Loud voice during environmental noise exposure in patients with vocal nodules

The Impact of a Vocal Loading Task on Voice Characteristics of Female Speakers With Benign Vocal Fold Lesions

OBJECTIVES

To examine the effect of a vocal loading task on measures of vocal structure and function in females with benign vocal fold lesions (BVFLs) and determine if change is observed in voice and lesion characteristics.

STUDY DESIGN

Prospective cohort study.

METHODS

Twenty-eight (n = 28) female subjects with phonotraumatic BVFLs completed a vocal loading task of 30 minutes of reading aloud at 75-85 dBA. Multidimensional voice evaluation was completed pre- and post-load, including audio and videostroboscopy recordings and images for expert perceptual ratings and acoustic and aerodynamic evaluation. Subjects also scored themselves using a 10 cm visual analogue scale for Perceived Phonatory Effort, and completed the Evaluation of Ability to Voice Easily, a 12 item self-report scale of current perceived speaking voice function. An exploratory rather than confirmatory approach to data analysis was adopted. The direction and magnitude of the change scores (pre- to post-load) for each individual, across a wide variety of instrumental and self-report measures, were assessed against a Minimal Clinically Important Difference criteria.

RESULTS

Observations of change and the direction of change in vocal response of individuals with BVFLs to 30 minutes of loud vocal load was variable. Minimal to no change was noted for participants pre- to post-load as rated perceptually, for auditory and videostroboscopy samples. For most instrumental measures, change was shown for many participants including an overall improvement in aerodynamic and acoustic measures of function and efficiency post-load for 20 participants (77%) and decline in function for 4 participants (15%). Self-reported effort and vocal function post-load was multidirectional with similar numbers of participants reporting no change, improved function or a decline.

CONCLUSION

Subjects with BVFLs demonstrate change in vocal function following 30 minutes of vocal load. While this change can be variable and multidirectional, overall improvement was observed in instrumental measures of function and efficiency for most participants. Some participants perceived this change to be an increase in effort, some a reduction in effort and some perceived no change. Improved vocal function despite relative lesion stability can seemingly occur after loading in some pathological voices.

Influence of the characteristics of home office work on self-perceived vocal fatigue during the COVID-19 pandemic

PURPOSE

To verify the influence of work characteristics and the occupational voice use on the self-perception of vocal fatigue symptoms in individuals working in the home office during the COVID-19 pandemic.

METHODS

This was a cross-sectional, observational, and descriptive study. The sample consisted of 206 individuals (123 women and 83 men), with an average age of 34 years, working exclusively in a home office mode due to the pandemic. Through an online form, all participants responded to the Vocal Fatigue Index (VFI) protocol and the questionnaire on the characterization of work and the occupational voice use during the pandemic, developed by the authors of this study. Multiple linear regression using the backward elimination technique was performed.

RESULTS

The variables the interlocutor does "not listen to me in home office work," "noise in the home office work environment," "the daily workload in home office," "vocal quality worsened in home office work," "increased vocal loudness in home office work" and "lack of training about voice use in home office work" are predictors of the dependent variable vocal fatigue symptoms.

CONCLUSION

The characteristics of work and occupational voice use influence the self-perception of vocal fatigue symptoms in individuals working in the home office mode during the COVID-19 pandemic.

Restoration Strategies Following Short-Term Vocal Exertion in Healthy Young Adults

Purpose This study aims to investigate the effects of a 10-min vocal exertion task on voice and respiratory measures, to determine whether restorative strategies can mitigate these effects after cessation of exertion, and to assess whether these strategies continue to reduce these detrimental effects when vocal exertion is resumed. Method A prospective, repeated-measures design was used. On consecutive days, 20 participants (equal men and women) completed two vocal exertion tasks separated by 10 min of restoration strategies: vocal rest or controlled phonation (low-level tissue mobilization using straw phonation). Voice and respiratory data were collected at baseline, following the first exertion task, after restoration strategies, and after the second exertion task. Outcome measures included (a) vocal effort, (b) phonation threshold pressure, (c) maximum and minimum fundamental frequencies, (d) cepstral peak prominence of connected speech, (e) lung volume initiation and termination, (f) percent vital capacity expended per syllable, and (g) number of syllables per breath group. Results A worsening of phonation threshold pressure (p < .001), vocal effort (p < .001), and increase of minimum fundamental frequency (p = .007) were observed after vocal exertion. Lung volume initiation (p < .001) and lung volume termination (p < .001) increased. These changes were largely reversed by restoration strategies, but only controlled phonation prevented exertion-induced changes in respiratory kinematic measures on a subsequent vocal exertion task. Conclusions Exertion-induced voice changes occur rapidly and may be mitigated by either controlled phonation or vocal rest. Controlled phonation is recommended as a superior strategy due to evidence of a protective effect on a successive vocal exertion task.

Voice Disorders Detection Through Multiband Cepstral Features of Sustained Vowel

This study aims to detect voice disorders related to vocal fold nodule, Reinke's edema and neurological pathologies through multiband cepstral features of the sustained vowel /a/. Detection is performed between pairs of study groups and multiband analysis is accomplished using the wavelet transform. For each pair of groups, a parameters selection is carried out. Time series of the selected parameters are used as input for four classifiers with leave-one-out cross validation. Classification accuracies of 100% are achieved for all pairs including the control group, surpassing the state-of-art methods based on cepstral features, while accuracies higher than 88.50% are obtained for the pathological pairs. The results indicated that the method may be adequate to assist in the diagnosis of the voice disorders addressed. The results must be updated in the future with a larger population to ensure generalization.

Acoustic, Perceptual, and Laryngoscopic Changes Post Vocal Abuse at a College Fest

INTRODUCTION

College students use their voices at excessively loud intensities and long durations during college fests. The accumulative effect of vocally abusive behaviors in the presence of high ambient noise, poor vocal hygiene, and other environmental factors contribute significantly towards reducing vocal effectiveness in college students.

OBJECTIVE

The present study aimed to study the effect of a vocally demanding situation (college Fest) on perceptual and objective voice features of college students.

METHODOLOGY

In this study, a total number of 27 undergraduate female students participated in the age range of 18-27 years. Pre-test-post-test research design was applied. Data analysis consisted of video stroboscopic examination, acoustic analysis using the Multi-dimensional voice program (MDVP), and perceptual evaluation with the GRBAS scale. The data obtained were processed using descriptive statistics and non-parametric tests to determine the difference in each measured parameter pre- and postfest.

RESULTS AND DISCUSSION

Incomplete glottis closure, asymmetric vibration of vocal folds, and aperiodicity of vocal folds increased significantly postcollege Fest. GRBAS parameters also showed a change from pre Fest scores on grade (hoarseness) increased by 38%, breathiness in 34%, roughness in 26%, Asthenia in 15%, and strain increased in 38% participants. A P-value estimation revealed significantly higher scores in Jitter percent, Shimmer percent, and relative average perturbation than pre-fest scores.

CONCLUSION

The results of the present study indicate a high risk of vocal disorders among college students post Fest. This study suggests a potential unmet need for college students to receive education before cultural events on optimal vocal usage, vocal hygiene, and an appropriate period of vocal rest.

Vocal fold nodules: A disorder of phonation organs or auditory feedback?

OBJECTIVE

Increasing evidence supports that auditory feedback of one's own voice closely relates to real-time adjustments of vocal control. Previous studies highlighted that the low-frequency modulations of below 3 Hz (LFM) embedded in vocal fundamental frequency (F0) showed a reflex-like response to altered auditory inputs. However, the auditory feedback control of different vocal disorders remains unclear.

DESIGN

A cross-sectional, case-controlled study.

SETTING

A tertiary medical centre.

PARTICIPANTS

Sustained vocalisations of vowel/a/ from adult healthy controls and patients with vocal fold nodules, vocal fold polyps and vocal fold cysts, respectively. The vocalisations were made at a comfortable pitch and at the intensity of 70 ~ 80 dBC under the following four auditory conditions: natural hearing, 90-dBC speech noise, 10-dBC enhanced feedback of self-produced voice and both the noise and voice feedback.

MAIN OUTCOME MEASURES

Power spectral analysis of F0 contour of sustained vowel.

RESULTS

Patients with vocal fold nodules presented with different audio-vocal feedback behaviour and audio-vocal response to speech noise from the other two vocal pathologies of vocal fold polyp and vocal fold cyst as well as the healthy controls (P < .001, one-way ANOVA).

CONCLUSION

The vocal fold nodules may be not only a vocal fold disease but also a disease caused by abnormal audio-vocal feedback. Moreover, the distinct audio-vocal feedback of vocal fold nodules could be revealed by power spectral analysis of vocal fundamental frequencies. Although further investigations are necessary, adjustments of audio-vocal feedback behaviour may provide a new insight and benefit to the treatment of vocal fold nodules in the future.

Classroom Noise and Teachers' Voice Production

PURPOSE

The aim of this study was to research the associations between noise (ambient and activity noise) and objective metrics of teachers' voices in real working environments (i.e., classrooms).

METHOD

Thirty-two female and 8 male teachers from 14 elementary schools were randomly selected for the study. Ambient noise was measured during breaks in unoccupied classrooms and, likewise, the noise caused by pupils' activity during lessons. Voice samples were recorded before and after a working day. Voice variables measured were sound pressure level (voice SPL), fundamental frequency, jitter, shimmer, and the tilt of the sound spectrum slope (alpha ratio).

RESULTS

The ambient noise correlated most often with the fundamental frequency of men and voice SPL, whereas activity noise correlated with the alpha ratio and perturbation values. Teachers working in louder ambient noise spoke more loudly before work than those working in lower noise levels. Voice variables generally changed less during work among teachers working in loud activity noise than among those working in lower noise levels.

CONCLUSIONS

Ambient and activity noises affect teachers' voice use. Under loud ambient noise teachers seem to speak habitually loudly, and under loud activity noise teachers' ability to react to loading deteriorates.

From Reactive Intervention to Proactive Prevention: The Evolution of Occupational Dysphonia

Voice clinicians long have been aware of the concept of professional voice users: individuals who work in professions that have a higher incidence and increased risk for voice disorders. This realization, coupled with the documented impact of work-related dysphonia on the economy, has resulted in a growing international interest in developing occupational health benchmarks for voice use, similar to other standards developed for work-related factors such as noise-induced hearing loss. In this article, we review current perspectives and examine some issues related to occupational vocal health.