Objectives/Hypothesis The purpose of this study was to evaluate current neck tension palpation rating systems to determine inter-rater reliability and possible correlation with neck surface electromyography (sEMG, collected from three electrode recording locations) and measures of the third formant for /a/ during various vocal behaviors. Study Design This prospective study examined the neck muscle tension of 16 participants before and after a single session of voice therapy. Methods Inter-rater reliability and relationships between palpation ratings and objective measures of sEMG (anterior neck) and the third formant for /a/ were assessed using Pearson’s correlations (r). Results Inter-rater reliability was relatively low as measured by Pearson’s correlations, although Wilcoxon Signed Rank Test results were similar as those in a previous study. Correlations between palpation ratings and sEMG, and between ratings of laryngeal height and the third formant for /a/ were generally low. Correlations increased between anterior neck sEMG and ratings of suprahyoid muscle tension when examined in a reduced set of individuals with higher inter-rater reliability. Conclusions Palpation rating scales do not reliably capture changes that may occur in neck muscle tension of typical voice therapy patients over one session. Consequently, little can be concluded from correlations between sEMG and palpation ratings.

Purpose-The goal of this study was to determine if there were significant differences between singers and non-singers in the morphology of vocal nodules and associated impact on vocal function.Method-Participants were 10 professionally trained singers with nodules, 8 non-singers with nodules, and 10 individuals with healthy normal voice (controls). Surface electromyography (sEMG) from three anterior neck locations and acoustic rise times for vowels /a/ and /i/ were measured in all participants. In individuals with nodules, dB SPL / cm H 2 O, glottal airflow, and nodule location and size were also measured.Results-There were no significant differences between singers and non-singers with nodules in terms of airflow, dB SPL / cm H 2 O, nodule size, or nodule location. In non-singers with nodules, airflow and nodule size were significantly correlated, but were not significantly correlated in singers. Vowel rise times and sEMG during vocal tasks did not differentiate among nodule and control groups. Sternocleidomastoid sEMG during initiation of the vowel /a/ was statistically significantly stronger in non-singers with nodules relative to singers with nodules and controls.Conclusions-Nodule morphology did not differ between singers and non-singers, although some behavioral aspects of phonation differed between the groups.

Purpose This study attempts to gain insights into the role of daily voice use in the etiology and pathophysiology of phonotraumatic vocal hyperfunction (PVH) by applying a logistic regression-based daily phonotrauma index (DPI) to predict group-based improvements in patients with PVH after laryngeal surgery and/or postsurgical voice therapy. Method A custom-designed ambulatory voice monitor was used to collect 1 week of pre- and postsurgery data from 27 female patients with PVH; 13 of these patients were also monitored after postsurgical voice therapy. Normative weeklong data were obtained from 27 matched controls. Each week was represented by the DPI, standard deviation of the difference between the first and second harmonic amplitudes (H1–H2). Results Compared to pretreatment, the DPI significantly decreased in the patient group after surgery (Cohen's d effect size = −0.86) and voice therapy ( d = −1.06). The patient group DPI only normalized after voice therapy. Conclusions The DPI produced the expected pattern of improved ambulatory voice use across laryngeal surgery and postsurgical voice therapy in a group of patients with PVH. The results were interpreted as providing new objective information about the role of daily voice use in the etiology and pathophysiology of PVH. The DPI is viewed as an estimate of potential vocal fold trauma that relies on combining the long-term distributional characteristics of two parameters representing the magnitude of phonatory forces (neck-surface acceleration magnitude) and vocal fold closure dynamics (H1–H2). Further validation of the DPI is needed to better understand its potential clinical use.

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