Balancing the Art and Science of the Singing Voice

Voice therapy for elite singers developed alongside the emergence of performing arts medicine in the 1980s. By this time the field of clinical speech pathology had already established close working relationships with otolaryngologists and voice-related clinical research studies were being conducted to define treatment methods and their outcomes. In the intervening years, the art of delivering various therapy techniques, coupled with the science of vocal fold wound healing, have provided speech-language pathologists who specialize in voice a new foundation on which voice therapy is predicated and has allowed clinicians and their elite voice patients to expect epithelial vocal fold changes as a result of behavioral intervention.

Voice of Reimbursement: Medicare Coverage for Vocal Disorders

Speech-language pathologists (SLPs) who treat patients with vocal disorders find they are the exception —rather than the rule—when it comes to Medicare policy. This article addresses statute, regulations, and policies related to acoustical assessments, endoscopy, electronic speech aids, and tracheo-esophageal prostheses (TEPs). Acoustical assessments have limited recognition in the Medicare program and are only reimbursed in certain states, despite advocacy efforts by the American Speech-Language-Hearing Associaiton and members of the State Medicare Administrative Contractor (SMAC) Network. For endoscopy evaluations, confusion is still prevalent related to the level of physician supervision required, primarily due to the changing policies in 2011. Electronic speech aids are a benefit that is often forgotten, though the national policy allows relatively broad coverage. Finally, TEPs are the subject of SLPs, patients, manufacturers, and Congressional attention due to their limited available secondary to poor reimbursement rates and a 2010 enforcement of distribution policy. Clarification regarding the provision of traditional Medicare services (not Medicare Advantage or supplemental plans managed by private companies) and statute is discussed.

Pharyngo-Laryngo-Palatal Myoclonus: A Case Report and Assessment Tutorial for Clinicians

Although palatal myoclonus has been extensively described (Deuschl, Mischke, Schenck, Schulte-Mönting, & Lücking, 1990), little is known about pharyngo-laryngo-palatal myoclonus (PLPM), a complex and rare subset of head and neck myoclonic disease. To date, there have been only 5 cases of PLPM reported (Drysdale, Ansell, & Adeley, 1993; Gupta, Samant, & Katiyar, 1972; Ito, Kimura, & Shibasaki, 1993; Juby, Shandro, & Emery, 2014; Toland, Porubsky, Coker, & Adams, 1984), and no review of the diagnosis and management of this disease has been performed. Early identification of the etiology of PLPM is critical and can aid in appropriate management, referrals, and subsequent treatment. This article presents a case of PLPM along with a review of the literature relevant to PLPM including key elements of diagnosis and treatment.

SIG 3 Perspectives Vol. 25, No. 3, November 2015

Download the CE Questions PDF from the toolbar, above. Use the questions to guide your Perspectives reading. When you're ready, purchase the activity from the ASHA Store and follow the instructions to take the exam in ASHA's Learning Center. Available until August 2, 2018.

SIG 3 Perspectives Vol. 25, No. 2, July 2015

Download the CE Questions PDF from the toolbar, above. Use the questions to guide your Perspectives reading. When you're ready, purchase the activity from the ASHA Store and follow the instructions to take the exam in ASHA's Learning Center. Available until April 6, 2018.

Interdisciplinary Program in Sweden Related to Transgender Voice

Gender incongruence occurs when there is a discrepancy between gender identity and a person's sex assigned at birth and their bodily appearance. Sweden was the first country in the world to pass a law regulating a person's legal right to change gender. There are six psychiatric gender teams in Sweden responsible for diagnostic assessments and coordination of gender confirming medical interventions. Extended gender teams include endocrinologists, speech-language pathologists, phoniatricians, gynecologists, dermatologists, and surgeons. All male-to-female (MtF) and female-to-male (FtM) transgender individuals are referred for voice assessment when a gender dysphoria diagnosis has been confirmed. Voice assessment includes questionnaires and voice recordings in habitual and loud voice and voice range profiles. Voice and communication therapy is provided for both MtF and FtM individuals. Pitch-raising surgery can be considered and pre- and post-operative voice therapy is required for optimal results. The Swedish Association for Transsexual Health was launched 2004. The national guidelines were recently updated to make those more congruent with WPATH's Standards of Care version 7. A national quality registry for Gender Dysphoria has been accepted for financial support. The registry will in the future be a unique source to provide data concerning patient satisfaction, safety, and life quality.

Transgender Voice and Communication: Research Evidence Underpinning Voice Intervention for Male-to-Female Transsexual Women

Transsexual clients seek speech-language pathology services to achieve voice characteristics congruent with their true gender. Male-to-Female Transsexual Women (MtF women) make up the majority of transsexual clients on clinicians' caseloads. For many MtF women, achieving gender congruent voice is critical to psychosocial and financial wellbeing and quality of life. It is incumbent on clinicians who offer voice services to MtF women to use the best evidence available for effective voice training. There is strong evidence that voice feminization should target increasing fundamental frequency to approximately 180 Hz and increasing formant frequencies close to biological female (cisfemale) levels, as well as some evidence that increasing fundamental frequency variability and minimum and maximum fundamental frequency, decreasing vocal effort and intensity, and increasing breathiness are an important focus of intervention. While further research is required, the evidence base is increasing. It is encouraging that studies indicate that most MtF women achieve vocal improvements and that most are satisfied with voice training. Important next steps are to increase the quality of research designs, increase sample sizes, and measure long-term voice outcomes. Expert clinicians in collaboration with MtF women's self-advocacy groups will then be able to develop clinical guidelines for this expanding area of practice.