Applicability of the Polish Vocal Tract Discomfort (VTD) scale in the diagnostics of occupational dysphonia

Population characteristics and self-assessment of speaking and singing voice in Polish contemporary commercial music singers-an exploratory, cross-sectional study

Background

The domination of the Contemporary Commercial Music (CCM) industry in music markets has led to a significant increase in the number of CCM performers. Performing in a wide variety of singing styles involves exposing CCM singers to specific risk factors potentially leading to voice problems. This, in turn, necessitates the consideration of this particular group of voice users in the Occupational Health framework. The aim of the present research was threefold. First, it sought to profile the group of Polish CCM singers. Second, it was designed to explore the prevalence of self-reported voice problems and voice quality in this population, in both speech and singing. Third, it aimed to explore the relationships between voice problems and lifetime singing involvement, occupational voice use, smoking, alcohol consumption, vocal training, and microphone use, as potential voice risk factors.

Materials and methods

The study was conducted in Poland from January 2020 to April 2023. An online survey included socio-demographic information, singing involvement characteristics, and singers' voice self-assessment. The prevalence of voice problems was assessed by the Polish versions of the Vocal Tract Discomfort Scale (VTDS) and the Singing Voice Handicap Index (SVHI). Also, a self-reported dysphonia symptoms protocol was applied. The perceived overall voice quality was assessed by a Visual Analogue Scale (VAS) of 100 mm.

Results

412 singers, 310 women and 102 men, completed the survey. Nearly half of the studied population declared lifetime singing experience over 10 years with an average daily singing time of 1 or 2 h. 283 participants received vocal training. For 11.4% of respondents, singing was the primary income source, and 42% defined their career goals as voice-related. The median scores of the VTDS were 11.00 (0-44) and 12.00 (0-40) for the Frequency and Severity subscales, respectively. The median SVHI score of 33 (0-139) was significantly higher than the normative values determined in a systematic review and meta-analysis (2018). Strong positive correlations were observed between SVHI and both VTD subscales: Frequency (r = 0.632, p < 0.001) and Severity (r = 0.611, p < 0.001). The relationships between most of the other variables studied were weak or negligible.

Conclusion

The examined CCM singers exhibited substantial diversity with regard to musical genre preferences, aspirations pertaining to singing endeavors, career affiliations, and source of income. Singing voice assessment revealed a greater degree of voice problems in the examined cohort than so far reported in the literature, based on the SVH and VTDS.

Vocal Tract Discomfort Scale: Adaptation, Validity, and Reliability of the Turkish Version

BACKGROUND

Currently, there is no Turkish assessment tool available for the evaluation of vocal tract discomfort. The objective of this study is to cross-cultural adaptation of the Vocal Tract Discomfort Scale (VTDS) to Turkish and assess its validity and reliability.

METHOD

The study was conducted with a total of 214 participants, consisting of 121 individuals with voice disorders and 93 individuals without voice disorders. All participants completed the Voice Handicap Index (VHI), Voice-Related Quality of Life (VRQOL), and VTDS. To conduct a test-retest reliability assessment, the VTDS was administered again to 54 participants within 7-14 days.

RESULTS

The internal consistency of VTDS was evaluated using Cronbach's alpha coefficient. The Cronbach's alpha coefficient for the scale was calculated at 0.964, while it was 0.922 for the frequency subscale and 0.930 for the severity subscale. It was found that there was a high degree of correlation (rho = 0.868, frequency rho = 0.847, severity rho = 0.875, P < 0.001) between the two administrations, indicating the reliability of the test-retest assessment. To assess the criterion validity of the scale, correlations between VTDS total scores and VHI and VRQOL scales were examined. Accordingly, it was found that there was a high degree of correlation between VTDS and VHI (rho = 0.631, frequency rho = 0.635, severity rho = 0.616, P < 0.001). It was also observed that there was a high degree of negative correlation between VTDS and VRQOL (rho = -0.701, frequency rho = -0.702, severity rho = -0.692, P < 0.001). It was assumed that there would be statistically significant differences in VTDS total scores among the diagnostic groups, and it was found that there was a significant difference between the two groups (U = 1095.000, z = -10.110, P < 0.001). These findings support the discriminative validity of VTDS.

CONCLUSIONS

The Turkish version of VTDS is a valid and reliable scale that can assess perceptible symptoms and sensations in the vocal tract in terms of both frequency and severity.

A mixed-method feasibility study of the use of the Complete Vocal Technique (CVT), a pedagogic method to improve the voice and vocal function in singers and actors, in the treatment of patients with muscle tension dysphonia: a study protocol

BACKGROUND

Muscle tension dysphonia (MTD) results from inefficient or ineffective voice production and is the cause of voice and throat complaints in up to 40% of patients presenting with hoarseness. Standard treatment is voice therapy (SLT-VT) delivered by specialist speech therapists in voice disorders (SLT-V). The Complete Vocal Technique (CVT) is a structured, pedagogic method which helps healthy singers and other performers optimise their vocal function enabling them to produce any sound required. The aim of this feasibility study is to investigate whether CVT administered by a trained, non-clinical CVT practitioner (CVT-P) can be applied to patients with MTD before progressing to a pilot randomised control study of CVT voice therapy (CVT-VT) versus SLT-VT.

METHODS/DESIGN

In this feasibility study, we use a mixed-method, single-arm, prospective cohort design. The primary aim is to demonstrate whether CVT-VT can improve the voice and vocal function in patients with MTD in a pilot study using multidimensional assessment methods. Secondary aims are to assess whether (1) a CVT-VT study is feasible to perform; (2) is acceptable to patients, the CVT-P and SLT-VTs; and (3) whether CVT-VT differs from existing SLT-VT techniques. A minimum of 10 consecutive patients with a clinical diagnosis of primary MTD (types I-III) will be recruited over a 6-month period. Up to 6 video sessions of CVT-VT will be delivered by a CVT-P using a video link. The primary outcome will be a change in pre-/post-therapy scores of a self-reported patient questionnaire (Voice Handicap Index (VHI)). Secondary outcomes include changes in throat symptoms (Vocal Tract Discomfort Scale), acoustic/electroglottographic and auditory-perceptual measures of voice. Acceptability of the CVT-VT will be assessed prospectively, concurrently and retrospectively both quantitatively and qualitatively. Differences from SLT-VT will be assessed by performing a deductive thematic analysis of CVT-P transcripts of therapy sessions.

CONCLUSION

This feasibility study will provide important data to support whether to proceed with a randomised controlled pilot study focusing on the effectiveness of the intervention compared to standard SLT-VT. Progression criteria will be based on demonstrating a positive outcome in treatment, successful delivery of the pilot study protocol, acceptability to all stakeholders and satisfactory recruitment rates.

TRIAL REGISTRATION

ClinicalTrials.gov website ( NCT05365126 Unique Protocol ID: 19ET004). Registered on 06 May 2022.

Relationship of cepstral analysis with voice self-assessments in dysphonic and normal speakers

PURPOSE

This study aimed to investigate the relationship of cepstral analysis (Cepstral Peak Prominence [CPP] and Cepstral Peak Prominence-Smoothed [CPPS]) with voice self-assessments (The Persian version of vocal tract discomfort [VTDp] scale and non-standard hoarseness self-assessment [NHS] questionnaire).

METHODS

223 participants (159 with and 64 without dysphonia) were asked to utter the vocal tasks namely vowels /a/ and /e/, six standard sentences, and a non-standard connected speech sample. CPP and CPPS were calculated in these three vocal tasks using the "Praat" software. The participants also asked to complete the VTDp scale and the NHS questionnaire.

RESULTS

The means of frequency and severity the VTDp and the means of NHS were statistically different between the dysphonic and normal voice groups (P < 0.05), except for tickling (P > 0.05). There was a very low significant correlation between cepstral analysis with aching and in the dysphonic group (P < 0.05). However, a very low to low significant correlation between cepstral analysis with burning, tight, aching, tickling, sore, and both frequency and severity subscales scores of the VTDp in the normal voice group (P < 0.05). Moreover, the means of the cepstral analysis did not differ significantly between all scores of the NHS in the dysphonic the normal voice groups (P > 0.05), except for 1 with 3, 4, and 5 in the dysphonic group (P < 0.05).

CONCLUSION

The cepstral analysis can provide some information about the status of vocal tract and person's perception of his/her own voice quality.

Vocal Tract Discomfort Symptoms in Elementary and High School Teachers

OBJECTIVES

The vocal tract discomfort scale is a self-rating seven-point Likert scale that quantifies frequency and severity of eight qualitative descriptors including burning, tight, dry, aching, tickling, sore, irritable, and lump in the throat, and ranges from 0 (never/none) to 6 (always/extreme; Mathieson et al. 2009). The objectives of the current study were to compare the vocal tract discomfort scale results between elementary school teachers and high school teachers and between male and female teachers using the Persian vocal tract discomfort scale. Also, teachers in different age ranges and with different experiences were compared regarding vocal tract discomfort symptoms.

METHODS

The researchers chose 20 elementary and high schools by simple random sampling in Khorramabad, Iran. The survey was given to available teachers of the selected schools. Considering the inclusion criteria, required sample size, and after excluding questionnaires that were not correctly answered, 120 were selected such that 30 were chosen for each subgroup. Subjects consisted of 60 elementary school teachers (30 females and 30 males) with the mean age of 40.92 years (standard deviation = 6.07) and 60 high school teachers (30 females and 30 males) with the mean age of 40.67 years (standard deviation = 6.00). SPSS 25 was used for analyzing the data.

RESULTS

Results indicated that the frequency and severity of the vocal tract discomfort in elementary school teachers were significantly higher than for the high school teachers with a medium to large effect size. Although the frequency and severity of the symptoms were higher in female compared with male teachers, those differences were not significantly different. Younger teachers had lower frequency and severity ratings of vocal tract discomfort symptoms than older teachers. Teaching experience was not an important factor in predicting vocal tract discomfort symptoms in teachers.

CONCLUSIONS

The results of this study suggest that there is higher frequency, greater severity, and higher percentages of vocal tract discomfort symptoms in elementary compared with high school teachers. In addition, although the mean frequency and severity of vocal tract discomfort symptoms were not significantly different between females and males, females reported higher percentages of the symptoms. Because each of the eight vocal tract symptoms was experienced at the time of testing by between 42% (tightness) and 68% (dryness) of the participants, it is suggested that an educational program regarding vocal tract discomfort may be helpful for this profession.

[Vocal tract discomfort and wellbeing of caregivers for the elderly during the pandemic]

BACKGROUND

During the Sars-CoV2-pandemic, people working in healthcare such as caregives for the elderly face additional burden, e.g. by the use of face masks.

METHODS

In a prospective study, the emotional and physical wellbeing as well as the vocal tract discomfort of caregivers of two municipal homes for the elderly were assessed by questionnaires, the Mini-SCL and the Vocal Tract Discomfort Scale (VTDS), and one on personal data (sex, age, lung disease, previous SARS-CoV2-infection) and on voice symptoms.

RESULTS

67% of the questionnaires were answered by 56 women and 11 men aged 45.2 ± 11.5. In the Mini-SCL, increased scores were found in depression in 23.8%, anxiety in 49.3%, somatization in 55.2% and in the global score in 44.7%. 52%. showed increased scores in the VTDS Significant correlations were found in between the subscales of the Mini-SCL and the VTDS as well as to dysphonia symptoms.

DISCUSSION

Psychological problems, somatization and vocal tract discomfort is more frequently reported by caregivers for the elderly than in the normal population. The VTDS, voice symptoms and the Mini-SCL scales are significantly related. Training on vocal hygiene should be included in workplace health promotion during the pandemic.

Comparison of teachers’ voice disorders before and during COVID -19 pandemic

Purpose: The aim of the study was to analyze the impact of the COVID-19 pandemic and the associated change in teaching mode from stationary to distance learning on the severity of voice-related complaints among teachers. Materials and methods: A questionnaire survey of teachers was conducted to assess voice disorders during stationary and remote work using the Vocal Tract Dyscomfort (VTDs) scale and Numeric Rating Scale (NRS), and respondents' subjective feelings were assessed. The demographic and environmental factors related to voice work were examined. Data on sickness absenteeism obtained from the Healthcare Needs Maps 2020 of the Ministry of Health were also analyzed. The statistical analysis of responses was conducted. A p-value below 0.05 was considered statistically significant. Results: 128 teachers participated in the survey. The overall assessment of voice disorders using VTDs and NRS scales did not show statistically significant differences for complaints between stationary and remote work. Detailed analysis revealed more severe voice disorders in teachers working more than 6 months remotely (p = 0.049) and having more than 20 lessons per week (p = 0.012). The subjective assessment confirmed a significantly lower percentage of teachers reporting voice disorders during remote work compared to stationary work (p = 0.043). This resulted in a reduction of sickness absences and a 40% decrease in sick leave related to voice disorders in 2020 compared to 2019. Conclusions: During the remote learning period in the COVID-19 pandemic, teachers reported lower severity of voice disorders and this contributed to a reduction in sickness absences. There were no statistically significant differences in voice-related complaints assessed by the VTDs and NRS scales for either mode of teaching. Several factors affecting the severity of vocal tract disorders were identified - the number of teaching hours per week (> 20) for stationary work and a long period of remote teaching (> 6 months).

Cross-Validation and Normative Values for the German Vocal Tract Discomfort Scale

Purpose The Vocal Tract Discomfort Scale (VTD Scale) is a self-rating questionnaire investigating physical symptoms in the larynx associated with vocal pathology. The aim of this work was to investigate the reliability, validity, sensitivity, and specificity of the first German version and to provide normative data with thresholds for pathology and a scaling scheme. Study Design A retrospective multicenter study was performed. Method A total of 571 participants (409 female and 162 male), with a mean age of 47.2 years, were recruited at three German centers; of these, there were 447 participants with voice disorder and 124 vocally healthy participants. The clinical examination consisted of patient history, visual laryngeal examination, acoustic and aerodynamic assessment, perceptual analysis by the Grading-Roughness-Breathiness-Asthenia-Strain Scale, and subjective evaluation using the VTD Scale and the Voice Handicap Index (VHI). Statistics included group comparisons (t test and analysis of variance), Pearson correlation coefficient (between VTD Scale and VHI), and Cronbach's alpha to assess validity and reliability. Analysis of receiver operating characteristics was performed to examine VTD Scale's discriminatory ability and provide a cutoff score. Additionally, percentiles were applied to provide VTD Scale ranges. Results There were highly significant differences between healthy participants and participants with voice disorder regarding the total score and both subscales of the VTD Scale. Internal consistency was excellent (α = .928). We found moderate, positive correlation between the VTD Scale and VHI (ρ = .596, p < .001). Receiver operating characteristics analysis showed an area under the curve of 0.876 (p < .001, 95% confidence interval [0.846, 0.906]). VTD Scale ranges were no (score: 0-13), mild (score: 14-26), moderate (score: 27-40), and severe (score: 41-96) disorder. Conclusions Results confirm an excellent reliability and validity of the German VTD Scale. It provides additional and independent diagnostic information and is a useful instrument to complement voice assessment. The scaling into four severity subgroups allows the tool to be used for screening patients and considers a transferral to a voice specialist.

Vocal tract discomfort in caregivers for the elderly during an interval of the COVID-19 pandemic

BACKGROUND

During the coronavirus disease 2019 (COVID-19) pandemic, professional caregivers caring for the elderly may experience more vocal tract problems in addition to regular high vocal demands while wearing face masks/coverings.

METHODS AND PARTICIPANTS

Vocal tract discomfort (VTD) was assessed in 64 caregivers in one home for the elderly (64% participation rate) in June 2020 using the German version of the VTD scale.

RESULTS

More than one-half of the participating caregivers experienced VTD, described mostly as dryness, irritability, and tightness. Approximately, 80% reported that sensations were not perceived before enhanced infection prevention standards were implemented.

CONCLUSIONS

Among caregivers caring for the elderly during the COVID-19 pandemic, special care should be focused on the voice and vocal tract well-being.

Vocal tract discomfort and voice handicap index in patients undergoing thyroidectomy

PURPOSE

This study aims to investigate the frequency and severity of vocal tract discomfort (VTD) symptoms and to determine the relationship between VTD and type of thyroidectomy, voice problem history, vocal abuse, and misuse behaviors, and the voice handicap index (VHI) in the thyroidectomy patients undergoing thyroidectomy, pre- and post-operatively pre- and post-thyroidectomy.

MATERIALS

The sample comprised 21 thyroidectomy patients undergoing thyroidectomy, including 10 patients with total thyroidectomy and 11 patients with partial thyroidectomy. The participants underwent videolaryngoscopy examination and completed the voice history questionnaire, the VTD scale, and the VHI, before and after the surgery.

RESULTS

Dryness was the most frequently occurring symptom, pre- and post-thyroidectomy. Participants with total thyroidectomy reported significantly higher frequency and severity of tickling than those in the preoperative status (p<.05). The frequency and severity of many VTD symptoms in the participants with voice problems and a vocal abuse and misuse history were higher than those without such a history at both assessment times (p<.05). There was significant correlation between the frequency and severity of VTD and VHI scores, pre-thyroidectomy pre-operatively (r = 0.488-0.575, p<.05).

CONCLUSIONS

An increment in the frequency and severity of tickling was reported by total thyroidectomy patients, post-thyroidectomy post-operatively. The type of thyroidectomy, voice problem history, and vocal abuse and misuse behaviors seem to influence the frequency and severity of VTD. Considering the correlation between VTD and VHI, the VTD scale provides important clinical information and can be used for evaluation and consultation purposes.

Vocal Tract Discomfort Scale (VTDS) and Voice Symptom Scale (VoiSS) in the Early Identification of Italian Teachers with Voice Disorders

Introduction  The current Italian law does not include any guidance regarding voice education, prevention of voice disorders and screening in subjects with high vocal loading such as teachers. Objectives  We aimed to check the correlation between the Vocal Tract Discomfort Scale (VTDS) with the Voice Symptom Scale (VoiSS) for the evaluation of Italian teachers. In addition, we aimed to investigate whether there are differences in the frequency and intensity of discomfort symptoms in teachers with disabilities comparing vocal tract discomfort symptoms in teachers with high risk (HRVD) and low risk (LRVD) of vocal disorders according to the VoiSS cutoff (> 15.5). Methods  We analyzed 160 Italian teachers (111 women and 49 men) that completed the VTDS and VoiSS at vocal evaluation. The Spearman correlation test was applied to all variables. The Mann-Whitney U test was used to compare the average number of discomfort symptoms among HRVD and LRVD teachers. Results  A moderate positive correlation was observed between the average number, frequency, and intensity of discomfort symptom and the total score, physical domain score, and limitation domain score of the VoiSS. Only the emotional domain score of the VoiSS showed a weak positive correlation ( p  < 0.001). Teachers considered in the HRVD group according to the VoiSS score had a higher number, frequency, and intensity of vocal tract discomfort symptoms. Conclusion  There is correlation between the VTDS and VoiSS scales. Like the VoiSS, the VTDS is a questionnaire that detects HRVD teachers. Therefore, the results suggest that both questionnaires could be useful for a preventive voice program for Italian teachers.

Transcultural Adaptation and Validation of the Korean Version of the Vocal Tract Discomfort Scale

OBJECTIVES

The present study translated the Vocal Tract Discomfort Scale (VTDS) into Korean (K-VTDS) and evaluated its reliability and validity.

STUDY DESIGN

This was a prospective study.

METHODS

The VTDS was first translated into Korean and validated. One hundred and fifty-nine patients with voice disorders were divided into three different diagnostic groups (functional, structural, and neurologic voice disorder) and 131 vocally healthy adults were also included. All participants completed the K-VTDS and the Korean version of the Voice Handicap Index (K-VHI) and Korean versions of the Voice-Related Quality of Life (K-VRQOL). The internal consistency of the K-VTDS was analyzed through Cronbach's α coefficient. The VTDS score differences related to the diagnostic groups were assessed with t test and analysis of variance. We assessed the correlation between the K-VTDS, the K-VHI, and the K-VRQOL using Pearson's correlation analysis.

RESULTS

High internal consistency and the test-retest reliability of the K-VTDS were found. The voice disorder group had significantly higher K-VTDS scores for the subscales and total scores than those in the healthy group (P < 0.001). The K-VTDS scores for the subscale of frequency and total scores were highest in the functional voice disorder group. We found a significant difference in frequency and total score of the K-VTDS between the functional voice disorder group and the structural voice disorder group (P < 0.05). We observed a strong positive correlation among the scores for the subscales of frequency and severity, and total scores in the K-VTDS. The K-VTDS showed moderate correlation with the K-VHI and the K-VRQOL.

CONCLUSION

The K-VTDS is a reliable and valid instrument for voice assessment for voice disorders in Korean-speaking patients.

The Vocal Tract Discomfort Scale: Validity and Reliability of the Persian Version in the Assessment of Patients With Muscle Tension Dysphonia

OBJECTIVE

To cross-culturally adapt of Persian Vocal Tract Discomfort (VTDp) scale and evaluate its validity and reliability in the assessment of patients with muscle tension dysphonia (MTD).

STUDY DESIGN

A cross-sectional and prospective cohort design was used to psychometrically test the VTDp.

METHODS

The VTD scale was cross-culturally adapted into Persian language following standard forward-backward translations. The VTDp scale was administrated to 100 patients with MTD (54 men and 46 women; mean age: 38.05 ± 10.02 years) and 50 healthy volunteers (26 men and 24 women; mean age: 36.50 ± 12.27 years). Forty-five patients with MTD completed the VTDp 7 days later for test-retest reliability. Patients also completed the Persian Voice Handicap Index (VHIp) to assess construct validity.

RESULTS

The results of discriminative validity demonstrated that the VTDp was able to discriminate between patients with MTD and healthy participants. The internal consistency was confirmed with Cronbach α .77 and 0.73 for VTDp frequency and severity subscales, respectively. The test-retest reliability was excellent with an intraclass correlation coefficient (ICC_agreement) of 0.93 for the frequency subscale and 0.91 for the severity subscale. Construct validity of the VTDp was shown with significant correlations between the VTDp frequency and severity subscales and the VHIp total scores (0.36 and 0.37, respectively). The standard error of measurement and smallest detectable change values for VTDp frequency (2.11 and 5.85, respectively) and severity (2.25 and 6.23, respectively) were acceptable. The Bland-Altman analysis for assessing the agreement between test and retest measurements showed no systematic bias.

CONCLUSION

The VTDp is a valid and reliable self-administered scale to measure patient's vocal tract sensations in Persian-speaking population.

Voz do professor: sintomas de desconforto do trato vocal, intensidade vocal e ruído em sala de aula

RESUMO Objetivo: Identificar se existe correlação entre a intensidade vocal das professoras e o ruído em sala de aula, assim como entre a intensidade vocal e os sintomas de desconforto do trato vocal, antes e após a aula. Métodos: Participaram 27 professoras do Ensino Fundamental I. Foram utilizados os questionários Condição de Produção Vocal do Professor e Escala de Desconforto do Trato Vocal, aplicados antes e após a aula. Para medição do ruído dentro da sala de aula e da intensidade vocal das professoras foi utilizado decibelímetro. Resultados: Houve correlação positiva moderada entre a intensidade vocal e o ruído. Observou-se diferença significativa entre a EDTV e as professoras com e sem queixa vocal antes e após a aula. Quando comparadas separadamente nos dois momentos, verificou-se aumento nos escores tanto para as professoras com queixa vocal quanto para as que não apresentaram queixa. Ocorreram associações dos sintomas do trato vocal antes e após a aula, da frequência de queimação, coceira, garganta irritada e garganta sensível. A intensidade dos sintomas foi significativa para garganta dolorida, coceira e bola na garganta. Observaram-se valores significativos sobre intensidade vocal e frequência e intensidade dos sintomas para garganta sensível e bola na garganta antes da aula e garganta irritada e bola na garganta após a aula. Conclusão: O aumento da intensidade vocal das professoras correlaciona-se aos altos níveis de ruído. Constata-se correlação entre intensidade vocal e sintomas de desconforto do trato vocal, sendo a maioria dos sintomas relatados com maior frequência e intensidade após a aula.