Development Of Voice Disorders Research Articles

Quantifying the Occupational Voice Use of Teachers.

The teaching profession is a high-voice use occupation at elevated risk for developing voice disorders. Continued research on teachers' vocal demands is necessary to advocate for and establish vocal health programs. This study quantified ambulatory vocal dose measures for teachers during both on- and off-work periods, comparing their occupational voice use to that in other studies that have reported percent phonation ranging from 17% to 30%. Participants included 26 full-time, female school teachers between 23 and 55 years of age across multiple grades and subjects, including individuals with and without a voice disorder. Ambulatory voice data were collected from weeklong voice monitoring that recorded phonatory activity through anterior neck-surface vibration. Three vocal dose measures-time, cycle, and distance doses-were computed for each participant for three time periods: on-work weekdays, off-work weekdays, and off-work weekend days. The teachers' average percent phonation was 16.2% on-work weekdays, 8.4% off-work weekdays, and 8.0% off-work weekend days. No statistically significant differences for vocal dose measures were found between off-work weekdays and weekend days. Overall, all vocal dose measures were approximately 2 times higher during work relative to off-work time periods. This study provides values for vocal dose measures for school teachers using ambulatory voice-monitoring technology. The vocal demands of this particular teacher sample and voice activity detection algorithm are potential factors contributing to percent phonation values on the lower end of the range reported in the literature. Future work is needed to continue to understand occupational voice use and its associated risks related to voice health, with the ultimate goal of preventing and managing voice disorders in individuals engaged in high-risk occupations.

Work-Related Vocal Challenges of Online Teaching: A Study of Female College Professors

College professors are at an elevated risk of developing voice disorders due to increased vocal demands associated with their working conditions, including high background noise levels, long reverberation times, prolonged voice use duration, and large class sizes. However, the impact of online classes on vocal health among college professors remains unclear. This longitudinal study aimed to characterize voice changes associated with online teaching among female Colombian college professors. Thirteen female college professors teaching online classes completed an online survey that included questions about voice functioning, working conditions, the Spanish translation of the Vocal Fatigue Index (VFI), and the Spanish translation of the Voice-Related Quality of Life. Instrumental measurements were also performed, including environmental background noise levels, hearing screening, and voice recordings before and after a synchronous online class. This study found a decreased fundamental frequency in connected speech (reading) associated with the number of students per class, the number of classes per week, and background noise levels measured with a sound level meter. L1L0 was statistically smaller among experienced teachers with higher background noise levels compared with less-experienced colleagues in quieter classes. 1558kHz was statistically associated with the average number of students, whereas HNR was slightly higher for professors with more students and more classes per week. The findings suggest that online teaching has important implications for voice production among participating teachers. This study highlights the importance of considering working conditions during online classes when designing workplace prevention programs for college professors.

Acoustic Parameters in the Evaluation of Voice Quality of Choral Singers. Prototype of Mobile Application for Voice Quality Evaluation

Choral singers are among intensive voice users whose excessive vocal effort puts them at risk of developing voice disorders. The aim of the work was to assess voice quality for choral singers in the choir at the Polish-Japanese Academy of Information Technology. This evaluation was carried out using the acoustic parameters from the COVAREP (A Collaborative Voice Analysis Repository For Speech Technologies) repository. A prototype of a mobile application was also prepared to allow the calculation of these parameters. The study group comprised 6 male and 19 female choir singers. The control group consisted of healthy non-singing individuals, 50 men and 39 women. Auditory perceptual assessment (using the RBH scale) as well as acoustic analysis were used to test the voice quality of all the participants. The voice quality of the female choir singers proved to be normal in comparison with the control group. The male choir singers were found to have tense voice in comparison with the controls. The parameters which proved most effective for voice evaluation were Peak Slope and Normalized Amplitude Quotient.

Risk Factors for Voice Disorders among Fado Singers: A Cross-Sectional Study

Fado is an urban Portuguese musical style rooted in popular culture. Previously found data suggests that Fado singers may have an increased risk of developing voice disorders. (1) Aim: To determine the risk factors for the development of voice disorders among Fado singers. (2) Methods: A cross-sectional study was conducted through the administration of a questionnaire containing questions related to voice disorders in singers. The relationship between personal and social data, musical background, performance demands and habits, vocal health and wellbeing, and strategies to overcome voice problems are reported. Beyond a comprehensive characterization, odds ratios (ORs) and their 95% confidence intervals (CIs) for the association with voice disorders were calculated through univariate and multivariate logistic regression analyses. (3) Results: The significant risk factors for voice disorders were as follows in decreasing order: nose-related disorders; decongestants or antihistamines; oral contraceptives or hormone replacement therapy; previous smoking habits; and vocal fatigue after performances. (4) Conclusion: These activities significantly increased the risk of developing voice disorders. The evidence from this study and the relative low prevalence of self-reported voice disorders suggest that these singers may develop a kind of protective combination of factors beyond the scope of this research.

Comparing Vocal Health and Attitudes to Voice care in Primary Teachers and Voiceover Artists – A Survey Study Using the Health Belief Model

A range of professions experience high demands on their voices and are potentially at risk of developing voice disorders. Teachers have been studied extensively in this respect, while voiceover artists are a growing professional group with unknown levels of voice training, voice problems and voice care attitudes. To better understand profession-specific voice care requirements, we compared voice training, voice care habits and self-reported voice problems of these two professional groups and measured attitudes to voice care, informed by the Health Belief Model (HBM). The study was a cross-sectional survey study with two cohorts. We surveyed 264 Scottish primary school teachers and 96 UK voiceover artists . Responses were obtained with multiple-choice and free-text questions. Attitudes to voice care were assessed with Likert-type questions that addressed five dimensions of the HBM. Most voiceover artists had some level of voice training, compared to a minority of teachers. Low numbers of teachers reported regular voice care, compared to over half of voiceover artists. Higher numbers of teachers reported work-related voice problems. Voiceover artists reported greater awareness for vocal health and perceived potential effects of voice problems on their work as more severe. Voiceover artists also saw voice care as more beneficial. Teachers perceived barriers to voice care as substantially higher and felt less confident about voice care. Teachers with existing voice problems showed increased perceptions of voice problem susceptibility and severity and saw more benefit in voice care. Cronbach's alpha was below 0.7 for about half of the HBM-informed survey subsets, suggesting that reliability could be improved. Both groups reported substantial levels of voice problems, and different attitudes to voice care suggest that the two groups require different approaches to preventative intervention. Future studies will benefit from the inclusion of further attitude dimensions beyond the HBM.

Speaking with mask in the COVID-19 era: Multiclass machine learning classification of acoustic and perceptual parameters.

The intensive use of personal protective equipment often requires increasing voice intensity, with possible development of voice disorders. This paper exploits machine learning approaches to investigate the impact of different types of masks on sustained vowels /a/, /i/, and /u/ and the sequence /a'jw/ inside a standardized sentence. Both objective acoustical parameters and subjective ratings were used for statistical analysis, multiple comparisons, and in multivariate machine learning classification experiments. Significant differences were found between mask+shield configuration and no-mask and between mask and mask+shield conditions. Power spectral density decreases with statistical significance above 1.5 kHz when wearing masks. Subjective ratings confirmed increasing discomfort from no-mask condition to protective masks and shield. Machine learning techniques proved that masks alter voice production: in a multiclass experiment, random forest (RF) models were able to distinguish amongst seven masks conditions with up to 94% validation accuracy, separating masked from unmasked conditions with up to 100% validation accuracy and detecting the shield presence with up to 86% validation accuracy. Moreover, an RF classifier allowed distinguishing male from female subject in masked conditions with 100% validation accuracy. Combining acoustic and perceptual analysis represents a robust approach to characterize masks configurations and quantify the corresponding level of discomfort.

Introducing a New Dosimeter for the Assessment and Monitoring of Vocal Risk Situations and Voice Disorders

There are many physiological parameters recorded by devices that are becoming more affordable, precise and accurate. However, the lack of development in the recording of voice parameters from the physiological or medical point of view is striking, given that it is a fundamental tool for the work of many people and given the high incidence and prevalence of voice pathologies that affect people's communication. In this paper we perform a complete literature review on the dosimeters used in voice research and to present a prototype dosimeter with a pilot study to show its capabilities. We conducted a literature review using the keywords [MONITORING], [PHONATION], [ACCUMULATOR], [PORTABLE], [DOSIMETRY], [VOICE] searching in PubMed, Trip Database, HONcode, and SciELO search engines. From our review of dosimeter designs, we created our own prototype consisting of two main components: a Knowles Electronics BU-7135-0000 accelerometer mounted on a neck brace; and the ultra-low power MSP430FR5994 microcontroller. The selected sampling frequency was 2048 Hz. The device calculates the F0 every 250 ms and the amplitude and phonation activity every 31.25 ms. A pilot study was conducted using 2 subjects: one male during 11 days and one female during 14 days. This work includes devices that have been created during the last 45 years as tools for the diagnosis and monitoring of the treatment of cases of vocal pathology and for the detection of phonatory patterns or risk situations for developing voice disorders or vocal pathologies. We also present recordings with our new device on the pattern of daily talk time, the fundamental frequency and the relative intensity of two subjects on different days. Interesting work has been done in the development of voice dosimeters with different approaches. In our experience it is not possible to access them for research and they are not yet in clinical use. It is possible that a joint approach with voice and voice disorders professionals and engineers working closely together could take advantage of current technology to develop a fully portable, useful, and efficient system.

Vocal fatigue perceived in remote working by teachers of different school grades during COVID-19 pandemic

ObjectiveTeachers have an increased prevalence of voice disorders. The present study aimed to investigate the impact of remote teaching on perceived voice fatigue among Italian teachers of all grades during the lockdown due to the COVID-19 pandemic. Methods The participants were 195 female teachers (Mage=48.77; SDage=9.61) in primary, secondary, and high schools. They completed the Vocal Fatigue Index (VFI) through an online survey. The tool includes 19 items grouped into three dimensions: tiredness of voice and avoidance of voice use (TA); physical discomfort (PD); and improvement of symptoms with rest (IS). The participants reported their perceived voice fatigue during remote teaching. They were also asked to provide data about voice fatigue as perceived in previous classroom teaching. The data were analyzed through two sets of independent one-way ANOVAs, with voice fatigue subscales as criterion variables and school grade as a between-subjects factor. ResultsThe teachers involved in the study reported higher voice fatigue scores than vocally healthy adults from the general population. Primary school teachers showed higher voice fatigue during remote teaching than both secondary and high school teachers, specifically for the TA and PD dimensions, whereas no difference emerged for IS. The VFI scores of primary school teachers were similar to those of dysphonic individuals. ConclusionThe results of the study confirm that primary school teachers are more vulnerable to developing voice disorders and suggest the need for specific vocal health interventions in case of prolonged remote work.

Vocal Behavior of Teachers Reading with Raised Voice in a Noisy Environment.

(1) Objective: Teaching is a particularly voice-demanding occupation. Voice training provided during teachers’ education is often insufficient and thus teachers are at risk of developing voice disorders. Vocal demands during teaching are not only characterized by speaking for long durations but also by speaking in noisy environments. This provokes the so-called Lombard effect, which intuitively leads to an increase in voice intensity, pitch and phonation time in laboratory studies. However, this effect has not been thoroughly investigated in realistic teaching scenarios. (2) Methods: This study thus examined how 13 experienced, but vocally untrained, teachers behaved when reading in a noisy compared to quiet background environment. The quiet and noisy conditions were provided by a live audience either listening quietly or making noise by talking to each other. By using a portable voice accumulator, the fundamental frequency, sound pressure level of the voice and the noise as well as the phonation time were recorded in both conditions. (3) Results: The results showed that the teachers mainly responded according to the Lombard effect. In addition, analysis of phonation time revealed that they failed to increase inhalation time and appeared to lose articulation through the shortening of voiceless consonants in the noisy condition. (4) Conclusions: The teachers demonstrated vocally demanding behavior when speaking in the noisy condition, which can lead to vocal fatigue and cause dysphonia. The findings underline the necessity for specific voice training in teachers’ education, and the content of such training is discussed in light of the results.

The Prevalence of Voice Disorders and the Related Factors in University Professors: A Systematic Review and Meta-Analysis.

This systematic review and meta-analysis aimed to estimate the prevalence of voice disorders and related factors in university professors. In this systematic review, Medline, Scopus, Embase, Cochrane Library, Eric, ProQuest, Magiran, Scientific Information Database and IranDoc databases were searched. The search was limited to January 1990 and May 2020. The inclusion criteria were reports of the prevalence of voice disorders in university professors and original studies in English and Persian languages. The exclusion criteria were studies assessing voice disorders in school or music teachers; the full-text not available; and case studies, conference papers, and review studies. All eligible studies were selected and critically appraised using the Joanna Briggs Institute checklist. Finally, a meta-analysis was performed using STATA 16.0 statistical software. The preliminary search yielded 1251 articles and 18 of which met the eligibility criteria. The overall prevalence of voice disorders in university professors was 41% (Pooled prevalence: 0.41, 95% CI: 0.34-0.49, P-value < 0.001). Country-based analysis showed that the highest prevalence of voice disorders among university professors was in Iran 69% (Pooled prevalence: 0.69, 95% CI: 0.62-0.76) and the lowest was in China 20% (Pooled prevalence: 0.20, CI: 0.14-0.27). Among 4037 university professors, caffeine consumption was the most frequent related factor (87%) and dry throat was the most frequent symptom (46%). The present study yielded about 41% of the professors had voice disorders. Among the influential habits, caffeine consumption and among the symptoms, dry throat were very common in university professors. Due to the cross-sectional nature of our studies, we were not able to perform further analyses on the risk factors for voice disorders. Therefore, more longitudinal surveys are needed for reaching a more reliable and deep view into the development of voice disorders.

An investigation about the relationship between dysarthria level of speech and the neurological state of Parkinson’s patients

Parkinson’s disease (PD) is the most common neurological disorder that typically affects elderly people. In the earlier stage of disease, it has been seen that 90% of the patients develop voice disorders namely hypokinetic dysarthria. As time passes, the severity of PD increases, and patients have difficulty performing different speech tasks. During the progression of the disease, due to less control of articulatory organs such as the tongue, jaw, and lips, the quality of speech signals deteriorates. Periodic medical evaluations are very important for PD patients; however, having access to a medical appointment with a neurologist is a privilege in most countries. Considering that the speech recording process is inexpensive and very easy to do, we want to explore in this paper the suitability of mapping information of the dysarthria level into the neurological state of patients and vice versa. Three levels of severity are considered in a multiclass framework using time–frequency (TF) features and random-forest along with an Error-Correcting Output Code (ECOC) approach. The multiclass classification task based on dysarthria level is performed using the TF features with words and diadochokinetic (DDK) speech tasks. The developed model shows an unweighted average recall (UAR) of 68.49% with the DDK task /pakata/ based on m-FDA level, and 48.8% with the word /petaka/ based on the UPDRS level using the Random Forest classifier. With the aim, to evaluate the neurological states using the dysarthria level, the developed models are used to predict the MDS-UPDRS-III level of patients. The highest matching accuracy of 32% with the word /petaka/ is achieved. Similarly, the multiclass classification framework based on MDS-UPDRS-III is applied to predict the dysarthria level of patients. In this case, the highest matching accuracy of 18% was obtained with the DDK tasks /pataka/.

Considerations and demands in the voice care of contemporary commercial singers in occupational health and safety aspects.

Singers, classified as "vocal performers" are at an increased risk of developing voice disorders. The area of contemporary commercial singing has not been studied as extensively as classical singing. Non-classical singing is generally considered detrimental to vocal health and thus the information on challenges contemporary commercial singers (CCS) pose to otolaryngologists and other healthcare professionals is scarce. The authors present an overview of contemporary commercial singing styles in comparison to classical singing, discuss the notion of non-classical style being harmful to vocal health, present major risk factors associated with developing voice disorders in contemporary commercial singers, and outline the diagnostic process of vocal health assessment in this group of occupational voice users. Given that contemporary commercial singers constitute a unique and vast group of elite vocal performers, the authors stress the importance of raising awareness among healthcare professionals of the fact that these patients require special considerations for voice evaluation and treatment in the occupational health and safety framework. Med Pr. 2022;73(1):33-41.

Vocal Health and Vocal Health Knowledge Among Occupational Voice Users in the Province of Quebec

Voice disorders are frequent among occupational voice users such as teachers. Although these disorders can have serious personal and professional consequences, they are not often recognized as occupational diseases and little attention is paid to their prevention. This study aimed to provide a portrait of the self-reported vocal health and vocal health knowledge of occupational voice users in Quebec, Canada, and to identify risk factors associated with voice disorder symptoms. We conducted an online survey targeting occupational voice users in the province of Quebec, Canada, with a focus on those involved in teaching or training. The final sample, after excluding incomplete surveys, included 808 respondents (665 women, M = 41.5 ± 10.4 years old). The survey responses were analyzed using descriptive and inferential statistics. Results indicated that 9.8% of the respondents had a history of a diagnosed voice disorder and 68.8% of the respondents experienced at least one voice symptom on a regular basis. Ordinal logistic regressions revealed that several personal and environmental factors are associated with an increased risk of developing voice disorders symptoms: being a woman, suffering from a breathing disorder, allergies, acid reflux and/or hearing impairment, having less work experience, working with elementary school children and/or with continuous or speech noise in the background. Most of the respondents (94.6%) had never received information regarding voice disorders during their academic training and less than half of them (47.7%) knew which professionals can treat voice disorders. These findings highlight the need for formal vocal health education among both occupational voice users and their employers to improve prevention and treatment for voice disorders in an at-risk population.

Incidence of Voice Disorders among Private School Teachers in Taiwan: A Nationwide Longitudinal Study.

Background: Teachers are more likely to use a loud voice at work than the general working population, but few longitudinal studies have been conducted on their risk of voice disorders. The occurrence of voice disorders in private school teachers was assessed by using the Longitudinal Health Insurance Database 2000 of Taiwan, which contains information on a random sample of 1 million beneficiaries of National Health Insurance. Methods: This study included private school teachers who were under 35 years old and newly employed between 2000 and 2010, and used workers with other occupations as the comparison cohort. Patients with voice disorders were identified using diagnostic codes on insurance claims. Cox proportional hazards regressions were applied to obtain relative risk estimates. Results: After adjusting for age, sex, income, and comorbidities of sinusitis and laryngitis, private school teachers had a higher risk of developing voice disorders (hazard ratio [HR] = 1.58; 95% confidence intervals: 1.43–1.75). In addition, the finding that elementary and high-school teachers had a higher risk than college teachers (HR: 2.56 vs. 1.44) and the pattern of increases in cumulative incidence over time supported a dose–response relationship between teaching and voice disorders. Conclusions: Private school teachers had higher risks of voice disorders. The results support the causality between occupation and voice disorders in teachers.

Clinical characteristics of singers attending a phoniatric outpatient clinic

Purpose: Studies suggest that singers are over-represented in voice clinics and present a high risk of developing voice disorders. This retrospective study aims to describe the characteristics of 78 singers consulting a phoniatrician. Methods: In their medical files, data related to age, gender, occupational status, singing training, musical style, voice complaint, diagnosis, voice-quality grading (GRBAS) and treatment were gathered. Results: The patients were mostly female singers (87%). Non-professional singers (semi-professional included) represented 64%, professional singers 25% and students of singing 11%. The majority of singers were choristers (27%) and 22% were classical-style/oratorio-style singers. Two-thirds of the population had intensive vocal activity in speech or singing. Vocal endurance, somatosensory signs and difficulties with high pitches were the most frequent symptoms. Among the patients, 79% presented with singing-voice disorders with 85% of these having vocal fold lesions. Generally, their speaking voices were preserved. Vocal-folds nodules were the most prevalent pathology (37%) followed by sulcus (26%) and voice therapy was the main treatment. Conclusions: This study emphasizes the fact that singers have specific voice complaints related to their voice usage. The high occurrence of sulcus and other congenital-lesion suspicions, unusual in the general population consulting an ENT phoniatrician, seems to be rather specific for singers in agreement with the literature.

Acoustic-Perceptual Correlates of Voice Among Steam Train Engineers: Effects of Noise and Hearing Protection

Occupational voice users are at a higher risk for developing voice disorders due to their vocal demands, such as prolonged periods of work-related voice use and nonideal environmental factors, such as speaking above background noise. The current study focused on the effects of background noise and hearing protection on acoustic-perceptual correlates of voice among steam train engineers. Fourteen participants phonated vowel /a/, read a phrase, and described a map under different noise and hearing protection conditions. Relative sound pressure level, relative fundamental frequency, and perceived vocal effort and disturbance decreased in the presence of hearing protection for all noise conditions. In contrast, these acoustic measures increased in the absence of hearing protection supporting Lombard effect. Overall, results of the current study provide insight into possible risks to vocal health in workers exposed to high levels of background noise and use hearing protection.

Gender differences in vocal doses among occupational voice users: a systematic review of literature and meta-analysis

Background Occupational voice users such as teachers, singers, and broadcasters have high vocal demands increasing the risk for developing voice disorders. Among occupational voice users, the literature has report gender differences in vocal doses as part of vocal demands. However, these differences have not been quantified. Objective To determine differences per gender on vocal doses among different groups of occupational voice users. Methods A systematic review of literature and meta-analysis were conducted on publications about vocal dose among occupational voice users. In total, 242 potential articles were found. After screening of titles and abstracts, 16 papers were included for full revision in the systematic review of literature. For the meta-analysis, 7 out of 16 papers were included. Results Females had higher phonation time percentage compared with males (mean difference = 1.44, p value = .16). Nevertheless, this difference was not statistically significant. Among call centre operators, there was no difference in time doses associated with gender. Sport teachers had high values in time dose percentage, dissipation, and radiated energies. Conclusions The meta-analysis shows variations in time doses, which could be associated with the vocal demand responses for females compared with males in occupational voice settings. Future investigations are required for establishing safe limits criteria for vocal doses, as well as vocal functioning in different working context.

Comparison between male and female teachers in Egyptian primary schools regarding the effect of teaching on their voice

BackgroundTeachers are more likely to develop voice disorders compared to non-teachers in other occupations. Teachers are often cited as a high-risk group for vocal dysfunction as they use their voices extensively over their profession for instructing and managing students, also due to other extra loading factors, such as background noise, long speaking distance, poor room acoustics, and lack of adequate equipment, like voice amplifiers. The primary school teachers are particularly at risk as they have little opportunity for voice rest during the working day. Gender is another factor affecting incidence of voice disorders. Female teachers seem to be more affected by voice disorders than male teachers. The aim of our study was to compare between genders (male–female teachers) in primary schools to show the effect of teaching and other risk factors on their voice for proper management.ResultsThe study showed that there were statistically significant differences between male teachers and female teachers regarding history of voice change; female teachers had history of voice change more than male teachers. Female teachers suffered from emotional stress more than male teachers, and this affects their voice. In addition, study showed a significant association between the grade of dysphonia and VHI.ConclusionThere is evidence that female teachers are complaining more of voice change and suffering from voice disorders than males. Besides, female teachers are showing a higher degree of emotional stress. This may necessitate a combined assessment of the voice and psychological profile of all teachers with voice change.

Vocal Quality, Symptoms, and Habits in Musical Theater Actors

The purpose of this study was to measure and compare the voice characteristics and vocal complaints and habits of musical theater actors and musical theater students. Thirty participants were included in the study, 18 musical theater students and 12 professional musical theater actors. Vocal quality was measured by the multiparameter indices Dysphonia Severity Index (DSI) and Acoustic Voice Quality Index (AVQI). A perceptual evaluation of the speaking voice was performed using the GRBASI scale. All participants completed the Voice Handicap Index (VHI), the VHI adapted to the singing voice, the Vocal Tract Discomfort (VTD) Scale and the Corporal Pain Scale. Excellent scores for DSI (resp. 7.3, 7.1) and AVQI (resp. 2.6, 2.5) were found in the musical theater actors and students. All participants reported at least two symptoms of VTD and the mean scores for the VHI adapted to the singing voice were located in the clinical zone. Musical theater students reported significantly more VTD and pain symptoms compared to the professionals. No significant differences in perceptual and objective voice characteristics were found between musical theater actors and students. A higher presence of vocal misuse and stress in the students was observed. Musical theater students and actors are elite vocal performers with comparable excellent objective vocal measures (DSI, AVQI). In both groups, an increased number of VTD and complaints of the singing voice were reported. Especially students were vulnerable for stress, vocal misuse, VTD, and pain symptoms. The findings suggest that musical theater actors are a risk group for developing voice disorders requiring multidimensional voice assessment and voice care.

The Effect of Upper Airway Ailments on Teachers’ Experience of Vocal Fatigue

Teachers have been found to have a higher than normal risk to develop voice disorders. One common symptom of voice problems among teachers is the report and occurrence of vocal fatigue, often associated with different individual, physical, environmental, and professional factors. The aim of this study was to provide insight into the potential effect of sinus infections, laryngitis, colds, seasonal allergies, and reflux on reported vocal fatigue, as quantified by the Vocal Fatigue Index (VFI). An exploratory cross-sectional design was implemented via an online survey sent by email to teachers of kindergarten through 12th-grade in 31 states throughout the USA. The main result of this study was that teachers with self-reported reflux and seasonal allergies had statistically significant higher scores on VFI Factor 1 (performance), VFI Factor 2 (pain), and VFI Factor 3 (recovery) when compared to those without self-reported reflux and seasonal allergies. It may be likely that an individuals' change in reported vocal fatigue over time may be also associated with health-related factors, such as reflux and seasonal allergies rather than just changes in voice production. These associated factors should be considered and potentially controlled for in future research and clinical practice surrounding teachers' experience of vocal fatigue.