Analysis of voice change during cellular phone use: a blinded controlled study

Increasing Prevalence of Voice Disorders in the USA: Updates in the COVID Era

OBJECTIVE

To estimate the current prevalence of voice disorders among adults in the United States; to determine the association of individual factors with voice disorders.

METHODS

The 2022 National Health Interview Survey (NHIS) was analyzed to identify adults reporting voice problems in the past 12 months. Demographics were assessed, as well as the duration, severity, and resolution of the voice problem. The relationship between voice problems, gender, lost workdays, and long COVID was investigated. A comparison to the 2012 NHIS was made to determine changes in voice disorder prevalence.

RESULTS

29.9 million Americans (95%CI[28.3-31.5]) annually report a voice problem, representing 12.2% of the population (95%CI[11.7-12.8%]). Overall, 26.8% and 13.2% reported the severity of their voice problem as moderate or severe, respectively. Only 5.1% (95%CI[4.3-6.0%]) of respondents sought treatment. Most voice problems were resolved within 1 week (53.0%,95%CI[50.9-55.1%]). Females were more likely than males to report a voice problem (14.4% vs. 10.0%,95%CI[13.7-15.1] and [9.3-10.7], respectively). The 17.6 million Americans with long COVID symptoms were more likely to have voice complaints than those without (21.1% vs. 11.6%,95%CI[18.9-23.5%] and [11.1-12.1%], respectively). Lost workdays were not significantly higher for those with voice disorders compared to those without (17.1 vs. 12.9 days,95%CI[12.0-22.1] and [11.0-14.8], respectively).

CONCLUSIONS

Voice problems affect approximately 1 in 8 adults in the U.S. annually, demonstrating an alarming increased prevalence since 2012 using the same survey methodology. Relatively few individuals seek care for their voice problem, despite significant self-reported impact. Further study is required regarding the impact of COVID and changes in voice use patterns on voice disorders.

LEVEL OF EVIDENCE

3 Laryngoscope, 134:3713-3718, 2024.

Prevalence of Voice Disorders in the United States: A National Survey

OBJECTIVES

The prevalence of voice disorders has not been explored in the context of recent trends in voice use, including voice assistant technology and increased use of teleconferencing for remote work. The objective of this research is (1) to determine the prevalence of voice disorders in the adult population of the United States, and (2) to understand the association of voice disorders with demographic and voice use factors, including vocal demands, and use of teleconferencing and voice assistant technology.

METHODS

A survey pertaining to voice disorders and voice use was developed and administered to a representative sample of US population. Demographics and information related to risk factors for voice disturbance, including high vocal demands, teleconferencing, and voice-assistant use were also analyzed.

RESULTS

A total of 1522 responses were included. Of these, 20.6% reported having had a voice disorder at some point in their life. This rate was higher in employed respondents, singers, and teachers (all p < 0.0001) and was notably higher in those who used teleconferencing technology and voice assistant technology (both p < 0.0001). Approximately 60% of this subset reported seeking medical care for their voice, 12.6% reported a current voice disorder, and 9.5% reported a voice problem that had recurred multiple times.

CONCLUSIONS

Approximately 1 in 5 Americans surveyed has had a voice disorder. Risk factors for voice disorders include use of teleconferencing technology, voice assistant use, and occupational factors.

LEVEL OF EVIDENCE

3 Laryngoscope, 134:347-352, 2024.

Factors Predicting Dysphonia in Professional Voice Users

OBJECTIVE

To analyze the contribution of organizational, environmental, and personal factors in predicting dysphonia in professional voice users.

STUDY DESIGN

This was a cross-sectional documentary study.

METHODS

The study sample consisted of 128 professional voice users (104 female and 24 male), with a mean age of 39.3 years. Dysphonia (laryngeal disorder associated with vocal complaints) was defined as the dependent variable. Organizational, environmental, and personal factors were defined as independent variables. Logistic regression models were used as predictive methods for data analysis. Evaluation and interpretation of the final model were performed using the ROC curve, odds ratio, and probability estimation.

RESULTS

Professional voice users exposed to low humidity and who talked a lot on their phones were less likely to be dysphonic than individuals who were not exposed to these factors. Those exposed to excessive vocal demand and who reported talking with effort were more likely to be dysphonic than those who were not exposed to these factors. The accuracy of the prediction model was 80.8%.

CONCLUSIONS

Exposure to low humidity and talking a lot on the phone were protective factors. However, excessive vocal demand and straining were risk factors for predicting the presence of dysphonia in professional voice users with high accuracy.

Psychometric Analysis of an Ecological Vocal Effort Scale in Individuals With and Without Vocal Hyperfunction During Activities of Daily Living

Objective The purpose of this study was to examine the psychometric properties of an ecological vocal effort scale linked to a voicing task. Method Thirty-eight patients with nodules, 18 patients with muscle tension dysphonia, and 45 vocally healthy control individuals participated in a week of ambulatory voice monitoring. A global vocal status question was asked hourly throughout the day. Participants produced a vowel-consonant-vowel syllable string and rated the vocal effort needed to produce the task on a visual analog scale. Test-retest reliability was calculated for a subset using the intraclass correlation coefficient, ICC(A, 1). Construct validity was assessed by (a) comparing the weeklong vocal effort ratings between the patient and control groups and (b) comparing weeklong vocal effort ratings before and after voice rehabilitation in a subset of 25 patients. Cohen's d, the standard error of measurement (SEM), and the minimal detectable change (MDC) assessed sensitivity. The minimal clinically important difference (MCID) assessed responsiveness. Results Test-retest reliability was excellent, ICC(A, 1) = .96. Weeklong mean effort was statistically higher in the patients than in controls (d = 1.62) and lower after voice rehabilitation (d = 1.75), supporting construct validity and sensitivity. SEM was 4.14, MDC was 11.47, and MCID was 9.74. Since the MCID was within the error of the measure, we must rely upon the MDC to detect real changes in ecological vocal effort. Conclusion The ecological vocal effort scale offers a reliable, valid, and sensitive method of monitoring vocal effort changes during the daily life of individuals with and without vocal hyperfunction.

The Impact of Communication Modality on Voice Production

Purpose Communicating remotely using audio and audiovisual technology is ubiquitous in modern work and social environments. Remote communication is increasing in medicine and in voice therapy delivery, and this evolution may have an impact on speakers' voices. This study sought to determine whether these communication modalities impact the voice production of typical speakers. Method The speech acoustics of 12 participants with healthy voices were recorded as they held standardized conversations with a single investigator using three communication modalities: in-person, remote-audio, and remote-audiovisual. Participants rated their vocal effort on a 100-mm visual analog scale. Results Compared to in-person communication, self-ratings of vocal effort were statistically significantly increased for remote-audiovisual communication; vocal effort during remote-audio and in-person communication were not significantly different. In comparison to in-person communication, vocal intensity and smoothed cepstral peak prominence (CPPS) were statistically significantly higher during remote-audio and remote-audiovisual communication. Effect sizes for CPPS changes were larger than for sound pressure level (SPL), and changes in CPPS and SPL between in-person and remote-audiovisual communication were not significantly correlated. Conclusions Vocal effort and SPL were increased when using remote-audio and remote-audiovisual communication in comparison to in-person communication. Voice quality was also impacted by technology use, with changes in CPPS that were consistent with, but not fully explained by, increases in SPL. This may impact the telepractice delivery of voice therapy, and further investigation is warranted.

Perceived vocal fatigue and effort in relation to laryngeal functional measures in paresis patients

OBJECTIVES/HYPOTHESIS

To determine if differences in objective measures of laryngeal function can meaningfully explain different levels of self-perceptions of effort or fatigue in patients with vocal fold paresis.

STUDY DESIGN

A retrospective chart review of 72 patients with vocal fold paresis diagnosed using laryngeal electromyography, who had either been observed (n=21), treated only by injection (n=24), or treated only by surgery (n=27).

METHODS

Before and after treatment/observation, patients' subjective ratings of severity of vocal effort and fatigue were assessed using the Glottal Function Index. Laryngeal function was assessed using maximum phonation time and translaryngeal flow.

RESULTS

None of the variables demonstrated a significant linear change across time. Post hoc Tukey analyses following analysis of variance (ANOVA) found significant differences in flow among three groups, those rating symptoms of effort as no problem, moderate problem, or severe problem. Post hoc Tukey analyses following ANOVA found significant differences in the amount that flow changed among three groups, those demonstrating no difference, minor differences, or major differences in ratings of effort before and after treatment.

CONCLUSIONS

Changes in reported symptom severity of effort were related to changes in translaryngeal midvowel flow that were not explained by passage of time.

LEVEL OF EVIDENCE

4.