Comparison of teachers' voice disorders before and during COVID-19 pandemic.

<b> Aim:</b> The aim of the study was to analyze the impact of the COVID-19 pandemic and the related change of the teaching mode from stationary to distance learning on the severity of voice-related ailments among teachers. </br></br> <b> Materials and methods:</b> A questionnaire survey of teachers was conducted to assess voice disorders during stationary and remote work using the Vocal Tract Discomfort (VTDs) scale and Numeric Rating Scale (NRS), and the respondents' subjective feelings were assessed. Demographic and environmental factors associated with voice work were examined. Data on sickness absence, which were obtained from the "Health Needs Maps 2020" Ministry of Health's, were also analyzed. Responses were subjected to statistical analysis. A P-value level below 0.05 was considered statistically significant. </br></br> <b>Results:</b> 128 teachers participated in the survey. The overall assessment of voice disorders using VTDs and NRS scales showed no statistically significant differences for complaints between stationary and remote work. Detailed analysis revealed more se-vere voice disorders in teachers working more than 6 months remotely (P = 0.049) and having more than 20 lessons per week (P = 0.012). Subjective assessment confirmed a significantly lower percentage of teachers reporting voice disorders when wor-king remotely compared to stationary (P = 0.043). This resulted in less sickness absence and a 40% decrease in sick leave related to voice disorders in 2020 compared to 2019. </br></br> <b>Conclusions:</b> During the remote learning period of the COVID-19 pandemic, teachers reported lower severity of voice disor-ders and this influenced the reduction of sickness absences. There were no statistically significant differences in voice complaints as assessed by VTDs and NRS scales for both teaching modes. Several factors affecting the severity of vocal tract disorders were identified - the number of class hours per week (>20) for stationary teaching and a long period of remote teaching (>6 months).

The comparison of the consultation-liaison in the psychiatry department of a general hospital before and after the outbreak of COVID-19 (preprint)

Objective: To compare the status of the consultation-liaison in the psychiatry department of inpatients in a general hospital before and after the outbreak of COVID-19.  Methods: 842 patients in a tertiary hospital during 2019 and 904 patients since the beginning of the epidemic in 2020 were enrolled in this study. Demographic data, departments that requested consultation, mental disorders, and the psychiatric treatments were retrospectively analyzed.  Results: Among the 1746 patients, most patients were 45 to 70 years old. The department of hematology received the most applications for consultation. In 2020, requests from the departments of cardiac and vascular surgeries, contrary to the emergency department, increased significantly. 32.6% patients were diagnosed with organic mental disorder. Delirium was the most common disorder, followed by anxiety and depression. After the COVID-19 outbreak in 2020, the stress-associated and sleep disorders increased.  Conclusions: In general hospitals, clinical departments have great demands forpsychiatric consultation.Since the pandemic, patients requiring consultations for stress-related disorders and sleep disorders increased. Moreover, patients with cardiac and major vascular surgeries suffering from mental and emotional disturbances also increased. The ability of non-psychiatrists in identifying and treating mental disorders and the awareness of biopsychosocial (BPS) models need to be improved.

Laplacian Change Point Detection for Single and Multi-view Dynamic Graphs (preprint)

Dynamic graphs are rich data structures that are used to model complex relationships between entities over time. In particular, anomaly detection in temporal graphs is crucial for many real world applications such as intrusion identification in network systems, detection of ecosystem disturbances and detection of epidemic outbreaks. In this paper, we focus on change point detection in dynamic graphs and address three main challenges associated with this problem: i). how to compare graph snapshots across time, ii). how to capture temporal dependencies, and iii). how to combine different views of a temporal graph. To solve the above challenges, we first propose Laplacian Anomaly Detection (LAD) which uses the spectrum of graph Laplacian as the low dimensional embedding of the graph structure at each snapshot. LAD explicitly models short term and long term dependencies by applying two sliding windows. Next, we propose MultiLAD, a simple and effective generalization of LAD to multi-view graphs. MultiLAD provides the first change point detection method for multi-view dynamic graphs. It aggregates the singular values of the normalized graph Laplacian from different views through the scalar power mean operation. Through extensive synthetic experiments, we show that i). LAD and MultiLAD are accurate and outperforms state-of-the-art baselines and their multi-view extensions by a large margin, ii). MultiLAD's advantage over contenders significantly increases when additional views are available, and iii). MultiLAD is highly robust to noise from individual views. In five real world dynamic graphs, we demonstrate that LAD and MultiLAD identify significant events as top anomalies such as the implementation of government COVID-19 interventions which impacted the population mobility in multi-view traffic networks.

Tele-rehabilitation in voice disorders during the pandemic: a consensus paper from the French Society of Phoniatrics and Laryngology.

OBJECTIVES: To establish a consensus protocol for telerehabilitation in speech therapy for voice disorders. METHODS: The study was conducted according to a modified Delphi method. Twenty speech therapist or laryngologist experts of the French Society of Phoniatrics and Laryngology assessed 24 statements of voice telerehabilitation with a 10-point visual analog scale ranging from 1 (totally disagree) to 10 (totally agree). The statements were accepted if more than 80% of the experts rated the item with a score of ≥ 8/10. The statements with ≥ 8/10 score by 60-80% of experts were improved and resubmitted to voting until they were validated or rejected. RESULTS: The French Society of Phoniatrics and Laryngology experts validated 10, 6, and 2 statements after the first, second and third voting round, respectively. Seven statements did not reach agreement threshold and were rejected. The validated statements included recommendations for setting (N = 4), medical/speech history (N = 2), subjective voice evaluations (N = 3), objective voice quality measurements (N = 3), and voice rehabilitation (N = 5). The experts agreed for a follow-up consisting of combined telerehabilitation and in-office rehabilitation. The final protocol may be applied in context of pandemic but could be assessed out of pandemic period for patients located in rural regions. CONCLUSIONS: This Delphi study established the first telerehabilitation protocol of the French Society of Phoniatrics and Laryngology for patients with voice disorders. Future controlled studies are needed to assess its feasibility, reliability, and the patient perception about telerehabilitation versus in-office rehabilitation.

Effectiveness of voice therapy after recovery from COVID-19 infection: A Rare Case Report (preprint)

Introduction: COVID-19 induces ear, nose, and throat (ENT) difficulties in nearly 57.4 percent of patients. In patients with COVID-19, voice disorder and dysphonia can be created by shortness of breath, upper airway congestion, and changes in the larynx. Case Presentation: We aimed to study the effect of voice therapy (VT) on a woman who suffered from long-term post-COVID-19 dysphonia and recurrent coughs that interrupted the connected speech. This study is a single case report. The patient was a 33-year-old woman referred by a laryngologist to the VT clinic with the diagnosis of muscle tension dysphonia (MTD). All voice assessments were conducted during two sessions before and after 10 sessions of VT. The evaluations included laryngostroboscopy, perceptual voice assessment, and acoustic-aerodynamic voice measurement. After that, ten sessions of Eclectic VT were done by a voice therapist. Following VT, the results showed better findings in all aspects of voice assessments. Conclusions: The results of this study showed improvement of different aspects of voice after Eclectic VT and also, and the effectiveness of VT for decreasing dysphonia post-COVID-19. Although significant improvement was achieved, there was some degree of dysphonia and recurrent coughs after VT. These findings indicated that some side-effects of COVID_19 are persistent even after VT. This case report can highlight the sensory-motor deficit hypothesis or damage in ACE2 receptor in the larynx after COVID_19, but it still needs more investigations.

Using SincNet for Learning Pathological Voice Disorders.

Deep learning techniques such as convolutional neural networks (CNN) have been successfully applied to identify pathological voices. However, the major disadvantage of using these advanced models is the lack of interpretability in explaining the predicted outcomes. This drawback further introduces a bottleneck for promoting the classification or detection of voice-disorder systems, especially in this pandemic period. In this paper, we proposed using a series of learnable sinc functions to replace the very first layer of a commonly used CNN to develop an explainable SincNet system for classifying or detecting pathological voices. The applied sinc filters, a front-end signal processor in SincNet, are critical for constructing the meaningful layer and are directly used to extract the acoustic features for following networks to generate high-level voice information. We conducted our tests on three different Far Eastern Memorial Hospital voice datasets. From our evaluations, the proposed approach achieves the highest 7%-accuracy and 9%-sensitivity improvements from conventional methods and thus demonstrates superior performance in predicting input pathological waveforms of the SincNet system. More importantly, we intended to give possible explanations between the system output and the first-layer extracted speech features based on our evaluated results.

Neuroinvasion and anosmia are independent phenomena upon infection with SARS-CoV-2 and its variants (preprint)

Anosmia was identified as a hallmark of COVID-19 early in the pandemic, however, with the emergence of variants of concern, the clinical profile induced by SARS-CoV-2 infection has changed, with anosmia being less frequent. Several studies have focused on the neuropathogenesis of the original SARS-CoV-2, but little is known about the neuropathological potential of the variants. Here, we assessed the clinical, olfactory and inflammatory conditions of golden hamsters infected with the original SARS-CoV-2, its ORF7-deleted mutant, and three variants: Gamma, Delta and Omicron/BA.1. We show that infected animals developed a variant-dependent clinical disease, and that the ORF7 of SARS-CoV-2 contribute to causing olfactory disturbances. Conversely, all SARS-CoV-2 variants were found to be neuroinvasive, regardless of the clinical presentation they induce. With newly-generated nanoluciferase-expressing SARS-CoV-2, we validated the olfactory pathway as a main entry point towards the brain, confirming that neuroinvasion and anosmia are independent phenomena upon SARS-CoV-2 infection.

The Copenhagen Neck Functional Disability Scale: an analysis of singers with dysphonia and without vocal complaints. / Escala Funcional de Incapacidade do Pescoço de Copenhagen: análise em cantoras disfônicas e em cantoras sem queixas vocais.

PURPOSE: To analyze and compare the degree of cervical disability in singers with dysphonia and in singers without self-reported vocal complaints. METHODS: A cross-sectional observational analysis. Sixty-two singers participated in the study: Thirty-two singers without vocal complaints and 30 singers with a speech-language pathology and otorhinolaryngological diagnosis of dysphonia. For singers without vocal complaints, two questionnaires were applied via Google Forms: A three-question questionnaire regarding vocal complaints and how each singer perceived their speaking and singing voice, and the Copenhagen Neck Functional Disability Scale (CNFDS). Data on singers with dysphonia were extracted from a database previously collected by a team of researchers at the speech-language pathology department of the Federal University of Minas Gerais. The difference in data collection methodology between the two groups was due to restrictions presented by the coronavirus pandemic. The Mann-Whitney test was used to compare the two groups, at a significance level of 5%. RESULTS: There was a significant difference between the groups (p=0.0001), demonstrating that singers with dysphonia suffered more from cervical pain and discomfort than singers without vocal complaints. CONCLUSION: Singers with dysphonia have more cervical pain and discomfort than singers without vocal complaints, thus presenting with greater cervical disability.

OBJETIVO: analisar e comparar o grau de incapacidade cervical em cantoras disfônicas e em cantoras sem queixas vocais autorreferidas. MÉTODO: estudo observacional analítico transversal. Participaram do estudo 32 cantoras sem queixas vocais e 30 cantoras com diagnóstico fonoaudiológico e otorrinolaringológico de disfonia. Para as cantoras sem queixas vocais foram utilizados dois questionários aplicados virtualmente via GoogleForms, sendo um questionário composto por três perguntas referentes às queixas vocais e como cada cantora percebia sua voz de falada e de forma cantada e a Escala Funcional de Incapacidade do Pescoço de Copenhagen (EFIPC). Os dados referentes às cantoras disfônicas foram extraídos de um banco de dados previamente coletado por uma equipe de pesquisadores no Observatório de Saúde Funcional em Fonoaudiologia da Universidade Federal de Minas Gerais e a diferença na metodologia de coleta de dados entre os dois grupos deu-se devido às restrições apresentadas pela pandemia causada pelo coronavírus. Para a comparação entre os dois grupos, foi utilizado o teste Mann-Whitney e foi considerado um nível de significância de 5%. RESULTADOS: Houve diferença significativa entre os grupos (p=0,0001), demonstrando que as cantoras disfônicas sofrem mais com dores e desconfortos cervicais do que as cantoras sem queixas vocais. CONCLUSÃO: cantoras disfônicas apresentam mais dor e desconforto cervical do que as cantoras sem queixas vocais, caracterizando uma maior incapacidade cervical.

Speech and language therapy assessment of patients on the 2-week wait head and neck cancer referral pathway: evidence and opinion following a pilot study.

PURPOSE OF REVIEW: Spiralling numbers of patients are being referred on the two-week wait (2WW) head and neck cancer referral pathway. Only a small proportion are found to have cancer. There is a call for change in the management of these referrals, particularly following coronavirus. Allied health professionals (AHPs) are being encouraged by the NHS to extend their clinical practice to address increased demand. Speech and Language Therapists (SLTs) may offer a solution to some of the 2WW pathway's challenges. RECENT FINDINGS: Recent evidence highlights problems with the pathway and reasons for change. Hoarse voice is consistently found to be the most common presenting symptom. Emerging evidence suggests SLTs can extend their scope of practice to manage new hoarse voice referrals. A pilot project is described. Outcomes from this and other ongoing studies explore efficacy and investment required to make this proposal an achievable prospect for the future. SUMMARY: The management of 2WW referrals on the head and neck cancer pathway needs to change. Preliminary findings suggest SLTs working within the context of the multidisciplinary team can safely extended their role to improve management of these patients. Professional role outline, recognition, guidance, and training framework are needed.

A Proof-of-Concept Study of The Complete Vocal Technique (CVT), a pedagogic technique used for Performers, in Improving the Voice and Vocal Function in Patients with Muscle Tension Dysphonia (CVT4MDT) delivered by Telehealth: Study Protocol (preprint)

Background: Muscle Tension Dysphonia (MTD) is responsible for up to 40% of patients presenting with voice and throat complaints. It is due to inefficient or ineffective voice production resulting from an imbalance in the control of the breathing mechanism, and uncontrolled constriction of the muscles in the larynx (voice box) or vocal tract (throat space above the vocal cords). Standard treatment is Voice Therapy delivered by a specialist Speech Therapist (SLT-V) often using a video link (telepractice aka telehealth). However, voice therapy has been portrayed as a “black box” and many recognised treatment regimens overlap in their treatment aims and therapeutic goals and have a poor-quality evidence base. The Complete Vocal Technique (CVT) is widely used in Europe by singers and vocal coaches. Practitioners (CVT-Ps) undergo a three-year accredited training programme, and the systematic and structured approach helps healthy singers and other performers optimise the function of the voice to produce any sound required. It also rapidly effective in performers with vocal problems, which are also mainly due to uncontrolled throat constrictions. Although there is a growing evidence base and understanding of how CVT can help singers, there is no evidence that, it can be of benefit to patients with MTD or is different from standard SLT techniques. This proof-of-concept study is designed to evaluate whether CVT can be used to help MTD patients using a multidimensional approach for assessment. Methods: /design: A proof of concept study, will recruit 10 people with a clinical diagnosis of primary muscle tension dysphonia (Type I-III) with a VHI score­ > 30, who meet the inclusion/exclusion criteria. Participants will have a multidimensional assessment using a range of validated and non-validated disease-specific questionnaires, statistical analysis of voice and electroglottographic (EGG) recordings and auditory-perceptual evaluations of the voice by Speech Therapy experts in Voice Disorders (SLT-V). They will then receive up to 6 video sessions of CVT-VT delivered using a video link by a CVT-P. The participants will then be reviewed back in clinic at 8 weeks and be reassessed, using further questionnaires and voice recordings. The assessors will be blinded to the testing order of the outcome measures and patients will act as their own controls. In addition, qualitative analysis of the therapy sessions will be made by direct observation of some of the CVT therapy sessions by an experienced SLT-V and review of the Therapist’s treatment log.The main objectives of this Proof-of Concept study are 1) to determine whether CVT-VT is beneficial in the treatment of patients with primary MTD; 2) to determine if and how CVT-VT differs from traditional SLT-VT methods and therefore if it could be a useful additional tool for SLT-VTs in the management of MTD; 3) whether delivery of CVT-VT via a video link is satisfactory to both patients and the CVT-P? Discussion: This study will involve a detailed assessment of the approach to therapy by the CVT-P to determine whether it leads to improvement in the presenting symptoms and voice production, whether it differs from traditional SLT-VT approaches, whether it is acceptable to patients as part of the evaluation as to whether a non-inferiority randomised controlled trial is feasible. Trial registration: The Protocol has been registered on the Clinicaltrials.gov website (NCT05365126 Unique Protocol ID: 19ET004). Registered 06 May 2022, https://beta.clinicaltrials.gov/study/NCT05365126?patient=Muscle%20Tension%20Dysphonia&locStr=Nottingham,%20UK&lat=52.9540223&lng=-1.1549892&distance=50

COVID-19 and the teacher's voice: self-perception and contributions of speech therapy to voice and communication during the pandemic.

OBJECTIVES: We aimed to analyze the vocal self-perception of Brazilian teachers and their communication needs, vocal signs and symptoms, and voice-related lifestyles during the coronavirus disease (COVID-19) pandemic and, based on this information, to develop guidance materials intended for dissemination to these teachers and the general community. METHODS: An online questionnaire designed for this survey was distributed via the researchers' networks and was available for completion by any teacher, except those who were not working at the time. There were 1,253 teachers from all over Brazil, of both sexes, covering a wide age range, working at different levels of education, and most with more than ten years of experience. Descriptive and inferential analyses of the data were performed. RESULTS: On comparing the prepandemic period with the current one, participants indicated voice improvements. In contrast, they presented symptoms such as dry throat, effort in addressing remote classes, hoarseness after classes, and difficulties with the use of headphones, among others. They further indicated stress, general fatigue, impact of the pandemic on mental health, and the overlapping of many home tasks with professional tasks. Some smoked, and others hydrated insufficiently. CONCLUSION: Although teachers generally noticed voice improvements during the pandemic, a proportion of them perceived worsening of voices. Many indicated several factors in which speech-language pathologists could guide them with the aim of improving performance and comfort during remote and hybrid classes, an initiative that will positively impact not only their voice and communication but also their quality of life.

COVID-19 and Speech-Language Pathology Clinical Practice of Voice and Upper Airway Disorders.

Purpose Evaluation and management of voice and upper airway disorders in adults and children, by speech-language pathologists worldwide, have been significantly altered by the COVID-19 pandemic. Secondary to the pathogenic nature of the virus in the respiratory tract and upper airway, it is essential that speech-language pathologists who specialize in these disorders are knowledgeable of current practices to provide evidence-based care while minimizing viral transmission. Understanding how and when SARS-CoV-2 spreads is critical to the development of effective infection prevention within clinical practices. Method We established an evidence-based clinical practice guide for clinicians working with voice and upper airway through a comprehensive evaluation of peer-reviewed journals, non-peer-reviewed manuscripts on preprint servers, national health guidelines, and published and online consensus statements and emerging data. Emphasis was placed on risk mitigation for viral transmission via safe clinical practices, including evaluative procedures, therapy including telehealth, personal protective equipment, room, staffing, and distancing considerations. Results/Conclusions While knowledge relevant to viral transmission of SARS-CoV-2 is rapidly evolving, there is a paucity of literature specific to the evaluation and treatment of voice and upper airway disorders. Within these confines and given the potentially significant high risk of infection secondary to the nature of COVID-19, we summarize current considerations and recommend best practices that maximize risk mitigation whereby ensuring patient and provider safety.

Telepractice Considerations for Evaluation and Treatment of Voice Disorders: Tailoring to Specific Populations.

PURPOSE: The aim of this clinical focus article is to provide recommendations for implementation of telepractice services for the evaluation and treatment of voice disorders and to use case examples to highlight the advantages of this modality of service delivery. METHOD: In this clinical focus article, key factors for successful telepractice evaluation and treatment of voice and related disorders are discussed relative to clinical outcome measures. Case examples of telepractice voice therapy are described for a pediatric, transgender, and chronic cough client including associated acoustic, auditory-perceptual, and quality-of-life treatment outcomes. RESULTS: Acoustic, perceptual, and quality-of-life outcome measures demonstrated functional voice improvements after treatment using the telepractice modality. The pediatric client showed decreased perceptual voice strain and increased speech intelligibility. The transgender client showed increased habitual speaking fundamental frequency (pitch) and quality of life. The chronic cough client showed improved vocal hygiene and reduced cough severity. CONCLUSIONS: A review of the literature shows comparable outcomes for in-person and telepractice voice therapy, but special considerations must be made to ensure therapeutic success. We present three representative types of voice cases that illustrate implementation of voice evaluation and treatment using the telepractice modality. In all three cases, the clients' personal therapeutic goals were achieved without needing to travel to the clinic. Furthermore, asynchronous practice opportunities were found to be positive byproducts of using the telepractice modality.

[Vocal tract discomfort and wellbeing of caregivers for the elderly during the pandemic]. / Vokaltraktbeschwerden und Gesundheitserleben von Pflegenden in Senioreneinrichtungen in der Pandemie.

BACKGROUND: During the SARS-CoV2-pandemic, people working in healthcare such as caregives for the elderly face additional burden, e.g. by the use of face masks. METHODS: In a prospective study, the emotional and physical wellbeing as well as the vocal tract discomfort of caregivers of two municipal homes for the elderly were assessed by questionnaires, the Mini-SCL and the Vocal Tract Discomfort Scale (VTDS), and one on personal data (sex, age, lung disease, previous SARS-CoV2-infection) and on voice symptoms. RESULTS: 67% of the questionnaires were answered by 56 women and 11 men aged 45.2 ± 11.5. In the Mini-SCL, increased scores were found in depression in 23.8%, anxiety in 49.3%, somatization in 55.2% and in the global score in 44.7%. 52% showed increased scores in the VTDS. Significant correlations were found in between the subscales of the Mini-SCL and the VTDS as well as to dysphonia symptoms. DISCUSSION: Psychological problems, somatization and vocal tract discomfort is more frequently reported by caregivers for the elderly than in the normal population. The VTDS, voice symptoms and the Mini-SCL scales are significantly related. Training on vocal hygiene should be included in workplace health promotion during the pandemic.

Voice Therapy in the Context of the COVID-19 Pandemic: Guidelines for Clinical Practice.

INTRODUCTION: Since the beginning of the new pandemic, COVID-19 health services have had to face a new scenario. Voice therapy faces a double challenge, interventions using telepractice, and delivering rehabilitation services to a growing population of patients at risk of functional impairment related to the COVID-19 disease. Moreover, as COVID-19 is transmitted through droplets, it is critical to understand how to mitigate these risks during assessment and treatment. OBJECTIVE: To promote safety, and effective clinical practice to voice assessment and rehabilitation in the pandemic COVID-19 context for speech-language pathologists. METHODS: A group of 11 experts in voice and swallowing disorders from five different countries conducted a consensus recommendation following the American Academy of Otolaryngology-Head and Neck Surgery rules building a clinical guide for speech-language pathologists during this pandemic context. RESULTS: The clinical guide provides 65 recommendations for clinicians in the management of voice disorders during the pandemic and includes advice from assessment, direct treatment, telepractice, and teamwork. The consensus was reached 95% for all topics. CONCLUSION: This guideline should be taken only as recommendation; each clinician must attempt to mitigate the risk of infection and achieve the best therapeutic results taking into account the patient's particular reality.

Terapia Vocal No Contexto Da Pandemia Do Covid-19; Orientações Para A Prática Clínica.

INTRODUCTION: Since the beginning of the new pandemic, Corona Virus Disease 2019 (COVID-19) health services have had to face a new scenario. Voice therapy faces a double challenge, interventions using telepractice, and delivering rehabilitation services to a growing population of patients at risk of functional impairment related to the COVID-19 disease. Moreover, as COVID-19 is transmitted through droplets, it is critical to understand how to mitigate these risks during assessment and treatment. OBJECTIVE: To promote safety, and effective clinical practice to voice assessment and rehabilitation in the pandemic COVID-19 context for speech-language pathologists. METHODS: A group of 11 experts in voice and swallowing disorders from five different countries conducted a consensus recommendation following the American Academy of Otolaryngology-Head and Neck Surgery rules building a clinical guide for speech-language pathologists during this pandemic context. RESULT: The clinical guide provides 79 recommendations for clinicians in the management of voice disorders during the pandemic and includes advice from assessment, direct treatment, telepractice, and teamwork. The consensus was reached 95% for all topics. CONCLUSION: This guideline should be taken only as recommendation; each clinician must attempt to mitigate the risk of infection and achieve the best therapeutic results taking into account the patient's particular reality.

A Nonrandomized Trial for Student Teachers of an In-Person and Telepractice Global Voice Prevention and Therapy Model With Estill Voice Training Assessed by the VoiceEvalU8 App.

Purpose This study investigated the effects of the in-person and telepractice Global Voice Prevention and Therapy Model (GVPTM) treatment conditions and a control condition with vocally healthy student teachers. Method In this single-blinded, nonrandomized trial, 82 participants completed all aspects of the study. Estill Voice Training was used as the stimulability component of the GVPTM to train multiple new voices meeting all the vocal needs of the student teachers. Outcomes were assessed using acoustic, perceptual, and aerodynamic measures captured by the VoiceEvalU8 app at pre and post in fall and during student teaching in spring. Results Significant improvements were achieved for several acoustic and perceptual measures in the treatment conditions, but not in the control condition. The in-person and telepractice conditions produced similar results. The all-voiced phrase and connected speech were more successful in demonstrating voice change for some of the perturbation measures as compared to sustained /a/. Conclusions The treatment conditions were successful in improving the participants' voices for fundamental frequency and some acoustic perturbation measures while maintaining the improvements during student teaching. In addition, the treatment conditions were successful in decreasing the negative impact of voice-related quality of life and vocal fatigue during student teaching. Future research should address the effectiveness of the various components of the GVPTM, the application of the GVPTM with patients with voice disorders, the relevance of defining auditory-perceptual terms by the anatomy and physiology of the voice production system (i.e., Estill Voice Training), and the continued use of the VoiceEvalU8 app for clinical voice investigations. Supplemental Material https://doi.org/10.23641/asha.13626824.

Identifying individuals with recent COVID-19 through voice classification using deep learning.

Recently deep learning has attained a breakthrough in model accuracy for the classification of images due mainly to convolutional neural networks. In the present study, we attempted to investigate the presence of subclinical voice feature alteration in COVID-19 patients after the recent resolution of disease using deep learning. The study was a prospective study of 76 post COVID-19 patients and 40 healthy individuals. The diagnoses of post COVID-19 patients were based on more than the eighth week after onset of symptoms. Voice samples of an 'ah' sound, coughing sound and a polysyllabic sentence were collected and preprocessed to log-mel spectrogram. Transfer learning using the VGG19 pre-trained convolutional neural network was performed with all voice samples. The performance of the model using the polysyllabic sentence yielded the highest classification performance of all models. The coughing sound produced the lowest classification performance while the ability of the monosyllabic 'ah' sound to predict the recent COVID-19 fell between the other two vocalizations. The model using the polysyllabic sentence achieved 85% accuracy, 89% sensitivity, and 77% specificity. In conclusion, deep learning is able to detect the subtle change in voice features of COVID-19 patients after recent resolution of the disease.

Does the wearing of masks change voice and speech parameters?

PURPOSE: The authors aim to review available reports on the potential effects of masks on voice and speech parameters. METHODS: A literature search was conducted using MEDLINE and Google Scholar databases through July 2021. Several targeted populations, mask scenarios and methodologies were approached. The assessed voice parameters were divided into self-reported, acoustic and aerodynamic. RESULTS: It was observed that the wearing of a face mask has been shown to induce several changes in voice parameters: (1) self-reported-significantly increased vocal effort and fatigue, increased vocal tract discomfort and increased values of voice handicap index (VHI) were observed; (2) acoustics-increased voice intensity, altered formants frequency (F2 and F3) with no changes in fundamental frequency, increased harmonics-to-noise ratio (HNR) and increased mean spectral values in high-frequency levels (1000-8000 Hz), especially with KN95 mask; (3) aerodynamics-maximum phonatory time was assessed in only two reports, and showed no alterations. CONCLUSION: Despite the different populations, mask-type scenarios and methodologies described by each study, the results of this review outline the significant changes in voice characteristics with the use of face masks. Wearing a mask shows to increase the perception of vocal effort and an alteration of the vocal tract length and speech articulatory movements, leading to spectral sound changes, impaired communication and perception. Studies analyzing the effect of masks on voice aerodynamics are lacking. Further research is required to study the long-term effects of face masks on the potential development of voice pathology.