Faculty Bibliography

PURPOSE/UNASSIGNED:Primary muscle tension dysphonia (pMTD) is a form of vocal hyperfunction with no preexisting tissue trauma to the vocal folds. There are no known structural or neurological causes of pMTD, and there is rarely obvious, confirmatory evidence to reliably diagnose individuals accurately. Furthermore, acoustic and aerodynamic measurements taken during voice assessments vary widely within this population. The purpose of this study was to find subgroups within a sample of pMTD patients based on acoustic and aerodynamic measurements. We use a computational approach to elucidate what has largely been observational in the past. METHOD/UNASSIGNED:-means clustering analysis was conducted. RESULTS/UNASSIGNED:The exploratory factor analysis grouped together variables across patients, which resulted in three principal axes. These three principal axes separately consisted of aperiodicity, fundamental frequency, and aerodynamic measurements. These principal axes explained 44.7% of the total variance. Four clusters of patients were identified across the three principal axes. These were characterized by (a) a high amount of aperiodicity in the voice, (b) lower fundamental frequency values, (c) higher fundamental frequency values, and (d) high aerodynamic values. CONCLUSIONS/UNASSIGNED:The clusters identified in the current study are reliable and moderately separated. Furthermore, these clusters align with previously identified subgroups in related work. The analysis presented here lays the groundwork for additional clustering analyses with new pMTD samples, as well as future work establishing subtype classifications of pMTD.

OBJECTIVE:Previous investigations demonstrated voice changes corresponding to menstrual cycle phases, but few explored longitudinal cycle-to-cycle variations. The aim of this longitudinal case study was to describe changes in acoustics, laryngeal kinematics, vocal effort, and ability to produce high soft phonation in relation to menstrual cycle phases over the course of multiple cycles in a single normally cycling individual. METHODS:Data were obtained from a 34-year-old professional voice user who had self-collected daily videostroboscopy, acoustics, vocal effort rating, and high soft phonation tasks for 394 days. Data were analyzed by cycle phase and across time for all cycles. RESULTS:Cycle length ranged from 24-32 days. All metrics demonstrated high cycle-to-cycle variability (±2 standard deviation or more). Greatest variability was during menses and luteal phases. The fertile window was the least variable and showed decreased glottal area index (GAI), asymmetry quotient, perceived vocal effort, and increased smoothed cepstral peak prominence, consistent with previous literature suggesting "best" voice quality during the periovulatory period. Perceived vocal effort and fundamental frequency were highest during the luteal phase. GAI was lowest during the luteal phase, and higher during estimated day of ovulation, which contradicts previous findings. CONCLUSION/CONCLUSIONS:This case study represents a unique, longitudinal data set demonstrating changes in phonatory characteristics across repeated menstrual cycles. In general, there was increased variability during rapid hormonal changes (menses, luteal phases) and less variability during hormonal stability (fertile window), suggesting that voice changes are sensitive to the rapid hormonal shifts. Future prospective studies should include multiple participants and concurrent hormone-level tracking. LEVEL OF EVIDENCE/METHODS:Level 4.

OBJECTIVES/OBJECTIVE:) and PRO scores; (3) explore how changes across individual PROs align with changes in DIGEST pre- to six weeks post- surgery. METHODS:) pharyngeal total score and the DIGEST. PROs included the Bazaz Dysphagia Scale, the Eating Assessment Tool (EAT-10), the Swallowing Quality of Life Questionnaire (SWAL-QoL), and the Hospital for Special Surgery Dysphagia Index (HSS-DDI). RESULTS:Statistical models for all outcome measures revealed a significant effect of operative timepoint, indicating worse outcomes postoperatively. There were greater postoperative increases in point prevalence and incidence rates using PROs compared with DIGEST. Rates of clinically meaningful change were similar across PROs and DIGEST, but not consistently across the same individual cases. CONCLUSION/CONCLUSIONS:This study highlights the difference between physical function and patient experience, suggesting the presence or absence of dysphagia symptoms may not correspond with observed physical impairments after ACDF. LEVEL OF EVIDENCE/METHODS:Level III.

OBJECTIVES/OBJECTIVE:To examine the effects of short-term and long-term engagement with structured choral singing on vocal function and quality of life outcomes in older adults. METHODS:Two groups of older adult singers over 55 years, one with fewer than 4 semesters and one with 4 or more semesters singing in a chorale, were assessed at 3 time points: baseline, after 1 semester of singing, and either after 1 semester of rest or after 1 semester of rest and 1 semester more of singing. Acoustic and aerodynamic measures, voice-related quality of life ratings, and measures of singing accuracy were obtained. Percent change between time points were calculated to determine three outcomes: improvement, lack of change, or worsening of measures across time. RESULTS:Long-term average spectrum (LTAS), difference in first and second harmonics and estimated subglottic pressure were significantly more likely to improve after a semester of singing with less experience singers, and LTAS continued to improve after a semester of rest. Flow was significantly more likely to improve with more singing experience after a semester of singing. Aerodynamic variables consistently changed in more experienced singers and improvement was maintained over the three visits. No significant changes occurred over time for singing accuracy for any singer type. Self-perception of singing voice continued to improve with more singing experience. CONCLUSIONS:This study demonstrated that for older adults in good health, regular singing provided a mechanism for maintaining speaking voice over time.

OBJECTIVES/HYPOTHESIS/OBJECTIVE:To identify vocal tract configuration patterns in vocally healthy contemporary commercial music (CCM) singers during the production of five industry-typical vocal qualities, including various belting qualities and traditional/legit musical theater singing. STUDY DESIGN/METHODS:Prospective, observational study. METHODS:Seven professional musical theater singers (four females, three males) performed arpeggiated patterns using five different vocal qualities: traditional/legit, neutral belt, brassy belt, warm belt, and rock belt. Real-time magnetic resonance imaging captured midsagittal vocal tract configurations. Eight morphological measures were analyzed: lip opening, jaw opening, jaw protrusion, tongue dorsum height, uvula elevation, oropharyngeal opening, laryngeal height, and laryngeal tilt. Linear mixed-effects modeling explored relationships between vocal qualities and anatomical measurements. RESULTS:Lip opening, jaw opening, oropharyngeal opening, and laryngeal height showed significant differences across vocal qualities. The traditional/legit voice quality demonstrated the smallest lip, jaw, and oropharyngeal openings with the lowest laryngeal position. Rock belt showed the largest lip and jaw openings. Brassy belt and rock belt featured larger oropharyngeal space and higher tongue positions than other qualities, creating a "tube-like" shape rather than the previously suggested megaphone shape. Laryngeal positioning was elevated in all belting styles, but not in traditional/legit. No significant differences were found between male and female participants. Lower pitch tasks were characterized by smaller lip, jaw, and oropharyngeal openings compared with higher pitch tasks. CONCLUSION/CONCLUSIONS:This pilot study revealed distinct vocal tract configurations for different vocal qualities, particularly between traditional/legit and belting styles. The findings challenge previous assumptions about megaphone-shaped vocal tracts in belting, demonstrating more complex configurations. These results provide a foundation for identifying typical versus atypical vocal tract adjustments in CCM singing, with implications for voice pedagogy and clinical practice.

OBJECTIVE:The purpose of this study is to characterize patients who work professionally as musical performers and undergo potassium titanyl phosphate (KTP) laser ablation of vocal fold lesions in the outpatient setting. METHODS:A retrospective chart review of patients who are vocal performers and underwent in-office KTP laser ablation of benign vocal fold lesions at a single academic institution between 2012 and 2023 was conducted. Demographics including occupation, were descriptively reviewed. Acoustic measures, including cepstral peak prominence (CPP) and mean fundamental frequency variance (F0CoV), were analyzed. Vocal fold vibratory amplitude and mucosal wave were evaluated on videostroboscopy utilizing the voice vibratory assessment with laryngeal imaging. Preablation and postablation outcome measures were compared via Wilcoxon signed rank and McNemar's test. RESULTS:26 patients who identified as singers successfully underwent single-treatment in-office KTP laser ablation of vocal fold polyps. Ten patients (38.5%) identified as professional performers, and all patients continued their occupation after ablation. 84.2% of patients had either complete recovery or mildly reduced mucosal wave and amplitude of the treated vocal fold following KTP laser ablation. Additionally, CPP vowel improved following in-office KTP laser ablation, and F0CoV decreased following the ablation. All patients were able to continue their occupation in the same capacity. CONCLUSION/CONCLUSIONS:In-office KTP ablation is a valuable, safe, and feasible intervention for professional performers with benign vocal fold polyps. This study provides insight into vocal outcomes in the largest cohort of professional performers with apt follow-up.

PURPOSE/OBJECTIVE:Dysphagia is a commonly occurring medical condition estimated to occur in between and 10% adults in the US. Despite this relatively high prevalence, the general population's understanding of this condition is currently unknown. Our aims were to (a) conduct a large-scale survey to determine the public's awareness and understanding of dysphagia in comparison to other three other health conditions and (b) compare this knowledge to relative prevalence rates of the conditions. METHODS:The survey was designed to measure four constructs of interest comparing dysphagia with insomnia, vertigo and ataxia. Constructs included: (1) Knowledge of the Condition, (2) Source of Knowledge, (3) Health Impact, (4) Treating Medical Professionals. The survey was launched via Qualtrics™ software and participants were recruited and paid using Prolific™. Descriptive statistics were used to compare participants knowledge of dysphagia with the other conditions. To obtain relative prevalence rates, Cosmos was used to quantify the number of Epic-based patient encounters with any ICD-10 code for each condition in 2023 and expressed as a percent of all patient encounters in the US in 2023. RESULTS:2000 adults (n = 1030 female) aged 18-95 (median 49, IQR = 33-62) completed our survey. When asked, 'Do you know what ____ is'? participants expressed higher familiarity with insomnia (99%) and vertigo (87%) in comparison to dysphagia (25%) and ataxia (18%). From a list of 8 options, 99% and 94% participants selected the correct impairment for insomnia and vertigo respectively, compared with 44% correct for dysphagia and 22% for ataxia. Participants selected an appropriate healthcare provider for dysphagia 47% of the time compared with 74% for insomnia, 56% for vertigo and 36% for ataxia. When asked to identify up to 3 sequelae (from a list of 9), only 4% of participants were able to correctly identify all three for dysphagia, in comparison to 16% for ataxia, 27% for vertigo and 60% for insomnia. The Cosmos analysis revealed that while insomnia had the highest prevalence in 2023 (5.5% of patient encounters), dysphagia occurred much more frequently (2.4%) than vertigo (0.68%) and ataxia (0.24%). CONCLUSIONS:These discrepancies highlight a notable gap in public awareness between dysphagia and more recognized conditions of insomnia and vertigo, even though the prevalence of dysphagia is higher than vertigo. Increasing public awareness of dysphagia is vital for early intervention, increasing quality of life, and advocating for equitable access to healthcare resources.

Rat ultrasonic vocalizations (USVs) have traditionally been used in psychosocial and psychobiological studies to understand emotion, social behavior, cognition, and associative learning. However, recent studies have expanded the goal of USVs to include the study of the laryngeal system and the effects of disease processes on vocal sensorimotor control. Without the foundational understanding of the goals of this area of laryngological research, fundamental differences in study objectives between psychobehavioral and laryngological studies can easily be missed, leading to misconceptions and misinterpretations of the role USVs play in laryngology-focused studies. Standardization of terminology and methods are also needed to improve communication, enhance study replicability, and prevent ambiguity that can lead to misinterpretations of study objectives and findings in this line of research. The primary objective is to describe the role of USVs in studies of laryngeal anatomy and physiology, with a focus on their connections to the neuromuscular and neurological aspects of the laryngeal system, particularly in relation to vocal sensorimotor control and voice disorders. It is intended for novice investigators interested in laryngology-specific USV research. Researchers experienced in USV studies within the context of the larynx and vocal sensorimotor control first outline the development and refinement of various USV elicitation methods. They provide insights into how these approaches have been tested across different studies and laboratories. Finally, they advocate for standardizing terminology and methodologies to enhance study replicability, reduce ambiguity, and foster collaboration across research groups.

OBJECTIVES/HYPOTHESIS/OBJECTIVE: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. STUDY DESIGN/METHODS:Prospective observational cohort study. METHODS: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. RESULTS: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). CONCLUSIONS: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.