title: A novel treatment for hypophonic voice: Twang therapy.
abstract: A hypophonic voice, characterized perceptually as weak and breathy, is associated with voice disorders such as vocal fold atrophy and unilateral vocal fold paralysis. Although voice therapy programs for hypophonia typically address the vocal folds or the sound source, twang voice quality was examined in this study as an alternative technique for increasing vocal power by altering the epilarynx or the sound filter.
  
  
  OBJECTIVE
  This study investigated the effect of twang production on physiologic, acoustic, and perceived voice handicap measures in speakers with hypophonia.
  
  
  METHODS
  This prospective pilot study compared the vocal outcomes of six participants with hypophonia at pre- and posttreatment time points. Outcome measures included mean airflow rate, intensity in dB sound pressure level (SPL), maximum phonation time, and self-report of voice handicap.
  
  
  RESULTS
  All subjects improved in at least three of the four vocal outcome measures. Wilcoxon signed-rank test of paired differences revealed significant differences between pre- and posttherapy group means for airflow rate, SPL, and Voice Handicap Index scores.
  
  
  CONCLUSIONS
  The twang voice quality as a manipulation of the sound filter offers a clinical complement to traditional voice therapies that primarily address the sound source.
authors.affiliation: Indiana University of Pennsylvania, Indiana, Pennsylvania 15705, USA. llombard@iup.edu
authors.forename: Lori E
authors.initials: LE
authors.lastname: Lombard
authors.forename: Kimberly M
authors.initials: KM
authors.lastname: Steinhauer
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013061:Speech Acoustics; D013070:Speech Therapy / Q000379:methods*; D014832:Voice Disorders / Q000503:physiopathology* / Q000628:therapy*; D014834:Voice Training