Acoustic Analysis of Voice: Iranian Teachers

Cross-Cultural Adaptation, Validation, and Diagnostic Accuracy of the Voice Fatigue Handicap Questionnaire-Persian Version

OBJECTIVE

The current study aimed to determine the psychometric characteristics of a translated version of the Voice Fatigue Handicap Questionnaire in Persian by examining the validity, reliability, and diagnostic accuracy using data collected from people with and without dysphonia.

STUDY DESIGN

Cross-sectional study.

METHOD

The original questionnaire was translated from Italian to Persian using the International Quality of Life Assessment criteria. The translated version was completed by 122 people with dysphonia and 49 people without dysphonia. The validity, reliability, and diagnostic accuracy of the Voice Fatigue Handicap Questionnaire Persian-version were evaluated. A panel of five voice-specializing Speech and Language Pathologists and 20 native Persian speakers (with dysphonia) in a pilot study confirmed the translated version for content and face validity, respectively. The internal consistency was evaluated by Cronbach's alpha and McDonald omega coefficients. The intraclass correlation coefficient was used to examine the test-retest reliability. For discriminant validity, the mean total and subscale scores of respondents with and without dysphonia were compared through independent t tests. Finally, sensitivity, specificity, and ideal cut-off value were determined using the receiver-operating characteristic curve.

RESULTS

Cronbach's alpha coefficient was 0.965 for the total score (functional: α = 0.883, emotional: α = 0.944, physical: α = 0.917). Also, the McDonald omega coefficient was 0.966 for the total score (functional: ω = 0.889, emotional: ω = 0.933, physical: ω = 0.920). The intraclass correlation coefficient for measuring the test-retest reliability was 0.971 for the total score (functional: ICC=0.937, emotional: ICC=0.954, physical ICC=0.976). The results of the independent samples t tests indicated that the dysphonia group obtained significantly higher mean scores (total and subscale scores) than the group without dysphonia. The cutoff value of 13.5 was determined based on the optimal balance of sensitivity (0.992) and specificity (0.918).

CONCLUSION

The Voice Fatigue Handicap Questionnaire-Persian version is a valid and reliable questionnaire to identify individuals at high risk of vocal fatigue and subsequent dysphonia.

Acoustic Characteristics of Voice in Teachers and Nonteachers

BACKGROUND

Teachers are professional voice users, and the vocal demands in the teaching profession can be considered unique. All teachers will wish to possess a voluminous, strongly-carrying voice that can be maintained for a prolonged time. This necessitated the need to understand and document the voice-acoustic characteristics of teachers.

OBJECTIVES

The specific objectives were to (a) investigate the acoustic characteristics of teachers' voices, (b) compare voice acoustic characteristics between female and male teachers, and (c) compare acoustic characteristics of voice between teachers and nonteachers.

PARTICIPANTS

Four hundred thirty-nine individuals congregated into two groups. Group 1 had 264 female teachers (mean age: 36.8 years) and 42 male teachers (mean age 36.8 years) with a minimum of 5 years of teaching experience. A hundred females (mean age: 37.3 years) and 33 males (mean age: 36.1 years) adults not indulging in additional, prolonged use of voice were in group 2.

MATERIALS AND METHOD

Sustenance of vowel /a/ for 3 seconds at a comfortable pitch and loudness followed by a monologue on "My school" for 1 minute were audio-recorded at the locations of the participants. Multidimensional Voice Profiles and Real Time Pitch were used to analyze the phonation and monologue samples, respectively.

RESULTS

Revealed that most F0 and its related measures, short- and long-term frequency perturbations were higher in female compared to the male participants. The majority of the acoustic parameters were higher in teachers compared to nonteachers of both sexes.

CONCLUSION

The results, in general, confirmed a few evinced findings in females and males, strengthening the nature-controlled biophysical influence on voice. A few acoustic measures discerned voices of teachers and nonteachers and also females and males in teachers. Nonteachers of both sexes showed better acoustic characteristics of voice against teachers signifying that the extended and prolonged voice use, an occupational demand of the teaching profession, led to vocal loading affecting the acoustic characteristics of teachers' voices.

A Cross-sectional Study of Perceptual and Acoustic Voice Characteristics in Healthy Aging

PURPOSE

The human voice qualitatively changes across the lifespan. Although some of these vocal changes may be pathologic, other changes likely reflect natural physiological aging. Normative data for voice characteristics in healthy aging is limited and disparate studies have used a range of different acoustic features, some of which are implicated in pathologic voice changes. We examined the perceptual and acoustic features that predict healthy aging.

METHOD

Participants (N = 150) aged between 50 and 92 years performed a sustained vowel task. Acoustic features were measured using the Multi-Dimensional Voice Program and the Analysis of Dysphonia in Speech and Voice. We used forward and backward variable elimination techniques based on the Bayesian information criterion and linear regression to assess which of these acoustic features predict age and perceptual features. Hearing thresholds were determined using pure-tone audiometry tests at frequencies 250 Hz, 500 Hz, 1000 Hz, 2000 Hz, and 4000 Hz. We further explored potential relationships between these acoustic features and clinical assessments of voice quality using the Consensus Auditory-Perceptual Evaluation of Voice.

RESULTS

Chronological age was significantly predicted by greater voice turbulence, variability of cepstral fundamental frequency, low relative to high spectral energy, and cepstral intensity. When controlling for hearing loss, age was significantly predicted by amplitude perturbations and cepstral intensity. Clinical assessments of voice indicated perceptual characteristics of speech were predicted by different acoustic features. For example, breathiness was predicted by the soft phonation index, mean cepstral peak prominence, mean low-high spectral ratio, and mean cepstral intensity.

CONCLUSIONS

Findings suggest that acoustic features that predict healthy aging are different than those previously reported for the pathologic voice. We propose a model of healthy and pathologic voice development in which voice characteristics are mediated by the inability to monitor vocal productions associated with age-related hearing loss. This normative data of healthy vocal aging may assist in separating voice pathologies from healthy aging.

A Vocal Hygiene Program for Mitigating the Effects of Occupational Vocal Demand in Primary School Teachers

PURPOSE

Teachers are occupational voice users with significant vocal demand. This study examined if a vocal hygiene program could mitigate the effects of occupational vocal demand in primary school teachers across 1 month.

METHOD

Sixty female teachers participated, with 30 in an experimental group receiving vocal hygiene education plus daily home practice for 1 month and 30 in a control group with no intervention. Their vocal changes across the month were quantified with (a) acoustic measures on fundamental frequency (f_o), vocal intensity, jitter and shimmer, harmonics-to-noise ratio, and smoothed cepstral peak prominence and (b) Voice Handicap Index (VHI-10) and Vocal Fatigue Index (VFI) scores.

RESULTS

Analysis of covariance showed significantly larger changes (significant decreases) in conversational f_o and in jitter for the experimental group relative to the control group. Post hoc pairwise comparisons following repeated-measures analysis of variance showed significant decreases in conversational f_o and in jitter across the month for the experimental group. No significant differences in VHI-10 and VFI scores were found between the groups.

CONCLUSIONS

Vocal demand-related changes in acoustic measures could be partially mitigated with the vocal hygiene program. Future studies with a more refined intervention program and more long-term follow-up are recommended to better understand the long-term benefits of vocal hygiene programs on primary school teachers.

What Is the Effect of Maxillary Impaction Orthognathic Surgery on Voice Characteristics? A Quasi-Experimental Study

Background

Regarding the impact of orthognathic surgery on the airway and voice, this study was carried out to investigate the effects of maxillary impaction surgery on patients' voices through acoustic analysis and articulation assessment.

Methods

This quasi-experimental, before-and-after, double-blind study aimed at examining the effects of maxillary impaction surgery on the voice of orthognathic surgery patients. Before the surgery, a speech therapist conducted acoustic analysis, which included fundament frequency (F0), Jitter, Shimmer, and the harmonic-to-noise ratio (HNR), as well as first, second, and third formants (F1, F2, and F3). The patient's age, sex, degree of maxillary deformity, and impaction were documented in a checklist. Voice analysis was repeated during follow-up appointments at one and six months after the surgery in a blinded manner. The data were statistically analyzed using SPSS 23, and the significance level was set at 0.05.

Results

Twenty two patients (18 females, 4 males) were examined, with ages ranging from 18 to 40 years and an average age of 25.54 years. F2, F3, HNR, and Shimmer demonstrated a significant increase over the investigation period compared to the initial phase of the study (P <0.001 for each). Conversely, the Jitter variable exhibited a significant decrease during the follow-up assessments in comparison to the initial phase of the study (P< 0.001).

Conclusion

Following maxillary impaction surgery, improvements in voice quality were observed compared to the preoperative condition. However, further studies with larger samples are needed to confirm the relevancy.

The Effect of Mandarin Vowels on Acoustic Analysis: A Prospective Observational Study

OBJECTIVES

Although vowels are of interest for acoustic analysis in clinics, there is no consensus regarding the effect of vowel selection on acoustic perturbation parameters. This study aimed to reveal the effects of Mandarin vowels on acoustic measurements.

STUDY DESIGN

A prospective observational study.

METHODS

This prospective observational study enrolled normal phonation Mandarin speakers at the Otolaryngology Department of the Eye & ENT Hospital affiliated with Fudan University from December 2020 to August 2021. This study recruited 107 normal-voiced Mandarin speakers (59 women and 49 men) with a median age of 26 (22, 33) years old. The objective measures included traditional acoustic parameters (fundamental frequency, harmonic-to-noise ratio, percent jitter, and percent shimmer) and cepstral analysis (smoothed cepstral peak prominence) of six Mandarin vowels (ɑ /a/, o /o/, e /ɤ/, i /i/, u /u/, ü /y/).

RESULTS

The acoustic analysis revealed no significant differences in the fundamental frequency among vowels. The low vowel /a/ had the highest values for percent jitter and percent shimmer and the lowest harmonic-to-noise ratio value. The back vowel /u/ had the lowest cepstral measures (P < 0.05).

CONCLUSIONS

The acoustic analysis significantly varied across the different Mandarin vowels, and these differences must be considered for the effective clinical application of objective evaluations.

Multi-Dimensional Variation in Adult Speech as a Function of Age

We present a multidimensional acoustic report describing variation in speech productions on data collected from 500 francophone adult speakers (20 to 93 y.o.a.) as a function of age. In this cross-sectional study, chronological age is considered as a continuous variable while oral productions, in reading and speech-like tasks, are characterized via 22 descriptors related to voice quality, pitch, vowel articulation and vocalic system organization, time-related measures and temporal organization, as well as maximal performances in speech-like tasks. In a first analysis, we detail how each descriptor varies according to the age of the speaker, for male and female speakers separately. In a second analysis, we explore how chronological age is, in turn, predicted by the combination of all descriptors. Overall, results confirm that with increasing age, speakers show more voice instability, sex-dependent pitch changes, slower speech and articulation rates, slower repetition rates and less complexity effects in maximal performance tasks. A notable finding of this study is that some of these changes are continuous throughout adulthood while other appear either at old age or in early adulthood. Chronological age appears only moderately indexed in speech, mainly through speech rate parameters. We discuss these results in relation with the notion of attrition and with other possible factors at play, in an attempt to better capture the multidimensional nature of the notion of “age”.

The Effect of Bimaxillary Orthognathic Surgery on Voice Characteristics in Skeletal Class 3 Deformity Patients: An Evaluation Using Acoustic Analysis

ABSTRACT

The aim of this study was to analyze the effects of bimaxillary orthognathic surgery on the acoustic voice characteristics of skeletal class 3 patients. All healthy nonsyndromic patients with Class 3 deformity who were eligible for bimaxillary orthognathic surgery, were included in this before and after quasi-experimental study. This experiment's main intervention was mandibular setback surgery by bilateral sagittal split osteotomy plus maxillary advancement using LeFort 1 osteotomy. Age, sex, and intraoperative jaw movements were recorded. Acoustic analysis of voice samples (vowels /a/ and /i/) was performed with Praat software as outcome variables. The formant frequencies (F0, F1, F2, and F3) of these vowels were extracted 1 week preoperatively (T0), 1 and 6 months (T1, T2) postoperatively by a speech therapist. The significance level was set at 0.05 using SPSS 19. The study sample comprised 20 patients including 11 women (55%) and 9 men (45%) with a mean age of 31.95 ± 4.72 years. The average mandibular setback and maxillary advancement were 3.30 ± 0.86 and 2.85 ± 0.74 mm, respectively. The fundamental frequency (F0) and the first, second, and third formants (F1, F2, F3) of vowels /i/ and /a/ were significantly decreased over time intervals, postoperatively (P < 0.05). The finding revealed that bimaxillary orthognathic surgery (maxillary advancement and mandibular setback with bilateral sagittal split osteotomy) might reduce the acoustic formant parameters of voice to the normal frequency ranges, in patients with class 3 skeletal deformities. More clinical trials with greater sample sizes and long-term follow-ups are suggested in the future.

How Does Our Voice Change as We Age? A Systematic Review and Meta-Analysis of Acoustic and Perceptual Voice Data From Healthy Adults Over 50 Years of Age

Purpose Approximately 30% of adults over the age of 50 years present with altered vocal function. Our understanding of how these changes manifest acoustically and perceptually is derived from relatively modest-sized studies using a diversity of tools. Voice changes can arise from the onset of disease or disorder, but also age-related physiological changes, which may not reflect pathology as such. Here, we bring together data on acoustic, perceptual, and instrumental assessments (electroglottography), with the aim of gaining a better understanding of the changes occurring across these measurement domains. We consider these changes in the context of different acoustic features, software programs, and perceptual protocols. Method Studies of voice function in healthy older adults over the age of 50 years were sought. Literature was systematically searched with 746 abstracts reviewed. Forty-seven studies were included in the review. A meta-analysis of included studies compared voice acoustic parameters between sex and age. Sixteen acoustic parameters collected from 1,475 participants were analyzed in the meta-analysis. These included some previously unpublished analyses using data provided by authors of included studies. Results Data from the systematic review suggest that older individuals are perceived to present with higher overall scores of dysphonia and roughness, breathiness, strain, and instability. Acoustically, males have significantly higher scores on measures of perturbation, including noise-to-harmonic ratio and absolute jitter. The meta-analysis outcomes suggest that participants aged 80-89 years produce significantly higher fundamental frequency, jitter percent, shimmer percent, and shimmer in decibels compared to participants aged 60-69 years and a significant increase in relative average perturbation, jitter percent, and shimmer in decibels compared to participants aged 70-79 years. Limited data were available comparing acoustic measures using the same acoustic software. Conclusions Variations in fundamental frequency and frequency and amplitude perturbation increase as healthy adults age. It was difficult to draw definitive conclusions based on existing literature due to variability in hardware used, limited descriptions of study cohorts, or missing data from statistical analysis. Supplemental Material https://doi.org/10.23641/asha.11868663.

An evaluation of Short-term Treatment Outcomes of Cricothyroid Visor Maneuver: A Proof-of-Concept Pilot Study

INTRODUCTION

Muscle tension dysphonia (MTD) is used as a clinical and diagnostic descriptive label for a diverse range of vocal fold behaviors caused by increased tension of the (para) laryngeal musculature. These increased tension can occur in the cricothyroid muscle and in the ''visor'' mechanism, contributing to voice problems. The main goal of this study is to determine whether a new method, the cricothyroid visor maneuver (CVM), is an effective method for improving quality and other aspects of the MTD patients' voices.

METHOD(S)

Eighty-eight adult female patients participated in this quasiexperimental study. One group consisted of 30 MTD patients (mean age 28.7 ± 4.95 years) for whom manual circumlaryngeal therapy (MCT) was provided. The other group consisted of 30 MTD patients (mean age 28.9 ± 5.1 years) who received CVM. Also, 28 adult females with MTD (mean age 28.60 ± 4.56 years), who were on the clinic's waiting list, served as a control group and did not receive any treatment. Treatment was provided in a single 30-minute session. Pre- and post-treatment audio recordings of sustained vowels, selected sentences, and connected speech samples were submitted to auditory-perceptual and acoustical analysis to assess the short-term effects of the two treatment programs. Also, perceptions of patients' about their voice quality before and after therapy were assessed by visual analogue scale.

RESULTS

Perceptually, Consensus Auditory Perceptual Evaluation of Voice (CAPE-V) ratings improved in all patients with both treatment methods. Acoustically, with CVM, harmonic-to-noise ratio and Cepstral Peak Prominence increased and perturbation (jitter and shimmer) measures decreased and there was not significant change in MCT and control groups. Visual analogue scale showed that feelings of patients improved after therapy in both treatment methods, with higher scores for patients receiving CVM in comparison to the MCT method.

DISCUSSION

These results suggest that CVM can be an effective method for voice rehabilitation in patients with MTD and manipulation of Cricothyroid muscle and ''visor'' mechanism can lead to marked voice improvement.

Acoustic Measurements of the Glottic Source of Female Teachers With Dysphonia

OBJECTIVE

To verify the acoustic measurements of glottic source of dysphonic teachers of a medium-sized municipality of interior of the state.

METHODS

Retrospective, cross-sectional, and quantitative study, with a composite sample of 34 dysphonic teachers, of which 21 teachers without laryngeal affections and 13 with laryngeal affections, mean age 39.1 years old and 39.5 years old, respectively. Glottic source acoustic analysis was performed with the Multi-Dimensional Voice Program Advanced. The data were analyzed statistically to verify the significance of each acoustic measure between the groups (with laryngeal affection, without laryngeal affection, and total) and in relation to the normality proposed by the software.

RESULTS

In the three conditions (groups with and without affection and total) the means were statistically below normality in the measurements of maximum and minimum fundamental frequency. In the group without affection, frequency, and noise measurements presented above normality. In both groups, measurements of frequency, noise, and subharmonic segments were above normal, and number of voice breaks below normal.

CONCLUSION

Acoustic parameters outside the normal pattern showed an aperiodic vocal production, with presence of noise and instability in the vocal signal, in dysphonic teachers with or without alteration at the laryngeal level.

An Acoustic-Signal-Based Preventive Program for University Lecturers' Vocal Health

INTRODUCTION

Professional activities of university lecturers involve continued and sustained use of the voice, leading in many cases to increased risk of developing voice disorders. Risk identification followed by the fast application of preventive or corrective measures is a key issue in this context.

OBJECTIVE

Define and implement a preventive program for the vocal health of university lecturers by using acoustic features automatically extracted from voice recordings to identify risk groups and manage preventive or corrective actions MATERIAL AND METHODS: A total of 170 subjects, aged between 18 and 65, were recruited at the San Pedro de Alcántara Hospital and at the University of Extremadura in Cáceres (Spain). They formed three groups-one of 25 people suffering from vocal fold nodules, another of 25 healthy people, and the third of 120 university lecturers. Medical history and voice status assessment was performed, and voice recordings were made following a research protocol. A feature extraction, selection, and classification procedure was applied to the voice recordings to provide the best predictors for discriminating between pathological and healthy voices. The model parameters were then used to determine the lecturers' probability of suffering vocal fold nodules or other pathologies with similar dysphonic speech. These probabilities were used to classify the lecturers into three risk groups-low, medium, and high. These groups were taken as the basis to assign the lecturers to a primary, secondary, or tertiary prevention level. Different preventive or corrective actions were applied for each prevention level.

RESULTS

The best set of predictors comprised sample entropy, correlation dimension, pitch period entropy, glottal noise excitation, and sex, achieving an overall accuracy of 92% with a random forest classifier. They all showed statistically significant differences between vocal fold nodules and healthy groups (P < 0.05). Three out of the four best acoustic features were nonlinear, showing the importance of nonlinear dynamics for clinical practice. The model parameters were applied to the predictors of the lecturers so as to assign them to the different risk groups, leading to 60.8% (73 out of 120) of the lecturers in the low-risk group, 29.2% (35 out of 120) in the medium-risk group, and 10% (12 out of 120) in the high-risk group. The prevention levels were assigned on the basis of this classification and the medical history and laryngological evaluation of some specific subjects. A statistically significant association was found between the voice status and the assigned prevention level (P < 0.001), with there being a clear dependence relationship (Cramér's V = 0.630).

CONCLUSION

It is feasible to develop and apply a preventive voice program for university lecturers that is aided by features automatically extracted from voice recordings. As the program progresses, it is expected that the information automatically provided for the assignment to prevention levels will become ever more precise. The method proposed can be extended to other voice professionals and other voice disorders.

A feasibility study on non-invasive oxidative metabolism detection and acoustic assessment of human vocal cords by using optical technique

Voice disorder such as vocal fatigue is a common and complex multifaceted clinical problem that presents a significant impact on quality of life. In this study, the functional near-infrared diffuse optical technique (fNIRS-DOT) was proposed as a novel approach for human vocal cords oxidative metabolism detection and acoustic assessment simultaneously to provide a multidimensional assessment of voice disorder. A totally of 60 healthy subjects included 30 male and 30 female adults of age-matched were recruited and performed a vocal loading task to trigger a mild inflammation of the vocal cords in this study. In the results of oxidative metabolism, the vocal cords expressed hypoxia after vocal loading task in both male and female groups that could provide relevant information on the relationship between tissue oxygen consumption and supply for vocal cords diagnosis. Additionally, the results of optical acoustic assessment revealed the worse/changes voice quality after vocal loading task. Therefore, integration of non-invasive oxidative metabolism detection and acoustic assessment by using optical technique could provide more relevant information for diagnosis of voice disorders. The multi-functional vocal cords detection system could provide a good feasibility for clinical applications such as diagnosis and therapeutic monitoring of voice disorder.

Relationship between Voice Complaints and Subjective and Objective Measures of Vocal Function in Iranian Female Teachers

OBJECTIVES

Teachers are at high risk of developing voice problems because of the excessive vocal demands necessitated by their profession. Teachers' self-assessment of vocal complaints, combined with subjective and objective measures of voice, may enable better therapeutic decision-making. This investigation compared audio-perceptual assessment and acoustic variables in teachers with and without voice complaints.

METHODS

Ninety-nine teachers completed this cross-sectional study and were assigned to one of two groups: those "with voice complaint (VC)" and those "without voice complaint (W-VC)." Voice samples were collected during reading, counting, and vowel prolongation tasks. Teachers were also asked to document any voice symptoms they experienced. Voice samples were analyzed using Dr. Speech program (4th version; Tiger Ltd., USA), and labeled "normal" or "abnormal" according to the "grade" dimension "G" from GRBAS scale.

RESULTS

Twenty-one teachers were assigned to the VC group based on self-assessment data. There were statistically significant differences between the two groups with regard to self-reported voice symptoms of hoarseness, breathiness, pitch breaks, and vocal fatigue (P < 0.05). Fourteen participants in the VC group and 40 from the W-VC group were determined to demonstrate "abnormal" vocal quality on perceptual assessment. Only harmonic-to-noise ratio was significantly higher for the W-VC group (ES = 0.55).

CONCLUSION

Teachers with and without voice complaints differed in the incidence, but not type of voice symptoms. Teachers' voice complaints did not correspond to perceptual and acoustic measures. This suggests a potential unmet need for teachers to receive further education on voice disorders.

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.