Abstracts
PLENARY SESSION 1
8:30am - 10:35am
Latest in Laryngeal Reinnervation
Dr Kate Heathcote (1)
1 University Hospital Dorset
Abstract TBC
Laryngeal Reflexes: Where Are We in 2026?
A/Prof Catherine Sinclair (1)
1 Melbourne Neck & Thyroid Surgery
Our understanding of laryngeal reflexes has advanced considerably over the past decade, driven by new insights into laryngeal neurophysiology, sensory testing, and the role of reflex pathways in airway protection. Yet important questions remain regarding how these reflexes should be measured, interpreted, and translated into clinical decision-making. This presentation will provide a state-of-the-art review of laryngeal reflexes in 2026, examining the evidence underpinning key protective laryngeal reflexes and discussing emerging concepts in laryngeal sensory dysfunction. We will explore recent advances in our understanding of central and peripheral neural mechanisms and discuss innovations in clinical assessment and possible therapeutic approaches for reflex-related pathologies. Attendees will leave with an evidence-based framework for evaluation of laryngeal reflexes, an appreciation of current controversies, and an understanding of the priorities that will shape research and clinical care in the years ahead.
Neuronal Hypersensitivity in Chronic Cough
Prof Stuart Mazzone (1)
1 University of Melbourne
Chronic cough is increasingly recognised as a disorder of neuronal hypersensitivity, characterised by heightened responsiveness of peripheral and central cough pathways. This presentation will provide an update on the current understanding of the neurobiological and neuropathic mechanisms underlying cough hypersensitivity and discuss emerging tools and treatments for clinical application. The presentation will also highlight current knowledge gaps and future research opportunities for advancing the understanding of chronic cough and the approaches for its effective clinical management.
Movement Disorders of the Larynx: Navigating the Complexities of Nomenclature and Classification
Dr Belinda Cruse (1)
1 The Royal Melbourne Hospital
Navigating the Complexities of Nomenclature and Classification: Movement disorders of the larynx are described using a range of overlapping and, at times, conflicting terminology across laryngology and neurology, creating challenges for diagnosis, communication, and research. This presentation will review the classification of primary laryngeal movement disorders, trace the historical evolution of nomenclature from both laryngological and neurological perspectives, and examine contemporary classification frameworks. The session will highlight areas of consensus and ongoing debate, providing clinicians and researchers with a practical understanding of current terminology and its implications for clinical practice and future research.
PLENARY SESSION 2
11:00am - 12:35pm
"Moving Beyond the Gap" - Decision Making in Presbyphonia
Dr Edie Hapner (1)
1 University of Alabama at Birmingham, Department of Otolaryngology
Treatment of ageing voice has mixed evidence for its effectiveness and candidacy. However, there is a plethora of publications since the early 2000’s that have documented the impact of presbyphonia, rivaling those of presbycusis and other medical comorbidities with its impact on quality of life and social isolation in ageing. Perhaps the missing link is the need to move beyond the presence of a glottal gap and acknowledge the collaborative contributions of respiration and phonation in reducing vocal effort and increasing vocal endurance in ageing voice. This lecture will move beyond laryngocentricity to determining candidacy and formulating treatment paradigms for the treatment of presbyphonia.
Basic-Science Techniques in Voice Research
Dr Aaron M. Johnson (1)
1 New York University, Grossman School of Medicine
This presentation outlines how translational voice research integrates basic science (molecular, cellular, tissue, and animal models) with clinical and real‑world studies to better understand laryngeal biology and improve evidence‑based voice therapy outcomes. It emphasizes that mechanistic insights, such as neuromuscular plasticity, tissue response to vibration, and hydration, are essential for explaining why interventions work and for developing more effective treatments.
Microelectrode Recordings of Cardiac, Respiratory and Digestion-Related Activity in the Human Vagus Nerve
Prof Vaughan Macefield (1)
1 Monash University
This presentation explores microelectrode recordings of physiological activity within the human Vagus nerve, with a particular emphasis on respiratory-related neural signalling. It examines how afferent and efferent pathways within the vagus nerve reflect dynamic interactions between breathing patterns and autonomic control, alongside concurrent cardiac and digestive activity. The findings highlight the potential of high-resolution neural recordings to better understand respiratory modulation and its integration within broader visceral regulation.
PLENARY SESSION 3: Advances in Assessment and Voice Therapy
1:20pm - 3:00pm
Identifying Medically Urgent Voice Disorders: Evaluation of an Australian Speech-Language Pathology Primary Contact Assessment
Dr Christopher Payten (1,2), Dr Duy Duong Nguyen (2), A/Prof Kelly Weir (3), A/Prof Daniel Novakovic (2)
1 Gold Coast Health, 2 The University of Sydney, 3 The University of Melbourne
Introduction: The Speech-Language Pathology Primary Contact (SLPPC) assessment clinic provides speech-language pathology (SLP) first-contact assessment of vocal symptoms either before or in place of an ENT surgeon. This study examined how the telehealth-adapted model (SLPPC-T) can triage patients with voice disorders for the urgency of videolaryngostroboscopy (VLS) and ENT review.
Methods: A prospective observational cohort study examined patients using a hybrid telehealth/face-to-face assessment model based on the SLPPC protocol. The SLP conducted virtual case history and voice assessments to prioritise patients for VLS. Study outcomes included: 1) association of SLPPC-T assessment findings with VD classification after VLS; 2) concordance between SLP priority for VLS after SLPPC-T and priority matched to ENT VD classification after VLS; 3) agreement between SLP and ENT VD classification post-VLS.
Results: 103 participants (73 CIS females, 26 males; mean age 57.66). After assessment, 2 were triaged for priority VLS within 1 week, 26 for urgent VLS within 4 weeks, and 75 for routine VLS within 6 weeks. Logistic regression modelling demonstrated current smoking, sudden onset, and a history of preceding intubation were key predictors of the SLP decision for urgent VLS. Agreement between SLP pre-VLS and ENT review was slight (Kappa=.196), but post-VLS agreement was substantial (Kappa=.74), almost perfect for malignancy (Kappa=.852) and vocal pathology (Kappa=.905).
Conclusion: The findings demonstrate the SLPPC assessment, when including VLS, can effectively identify patients for medically urgent VD assessments. The findings may inform referral and triage guidelines for GPs and ENTs to support timely access to diagnostic assessments.
Laryngeal Sensory Dysfunction in Subgroups of Voice Disorders
Dr Catherine Madill (1), Ms Antonia Chacon (1), Dr Daniel Novakovic (1,2), Dr Duy Duong Nguyen (1)
1 The University of Sydney, 2 Canterbury Hospital
Background: Laryngeal sensory dysfunction (LSD) has been implicated in several conditions such as chronic refractory cough and muscle tension dysphonia (MTD). It is unclear whether LSD is present in a wider range of voice disorders. This study aimed to investigate LSD in patients in different subgroups of voice disorders.
Method: This study included 254 adult voice-disordered patients (184 females, 66 males, 4 nonbinaries; mean age = 38.6 years, SD = 17.9) and 35 non-voice disordered speakers (20 females, 14 males, 1 nonbinary; mean age = 23.1 years, SD = 8.3). All underwent comprehensive voice assessment involving SLP evaluation and laryngologist strobolaryngoscopy examination. The Newcastle Laryngeal Hypersensitivity Questionnaire (NLHQ) was completed by all participants at baseline. These scores were compared across diagnostic groups identified based upon a classification framework 1. The framework's diagnostic levels used for comparisons included (1) non-disordered vs voice-disordered; (2) etiological category; and (3) organic subtype.
Results: Total NLHQ scores and sub-scores (irritation, obstruction, pain) were significantly lower in the voice-disordered than in the non-disordered group. In broad etiological category, compared with non-disordered, total NLHQ scores were significantly lower in MTD, organic, and functional neurological voice disorders (FNVD); There were no significant differences between organic vs MTD, between organic vs FNVD, and between MTD vs FNVD subtypes. Comparing across organic subtypes, there were no significant differences in NLHQ scores between structural and neuromuscular voice disorders.
Conclusion: NLHQ scores showed significant differences across non-disordered and voice-disordered groups but did not show the same trend across voice diagnostic subtypes.
Their Story Tells the Picture: Self-Rated Voice Function Using the EASE Scale and Laryngeal Diagnoses in Treatment-Seeking Singers
A/Prof Debbie Phyland (1), Prof Anna Miles (1)
1 Melbourne Voice Analysis Centre
Objective: To describe the laryngeal diagnoses and patient characteristics of treatment-seeking singers and explore relationships between self-reported Evaluation of the Ability to Sing Easily (EASE) scores, laryngeal diagnoses and patient characteristics.
Methods: A retrospective analysis was undertaken of 1,134 singers attending a specialist multidisciplinary voice clinic. Demographic, voice use, stroboscopic diagnosis and EASE data were analysed using comparative statistics and ROC analysis.
Results: The cohort (mean age 32 years; 67% female) included amateur (24%), professional casual (38%), professional full-time (28%) and elite (8%) singers. Stroboscopic findings were available for 1,117 singers, with 51.3% demonstrating clinically significant pathology, most commonly phonotraumatic lesions (34.7%), followed by neurological disorders (7.9%) and functional voice disorders (6.8%). Diagnostic category differed significantly according to gender, age, employment status, primary occupation and singing genre (all p≤0.002), demonstrating distinct risk profiles across singer populations. EASE scores were significantly higher in singers with clinically significant pathology than those with normal examinations or mild swelling (p<0.001). Total EASE demonstrated acceptable discrimination for clinically significant pathology (AUC=0.729), with a threshold of ≥48 providing 73% sensitivity and 64% specificity.
Conclusion: This study provides the first comprehensive profile of laryngeal diagnoses and EASE scores in a large, treatment-seeking cohort of singers across multiple genres and career stages. Distinct demographic, occupational and genre-related differences in voice disorders highlight differing risk profiles among singers. The EASE was strongly associated with clinically significant laryngeal pathology and demonstrated utility as a clinical triage tool, supporting its use to identify singers who may benefit from specialist laryngeal assessment.
The Development and Preliminary Validation of the Thyroid Symptom Questionnaire: A Tool for the Assessment of Laryngopharyngeal Symptoms in Benign Thyroid Disease
Dr Vikash Yogaraj (1), A/Prof Debbie Phyland (2), A/Prof Catherine Sinclair (2)
1 The Royal Melbourne Hospital, 2 Monash University
Background:
To broaden the scope of the existing Thyroidectomy-related Voice and Symptom Questionnaire (TVSQ) by adding clinically-relevant symptoms, and evaluate its psychometric properties for assessing laryngopharyngeal symptom prevalence in patients with benign thyroid disease.
Methods:
A 32-item modified TVSQ was developed and administered to outpatients alongside a symptom checklist (as a surrogate for routine history-taking) to compare sensitivity in eliciting the presence of symptoms. Controls were recruited to assess discriminative validity using independent samples t-tests. Descriptive statistics characterised symptom frequency. Reliability analysis informed item reduction, and Principal Components Analysis (PCA) evaluated subscale structure.
Results:
102 thyroid patients and 100 control participants were recruited. Symptom prevalence was higher when assessed with the questionnaire than with the checklist, including dyspnoea (58% vs 24%) and dysphonia (42% vs 30%). Item reduction based on symptom prevalence and reliability metrics resulted in a 20-item instrument termed the “Thyroid Symptom Questionnaire” (TSQ). PCA supported the division of the TSQ into two subscales: “voice change” and “throat and neck discomfort”. The TSQ demonstrated excellent internal consistency and thyroid patients scored significantly higher than controls on total symptom scores (p <0.001, effect size = 0.09).
Conclusions:
The TSQ is a valid and sensitive tool for screening laryngopharyngeal symptoms in benign thyroid disease. It identifies a higher prevalence of symptoms than a checklist-based history and effectively discriminates between thyroid and control populations, extending the utility of the TVSQ beyond its post-surgical focus. Further longitudinal evaluation in primary care settings is warranted to confirm broader generalisability.
Perspectives and Acceptance of a Collaborative Database of Voice Disorders: A National Survey of Australian Otolaryngologists and Speech Pathologists
Dr Catherine Madill (1), Ms Dharshini Manoharan (1), Dr Dhanshree Gunjawate (1,3), Mr Rijul Gupta (1), Dr Craig Jin (1), Ms Antonia Chacon (1), Dr Daniel Novakovic (1,2)
1 The University of Sydney, 2 Canterbury Hospital, 3 Kasturba Medical College, Mangalore, Manipal Academy of Higher Education
Objective(s): This study aimed to (1) outline voice data collection and storage practices amongst Australian otolaryngologists (ENTs) and speech language pathologists (SLPs), (2) explore perspectives relating to a shared voice disorder registry and (3) understand factors which may impact ENT and SLP use and contribution to this registry.
Methods: A 27-question survey was developed using Qualtrics and distributed to qualified Australian ENTs and SLPs. Survey questions were divided into five categories, including caseload, existing data collection and storage methods, perspectives in using a shared data registry and the barriers and facilitators to both existing means of data collection and storage, and use of a shared data registry. Survey data was collected over four months, from November 2023 to February 2024.
Results: Forty-six ENTs (n=7) and SLPs (n=39) responded to the survey, of which 85.7% collect voice data routinely. Most respondents (87.2%) reported that they would use or contribute to a de-identified shared voice disorder data registry, mainly through data storage and collection. Factors which would promote use and contribution included ease of use, security and reduced data collection time, while data privacy, cost and time taken for data collection were the main
barriers identified.
Conclusion: Most Australian ENTs and SLPs are willing to use and contribute to a shared voice disorder data registry. This would enable greater standardisation of voice data and pave the way for future automation of voice data collection. Further research is needed to ascertain user accessibility, data security, privacy and specific voice data to be collected.
A Mixed-Method Study on the Efficacy of a Singing-Based Voice Therapy for Patients with Presbyphonia
Dr Wing-nam Crystal Yuen (1), Dr Pui-man Estella Ma (1), Dr Dan Lyu (2), Dr Alice Kwai-yee Siu (2)
1 Voice Research Laboratory, the University of Hong Kong, 2 Department of Otorhinolaryngology, Head & Neck Surgery, West China Tian Fu Hospital, Sichuan University, Chengdu, Sichuan, China
Background: The first line management of presbyphonia is behavioral voice therapy. Existing voice therapies for older adults with presbyphonia frequently draw on principles from exercise science. Previous literature recommends integrating leisure activities such as singing to boost adherence. Singing engages the larynx, improves respiration and phonation, and offers therapeutic benefits. Therefore, this study investigates the efficacy of a newly developed singing-based voice therapy for presbyphonia.
Methods and Results: Forty-three patients with presbyphonia (12 males, 31 females) were randomized to the Singing Group, receiving the novel singing-based therapy, or the Traditional Group, receiving vocal function exercises. They completed an 8-session, twice-weekly intervention. Quantitative assessments included vocal function, effort, quality, aging voice-related quality of life and adherence, measured pre-treatment, post-treatment, and at two-month follow-up. Both groups showed significant improvements in vocal function, effort and quality of life, with comparable treatment effects. Follow-up individual interviews with 18 participants (10 from Traditional Group, 8 from Singing Group) were conducted to explore their perceptions and experiences of the intervention qualitatively. The interview recordings were transcribed verbatim and analyzed according to inductive thematic analysis. Patients reported improvement in voice, respiration, physical and mental health, and socialization. While both groups reported strong patient-clinician relationships and satisfaction, the Singing Group showed a slight preference and better adherence.
Conclusion: Both singing-based and traditional therapies yielded comparable improvements in vocal outcomes among older adults with presbyphonia, while the singing-based therapy demonstrated marginally better adherence. These support its validity as an effective intervention for patients with presbyphonia.
CONCURRENT A: Advances in Surgery, Dysphagia and Airway
4:00pm - 5:10pm
First Clinical Experience with Combined Platelet-Rich Plasma and Hyaluronic Acid Injection for Vocal Fold Atrophy and Scar
Dr Zuraini Mohammad Nasir (1), Dr James Johnston (2), Katrina Sandham (1), A/Prof Daniel Novakovic (1)
1 University of Sydney Voice Lab, 2 University of Auckland
Background: Platelet-rich plasma (PRP) has emerged as a regenerative treatment for vocal fold pathology, while hyaluronic acid (HA) is widely used for vocal fold augmentation. Combination PRP-HA therapy has been extensively applied in Orthopaedics; however, its use in laryngology has not previously been reported. We aim to evaluate safety and outcomes of PRP-HA injection for vocal fold atrophy and scar.
Method: A retrospective review of patients undergoing PRP-HA vocal fold injection was performed. Demographic characteristics, indications, treatment tolerability and patient-reported outcome measures were collected. Pre- and post-treatment Voice Handicap Index-10 (VHI-10) and Glottal Function Index (GFI) scores were compared.
Results: Forty-eight patients were included (mean age 62.3 ± 18.4 years; 52% male). The most common indications were vocal fold atrophy (52.1%) and scar (37.5%). Treatment was generally well tolerated with only one patient withdrawing from further treatment. Mean VHI-10 improved significantly from 22.11 ± 8.02 to 16.42 ± 8.51 (p < 0.001), while mean GFI improved from 11.71 ± 5.79 to 8.38 ± 4.69 (p < 0.001). No major adverse events occurred.
Conclusion: Combined PRP-HA vocal fold injection appears feasible, well tolerated and safe, with significant improvements in patient-reported outcome measures. To our knowledge, this represents the first reported clinical experience of PRP-HA therapy in laryngology and supports further prospective evaluation of this regenerative treatment strategy.
Feasibility, Safety and Outcomes of Awake Oesophageal Dilatation in Head and Neck Cancer Patients via Trans-Nasal Oesophagoscopy
Dr Jonathan Woliansky (1), Dr Anthony Rotman (1), A/Prof Paul Paddle (1,2,3)
1 Monash Health, 2 La Trobe University, 3 Monash University
Background: Head and neck cancer (HNC) treatment can result in hypopharyngeal and upper oesophageal stenosis, causing persistent dysphagia and morbidity. Conventional management involves dilatation under general anaesthesia (GA), exposing patients to repeated anaesthetic risk and technical challenges related to altered anatomy and radiation-induced fibrosis. Awake transnasal oesophagoscopy (TNO)-assisted balloon dilatation offers a minimally invasive alternative.
Objective: To evaluate the feasibility, safety, and functional outcomes of awake TNO-assisted dilatation in patients previously treated for HNC.
Methods: A retrospective single-centre review was performed of adult HNC survivors who underwent awake TNO-assisted dilatation for hypopharyngeal or oesophageal stenosis between 2021 and 2026. Demographic, oncological, procedural, and dysphagia-related data were collected. The primary outcome was successful completion of awake dilatation without significant complication.
Results: Twelve patients were identified. Sixty-three percent were male and all had SCC, with an oropharyngeal primary in 54%. Among patients with available staging data, 77% had stage III–IV disease. All received radiotherapy and 90% chemotherapy. Cricopharyngeal stenosis was present in 73%, with the remainder demonstrating upper oesophageal stenosis. Overall, 9 GA procedures and 86 awake dilatations were performed. GA procedures were associated with intraoperative complications in 33% and postoperative complications in 11%, with one procedure abandoned due to poor access. Of the awake procedures, one was abandoned because of patient discomfort, with no other complications observed.
Conclusion: TNO-assisted dilatation is a feasible and safe intervention in HNC patients, with low complication rates. Our findings support its adoption as an alternative to repeated dilatation under GA in a medically complex population.
Prevalence and Predictors of Laryngeal Sensory Symptoms in Unilateral Vocal Fold Paralysis
Dr Zuraini Mohammad Nasir (1), Dr Thomas Stewart (1), A/Prof Daniel Novakovic (1)
1 The University of Sydney Voice Lab
Background: Unilateral vocal fold paralysis (UVFP) has traditionally been regarded as a motor disorder resulting from recurrent laryngeal nerve dysfunction. Increasing evidence suggests that many patients also experience symptoms of laryngeal sensory dysfunction, including chronic cough, globus sensation, pain and laryngeal spasm. We aim to determine the prevalence and predictors of laryngeal sensory symptoms in UVFP.
Method: A retrospective cohort study of 170 patients with UVFP was performed. Laryngeal sensory symptoms were defined by a Laryngeal Hypersensitivity Questionnaire (LHQ) score <17.1. Demographic, clinical and patient-reported outcome data were analysed.
Results: The cohort comprised 96 females and 74 males with a mean age of 59.5 ± 17.1 years. Median symptom duration was 5.5 months (IQR 2.0–21.4), and iatrogenic injury was the most common aetiology (51.2%). Laryngeal sensory symptoms were present in 103 of 169 patients (60.9%). Logistic regression demonstrated that iatrogenic aetiology was independently associated with laryngeal sensory symptoms (OR 2.22, 95% CI: 1.17-4.23, p=0.015). Patients presenting predominantly with sensory symptoms demonstrated significantly prolonged symptom duration (median 36.0 vs 4.2 months, p<0.001) and lower LHQ scores (median 13.5 vs 16.2, p=0.012). Significant improvements in LHQ (p<0.001) and VHI scores (p<0.001) were observed following treatment.
Conclusion: Laryngeal sensory symptoms are prevalent in UVFP and are independently associated with iatrogenic aetiology. A sensory-predominant subgroup characterised by chronic symptoms, and greater sensory symptom burden was identified. Significant improvements in sensory and voice outcomes following treatment suggest that laryngeal sensory symptoms improve with treatment of UVFP.
Piloting a Multidisciplinary Nonsurgical Pathway for Infants with Laryngomalacia
Mrs Siew-Lian Crossley (1), Mrs Julie Bettle (2)
1 The Royal Children's Hospital
Background: Laryngomalacia is a dynamic supraglottic collapse impacting infant feeding, growth and development. Management includes feeding support, medical therapy, and/or surgical intervention. Allied health-led models of care may support timely access to management, decrease ENT occasions of service(OOS) and health-related costs. We piloted a Speech Pathology-Dietetics ENT(SP-ENT) service embedded in the tertiary Laryngology-ENT clinic aimed at improving overall management of feeding-related issues, increase caregiver educational support and secondarily reduce possible need for surgical intervention.
Method: All infants diagnosed with laryngomalacia seen in the pilot SP-ENT clinic between 1 July 2025 - 31 June 2026 were enrolled. They received SP-ENT interventions informed by clinical feeding evaluation (including Children’s Eating and Drinking Activity Scale, CEDAS), anthropometric assessment and dietary review, and instrumental swallowing evaluation if indicated.
Results: Preliminary data: 69 infants (45 male, 65.2%), mean age 3.0±3.7 months (R: 0-19mo) were seen. 55 (80%) had feeding-swallowing difficulties, and 31 (45%) had associated growth concerns. 39 (56%) of infants presented with reflux and 22 (31%) reported obvious apnoeas during feeding or sleep. 16 (23%) proceeded to supraglottoplasty. Infants received a mean of 3.36±1.98 OOS (R:1-8) with 9 (13%) patients avoiding the need for a planned surgery. ENT service time was saved for 32 (46)% of patients (1-2 OOS, approximately 30-60 mins/patient). Infants’ feeding-swallowing improved (CEDAS mean score 4.2 vs 6, n=47) following SP intervention.
Conclusion: Access to a SP-DIET (SP-ENT) pathway optimized care for infants with laryngomalacia, reduced ENT service occasions and secondarily reduced the need for surgery. Comprehensive analysis will be presented.
CONCURRENT B: Advances in Professional Voice
4:00pm - 5:10pm
Hearing Their Voices: Current Perspectives of Australian Teachers Toward Voice Care
Dr Jane Bickford (1), Professor Belinda Lange (1,2)
1 Caring Futures Institute, College of Health and Enablement, Flinders University, 2 Australian Centre for Health Services Innovations, School of Public Health and Social Work, Queensland University of Technology
Background: Australian Teachers have a high incidence of voice disorders (Roy et al., 2004) that can negatively affect their professional and personal lives. Preventative voice care programs (PVCP) aim to promote healthy voice use through knowledge and behaviour change. However, a recent systematic review found limited evidence supporting the efficacy of PVCPs and highlighted the need for more rigorous program development and evaluation. Most PVCPs have been designed by voice experts, with limited investigation into Australian teachers’ perspectives regarding voice-related professional development (PD). This study explored teachers’ perspectives of voice care and their preferences toward design and delivery of voice-related PD.
Method: A qualitative research design was employed. Data were collected through six focus groups with Australian teachers, while demographic information was gathered via an online survey. Survey data were analysed descriptively and focus group transcripts underwent reflexive thematic analysis.
Result: Nineteen teachers participated across six focus groups. Participants represented early childhood/kindergarten, primary and high school sectors, and were located across six states and territories. Analysis generated five themes related to teachers’ knowledge and perceptions of voice, the impact of voice use, as well as their preferences for engaging in voice-related PD.
Discussion and Conclusion: Findings reinforce existing evidence regarding the impact of voice-related difficulties on teachers and provide new insights into how teachers value and prioritise voice care within their professional practice. The results highlight the importance of developing contemporary, accessible and teacher-informed PVCPs that align with the realities of classroom teaching and may support greater engagement and uptake.
Voice Care Perspectives of Australian School Leadership
Dr Jane Bickford (1),
1 Flinders University
Background: Preventative voice care programs (PVCPs) have been developed to support teachers’ vocal health as they face high risks of developing voice disorders (Duffy & Hazlett, 2004). Despite showing positive vocal outcomes for teachers in trials, PVCP efficacy is inconclusive, largely due to inconsistent program designs across studies and limited long-term outcome monitoring. Additionally, many teachers lack formal education in vocal health, seeking information only after developing symptoms, suggesting wider systemic and motivational barriers to early engagement. There is limited research on leadership perspectives despite their key role in the implementation and success of health programs within schools. This study explores Australian leadership perspectives on teachers’ vocal health and related professional development (PD) to provide insights that may inform the future development of PVCPs that are feasible, sustainable and leadership-informed.
Method: A qualitative research design was used, with data collected from semi-structured interviews conducted with education leaders across Australia. Demographic information was collected through an online survey. Interview transcripts were analysed using reflexive thematic analysis, with survey results analysed descriptively.
Result: At time of submission, data collection and data analysis is currently underway, with results to be finalised in September.
Conclusion: Preliminary results reveal recurring themes related to teacher vocal wellbeing, considerations for future voice-related PD, and barriers to engagement in voice-related PD including competing priorities, and lack of awareness at policy levels. Participants voiced the importance of approaches that could be integrated into existing practices without increasing workload.
Does Practicing Resonant Voice in 360-Degree Videos of Classroom Environments Enhance Voice Therapy Outcomes for Teachers?
A/Prof Estella Ma (1), Ms Wing-nam Crystal Yuen (1), Dr Alice Kwai-yee Siu (2)
1 Voice Research Lab, The University of Hong Kong, 2 Department of Otorhinolaryngology, Head and Neck Surgery - The Chinese University of Hong Kong
Purpose: This randomized controlled trial compared outcomes of resonant voice therapy practiced under immersive 360-degree video of classroom environments versus traditional 2-dimensional format, as indicated by participants’ voice quality, voice-related quality of life, and confidence in resonant voice skill generalization.
Methods: Fourteen Cantonese-speaking teachers with voice problems participated in eight weekly training sessions. Participants were randomly assigned to either 360-degree (experimental) group or two-dimensional (control) group. Outcome measures included acoustic parameters of fundamental frequency, cepstral peak prominence; and auditory-perceptual evaluation of overall severity performed using paired comparison paradigm. Self-report measures included Vocal Fatigue Index-Hong Kong (VFI-HK), Chinese Voice Handicap Index (VHI-30), Voice Activity and Participation Profile (VAPP), and a confidence rating assessing teachers’ skill generalization were also collected. Data collected at pre-training, post-training, and one-month post-training were analyzed.
Results: Results were mixed regarding the effectiveness of immersive 360-degree videos on resonant voice skills learning. Modest improvements in overall dysphonia severity, selective acoustic parameters, and quality of life outcome measures in the experimental group. However, comparable between-group performances were suggested. No significant between-group difference in confidence of skill generalization was found. The results suggest that immersive 360-degree videos do not necessarily yield superior clinical outcomes over traditional 2-dimensional formats in clinical voice training.
[This study was funded by Seed Fund for Basic Research (Project 126417) and RGC General Research Fund (Project 17607623)]
Voice Therapy Adherence from the Perspective of Occupational Voice Users
Dr Lauryn Stewart (1), Professor Jennifer Oates (2)
1 Australian Catholic University, 2 La Trobe University
Background: Voice therapy is a key component in the management of voice disorders; however, adherence remains poorly understood. Limited evidence exists regarding how occupational voice users engage with prescribed behavioral voice therapy beyond attendance and how this influences clinical outcomes.
Method: A qualitative study using semi-structured interviews was conducted with 15 occupational voice users with diagnosed voice disorders. Data were analysed using reflexive thematic analysis within a constructivist framework.
Results: Adherence was a dynamic process influenced by occupational vocal demands, competing life responsibilities, and symptom fluctuations. Engagement was enhanced when therapy was perceived as directly relevant to occupational voice use and when patients felt confident in their technique. Clinician feedback was identified as an important factor in supporting this confidence. Structural factors, including cost, access, scheduling, and delivery mode, also influenced engagement.
Conclusion: From a laryngology perspective, voice therapy adherence is shaped by interacting occupational, clinical, and systemic factors rather than motivation and therapy attendance alone. These findings highlight the importance of functionally relevant therapy design, structured clinical follow-up, and flexible models of care to optimise outcomes for occupational voice users within multidisciplinary voice services.
PLENARY SESSION 4
8:30am - 10:05am
The Rise of In-Office Laryngology: Innovation, Efficiency, and Patient-Centred Care
Dr Kate Heathcote (1)
1 University Hospitals Dorset
Advances in in-office procedures are redefining laryngology practice by reducing reliance on the operating theatre and enhancing patient access to care. This keynote highlights current techniques—including injections, laser treatments, and endoscopic interventions—examining their safety, efficacy, and role in modern service delivery.
Effect of Vocal Training on Neuromuscular Plasticity
Dr Aaron M. Johnson (1)
1 New York University, Grossman School of Medicine
This presentation examines how vocal training drives neuromuscular adaptation, arguing that vocal exercise functions more like endurance training than strength training and induces changes primarily at the neural/neuromuscular junction level rather than muscle hypertrophy. It integrates exercise physiology principles with animal and translational models to explain how vocal training improves function.
Changing Voices: Evolving Multidisciplinary Care in Gender-Affirming Voice Surgery
A/Prof Paul Paddle (2), A/Prof Debbie Phyland (1)
1 Melbourne Voice Analysis Centre, 2 Monash Health, 3 Monash University, 4 Voice Medicine Australia, 5 Melbourne ENT Group
Objectives: To describe the development of an integrated multidisciplinary service for pitch-raising surgery in trans women, and how experience across more than 100 surgical cases has shaped surgical technique, peri-operative management, and outcome evaluation.
Method: This presentation describes the evolution of a clinical service involving laryngology and speech pathology. Since establishment of the service, the surgical approach has undergone progressive refinement alongside coordinated peri-operative voice care. Pre-operative assessment includes multidisciplinary evaluation of laryngeal health, vocal function, communication goals, and surgical readiness to optimise patient selection and counselling. Surgical management has evolved through modification of operative techniques and post-operative protocols, while rehabilitation pathways support tissue healing, pitch stabilisation, functional communication, and return to high-level voice use where required. Continuous collaboration between surgeon and speech pathologist has informed clinical decision-making throughout the patient journey.
Service evaluation: Experience across more than 100 patients demonstrates high satisfaction and improvements in vocal congruence and communicative confidence. Variability in outcomes reinforces the importance of multidisciplinary assessment beyond isolated acoustic measures. Clinical experience has informed refinement of surgical technique, rehabilitation timing, expectation management, and integrated follow-up.
Conclusion: This presentation describes an evolving model of multidisciplinary care for pitch-raising surgery and presents patient-reported, instrumental and clinician-perceived outcome and satisfaction data. Rather than presenting surgery and voice therapy as separate interventions, it demonstrates how refinement of surgical techniques, peri-operative care, and rehabilitation within an integrated team has optimised patient-centred outcomes. This model highlights the value of collaborative service development in advancing surgical practice and identity-affirming voice care.
PLENARY SESSION 5: Exercise Testing, ILO and Cough
11:00am - 12:15pm
Exercise Testing: A Performance Perspective
A/Prof Paul Tofari (1). Dr Doug Whyte (1)
1 Australian Catholic University
Laboratory-based exercise testing, such as Cardiopulmonary Exercise Tests (CPET) can be utilised clinically to diagnose conditions relating to respiratory and cardiovascular health. However, CPETs are also commonly used in Exercise and Sports Science to assess determinants of performance in athletic populations, allowing performance benchmarking and specific training intensity prescription. This presentation aims to explain key variables measured during CPETs, highlight the performance-based applications and consider the crossover between clinical and performance-based scenarios.
Comparing Eucapnic Voluntary Hyperventilation and Cardiopulmonary Exercise Testing in the Diagnosis of Exercise Induced Laryngeal Obstruction
Dr Danielle Stone (1,2,3), Mr Ryan Wallis (3), Dr Louise Hansell (3), Professor Greg King (3), Dr David Chapman (3)
1 Faculty of Medicine, The University of Sydney, 2 Respiratory Investigation Unit, Department of Respiratory Medicine, Royal North Shore Hospital, 3 Voice Swallow Medicine.
Introduction: Exercise-induced laryngeal obstruction (EILO) is typically diagnosed during Cardiopulmonary Exercise Testing (CPET); however, symptoms are not always induced. Eucapnic Voluntary Hyperventilation (EVH) with continuous laryngoscopy (CL) has demonstrated utility in EILO diagnosis, however with concerns raised over image quality. This study compared EVH and CPET in the diagnosis of EILO.
Methods: Twelve individuals with suspected EILO underwent CL during CPET and EVH at 80% maximal voluntary ventilation (MVV) for 4-minutes. Percentage of diagnostically acceptable frames was calculated for EVH tests. EILO was graded using the Maat CLE score. CLE glottic and supraglottic score, time (min:sec) to supraglottic narrowing, median Minute Ventilation (VE) and percentage of breaths over 80% MVV were compared. Continuous and nominal data were compared using Wilcoxon signed-rank test. Ordinal data was compared using McNemar’s test.
Results: Percentage of diagnostically acceptable frames for EVH was high (median [range] = 97.8% [89.3799.86]). Supraglottic EILO was observed in 9/12 during EVH vs 6/12 in CPET, (p=0.04). Glottic EILO was observed in 10/12 during EVH and 1/12 during CPET (p=0.01). Median time to ≥ grade 2 supraglottic narrowing was shorter during EVH (0:36; 0:02-2:09) vs CPET (7:28; 1:53-12:06) (p=0.02). Median V’E was higher in EVH (118.0L/min) vs CPET (56.9L/min), (p=0.002). Percentage of breaths ≥80%MVV was higher in EVH (42.4%) vs CPET (5.4%), (p=0.004).
Conclusion: EVH diagnosed more cases of EILO vs CPET. Maximum supraglottic grading was higher and laryngeal narrowing occurred faster in EVH vs CPET. This suggests EVH may be a viable alternative as a diagnostic tool for EILO.
Addition of Amitriptyline or Placebo to Speech Pathology for Inducible Laryngeal Obstruction: A Double-Blind Randomised Controlled Trial
Dr Janine Mahoney (1,2), Professor Mark Hew (3,4), A/Prof Anne Vertigan (5,6,7), A/Prof Joy Lee (3,8), A/Prof Eve Denton (3,8), Prof Jennifer Oates (2)
1 Department of Speech Pathology, The Alfred, 2 Department of Speech Pathology, La Trobe University, 3 Allergy, Asthma, Clinical Immunology Service, The Alfred, 4 Department of Public Health and Preventive Medicine, Monash University, 5 Department of Speech Pathologist, John Hunter Hospital, 6 College of Health, Medicine and Wellbeing, School of Medicine and Public Health, University of Newcastle, 7 Hunter Medical Research Institute, 8 Department of Respiratory Research @ Alfred, School of Translational Medicine, Monash University
Background: The impact of Inducible Laryngeal Obstruction (ILO) is significant, supporting the importance of determining effective treatments. Previous observational studies have reported ILO symptom reduction following both speech pathology and amitriptyline, however there is a lack of randomised controlled trials investigating effectiveness.
Methods: Adults with newly diagnosed ILO were randomised to amitriptyline or placebo in combination with six speech pathology (SP) sessions. ILO symptom severity and frequency were assessed using the Vocal Cord Dysfunction Questionnaire (VCDQ) and the Dyspnea Index (DI). Co-primary outcomes were the difference in post-treatment VCDQ and DI scores between groups, adjusted for baseline scores and analysed per protocol.
Results: Forty-one participants were recruited, three did not complete the protocol, leaving 19 per group for analysis. There were no differences in post-treatment ILO symptom severity (VCDQ) or frequency (DI) between groups; VCDQ 37.35(CI 32.54 to 42.17) for SP+amitriptyline, versus 38.12(CI 33.31 to 42.94) for SP+placebo, p= .82; DI 15.96 (CI 12.24 to 19.68) for SP+amitriptyline, versus 16.52 (CI 12.79 to 20.24) for SP+ placebo p= .83. There were significant improvements in post-treatment mean scores compared to baseline scores in ILO symptom severity (VCDQ) and frequency (DI) in both groups. The minimal clinically important difference on ILO symptom questionnaires (VCDQ and/or DI) was achieved in 28/38 (73.7%) of all participants.
Conclusions: In this trial, speech pathology effectively reduced ILO symptom severity and/or frequency in 73.7% of all participants, with no additional benefit from concurrent amitriptyline.
Effectiveness of a Speech Pathology Led Primary Contact Clinic for Chronic Cough: Pre & Post Outcomes
Dr Chloe Walton (1), Dr Anna Rumbach (1), Mrs Marnie Seabrook (1), Dr Timothy Ryder (1)
1 Logan and Beaudesert Health Service, Metro South Health, Queensland Health
Background: Chronic cough (CC) significantly impacts quality of life and is often triaged as low risk, resulting in long waits. A speech pathology (SP)–led primary contact clinic (PCC) was established to manage low-risk patients. Clinic data demonstrated improved access, high satisfaction, and low re-referral rates. The SP-led PCC model uniquely integrates medical & non-medical management for CC by a SP working to full scope; however, to date, there is no evidence of treatment effects across patient-reported outcome measures (PROMs).
Methods: Retrospective data of 78 patients who completed pre–post outcome measures from the clinic assessment battery. Wilcoxon signed-rank tests were used to assess treatment effects, with effect sizes calculated. Associations between number of diagnoses and outcome changes were examined, controlling for age and gender.
Results: Significant improvements were observed for LCQ (p < .001) and RSI (p < .001), with large, clinically meaningful effects. Clinically significant improvement in LCQ was achieved by 78% of patients, and 47% improved to below the RSI diagnostic threshold post-treatment. Both EAT-10 (p = .003) and V-RQOL (p = .007) scores also demonstrated statistically significant changes. Number of diagnoses was slightly associated with greater LCQ improvement after adjustment for age and sex (p = .032), with no associations observed for other variables.
Conclusion: Delegated SP-led PCC care represents an effective alternative pathway for CC, demonstrating that SPs working to full scope can achieve significant improvements in key PROMs. These findings extend previous service outcomes, supporting the effectiveness of SP-led care for CC.
CONCURRENT A: ILO and Laryngeal Dysfunction
1:00pm - 2:10pm
Quantification of Laryngeal Narrowing in Inducible Laryngeal Obstruction - Validation of Novel Software
Dr Danielle Stone (1,2,3,4), Mr Ryan Wallis (1), Dr Louise Hansell (1), Ms Mia Whitehall (4), Professor Greg King (1), Dr David Chapman (1)
1 Respiratory Investigation Unit, Department of Respiratory Medicine, Royal North Shore Hospital, 2 Faculty of Medicine, School of Health Sciences, The University of Sydney, 3 Voice Swallow Medicine, 4 Speech Pathology Department, Royal North Shore Hospital
Introduction - Diagnosis of Inducible laryngeal obstruction (ILO) is based on visual assessment of laryngeal narrowing. To address subjectivity in diagnosis we developed software (Scopix) to quantify glottic and supraglottic narrowing from videolaryngoscopic images. This study aims to assess interrater reliability and repeatability of Scopix measurements during tidal breathing and simulated laryngeal narrowing.
Methods - Fourteen healthy participants underwent functional laryngoscopy during five tidal breaths and five breaths simulating maximal laryngeal narrowing. Scopix software was used to measure glottic narrowing as the angle from left vocal process to anterior commissure to right vocal process (Angle A) and supraglottic narrowing as the angle from the left cuneiform tubercle to arytenoid notch to right cuneiform tubercle (Angle B). Five raters (2 expert, 3 naïve) independently measured Angle A and B for the point of least narrowing (Baseline) and maximal narrowing (Max) from two sets of frames; frames selected by the rater, and pre-selected frames. Mean Baseline and Max angles were compared for one expert rater using paired t-test. Inter-rater reliability was assessed using Intraclass Correlation Coefficient (ICC) in SPSS.
Results - Simulated laryngeal narrowing reduced glottic closure by 77% (62° vs 13°, p <0.001) and supraglottic closure by 33% (117° vs 80°, p<0.001). Interrater repeatability was good-to excellent across most conditions (ICC 0.79-0.91), except for glottic angle at maximal narrowing, which showed poor repeatability (ICC 0.25-0.54).
Conclusion - Scopix software enabled reliable measurement of glottic and supraglottic angle at baseline and simulated laryngeal narrowing, demonstrating potential to enhance diagnostic accuracy in ILO.
Evaluation of a laryngeal dysfunction assessment and treatment tool
A/Prof Anne Vertigan (1,2,3)
1 John Hunter Hospital, 2 University of Newcastle, 3 Hunter Medical Research Institute
Background: Speech pathology intervention for refractory chronic cough (RCC) and inducible laryngeal dysfunction (ILO) is difficult to access outside of specialist settings. There is a high degree of heterogeneity in RCC and ILO which in turn impacts treatment planning and clinical outcomes. There is little data to support clinicians tailor treatment to individual patients and identify appropriate candidates for behavioural intervention. This project developed and evaluated an online tool to support clinicians in the management of RCC and ILO.
Method: A tool was developed in REDCap to facilitate diagnosis of RCC and ILO, reduce documentation time, and assist treatment planning. The tool facilitates contemporaneous data collection during the clinical appointment including case history, patient reported outcome measures, and clinical assessment. Branching logic is used to generate a report, suggest possible diagnoses, summarise comorbidities, identify contributing factors and propose individualised treatment strategies. To date the tool has been evaluated on 22 patients with RCC and ILO.
Results: Six domains were identified including cough sensitivity, ILO, laryngeal muscle tension, dysphonia, cognition and dysfunctional breathing with patients showing features in at least two domains. The tool generated potential diagnosis and treatment recommendations in all cases and reduced documentation time to 10 minutes per patient. The tool is flexible, caters to various service delivery models and reports are compatible with Electronic Medical Record Systems.
Conclusion: The tool improves documentation quality but does not replace the need for clinical decision making. It will guide less experienced speech pathologists manage patients with RCC and ILO.
Bridging the Airway Divide: Educating Speech Pathologists About Laryngeal Dysfunction and Co-Occurring Asthma
Jordan Jeffery (1,2)
1 Hunter New England Health, 2 Hunter Medical Research Institute
Background: Approximately 17% of people with asthma also experience ILO/VCD. Speech pathologists play a key role in the assessment and management of ILO/VCD; however, many receive limited education regarding asthma and its interaction with laryngeal disorders. This knowledge gap may affect clinician confidence and service delivery, particularly in settings where adult services are limited.
Aim: To develop and evaluate educational resources designed to improve speech pathologists' knowledge, confidence, and clinical preparedness in managing patients with co-occurring laryngeal dysfunction and asthma.
Methods: An evidence-based educational package was developed, comprising a 44-page PDF resource and a 34-minute recorded presentation. These materials were uploaded to the ILO/VCD Toolkit and Treatable Traits CRE websites to support ongoing access and dissemination. A live webinar was delivered to 42 speech pathologists across Hunter New England Health and Sydney-based services. Participants completed pre- and post-webinar surveys assessing their confidence assessing and treating this population.
Results: Survey findings demonstrated improved clinician confidence for the assessment and treatment of patients with co-occurring asthma and laryngeal dysfunction following webinar attendance. The recorded presentation has had 129 views on YouTube. Website ‘hits’ to the PDF and recording link were unable to be accessed at the time of writing this abstract but will be included in the presentation.
Conclusions: Targeted education may address important knowledge gaps among speech pathologists and enhance workforce capability in the management of co-occurring laryngeal dysfunction and asthma. Educational resources of this kind have the potential to support more integrated, multidisciplinary airway care and improve patient outcomes.
Exploring factors impacting engagement in speech pathology intervention for Inducible Laryngeal Obstruction: A qualitative study
Dr Janine Mahoney (1,2), A/Prof Anne Vertigan (5,6,7), Professor Jennifer Oates (2), Professor Mark Hew (3,4)
1 Department of Speech Pathology, The Alfred, 2 Department of Speech Pathology, La Trobe University, 3 Allergy, Asthma and Clinical Immunology Service, The Alfred, 4 Department of Public Health and Preventive Medicine, Monash University, 5 Department of Speech Pathologist, John Hunter Hospital, 6 College of Health, Medicine and Wellbeing, School of Medicine and Public Health, University of Newcastle, 7 Hunter Medical Research Institute
Background: Speech pathology is the first line treatment for inducible laryngeal obstruction (ILO) and relies on patients engaging in treatment sessions, regular home practice and generalising techniques to everyday activities. This study explores the experiences of living with ILO and how this may impact the way patients engage in speech pathology treatment.
Method: Semi structured interviews were completed with seven participants exploring their experiences living with ILO, the diagnostic process and speech pathology treatment. Data were analysed using reflexive thematic analysis.
Results: Three major themes were identified - Life with ILO, Challenges of Speech Pathology Treatment, and What Matters to Me. Engagement appeared to be positively associated with significant ILO symptom burden, confidence in the diagnostic process and speech pathologist, working in a partnership with a tailored intervention and developing a sense of agency. Participants indicated their engagement was negatively influenced by competing time demands, social embarrassment when using symptom relief techniques and laryngeal exercises, and a low ILO symptom impact.
Conclusion: The reasons behind engagement in speech pathology treatment for ILO appear to be a complex interaction between previous experiences of living with ILO including the diagnostic process and the experience of speech pathology treatment. A patient centred approach to therapy may help to maximise engagement by exploring readiness and expectations for treatment. The greater understanding of the patient experience provided through this study may allow speech pathologists to devise meaningful ways to maximise engagement in treatment for people with ILO.
CONCURRENT B: Assessment and Service Delivery
1:00pm - 2:10pm
Evaluating the Feasibility and Outcomes of an Advanced Practice Speech Pathology – ENT Primary Contact Service
Chantal Mitvalsky (1)
1 Austin Health
Background: The growing demand for Ear, Nose and Throat (ENT) outpatient services has created substantial delays in access to care. This study evaluated the feasibility and outcomes of a Speech Pathology First Contact model, in which patients referred for swallowing, voice, and middle airway disorders were initially assessed and managed by a speech pathologist rather than an otolaryngologist.
Methods: A quantitative feasibility study, guided by the RE AIM framework, examined implementation of a Speech Pathology First Contact ENT service in a public tertiary health service in Melbourne. Adult ENT referrals were triaged using structured criteria, with eligible patients redirected to a senior speech pathologist for assessment and management.
Results: Outcomes included waiting times, escalation rates and discharges from ENT. The model was feasible and effective in reducing mean wait times from 883 to 41 days (semi urgent) and from 2,329 to 345 days (routine). Patient’s meeting escalation criteria were directed to ENT for diagnostic review and surgical or non surgical management. Escalation rates were 32.5% during the pilot and 41.42% in the established phase. The established phase rate was higher than comparable services in the literature, likely reflecting broader triage criteria, a combined monthly clinic with ENT, and the addition of a newly trained advanced practice clinician.
Conclusion: A Speech Pathology First Contact ENT model was efficient in reducing wait times for referrals involving swallowing, voice, and middle airway disorders. It provided a replicable, evidence based framework that improved access, efficiency, and patient flow by reducing pressure on ENT services
Patient Completed Voice Case History Questionnaire – Part 2: A Two-Part Global Survey of Otorhinolaryngologists and Speech Language Pathologists
Dr Catherine Madill (1)
1 Sydney Voice Lab, University of Sydney, 2 Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, 3 Canterbury Hospital
BACKGROUND: Case history is considered the primary component of voice disorder assessment. While standardized voice assessment protocols exist, no standard questionnaire is available for collecting case history information. This two-part global survey aimed to identify preferred categories, sub-categories, and questions for a patient-completed voice case history questionnaire among otorhinolaryngologists and speech-language pathologists.
METHODOLOGY: Part one identified 217 questions across 12 categories from published literature. Based on responses from 135 professionals, 132 questions across 11 categories were selected as preferred. A Qualtrics survey containing these questions was distributed internationally through professional groups, websites, social media, and email.
RESULTS: Fifty-eight professionals from 15 countries, across diverse clinical settings and experience levels, completed the survey. Most respondents had over 10 years’ experience and regularly managed adults with voice problems. Seventy percent considered inclusion of a case history questionnaire important. Questions relating to identifying information, onset, symptoms, and health status were most strongly supported. Preferences for question types varied depending on whether the purpose was screening, diagnosis, or treatment prognosis.
CONCLUSIONS: Findings from this global survey identify a core set of questions and domains for inclusion in a patient-completed voice case history questionnaire. This resource may support more consistent and comprehensive voice assessment practices internationally.
Aerodynamic Characteristics of Phonation in Subgroups of Voice Disorders Classified Based Upon the USVAC-C2025 Framework
Dr Duy Duong Nguyen (1), Ms Antonia Chacon (1), A/Prof Daniel Novakovic (1), A/Prof Catherine Madill (1)
1 The University of Sydney
Background: Airflow, pressure (Ps), and laryngeal resistance (Rlaw) reflect glottal function and are useful in monitoring voice treatment outcomes. This study aimed to investigate these measures in diagnostic subgroups of voice disorders (VD).
Method: This study included 243 VD (mean age: 38.5 years) and 34 non-VD speakers (mean age: 23.1 years). All underwent comprehensive voice assessment for diagnoses. Air pressure, airflow, and Rlaw were collected using the Phonatory Aerodynamic System (PentaxMedical) using participants' most comfortable voices. Data were compared across diagnostic groups based upon the USVAC-C2025 Framework.
Results: Across broad categories, significant main effects were found for Ps and Rlaw but not for airflow. For females, compared to non-VD, Ps and Rlaw were significantly lower for muscle tension and organic VD; There were no significant differences in Ps and Rlaw between muscle tension and organic VDs. For males, Ps in organic VD was significantly lower than in non-VD; No significant differences in Rlaw were found. In diagnostic subgroups, significant effects were observed for Ps and Rlaw but not for airflow. For females, compared to non-VD, Ps was significantly lower for functional and neurological subtypes whilst Rlaw was significantly lower in functional and benign lesions; There were no significant differences in Ps and Rlaw across functional, benign lesions, and neurological VD. For males, no significant differences in Ps and Rlaw across diagnostic subgroups were found.
Conclusion: VD patients phonated with significantly lower Ps and Rlaw than non-VD speakers across broad category and diagnostic subgroups. Gender had an effect on these findings.
Effects of Respiratory Priming on Lung Volume and Laryngeal Resistance in Trained and Untrained Speakers
Dr Catherine Madill (1), Mr John Holik (1), Dr Duy Duong Nguyen (1)
1 The University of Sydney
Objective: The relationship between lung volume (LV) and laryngeal resistance (Rlaw) during phonation onset remains debated. This study investigated how respiratory priming at different LV conditions influences Rlaw during phonation onset in vocally trained and untrained speakers.
Methods: Thirteen vocally healthy participants (9 females, mean age = 27.1 ± 6.1 years; 4 males, mean age = 36.0 ± 3.5 years) were classified as vocally trained (n = 5) or untrained (n = 8). Participants produced the sustained vowel /pi:/ following respiratory priming at habitual LV (60% vital capacity [HAB]), high LV (90% VC [HIGH]), and low LV (resting expiratory level [REL], 40% VC). LV was measured using respiratory inductive plethysmography, while airflow and subglottal pressure were recorded to calculate Rlaw. A three-way ANOVA examined effects of condition, task order, and vocal training.
Results: Participants accurately targeted REL (40.4% VC). Significant main effects of condition (p = 0.015) and group (p < 0.001) on Rlaw were observed. Vocal training alone did not significantly influence Rlaw (p = 0.866). Rlaw was higher at REL (p = 0.025) and HIGH (p = 0.053) compared with baseline, however airflow and pressure were significantly lower in REL compared with the HIGH condition.
Conclusions: Respiratory priming at REL and HIGH LVs increased Rlaw during phonation onset, however reduced flow and pressure in the REL condition suggests more optimal closure using entrainment rather than increased muscular forces. Findings highlight respiratory-phonatory interaction as a potential target for voice training and clinical intervention.
PLENARY SESSION 6: AI and Technology
2:10pm - 2:45pm
Machine Learning Models for Automated Voice Disorder Assessment Using Acoustic Data
Prof Dr-Ing Michael Döllinger (1)
1 University Hospital Erlangen, Germany
This presentation will explore the development and application of machine learning models for the automated assessment of voice disorders using acoustic voice recordings. The focus will be on acoustic data collected both as standalone recordings and synchronously with high-speed vocal fold imaging, enabling examination of the relationship between acoustic features and underlying laryngeal physiology. Methods for feature extraction, model training, and classification of voice disorders will be discussed, along with considerations for data quality and clinical implementation. Preliminary findings regarding model performance and diagnostic accuracy will be presented followed by a discussion of the potential for machine learning to enhance the objectivity, efficiency, and accessibility of clinical voice assessment.
Classifying Voice Disorders for Machine Learning: A Pilot Study of a Novel Diagnostic Framework, the USVAC-C2025
Dr Catherine Madill (1), Dr James Johnson (1), Dr Daniel Novakovic (1), Dr Leong Zhao Hao (1,2), Ms Dharshini Manoharan (1), Dr Dhanshree Gunjawate (1,3), Dr Charu Grover (1), Mrs Katrina Sandham (1), Mr Rijul Gupta (1), Dr Craig Jin (1), Dr Duy Duong Nguyen (1)
1 The University of Sydney, 2 Department of Otorhinolaryngology - Head and Neck Surgery at Singapore General Hospital, 3 Kasturba Medical College, Mangalore, Manipal Academy of Higher Education
Objectives: This study aimed to: 1) Develop and evaluate a standardized, multilayered diagnostic classification system for voice disorders tailored for machine learning (ML) applications; and 2) Assess this framework's inter- and intra-rater reliability among experienced clinicians.
Methods: A diagnostic framework was designed through a three-stage consensus process involving laryngologists, speech-language pathologists, and ML experts. The system classifies voice disorders hierarchically from "normal" vs. "abnormal" through five nested levels encompassing organic, functional, neuromuscular, structural, and muscle tension etiologies. Forty-five patients from a tertiary voice clinic were retrospectively reviewed. Blinded assessment reports and videostroboscopic recordings were evaluated by four blinded raters. A random subset of 15 cases was repeated to assess intra-rater reliability. Fleiss' kappa and intraclass correlation coefficients (ICCs) were calculated.
Results: Intra-rater reliability ranged from κ = 0.768 to 0.865 across raters. No significant differences were observed between otolaryngologists and speech-language pathologists.
Inter-rater reliability was very good for functional neurological voice disorders (κ = 0.830, 95% CI: 0.709–0.951) and suitable for structural organic pathology (κ = 0.790). The agreement was moderate for organic-neuromuscular (κ = 0.392) and fair for muscle tension voice disorders (κ = 0.253). The lowest agreement was observed for vocal fold paresis (κ = 0.238).
Conclusion: This novel framework improves reliability in classifying structural and functional voice disorders and highlights diagnostic ambiguity in muscle tension and neuromuscular conditions. It offers a foundational tool for consistent labelling in ML datasets for automated voice disorder classification.
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