Research Article|Articles in Press

Variability in Voice Characteristics of Female Speakers With Phonotraumatic Vocal Fold Lesions

  • Nicole Free
    Address correspondence and reprint requests to Nicole Free, PhD, Department of Surgery, Faculty of Medicine, Nursing and Health Sciences, Monash University, 3168 Clayton, Victoria, Australia.
    Department of Surgery, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
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  • Joseph C. Stemple
    Department of Communication Sciences and Disorders, and Rehabilitation and Health Sciences PhD Program, University of Kentucky, Lexington, Kentucky
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  • Julian A. Smith
    Department of Surgery, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
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  • Debra J. Phyland
    Department of Surgery, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
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Published:February 20, 2023DOI:



      To examine the variability of lesion characteristics and vocal function in female speakers with phonotraumatic vocal fold lesions (PVFLs).

      Study Design

      Prospective Cohort Study


      Thirty adult female speakers with PVFL who were participating in voice therapy were recruited to complete a multidimensional voice analysis at four time points across 1 month. Analysis comprised self-ratings of effort and vocal function, expert ratings of videostroboscopy and audio recordings, and instrumental evaluation by selected aerodynamic and acoustic parameters. The degree of variability across time for each individual was assessed against a minimal clinically important difference threshold.


      A high degree of variability across time was observed for participant self-ratings of perceived effort and vocal function, and for instrumental parameters. The greatest degree of variability was observed in aerodynamic measures of airflow and pressure, and the acoustic parameter semitone range. Comparatively less variability was observed in perceptual evaluation of speech, and lesion characteristics via stroboscopy still images. Findings suggest that individuals with all PVFL types and sizes present with variability in function across time, with the greatest degree of variability in function observed in participants with large lesions and vocal fold polyps.


      Variability is observed in voice characteristics of female speakers with PVFLs across 1 month despite general stability in lesion presentation, suggesting vocal function can change despite the presence of laryngeal pathology. This study highlights the need to explore individual functional and lesion responses across time to determine potential for change and improvement in both aspects when selecting treatment options.

      Key words

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