Professional Voice Users Research Articles

Efectos del entrenamiento respiratorio aislado en las variables respiratorias y vocales

La implementación del entrenamiento respiratorio aislado en la rehabilitación y el entrenamiento de la voz es una práctica común en los países de habla hispana. Actualmente, no existe ningún manuscrito en español que revise la información teórica y empírica del entrenamiento respiratorio en este contexto. El propósito de la presente revisión es entregar la evidencia actualizada del efecto del entrenamiento respiratorio aislado en la voz. El entrenamiento de la fuerza respiratoria ha demostrado tener consecuencias positivas en los parámetros medidos; no obstante, los datos disponibles hasta ahora no reporta efectos significativos en la voz, exceptuando los casos de personas con trastornos neurológicos de base y presbifonía. Si el entrenamiento respiratorio con el uso de dispositivos no ha demostrado impactar favorablemente sobre otras disfonías (no neurológicas ni presbifonía) ni en sujetos sanos profesionales de la voz, no existiría razón para esperar que los ejercicios respiratorios aislados que se suelen incluir en las rutinas de entrenadores vocales, fonoaudiólogos, logopedas y foniatras tengan un efecto positivo. Considerando que el entrenamiento de la fuerza muscular respiratoria parece actuar sobre algunos parámetros vocales en personas con alteraciones neurológicas y presbifonía, futuras investigaciones deberían considerar la exploración del posible efecto positivo en otros parámetros vocales no medidos aún en este tipo de población.

Objective and Subjective Voice Examination in Turkish Imams

Imams are professional voice users and they are at high risk of developing voice problems. The aim of the present study was to investigate vocal acoustic parameters and voice handicap index (VHI) scores in Turkish imams and comparing these paramaters with a control group of male nonprofessional voice users. A total of 62 active working Turkish imams that never applied to our clinic with voice problems volunteered as subjects for the study and the control group consisted of 47 male nonprofessional voice users. Every participant completed a VHI questionnaire. A voice analysis was performed using computer program Dr.Speech Version 4 in an acoustically treated setting. Mean fundamental frequency, jitter, shimmer, harmonics to noise ratio values were recorded during the phonation and were analyzed. All imams were active working men aged 27-57 and the control group was comprised of male nonprofessional voice users of a similar age group. The measure of mean fundamental frequency, harmonics to noise ratio, jitter and shimmer rates were similar between two groups. In comparison of VHI between the groups no significant differences were found. Even though imams in the study group stated that they experienced voice problems in their professional lives, this did not cause any adverse changes in acoustic and subjective parameters (VHI) compared with control group.

Comparison Between Combination of Resonant Voice Therapy and Vocal Hygiene Education and Vocal Hygiene Education Only for Female Elementary School Teachers

The study compares the rehabilitation outcome of two voice intervention methods for female elementary school teachers with self-reported voice disorders. A total of 34 female teachers from two primary schools volunteered in the study. Participants from one school were assigned to the experimental group (16 teachers), who received the combination of vocal hygiene education and resonant voice therapy. Participants from the other school were assigned to the control group (18 teachers), who received vocal hygiene education only. Pre- and post-treatment data were compared. The total score of the Voice Handicap Index (VHI) decreased significantly from 12.19 ± 8.58 to 8.63 ± 7.27 (P < 0.05); the functional score of VHI significantly decreased from 5.38 ± 3.9 to 3.81 ± 3.62 (P < 0.05). No statistical significance was found in physiological and emotional scores of VHI. No statistical significance was found in the control group. In the experimental group, the maximum phonation time was increased from 14.34 ± 6.80s to 17.21 ± 6.06s (P < 0.05), Jitter decreased from 0.45% ± 0.13% to 0.26% ± 0.05% (P < 0.05), and Shimmer decreased from 0.21 ± 0.10. to 0.12 ± 0.03 (P < 0.05). Furthermore, the harmonic to noise ratio increased from 23.06 ± 2.99 to 25.23 ± 1.92 (P < 0.05), Spectrum Convergence Ratio increased from 0.53 ± 0.12 to 0.60 ± 0.11 (P < 0.05), yet no statistical significance was found in Nonlinear Energy Difference Ratio data for the experimental group. No statistical significance was found in the control group. In the auditory perception assessment (GRBAS), the G score decreased from 1.19 ± 0.54 to 0.81 ± 0.40 (P < 0.05), and the R score decreased from 1.19 ± 0.54 to 0.75 ± 0.45 (P < 0.05) in the experimental group. No statistical significance was found in the B, A, and S scores in the experimental group; moreover, none of the GRBAS scores in the control group demonstrated statistical significance. In the voice type component profile (VTC), the proportion of VTC1 of the experimental group increased significantly, while the proportions of VTC3 and VTC4 decreased significantly, indicating the improvement of voice quality was obvious after the intervention. The proportions of VTC of the control group did not demonstrate significant change. The results of this study show that a combination of vocal hygiene education and resonant voice therapy can significantly improve the voice function of professional voice users and effectively improve their voice quality. In this study, the professional voice users receiving vocal hygiene education only did not show significant improvement of their voice quality.

Voice-Related Quality of Life, Anxiety, and Depression in Female Teachers: Finger Kazoo Intensive Short-Term Vocal Therapy

Among professional voice users, teachers are subject to higher risks of developing occupational dysphonia due to their abusive use of the voice, usually under unfavorable conditions. Quantify the vocal self-perception, the voice-related quality of life, and the anxiety, and depression symptoms, of dysphonic female teachers, after a brief and intensive short-term voice therapy using the finger kazoo technique. Blinded, randomized, and controlled clinical trial. Questionnaires applied to two study groups (15 subjects without structural laryngeal disorder in one group, and nine subjects with vocal nodules in the other), and to two control groups (9 subjects without structural laryngeal disorder in one group, and eight subjects with vocal nodules in the other). The Vocal Tract Discomfort Scale, the Voice Activity and Participation Profile, the Voice Symptom Scale, and the Voice-Related Quality of Life Protocol, showed significant improvement in both study groups. The Vocal Perception Protocol showed that negative vocal self-perception reduced significantly in subjects without structural alteration of the vocal folds in the study group. Anxiety symptoms improved significantly in subjects with vocal nodules in the study group; depression symptoms improved significantly in subjects with vocal nodules in the control group, and in subjects without structural alteration of the vocal folds in the study group. Brief and intensive short-term voice therapy using the finger kazoo technique provided improvement in the vocal self-perception, the voice-related quality of life, and in the symptoms of anxiety and depression in dysphonic teachers, more evidently in teachers with vocal nodules.

"Innocent" arytenoid adduction asymmetry: An etiological survey.

To estimate the incidence of "innocent" arytenoid adduction asymmetry (AAA) among patients presenting at a laryngology clinic, identify its association with demographic characteristics, symptomatology and various clinical/pathological conditions and thereby determine its clinical significance. A prospective comparative observational clinical study was conducted. Group 1 included patients presenting at the Department of Laryngology, identified with a primary diagnosis and coexisting "innocent" AAA i.e., an overriding arytenoid with normal vocal fold mobility on laryngoscopy. Group 2 included an equal number of randomly selected patients fulfilling the same criteria, without AAA. Demographic and clinical details were recorded and analyzed. 110 cases were included in each group. The incidence of innocent AAA was 12.7%. Males were predominant in both Groups, with the gender difference significant in Group 1. Patients in Group 1 were significantly younger than in Group 2. Professional voice users, namely singers, were significantly greater in Group 1. Symptoms associated with Group 1 (i.e. AAA) were high pitch strain while singing (p = 0.01) and unilateral throat pain (p = 0.01), and the associated diagnoses were Singing Voice Dysphonia (p = 0.005), Vocal Process Granuloma (p = 0.04) and Ventricular Band Dysphonia (p = 0.047). As a definitive diagnosis was made in all patients, the presenting complaints were not attributed to AAA. Right sided preponderance of AAA was significant. Among the diagnoses with a laterality (e.g. vocal process granuloma), AAA was observed contralateral to the pathology in 70.7% and ipsilaterally in 29.3% (p = 0.0058). Innocent AAA is common among males in the 3rd-4th decades, in singers among professional voice users, and in those with the muscle tension dysphonia spectrum and vocal process granuloma, thereby suggesting that it is an acquired habit/response to greater vocal demand. The observation of AAA contralateral to laryngeal lesions, highlights its compensatory nature, attempting to optimize glottic closure.

Superior laryngeal nerve dysfunction following thyroid surgery: assessment of incidence and long-term effect

&lt;p class="abstract"&gt;&lt;strong&gt;Background: &lt;/strong&gt;Importance of Sentinel lymph node (SLN) in thyroid surgery has received little attention compared to Recurrent laryngeal nerve (RLN). Injury to the external branch of the superior laryngeal nerve (EBSLN) is a voice-altering complication of thyroid surgery that has significant implications for professional voice users. The symptoms can be nonspecific and the subtle laryngoscopic manifestations are often overlooked. &lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This study involved 50 patients of thyroid disease with no prior voice pathology who subsequently underwent thyroid surgery. All patients underwent voice analysis pre-operatively, including video laryngoscopy, voice analysis and Grade of hoarseness, roughness, breathiness, asthenia, and strain (GRBAS) scale. Voice analysis was repeated at 2 weeks, 4 weeks, 3 months and 6 months post operatively. Patients with no change in voice after 04 weeks were not followed up subsequently.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 50 patients, 20 (40%) patients underwent hemithyroidectomy, 18 (36%) total thyroidectomy, 11 (22%) subtotal thyroidectomy and 1 (2%) Near total thyroidectomy. Based on voice analysis, patients were categorized into four different groups namely - normal with no laryngeal nerve injury (N=45, 90%), RLN palsy (N=2, 4%), SLN palsy (N=3, 6%). Patients with SLN palsy showed bowing of vocal cords persisting till 06 months post operatively. There were changes in fundamental frequency also, which appeared at 02 weeks and gradually improved on subsequent follow up. &lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The prevalence of SLN injury and dysfunction is unknown as many cases go undiagnosed. Further research is needed to improve the index of suspicion in patients with poor voice quality and reduced vocal range post operatively. On improved diagnostic accuracy, early treatment of this complex disorder may lead to significant recovery.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;

Songbirds Must Sing: How Artistic Voice Users Perceive Their Voice in Times of COVID-19

ObjectiveThe COVID-19 pandemic has led to a critical disruption in the music and performing arts industry, and affected singers and other artists. This study was designed to examine the effect of this unique time on artistic voice users, the way they perceive their voice and their voice-related behaviors.MethodsA total of 110 participants volunteered for the study: 57 professional artistic voice users (34 singers and 19 actors) and a control group of 53 nonprofessional voice users. All participants completed three questionnaires related to their self-assessment of their voice, their voice difficulties, vocal training, and current stress in the time of the COVID-19 pandemic.ResultsCompared to the controls, artistic voice users were more concerned about their voice (P < 0.001), practiced their voice more often (P < 0.001), and experienced more anxiety and stress (P < 0.05). In addition, within the professional group, singers reported practicing their voice in the time of the COVID-19 significantly more than actors (P < 0.01).ConclusionsProfessional artistic voice users experience the COVID-19 pandemic as a stressful time, with negative effects on their well-being and specifically on their voice. This should be considered in the treatment and maintenance of their voice and professional career at current and future stressful times.

A Cross-Sectional Study of the Portrayal of Vocal Health in YouTube Videos

PurposeThe current study examines metadata, upload source, type of informational content, understandability, and actionability of YouTube videos related to vocal health.MethodA search for videos related to vocal health in YouTube was completed. Metadata (i.e., number of views, video length, thumbs-up, thumbs-down), upload source (i.e., consumer, professional, media), and type of informational content were identified. The Patient Education Material Assessment Tool for Audiovisual Materials was used to assess understandability and actionability of the 100 most frequently viewed videos.ResultsA total of 166 videos were obtained. The collective number of views was 19,799,299. A significant difference between video source groups was found for number of views and thumbs-down, but not for video length or thumbs-up. The YouTube videos were primarily educational, and a majority of the content focused on tips and techniques for professional voice users. Videos had adequate understandability (i.e., 71.5%) and actionability scores (i.e., 74%). Videos uploaded by consumers were superior to professional sources in actionability, but no difference was noted between video source for understandability.ConclusionsStudy insights about metadata, source, type of informational content, understandability, and actionability of YouTube videos may help professionals understand the nature of online content related to vocal health. Study implications and recommendations for further research are discussed.

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

Teachers are the largest group of professional voice users with predispositions to functional or organic changes in the larynx. The dysfunction of intrinsic muscles of the larynx frequently occurs which leads to changes in parameters of quality of voice (dysphonia). The aim of the study is the assessment of parameters of vocal folds vibrations, Mucosal Wave morphology, Glottal Closure Type and Open Quotient (OQ) using High Speed (HS) camera and High Speed Digital Imaging (HSDI) technique in teachers with disorders of voice quality classified in GRBAS scale in glottal insufficiencies. The study included group of 50 teachers of both genders, working in primary and secondary education units for 15 years, without systemic diseases with disorders of quality of voice confirmed by the results in GRBAS scale assessment. Vocal folds vibrations were assessed with HS camera by R. Wolf and HSDI technique. Rigid endoscope with 90o optics by the same company was used in the study. Vocal folds vibrations were registered with the speed of 4000 frames/sec. Regularity, symmetry of vibrations, Mucosal Wave (MW) morphology as well as Glottal Closure Type were assessed. Numerical value of OQ was determined in anterior, middle and posterior segment of the glottis during phonation. Assessment of real vibrations of vocal folds revealed irregularity, mean asymmetry of vibrations, MW reduction as well as glottal insufficiency, the most frequently (96%), in the middle segment - type E according to European Laryngological Society, less frequently (4%) - type E+C. The highest value of OQ (average 0.98) was registered in the middle segment of the glottis. In GRBAS scale, significant dysphonia has been registered, classified as G3R3B3A3 without the features of voice strain - S0. In group of teachers with extensive professional experience, glottal insufficiency in the middle segment was registered the most frequently which was confirmed by high values of OQ in this region obtained with HSDI technique. What is more, irregularity, mean asymmetry and asynchrony of vibrations with MW reduction were registered which confirmed the existence of glottal insufficiency in this group. GRBAS scale was useful in preliminary evaluation of dysphonia and its severity, however, the diagnosis of its clinical form was possible only with visualization of the larynx and objective parameters obtained with HSDI.

Identifying Type III Sulcus: Patient Characteristics and Endoscopic Findings.

Type III sulcus is a pathologic structural deformity of the vocal folds that is challenging to accurately diagnose without endoscopic examination under anesthesia. This study aims to further define the clinical presentation and examination features shared among a patient cohort intraoperatively diagnosed with type III sulcus. Case series with chart review. Tertiary laryngology practice. All patients diagnosed intraoperatively with type III sulcus from 2002 to 2014 at a tertiary laryngology practice were included. Clinical history of presenting symptoms, videostroboscopy, and intraoperative and histologic findings were reviewed. Twenty-two patients were included in the study. A majority were female (77%) and had a mean age of 32.4 years. All patients endorsed hoarseness, and 86% were defined as professional voice users. Endoscopic examination revealed bilateral type III sulcus in 23% of patients. The most common preoperative stroboscopic findings included decreased mucosal wave (100%), dilated vessel (95%), phase asymmetry (91%), additional benign lesion (91%), and cyst (82%). Histology revealed epithelial changes of atypia and keratosis. Both the severity of dysphonia and the difficulty observing structural malformations of the vocal folds make type III sulcus challenging to preoperatively diagnose. This study reports the clinical and endoscopic features seen within a cohort of patients with type III sulcus.

Prevalence of Benign Vocal Fold Lesions in Ear, Nose, and Throat Outpatient Unit of Dr. Soetomo General Hospital, Surabaya, Indonesia

Introduction: Benign vocal fold lesions reduce the efficiency of sound production. Reports of dysphonia cases caused by vocal principles in Indonesia are still very limited. This study aimed to determine incidence and prevalence of benign vocal fold lesions, namely vocal cord nodules, cysts, and polyps.Methods: A descriptive retrospective study was conducted using patient’s medical record of Ear, Nose, and Throat (ENT) Outpatient Unit. Dysphonia patients with benign vocal cord abnormalities were identified. The data analyzed using descriptive analytic.Results: There were 20 patients with benign vocal fold lesions, consisting of 13 patients (65%) with nodules, 3 patients (15%) with polyps, and 4 patients (20%) with cysts. The ratio of male and female patients was 1: 1. Most patients belonged to age group of 20-59 years (12 patients; 60%). In term of occupation, most patients belonged to group III, which is a group of workers who are not professional voice users (12 patients; 60%). Most vocal fold lesions were found in the 1/3 of bilateral anterior (17 patients; 85%). Most therapy was non-operative in 13 patients (65%). Conclusion: Benign vocal fold lesions, including vocal cord nodules, polyps, and cysts, are found in all patients with dysphonic complaints. The prevalence of dysphonia symptoms is quite high every year, but only a small portion are diagnosed with benign vocal cord lesion.

Factors Associated with Failure of Botulinum Toxin Injection in Adductor Spasmodic Dysphonia.

Electromyography (EMG) Guided botulinum toxin (BTX) injection is considered first-line treatment for adductor spasmodic dysphonia (SD). Failure rate can range between 6% and 29%. Study objective was to determine which factors were associated with failure. This was a retrospective review conducted at a tertiary, academic center. Adductor SD patients presenting for BTX injections from August 2017 to October 2018 were eligible. Age, gender, Voice Handicap Index (VHI-10), Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V), number of injections, disease duration, unilateral/bilateral injection, right/left injection, dose quantity, body mass index (BMI), professional voice user, employment, psychiatric comorbidity, breathiness, and dysphagia were investigated. Outcomes included failure as defined by the patient and dosage change. Univariate and multivariate statistical analysis was conducted. Sixty seven out of 564 injections (12%) were categorized as failure by 131 patients. In multivariate analysis, dosage change was associated with shorter duration of good effect (P < .001), BTX dose (P = .016), breathiness (P < .001), bilateral injection (P = .024), dysphagia (P = .012) and professional voice user (P = .021). Failure was associated with first injection with a new physician (P < .001), professional voice user P < .001) and lack of breathiness (P = .003). Failure rate was not associated with age, gender, VHI-10, CAPE-V, disease duration, left/right injection, dose quantity, BMI, psychiatric comorbidity, and dysphagia. Failure rate was 12% and associated with patients' first injection with a physician, professional voice user, and lack of breathiness. Dosage change occurred in 29% of injections and was associated with injection side effects, bilateral injections, BTX dose, professional voice user, and shorter duration of good effect.Level of evidence: 3.

Incidence and Outcome of Vocal Cord Polyp: An Endoscopic Experience and Perception

Background: Thelarynx is an intricate part of the body which has to perform a very composite function like protection, respiration, phonation. To carry out the function, larynx should be adaptable and flexible. Any structural disorder like vocal cord polyp alter these specialized function and squander the laryngeal pacing, and increasing voice discomfort of the patient like hoarseness, dysphonia, and odynophagia day by day. Phonosurgery is the mainstay of treatment. Methods: It is a cohort retrospective study of 54 cases in the Department of Otolaryngology and Head-Neck Surgery, Comilla Medical College, Bangladesh, from 20 February 2017 to 27 October 2019. Result: Incidence of vocal cord polyp in laryngeal disorder patient was 6.83%, and the laryngeal operative patient was 28.27%. All patients were treated by micro laryngeal surgery with rigid Hopkin’s laryngeal telescope, and setback was 2 (3.70%). Of them, male were 41(75.92%), females were 13(24.08%), below 20 years were 2(3.70%), 20-50 years 39(72.23%,) and above 50 years 13(24.07%), unilateral was 50(92.59%) and 4(7.41%) were bilateral, smoker was 41(75.92%), nonsmoker 13(24.08%), industrial workers were 21(38.89%), professional voice user was 13(24.07%)

Comparison of Habitual and High Pitch Phonation in Teachers With and Without Vocal Fatigue

The main aim of this study was to investigate whether or not high pitch phonation can be used for assessing the vocal loading model. For this purpose, habitual and high pitch phonations were compared between teachers with and without vocal fatigue. Sixty teachers (30 teachers with vocal fatigue and 30 teachers without vocal fatigue) participated in the present study. From both the groups of teachers, habitual and high pitch phonations were recorded. Fundamental frequency measures (mean, minimum, and maximum fundamental frequency), percent Jitter (Jitt), relative average perturbation (RAP), pitch perturbation quotient (PPQ), smoothened pitch perturbation quotient (SPPQ), noise-to-harmonic ratio (NHR), cepstral peak prominence (CPP), and smoothened cepstral peak prominence (CPPS) measurements were extracted from the recorded samples. The different acoustic measurements were compared across the two phonations and two groups of teachers. Significant decrease in mean, minimum, and maximum fundamental frequency values were found in high pitch phonation in teachers with vocal fatigue when compared with teachers without vocal fatigue. However, there was no significant difference between the two groups of participants for any of the acoustic measurements during the habitual phonation. Current results highlight that high pitch phonation may serve as a better sensitive sample than habitual phonation as an indicator to assess vocal fatigue in teachers. Hence, further studies need to be done with different professional voice users to early identify those individuals who are susceptible to develop voice problems.

Prevalence of Benign Vocal Cord Disorder at Dr. Soetomo General Hospital Surabaya Indonesia in June 2015-June 2016

Benign vocal cord disorder is a common case but its prevalence is difficult to determine. Reporting on the number of benign vocal cord disorder events is important for data management to arrange the effective management. Objective this research to determine the prevalence of benign vocal cord disorders, i.e. nodules, cysts, and vocal cord polyps. Method is a retrospective descriptive study conducted using medical record data of outpatient unit of Otolaryngology-HN division of larynx-pharynx Dr. Soetomo General Hospital Surabaya in the period of June 2015 to July 2016. Result benign vocal cord disorders consisted of 65.00% of subjects with nodules, 15.00% of subjects with polyps, and 20.00% of subjects with cysts. The ratio of male and female was 1: 1. The most age was 20-59 years old with 60.00%. The largest occupational group is professional voice user with 60.00%. The location of benign vocal cord disorders was in 1/3 of the bilateral anterior as much as 85.00%. The most frequently used therapy is non-operative with 65.00%. The conclusion benign vocal cords disorder with the types of vodal, polyps, and vocal cord cyst occurred in 4.21% of all patients with dysphonic complaints. Vocal cord nodules had the highest incidence among other types of cord vocal diseases with 2.73% while the highest prevalence was shown by vocal cord nodules with 4.42%.

Effects of Voice Quality Improvement Program for Professional Voice Users with Functional Voice Disorders

Background/Objectives: One of the most emphasized aspects in voice therapy is voice quality. We investigated the effect of our intervention program on improving voice quality and reducing vocal fatigue.Method/Statistical Analysis: 10 musical actors/actresses with functional voice disorders were given eight training sessions once a week, and both subjective and objective evaluations of their voices were conducted before and after the training. K-SVHI and VFI were used to measure voice handicap index and voice fatigue index. Praat was used to measure the objective acoustic indices. To examine the statistical significance, a paired sample t-test was performed.Findings: The result of subjective voice quality evaluation showed that both scores of voice handicap index and voice fatigue index were decreased. The objective voice evaluation results showed that the jitter (%) and shimmer(%) scores decreased while the harmonics to noise ratio (HNR) and the speaking fundamental frequency (SF0) scores increased. The lower the jitter and shimmer, the better the quality of voice, while the higher the HNR, the better the quality of voice.The difference between pretest and posttest scores was statistically significant except for the SF0. The reason for small changes in the SF0 seems to be that all participants of musical actor/actresses who skillfully use the voice were able to control their voice to maintain the frequency at a certain level.Improvements/Applications: Our findings indicate that patients with functional voice disorders have problems ways to use their voice and showed that their voice quality and vocal fatigue can be improved by modifying and training four stages of voice production.

인후두역류 환자의 폐활량 및 공기역학적 특성

The Laryngopharyngeal reflux is high incidence, accounting for 20% of patients who visit a voice center, and has a great impact on the quality of life of professional voice users. Therefore the purpose of this study was to investigate the aerodynamic characteristics at the sentence level of professional voice users diagnosed with LPR. The subjects were 31 patients diagnosed with LRP by an otolaryngologist. In addition, we used the Phonatory Aerodynamic System to examine the results of protocols related to vital capacity and running speech according to the severity of pharyngeal reflux, and SPSS was used for statistical analysis. As a result, the vital capacity-related expiratory volume was lower in patients with RSI > 13 but higher than that in running speech-related expiratory volume (P <.05). Therefore, the more severe laryngopharyngeal reflux, the lower the acoustic efficiency during speech.

Voice Rehabilitation and Resilience Work With the Commercial Singer: A Concept Piece

Purpose This clinical focus article presents a perspective on an approach in scaffolding vocal recovery and rehabilitation for commercial singers. The expectation in vocal performance is sound production that is repeatable, reliable, and relatable. When an artist cannot meet those standards, failure is experienced in three locations: the Body, the Head, and the Heart. Referencing each of these areas of intelligence provides a metalanguage for structuring vocal recovery and rehabilitation that goes beyond physical voice work alone. This clinical focus article discusses standards of voice production specific to commercial music, expectations of use, and what vocal demands look like on and off tour. Indirect and direct voice therapy within this niche group of professional voice users can be better tailored within this context of use and need. They need intervention that is specific to individual voice demands and uses a methodology that cultivates self-efficacy and resilience in singers as athletes. The path to vocal rehabilitation and stability extends beyond work with body mechanics and extends beyond the specific tools the voice pathologist and artist have to choose from to return to performance level production. Cultivating resilience involves intentional accessing of the Body, Head, and Heart in the moments of disintegration with the goal of meeting and bridging physical, emotional, and mental barriers for the commercial artist. The end goal is resilience when the artist returns to performance level production. Conclusions This clinical focus article explores the interplay between these three centers of intelligence for commercial singers within the framework of indirect and direct voice rehabilitation. This Body work can lead to maturation and resilience to support a long career using a feeling that is mechanically efficient, portable, and repeatable. The transfer of gains outside that treatment room may be more consistently realized through the incorporation of Head and Heart in early stages of intervention.

Analysis of Phonatory and Respiratory Functions in Physical Fitness Instructors in Comparison to Controls

Professional voice users form an increasing part of our population. Physical fitness instructors listed as professional voice users are at risk for voice problem as they perform vigorous exercises, instruct at the same time and compete vocally with loud background music. Hence, there is a dire need to study the voice problems in this population. The current study was aimed at investigating the phonatory and respiratory functions in physical fitness instructors in comparison to a control group. Cross-sectional study design MATERIALS AND METHODS: Fifty physical fitness instructors (48 males and two females) and 50 controls (45 males and five females) with the age range of 18-40 years were initially enrolled in the study. The phonatory function measures (perceptual, physiological, and acoustic) and respiratory function measures (aerodynamics) were obtained. Following the data analysis only for male participants, the majority of the perceptual parameters such as grade, roughness, breathiness, and strain showed significant increase in the clinical group compared to controls (P < 0.05). Similarly, few acoustic parameters such as fundamental frequency (F0) related parameters such as average F0, mean F0, highest fundamental frequency (Fhi) and lowest fundamental frequency (Flo) showed significant decrease in clinical group compared to controls (P < 0.05). Few perceptual and acoustic parameters are sensitive in differentiating the voice problems in physical fitness instructors from the controls. The significant perceptual and acoustic parameters implied that they are at risk for developing voice problems. Hence, early identification and prevention of voice problems in this population is warranted.

Side effects of medications in professional opera singers’ voice: survey findings

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Opera singers are classified under level I, as the elite vocal performers, being the quintessential representatives of this group. As the professional voice users, they meticulously observe any changes relevant to their health, therefore self-reported side effects should be taken under serious consideration. The aim of this study was to initiate the process of gathering general information about the most common side effects of medications taken by the opera singers.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; The study group consisted of 264 professional opera singers, treated in Clarós Clinic in a 35 years period, who were asked to complete a questionnaire. The response rate was 62.1% (n=164) with a male-to-female ratio being 1.27:1 (72 men and 92 women). 46 cases of adverse effects of medicines were updated and analysed. All the responses were collected between February and April 2018. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The mean age of our study group was 38.3 for females and 49.95 for males, with the range between 18-83 years. The vocal categories were as follows: 39 tenors, 17 baritones, 14 basses, 64 sopranos, 23 mezzo-sopranos and 5 contraltos. Patients with chronic diseases and comorbidities represented the 39.1% of the study group. The most common adverse effect reported was dryness (15.2%). The most frequent voice side effects raised by singers were clearing the throat frequently (14.63%), hoarseness and coarse or scratchy sound (10.37%), and vocal fatigue (7.32%).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; We believe that exploring the subject of vocal side effects of medications in professional opera singers is extremely important.&lt;/p&gt;