequency and sound pressure level and model-based glottal airflow properties. The smartphone-based platform enables future clinical studies for the identification of the best set of measures for differentiating between normal and hyperfunctional patterns of voice use.

Purpose: The purpose of this viewpoint article is to facilitate research on vocal hyperfunction (VH). VH is implicated in the most commonly occurring types of voice disorders, but there remains a pressing need to increase our understanding of the etiological and pathophysiological mechanisms associated with VH to improve the prevention, diagnosis, and treatment of VH-related disorders. Method: A comprehensive theoretical framework for VH is proposed based on an integration of prevailing clinical views and research evidence. Results: The fundamental structure of the current framework is based on a previous (simplified) version that was published over 30 years ago (Hillman et al., 1989). A central premise of the framework is that there are two primary manifestations of VH—phonotraumatic VH and nonphonotraumatic VH—and that multiple factors contribute and interact in different ways to cause and maintain these two types of VH. Key hypotheses are presented about the way different factors may contribute to phonotraumatic VH and nonphonotraumatic VH and how the associated disorders may respond to treatment. Conclusions: This updated and expanded framework is meant to help guide future research, particularly the design of longitudinal studies, which can lead to a refinement in knowledge about the etiology and pathophysiology of VH-related disorders. Such new knowledge should lead to further refinements in the framework and serve as a basis for improving the prevention and evidence-based clinical management of VH.

Many common voice disorders are chronic or recurring conditions that are likely to result from inefficient and/or abusive patterns of vocal behavior, referred to as vocal hyperfunction. The clinical management of hyperfunctional voice disorders would be greatly enhanced by the ability to monitor and quantify detrimental vocal behaviors during an individual’s activities of daily life. This paper provides an update on ongoing work that uses a miniature accelerometer on the neck surface below the larynx to collect a large set of ambulatory data on patients with hyperfunctional voice disorders (before and after treatment) and matched control subjects. Three types of analysis approaches are being employed in an effort to identify the best set of measures for differentiating among hyperfunctional and normal patterns of vocal behavior: 1) ambulatory measures of voice use that include vocal dose and voice quality correlates, 2) aerodynamic measures based on glottal airflow estimates extracted from the accelerometer signal using subject-specific vocal system models, and 3) classification based on machine learning and pattern recognition approaches that have been used successfully in analyzing long-term recordings of other physiological signals. Preliminary results demonstrate the potential for ambulatory voice monitoring to improve the diagnosis and treatment of common hyperfunctional voice disorders.

Purpose of review To summarize recent technological advancements and insight into the role of stroboscopy in laryngeal imaging. Recent findings Although stroboscopic technology has not undergone major technological improvements, recent clarifications have been made to the application of stroboscopic principles to video-based laryngeal imaging. Also recent advances in coupling stroboscopy with high-definition video cameras provide higher spatial resolution of vocal fold vibratory function during phonation. Studies indicate that the interrater reliability of visual stroboscopic assessment varies depending on the laryngeal feature being rated and that only a subset of features may be needed to be representative of an entire assessment. High-speed videoendoscopy (HSV) judgments have been shown to be more sensitive than stroboscopy for evaluating vocal fold phase asymmetry, pointing to the future potential of complementing stroboscopy with alternative imaging modalities in hybrid systems. Laryngeal videostroboscopy alone continues to play a central role in clinical voice assessment. Even though HSV may provide more detailed information about phonatory function, its eventual clinical adoption will depend on how remaining practical, technical, and methodological challenges will be met. Summary Laryngeal videostroboscopy continues to be the modality of choice for imaging vocal fold vibration, but technological advancements in HSV and associated research findings are driving increased interest in the clinical adoption of HSV to complement videostroboscopic assessment.