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

Vocal effectiveness of speech-language pathology students: Before and after voice use during service delivery

Background

As a professional voice user, it is imperative that a speech-language pathologist's (SLP) vocal effectiveness remain consistent throughout the day. Many factors may contribute to reduced vocal effectiveness, including prolonged voice use, vocally abusive behaviours, poor vocal hygiene and environmental factors.

Objectives

To determine the effect of service delivery on the perceptual and acoustic features of voice.

Method

A quasi-experimental., pre-test–post-test research design was used. Participants included third- and final-year speech-language pathology students at the University of Pretoria (South Africa). Voice parameters were evaluated in a pre-test measurement, after which the participants provided two consecutive hours of therapy. A post-test measurement was then completed. Data analysis consisted of an instrumental analysis in which the multidimensional voice programme (MDVP) and the voice range profile (VRP) were used to measure vocal parameters and then calculate the dysphonia severity index (DSI). The GRBASI scale was used to conduct a perceptual analysis of voice quality. Data were processed using descriptive statistics to determine change in each measured parameter after service delivery.

Results

A change of clinical significance was observed in the acoustic and perceptual parameters of voice.

Conclusion

Guidelines for SLPs in order to maintain optimal vocal effectiveness were suggested.

Voice disorders in the general Greek population and in patients with laryngopharyngeal reflux. Prevalence and risk factors

OBJECTIVES

To assess the prevalence of voice disorders in the general Greek population and in patients with laryngopharyngeal reflux (LPR) with the use of the reflux symptom index (RSI).

STUDY DESIGN

Prospective epidemiological adult participant survey.

SETTING

General Greek population.

METHOD

The validated Greek version of the RSI was used to assess the prevalence of voice disorders in the general Greek population, as well as in patients with LPR, which were diagnosed using the RSI. The RSI questionnaire was completed by 340 (183 males and 157 females) randomly selected subjects. Subjects with RSI score of >13 were considered to be LPR patients.

RESULTS

The prevalence of voice disorders, which was determined by the participants giving a positive response to the field "hoarseness or a problem with your voice," was found to be 38.5% in the general Greek population. In patients with LPR, "hoarseness or a problem with your voice" was present in 90.6%. The number of cigarettes smoked daily and the number of alcoholic drinks consumed daily, each correlated with the presence of voice disorders. No relationship was revealed between voice disorders and coexisting diseases and especially with gastroesophageal reflux disease, which was the most frequent reported disorder among peptic diseases.

CONCLUSIONS

The prevalence of voice disorders, determined by a positive response to the question "hoarseness or a problem with your voice," is high (38.5%) in the general population and very high (90.6%) in patients with LPR. The number of tobacco cigarettes smoked daily and the number of alcoholic drinks consumed daily were found to be related to voice disorders.

Subjective and Objective Effects of Androgen Ablation Therapy on Voice

OBJECTIVES

The aim of present study was to evaluate possible side effects of androgen deprivation therapy (ADT) on voice quality by means of objective and subjective measures.

STUDY DESIGN

Cross-sectional.

METHODS

Thirty-five male patients who had been diagnosed with prostate cancer and who had been using bicalutamide and goserelin acetate combination for at least 12 months were included in the study. Thirty healthy nonsmoker males of similar age and without any laryngeal pathology constituted the control group. Acoustic and aerodynamic voice analyses and voice handicap index-10 were applied to both groups. Maximum phonation time, fundamental frequency, jitter, shimmer, and noise-to-harmonic ratio were determined during acoustic and aerodynamic voice analyses.

RESULTS

Maximum phonation times were 18.86 ± 5.24 and 24.20 ± 3.59 in ADT and control groups, respectively. It was significantly higher in the control group. Fundamental frequencies were 143.73 ± 18.47 and 135.00 ± 13.18 in ADT and control groups, respectively. Jitter values were 2.72 ± 0.62 and 1.99 ± 0.27 in ADT and control groups, respectively. Shimmer values were 11.50 ± 1.81 and 10.48 ± 1.36 in ADT and control groups, respectively. Fundamental frequency, jitter, and shimmer values were significantly higher in the ADT group. Noise-to-harmonic ratio values did not differ between groups. Voice handicap index-10 result was significantly higher in the ADT group.

CONCLUSIONS

ADT has adverse effects on the human voice. Prospective studies with long-term follow-up of a larger cohort are required for more detailed analysis.

Voice dosimetry and monitoring, with emphasis on professional voice diseases: Critical review and framework for future research

Professional voice has become an important issue in the field of occupational health. Similarly, voice diseases related to occupations gain interest in insurance medicine, particularly within the frame of specific insurance systems for occupational diseases. Technological developments have made possible dosimetry of voice loading in the work-place, as well as long-term monitoring of relevant voice parameters during professional activities. A critical review is given, with focus on the specificity of occupational voice use and on the point of view of insurance medicine. Remaining questions and suggestions for future research are proposed.

Teachers' voice disorders and loss of work ability: a case-control study

BACKGROUND

Teachers constitute a profession with a high occurrence of voice disorders due to the occupation's intense vocal demands and unfavorable work environment.

PURPOSE

To identify the association between voice disorders and work ability among teachers from public schools in São Paulo, Brazil.

METHODS

This is a case-control study. The case group comprised teachers with voice disorder complaints, vocal quality deviations in speech pathology evaluations, and vocal fold lesions according to an evaluation by an otorhinolaryngologist. The control group was randomly selected from the same schools as those in the case group. Both groups answered the following questionnaires: sociodemographic, lifestyles, working conditions, work organization, conditions of vocal production-teacher (CVP-T), and Work Ability Index (WAI). The analysis used the chi-square association test and univariate and multivariate regression models.

RESULTS

The analyses of both groups showed comparable populations with no significant differences in the demographic and control variables. The groups differed, as expected, in vocal symptoms. Analyzing associations with the WAI, there was an association between decreased work ability and voice disorder (P < 0.001). This association remained in multivariate analyses where decreased (OR = 9.5, P = 0.001) and moderate (OR = 6.7, P < 0.001) work ability were also associated with voice disorders. Analyzing the ability to work, age, and acoustics; decreased (OR = 12.2, P < 0.001) and moderate (OR = 7.7, P < 0.001) work ability, age 50-65 years (OR = 3.7, P = 0.006) and poor acoustics (OR = 2.7, P = 0.007) were factors associated with voice disorders.

CONCLUSIONS

The occurrence of voice disorders is significantly associated with work ability, which may eventually compromise teachers' ability to continue working.

Voice Disorders in Occupations with Vocal Load in Slovenia

Aim

The aim of this paper is to compare the prevalence of voice disorders and the risk factors for them in different occupations with a vocal load in Slovenia.

Methods

A meta-analysis of six different Slovenian studies involving teachers, physicians, salespeople, catholic priests, nurses and speech-and-language therapists (SLTs) was performed. In all six studies, similar questions about the prevalence of voice disorders and the causes for them were included.

Results

The comparison of the six studies showed that more than 82% of the 2347 included subjects had voice problems at some time during their career. The teachers were the most affected by voice problems. The prevalent cause of voice problems was the vocal load in teachers and salespeople and respiratory-tract infections in all the other occupational groups. When the occupational groups were compared, it was stated that the teachers had more voice problems and showed less care for their voices than the priests. The physicians had more voice problems and showed better consideration of vocal hygiene rules than the SLTs. The majority of all the included subjects did not receive instructions about voice care during education.

Conclusions

In order to decrease the prevalence of voice disorders in vocal professionals, a screening program is recommended before the beginning of their studies. Regular courses on voice care and proper vocal technique should be obligatory for all professional voice users during their career. The inclusion of dysphonia in the list of occupational diseases should be considered in Slovenia as it is in some European countries.

Psychosocial distress in patients presenting with voice concerns

OBJECTIVES

To assess the prevalence of psychosocial distress (depression, anxiety, somatization, and perceived stress) in a consecutive sample of patients presenting with voice concerns and to qualitatively analyze patient comments on challenges associated with voice problems.

STUDY DESIGN

Cross-sectional study.

METHODS

New patients presenting to a multidisciplinary voice clinic with voice concerns were invited to participate. Respondents (n = 197) completed the Brief Symptom Inventory 18-item scale, the 4-item Perceived Stress Scale, and the Voice Handicap Index 10-item scale. Qualitative analysis was performed of responses to an open-ended question about challenges associated with a voice problem.

RESULTS

Approximately one-third (32%) of the patients met the strict case criteria for depression, anxiety, and/or somatic concerns based on the Brief Symptom Inventory 18-item scale. Most patients had no prior diagnosis of depression or anxiety, and the degree of distress was not predicted by the type of voice-related diagnosis. Perceived stress was higher among female patients (P = 0.02). As expected, scores on the Voice Handicap Index 10-item scale were indicative of concurrent voice-related handicap (mean, 19.5; standard deviation, 9.4). In qualitative analysis of responses regarding challenges associated with a voice problem, 19 themes were identified (eg, threat to occupational functioning).

CONCLUSIONS

These findings identify a high prevalence of multiple types of distress among patients with voice disorders, presenting an opportunity to provide more comprehensive care to this patient population.

Electroglottographic study of seven semi-occluded exercises: LaxVox, straw, lip-trill, tongue-trill, humming, hand-over-mouth, and tongue-trill combined with hand-over-mouth

INTRODUCTION

Semi-occluded vocal tract exercises (SOVTE) are often used in voice clinics. SOVTE change the acoustic vocal tract impedance in relation to the glottis impedance, improving voice quality. However, differences among SOVTE, such as the number of vibration sources into the vocal tract, are often disregarded by clinicians. Some SOVTE present single, whereas others double source. This study aims at investigating changes in voice production pattern for a series of SOVTE. A combined exercise (tongue-trill coupled with hand-over-mouth) was implemented to illustrate the effect of a secondary source of vibration in the vocal tract.

METHOD

Twenty-three healthy volunteers performed a series of SOVTE: LaxVox, straw, lip-trill, tongue-trill, hand-over-mouth, humming, and tongue-trill combined with hand-over-mouth. Comfortable phonation served as control exercise. The dependent variables were electroglottography contact quotient (CQ), contact quotient range (CQr), fundamental frequency (F0), fundamental frequency range, and difference between the first formant frequency and F0 (F1 - F0).

RESULTS

A significant difference for CQr scores compared with comfortable phonation was found for the combined tongue-trill with hand-over-mouth, lip-trill, LaxVox, and tongue-trill exercises. The F1 - F0 acoustic analysis showed significant differences in scores for exercises with one versus two sources of vibration.

DISCUSSION AND CONCLUSION

The results indicate that SOVTE should be divided into two groups, as follows: (a) steady (single sourced) with lower CQr and F1 - F0 difference (hand-over-mouth, humming, and straw) and (b) fluctuating (dual source) with larger CQr and F1 - F0 difference (tongue-trill, lip-trill, and LaxVox). Because of these differences, also different therapeutic effects can be expected. Tongue-trill combined with hand-over-mouth exhibited mixed effects of both the exercise groups.

Jordanian teachers' perceptions of voice handicap

This study aimed to investigate if Jordanian school teachers perceive their voice as handicapped using the Voice Handicap Index (VHI)-Arab. The effect of teachers' age, gender, years of teaching, class taught, and education level on VHI was examined. A total of 289 teachers and a control group of 100 participants took part in the study. The teachers' group differed significantly from the control group in the physical, emotional, and functional subscales and the total score of the VHI-Arab. There was no significant difference among teachers in any of the three VHI subscales or total regarding gender, age, years of teaching experience, education level, and classes taught. Jordanian teachers have a strong perception of voice handicap. Thus, preventive and treatment vocal programs are strongly advised.

Clinical Practice Guideline

Objective

Thyroidectomy may be performed for clinical indications that include malignancy, benign nodules or cysts, suspicious findings on fine needle aspiration biopsy, dysphagia from cervical esophageal compression, or dyspnea from airway compression. About 1 in 10 patients experience temporary laryngeal nerve injury after surgery, with longer lasting voice problems in up to 1 in 25. Reduced quality of life after thyroid surgery is multifactorial and may include the need for lifelong medication, thyroid suppression, radioactive scanning/treatment, temporary and permanent hypoparathyroidism, temporary or permanent dysphonia postoperatively, and dysphagia. This clinical practice guideline provides evidence-based recommendations for management of the patient’s voice when undergoing thyroid surgery during the preoperative, intraoperative, and postoperative period.

Purpose

The purpose of this guideline is to optimize voice outcomes for adult patients aged 18 years or older after thyroid surgery. The target audience is any clinician involved in managing such patients, which includes but may not be limited to otolaryngologists, general surgeons, endocrinologists, internists, speech-language pathologists, family physicians and other primary care providers, anesthesiologists, nurses, and others who manage patients with thyroid/voice issues. The guideline applies to any setting in which clinicians may interact with patients before, during, or after thyroid surgery. Children under age 18 years are specifically excluded from the target population; however, the panel understands that many of the findings may be applicable to this population. Also excluded are patients undergoing concurrent laryngectomy. Although this guideline is limited to thyroidectomy, some of the recommendations may extrapolate to parathyroidectomy as well.

Results

The guideline development group made a strong recommendation that the surgeon should identify the recurrent laryngeal nerve(s) during thyroid surgery. The group made recommendations that the clinician or surgeon should (1) document assessment of the patient’s voice once a decision has been made to proceed with thyroid surgery; (2) examine vocal fold mobility, or refer the patient to a clinician who can examine vocal fold mobility, if the patient’s voice is impaired and a decision has been made to proceed with thyroid surgery; (3) examine vocal fold mobility, or refer the patient to a clinician who can examine vocal fold mobility, once a decision has been made to proceed with thyroid surgery if the patient’s voice is normal and the patient has (a) thyroid cancer with suspected extrathyroidal extension, or (b) prior neck surgery that increases the risk of laryngeal nerve injury (carotid endarterectomy, anterior approach to the cervical spine, cervical esophagectomy, and prior thyroid or parathyroid surgery), or (c) both; (4) educate the patient about the potential impact of thyroid surgery on voice once a decision has been made to proceed with thyroid surgery; (5) inform the anesthesiologist of the results of abnormal preoperative laryngeal assessment in patients who have had laryngoscopy prior to thyroid surgery; (6) take steps to preserve the external branch of the surperior laryngeal nerve(s) when performing thyroid surgery; (7) document whether there has been a change in voice between 2 weeks and 2 months following thyroid surgery; (8) examine vocal fold mobility or refer the patient for examination of vocal fold mobility in patients with a change in voice following thyroid surgery; (9) refer a patient to an otolaryngologist when abnormal vocal fold mobility is identified after thyroid surgery; (10) counsel patients with voice change or abnormal vocal fold mobility after thyroid surgery on options for voice rehabilitation. The group made an option that the surgeon or his or her designee may monitor laryngeal electromyography during thyroid surgery. The group made no recommendation regarding the impact of a single intraoperative dose of intravenous corticosteroid on voice outcomes in patients undergoing thyroid surgery.

Acoustic changes of the voice as signs of vocal fatigue in radio broadcasters: preliminary findings

INTRODUCTION AND OBJECTIVES

Vocal fatigue is one of the most common voice symptoms. It usually refers to the sensation of vocal tiredness after a long period of speaking or singing. The purpose of this study was to compare the acoustic characteristics of the voice before and after a long period of voice use in a group of radio broadcasters.

METHODS

Eight radio broadcasters with normal voices were assessed. We used cepstrum, energy ratio, noise to harmonic ratio and soft phonation index as acoustic variables to assess the possible pre-post vocal loading changes objectively.

RESULTS

There were no statistically significant pre-post differences in any of the acoustic parameters. Although cepstrum at high pitch did not show a significant difference, it obtained the greatest difference among the acoustic variables.

CONCLUSIONS

The acoustic measurements used in the present study might not be sensitive enough or appropriate for detecting vocal changes after a long period of voice use, whether in reading (as reported in previous research) or speaking tasks. Moreover, a longer period of vocal loading would eventually reveal more evident and consistent acoustic voice changes.

An overview of occupational voice disorders in Poland

Occupational voice disorders make the most frequently certified category of occupational diseases in Poland, making up approximately 20% of all cases. This study presents the current knowledge of the etiopathogenesis of occupational voice disorders. It stresses the importance of the evaluation of vocal loading by means of objective measurements. Furthermore, this study discusses the medico-legal aspects of the procedure of certifying occupational voice disorders in Poland. The paper also describes the preventive programs addressed particularly to teachers, including multidisciplinary and holistic management of occupational dysphonia. Their role in the improvement of occupational safety and health (OSH) arrangement for vocally demanding professions is emphasized.

A comparison of vocal demands with vocal performance among classroom student teachers

PURPOSE

This investigation compared voice performance of student teachers across an academic semester in order to examine the effect of increasing demands on their voice.

METHOD

A repeated measures design was applied to the data analysis: all participants were tested three separate times throughout the semester. The equipments used for monitoring vocal behavior were the Ambulatory Phonation Monitor (APM), the Computerized Speech Lab (CSL), and the Phonatory Aerodynamic System (PAS), which are computer-based systems for acoustic and aerodynamic assessment of voice. Additionally, participants completed surveys related to voice usage.

RESULTS

In this study, most voice parameters of student teachers measured in a natural setting and in a controlled environment indicated changes that revealed progressive instability and noise in the course of an academic semester. Additional comparisons demonstrated differences between voice usage in the school environment and voice produced in the voice lab. Self-reported information demonstrated overall reduced awareness regarding preventive methods for voice disorders.

CONCLUSIONS

Based on the results of this study, increased teaching-related voice demands associated with reduced awareness of voice production and preventive measures of voice disorders may have a detrimental impact on voice performance, leading to a risk of developing voice disorders.

LEARNING OUTCOMES

Participants will recognize the importance of clarifying and quantifying the relationship of vocal demands and voice performance among student teachers.

Effects of vocal fatigue on voice parameters of Indian Teachers

Vocal fatigue is a frequently reported voicec symptom among professional voice users. Indian School teachers teach lontinuously for many hours in advene acoustical environments and are highly susceptible to vocal fatigue. The present study is the first to examine acoustic voice measures in teacher, reporting naturally induced vocal fatigue. 40 female primary school teachers (mean age =36 yearn) with varying severity of vocal fatigue participated in this studr. Voice measures of minimum and maximum fundametal frequency were obtained before and after one and a half hours of continuous teaching at the workplace. Maximum fundamental frequent was an important acoustic parameter in determining presence of weal fatigue. Most cummin perceptual sympioms include throat dryneis, discomfort and loss of voit e. The rule of vocal hygiene and warm-up in reducing vocal fatigue are considered.

Optimal dose-response relationships in voice therapy

Like other areas of speech-language pathology, the behavioural management of voice disorders lacks precision regarding optimal dose-response relationships. In voice therapy, dosing can presumably vary from no measurable effect (i.e., no observable benefit or adverse effect), to ideal dose (maximum benefit with no adverse effects), to doses that produce toxic or harmful effects on voice production. Practicing specific vocal exercises will inevitably increase vocal load. At ideal doses, these exercises may be non-toxic and beneficial, while at intermediate or high doses, the same exercises may actually be toxic or damaging to vocal fold tissues. In pharmacology, toxicity is a critical concept, yet it is rarely considered in voice therapy, with little known regarding "effective" concentrations of specific voice therapies vs "toxic" concentrations. The potential for vocal fold tissue damage related to overdosing on specific vocal exercises has been under-studied. In this commentary, the issue of dosing will be explored within the context of voice therapy, with particular emphasis placed on possible "overdosing".

Practical considerations for dysphonia caused by inhaled corticosteroids

Inhaled corticosteroid (ICS) therapy has become standard in the treatment of asthma. A common local adverse effect of ICS therapy is dysphonia, which has been reported to affect 5% to 58% of patients. Although causes of dysphonia associated with ICS therapy have been underinvestigated, it may result from deposition of an active ICS in the oropharynx during administration, which then causes myopathy or a mucosal effect in the laryngopharynx. Use of ICS should be considered during any evaluation of dysphonia. We recommend using the lowest effective dosage of ICS, administering medication with a spacer, gargling, rinsing the mouth and washing the face after inhalation, and washing the spacer. If dysphonia develops despite these interventions, ICS use should be suspended until symptoms resolve, provided that asthma control is not compromised.

The impact of laryngeal disorders on work-related dysfunction

OBJECTIVES/HYPOTHESIS

To determine the short-term disability (STD) and lost work productivity related to laryngeal disorders.

STUDY DESIGN

A retrospective analysis of a national database of work absence and STD claims was performed.

METHODS

Patients with 12 months of follow-up who had an STD claim specifically linked to a dysphonia diagnosis based on ICD-9 codes were identified during the period of January 1, 2004, to December 31, 2008. Patient age, sex, and diagnosis and the total number of work days absent were determined. Using the mean national hourly wage, productivity losses in terms of lost wages were calculated.

RESULTS

Of the 18,466 unique patients with an STD claim, 386 (2.1%) had an STD claim due to a laryngeal disorder. The mean age was 45.9 years (standard deviation, 9.6) with 53.2% male. The mean number of work days absent was 39.2 days (95% confidence interval: 31.9-46.5). Total STD payments in 2008 dollars were $647,269.30 with a mean per person in 12 months of $3,406.68. Total and mean lost wages in 12 months were $843,198.72 and $4,437.89, respectively. Patients with laryngeal cancer had the most days absent and highest total STD payment.

CONCLUSIONS

Laryngeal disorders lead to work-related disability with STD and productivity losses and represent a significant societal burden. Managing work limitations from laryngeal disorders is an important public health goal.

Epidemiology of voice disorders in teachers and nonteachers in Brazil: prevalence and adverse effects

PURPOSE

This epidemiological study compared the frequency and adverse effects of voice disorders in Brazilian teachers and nonteachers.

METHODS

A standardized interview/questionnaire was administered to 3,265 participants; 1,651 teachers; and 1,614 nonteachers recruited from all 27 Brazilian states.

RESULTS

Prevalence of reporting a current voice disorder was 11.6% for teachers and 7.5% for nonteachers, respectively (χ2(1)=16.1, P<0.001). Sixty-three percent of teachers and 35.8% of nonteachers reported having experienced a voice problem at some point during their lifetime (χ2(1)=246.6, P<0.001). Teachers reported a higher number of current (3.7) and past (3.6) voice symptoms as compared with nonteachers (1.7 current, 2.3 past) and more often attributed these symptoms to their occupation (P<0.001). Teachers, as compared with nonteachers (1) more frequently reported that their voice limited their ability to do certain tasks within their current occupation (29.9% of teachers vs 5.4% of nonteachers; P<0.001); (2) experienced more voice-related absenteeism over the past year (12.1% of teachers missed 5 or more days of work vs 2.4% of nonteachers; P<0.001); and (3) more often considered changing occupations in the future because of voice problems (16.7% of teachers vs 0.9% of nonteachers; P<0.001). The magnitude of voice-related dysfunction among teachers was similar across Brazilian states, and regional characteristics did not appear to significantly influence the results.

CONCLUSION

This large epidemiological study comparing teachers and nonteachers confirms that teaching at school is a high-risk occupation for developing voice disorders. These voice disorders contribute to reduced job performance, attendance, and force many Brazilian teachers to consider changing occupations in the future because of their voice.

Investigations into vocal doses and parameters pertaining to primary school teachers in classrooms

Investigations into vocal doses and parameters were carried out on 40 primary school teachers (36 females and 4 males) in six schools in Italy, divided into two groups of three, A and B, on the basis of the type of building and the mid-frequency reverberation time in the classrooms, which was 1.13 and 0.79 s, respectively. A total of 73 working-day samples were collected (66 for females and 7 for males), from which 54 traditional lessons were analyzed separately. The average value over the working days of the mean sound pressure level of the voiced speech at 1 m from the teacher's mouth was 62.1 dB for the females and 57.7 dB for the males, while the voicing time percentage was 25.9 and 25.1 %, respectively. Even though the vocal doses and parameters did not differ for the two school groups, the differences in the subjective scores were significant, with enhanced scores in group B. A 0.72 dB increase in speech level per 1 dB increase in background noise level, L(A90), was found during traditional lessons, as well as an increase in the mean value of the fundamental frequency with an increase in L(A90), at a rate of 1.0 Hz/dB.

Professional theatre actors: environmental and socio-occupational use of voice

PURPOSE

To investigate the occurrence of vocal complaints and symptoms among professional theatre actors, and its relationship with environmental aspects of this professional activity and with the history of specialized intervention.

METHODS

Cross-sectional study with 48 professional actors who answered a questionnaire regarding vocal and extra-vocal complaints, as well as environmental aspects, habits and demands related to their professional activity in the theatre. A specific previously structured protocol (PROTEA) was used for this purpose.

RESULTS

Previous history of acting vocal training was reported by 40 (83.3%) subjects. The most used resources were vocal warming, hydrating therapy, and alternative methods. Vocal difficulties in day-to-day demands were reported by 14 (35.0%) subjects, and eight (16.7%) of them noticed these difficulties since the beginning of their career. During performances, 14 (29.2%) reported difficulties coordinating breathing and speaking. All actors interviewed consider vocal health important for theatre acting. Most actors denied difficulties regarding vocal projection, breathing and/or articulation of words in scene. However, the Italian stage seems to be more related to difficulties coordinating breathing and speaking than the arena theater (p=0.00).

CONCLUSION

In spite of professional actors who have a history of training and orientation regarding the use of professional voice, a significant portion of them have complaints related to professional voice use, especially associated to the environment conditions at work.

The relation of vocal fold lesions and voice quality to voice handicap and psychosomatic well-being

BACKGROUND

Voice disorders have a multifactorial genesis and may be present in various ways. They can cause a significant communication handicap and impaired quality of life.

OBJECTIVE

To assess the effect of vocal fold lesions and voice quality on voice handicap and psychosomatic well-being.

METHODS

Female patients, aged 18-65 years, who were referred to the outpatient clinic with voice problems were subsequently assessed. Laryngostroboscopic examination and acoustic voice analysis were carried out, and the patients were asked to fill in the Voice Handicap Index (VHI) and Symptom Check List-90 questionnaires.

RESULTS

Eighty-two patients were included. In 43 patients (52.4%), a vocal fold lesion was observed. The VHI and psychosomatic well-being did not differ significantly between patients with and without a vocal fold lesion. The patients with a vocal fold lesion showed lower scores on the Dysphonia Severity Index (DSI) compared with those without a vocal fold lesion. However, the DSI was not correlated with voice handicap and psychosomatic well-being, except for the VHI physical subscale.

CONCLUSION

Objective measurement does not necessarily correlate with the subjective appraisal of the patient's voice handicap and psychosomatic well-being. Furthermore, the criterion of the presence of a vocal fold lesion as the base of indemnity that is applied by health insurance institutions should be questioned.

Automatic intelligibility assessment of speakers after laryngeal cancer by means of acoustic modeling

OBJECTIVE

One aspect of voice and speech evaluation after laryngeal cancer is acoustic analysis. Perceptual evaluation by expert raters is a standard in the clinical environment for global criteria such as overall quality or intelligibility. So far, automatic approaches evaluate acoustic properties of pathologic voices based on voiced/unvoiced distinction and fundamental frequency analysis of sustained vowels. Because of the high amount of noisy components and the increasing aperiodicity of highly pathologic voices, a fully automatic analysis of fundamental frequency is difficult. We introduce a purely data-driven system for the acoustic analysis of pathologic voices based on recordings of a standard text.

METHODS

Short-time segments of the speech signal are analyzed in the spectral domain, and speaker models based on this information are built. These speaker models act as a clustered representation of the acoustic properties of a person's voice and are thus characteristic for speakers with different kinds and degrees of pathologic conditions. The system is evaluated on two different data sets with speakers reading standardized texts. One data set contains 77 speakers after laryngeal cancer treated with partial removal of the larynx. The other data set contains 54 totally laryngectomized patients, equipped with a Provox shunt valve. Each speaker was rated by five expert listeners regarding three different criteria: strain, voice quality, and speech intelligibility.

RESULTS/CONCLUSION

We show correlations for each data set with r and ρ≥0.8 between the automatic system and the mean value of the five raters. The interrater correlation of one rater to the mean value of the remaining raters is in the same range. We thus assume that for selected evaluation criteria, the system can serve as a validated objective support for acoustic voice and speech analysis.

The inability to produce soft voice (IPSV): a tool to detect vocal change in school-teachers

PURPOSE

This study investigated whether clinicians could detect voice changes reported by teachers, from self-ratings teachers conducted of their inability to produce soft voice (IPSV).

METHODS

Ten teachers wore a vocal dosimeter and completed daily IPSV ratings approximately every 2 hours for 14 days. Following the 2 weeks of dosimetry, two speech clinicians specialized in voice rated the teachers' IPSV from dosimeter recordings. Teacher and clinician ratings were compared for each participant.

RESULTS

Although agreement between teacher and clinician ratings was not significant, descriptive analyses demonstrated an average difference score of 1.7 (SD 1.4) between teacher and clinician ratings.

CONCLUSIONS

This study supports the potential usefulness of the IPSV as a simple tool to detect voice changes in oneself or others.

Gender differences affecting vocal health of women in vocally demanding careers

Studies suggest that occupational voice users have a greater incidence of vocal issues than the general population. Women have been found to experience vocal health problems more frequently than men, regardless of their occupation. Traditionally, it has been assumed that differences in the laryngeal system are the cause of this disproportion. Nevertheless, it is valuable to identify other potential gender distinctions which may make women more vulnerable to voice disorders. A search of the literature was conducted for gender-specific characteristics which might impact the vocal health of women. This search can be used by health care practitioners to help female patients avoid serious vocal health injuries, as well as to treat better those women who already suffer from such vocal health issues.