Journal of Voice最新文献

{"title":"Evaluating the Role of Adding Platelet-Rich Plasma to Autologous Fat Injection for Unilateral Vocal Fold Immobility: A Comparative Study.","authors":"Mohamed Fawaz, Islam Mohamed Hassan, Amr Roshdy Elbadrawy, Heba Ashour Mostafa, Ramez Reda, Ahmed Ali Abdelmonem","doi":"10.1016/j.jvoice.2025.06.038","DOIUrl":"https://doi.org/10.1016/j.jvoice.2025.06.038","url":null,"abstract":"<p><strong>Objectives: </strong>This study assessed the efficacy and safety of vocal fold injection using autologous fat combined with platelet-rich plasma (PRP) compared with autologous fat alone in patients with unilateral vocal fold immobility (UVFI).</p><p><strong>Study design: </strong>A randomized controlled trial included 50 patients with dysphonia due to UVFI. Group A (25 patients) received an injection of autologous fat combined with PRP, while Group B (25 patients) received autologous fat only.</p><p><strong>Methods: </strong>Patients were evaluated using the modified GRBAS scale, telescopic laryngeal examination, the Arabic version of the Voice Handicap Index (VHI), computerized speech lab (CSL), and maximum phonation time (MPT). Assessments were conducted preinjection and at 1 and 12 months postinjection.</p><p><strong>Results: </strong>Group A showed significantly better outcomes in dysphonia grade, breathiness, and glottal gap at 1 month, but differences diminished by 12 months. Both groups improved similarly over time in jitter, shimmer, noise-to-harmonic ratio (NHR), MPT, and VHI, with no significant between-group differences. No postoperative complications were observed in either group, and none required reinjection 12 months after injection.</p><p><strong>Conclusion: </strong>Injection laryngoplasty using a combination of autologous fat and PRP is a safe and effective method for managing UVFI. While early subjective voice improvement was noted at 1 month in the PRP group, these differences were not sustained at 12 months. Thus, the addition of PRP to fat injection may provide transient early benefits but does not demonstrate clinically significant long-term superiority. Further studies with extended follow-up and more advanced instrumental assessment tools are still recommended for better management of UVFI.</p>","PeriodicalId":49954,"journal":{"name":"Journal of Voice","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144676351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anthropological Unfoldings of the Human Voice: The Formation of Humanity Through Voice.","authors":"Rubens Costa Güths","doi":"10.1016/j.jvoice.2025.06.026","DOIUrl":"https://doi.org/10.1016/j.jvoice.2025.06.026","url":null,"abstract":"<p><strong>Objectives: </strong>This study aims to describe six stages in which the voice plays a central role in the cultural and anthropological formation of humankind. These stages are referred to in this study as the Stages of Liberation of the Human Voice.</p><p><strong>Methods: </strong>Using a bibliographic approach, the history of the human voice is examined as a phenomenon rather than as an object of study within a specific field such as medicine or the arts.</p><p><strong>Results: </strong>The study first introduces four earlier stages, termed the Stages of Human Voice Imprisonment (SHVI). These stages encompass various historical events that have shaped human culture and, in some way, have directly or indirectly influenced vocal production-whether in theoretical, practical, or both forms. However, these stages should not be viewed as negative developments in the evolution of voice studies, but rather as necessary processes. Following this, the six Stages of Liberation of the Human Voice (SHVL) are presented. These stages represent the emancipation from implicit or explicit pre established premises concerning the phenomenon of voice and its various manifestations-such as speech, singing, poetry, ventriloquism, and vocal therapy. This liberation occurs in relation to constraints imposed by societal norms, the available knowledge and technology of a given historical period, prevailing beliefs about vocal production and its applications, and, in some cases, the inherent organic nature of the voice itself.</p><p><strong>Final considerations: </strong>Finally, the study concludes with a discussion on the significance of both the SHVI and the (SHVL) in contemporary vocal sciences, particularly in addressing the fundamental question: What is voice?</p>","PeriodicalId":49954,"journal":{"name":"Journal of Voice","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144668873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Virtual Reality as a Tool in Gender-Affirming Voice Training: A Pilot Study.","authors":"Clara Leyns, Lien Bosschem, Tine Papeleu, Lode Sabbe, Gareth Walkom, Evelien D'haeseleer","doi":"10.1016/j.jvoice.2025.06.034","DOIUrl":"https://doi.org/10.1016/j.jvoice.2025.06.034","url":null,"abstract":"<p><strong>Objectives: </strong>The pilot study aimed to explore the potential of virtual reality (VR) speaking situations in generalizing elevated pitch to spontaneous speech and reducing speaking anxiety in trans women, as part of a voice feminization training program.</p><p><strong>Study design: </strong>A randomized controlled trial design was used, with an experimental group exposed to VR training (VRT) and a control group receiving traditional training without VR (TT).</p><p><strong>Methods: </strong>Eleven trans women were included, of which five were randomly assigned to the control group and six to the experimental group. All participants received four weekly 30-minute one-on-one training sessions. A Meta Quest 2 VR headset was used, in combination with the Therapy withVR web app. Outcome measures before and after training included the Trans Woman Voice Questionnaire (TWVQ), Willingness to Communicate (WTC), and median fundamental frequency (f_o) during reading and spontaneous speech. Descriptive analyses and figures were conducted in RStudio.</p><p><strong>Results: </strong>The TWVQ total scores showed a slight decrease for both groups, indicating minimal improvement in voice-related quality of life. In the VRT group, WTC scores increased across contexts, particularly in interactions with strangers and public speaking, while TT scores remained stable. For f_o, both groups demonstrated increased pitch. However, individual results show high variability between participants across the questionnaires.</p><p><strong>Conclusions: </strong>This pilot study suggests that VRT might potentially increase pitch and WTC among trans women, particularly in interactions with strangers. However, improvements in voice-related quality of life were modest. Larger, mixed-methods, and long-term studies are needed to better understand VR's potential as a supportive tool for gender-affirming voice training in the transgender and gender diverse population.</p>","PeriodicalId":49954,"journal":{"name":"Journal of Voice","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144668831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Teachers' Self-Perception of Voice Before and After a Voice Awareness Program.","authors":"Gabriella Lucena Feitosa Rufino, Eduardo Lucas de Sousa Enéas, Bárbara Tayná Santos Eugênio da Silva Dantas, Maurícia Sousa Bernardo, Gleicy Nieskier Souza Ventura E Alencar, Marylia Albuquerque Andrade Ramos, Maria Fabiana Bonfim de Lima-Silva","doi":"10.1016/j.jvoice.2025.05.019","DOIUrl":"https://doi.org/10.1016/j.jvoice.2025.05.019","url":null,"abstract":"<p><strong>Purpose: </strong>To assess teachers' voice self-perception before and after participating in a voice awareness program.</p><p><strong>Material and methods: </strong>This interventional, descriptive, quantitative study, approved by the Human Research Ethics Committee under CAAE: 10719513.5.0000.5188, included 33 elementary and middle school teachers of both sexes from municipal schools in northeastern Brazil. The intervention had three stages, applying the Vocal Health and Hygiene Questionnaire (VHHQ) and the Voice-Related Quality-of-Life (V-RQOL) in the first one; conducting four vocal health workshops with theoretical and practical content in the second; and reapplying the VHHQ and V-RQOL in the third stage to compare results before and after the intervention.</p><p><strong>Results: </strong>Most participants were females, whose mean age neared the end of the vocal efficiency period. The protocols indicated that the voice awareness program positively impacted the study participants, with better voice perception and greater knowledge about factors harmful to vocal health.</p><p><strong>Conclusions: </strong>The research demonstrated the importance of informative programs on vocal health by exchanging knowledge, improving voice-related quality of life, and preventing vocal disorders.</p>","PeriodicalId":49954,"journal":{"name":"Journal of Voice","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144660916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validation of a Python-Based Graphical User Interface for Calculation of Relative Fundamental Frequency.","authors":"Mara R Kapsner-Smith, Aideen Gill, Abigail Muzila, Tamara Polyakova, Austeja Rubeski, Joshua Kline, Cara E Stepp, Jenny Vojtech","doi":"10.1016/j.jvoice.2025.06.031","DOIUrl":"https://doi.org/10.1016/j.jvoice.2025.06.031","url":null,"abstract":"<p><strong>Objectives: </strong>The purpose of this study was to validate PyRFF, a semi-automated software for calculating relative fundamental frequency (RFF). PyRFF was developed in Python, a widely used open source programming language, making it freely accessible and broadly applicable for researchers and clinicians. By providing an accessible tool for RFF extraction, PyRFF has the potential to facilitate wider adoption of RFF measures in both research and clinical settings.</p><p><strong>Study design: </strong>Validation study.</p><p><strong>Methods: </strong>To assess the accuracy of PyRFF, RFF measures were extracted using both PyRFF and a previously validated, semi-automated algorithm implemented in MATLAB. The outputs from the two programs were then compared using statistical measures of error, including root mean square error (RMSE) and mean bias error (MBE).</p><p><strong>Results: </strong>The results demonstrated near-identical outputs between PyRFF and the MATLAB-based algorithm. RMSE and MBE values were close to zero for all comparisons, indicating minimal discrepancy between the two methods.</p><p><strong>Conclusions: </strong>PyRFF offers a valid, freely available software platform for extracting RFF measures, ensuring accessibility for a broad user base of researchers, clinicians, and students. The availability of free, user-friendly software is essential for advancing research and clinical application of RFF in voice assessment. By providing an alternative to MATLAB-based methods, PyRFF lowers financial and technical barriers, promoting further exploration of RFF as a potential tool in voice disorder assessment and treatment.</p>","PeriodicalId":49954,"journal":{"name":"Journal of Voice","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144668829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Influence of Inhaled Drugs on Multidimensional Voice Quality of Asthma Patients: A Controlled Study.","authors":"Isra Slimani, Jérôme R Lechien","doi":"10.1016/j.jvoice.2025.06.035","DOIUrl":"https://doi.org/10.1016/j.jvoice.2025.06.035","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the voice quality in asthma patients treated with inhaled drugs (ID) through multidimensional voice quality assessment.</p><p><strong>Methods: </strong>Consecutive patients with well-controlled asthma treated with ID were prospectively recruited from the otolaryngology offices of two private practice settings from August 2024 to April 2025. A control group of patients without ID treatment was composed of patients without ear, nose, and throat disorders. The voice quality of patients and controls was evaluated with the Voice Handicap Index (VHI), blinded perceptual GRBASI evaluation, maximum phonation time (MPT), and acoustic measurements. Laryngopharyngitis symptoms and findings were evaluated with the Reflux Symptom Score (RSS) and Reflux Sign Assessment (RSA). Laryngopharyngeal, nose, and eye dryness was evaluated with the total rating of eye, nasal, and dry-mouth (TREND) assessment.</p><p><strong>Results: </strong>Thirty asthma patients with an inhaled corticosteroid treatment and 50 controls completed the evaluation. Asthma patients reported significantly higher VHI, GRBASI, RSS, and RSA compared to controls. MPT was significantly lower in asthmatics compared to controls. F0 standard deviation and percent shimmer were significantly higher in asthmatics versus controls. Grade of dysphonia and breathiness were significantly correlated with STD and percent shimmer.</p><p><strong>Conclusion: </strong>ID users demonstrated impaired multidimensional subjective and objective voice quality evaluations compared to controls. Future controlled mechanistic studies are needed to better understand to relationship between ID and vocal fold function impairments.</p>","PeriodicalId":49954,"journal":{"name":"Journal of Voice","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144668826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validity and Reliability of a German Version of Reflux Symptom Index.","authors":"Jiri Podzimek","doi":"10.1016/j.jvoice.2025.06.027","DOIUrl":"https://doi.org/10.1016/j.jvoice.2025.06.027","url":null,"abstract":"<p><strong>Objective: </strong>The Reflux Symptom Index (RSI) is a widely used self-administered questionnaire for assessing laryngopharyngeal reflux (LPR). This study aimed to develop a German version of the RSI (G-RSI) and to evaluate its reliability, clinical validity, and responsiveness.</p><p><strong>Study design: </strong>prospective, controlled, cross-sectional study.</p><p><strong>Methods: </strong>This case-control study included 95 patients with LPR symptoms and 60 asymptomatic control subjects. The RSI was translated into German using a forward-backward methodology. Participants completed the G-RSI at baseline (G-RSI d0), and LPR patients completed it again after 14 days (G-RSI d14) and after a 12-week treatment period (G-RSI w12). Reliability was analyzed using Cronbach's alpha and intraclass correlation coefficients (ICC). Internal validity was evaluated by comparing the G-RSI scores of patients and controls. Responsiveness was assessed by comparing the pretreatment and post treatment scores. The G-RSI cutoff for determining the presence or absence of LPR was examined using receiver operating characteristic analysis.</p><p><strong>Results: </strong>The Cronbach's α for the G-RSI was 0.924, indicating high internal consistency. Test-retest reliability was excellent (ICC = 0.92). The G-RSI demonstrated high internal validity, with significant differences between patient and control scores (P < 0.001). Responsiveness was also high, with significant improvements in G-RSI scores after treatment (P < 0.001). A G-RSI cut-off value of 13 was indicative of LPR, with high sensitivity (97.4%) and specificity (90.5%).</p><p><strong>Conclusions: </strong>The German RSI demonstrated high reproducibility, excellent clinical validity, and responsiveness after transcultural adaptation. It is a valuable tool for the initial symptom assessment and evaluation of therapeutic interventions in individuals with suspected acid LPR in outpatient clinics and primary healthcare settings.</p>","PeriodicalId":49954,"journal":{"name":"Journal of Voice","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144668830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pitch Alteration Techniques for Transgender Women: A Systematic Review of Surgical and Nonsurgical Approaches.","authors":"Raisa Chowdhury, Jennifer A Silver, Eleni Philippopoulos, Karen M Kost","doi":"10.1016/j.jvoice.2025.06.032","DOIUrl":"https://doi.org/10.1016/j.jvoice.2025.06.032","url":null,"abstract":"<p><strong>Objective: </strong>To systematically evaluate and compare the effectiveness of surgical and nonsurgical pitch elevation techniques in transgender women using acoustic outcomes and validated patient-reported outcome measures (PROMs).</p><p><strong>Methods: </strong>A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Comprehensive searches of Ovid MEDLINE, Embase, CENTRAL, PsycINFO, CINAHL, and gray literature were completed through January 2025. Included studies involved transgender women (≥18 years) undergoing pitch elevation via surgical (Wendler glottoplasty [WG], cricothyroid approximation [CTA], vocal fold shortening and retrodisplacement of the anterior commissure [VFSRAC], and laser-assisted voice adjustment [LAVA]), laser-reduction glottoplasty [LRG], nonsurgical (voice therapy [VT]), or combination approaches. Eligible studies reported both changes in fundamental frequency (F0) and validated PROMs, such as the Voice Handicap Index (VHI) or Trans Woman Voice Questionnaire (TWVQ). Risk of bias was assessed using the Cochrane Risk of Bias Tool and Newcastle-Ottawa Scale. Data were synthesized narratively with weighted means calculated for key outcomes.</p><p><strong>Results: </strong>Twenty-two studies (N = 977) were included. VFSRAC yielded the highest mean F0 increase (+73.3 Hz), followed by WG (+54.1 Hz), VT (+39.9 Hz), CTA (+30.3 Hz), and LAVA (+26 Hz). WG + VT showed comparable F0 gains (+54.5 Hz) with more consistent outcomes. TWVQ scores improved most with WG + VT (-47.9), followed by WG (-29.0) and VT (-18.7). VHI scores improved most with LAVA (-48.0) and WG (-21.7); VFSRAC and CTA showed modest PROM improvements. Adverse events, including granuloma and vocal fatigue, were more common with surgical combinations. Follow-up ranged from 2 weeks to 4.4 years, with most studies reporting 6-12 months.</p><p><strong>Conclusion: </strong>Surgical and nonsurgical interventions both elevate pitch and improve voice-related quality of life. Surgery provides greater F0 gains, while combining VT enhances patient satisfaction. Findings support individualized care and the need for standardized PROMs in future studies.</p>","PeriodicalId":49954,"journal":{"name":"Journal of Voice","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144668827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impacts of Testosterone Therapy Beyond Fundamental Frequency in Transmasculine Voice: Vocal Quality and Fricative Articulation.","authors":"Collin McHenry Eagen, Christine Brennan, Allison I Hilger","doi":"10.1016/j.jvoice.2025.06.005","DOIUrl":"https://doi.org/10.1016/j.jvoice.2025.06.005","url":null,"abstract":"<p><p>Prior investigation of the effects of testosterone therapy on transmasculine voices has demonstrated that most trans men who undergo testosterone therapy will have a resulting voice in the normative fundamental frequency range of cisgender men, yet there is little information about the effects of testosterone therapy on other features of voice and speech. The purpose of this study was to expand upon the current body of literature about the effects of testosterone therapy on transmasculine voices by including measures of vowel duration, jitter, shimmer, and spectral changes in fricative skew and fricative kurtosis. This study analyzed multiple progressive voice change recordings posted by 21 trans men on public platforms. Voice samples included at least 10 data points (ie, a collection of unique recordings from different dates) not exceeding the first year of testosterone therapy. Six linear mixed-effects regression models separately measured the effects of time point on mean fundamental frequency, vowel duration, jitter, shimmer, and spectral analysis (fricative kurtosis and fricative skew). The results confirmed that given testosterone therapy over a year, there was a significant decrease in fundamental frequency, a decrease in shimmer, and an increase in fricative kurtosis. There were no significant changes in vowel duration, jitter, and fricative skew. This study identifies voice features that could be the focus of future research that involves in-person testing. Additionally, the results motivate research focused on novel approaches to specialized voice therapy treatments that consider the impact of the voice features that did or did not change following testosterone therapy.</p>","PeriodicalId":49954,"journal":{"name":"Journal of Voice","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144668828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transcranial Direct Current Stimulation Combined With Straw Phonation in Water Technique in Subjects With and Without Vocal Symptoms: Exploratory Study.","authors":"Silvio Ricardo Couto Moura, Kátia Monte-Silva, Kelly Sukar Cavalcanti Oliveira, Fúlvia Nicolly de Oliveira Bezerra, Tatiany Cíntia da Silva Brito, Ana Claudia de Carvalho Vieira, Adriana de Oliveira Camargo Gomes","doi":"10.1016/j.jvoice.2025.06.030","DOIUrl":"https://doi.org/10.1016/j.jvoice.2025.06.030","url":null,"abstract":"<p><p>Transcranial direct current stimulation (tDCS) is a noninvasive neuromodulation technique whose effects on the voice have been explored, although still in a preliminary manner. The aim of this exploratory study was to verify the immediate effect of tDCS combined with straw phonation in water technique on the voice of adults with and without vocal symptoms. Twenty-two volunteers (11 with vocal symptoms and 11 without vocal symptoms) were evaluated before and after the exercise with straw phonation in water and tDCS session in primary motor cortex (M1). All participants underwent one anodal tDCS session (20 minutes; 2 mA) and one sham tDCS session with a 1-week washout period. The order of the real stimulus session and sham session was defined by drawing lots for blinding purposes. Voice recorders were taken to assess the acoustic parameters of vocal quality (jitter, shimmer, and glottal-to-noise excitation ratio), cepstral measures, acoustic index of dysphonia, voice range profile, laryngeal diadochokinesis, and in vocal effort self-perceived. RESULTS: There was a more pronounced decrease in vocal effort after neuromodulation and an improvement in dysphonia acoustic index and spectral decline, in habitual and high-intensity in subjects with and without vocal symptoms, indicating probable improvement in vocal signal regularity. There was an improvement in CPPS in both groups and a decrease in vocal effort self-perceived, both in the situation with neuromodulation and in the sham stimulus. There was also an increase in maximum intensity values in the groups with real and sham stimulation. CONCLUSION: Neuromodulation combined with the technique with straw phonation in water potentiated the decrease in self-perceived vocal effort in subjects with and without vocal symptoms and an improvement in cepstral values in subjects with vocal symptoms. A possible improvement in spectral decline values was also observed in subjects with vocal symptoms.</p>","PeriodicalId":49954,"journal":{"name":"Journal of Voice","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144660917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}