Background
Pitch perception is an individual’s ability to distinguish sounds as high or low based on their fundamental frequency (Fo). Exposure to music may enhance pitch perception, which may vary across cultures and geographical regions. In our voice clinic, Fo and maximum phonation time (MPT) are routinely measured in all patients. However, many of our patients confuse pitch with loudness. Voice therapy is the first-line management for most benign vocal fold lesions and our study hypothesis is that comprehension of pitch is beneficial to optimal participation in voice therapy.

Aim
To assess improvement in vocal outcome measures (MPT and Fo) after voice therapy in patients who understood the concept of pitch versus those who required a pitch perception explanation.

Methods
Patients with vocal fold sulcus were selected as the study group, as this condition typically presents with hoarseness and elevated pitch. A six-month retrospective study was conducted on patients diagnosed with vocal fold sulcus on stroboscopy. Based on clinic records, patients were divided into two groups:
• Group A: patients who understood pitch,
• Group B: patients who required an explanation.
All patients underwent four sessions of voice therapy over 4–6 weeks. MPT and Fo were recorded before and after therapy. Data was analysed for changes in outcome measures and compared between groups.

Results
Group A included eight patients and Group B six patients. The mean percentage increase in MPT was 28.6% in Group A and 5.96% in Group B. Although this difference was not statistically significant due to a small sample size, Cohen’s d = 0.88 indicated a large effect size.
Notably, 5/8 patients in Group A were singers (62.5%) whereas 0/6 in Group B were singers which is a statistically significant finding (p = 0.031, p < 0.05).

Conclusion
Exposure to music appears to significantly influence pitch perception in our study. Understanding pitch had a large positive effect on voice therapy outcomes in our study group of vocal fold sulcus patients. Incorporating pitch perception training into voice therapy, for patients unfamiliar with the concept of pitch, may improve treatment effectiveness and vocal rehabilitation success.