Journal of Voice最新文献

{"title":"Study of Glottal Attack Time and Glottal Offset Time in Neurogenic Voice Disorders During Sustained Phonation.","authors":"Trent M Henry, Dimitar D Deliyski, Mohsen Zayernouri, Stephanie R C Zacharias, Maryam Naghibolhosseini","doi":"10.1016/j.jvoice.2025.02.030","DOIUrl":"https://doi.org/10.1016/j.jvoice.2025.02.030","url":null,"abstract":"<p><strong>Objective: </strong>Neurogenic voice disorders like adductor laryngeal dystonia (AdLD), vocal tremor, and vocal paresis/paralysis impact the neuromuscular control of the phonatory system, which might lead to an impaired phonation onset/offset. Utilizing laryngeal high-speed videoendoscopy (HSV), this study investigates the glottal attack time (GAT) and glottal offset time (GOT) during soft, habitual, and hard glottal attack modalities in sustained phonation for several neurogenic voice disorders.</p><p><strong>Methods: </strong>HSV data and audio recordings were obtained simultaneously from 14 participants with neurogenic voice disorders and 14 normophonic participants during two productions of the /i/ vowel at soft, habitual, and hard glottal attacks. Using HSV, GAT, defined as the time interval between the first oscillation and the first contact of the vocal folds at phonation onset, and GOT, the time interval between the last oscillation and the last contact of the vocal folds at phonation offset, were measured. GAT and GOT for different glottal attack modalities were compared within each group, also among the different disorders and normophonic participants. Additionally, these values were compared between sustained phonation and connected speech for the normophonic participants and those with AdLD.</p><p><strong>Results: </strong>The neurogenic disorders group exhibited significantly higher GAT values than the normophonic participants during the hard glottal attack modality. Habitual GOTs for vocal tremor were significantly different than those of unilateral vocal fold paralysis and AdLD. Moreover, the normophonic participants shared similar trends between connected speech and sustained phonation across glottal attack modalities for GAT, while the AdLD group did not. AdLD participants shared the same trend for GOT, while normophonic participants did not.</p><p><strong>Conclusions: </strong>This study provides evidence of differences in GAT and GOT values during sustained phonation across different neurogenic voice disorders, contributing to the understanding of their pathophysiology. These findings may inform the development of strategies and speech tasks for clinical assessment of neurogenic voice disorders.</p>","PeriodicalId":49954,"journal":{"name":"Journal of Voice","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665205","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":"Comparison of Voice Quality in Persian Parkinson Patients With Healthy Counterparts Using Cepstral Peak Prominence and Cepstral Peak Prominence-Smooth and Their Relationship With Disease Severity (UPDRS-III) and Disease Duration.","authors":"Parvaneh Rahimifar, Majid Soltani, Shahram Rafie, Saeed Hesam, Mohammad Jafar Shaterzadeh Yazdi, Negin Moradi","doi":"10.1016/j.jvoice.2025.02.042","DOIUrl":"https://doi.org/10.1016/j.jvoice.2025.02.042","url":null,"abstract":"<p><strong>Introduction: </strong>One of the earliest impairments in Parkinson's patients is speech motor dysfunction, which adversely affects the phonation subsystem (voice). To date, acoustic frequency-dependent voice features such as cepstral peak prominence (CPP) and cepstral peak prominence-smooth (CPPS) have not been examined in Persian-speaking Parkinson's patients. This study aims to compare the voice quality of Persian Parkinson's patients with healthy counterparts using CPP and CPPS, as well as to investigate the relationship of these metrics with Unified Parkinson's Disease Rating Scale-Part III (UPDRS-III) and disease duration.</p><p><strong>Method: </strong>This study included 35 Persian Parkinson's patients and 35 healthy individuals. Disease severity was assessed using UPDRS-III. Speech samples (sustained vowel phonation of /ɑ/ and reading of the \"Grandfather Passage\") were recorded by a microphone. CPP and CPPS were extracted by Praat software.</p><p><strong>Results: </strong>The results showed that the mean CPP and CPPS in both tasks were significantly lower in the patient group compared with the healthy group (P value ≤ 0.001). Spearman correlation analysis of CPP and CPPS values in both tasks with disease severity revealed a significant negative correlation between CPP and CPPS and UPDRS-III in both tasks (P value ≤ 0.001). However, no significant correlation was observed between these indices and disease duration in any task (P value ≥ 0.001).</p><p><strong>Conclusion: </strong>These cepstral indices effectively distinguish vocal differences between Persian Parkinson's patients and healthy individuals. Additionally, these indices show a significant association with disease severity, underscoring their potential utility in the early diagnosis and monitoring of Parkinson's disease progression through vocal screening, especially when combined with other medical and neurological evaluations. However, this study found no relationship between disease duration and these indices. The absence of such a correlation may be attributed to the medication regimens of the patients.</p>","PeriodicalId":49954,"journal":{"name":"Journal of Voice","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659502","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":"Phonatory and Radiological Analysis in Modified Montgomery Thyroplasty.","authors":"Natsuki Oishi, Marta Torres-Pérez, Rosa Hernández-Sandemetrio, Cristina Rodríguez-Prado, Juana Forner, Enrique Zapater","doi":"10.1016/j.jvoice.2025.02.034","DOIUrl":"https://doi.org/10.1016/j.jvoice.2025.02.034","url":null,"abstract":"<p><strong>Background: </strong>Our main objective was to analyze the phonatory and radiological characteristics of patients with optimal and suboptimal grade of hoarseness, roughness, and breathiness (GRB) of Auditory Perceptual Voice Evaluation Scale results after modified Montgomery thyroplasty. We have analyzed the functional characteristics using maximum phonatory time (MPT), Voice Handicap Index-30 (VHI-30), as well as a radiological study. We also aimed to determine the influence of sex on the variables studied.</p><p><strong>Methods: </strong>Descriptive study of the postoperative phonatory results complemented with a radiological analysis using laryngeal computed tomography images of adult patients. A total of nine measurements of important laryngeal landmarks of interest were taken on each patient.</p><p><strong>Results: </strong>The study included 24 patients with a mean age of 57 years. Younger patients obtained better results. The improvement in VHI-30 in optimal GRB group was significantly greater. No significant differences in the MPT were obtained. Most men obtain an optimal MPT, and women a more variable result. As for the % of vocal quality, the result is similar between sexes. The thyroid window closer to the anteroinferior corner was observed in men with better GRB results.</p><p><strong>Conclusions: </strong>A significant relationship was found between optimal grade of hoarseness (G) and VHI-30 score. However, neither was related to MPT. We have described laryngeal radiological data focusing on the surgical approach.</p>","PeriodicalId":49954,"journal":{"name":"Journal of Voice","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659512","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":"Technical Aspects of Transcutaneous Laryngeal Ultrasonography: A Review.","authors":"Agastya Patel, Piotr Spychalski, Katarzyna Polomska, Mohammed Albrahim, Karolina Markiet, Jagoda Kurylowicz, Boguslaw Mikaszewski, Jarek Kobiela","doi":"10.1016/j.jvoice.2025.01.040","DOIUrl":"https://doi.org/10.1016/j.jvoice.2025.01.040","url":null,"abstract":"<p><strong>Importance: </strong>Vocal fold palsy is a crucial complication of thyroidectomy. Although laryngoscopic examination is the gold standard for vocal fold assessment, there is a growing interest in incorporating transcutaneous laryngeal ultrasonography (TLUSG) in the peri-operative period. This review provides a detailed technical report on how to efficiently perform TLUSG assessment of the vocal folds.</p><p><strong>Observations: </strong>The ultrasonographic assessment of vocal folds is based on the recognition and observation of one of three structures: false vocal folds, true vocal folds, and arytenoid cartilages. These structures can be visualized either through the anterior (transverse) approach or the lateral (sagittal) approach. The movement of vocal fold structures is elicited and assessed using three maneuvers, namely passive breathing, active phonation or Valsalva maneuver. This examination can allow adequate visualization and assessment of vocal fold function in the majority of the patients in the peri-operative period.</p><p><strong>Conclusions and relevance: </strong>This review provides a step-by-step description and algorithmic approach to TLUSG assessment of the vocal folds. It details the common pitfalls and modifications of TLUSG required to assist surgeons, anesthesiologists, and endocrinologists in incorporating this examination in their practice.</p>","PeriodicalId":49954,"journal":{"name":"Journal of Voice","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659534","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":"Comparison of Injection Laryngoplasty With and Without Ultrasound Marking After Thyroid Surgery.","authors":"JunHo Park, Min-Su Kim","doi":"10.1016/j.jvoice.2025.02.047","DOIUrl":"https://doi.org/10.1016/j.jvoice.2025.02.047","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to assess the clinical efficacy of injection laryngoplasty using ultrasound marking in patients with unilateral vocal fold paralysis after thyroidectomy compared with injection laryngoplasty without ultrasound marking.</p><p><strong>Methods: </strong>Ten patients with unilateral vocal fold paralysis after thyroidectomy were retrospectively analyzed. There were five patients in the ultrasound marking group and matched five patients in the non-ultrasound marking group. Auditory-perceptual evaluation, acoustic analysis, aerodynamic analysis, and Voice Handicap Index-30 were performed on all patients before and 1 month after injection laryngoplasty.</p><p><strong>Results: </strong>In all patients, auditory-perceptual parameters and the Voice Handicap Index-30 revealed statistically significant improvements following injection laryngoplasty. No adverse effects were observed in any patient. The Voice Handicap Index-30 and the injection laryngoplasty procedure time were substantially reduced in the ultrasound marking group compared to that in the non-ultrasound marking group. However, other parameters did not exhibit a statistically significant difference between the two groups before and 1 month after injection laryngoplasty.</p><p><strong>Conclusion: </strong>Injection laryngoplasty with ultrasound marking is an easy, rapid, and convenient method for patients who experienced unilateral vocal fold paralysis following thyroidectomy.</p>","PeriodicalId":49954,"journal":{"name":"Journal of Voice","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659499","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":"Acoustic Parameters After Vocal Technique Associated With Virtual Reality With Electromyographic Biofeedback and Rhythmic Auditory Stimulation in Individuals With Parkinson's Disease.","authors":"Thalita Vitória Silva da Cruz, Hilton Justino da Silva, Kelli Nogueira Ferraz Pereira Althoff, Ana Cláudia de Carvalho Vieira, Thiago Freire Pinto Bezerra, Hellen Vasconcelos Silva Leal de Lima, Julianne Pitanga Teixeira, Adriana de Oliveira Camargo Gomes, Zulina Souza de Lira","doi":"10.1016/j.jvoice.2025.02.038","DOIUrl":"https://doi.org/10.1016/j.jvoice.2025.02.038","url":null,"abstract":"<p><strong>Objective: </strong>To compare the post technique effect of pushing with plosive sounds associated with virtual reality (VR) using electromyographic biofeedback and rhythmic auditory stimulation (RAS) on acoustic parameters in the voice of individuals with Parkinson's disease (PD).</p><p><strong>Method: </strong>The study sample included 30 individuals with PD (15 men and 15 women), with a mean age of 62.13 ± 9.05 years. All participants underwent vocal exercises associated with VR and RAS interventions. The first intervention was randomly assigned, and the second was conducted after 7 days. Speech tasks were recorded before and after interventions. The study analyzed the acoustic voice parameters from these recordings, assessed the participants' satisfaction after VR and RAS, and surveyed their preference between these strategies.</p><p><strong>Results: </strong>The jitter, shimmer, and vocal irregularity parameters of the individuals with PD improved after the vocal technique associated with RAS. No improvements in these parameters were observed with VR. The comparison between RAS and VR results showed a reduction in shimmer with RAS. Participants reported a significant preference for VR rather than RAS in combination with vocal exercises.</p><p><strong>Conclusion: </strong>The vocal technique associated with RAS applied to individuals with PD improved vocal parameters related to sound wave perturbation. The study population preferred VR to RAS.</p>","PeriodicalId":49954,"journal":{"name":"Journal of Voice","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639772","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 Voice Curriculum: Exploring Perceptions and Experiences of Graduate-Level Speech Pathology Education.","authors":"Serena Pu, Sarah K Brown, Anne M Perrotti, Tancy Vandecar-Burdin, Mark S Courey, John T Sinacori, Benjamin J Rubinstein","doi":"10.1016/j.jvoice.2025.02.031","DOIUrl":"https://doi.org/10.1016/j.jvoice.2025.02.031","url":null,"abstract":"<p><strong>Objectives: </strong>While all speech-language pathologists (SLPs) are licensed to practice as voice specialists, graduate education experiences in voice vary significantly. This qualitative research project explores perceptions of and experiences in graduate voice education of SLPs by various participants in the educational clinical voice setting.</p><p><strong>Study design: </strong>Qualitative research design.</p><p><strong>Methods: </strong>Thirteen voice providers were interviewed through semi-structured virtual focus groups about the experience and perception of graduate level education in speech pathology and the practice of voice care by postgraduate speech pathologists. Narrative analysis was used to identify relevant themes across the interviews.</p><p><strong>Results: </strong>Four broad themes were identified: a) inconsistency in graduate voice courses, b) inconsistency in clinical experiences, c) barriers to voice preparation, and d) areas of success and suggestions for improvement in graduate voice education for SLPs.</p><p><strong>Conclusions: </strong>The lack of specific standardized requirements, variability in access to clinical experiences and perspectives of graduate voice instructors, and barriers to voice preparation, including competitive clinical fellowship programs, are challenges in the process of voice education for early-career SLPs. These inconsistencies of preparation impact perceptions of preparedness and competence for clinical voice service delivery and are areas for large scale improvement of graduate voice education.</p>","PeriodicalId":49954,"journal":{"name":"Journal of Voice","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143631005","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":"Effects of Intentional Register Instability During Onset of High-Intensity Phonation.","authors":"Tyler Crosby, Mike Ruckles, Aaron M Johnson","doi":"10.1016/j.jvoice.2025.02.043","DOIUrl":"https://doi.org/10.1016/j.jvoice.2025.02.043","url":null,"abstract":"<p><strong>Objectives/hypothesis: </strong>This study investigated the effects of the \"crack-sob\" onset-a distinctive vocal technique combining a sob gesture with an intentional pitch break-on vocal fold function during high-intensity singing. We hypothesized that this onset would either decrease glottal adduction and increase vocal fold vibration stability or alternatively, show no measurable effects while still providing perceived benefits to singers.</p><p><strong>Study design: </strong>Prospective observational cohort study.</p><p><strong>Methods: </strong>Twenty professional musical theatre singers (10 male, 10 female) performed high-intensity sustained notes with and without the crack-sob onset using both a control phrase and self-selected repertoire. Electroglottography measured contact quotient (CQ) and its relative standard deviation (relSDCQ). Acoustic analysis quantified smoothed cepstral peak prominence (CPPS), harmonics-to-noise ratio (HNR), and vocal intensity (dB SPL). Linear mixed effects modeling was used to analyze the effects of the crack-sob maneuver, with sex and vocal phrase as covariates.</p><p><strong>Results: </strong>The crack-sob onset showed no significant effects on any measured parameters. CQ remained consistent at 66% regardless of onset type. No significant changes were observed in CPPS, dB SPL, relSDCQ, or HNR when using the crack-sob onset, with all effect sizes below 0.1. Significant differences were found between control and self-selected phrases, with the control phrase showing higher CPPS (+2.6 dB), intensity (+2.7 dB SPL), and HNR (+4.3).</p><p><strong>Conclusions: </strong>The crack-sob onset does not significantly alter objective measures of vocal fold adduction or vibratory stability during sustained high-intensity phonation in trained singers. The technique's reported benefits may be primarily perceptual rather than physiological, suggesting its value as a pedagogical tool for managing singer effort without compromising vocal function.</p>","PeriodicalId":49954,"journal":{"name":"Journal of Voice","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143631004","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":"Voice Disorders in Patients With Discordant RFS and RSI Scores.","authors":"Feng Zhang, Jinhong Zhang, Dan Wang, Xingmei Wu, Liang Peng, Zhangfeng Wang, Xiaolin Zhu, Renqiang Ma, Lin Chen, Yun Li, Wenbin Lei, Jie Deng","doi":"10.1016/j.jvoice.2025.02.014","DOIUrl":"https://doi.org/10.1016/j.jvoice.2025.02.014","url":null,"abstract":"<p><strong>Background: </strong>Laryngopharyngeal reflux (LPR) is a significant risk factor for various voice disorders. The reflux finding score (RFS) and Reflux Symptom Index (RSI) are widely used diagnostic tools for LPR, but they often show poor concordance. It remains unclear whether patients with discordant RFS and RSI scores (one positive, one negative) have a higher risk of developing voice disorders, and whether proton pump inhibitor (PPI) therapy can improve voice quality in this subgroup.</p><p><strong>Objective: </strong>This study aims to evaluate the risk of developing voice disorders in patients with discordant RFS and RSI scores and to assess the efficacy of PPI therapy on voice-related symptoms and objective voice parameters.</p><p><strong>Study design: </strong>This study consists of a large-sample logistic regression analysis followed by a case-control phase and a prospective interventional phase.</p><p><strong>Methods: </strong>Logistic regression analysis was performed on 915 patients, followed by telephone follow-up of 200 patients. A case-control study was conducted on these 200 patients, with a subsequent multivariate logistic regression analysis. A prospective study assessed the effects of PPI therapy on voice symptoms and objective voice parameters.</p><p><strong>Results: </strong>Logistic regression analysis suggested that the risk of developing voice disorders in this subgroup was significantly higher compared with patients with both negative scores. PPI therapy led to significant reductions in the Voice Handicap Index (VHI), and GRBAS (Grade, Roughness, Breathiness, Asthenia, Strain) scores in this subgroup, alongside enhancements in several objective voice parameters.</p><p><strong>Conclusion: </strong>Discordant RFS and RSI scores are associated with an increased risk of voice disorders. PPI therapy alleviates symptoms and improves voice quality, suggesting benefits for managing voice disorders in this subgroup.</p>","PeriodicalId":49954,"journal":{"name":"Journal of Voice","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626622","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":"Self-Reported Fatigue and Bioenergetic Pathways Secondary to Interventions for Vocal Fatigue: A Feasibility Study.","authors":"Chaya Guntupalli Nanjundeswaran, Jessie VanSwearingen","doi":"10.1016/j.jvoice.2025.02.027","DOIUrl":"https://doi.org/10.1016/j.jvoice.2025.02.027","url":null,"abstract":"<p><strong>Objective: </strong>Vocal fatigue, a multifaceted condition affecting professional voice users, significantly impacts occupational performance and quality of life, particularly in teachers, with a prevalence of 18%-33%. This feasibility study explored the metabolic and self-perceptual mechanisms underlying vocal fatigue and the efficacy of two intervention strategies: cardiovascular conditioning and voice production exercises.</p><p><strong>Methods: </strong>The study involved 22 female teachers and college instructors categorized into high and low vocal fatigue (VF) groups based on the Vocal Fatigue Index (VFI). Participants underwent 4-week interventions with outcomes assessed via VFI scores, perceived effort, metabolic costs, and recovery times for vocal tasks.</p><p><strong>Results: </strong>The results indicated intervention-specific benefits: voice therapy reduced tiredness, avoidance, and physical discomfort (VFI factors 1 and 2), improving loud speaking effort. Cardiovascular training alleviated symptoms of tiredness with recovery (VFI factor 3) and enhanced conversational speaking effort. Both treatments increased metabolic costs but shortened recovery times, suggesting a shift toward reliance on aerobic energy pathways. Patterns of improvement varied between high and low VF groups, emphasizing the heterogeneous nature of VF.</p><p><strong>Conclusion: </strong>The findings highlight the need for personalized treatment strategies tailored to individual bioenergetic and self-perceptual profiles. Future studies should refine task designs and outcome measures to further delineate aerobic and anaerobic contributions to VF mechanisms.</p>","PeriodicalId":49954,"journal":{"name":"Journal of Voice","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143606413","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}