Objective: This study aimed to investigate how voice production adapts to virtual reality (VR) environments by examining the influence of sensory streams on voice acoustic outcomes and the feasibility of VR-based voice therapy. Specifically, it explored (i) the effects of various simulated and non-simulated speaking conditions and (ii) the role of clinician-mediated feedback within VR on acoustic voice parameters.

Methods: Two groups of vocally healthy participants were involved: (Group one): 47 young adults (18-27 years) and (Group 2): 10 pre-service teachers (18-19 years). Group one performed speech tasks in varying VR conditions: (i) auralized (simulated acoustic), (ii) visual-only, and (iii) multisensory (audiovisual) conditions, while Group two performed speech tasks in varying real- and VR conditions: (i) control (conversation), (ii) teaching style, and (iii) VR intervention. Additionally, with Group 2, clinician-mediated feedback was provided in real-time during the VR intervention. Acoustic parameters such as sound pressure level, fundamental frequency, and time dose were analyzed.

Results: With Group one, multisensory VR environments significantly (p <.05) influenced voice outcomes compared to unisensory conditions, with larger, louder, and densely occupied VR spaces leading to more pronounced effects. With Group two, the VR intervention resulted in significantly lower time dose (p <.05) compared to the control condition. Real-time clinician feedback within VR further resulted in reduced SPL (p <.05), fundamental frequency (p <.05), and time dose (p <.05).

Conclusions: The results demonstrate that VR environments can significantly alter voice production and may serve as effective tools for voice therapy. Multisensory integration within VR, along with real-time clinician feedback, shows promise for enhancing voice outcomes by simulating real-world communication environments. These findings provide evidence for VR's potential to address carryover challenges in voice therapy through personalized environments that may improve voice-related outcomes.