The Effect of Background Noise, Bilingualism, Socioeconomic Status, and Cognitive Functioning on Primary School Children's Narrative Listening Comprehension.

PURPOSE: This study focuses on 7- to 9-year-old children attending primary school in Swedish areas of low socioeconomic status, where most children's school language is their second language. The aim was to better understand what factors influence these children's narrative listening comprehension both in an ideal listening condition (in quiet) and for the primary school classroom, a typical listening condition (with multitalker babble noise). METHOD: A total of 86 typically developing 7- to 9-year-olds performed a narrative listening comprehension test (Lyssna, Förstå och Minnas [LFM]; English translation: Listen, Comprehend, and Remember) in two listening conditions: quiet and multitalker babble noise. They also performed the crosslinguistic nonword repetition test and a digit span backwards (DSB) test. A predictive statistical model including these factors, the children's degree of school language exposure, parental education level, and age was derived. RESULTS: Listening condition had the strongest predictive value for LFM performance, followed by school language exposure and nonword repetition accuracy. Parental education level was also a significant predictor. There was a significant three-way interaction effect between listening condition, age, and DSB performance. CONCLUSIONS: Multitalker babble noise has a negative effect on children's narrative listening comprehension. The effect of multitalker babble noise could be explained by age differences in the ability to allocate working memory capacity during the narrative listening comprehension task, suggesting that younger children may be more vulnerable for missing information when listening in background noise than their older peers. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.25209248.

Degree of Breathiness in a Synthesized Voice Signal as it Differentiates Masculine versus Feminine Voices.

INTRODUCTION: Most studies determining speakers' perceived gender as binarily female or male are reliant on F0 perception, although other vocal parameters may also contribute to the perception of gender. The current study focused on the impact of breathiness on the perception of speakers' gender as a biological variable (feminine or masculine). METHODS: n = 31 normal hearing, native English speakers, 18 female, 13 male, mean age 23 (SD = 3.54), were auditorily and visually trained in and then took part in a categorical perception task. A continuum of nine samples of the word "hello", was created in an airway modulation model of speech and voice production. Resting vocal fold length, resting vocal fold thickness, F0, and vocal tract length were fixed. Glottal width at the vocal process, posterior glottal gap, and bronchial pressure were continually modified for all stimuli. Each stimulus was randomly presented 30 times within each of the five blocks (150 presentations in total). Participants rated stimuli as binarily female or male. RESULTS: Showed a sigmoidal shift in breathiness along the continuum between perceived feminine or masculine voicing. This shift was evident at stimuli four and five, indicating a nonlinear, discrete perception of breathiness among participants. Response times were also significantly slower in these two stimuli, suggesting a categorical perception of breathiness among participants. CONCLUSION: Breathiness created by the change in glottal width of at least 0.21 cm may influence the perception of a speaker's perceived gender.

Effects of warm-up exercises on self-assessed vocal effort.

PURPOSE: An elevated sense of vocal effort due to increased vocal demand is frequently reported by patients with voice disorders. However, effects of vocal warm-up on self-assessed vocal effort have not been thoroughly examined. A recently developed version of the Borg CR-10 Scale facilitates vocal effort assessments, following different vocal warm-up tasks. METHODS: Effects of a short (5 min) vocal warm-up on self-assessed vocal effort was evaluated using the Borg CR-10. Twenty-six vocally healthy participants (13F, 13M, mean age 22.6), in two randomised groups, underwent sessions of either reading aloud or semi-occluded vocal tract exercises (SOVTE). Vocal effort was evaluated at four times: pre to post vocal warm-up and two silence periods. Non-parametric analyses for repeated measures and calculations for within-subject standard deviation were applied in group comparisons. RESULTS: Following vocal warm-up, vocal effort ratings were increased to a statistically significant degree in both intervention groups compared to baseline ratings. After a 5-min rest in silence following completion of the vocal warm-up, vocal effort ratings returned to baseline levels in both groups. The drop in ratings immediately post warm-up compared to 5 min later was statistically significant for the SOVTE group. CONCLUSIONS: Five minutes of vocal warm-up caused increased self-perceived vocal effort in vocally healthy individuals. The increased sense of effort dissipated faster following warm-up for the SOVTE group. When using the Borg CR-10 scale to track vocal effort, it may be beneficial to apply experience-based anchors.

A Semiautomated Protocol Towards Quantifying Vocal Effort in Relation to Vocal Performance During a Vocal Loading Task.

To increase the reliability and comparability of vocal loading studies, this paper proposes the use of a standardized approach with experiments that are [1] grounded on consistent definitions of terms related to vocal fatigue (vocal effort, vocal demand, and vocal demand response), and [2] designed to reduce uncertainty and increase repeatability. In the approach, a semi-automated vocal loading task that also increases efficiencies in collecting and preparing vocal samples for analysis was used to answer the following research question: To what extent is vocal effort and vocal demand response sensitive to changes in vocal demands (ie, noise only, noise plus duration)? Results indicate that the proposed protocol design consistently induced change in both vocal effort and vocal demand response, indicating vocal fatigue. The efficacy of future vocal loading studies would be improved by adopting a more consistent methodology for quantifying vocal fatigue, thus increasing interstudy comparability of results and conclusions.

Tracheostomy management by speech-language pathologists in Sweden.

Purpose: Speech-language pathologists' (SLPs) role in tracheostomy management is well described internationally. Surveys from Australia and the United Kingdom show high clinical consistency in SLP tracheostomy management, and that practice follows guidelines, research evidence and protocols. Swedish SLPs work with tracheostomised patients, however, the content and extent of this practice, and how it compares to international research is unknown. This study reports how SLPs in Sweden work with tracheostomised patients, investigating (a) the differences and similarities in SLPs tracheostomy management and (b) the facilitators and barriers to tracheostomy management, as reported by SLPs.Methods: A study-specific, online questionnaire was completed by 28 SLPs who had managed tracheostomised patients during the previous year. This study was conducted in 2018, pre Covid-19 pandemic. The answers were analysed for exploratory descriptive comparison of data. Content analyses were made on answers from open-ended questions.Results: Swedish SLPs manage tracheostomised patients, both for dysphagia and communication. During this study, the use of protocols and guidelines were limited and SLPs were often not part of a tracheostomy team. Speech-language pathologists reported that the biggest challenges in tracheostomy management were in (a) collaboration with other professionals, (b) unclear roles and (c) self-perceived inexperience. Improved collaboration with other professionals and clearer roles was suggested to facilitate team tracheostomy management.Conclusions: This study provides insight into SLP tracheostomy management in Sweden, previously uncharted. Results suggest improved collaboration, further education and clinical training as beneficial for a clearer and more involved SLP role in tracheostomy management.

Clinical Application and Psychometric Properties of a Swedish Translation of the Abbreviated Profile of Hearing Aid Benefit.

BACKGROUND: The impact of hearing loss on the individual and his/her everyday life can be assessed using questionnaires with the purpose to improve rehabilitation quality. The Abbreviated Profile of Hearing Aid Benefit (APHAB) can be used to evaluate disability in everyday life associated with hearing loss. Previous studies have examined APHAB outcomes in sensorineural hearing loss and we do not know whether the type of hearing loss influence questionnaire outcomes. PURPOSE: The purpose was to evaluate the psychometric properties of a Swedish translation of the APHAB and the influence of demographic variables on the outcome in a clinical sample. RESEARCH DESIGN: A descriptive, cross-sectional study in a clinical sample. STUDY SAMPLE: Forty-eight participants with no hearing aid experience seeking audiological rehabilitation for the first time. These participants represented different degrees of hearing loss and three types of hearing loss: monaural mixed, binaural mixed, and binaural sensorineural hearing loss. DATA COLLECTION AND ANALYSIS: Pure-tone audiometry was conducted and the participants completed the unaided APHAB during their first appointment at the clinic. Psychometric properties of the questionnaire were examined and the influence of age, gender, type of hearing loss, and degree of hearing loss on APHAB scores were studied. RESULTS: The psychometric properties indicate high test-retest reliability but there seems to be some potential issues with the properties of the reverberation (RV) subscale. The items from the RV subscale failed to load as a separate component and the internal consistency of the subscale improved by removing four items (items 1, 9, 11, and 16). With few exceptions, APHAB scores were not influenced by age, gender, or type of hearing loss. APHAB scores were generally influenced by degree of hearing loss in both the best and the worst ear. CONCLUSION: This Swedish version of the APHAB can be additionally improved by addressing the inconsistencies found in the RV subscale by rephrasing or removing some items. The degree of hearing loss has some influence on questionnaire outcomes but not age, gender, and type of hearing loss.

Toward a Consensus Description of Vocal Effort, Vocal Load, Vocal Loading, and Vocal Fatigue.

Purpose The purpose of this document is threefold: (a) review the uses of the terms "vocal fatigue," "vocal effort," "vocal load," and "vocal loading" (as found in the literature) in order to track the occurrence and the related evolution of research; (b) present a "linguistically modeled" definition of the same from the review of literature on the terms; and (c) propose conceptualized definitions of the concepts. Method A comprehensive literature search was conducted using PubMed/MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Scientific Electronic Library Online. Four terms ("vocal fatigue," "vocal effort," "vocal load," and "vocal loading"), as well as possible variants, were included in the search, and their usages were compiled into conceptual definitions. Finally, a focus group of eight experts in the field (current authors) worked together to make conceptual connections and proposed consensus definitions. Results The occurrence and frequency of "vocal load," "vocal loading," "vocal effort," and "vocal fatigue" in the literature are presented, and summary definitions are developed. The results indicate that these terms appear to be often interchanged with blurred distinctions. Therefore, the focus group proposes the use of two new terms, "vocal demand" and "vocal demand response," in place of the terms "vocal load" and "vocal loading." We also propose standardized definitions for all four concepts. Conclusion Through a comprehensive literature search, the terms "vocal fatigue," "vocal effort," "vocal load," and "vocal loading" were explored, new terms were proposed, and standardized definitions were presented. Future work should refine these proposed definitions as research continues to address vocal health concerns.

Absolute or relative voice rest after phonosurgery: a blind randomized prospective clinical trial.

OBJECTIVES: The first aim, was to compare participant compliance with postoperative voice rest advice in two groups. The second aim was to compare vocal function and recovery in the short-term, seven days post-surgery and in the long-term, 3-6 months post-surgery. DESIGN: Preliminary randomized prospective blind clinical trial. METHODS: Twenty patients scheduled for surgery for benign vocal fold lesions were randomized into seven days of absolute or relative voice rest. Compliance with voice rest advice was monitored with a voice accumulator for seven days following surgery. Vocal recovery was tracked through (a) self-perceived vocal function, (b) perceptual assessments of voice recordings and (c) visual assessment of high resolution and high speed digital imaging (d) vocal stamina and reaction to vocal loading, explored with a vocal loading task. RESULTS: The absolute voice rest group phonated significantly less than the relative voice rest group during seven days post-surgery, but they were not silent. The absolute voice rest group self-reported more difficulty with compliance than the relative voice rest group. The relative voice rest group coped with significantly more vocal loading at long-term check-up. In the short-term the absolute voice rest group improved morphological recovery to a significant degree, however relative voice rest renders superior long-term recovery. CONCLUSIONS: Absolute voice rest is difficult to comply with. Neither short-term, nor long-term vocal recovery differed significantly between groups. Within-group comparisons showed significant improvements in vocal stamina, immediate recovery from vocal loading and self-assessments of voice problems only for the group with recommended relative voice rest.

Recovery From Heavy Vocal Loading in Women With Different Degrees of Functional Voice Problems.

TYPE OF STUDY: This is a longitudinal, case-control clinical trial. OBJECTIVES: This study aims to track recovery time following a vocal loading task (VLT) imposing vocal fatigue and to explore if patients with functional dysphonia (FD) are worse affected by vocal loading, and if these patients take longer than others to recover. METHODS: Fifty (n = 50) female participants in four vocal subgroups on a spectrum of everyday vocal loading and functional voice complaints, including n = 20 patients with FD, took part in a clinical VLT, inflicting vocal fatigue through loud speech in ambient noise. Short-term recovery was explored through self-assessment of unspecified voice problems every 15 minutes for 2 hours following loading. Long-term recovery was tracked through self-assessments of specific voice symptoms during 3 days following vocal loading. Effects of heavy vocal loading were evaluated through voice recordings, long-time-average spectrum, perceptual assessments, and assessments of digital imaging performed pre- and post vocal loading. RESULTS: Patients with FD did not return to baseline for unspecified voice problems within 2 hours of vocal loading and were worse affected by vocal loading than other groups. Women with high everyday vocal loading with no voice complaints identified vocal loading more evidently than other groups. Long-term recovery took 7-20 hours for all groups. CONCLUSIONS: Short-term recovery is slower for patients with FD and these patients are worse affected by a VLT than others.

Long-Time Voice Accumulation During Work, Leisure, and a Vocal Loading Task in Groups With Different Levels of Functional Voice Problems.

OBJECTIVE: The study aimed to examine the vocal behavior and self-assessed vocal health in women with varying everyday vocal load and functional voice problems, including patients with functional dysphonia, in three conditions: work, leisure, and a vocal loading task (VLT). STUDY DESIGN: This is a longitudinal controlled, clinical trial. METHODS: Fifty (n = 50) female subjects were tracked during 7 days' voice accumulation accompanied by a voice health questionnaire, containing general assessments with visual analogue scale and specific voice health questions. Subjects were divided into four vocal subgroups according to everyday vocal load and functional vocal complaints. Accumulation time was divided into three conditions: a VLT, work, and leisure. The following behavioral parameters were measured: (1) relative phonation time (%), (2) phonatory sound pressure/voice level (dB sound pressure level), (3) ambient noise level (dB sound pressure level), and (4) phonatory fundamental frequency (Hz). RESULTS: Patients with functional dysphonia reported significantly higher specific voice problems across conditions and worse general voice problems during work and leisure than other groups. Women with high everyday vocal load and voice complaints showed higher phonation times and fundamental frequency during work than voice healthy controls. They also reported the highest incidence of general voice problems in the VLT. CONCLUSIONS: Vocal loading relates to prolonged phonation time at high fundamental frequencies. Patients with functional dysphonia experience general and specific voice problems permanently, whereas women with everyday vocal load and voice complaints recover during leisure. This may explain why the latter group does not seek voice therapy.

Design of a clinical vocal loading test with long-time measurement of voice.

OBJECTIVES: The aim of this study was to design a clinical vocal loading task (VLT) and to track vocal loading and recovery in voice-healthy subjects. STUDY DESIGN: Pilot study. METHODS: Voice-healthy subjects (six female, five male) took part in a controlled VLT in the voice clinic. The VLT was designed to induce vocal fatigue. The subjects read aloud while making themselves heard through ambient speech-babble aired at 85 dB sound pressure level (SPL). Reading was terminated by the subjects when or if they felt any discomfort from the throat. The subjects wore a voice accumulator and filled out a voice activity questionnaire 1 day preceding and for 2 days following the VLT. Expert panels assessed vocal quality and laryngeal physiology from recordings. RESULTS: The subjects endured the VLT for 3-30 minutes. All subjects perceived vocal loading in the VLT. All subjects raised the fundamental frequency and SPL of their speech during the VLT. No match was shown between assessment of voice quality and laryngeal physiology. The subjects showed phonation quotients of 64-82% in the task. Measurements of phonation threshold pressure (PTP) were unstable and were not used. Self-perceived vocal loading receded after 24 hours. CONCLUSIONS: An authentic vocal load was simulated through the chosen method. Onset and recovery from self-perceived vocal loading was traceable through the voice activity questionnaire. The range of endurance in the VLT was an unexpected finding, indicating the complexity of vocal loading.

Teachers' voice use in teaching environments: a field study using ambulatory phonation monitor.

OBJECTIVES: This case-control designed field study examines the vocal behavior in teachers with self-estimated voice problems (VP) and their age- and school-matched voice healthy (VH) colleagues. It was hypothesized that teachers with and teachers without VP use their voices differently regarding fundamental frequency, sound pressure level (SPL), and in relation to the background noise. METHODS: Teachers with self-estimated VP (n = 14; two males and 12 females) were age and gender matched to VH school colleagues (n = 14; two males and 12 females). The subjects, recruited from an earlier study, had been examined in laryngeal, vocal, hearing, and psychosocial aspects. The fundamental frequency, SPL, and phonation time were recorded with an Ambulatory Phonation Monitor during one representative workday. The teachers reported their activities in a structured diary. The SPL (including teachers' and students' activity and ambient noise) was recorded with a sound level meter; the room temperature and air quality were measured simultaneously. The acoustic properties of the empty classrooms were measured. RESULTS: Teachers with VP behaved vocally different from their VH peers, in particular during teaching sessions. The phonation time was significantly higher in the group with VP, and the number of vibratory cycles differed between the female teachers. The F0 pattern, related to the vocal SPL and room acoustics, differed between the groups. CONCLUSION: The results suggest a different vocal behavior in subjects with subjective VP and a higher vocal load with fewer possibilities for vocal recovery.