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Review of  International Perspectives on Voice Disorders

Reviewer: Claudia Enbe
Book Title: International Perspectives on Voice Disorders
Book Author: Edwin M-Y. Yiu
Publisher: Multilingual Matters
Linguistic Field(s): Applied Linguistics
Issue Number: 25.1623

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This book fills a current gap in the field of Voice Research. This books is intended for researchers in Speech Language Pathology and Otolaryngology in order to understand the anatomical and voice therapy research developments in different countries of the world such as: Australia, Belgium, Brazil, China, Hong Kong, Israel, Japan, the UK and the USA.

Voice research has a long history, but in the last thirty years, there has been an increase of studies in anatomical and clinical voice assessment. However, different points of view, various methodological approaches and diverse techniques of analysis have caused controversial discussions in the field.

The book starts with a table of contents, followed by a list of contributors, and a brief editor's note. The book has two parts: the first part is about ''Current Issues in Voice Assessment and Intervention: a World Perspective'', and the second part about ''Contemporary Voice Research: A World Perspective.'' Part I has nine chapters and part II has eight chapters.

Each chapter begins with an introduction of voice research development in each country. There is also a description of materials and methods used in each country in order to evaluate and treat speech disorders. Many countries also have specific techniques used to solve anatomical disorders in the vocal folds. Each chapter ends with a bibliography.

Chapter 1, “Current issues in voice assessment and intervention in Australia,” consists of an overview of the Clinical Voice practice in Australia, by Jennifer Oates, Janet Baker and Anne Vertigan. The authors walk the reader through voice practice in Australia and discuss the current practices in the education of speech pathologists, the professional development, different types of voice services and cultural influences. They describe the contributions in the areas of neurophysiology, respiratory, phonatory, auditory and perceptual evaluation, instrumental assessment and diagnostic classification, acoustic features in singing and acting voice, in which Australian speech pathologists have a strong participation.

Chapter 2, “Current issues in voice assessment and intervention in Belgium” is by Marc S. De Bodt, Bernadette Timmermans and Kristiane M. Van Lierde. This chapter summarizes voice research in Belgium. The chapter reviews a number of projects that have been done in order to focus voice training, preventive strategies by using warming-up and voice therapy like laryngeal biofeedback in order to change laryngeal postures and a manual circumlaryngeal treatment for improving the range of movements of the laryngeal joints.

Chapter 3, “Speech language pathology and the voice specialist in Brazil: an overview,” is by Mara Behlau, Gisele Oliveira, Glaucya Madazio and Rosiane Yamasaki. This chapter summarizes the development of the profession of speech pathologists in Brazil. The chapter introduces the perceptual and acoustic analysis of voice, self-assessment protocols and therapeutic practice in order to evaluate a voice quality and adequate treatment.

Chapter 4, deals with “ Current issues in voice assessment and intervention in China,” by Wen Xu and Demin Han. The authors introduce the chapter with an overview of clinical examination of voice disorders in China. In this country, voice assessment is carried out by a physician as the speech pathology/therapy profession does not exist. The clinical practice is based in two clinical voice assessments: the first one is voice related to the quality of life, and the other one, the laryngeal function. There is a focus on the patient's own perspective of how voice problems affect his or her quality of life.

Chapter 5 deals with “Current issues in voice assessment and intervention in Hong Kong,” by Estella P-M. Ma and Triska K-Y.Lee. This chapter consists of an overview of the voice assessment and treatment in Hong Kong. The major spoken language in Hong Kong is a Cantonese, a Chinese dialect which is a tone language. This type of language influences in the voice features and the measures cannot be compared with a range of voice found in American English speakers. The author introduces a number of assessment tools created for the Cantonese.

Chapter 6 is about “Current issues in voice assessment and intervention in Israel.” In this chapter, Ofer Amir summarizes the historical development of voice disorder treatments in Israel. Similar to other countries, voice evaluation includes a medical and laryngeal examination performed by the otolaryngologist and a functional voice evaluation given by a speech pathologist. Even though there are many instrumental techniques for voice evaluation (like fibro-laringoscopy, stroboscopy and acoustic analysis), the use of indirect laryngology in the clinical practice is still found. The author concludes that in recent years, the clinical practice incorporates standardized guidelines for voice evaluation translated into Hebrew.

Chapter 7 deals with “Contemporary phonosurgery in Japan.” The author, Koichi Tsunoda, reports that Japanese laryngologists have a strong interest in laryngeal research in order to develop phonosurgical procedures. Different methods in laryngeal surgery are described in this chapter, such as the treatment of sulcus vocalis and vocal fold paralysis.

Chapter 8 is about “Current issues in voice assessment and intervention in the United Kingdom.” In the first part of the chapter, Paul Carding offers a description about the National Health Service in the UK. He claims that speech and voice pathologists perform laryngeal endoscopies for both assessments and treatment. At the end of the chapter, he describes different studies in order to investigate treatment efficacy/effectiveness in voice disorder.

Chapter 9 turns to the United States. In “Current issues in voice assessment and intervention in the USA,” Tanya L. Eadie and Edie R. Hapner state that diagnoses of laryngeal pathology that affect voice are provided only by physicians. Speech/language pathologists perform the assessment and effective behavioral treatment of dysphonia. Even though in the USA the clinical practice of the speech/language pathologists is governed by the American Speech- Language-Hearing Association (ASHA), there is not yet one standardized protocol for assessing voice pathology. In consequence, variations in voice measurements provide difficulties to establish the diagnosis of voice disorders across different centers. The gold standard is the use of laryngo-videostroboscopy using endoscopy for clinical practice, but still there is a use of the indirect lanyngoscopy to evaluate voice disorders. At the end of the chapter, the authors summarize different tools for voice assessment currently used in the clinical practice.

Chapter 10 returns to Japan. In “Contemporary voice research in Japan, “Shigeru Hirano gives a historical perspective on voice research in Japan. The author claims that especially between 1975 and 1985 there were a great number of studies in histological research that contributed to the research in voice field. The author also describes a variety of studies in histology, physiology, neurolaryngology, imagining, regenerative medicine and phonosurgery that have been carried out in Japan and have contributed to the understanding of voice functioning.

In chapter 11, “A USA perspective: vocal fold injuries and their management,” by Nicole Yee-Key Li and Katherine Verdolini Abbott, the authors explain the general principle of wound healing, current investigations of phonotrauma and surgical trauma and techniques used in the USA. The studies show that phonotrauma may result from a single traumatic force with a great magnitude or from repeated forces of relative small magnitude. Different investigations for therapeutics techniques are summarized.

Chapter 12 deals with “Cognitive behavioural therapy in the treatment of functional dysphonia in the United Kingdom. “ Paul Carding, Vicent Deary and Tracy Miller explain the use of cognitive behavioural therapy (CBT) techniques with which individuals with functional dysphonia (FD) are treated. The use of CBT techniques helps improve significantly the anxiety and depression of the individual with FD. These two categories have not been used in conventional voice therapy. However, in terms of quality of voice, the traditional voice techniques and the CBT techniques have similar results. At the end of the chapter the authors provide an appendix with an explanation of the CBT interventions.

Chapter 13 is about “Acupuncture and voice treatment.” In this chapter, Edwin M-L.Yiu explains studies that used acupuncture to improve the vocal functions in phonotraumatic voice problems. Another technique is the use of laser stimulation of acupoints for individuals that cannot tolerate a traditional acupuncture.

Chapter 14 deals with the “Application of Motor Learning Principles in Voice Motor Learning.” In this chapter, Estella P-M. Ma and Edwin M-L. Yiu describe some studies applying the theories of motor learning to individuals with hyperfuntional or phonotraumatic voice disorders. The authors conclude that general motor learning principles cannot be always applicable to the learning of vocal skills and it requires further investigations in the field.

Chapter 15 presents “Contemporary voice research: a China perspective.” Jiangping Kong and Gaowu Wang summarize some studies base on a linguistic perspective. There are more than 80 languages used in China. Differences in voice characteristics are found for each lexical tone according to each language (e.g tense/lax phonation, voiced aspiration). The authors say that the fields of phonetics and linguistics integrate a physiological model of voice production with phonetic and linguistic theories.

Chapter 16 is an “Analysis of professional voice users in the clinical setting.” Cate Madill and Patricia Mc Cabe introduce the use of the acoustic analysis and the visual assessment of the vocal tract for the description of voice features of professional voice users. Some studies of singing voice and professional spoken voice are summarized.

Chapter 17 turns to Belgium. In “Contemporary voice research: a Belgian perspective” Marc De Bodt and Youri Maryn refer to the contribution of objective voice measurements in clinical practice. However, the results need to be taken into account carefully by comparing perceptual and acoustic metrics in order to describe voice quality. The authors suggest the use of multivariate approaches and also describe different protocols used in Belgium in order to assessment voice disorders.


This book, part of the prestigious ''Communication Disorders Across Language'' series (edited by Nicole Muller and Martin Ball), is a pioneering work that brings together the state-of-the-art in voice research and the therapeutic treatment of voice in the world. The studies on voice started more than a century ago, but today the use of instrumental techniques and computerized systems predominate the research in the field. However, the analysis of the voice and voice disorders are still the subjects of discussions in academic research. The main problem is a variety of features in the voice characterized by a particular language, but also the voice is specific to each human associated with his/ her history and cultural differences. These aspects may have comparable conclusions within countries and in communities in the field.

The book offers a broad historical research development in different countries such as Australia, Belgium, Brazil, China, Hong Kong, Israel, Japan, the UK and the USA. The majority of chapters have a review of the research and the state of the clinic voice treatment in each country and a bibliography. Though each chapter is written by a different author(s) , the writing style is uniform, and each chapter provides details by introducing the local historical development of voice research in each state. The book contains 17 chapters from different areas of anatomy and therapeutic voice research in the world. They were written by some of the finest researchers our each area has to offer. This book is appropriate for researchers in the field for physician's otolaryngologist, speech language pathologist and other areas like psychology, linguistics, alternative medicine and voice teachers in order to understand more the research on voice disorders. Though it is technical, it offers extensive and actualized details to ensure clarity in the writing, while also educating to the reader on the particular topic.

Another merit of the book is the breadth of areas included. This book exposes the past, present and further investigations in the clinical voice assessment and therapy. It is very interesting to note that in the majority of health services in the world, if an individual has a voice disorder, the first assessment is done by the physician's otolaryngologist, who is making a medical diagnosis of the anatomical structure of vocal folds and upper vocal structures. Then, the patients are referred to a speech pathologist. In some cases, there is a relationship between the otolaryngological clinician and the speech pathologist, but sometimes there is a limited understanding of the role and skill base of the speech pathologist in a multidisciplinary collaboration. Many authors describe that some countries have speech pathology services either in the public or private system, but sometimes, the scope and time access is limited by insurance plans to a number of sessions for the treatment. Some countries assign voice disorders low priority according to referred criteria or to a medical condition. In some countries, voice problems may receive low priority in comparison to areas of speech or dysphagia in a community health centre.

It is very interesting to note that while the interest in voice research is growing around the world, near to 5-10% of the population is interested in consulting about voice disorders. Even though the voice is a tool of work for many professions like singers, actors, teachers and solders, low interest is still found in these individuals to care about the quality of voice.

To conclude, I note that this book is an important bridge between voice research and clinical voice treatment that will promote the use standardized methods of analysis and an increase in the awareness of voice disorders.
Claudia Enbe (PhD) is a Speech Language Pathologist. She earned her PhD in the Department of Foreign Languages and Linguistics from Ben Gurion University of the Negev, Israel in 2009. She has worked in clinical therapy in Voice and Language at Healthcare Services and in private care for over twenty years in Argentina and Israel. She is teaching at the Kaye Academic College of Education, Israel. Her subjects of interest include speech, voice, prosody and language acquisition in typically and atypically Spanish and Hebrew speaking children and adults.

Format: Hardback
ISBN-13: 9781847698735
Pages: 216
Prices: U.K. £ 69.95
U.S. $ 119.95