title: Average Ambulatory Measures of Sound Pressure Level, Fundamental Frequency, and Vocal Dose Do Not Differ Between Adult Females With Phonotraumatic Lesions and Matched Control Subjects.
abstract: OBJECTIVE
  Clinical management of phonotraumatic vocal fold lesions (nodules, polyps) is based largely on assumptions that abnormalities in habitual levels of sound pressure level (SPL), fundamental frequency (f0), and/or amount of voice use play a major role in lesion development and chronic persistence. This study used ambulatory voice monitoring to evaluate if significant differences in voice use exist between patients with phonotraumatic lesions and normal matched controls.
  
  
  METHODS
  Subjects were 70 adult females: 35 with vocal fold nodules or polyps and 35 age-, sex-, and occupation-matched normal individuals. Weeklong summary statistics of voice use were computed from anterior neck surface acceleration recorded using a smartphone-based ambulatory voice monitor.
  
  
  RESULTS
  Paired t tests and Kolmogorov-Smirnov tests resulted in no statistically significant differences between patients and matched controls regarding average measures of SPL, f0, vocal dose measures, and voicing/voice rest periods. Paired t tests comparing f0 variability between the groups resulted in statistically significant differences with moderate effect sizes.
  
  
  CONCLUSIONS
  Individuals with phonotraumatic lesions did not exhibit differences in average ambulatory measures of vocal behavior when compared with matched controls. More refined characterizations of underlying phonatory mechanisms and other potentially contributing causes are warranted to better understand risk factors associated with phonotraumatic lesions.
authors.affiliation: Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA MGH Institute of Health Professions, Boston, Massachusetts, USA.
authors.forename: Jarrad H
authors.initials: JH
authors.lastname: Van Stan
authors.affiliation: Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA MGH Institute of Health Professions, Boston, Massachusetts, USA Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Daryush D
authors.initials: DD
authors.lastname: Mehta
authors.affiliation: Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Zeitels
authors.affiliation: Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: James A
authors.initials: JA
authors.lastname: Burns
authors.affiliation: Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Anca M
authors.initials: AM
authors.lastname: Barbu
authors.affiliation: Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA MGH Institute of Health Professions, Boston, Massachusetts, USA Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA Hillman.Robert@MGH.HARVARD.EDU.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Hillman
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D018670:Monitoring, Ambulatory / Q000379:methods; D016272:Occupational Health; D014827:Vocal Cords / Q000473:pathology / Q000503:physiopathology; D014832:Voice Disorders / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D014833:Voice Quality / Q000502:physiology
keywords: ambulatory voice monitoring; occupational voice use; vocal fold nodules; vocal fold polyps; vocal loading; voice disorders