Populations in the U.S. workforce who rely on voice as a primary tool of trade: a preliminary report

A study of VHI scores and acoustic features in street vendors as occupational voice users

PURPOSE

to investigate acoustic features of phonation and perception of voice handicap in street vendors.

METHODS

Eighty-eight participants (44 street vendors, 44 controls) were recruited. The mean age of the group was 38.9±16.0 years (range: 20-78 years). Scores of the Arabic version of the Voice Handicap Index (VHI-Arab) were used for analysis. Acoustic measures of fundamental frequency (F₀), jitter, shimmer, and signal-to-noise ratio (SNR) were also analyzed.

RESULTS

Analysis showed a significant difference between street vendors and controls in the total score of the VHI-Arab (p<0.001) as well as scores of all three VHI-Arab subsections: functional (p<0.001), physical (p<0.001), and emotional (p=0.025). Weak correlations were found among all of the VHI scores and acoustic measures (-0.219≤ r≤0.355), except for SNR where a moderate negative correlations were found (r=-0.555; -0.4) between the VHI (physical and total) scores and SNR values. Significant differences also were found in F₀, jitter, and SNR among specific subgroups of street vendors when stratified by weekly hours worked (p<0.05), and in jitter (p=0.39) when stratified by educational level.

CONCLUSIONS

Perception of voice handicap and a possible effect on vocal quality in street vendors were noted. The effect of factors, namely work hours and educational level, on voice quality should be further studied.

Gender Differences in the Reporting of Vocal Fatigue in Teachers as Quantified by the Vocal Fatigue Index

OBJECTIVES

Occupational voice users report higher instances of vocal health problems. Women, who are more likely than men to report voice problems, are the largest members of some occupational voice users, such as teachers. While a common complaint among this population is vocal fatigue, it has been difficult to quantify. Therefore, the goal of this study is to quantify vocal fatigue generally in school teachers and investigate any related gender differences.

METHODS

Six hundred forty (518 female, 122 male) teachers were surveyed using an online questionnaire consisting in part of the Vocal Fatigue Index (VFI), an index specifically designed to quantify vocal fatigue.

RESULTS

Compared to vocally healthy adults, the teachers surveyed were 3 times as likely to report vocal tiredness or vocal avoidance and over 3 times as likely to report physical voice discomfort. Additionally, female teachers were more likely to have scores approaching those with dysphonia.

CONCLUSIONS

The VFI quantified elevated levels of vocal fatigue in teachers, with a significant prevalence of symptoms reported among females compared to males. Further, because the VFI indicated elevated complaints (between normal and dysphonic) in a population likely to be elevated, the VFI might be used to identify early indications of voice problems and/or track recovery.

A Case Series of the Probability Density and Cumulative Distribution of Laryngeal Disease in a Tertiary Care Voice Center

OBJECTIVE

To examine the distribution of clinic and operative pathology in a tertiary care laryngology practice.

METHODS

Probability density and cumulative distribution analyses (Pareto analysis) was used to rank order laryngeal conditions seen in an outpatient tertiary care laryngology practice and those requiring surgical intervention during a 3-year period.

RESULTS

Among 3783 new clinic consultations and 1380 operative procedures, voice disorders were the most common primary diagnostic category seen in clinic (n = 3223), followed by airway (n = 374) and swallowing (n = 186) disorders. Within the voice strata, the most common primary ICD-9 code used was dysphonia (41%), followed by unilateral vocal fold paralysis (UVFP) (9%) and cough (7%). Among new voice patients, 45% were found to have a structural abnormality. The most common surgical indications were laryngotracheal stenosis (37%), followed by recurrent respiratory papillomatosis (18%) and UVFP (17%).

CONCLUSIONS

Nearly 55% of patients presenting to a tertiary referral laryngology practice did not have an identifiable structural abnormality in the larynx on direct or indirect examination. The distribution of ICD-9 codes requiring surgical intervention was disparate from that seen in clinic. Application of the Pareto principle may improve resource allocation in laryngology, but these initial results require confirmation across multiple institutions.

Development of a voice disorder work productivity inventory utilizing cognitive interviewing technique

Objectives/Hypothesis

Voice disorders have been shown to impair workplace productivity primarily by reduced efficiency while at work (presenteeism) versus increased days missed (absenteeism). Work productivity measures such as the Work Productivity and Activity Impairment (WPAI) Questionnaire or the World Health Organization Health ‐ Work Performance Questionnaire (HPQ) can be customized to a specific disease but do not fully capture impaired work productivity associated with voice disorders. The purpose of this study was to develop a novel questionnaire to evaluate work productivity in patients with voice disorders.

Study Design

Descriptive

Methods

At a tertiary medical center, patients with gainful employment and with chronic voice disorders were given the WPAI, HPQ, and 20 voice‐related statements (VRS‐20). Cognitive interviews were conducted and recorded with all patients.

Results

Ten patients (7 females, 3 males) completed the questionnaires and subsequent cognitive interviews. One patient had spasmodic dysphonia, 6 had benign vocal fold lesions, and 3 had vocal fold motion disorders. The median VHI‐10 was 18 (9‐40). Themes that emerged during interviews include: avoiding oral communication/telephone, use of voice associated with strain/fatigue, frustration and stress at work, and workplace integrity. Conclusions: In cognitive interviews, participants felt the VRS‐20 captured the impact of their voice disorder at work better than the WPAI and HPQ. Participants also felt some statements were more important than others.

Level of Evidence

5.

Identifying Occupations at Risk for Laryngeal Disorders Requiring Specialty Voice Care

Objective

To identify occupational groups’ use of specialty voice clinic evaluation.

Study Design

Retrospective cohort study.

Setting

Tertiary subspecialty clinic.

Subjects and Methods

We analyzed data collected on patients presenting to the Massachusetts Eye and Ear Infirmary Voice and Speech Laboratory over a 20-year period (1993-2013). The relative risk (RR) and 99% confidence interval (CI) of presentation were calculated for each occupational category in the greater Boston population using year-matched data from the Bureau of Labor Statistics (BLS).

Results

The records of 12,120 new patients were reviewed. Using year- and occupation-matched BLS data from 2005 to 2013, 2726 patients were included in the cohort analysis. Several occupations had significantly higher risk of presentation. These included arts and entertainment (RR 4.98, CI 4.18-5.95), law (RR 3.24, CI 2.48-4.23), education (RR 3.08, CI 2.70-3.52), and social services (RR 2.07, CI 1.57-2.73). In contrast, many occupations had significantly reduced risk of presentation for laryngological disorders, for example, maintenance (RR 0.25, CI 0.15-0.42), food preparation (RR 0.35, CI 0.26-0.48), and administrative support (RR 0.49, CI 0.41-0.57).

Conclusion

Certain occupations are associated with higher use of laryngological services presumably because of their vocational voice needs. In addition to confirming findings from other studies, we identified several new occupation groups with increased or decreased risk for laryngologic disorders. Understanding what factors predispose to requiring specialty voice evaluation may help in targeting preventative efforts.

Long-term Surveillance Following Intralesional Steroid Injection for Benign Vocal Fold Lesions

Importance

The short-term outcomes of vocal fold steroid injection (VFSI) are well documented. However, few studies have reported the long-term outcomes following VFSI.

Objective

To investigate the incidence rates of symptom recurrence and secondary interventions following VFSI for benign vocal fold lesions.

Design, Setting, and Participants

This prospective cohort study was conducted at a tertiary referral medical center in Taipei, Taiwan. The cohort included 189 patients with vocal fold lesions who had received VFSI as the primary treatment between August 2011 and September 2013.

Exposures

All participants underwent VFSI.

Main Outcomes and Measures

Long-term surveillance was conducted through structured telephonic interviews and by reviewing medical charts every 6 months over a 2-year period. We assessed the 10-item voice handicap index, dysphonic symptoms, and whether the patients had received any additional interventions after the initial VFSI.

Results

The 189 participants (32 men and 157 women; mean [SD] age, 39 [10] years [range, 20-74 years] included patients who had undergone VFSI for vocal fold nodules (n = 72), polyps (n = 72), or mucus-retention cysts (n = 45). Following VFSI, 141 patients (74.6%; 23 men and 118 women; mean age, 39 years [range, 20-70 years]) showed positive response (ie, clinically significant symptom resolution without the need for additional procedures) and received long-term surveillance. The median follow-up period was 19.4 months, and 2 patients were lost to follow-up postoperatively within 1 year. The cumulative failure rates (subjective symptom recurrence plus secondary treatments) at 6, 12, 18, and 24 months after VFSI were 12%, 17%, 24%, and 32%, respectively. When the initial response rate to VFSI (141 of 189, 74.6%) was considered altogether, VFSI remained effective after 2 years in 50% of the initially recruited 189 patients. The highest rate of long-term effectiveness of VFSI occurred in vocal polyps (54%), followed by nodules (49%) and cysts (43%).

Conclusions and Relevance

This study demonstrates that VFSI can be beneficial in managing benign vocal lesions, especially when first-line treatments are unsuitable. However, the long-term results of this study clarify that a substantial number of patients experience symptom recurrence or receive subsequent interventions within 2 years after VFSI; this should be considered in medical decision making.

A one-school year longitudinal study of secondary school teachers' voice parameters and the influence of classroom acoustics

Recent literature reports that a large percentage of teachers complain that teaching has an adverse effect on their voice status. Thus, more needs to be done to study their vocal behavior. The objective of this longitudinal study was twofold: to determine changes in the voice use of teachers over a school year, and to study the relationships between voice use and classroom acoustic parameters. Thirty-one teachers from two secondary schools in Turin (Italy) were involved at the beginning of the 2014-2015 school year, and 22 of them also participated at the end of the same school year. The results show that teachers adjust their voices with noise and reverberation. A minimum value of the sound pressure level of voice (SPL) was found at a mid-frequency reverberation time of 0.8 s in both periods. Moreover, the teachers who worked in the worst classroom acoustic conditions showed an increase of 2.3 dB in the mean SPL and a decrease of 10% in the voicing time percentage at the end of the school year. A predictive model that can be used to estimate the mean SPL from the background noise level and the reverberation time, based on collected data, is here proposed.

Acoustic and Perceived Measurements Certifying Tango as Voice Treatment Method

Voice disorders are affecting everyday life in many levels, and their prevalence has been studied extensively in certain and general populations. Notably, several factors have a cohesive influence on voice disorders and voice characteristics. Several studies report that health and environmental and psychological etiologies can serve as risk factors for voice disorders. Many diagnostic protocols, in the literature, evaluate voice and its parameters leading to direct or indirect treatment intervention. This study was designed to examine the effect of tango on adult acoustic voice parameters. Fifty-two adults (26 male and 26 female) were recruited and divided into four subgroups (male dancers, female dancers, male nondancers, and female nondancers). The participants were asked to answer two questionnaires (Voice Handicap Index and Voice Evaluation Form), and their voices were recorded before and after the tango dance session. Moreover, water consumption was investigated. The study's results indicated that the voices' acoustic characteristics were different between tango dancers and the control group. The beneficial results are far from prominent as they prove that tango dance can serve stand-alone as voice therapy without the need for hydration. Also, more research is imperative to be conducted on a longitudinal basis to obtain a more accurate result on the required time for the proposed therapy.

An Online Telepractice Model for the Prevention of Voice Disorders in Vocally Healthy Student Teachers Evaluated by a Smartphone Application

This article describes the Global Voice Prevention Model (GVPM) facilitated with student teachers at West Chester University and the VoiceEvalU8 smartphone application (app) used to assess the effectiveness of the GVPM. Twenty-one participants completed 1 of 3 conditions (i.e., in-person GVPM, telepractice GVPM, and control). The in-person and telepractice conditions ran for 4 weeks during fall 2016, with 1 week dedicated to vocal education and vocal hygiene and 3 weeks spent in vocal training. The control condition ran for 1 week and included only vocal education and vocal hygiene. The VoiceEvalU8 app was used at pre- and post-condition twice a day for 5 days to record acoustic, perceptual, and aerodynamic voice measures. The study is ongoing; therefore, preliminary acoustic results for fundamental frequency (F0) and jitter% are presented from pre- to post-condition. During spring 2017, the participants were student teaching and using the VoiceEvalU8 app to record the voice measures before and after teaching all day. A new group of participants will be enrolled fall 2017 for selection into 1 of the 3 conditions and then continue on to student teaching spring 2018.

Quantifying Vocal Fatigue Recovery: Dynamic Vocal Recovery Trajectories after a Vocal Loading Exercise

Objectives

We quantified the recovery of voice following a 2-hour vocal loading exercise (oral reading).

Methods

Eighty-six adult participants tracked their voice recovery using short vocal tasks and perceptual ratings after an initial vocal loading exercise and for the following 2 days.

Results

Short-term recovery was apparent, with 90% recovery within 4 to 6 hours and full recovery at 12 to 18 hours. Recovery was shown to be similar to a dermal wound healing trajectory.

Conclusions

The new recovery trajectory highlighted by the vocal loading exercise in the current study is called a vocal recovery trajectory. By comparing vocal fatigue to dermal wound healing, this trajectory is parallel to a chronic wound healing trajectory (as opposed to an acute wound healing trajectory). This parallel suggests that vocal fatigue from the daily use of the voice could be treated as a chronic wound, with the healing and repair mechanisms in a state of constant repair. In addition, there is likely a vocal fatigue threshold at which point the level of tissue damage would shift the chronic healing trajectory to an acute healing trajectory.

Hemilaryngeal Microsomia: An Anatomic Variant

OBJECTIVES

This study aims to describe a congenital laryngeal structural variant, hemilaryngeal microsomia (HLM), and to correlate identification on physical examination with computerized tomography scan (CT) and laryngoscopy findings.

METHODS

The study was conducted at a tertiary care center. Six patients presenting with hoarseness were admitted to a tertiary care otolaryngology office. These patients had asymmetrical thyroid cartilage prominence on palpation during physical examination. A diagnosis of HLM was made. All patients underwent laryngostroboscopy and CT scan. Four control patients with normal thyroid cartilage anatomy on physical examination, CT, and stroboscopy results were included for comparison.

RESULTS

Disparities in thyroid cartilage angles correlated with documented physical examination findings for six out of six HLM patients. On CT scan, the average difference in left and right thyroid laminar angles was 30.2° ± 18.3° in HLM patients vs 4.00° ± 1.63° in control patients (P = 0.023). Strobosocopic findings also correlated with HLM. The arytenoid cartilage was anteriorly or medially displaced on the microsomic side in all six HLM patients. Three patients had anterior placement of the vocal process resulting in shortening of the vocal fold on the microsomic side of the larynx.

CONCLUSIONS

HLM is a congenital structural anomaly of the larynx that may be palpated on physical examination. HLM found on physical examination can be correlated with asymmetries found on CT scan and endoscopy. There is no evidence that the structural features of HLM were causally related to voice symptoms, but the findings on HLM may lead to misdiagnosis. A larger study is indicated to confirm laryngeal structural differences between patients with HLM on physical examination and the general population. Whether or not HLM affects clinical or surgical outcomes remains to be studied.

The Impact of Cumulative Vocal Demands on Vocal Performance of Student Clinicians in Speech-Language Pathology

Effects of cumulative vocal demands on voice performance of student clinicians majoring in speech-language pathology were observed at three distinct points over the period of an academic semester. Acoustic and aerodynamic voice parameters were monitored in controlled and natural settings; participants also provided subjective information related to their voice usage. Comparisons of voice parameters in student clinicians repeatedly measured throughout an extended period of time did not lead to statistically significant differences. Self-reported data revealed a satisfactory level of knowledge and awareness regarding voice concerns in this population. These outcomes suggested consistent voice stability in this group, over the cycle of an academic semester.

Four-day-follow-up study on the voice monitoring of primary school teachers: Relationships with conversational task and classroom acoustics

The present study has investigated the occupational voice use of 27 female primary school teachers over a four-day-follow-up. Sixty-one working-day voice samples were acquired with two contact sensor-based vocal analyzers in four schools with highly different classroom acoustics. The vocal parameters were compared with a conversational task that the teachers performed before each lesson and with the measured classroom acoustic parameters. The average equivalent sound pressure level at 1 m from the mouth, which refers to the teacher's vocal effort, and the voicing time percentage were 71.2 dB [standard error (SE) 1.0 dB] and 29%, respectively. The teachers' mean voice level and fundamental frequency were significantly higher in the occupational setting than in the conversational one, which is by 5.5 dB (SE 0.5 dB) and 50 Hz (SE 3 Hz), respectively. Higher voice levels were observed for higher background noise levels, at a rate of 0.53 dB/dB, and a tendency of the background noise to increase with increasing reverberation time was observed at a rate of 13 dB/s. An optimal reverberation time of 0.7 s was found to minimize the voice level, since teachers raised their voice at lower and higher reverberation times, the latter presumably due to higher background noise levels.

Intra- and Inter-database Study for Arabic, English, and German Databases: Do Conventional Speech Features Detect Voice Pathology?

A large population around the world has voice complications. Various approaches for subjective and objective evaluations have been suggested in the literature. The subjective approach strongly depends on the experience and area of expertise of a clinician, and human error cannot be neglected. On the other hand, the objective or automatic approach is noninvasive. Automatic developed systems can provide complementary information that may be helpful for a clinician in the early screening of a voice disorder. At the same time, automatic systems can be deployed in remote areas where a general practitioner can use them and may refer the patient to a specialist to avoid complications that may be life threatening. Many automatic systems for disorder detection have been developed by applying different types of conventional speech features such as the linear prediction coefficients, linear prediction cepstral coefficients, and Mel-frequency cepstral coefficients (MFCCs). This study aims to ascertain whether conventional speech features detect voice pathology reliably, and whether they can be correlated with voice quality. To investigate this, an automatic detection system based on MFCC was developed, and three different voice disorder databases were used in this study. The experimental results suggest that the accuracy of the MFCC-based system varies from database to database. The detection rate for the intra-database ranges from 72% to 95%, and that for the inter-database is from 47% to 82%. The results conclude that conventional speech features are not correlated with voice, and hence are not reliable in pathology detection.

Comparative Analysis of Characteristics of Voice Use Amidst Clergy

The development of "Care of the Professional Voice" as a subspecialty of Otolaryngology-Head and Neck Surgery has expanded the concept of professional voice users. Although sometimes uncompensated, the clergy represents a unique group of voice users who are required to perform at a professional level. Additionally, cultural norms create great diversity in terms of style of delivery and typical venues, adding to the interest in this subset of professional voice users. We surveyed 403 respondents and found certain factors predictive of voice problems for members of the clergy. Age, length of sermon, and ethnicity were all found to be statistically significant indicators. Further investigations are needed.

Perceptual and Acoustic Analyses of Good Voice Quality in Male Radio Performers

OBJECTIVES

Good voice quality is an asset to professional voice users, including radio performers. We examined whether (1) voices could be reliably categorized as good for the radio and (2) these categories could be predicted using acoustic measures.

PARTICIPANTS AND METHODS

Male radio performers (n = 24) and age-matched male controls performed "The Rainbow Passage" as if presenting on the radio. Voice samples were rated using a three-stage paired-comparison paradigm by 51 naive listeners and perceptual categories were identified (Study 1), and then analyzed for fundamental frequency, long-term average spectrum, cepstral peak prominence, and pause or spoken-phrase duration (Study 2).

RESULTS

Study 1: Good inter-judge reliability was found for perceptual judgments of the best 15 voices (good for radio category, 14/15 = radio performers), but agreement on the remaining 33 voices (unranked category) was poor. Study 2: Discriminant function analyses showed that the SD standard deviation of sounded portion duration, equivalent sound level, and smoothed cepstral peak prominence predicted membership of categories with moderate accuracy (R² = 0.328).

CONCLUSIONS

Radio performers are heterogeneous for voice quality; good voice quality was judged reliably in only 14 out of 24 radio performers. Current acoustic analyses detected some of the relevant signal properties that were salient in these judgments. More refined perceptual analysis and the use of other perceptual methods might provide more information on the complex nature of judging good voices.

Silence and Voicing Accumulations in Italian Primary School Teachers With and Without Voice Disorders

OBJECTIVES

The relationship between the silence and voicing accumulations of primary school teachers and the teachers' clinical status was examined to determine whether more voicing accumulations and fewer silence accumulations were measured for the vocally unhealthy subjects than for the healthy subjects, which would imply more vocal loading and fewer short-term recovery moments.

METHODS

Twenty-six Italian primary school teachers were allocated by clinicians to three groups: (1) with organic voice disorders, (2) with subjectively mild organic alteration or functional voice symptoms, and (3) normal voice quality and physiology. Continuous silence and voicing periods were measured with the APM3200 during the teachers' 4-hour workdays. The accumulations were grouped into seven time intervals, ranging from 0.03-0.9 to 3.16-10 seconds, according to Italian prosody. The effects of group on silence and voicing accumulations were evaluated.

RESULTS

Regarding silence accumulations, Group 1 accumulated higher values in intervals between 0.1 and 3.15 seconds than other groups, whereas Groups 2 and 3 did not differ from each other. Voicing accumulations between 0.17 and 3.15 seconds were higher for subjects with a structural disorder. A higher time dose was accumulated by these subjects (40.6%) than other subjects (Group 2, 31.9%; Group 3, 32.3%).

CONCLUSIONS

Although previous research has suggested that a rest period of a few seconds may produce some vocal fatigue recovery, these results indicate that periods shorter than 3.16 seconds may not have an observable effect on recovery. The results provide insight into how vocal fatigue and vocal recovery may relate to voice disorders in occupational voice users.

Successful intraoperative electrophysiologic monitoring of the recurrent laryngeal nerve, a multidisciplinary approach: The Massachusetts Eye and Ear Infirmary monitoring collaborative protocol with experience in over 3000 cases

BACKGROUND

Although intraoperative nerve monitoring (IONM) is utilized increasingly, the information on the related anesthesia technique is limited. This study presents an up-to-date clinical algorithm, including setup and troubleshooting of an IONM system, endotracheal tube placement, and anesthetic parameters. To our knowledge, this is the first interdisciplinary collaborative protocol for monitored neck surgery based on the published evidence and clinical experience.

METHODS

The Departments of Otolaryngology Head and Neck Surgery, Anesthesiology, and Audiology collaboratively developed a protocol for IONM of the recurrent laryngeal nerve (RLN) based on published evidence and our experience with 3000 patients over a 16-year period.

RESULTS

No complications related to monitoring or endotracheal tube placement were noted when the IONM protocol was implemented at Massachusetts Eye and Ear Infirmary (MEEI). The IONM protocol has proven to be vital in standardizing care and in avoiding intraoperative errors.

CONCLUSION

An IONM system entails an anesthesiologist who understands the challenges posed by this technique; muscle relaxation must be minimized/eliminated to optimize IONM. © 2016 Wiley Periodicals, Inc. Head Neck 38: First-1494, 2016.

Comparison of Voice Quality Between Patients Who Underwent Inferior Turbinoplasty or Radiofrequency Cauterization

OBJECTIVES

The aim of this study was to analyze and compare the vocal quality in patients who underwent either submucosal turbinectomy or radiofrequency cauterization.

METHODS

In this study, we enrolled 60 patients diagnosed with inferior concha hypertrophy. These patients were divided into two groups by using computer program "Research Randomizer." Of the 60 patients, 30 underwent submucosal inferior turbinoplasty and 30 underwent radiofrequency cauterization. The control group was composed of 30 healthy adults with no nasal or upper aerodigestive system pathology. The patients were checked at weeks 1, 2, and 4. Voice records were taken before the procedure and at week 4 postprocedure.

RESULTS

The mean age of patients in the inferior turbinoplasty group was 29.4 years (range: 19-42 years); in the radiofrequency group, it was 30.30 years (range: 18-50 years). There was no statistical difference in age between groups. In the inferior turbinoplasty group, there were 16 male and 14 female patients, and in the radiofrequency group, there were 13 male and 17 female patients. There was no significant difference in the number of males and females between groups.

CONCLUSIONS

Voice professionals, especially singers, actors, and actresses, should be informed about possible voice changes before undergoing endonasal surgery because these individuals are more sensitive to changes in resonance organs. We believe that voice quality should be regarded as a highly important parameter when measuring the success of endonasal surgery.

Teachers' Perception of Vocal Quality Compared With Professional Perception

PURPOSE

The purpose of this study was to investigate the difference in teachers' self-perception of their own voices compared with a voice clinician's perceptual assessment.

METHODS

Participants included 45 elementary school (grades 1-8) teachers (34 females, 11 males) in public and private schools, with a mean age of 38.9 and age ranging from 24 to 65 years. The procedures included a demographic questionnaire, a self-assessment scale, and perceptual analysis.

RESULTS

We found no difference when comparing overall vocal deviation of connected speech perceived by the teachers and the voice clinician (P = 0.509). However, the sustained vowel samples were perceived differently (P = 0.015). When comparing the teachers' and the voice clinician's perception of vocal qualities in both the vowel and the connected speech samples, we observed that they perceive roughness (P < 0.001 for both samples) and strain (P = 0.005 for vowel and P = 0.019 for connected speech) differently; however, breathiness is perceived similarly for both the vowel and the connected speech samples (P = 0.591 for vowel and P = 0.134 for connected speech). Increase in the numbers of years teaching showed a significant correlation with increase in teachers' perception of frequency of overall deviation (r = .870; P < 0.001). Additionally, increase in number of students in class was associated with increase in teachers' perception of frequency of strain (r = .819) (P < 0.001).

CONCLUSION

The findings indicate that the teachers' perception corresponds partially with the clinician's perceptual analysis. A similar impression about the voice deviation was found only when comparing the perceptual analysis of connected speech.

Prevalence and Influencing Risk Factors of Voice Problems in Priests in Kerala

OBJECTIVE

Voice problems are commonly reported by professionals in occupations involving a large amount of voice loading. The aim of the present study was to investigate the prevalence of voice problems in Mar Thoma priests and identify possible risk factors responsible for voice problems.

STUDY DESIGN

This is a cross-sectional study.

METHOD

The study group consisted of 270 Mar Thoma priests with 1-35 years of professional experience. A self-reported questionnaire was used to collect the data.

RESULTS

Mar Thoma priests were found to have higher career (47.8%) and year prevalence (25.2%) of voice problems with 17.8% of them reporting frequent voice problems during their career. Asthma, allergy and frequent throat clearing behavior were found to have significant association with priests reporting frequent voice problems. Significantly higher number of priests with frequent voice problems missed their work.

CONCLUSION

The study results provide valuable preliminary information regarding the prevalence voice problems and associated risk factors in Mar Thoma priests. However, further investigations are required for in-depth understanding of the types of voice problems these priests experience and their impact on their quality of life.

Determinants and Effects of Voice Disorders among Secondary School Teachers in Peninsular Malaysia Using a Validated Malay Version of VHI-10

OBJECTIVES

To establish the prevalence of voice disorder using the Malay-Voice Handicap Index 10 (Malay-VHI-10) and to study the determinants, quality of life, depression, anxiety and stress associated with voice disorder among secondary school teachers in Peninsular Malaysia.

METHODS

This study was divided into two phases. Phase I tested the reliability of the Malay-VHI-10 while Phase II was a cross-sectional study with two-stage sampling. In Phase II, a self-administered questionnaire was used to collect socio-demographic and teaching characteristics, depression, anxiety and stress scale (Malay version of DASS-21); and health-related quality of life (Malay version of SF12-v2). Complex sample analysis was conducted using multivariate Poisson regression with robust variance.

RESULTS

In Phase I, the Spearman correlation coefficient and Cronbach alpha for total VHI-10 score was 0.72 (p < 0.001) and 0.77 respectively; showing good correlation and internal consistency. The ICCs ranged from 0.65 to 0.78 showing fair to good reliability and demonstrating the subscales to be reliable and stable. A total of 6039 teachers participated in Phase II. They were primarily Malays, females, married, had completed tertiary education and aged between 30 to 50 years. A total of 10.4% (95% CI 7.1, 14.9) of the teachers had voice disorder (VHI-10 score > 11). Compared to Malays, a greater proportion of ethnic Chinese teachers reported voice disorder while ethnic Indian teachers were less likely to report this problem. There was a higher prevalence ratio (PR) of voice disorder among single or divorced/widowed teachers. Teachers with voice disorder were more likely to report higher rates of absenteeism (PR: 1.70, 95% CI 1.33, 2.19), lower quality of life with lower SF12-v2 physical (0.98, 95% CI 0.96, 0.99) and mental (0.97, 95% CI 0.96, 0.98) component summary scales; and higher anxiety levels (1.04, 95% CI 1.02, 1.06).

CONCLUSIONS

The Malay-VHI-10 is valid and reliable. Voice disorder was associated with increased absenteeism, marginally associated with reduced health-related quality of life as well as increased anxiety among teachers.

Survey of Voice Acoustic Parameters in Iranian Female Teachers

Objectives

Teachers are one of the professional voice users. Voice problems are common among them. Female teachers are known to have more voice problems than male ones. Furthermore, there are only few studies on the voice of Iranian female teachers. The present study investigated the acoustic parameters of voice in Iranian female teachers and compares them with nonteachers.

Methods

In this cross-sectional study, 90 Iranian female elementary teachers, 30–50 years old, and 90 Iranian female nonteachers in the same age were assessed between May 2010 and October 2011. Data collection was carried out, using the Dr. Speech software (subprogram: vocal assessment Version 4.0 from Tiger Electronics) at the speech therapy clinic under a comfortable phonation. Normal voice in practitioners was judged by the perceptual evaluation by a voice therapist and indirect laryngoscopy examination by an otorhinolaryngologist. Voice characteristics were assessed with GRBAS scale. The speech sample was sustained /â/ using habitual and constant vocal for 10 seconds. Three tokens from each subject were obtained. Then, each subject was asked to read a standard passage in Farsi. Eventually, the difference measures of F₀, jitter, shimmer, harmonic to noise ratio (HNR), and maximum of phonation time (MPT) between two groups were investigated by statistics software SPSS 19.0 (IBM corp.2010).

Results

Results showed that the values of F₀ were higher in teachers (210.03 Hz) than in nonteachers (194.11 Hz; P < 0.001). In addition, the values of perturbation measures were greater in teachers (jitter 0.32% and shimmer 4.63%) than those in the control group (jitter 0.22% and shimmer 3.15%; P < 0.001), but in HNR and MPT values, nonteachers showed higher levels (P < 0.001). The value of HNR in teachers was (18.84±1.56) but it was (21.3±1.73) in non-teachers and MPT value in teachers was (16.83±3.65) and in non-teachers was (22.5±5.2).

Conclusions

It can be concluded that vocal overuse, abuse, or misuse during teaching over a period of time result in achievement of inadequate phonatory pattern with excessive musculoskeletal tension, and the possible result is tissue changes in teacher's voice. In addition, acoustic analysis of voice parameters for teachers may significantly contribute to the objective voice examination of this group.

Emirati Teachers' Perceptions of Voice Handicap

OBJECTIVES

The purpose of the study was to explore Emirati teachers' perceptions of voice handicap and to analyze their acoustic characteristics to determine whether acoustic measures of teachers' voice would verify their perceptions of voice handicap.

METHODS

Sixty-six Emirati school teachers (33 men and 33 women), with different years of teaching experience and age, and 100 control participants (50 men and 50 women) underwent vocal assessment that included the Voice Handicap Index (VHI-Arab) and acoustic measures (F0, jitter%, shimmer%, signal to noise ratio [SNR]).

RESULTS

Significant differences between the teachers' group scores and the control group scores on the following subscales of VHI-Arab: physical (P = 0.006), emotional (P = 0.004), and total score of the test (P = 0.002). No significant differences were found among teachers in the three VHI subscales, and the total score regarding gender (functional P = 0.307; physical P = 0.341; emotional P = 0.126; and total P = 0.184), age (functional P = 0.972; physical P = 0.525; emotional P = 0.772; and total P = 0.848), and years of teaching experience (functional P = 0.319; physical P = 0.619; emotional P = 0.926; and total P = 0.638). The significant differences between the teacher's group and the control group in three acoustic measures: F0 (P = 0.000), shimmer% (P = 0.000), and SNR (P = 0.000) were further investigated. Significant differences were found among female and male teachers in F0 (P = 0.00) and SNR (P = 0.007). As for teachers' age, significant differences were found in SNR (P = 0.028). Teachers' years of experience did not show significant differences in any of the acoustic measures.

CONCLUSIONS

Teachers have a higher perception of voice handicap. However, they were able to produce better voice quality than control participants were, as expressed in better SNRs. This might have been caused either by manipulation of vocal properties or abusive overloading the vocal system to produce a procedurally acceptable voice quality.

Effects of Adventitious Acute Vocal Trauma: Relative Fundamental Frequency and Listener Perception

OBJECTIVE

High voice users (individuals who demonstrate excessive or loud vocal use) are at risk for developing voice disorders. The objective of this study was to examine, both acoustically and perceptually, vocal changes in healthy speakers after an acute period of high voice use.

METHODS

Members of a university women's volleyball team (n = 12) were recorded a week before (pre) and week after (post) the 10-week spring season; n = 6 control speakers were recorded over the same time period for comparison. Speakers read four sentences, which were analyzed for relative fundamental frequency (RFF). Eight naïve listeners participated in an auditory-perceptual visual sort and rate (VSR) task, in which they rated each voice sample's overall severity and strain.

RESULTS

No significant differences were found as a function of time point in the VSR ratings for the volleyball group. Onset cycle 1 RFF values were significantly lower (P = 0.04) in the postrecordings of the volleyball participants compared with prerecordings, but there was no significant difference (P = 0.20) in offset cycle 10 RFF values. Receiver operating characteristic analyses indicated moderate sensitivity and specificity of onset cycle 1 RFF for discrimination between the volleyball and control participants. Changes were not apparent in the control group as a function of time for either, onset cycle 1 RFF, offset cycle 10 RFF, or either vocal attribute.

CONCLUSIONS

Onset cycle 1 RFF may be an effective marker for detecting vocal changes over an acute high voice use period of time before perceptual changes are noted.