High Vocal Demands Research Articles

Revisiting the etiology and clinical characteristics of hemorrhagic polyps of the vocal fold.

Benign phonotraumatic lesions of the vocal folds (BVFLs) are typically seen in younger female patients with high vocal loads. Hemorrhagic polyps (HPs) do not fit the classic paradigm of most BVFLs, as they tend to occur in an older population, have a male predominance, and report to result from a vocal accident. We present one of the largest cohorts of HPs, to reexamine their etiology and clinical features. Retrospective cohort study, inclusive of all patients with HP managed by the senior authors between the years 2016 through 2023. Demographic data, management, phonotraumatic risk factors, pre- and post-treatment VHI-10 were reviewed. We examined patient videostroboscopy, categorized the size of the lesion, and identified any concurrent mucosal abnormality. One hundred and eleven patients had confirmed HP, 84 males (75.7%). Thirty-five patients were size category 1; pinpoint (28.9%), 57 were category 2; less than 1/3rd the vocal fold (45.5%), and 26 were category 3; greater than 1/3rd the vocal fold (21.5%). Ten patients (9%) had bilateral HPs. Thirty-five patients had an additional 40 mucosal lesions in addition to the HP(s). The onset of symptoms was gradual in 60% of patients. The mean pretreatment VHI-10 was 18.0 (SD 10.7), compared to 6.0 (SD 10.5) post-treatment, (p < .001). 57/111 patients reported high voice demand professions or recreational activities. The average self-reported talkative scale score was 7.6/10. Patients were managed with operative microdirect laryngoscopy and microflap excision (53.1%), in-office clinic potassium titanyl phosphate (KTP) laser (24.3%), voice therapy alone (7.2%), and KTP in the operating room (6.3%). In our cohort, most patients were male, had high vocal demands, reported gradual symptom onset, and almost a third of patients had additional BVFLs. Level 3: Retrospective cohort study.

Knowledge and Needs of Theology Students on Voice and Vocal Hygiene at a South African Institution of Higher Education

Preachers are professional voice users (PVUs) who regularly experience high vocal demands, often leading to vocal difficulties or disorders. Research has established that this often occurs due to a lack of sufficient knowledge of the vocal mechanism and vocal hygiene in this population. Student preachers are therefore also considered to be a potential at-risk group for the development of vocal difficulties once they enter the occupation. This study therefore aimed to determine the knowledge and needs of theology students at a South African institution of higher education regarding voice production and vocal hygiene. A cross-sectional online survey using non-probability purposive and convenience sampling was distributed to participants through email to obtain data on the education, training, needs, and knowledge of voice production, vocal hygiene, and voice use among the participants. A clear need was observed for education and training on vocal health and hygiene amongst the study population. The participants presented with limited knowledge about voice production and vocal hygiene; however, they also reported to not regularly implement this limited knowledge in day-to-day voice use or practice. This study found a willingness among participants to learn more about voice and vocal hygiene. This study confirmed that theology students, as future PVUs, receive minimal-to-no training on voice and vocal hygiene, despite their increased risk for voice difficulties.

Functional voice disorders in various occupational groups: an initial study in Ecuador

In recent years, the promotion of vocal health in the workplace has become increasingly important. Current literature has identified workers with high vocal demands as a high-risk group for developing Functional Voice Disorders (FVDs). However, in Latin American countries, such as the Republic of Ecuador, there is limited knowledge about this occupational pathology. The objective of this study was to compare the differences in the risk of developing FVDs among occupational groups by analyzing the records of qualifying occupational diseases in the country. The results should be interpreted with caution due to the underdiagnosis of occupational diseases. Given the importance of voice care, comprehensive epidemiologic studies are needed to identify more vulnerable workers.

Vocal Demand Response to the Educational Setting Based Communication Scenarios: A Single Subject Study

Objectives. This was a single-subject study, aimed to demonstrate different vocal demand situations that are typical for primary school and teacher's vocal demand response under two acoustical conditions, with and without voice amplification, during five working days. Methods. The long-term voice dosimetry with Vocal Holter Med (PR.O. Voice Srl) was carried out on a 49-year-old female teacher with voice disorders during daily teaching activities. A sound field amplification system (SFAS) PentaClass Runa was installed in the classroom. Voice dosimetry was provided under two different acoustical conditions: without SFAS (2 days) and with SFAS (3 days). Results. Phonation time percentage, sound pressure level (SPL), SPL SD, fundamental frequency (F0), F0 SD, cycle, and distance doses were investigated in seven communication scenarios (lessons, group/individual classes, sports lessons in the gym and schoolyard, breaks, lunch breaks, and other activities). The median scores of all voice parameters differed significantly between different vocal demand contexts. The significant statistical difference in the vocal demand response was in the communication situations with and without SFAS. In addition, the number of children, reverberation time, and ambient air relative humidity impacted voice SPL and the cycle dose. Conclusions. Lessons, sports lessons held in the gym or schoolyard, breaks, and lunch breaks were considered as high vocal demand communication situations requiring higher voice intensity and fundamental frequency, higher phonation time percentage, cycle, and distance doses. Group/individual work and other teacher activities during the day, unrelated to direct work with students, were categorized as low vocal demand communication scenarios.

Prevalence of Voice Disorders in the United States: A National Survey.

The prevalence of voice disorders has not been explored in the context of recent trends in voice use, including voice assistant technology and increased use of teleconferencing for remote work. The objective of this research is (1) to determine the prevalence of voice disorders in the adult population of the United States, and (2) to understand the association of voice disorders with demographic and voice use factors, including vocal demands, and use of teleconferencing and voice assistant technology. A survey pertaining to voice disorders and voice use was developed and administered to a representative sample of US population. Demographics and information related to risk factors for voice disturbance, including high vocal demands, teleconferencing, and voice-assistant use were also analyzed. A total of 1522 responses were included. Of these, 20.6% reported having had a voice disorder at some point in their life. This rate was higher in employed respondents, singers, and teachers (all p < 0.0001) and was notably higher in those who used teleconferencing technology and voice assistant technology (both p < 0.0001). Approximately 60% of this subset reported seeking medical care for their voice, 12.6% reported a current voice disorder, and 9.5% reported a voice problem that had recurred multiple times. Approximately 1 in 5 Americans surveyed has had a voice disorder. Risk factors for voice disorders include use of teleconferencing technology, voice assistant use, and occupational factors. 3 Laryngoscope, 134:347-352, 2024.

Effects of Occupation-Specific Vocal Stress on the Mental Health of Day Care Teachers

Introduction: Kindergarten teachers are exposed to numerous kinds of strains, such as noise, which can negatively affect their voices. This cross-sectional study investigates whether and to what extent the profession-specific high vocal demand is associated with the educators’ mental health. Methods: One hundred and ninety-two kindergarten teachers from Magdeburg, Germany and its surrounding areas aged 43.4 ± 12.8 years, voluntarily participated in a survey. Vocal demand and vocal demand response, general strain factors, and mental health were assessed by using questionnaires (self-check on voice demands, Rudow checklist, General Health Questionnaire, and Maslach Burnout Inventory). The statistical analyses were carried out using SPSS. Results: The interviewed educators felt stressed by the excessive number of work tasks and children in each class, noisy work environment, and loud conversations. In addition, educators complained of headaches and neck pain (66%), while 28% of them experienced hoarseness and a burning throat. The mental health of 39 of the educators was impaired, and nine were at an increased risk of burnout. Self-reported voice effort correlated low with mental health (r = 0.287; p < 0.001) and burnout risk (r = 0.306; p < 0.001). Conclusion: The vocal demands on educators in day care settings are very high, which is a major associated factor for the development of burnout syndrome and is also associated with headaches and neck pain. Measures for the prevention of occupational voice disorders and voice training should be a mandatory part of the educators’ training and must be offered as in-service training.

Closed-loop network of skin-interfaced wireless devices for quantifying vocal fatigue and providing user feedback

Vocal fatigue is a measurable form of performance fatigue resulting from overuse of the voice and is characterized by negative vocal adaptation. Vocal dose refers to cumulative exposure of the vocal fold tissue to vibration. Professionals with high vocal demands, such as singers and teachers, are especially prone to vocal fatigue. Failure to adjust habits can lead to compensatory lapses in vocal technique and an increased risk of vocal fold injury. Quantifying and recording vocal dose to inform individuals about potential overuse is an important step toward mitigating vocal fatigue. Previous work establishes vocal dosimetry methods, that is, processes to quantify vocal fold vibration dose but with bulky, wired devices that are not amenable to continuous use during natural daily activities; these previously reported systems also provide limited mechanisms for real-time user feedback. This study introduces a soft, wireless, skin-conformal technology that gently mounts on the upper chest to capture vibratory responses associated with vocalization in a manner that is immune to ambient noises. Pairing with a separate, wirelessly linked device supports haptic feedback to the user based on quantitative thresholds in vocal usage. A machine learning-based approach enables precise vocal dosimetry from the recorded data, to support personalized, real-time quantitation and feedback. These systems have strong potential to guide healthy behaviors in vocal use.

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

The study aimed to describe daily vocal demands, perceptions and knowledge as reported by occupational voice users. A descriptive, cross-sectional research design was employed. A survey on vocal demands, perceptions and knowledge was distributed to 102 occupational voice users via a snowball sampling technique. 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. 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.

Hyperfunctional Laryngeal Behavior: Is It the Cause or Consequence of Vocal Fold Polyps?

To evaluate the relationship between arytenoid adduction asymmetry (AAA) and the demographic and morphological characteristics of true vocal fold (TVF) polyps and establish the cause and effect relationship between AAA and TVF polyps. Videolaryngostroboscopic findings of 163 patients with TVF polyps were retrospectively reviewed and categorized into Group 1 with AAA or Group 2 without AAA. Demographic details, clinicomorphological polyp characteristics, supraglottic phenomena, and AAA attributes were analyzed. Group 1 was younger than Group 2 (fourth vs fifth decade; P = .0066). Polyp characteristics showed no significant intergroup differences. The association between AAA and false vocal fold (FVF) adduction (65.28% vs 47.62% in Group 1 and 2 respectively; P = .0441) was significant. In relation to TVF polyp laterality, contralateral and bilateral AAA and FVF adduction respectively, was significant. AAA is a compensatory laryngeal adaptation akin to a FVF adduction muscle tension pattern. With a concomitant laryngeal pathology and high vocal demand, AAA is a consequence and not the cause for underlying laryngeal pathology which hinders glottic closure.

Voice Quality of Choir Singers and the Effect of a Performance on the Voice

The voice use of choir singers is understudied despite the imbalance of high vocal demands versus low vocal education, and consequently increased risk for voice problems. Also, there is a lack of information on the effects of a performance on choristers' voices. Available studies included performances of at least one hour. To date, no studies investigated the effects of a choir performance with a duration resembling vocal warm-ups. The first purpose of this study was to determine the voice quality, capacities, symptoms and voice-related quality of life of choir singers. Secondly, the effect of a short choir performance, resembling warm-up duration (15 minutes), on the choristers' voices was investigated. A randomized controlled trial was used. Thirty adult choir singers (25 women, 5 men; mean age: 32 years) were assigned randomly to an experimental group or a control group. Participants in the experimental group sung in choir for 15 minutes immediately after their pre voice assessment, whereas the control group was instructed to have standard voice use (one-on-one conversation with the investigator, no singing) across that time span. A second voice assessment was repeated afterwards. The choir singers showed excellent voice quality and capacities with mean scores on the Dysphonia Severity Index and Acoustic Voice Quality Index of 7.5 and 2.0, respectively. Auditory-perceptually, the mean grade score was 5/100 corresponding with a normal to mildly deviant voice quality. Patient-reported outcome measures showed mean deviant scores, indicating a considerable singing voice handicap. The choir singers seem vulnerable for stress with a high occurrence rate of 76.7% (23/30). Compared with the control group, the Dysphonia Severity Index significantly improved, whereas the self-perceived presence of vocal fatigue and complaints increased after 15 minutes of choir singing. Fundamental frequency increased in both groups, being more outspoken in the experimental group. Choir singers show excellent voice quality and capacities, that further improve after a short choir performance of 15 minutes. Vocal fatigue and complaints, on the other hand, already increased after that short time span. Realizing that vocal load is much higher in real-life rehearsals, competitions and performances, choristers deserve and need a qualitative voice training and a strict follow-up. Future research should focus on effective vocal warm-up and cool-down programs for this population.

Predisposing factors of childhood dysphonia in primary school children

BackgroundAlthough dysphonia is a common symptom in children, there is lack of mass screening studies to cover its prevalence rate in the Egyptian Alexandrian schools. The aim of the work was to screen Alexandrian school-age children for dysphonia in order to determine the prevalence and to detect its possible predisposing factors. The study was carried out on 1913 school children (4th-6th grade), age range of 9-13 years and presenting the seven Alexandrian Educational districts. All patients were screened for the presence of dysphonia. The grade of dysphonia was assessed by a phoniatrician using perceptual auditory evaluation. Determination of possible predisposing factors was done through the application of a questionnaire. Only 317 students responded to the questionnaire.ResultsThere was a significant difference between dysphonic and non-dysphonic as regards gender, and school grade. Having a smoking family member and conducting activities requiring high vocal demands were recorded with the highest percentage among dysphonic children.ConclusionThe Study revealed a prevalence rate of childhood Dysphonia of 12.4%. The presence of chest problems, prolonged loud cry, temperament personality and passive smoking predisposed to dysphonia in primary school students.

Computational simulations of respiratory-laryngeal interactions and their effects on lung volume termination during phonation: Considerations for hyperfunctional voice disorders.

Glottal resistance plays an important role in airflow conservation, especially in the context of high vocal demands. However, it remains unclear if laryngeal strategies most effective in controlling airflow during phonation are consistent with clinical manifestations of vocal hyperfunction. This study used a previously validated three-dimensional computational model of the vocal folds coupled with a respiratory model to investigate which laryngeal strategies were the best predictors of lung volume termination (LVT) and how these strategies' effects were modulated by respiratory parameters. Results indicated that the initial glottal angle and vertical thickness of the vocal folds were the best predictors of LVT regardless of subglottal pressure, lung volume initiation, and breath group duration. The effect of vertical thickness on LVT increased with the subglottal pressure-highlighting the importance of monitoring loudness during voice therapy to avoid laryngeal compensation-and decreased with increasing vocal fold stiffness. A positive initial glottal angle required an increase in vertical thickness to complete a target utterance, especially when the respiratory system was taxed. Overall, findings support the hypothesis that laryngeal strategies consistent with hyperfunctional voice disorders are effective in increasing LVT, and that conservation of airflow and respiratory effort may represent underlying mechanisms in those disorders.

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.

Do Professionals Who Use the Voice in a Journalistic Context Benefit from Humming as a Semi-occluded Vocal Tract Exercise?

Many vocal enhancement and rehabilitation programs for voice professionals define vocal exercises without analyzing their effects on that specific population in which they will be applied, in the established dose and often without considering the presence and absence of vocal alteration. Journalists have sought the voice clinic due to new professional vocal demands and a vocal program is being elaborated. To determine the immediate effect of humming in professionals with and without voice disorders who work under high vocal demand in a journalistic context. Thirty-six individuals who completed the Dysphonia Risk Screening Protocol and underwent voice recording participated in the study. Three speech therapists defined the presence and/or absence of vocal changes by consensus. Subsequently, five repetitions of humming were proposed; the exercises lasted five seconds each and were separated by five seconds of complete silence, and recordings were made before and after the exercise (vowel and phrase). For the pre and post comparison between the groups with and without vocal changes, acoustic measurements and spectrogram, including the classification of the signal type, were performed. The sample had a similar distribution of men and women and a mean age of 39.9 years. Most of the professionals were journalists or reporters. The risk of dysphonia was high for half of the sample, and the presence of vocal changes, predominantly mild ones, was identified in 56%. After the exercise, a decrease in noise at low frequencies and an improvement in the series of harmonics and the signal type were observed in both groups; a decrease in irregularity was observed only in the participants without vocal changes. The proposed humming exercise had an immediate positive effect on the voice of professionals working in a journalistic context, and the changes were particularly evident in aspects of the voice that were initially altered.

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.

A Preliminary Study on the Need for Structured Vocal Seminars for Fitness Instructors to Prevent Voice Disorders and Improve Overall Voice Use During Instruction

Purpose The purpose of this study was to determine and demonstrate the need for structured vocal training/seminars for fitness professionals to prevent voice disorders and improve overall voice use during instruction. Method Approximately 230 fitness professionals responded to an anonymous online questionnaire consisting of 20 items addressing voice care, voice use, vocal demands, and self-reported vocal difficulties within the fitness instructor role. The survey was distributed via SurveyMonkey, and the answers contributed to the data results (see Appendix ). Results The data display overwhelming agreement among fitness professionals that voice has an important role in and major impact on every class. The majority of respondents consider themselves occupational voice users but affirm they have never had a vocal training, although they feel a vocal training would be beneficial for their work in the fitness industry and they would be interested in attending such a training. A majority of respondents also teach three or more classes per week and qualify as “vocal athletes.” Over half of the respondents perceive themselves to be inadequately hydrated, and the majority also report hoarseness at some point related to their jobs teaching fitness classes. A majority of those surveyed have experienced a feeling of straining the voice/using effort during and/or after instruction of classes and also report being social/talkative individuals outside class instruction—therefore displaying a consistent use of voice in and outside their “work” setting, implying high vocal demand and full vocal schedules with reduced time for vocal rest. Conclusions The results of this study indicate that there is an imperative need to educate and empower fitness professionals to take adequate care of their voices and use their voices in the most healthy, efficient, effective, and dynamic ways possible to create outstanding classes, motivate clients, and protect their instrument (larynx/vocal folds) while doing so.

Calentamiento vocal en locutores comerciales

IntroductionThe announcers are professionals of the voice that are characterized by presenting high vocal demand. The objective of this research was to measure the acoustic changes that could be attributed to a routine of vocal warm-up on the quality of the voice in commercial radio and television announcers in Chile. Material and methodThirteen commercial announcers were selected and a vocal warm-up routine was applied. The parameters of fundamental frequency, jitter, shimmer, noise, maximum time of phonation and articulatory agility were measured. All parameters were measured before and after the exercise routine. On the other hand, 6 experts voice therapist analyzed through a visual analog scale changes in the narrow band spectrograms of the emissions before and after the vocal warm-up routine. ResultsSignificant changes were found in the fundamental frequency and maximum phonation time. In the analysis of the spectrograms performed by the experts, in 11 cases there was improvement between the before and after the routine. In addition to the above, in 6 of these cases the changes were significant. ConclusionsThe vocal warm-up can be an effective tool for the care of the voice in commercial announcers.

Influence of Noise Resulting From the Location and Conditions of Classrooms and Schools in Upper Egypt on Teachers' Voices

Teachers are professional voice users, always at high risk of developing voice disorders due to high vocal demand and unfavorable environmental conditions. This study aimed at identifying possible correlations between teachers' voice symptoms and their perception of noise, the location of schools, as well as the location and conditions of their classrooms. One hundred forty teachers (ages 21-56) from schools in Upper Egypt participated in this study. They filled out a questionnaire including questions about the severity and frequency of their voice symptoms, noise perception, and the location and conditions of their schools and classrooms. Questionnaire responses were statistically analyzed to identify possible correlations. There were significant correlations (P < 0.05) between voice symptoms, teachers' noise perception, and noise resulting from the location and conditions of schools and classrooms. Teachers experienced severe dysphonia, neck pain, and increased vocal effort with weekly or daily recurrence. Among the teachers who participated in the study, 24.2% felt they were always in a noisy environment, with 51.4% of the total participants reporting having to raise their voices. The most common sources of noise were from student activities and talking in the teachers' own classrooms (61.4%), noise from adjacent classrooms (52.9%), and road traffic (40.7%). Adverse effect on teachers' voices due to noise from poor school and classroom conditions necessitates solutions for the future improvement of conditions in Egyptian schools. This study may help future studies that focus on developing guidelines for the better planning of Egyptian schools in terms of improved infrastructure and architecture, thus considering the general and vocal health of teachers.

Videostroboscopic Evaluation of the Vocal Cords before and after Microlaryngeal Phonosurgery for Benign Lesions

Background: Benign vocal lesions are common clinical and surgical problems affecting individuals with high vocal demand. These lesions are assessed and treated in different ways. Good phonatory function can be achieved by proper diagnosis, perfect surgical technique and good voice rehabilitation. Videostroboscopy is an important tool to assess the dynamic properties of vocal cord mucosa, the phonatory functional part. Study design: Prospective cross-sectional study. Objectives: To evaluate the postoperative results of microlaryngeal phonosurgery by the use of videostroposcopy. Method: Twenty patients with benign vocal lesions were included and studied. Videostroboscopic examination was undertaken preoperatively, one week and one month postoperatively. Results and discussion: There were significant differences of videostroboscopic parameters between preoperative and postoperative examinations; there was an improvement in most of these parameters one week after surgery, except for, closure pattern and duration of closure where they had been shown to be improved one month after surgery. Conclusion: Videostroboscopy is an excellent tool to assess and understand vocal cord mucosal vibration changes before and after microlaryngeal phonosurgery and recommended to be used in routine outpatient examination of patients with benign vocal lesions especially those who required surgical treatment .

Application of Exercise Physiology Principles for Vocal Athletes During Vocal Injury Recovery and Performance Maximization

Purpose Vocal athletes are individuals who have high vocal demand conditions in order to effectively meet industry demands and performance expectations within a competitive environment. Just as the...