Voice Lab

Welcome to the Find Your Voice Lab

Director Information: Anusha Sundarrajan

Anusha Sundarrajan, Ph.D., CCC-SLP (Faculty Advisor, Co-Investigator) received her Bachelor’s and Master’s degrees in Audiology and Speech Language Pathology in India. She earned her Ph.D. in Speech Language Pathology and a minor in Gerontology at Purdue University in 2016. Her research interests center around understanding the physiology of aging voice using aerodynamic and acoustic measures. She is specifically interested in understanding how the healthy young and old larynx responds to the effects of unhealthy, and the excessive use of the laryngeal mechanism. She has extensive experience collecting and analyzing voice measurements in young and older adult population. After joining SFSU’s Department of Speech, Language, and Hearing Sciences in Spring 2019, Dr. Sundarrajan expanded her interests and started the first gender-affirming voice clinic to serve the student community on campus. She has attended workshops and continued education courses to gain knowledge in this area. This includes volunteer training at one of the community centers, St James Infirmary to learn about safety procedures and policies.

Research in Action

The Long term goal of our research is to improve the quality of life of individuals with voice disorders, inappropriate habitual voice users, and individuals in need of gender affirming voice for voice feminization or masculinization.

Conversation Training Therapy to Target Voice and Communication for Trans Women

Transgender women who are perceived as having a voice incongruent with their gender expression have reported experiencing various negative psychosocial effects including decreased financial/employment prospects or concerns for personal safety (Oates & Dacakis, 2015). Clinical voice researchers have investigated several modified resonant voice therapies to address concerns of gender congruence with voice for transgender women.

Conversation Training Therapy (CTT) was developed to assist therapeutic carryover for people with voice disorders and to address inconsistencies with motor learning theory posed by voice treatment hierarchies (Gartner-Schmidt et al., 2016). CTT trains target voice production in the context of participant-led conversation using “clear speech.” The application of CTT on participants with functional voice disorders has demonstrated increased generalization of target voice production (Gillespie et al., 2019).

The goal of our study is to adapt a CTT protocol to address voice and communication goals for trans women and to evaluate the effects of CTT on trans women’s voice patterns including average speaking fundamental frequency, smoothed cepstral peak prominence, voice satisfaction, and perception of voice femininity. Participant reported outcomes are a vital component of our study as Davies (2017) concludes that “The match between a client's sense of gender and their voice can profoundly affect wellbeing,” and “The client is the expert in their own sense of gender.”

Our lab hopes to help other speech pathologists facilitate the journey of trans and non-binary people in our community through culturally responsive research utilizing participant-centered outcomes and interventions.

References

Davies, S. (2017). The Evidence Behind the Practice: A Review of WPATH Suggested Guidelines in Transgender Voice and Communication. Perspectives of the ASHA Special Interest Groups SIG 10,  2(Part 2), 64-73.

Gartner-Schmidt, J., Gherson, S., Hapner, E.R., Muckala, J., Roth, D., Schneider, S., & Gillespie, A.I. (2016). The development of conversation training therapy: A concept paper. Journal of Voice, 30(5), 563-573.

Gillespie, A.I., Yabes, J., Rosen, C.A., & Gartner-Schmidt, J.L. (2019). Efficacy of conversation training therapy for patients with benign vocal fold lesions and muscle tension dysphonia compared to historical matched control patients. Journal of Speech, Language, and Hearing Research, 62(11), 4062-4079.

Oates, J., & Dacakis, G. (2015). Transgender voice and communication: Research evidence underpinning voice intervention for male-to-female transsexual women. Perspectives on Voice and Voice Disorders, 25(2), 48–58.

For more information, contact the Lead Researcher Mitchell.

Occupational voice users  rely on their voices for their livelihood. The National Institutes of Health report that 7.5 million Americans currently have voice disorders, and that about 500,000 people are diagnosed with voice disorders each year (Higgins and Smith, 2012). Some occupational voice users like teachers, are reported to be at a high risk for developing voice problems (Roy et al., 2004). Recent research findings also highlight the widespread negative social impact of voice disorders including lower academic performance in classrooms when the teacher has a voice problem (Higgins and Smith, 2012). Given the high prevalence of voice problems in teachers, associated economic costs, and societal burden, this area of investigation is timely and necessary. This study aims to examine the effects of lecturing for long periods of time on voice and quality of life in university teachers. There is a lot of research on the prevalence of voice problems in teachers, specifically primary and secondary school teachers, and fewer studies are available for teachers at the university level (Leao et al., 2015). Hence, the primary purpose and motivation of the Voice Lab’s current study is to establish a baseline of information for voice disorders for teachers at the university level impacted by SARS-CoVid-2.

At the beginning of 2020, the country was struck by the highly contagious respiratory virus, SARS-CoVid-2. The nature of this virus required Americans to adhere to a stay at home order, forcing professors to adjust to and carry out class instruction remotely from their homes. Our study is unique in that the recent switch to an online learning format allows us to examine the effects that online vs. face to face lecturing has on voice quality in university teachers. The results of the study will aid in identifying possible preventative measures and treatments of voice disorders. This study will further identify the wide variety of effects from chronic voice disorders and use this data to target specific physiological mechanisms that lead to voice discomfort, voice misuse, and abuse and essentially voice disorders.

This research will benefit SLPs by providing them with data that evaluates the differences in voice production and use between face-to-face lecturing versus online lecturing. The Center for Disease Control’s recommendations to transition to remote learning have forced many educators to change their style of teaching as well as their teaching environment. With all these adaptations, we are able to identify the main characteristics of vocal distress, which will enable SLPs to make recommendations for teachers specifically, that will lessen the occurrence of vocal fatigue and increase knowledge of vocal health and care. The goal of this research is to identify those shifts and their effects on voice quality which will enable Speech-Language Pathologists to make recommendations in both preventative and treatment contexts.

The results provided from this study will improve the quality of life of University professors. This study will allow investigators to examine the causes of vocal impairments, their specific diagnoses, and treatment strategies. By examining what the root causes of vocal impairments are in university professors, we will be able to offer preventive recommendations that will allow teaching professionals to avoid the negative vocal effects that come with teaching for long periods of time. This study will also provide information that will support future recommendations concerning how the voice may recover following prolonged use and what professionals can do to mediate negative effects in their voices.

References:

Higgins, K. P., & Smith, A. B. (2012). Prevalence and Characteristics of Voice Disorders in a Sample of University Teaching Faculty. Contemporary Issues in Communication Science and Disorders, 39, 69-75.

Roy, N., Merrill, R. M., Thibeault, S., Gray, S. D., & Smith, E. M. (2004). Voice disorders in teachers and the general population: effects on work performance, attendance, and future career choices. Journal of speech, language, and hearing research : JSLHR, 47(3), 542–551.

Leão, S. H. d.,S., Oates, J. M., Purdy, S. C., Scott, D., & Morton, R. P. (2015). Voice Problems in New Zealand Teachers: A National Survey. Journal of Voice, 29(5)

In this project, we are focusing on the Transgender Non-Conforming (TG NC) community and the impacts COVID-19 has had on it. Since the global pandemic, many resources such as support groups and gender-affirming sources that are necessary for the TG NC community have been deemed "non-essential." Our goal is to bring awareness to the TG NC and shine a light on the inequities that have risen from the pandemic, looking at the emotions and feelings within theTG NC community.

Additional Information

Get to know the Speech, Language and Hearing Sciences Voice Lab team.

Cassie Poe

Cassie is an SF State student in the Science Language Hearing Sciences field. She hopes to get her master's degree after obtaining her B.S. with a minor in Spanish. Cassie has worked in the education field for over 10 years and loves working with a diverse group of children and young adults, including those within the LGBTQIA+ community. She has a passion for gender studies and social justice for the trans community, as well as research. She looks forward to being a part of this amazing research.

Marisol Rivas

Marisol is a senior in the Speech, Language, and Hearing Sciences undergraduate program at San Francisco State University. She was introduced to speech language pathology while taking a course in early childhood education at a community college. With the help of her mother who works as a teacher’s aide at a preschool, Marisol decided to shadow a speech-language pathologist who works in early intervention. She met many families who only spoke Spanish and realized that there was a language barrier between the speech-language pathologist and the client’s family. After volunteering as a Spanish interpreter in many sessions, Marisol knew at that moment that this field was for her. Since joining the undergraduate program, Marisol has had the opportunity to volunteer as a research assistant in Dr. Anusha Sundarrajan’s Voice Lab in An investigation of voice problems in university teachers as well as a clinic aide for Dr. Laura Epstein’s Bayshore Clinic. Marisol aspires to be a bilingual speech-language pathologist and hopes to work with children who are culturally and linguistically diverse.

Daisy Sheard

Daisy Sheard is a junior in the Speech, Language, and Hearing Sciences major at San Francisco State University. Her interest in speech therapy was sparked by watching her brother navigate the world of communication with a stutter and by her great aunt who loves her job providing intervention to preschoolers. Daisy has a love for helping others which she hopes to continue to achieve through her work with children and the LGBTQ+ community.

Publications:

  • Chi, O., & Sundarrajan, A.  (manuscript in preparation) The Nicholas Certo Speech, Language and Hearing Clinic organizes the first Gender Affirming Voice Workshop in San Francisco State University.
  • Rangwala, R., & Sundarrajan, A. (manuscript in preparation) Voice therapy in transfeminine voices: A review of literature
  • Herndon, N., Sundarrajan, A., Sivasankar, M., & Huber, J. (2019) Respiratory and Laryngeal Function in Teachers: Pre- and Postvocal Loading Challenge. Journal of Voice, 33(3), 302-309.
  • Sundarrajan, A., Huber, J., & Sivasankar, M. (2017) Respiratory and laryngeal changes with vocal loading in young and old individuals, Journal of Speech, Language, and Hearing Research, 60, 2551-2556.
  • Sundarrajan, A., Fujiki, R., Loerch, S., Venkatraman, A., & Sivasankar, M. (2017) Vocal loading and environmental humidity effects in older adults. Journal of Voice, 31 (6), 707- 713.
  • Fujiki, R., Chapleau, A., Sundarrajan, A., McKenna, V., & Sivasankar, M. (2017). The interaction of surface hydration and vocal loading on voice measures. Journal of Voice, 31(2), 211-217.
  • Sundarrajan, A., Levendoski, E., & Sivasankar, M. (2015). A preliminary investigation of potential biases in Phonation Threshold Pressure analysis. Journal of Voice, 29(1), 22-25.
  • Erickson, E., Sundarrajan, A., & Sivasankar, M. (2014). Reducing the negative vocal effects of superficial laryngeal dehydration with humidification. Annals of Otology, Rhinology, and Laryngology, 123(7), 475-481.
  • Boominathan, P., Chandrasekhar, D., Nagarajan, R., Madraswala, Z., & Rajan, A. (2008). Vocal hygiene awareness program for professional voice users (Teachers): An evaluative study from Chennai. Asia Pacific Journal of Speech, Language, and Hearing, 11(1), 39- 44.

Conference Papers and Presentations:

  • Peck, M., Schneider, S, & Sundarrajan, A. Conversation Training Therapy to Target Voice and Communication for Trans Women (2021). Abstract accepted at the Voice Foundation Symposium, Philadelphia, PA. 
  • Khorrasani, H., Madriaga, A., Hernandez, Z, & Sundarrajan, A. Psychological and Daily Life Impacts of SARS-COV-2 on the Transgender Non-Conforming Community (2021). Abstract accepted at the Voice Foundation Symposium, Philadelphia, PA. 
  • Herndon, N., Sundarrajan, A., Huber, J., & Sivasankar, M. (2015). Respiratory and Laryngeal Interactions in Determining Phenotypes for Voice Disorders. Poster presented at the American Speech Language-Hearing Association Conference, Denver, CO. 
  • Rangwala, R., & Sundarrajan, A. (abstract in preparation) Voice therapy in transfeminine voices: A review of literature. Proposal to be submitted to the American Speech- Language-Hearing Association Conference, San Diego, CA
  • Peck, M., & Sundarrajan, A. (abstract in preparation) Comparing Conversation Training Therapy to traditional voice therapy for transgender women. Proposal to be submitted to the American Speech-Language-Hearing Association Conference, San Diego, CA
  • Crotwell, L., Lara, N., & Sundarrajan, A. NSSLHA’s First Interprofessional Event at San Francisco State University (2020). Abstract accepted at the Annual Convention of the California Speech-Language-Hearing Association, Anaheim, CA
  • Crotwell, L., Lara, N., & Sundarrajan, A. NSSLHA’s First Interprofessional Event at San Francisco State University (2020). Abstract Accepted at the Annual Convention of the American Speech-Language-Hearing Association, San Diego, CA
  • Venkatraman, A., Sundarrajan, A., Loerch, S., & Sivasankar, M. Preliminary Effects of Sustained Whispered Speech on Voice Measures (2017). Talk presented at the American Speech-Language-Hearing Association Conference, Los Angeles, CA.
  • Sundarrajan, A., Fujiki, R., & Sivasankar, M. (2016). Humidity effects on an innovative vocal loading challenge. Poster presented at the Combined Otolaryngology Spring Meetings (COSM), Chicago, IL.
  • Sundarrajan, A., Fujiki, R., & Sivasankar, M. (2016). Humidity and Vocal Loading on the Aging Voice. Talk presented at the Voice Foundation Annual Symposium, Philadelphia, PA.
  • Fujiki, R., Sundarrajan, A., & Sivasankar, M. (2016). The Role of Surface Hydration on a 30-Minute Vocal Loading Challenge. Talk presented at the Voice Foundation Annual Symposium, Philadelphia, PA.
  • Herndon, N., Sundarrajan, A., Huber, J., & Sivasankar, M. (2015). Respiratory and Laryngeal
  • Interactions in Determining Phenotypes for Voice Disorders. Poster presented at the American Speech Language-Hearing Association Conference, Denver, CO.
  • Sundarrajan, A., Erickson, E., Sivasankar, M. (2014). Does Knowledge of the Experimental Hypothesis Bias PTP Analysis? Poster presented at the Voice Foundation Annual Symposium, Philadelphia, PA.
  • Sundarrajan, A., Huber, J, & Sivasankar, M. (2014). Effects of aging on the laryngeal and respiratory system. Talk presented at the American Speech-Language-Hearing Association Conference, Orlando, FL.
  • Sundarrajan, A., Erickson, E., Sivasankar, M. (2012). Experimental considerations in using Phonation Threshold Pressure (PTP): Investigating the effects of humidity. Poster presented at the American Speech-Language-Hearing Association Conference, Atlanta, GA.

Gender-Affirming Voice Research Study

We are currently recruiting transgender women to participate in evidence-based conversation training therapy

  • Over 18 years old?
  • Interested in receiving voice feminization therapy?

The Find Your Voice research laboratory is part of the Speech, Language and Hearing Sciences Department within San Francisco State University. The Find Your Voice lab is conducting Gender-Affirming Voice Research by investigating a conversation-based approach to gender-affirming voice therapy for women who are transgender. The goal of the research study is to adapt a conversation training approach to address voice and communication goals for transgender women and to evaluate the effects of conversation training on transgender womens voice patterns. The study also takes into account the participants voice satisfaction and perception of voice femininity by having participants report these outcomes independently and monitoring perception and voice satisfaction while participating in data collection of the participants voice patterns and conversation training therapy. Participants are welcome to join the study if they: (a) are a woman who is transgender, (b) would like to learn strategies to feminize their voice in conversation, (c) are willing to get clearance from their healthcare provider prior to beginning voice therapy, and (d) have relaible internet access and a device with a webcam and microphone. Participants must also be over the age of 18 years old and fluent in English. While participating in the study participants will receive five free gender-affirming voice therapy sessions via video conference online. 

If you are interested in participating please email Mitchell Peck-Eng.

Voice Perception Study

We are currently looking for Naive Listener participants to give their first impression of pre-recorded voice samples

  • Over 18 years old?
  • Fluent in English?

The Find Your Voice research laboratory is part of the Speech, Language and Hearing Sciences Department within San Francisco State University. The Find Your Voice lab is conducting Gender-Affirming Voice Research by investigating a conversation-based approach to gender-affirming voice therapy for women who are transgender. The Find Your Voice Lab is looking for naive listener participants to give their first impression of  pre-recorded video samples. Naive listeners must be: (a) over 18 years old, (b) fluent in English, (c) have normal hearing in both ears, (d) interested in giving your first impressions of anonymous voice samples, (e) have access to reliable internet and a device with a webcam and microphone, (f) have access to headphones. If you are eligible and decide to participate you will be required to fill out a short survey after each 10 second speech sample. Participation will take up to one hour. Compensation will be provided in the form of 10$ at the end of the study for your time. 

If you are interested in participating please email Mitchell Peck-Eng.

The goal of our study is to adapt a CTT protocol to address voice and communication goals for trans women and to evaluate the effects of CTT on trans women’s voice patterns including average speaking fundamental frequency, smoothed cepstral peak prominence, voice satisfaction, and perception of voice femininity.

Our lab hopes to help other speech pathologists facilitate the journey of trans and non-binary people in our community through culturally responsive research utilizing participant-centered outcomes and interventions.

For any questions, feel free to contact Mitchell Peck-Eng or for the Gender Affirming Voice SFSU Clinic please contact Dr. Anusha Sundarrajan.

Gender Affirming Voice Workshop

The Gender Affirming Workshop was created within the Speech, Language and Hearing Sciences Department at San Francisco State University. The goal of the Gender Affirming Workshop is to assist participants in feelings of empowerment and confidence when communicating in both personal and professional settings and contexts. This goal is achieved by participants and Speech Language Therapy students supporting one another in group voice sessions. Speech Language Therapy students provide participants with tips and practices to identify and maintain a healthy gender affirming voice in both group and breakout independent sessions. Speech Language Therapy students assist the participants in safely modifying pitch, resonance, and intonation. Participants are welcome to join the Gender Affirming Workshop if they: (a) Attend San Francisco State University, (b) identify as transfeminine, transmaculine or non-binary, (c) would like to learn strategies to safely modify and take care of your gender affirming voice, and (d) can committ to weekly 90 minute group meetings TBD based on your groups best availability. Please email: VoiceClinicSFSU@gmail.com if you are interested.

Voice Clinic for University Teachers

The Voice Clinic For University Teachers was created within the Speech, Language, and Hearing Sciences at San Francisco State University. The goal of the Voice Clinic for University teachers is to provide healthy and safe vocal techniques and strategies to vocal habitual users that may need to release strain or tension built up within their vocal tract from everyday professional and/or personal voice usage. Speech Language Pathology graduate clinicians provide participants with tips and practices to identify and maintain a healthy voice in both group sessions and break-out independent sessions. Participants are welcome to join the Voice Clinic For University Teachers if they: (a) are a full-time, part-time, or adjunct faculty member at San Francisco State University, (b) have no history of voice and/or respiratory problems, (c) have reliable access to internet with a microphone and webcam, and (d) can commit to weekly 90-minute group meetings TBD based on your group availability. For further information or to express interest please email: Anusha@sfsu.edu.  A Flier is available below for viewing and downloading as needed.

Podcast co-featuring Anusha S.

In this episode, we are joined by Dr. Anusha Sundarrajan, the director of the Find Your Voice Research Lab at San Francisco State University. Dr. Sundarrajan unfolds the concept and factors of vocal loading. We discuss if the present virtual reality that we live in is causing an increase or decrease in unhealthy use of voice, especially in professional voice users. She shares with the other SLPs about the benefits of vocal naps. Finally, we discuss the role of SLPs and voice therapy in the transgender population.

Listen Now

Gender Affirming Voice and Habitual Voice Users Education Seminar Presented by Anusha Sundarrajan and Oneida

The Find You Voice Lab at SFSU is committed to distributing information material on vocal health, gender affirming voice, and how habitual voice users can protect and sustain their vocal health. Professor and Faculty Anusha S. and Onedia presented information on Gender Affirming Voice. Professor Anusha S. presented on habitual voice users such as singers and teachers and the importance and value of practicing vocal health during times of elevated stress such as the COVID19 pandemic. The speech was presented at the San Mateo Pride Center

LYRIC. A San Francisco LGBTQQ youth organization

LYRIC is a youth organization for GBTQQ youth in San Francisco California. The organization's mission is to build community and inspire positive social change through education enhancement, career training, health promotion, and leadership development with LGBTQQ youth, their families, and allies of all races, classes, genders, and abilities. Find You Voice SFSU has partnered with LYRIC to provide LYRIC community members with education, research participation, and entrance in the SFSU Find Your Voice laboratory and SFSU gender.