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

Self-reported Vocal Demands, Perceptions, and Knowledge of Occupational Voice Users in South Africa

OBJECTIVES

The study aimed to describe daily vocal demands, perceptions and knowledge as reported by occupational voice users.

STUDY DESIGN

A descriptive, cross-sectional research design was employed.

METHODS

A survey on vocal demands, perceptions and knowledge was distributed to 102 occupational voice users via a snowball sampling technique.

RESULTS

Slightly more than half of the participants (55%) reported using their voice for work 36.5 hours a week on average (SD = 15.5, range: 33-40). Participants reported that, on average, their daily voice use is 6.3 hours (SD = 2.7) for work and the majority (81%) reported a decrease in voice quality after work; Three-quarters (75%) also reported vocal fatigue at the end of day. Approximately one-third (33%) reported being exposed to environments where they are expected to shout, scream or cheer loudly. More than half of the participants (61%) reported that they have previously received vocal health education but 40% reported that they felt this training was insufficient. High vocal demands are significantly correlated to an increase in perceived vocal handicap rs = 0.242; (P = 0.018), tiredness of voice rs = 0.270; (P = 0.008), physical discomfort rs = 0.217; (P = 0.038) as well as how occupational voice users experience improvement of symptoms with rest rs = -0.356 (P < 0.001). Other risk factors highlighted by occupational voice users are the ingestion of liquid caffeine, alcohol, and carbonated drinks, smoking or the presence of chronic cough, chronic laryngitis, and gastroesophageal reflux disease.

CONCLUSIONS

Occupational voice users are subjected to high daily vocal demands that can be seen to be linked to vocal fatigue, changes in voice quality and vocal symptoms experienced. It is essential that occupational voice users as well as treating clinicians are aware of certain significant predictors of both vocal handicap and vocal fatigue. These findings provide insights for developing strategies for training and cultivating vocal health consciousness and preventive voice care initiatives that focus on occupational voice users in South Africa.

The Effect of Vocal Hygiene Education Programs on Voice Quality in Professional Voice Users: A Systematic Review

PURPOSE

This study aimed to critically appraise recent peer-reviewed scientific evidence on the effect of vocal hygiene education on voice quality and function directly and indirectly measured by auditory-perceptual, acoustic, and self-report measures in professional voice users.

METHOD

A systematic review was conducted utilizing the Preferred Reporting Items for Systematic review and Meta-Analyses Protocols (PRISMA-P) guidelines. Five databases were searched using the keywords "vocal hygiene," "vocal hygiene education," "vocal health," "vocal quality," and "voice quality" with Boolean phrases "AND" and "OR." Twenty-three studies that met the eligibility criteria were included. Scoring was based on the American Speech-Language-Hearing Association's levels of evidence and quality indicators, as well as the Newcastle-Ottawa Scale for assessing the risk of bias.

RESULTS

Four studies (17%) linked low awareness of vocal hygiene or insufficient vocal hygiene education to self-reported acute and chronic voice symptoms, as well as a greater perception of voice handicap among professional voice users. Numerous studies (n = 10; 43%) showed that adequate voice training or vocal hygiene education was linked to positive voice outcomes. Six studies (6.26%), however, demonstrated that vocal hygiene education is more effective when combined with direct voice therapy. When vocal hygiene education is presented in isolation, the superiority of a direct voice therapy approach, with or without vocal hygiene education, is seen over a vocal hygiene education program alone (indirect treatment).

CONCLUSIONS

Recent literature demonstrates mixed results obtained through auditory-perceptual, acoustic, and self-rating measures on the effects of vocal hygiene instruction on vocal quality and function in professional voice users. However, the compelling positive outcomes presented do warrant implementation of vocal hygiene education programs in combination with direct voice therapy for professional voice users.

Application of the HRES 5562 Camera Using the HSDI Technique in the Diagnosis of Glottal Insufficiencies in Teachers

OBJECTIVE

Teachers are the largest group of professional voice users with predispositions to functional or organic changes in the larynx. The dysfunction of intrinsic muscles of the larynx frequently occurs which leads to changes in parameters of quality of voice (dysphonia). The aim of the study is the assessment of parameters of vocal folds vibrations, Mucosal Wave morphology, Glottal Closure Type and Open Quotient (OQ) using High Speed (HS) camera and High Speed Digital Imaging (HSDI) technique in teachers with disorders of voice quality classified in GRBAS scale in glottal insufficiencies.

MATERIAL AND METHOD

The study included group of 50 teachers of both genders, working in primary and secondary education units for 15 years, without systemic diseases with disorders of quality of voice confirmed by the results in GRBAS scale assessment. Vocal folds vibrations were assessed with HS camera by R. Wolf and HSDI technique. Rigid endoscope with 90^o optics by the same company was used in the study. Vocal folds vibrations were registered with the speed of 4000 frames/sec. Regularity, symmetry of vibrations, Mucosal Wave (MW) morphology as well as Glottal Closure Type were assessed. Numerical value of OQ was determined in anterior, middle and posterior segment of the glottis during phonation.

RESULTS

Assessment of real vibrations of vocal folds revealed irregularity, mean asymmetry of vibrations, MW reduction as well as glottal insufficiency, the most frequently (96%), in the middle segment - type E according to European Laryngological Society, less frequently (4%) - type E+C. The highest value of OQ (average 0.98) was registered in the middle segment of the glottis. In GRBAS scale, significant dysphonia has been registered, classified as G₃R₃B₃A₃ without the features of voice strain - S₀.

CONCLUSION

In group of teachers with extensive professional experience, glottal insufficiency in the middle segment was registered the most frequently which was confirmed by high values of OQ in this region obtained with HSDI technique. What is more, irregularity, mean asymmetry and asynchrony of vibrations with MW reduction were registered which confirmed the existence of glottal insufficiency in this group. GRBAS scale was useful in preliminary evaluation of dysphonia and its severity, however, the diagnosis of its clinical form was possible only with visualization of the larynx and objective parameters obtained with HSDI.

Toward a Consensus Description of Vocal Effort, Vocal Load, Vocal Loading, and Vocal Fatigue

Purpose The purpose of this document is threefold: (a) review the uses of the terms "vocal fatigue," "vocal effort," "vocal load," and "vocal loading" (as found in the literature) in order to track the occurrence and the related evolution of research; (b) present a "linguistically modeled" definition of the same from the review of literature on the terms; and (c) propose conceptualized definitions of the concepts. Method A comprehensive literature search was conducted using PubMed/MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Scientific Electronic Library Online. Four terms ("vocal fatigue," "vocal effort," "vocal load," and "vocal loading"), as well as possible variants, were included in the search, and their usages were compiled into conceptual definitions. Finally, a focus group of eight experts in the field (current authors) worked together to make conceptual connections and proposed consensus definitions. Results The occurrence and frequency of "vocal load," "vocal loading," "vocal effort," and "vocal fatigue" in the literature are presented, and summary definitions are developed. The results indicate that these terms appear to be often interchanged with blurred distinctions. Therefore, the focus group proposes the use of two new terms, "vocal demand" and "vocal demand response," in place of the terms "vocal load" and "vocal loading." We also propose standardized definitions for all four concepts. Conclusion Through a comprehensive literature search, the terms "vocal fatigue," "vocal effort," "vocal load," and "vocal loading" were explored, new terms were proposed, and standardized definitions were presented. Future work should refine these proposed definitions as research continues to address vocal health concerns.