Professional Voice Users Research Articles

Vocal Hygiene: What Are Professional Voice Users Saying About It on YouTube?

PurposeHealth content has been presented and accessed freely on social networks and can generate misinformation; hence, this study aimed to analyze the voice guidance in videos available on YouTube. MethodThis observational cross-sectional research selected the 45 most viewed videos on YouTube in 2022, produced by professional voice users with guidance on vocal hygiene and well-being. The content was described and compared with the scientific literature on the topic, analyzing which category of professional voice users produced the most scientifically based content. ResultsAltogether, 38 topics were found in the videos, distributed in nine blocks, identified from A to I. Block A (foods with a positive effect on the voice) was the only one that had no citations in scientific articles, whereas block D (negative habits for the voice) had the highest mean number of articles in relation to the others. The most publicized guidelines were mainly related to actions and/or behaviors and resources considered positive for the voice. Eight professional categories were found who produced these videos. Singing teachers who also worked as singers produced the most scientifically based content. ConclusionThe study showed that not all the information in the videos was scientifically based, which means that people with voice problems have easy access to information that could even harm them if used in their professions.

Influence of Carnatic Vocal Training on Voice Measures in Males

Introduction: Training is an integral part of learning any skill. The vocal training helps singers attain proficiency as they are the most demanding vocal group of all professional voice users. Hence, it is necessary to evaluate the influence of training on the singer’s voice. The current study objective was to investigate the influence of vocal training on voice measures (acoustic and aerodynamic) between male Carnatic singers with lower (6 months–5 years) and higher (6–10 years) training using novel task “mkaram” along with lyrical task. Methods: Group 1 consisted of 30 trained male Carnatic singers with lower vocal training, and group 2, thirty trained male singers with higher training in the age of 18–45 years. The acoustic (frequency-related parameter, cepstral, spectral, perturbation, and noise) and aerodynamic measures (maximum phonation time and s/z ratio) of voice were obtained. The test-retest reliability was conducted on a sample of 10% of the population from each group, with a 2-week interval between the tests. Cross-sectional study design was applied. Results: The statistical analysis revealed significantly decreased frequency-related parameters (semitones) such as the mean fundamental frequency, lowest fundamental frequency, highest fundamental frequency at the low register and the highest fundamental frequency at the middle register in group 2 during “mkaram” task (p ≤ 0.05). Similarly, one of the spectral-related measures 1st harmonic-2nd harmonic (dB) during lyrical task and one of the noise-related measure harmonic-to-noise ratio (dB) at the middle register during “mkaram” task showed a significant decrease in group 2 compared to group 1 (p ≤ 0.05). Test-retest reliability revealed that most of the parameters had “acceptable to excellent” internal consistency (Cronbach’s α >0.7 to 1). Conclusion: Few frequency and noise measures during “mkaram” task and a spectral measure during lyrical task showed to be sensitive in distinguishing the impact of vocal training on the voices of male Carnatic singers. The higher vocal training was found to help the singers to perform more efficiently with enhanced vocal range particularly in the low register and to some extent in the middle register. Indeed, the study highlighted the positive effects of vocal training on male Carnatic singers.

Perceived Benefits of Interdisciplinary Coaching Strategies for Professional Vocalists: A Pilot Study

ABSTRACT Professional vocalists, specifically teachers, are at increased risk of missing work and having vocal damage due to vocal misuse and overuse. The purpose of this pilot study was to examine the perceptions of participants (N = 4) taking part in interdisciplinary voice coaching sessions with both a singing and theatre voice specialist. Participant perceptions were obtained using the Voice Handicap Index (VHI), individual weekly journals, and a post-study researcher-created questionnaire. Results are discussed in terms of potential for future research and application of results to mutli-disciplinary voice training options for professional voice users as a solution to mitigate voice problems.

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.

Vocal Fatigue and Its Relationship with Vocal Hygiene and Work-Related Factors in Professional and Nonprofessional Voice Users: A Multiple Linear Regression Model Study

To investigate vocal fatigue severity between professional voice users (PVUs) and nonprofessional voice users (NPVUs), and across different levels of voice users. Also to examine the relationship between vocal hygiene and work-related factors with vocal fatigue. This is a cross-sectional descriptive study. Four hundred one individuals from different professions were included in total. Participants were divided into four levels of voice users by classification of Koufman and Isaacson. The top three levels of voice users further identified as PVU, and level 4 voice users identified as NPVU. An online questionnaire which included vocal hygiene checklist, work-related factors, and Turkish version of vocal fatigue index (VFI) was submitted by the participants. Vocal fatigue severity of PVUs were found higher than NPVUs in all VFI scores (P<0.05). Level 2 voice users were found to have more vocal fatigue severity than all other levels of voice users. Call center workers (CCWs) had the highest means of vocal fatigue severity. Based on the multiple linear regression model vocal hygiene and the number of vocal rest breaks were found to have related with vocal fatigue the most (P<0.05). There was also a relation with some VFI scores (P<0.05) with voice usage duration at work and vocal rest duration. We found no relationship between working experience and vocal fatigue. The data suggests the relation between vocal fatigue and vocal hygiene, and work-related factors explain a small proportion of the association. However, in CCWs r2 was found 0.44. The change in vocal fatigue severity did not match with Koufman and Isaacson's classification of voice users. We suggest that there may be other contributing factors to vocal fatigue than vocal hygiene, vocal rest, and voice usage duration even those factors may differ from profession to profession.

Prevalence of and Risk Factors for Self-Reported Voice Problems in Tibetan Monks

BackgroundIt is observed that Tibetan monks pray for a long duration with inappropriate pitch and loudness. Hence, they may be prone to developing voice problems (VPs). However, the monks are not stressed and do not miss praying in the monastery (which is quite different from many other professional voice users in Western countries). Moreover, no studies have investigated the nature of VPs among Tibetan monks. Such a study may provide insight into the prevalence of and risk factors for VPs and may help enhance our knowledge of the VPs in Tibetan monks. Study DesignCross-sectional survey MethodA self-reporting questionnaire was distributed among 300 Tibetan monks residing in Namdroling Nyingmapa Monastery, Karnataka, India, from February 2023 to June 2023. Results39% of Tibetan monks experienced voice problems in their careers; hoarseness, momentary voice loss/sudden voice changes, and dryness were the most frequently reported symptoms. Monks reporting the presence of VPs also exhibited significantly higher frequencies of different phonotraumatic behaviors like speaking with a loud voice, constantly altering the voice, frequent throat clearing, speaking/chanting during throat infections, or voice problems than those who did not report VPs. The results of bivariate regression analysis identified factors such as more than eight hours of prayer duration per day, praying in the presence of musical instruments, not sipping water in between prayers, less than three litres of water intake, and the presence of acid reflux and dry throat, as significant risk factors responsible for VPs in Tibetan monks. ConclusionsCurrent results suggest that monks are at a high risk of developing VPs, and several factors (vocational, environmental, lifestyle, and health-related) contribute to the development of VPs. Further, VPs in monks also affect them in terms of missing prayers, interacting less with family/friends, and avoiding social gatherings. Overall, there is a great need to educate the monks about vocal health and preventing VPs.

Arytenoid adduction asymmetry among patients with laryngeal disorders

BackgroundArytenoid asymmetry is usually an incidental finding during video-pharyngo-laryngoscopic examinations, and few otolaryngologists have described the clinical implications of this among patient with laryngeal disorders.AimThe aim of the study is to document the prevalence of arytenoid adduction asymmetry in patients who had video-pharyngo-laryngoscopy and determine if there is any possible association between arytenoid adduction asymmetry and hoarseness.MethodsThis is a retrospective descriptive study involving patients who had video-pharyngo-laryngoscopic examinations for various indications. The medical charts and video-pharyngo-laryngoscopic examination findings recorded in the stored database in ENT outpatient departments of two institutions over a 2-year period were retrospectively reviewed for age, sex, occupation, presenting complaint, and indication for video-pharyngo-laryngoscopic findings and diagnosis. Arytenoid adduction asymmetry was defined in relation to the position of the corniculate cartilages, cuneiform cartilages, and aryepiglottic angle. All the variables in the data were analyzed using Statistical Product and Service Solution (SPSS) version 25.ResultsA total of 152 out of 209 patients had complete information needed for the review, 59 were males and 93 females with age range 20–91 years, and mean age was 46 ± 15.5 years. The overall prevalence rate for adduction asymmetry was 44.7%. Arytenoid asymmetry was seen commonest among the 5th and 6th decades of life and highest among the professional voice users (55%), while the male-to-female ratio was 1.6:1.Hoarseness constituted 40.1% of all indications for video-pharyngo-laryngoscopy, with 71% of patients with hoarseness having a primary laryngeal lesion, 26% had laryngopharyngeal reflux, and 3.3% were due to pubertal voice changes. A significant association was found between arytenoid asymmetry of the male gender P-value 0.027 and hoarseness P-value 0.026.ConclusionArytenoid adduction asymmetry is prevalent in the 5th and 6th decades of life, among patients with hoarseness resulting from unilateral primary laryngeal disorders.

Effect of vocal loading on voice parameters in trainee actors

Introduction: Prolonged use of voice or vocal load can be a risk factor for individuals and can end up in vocal fatigue and dysphonia. Vocal loading can alter tissue structure and affect the voice quality forever. An obvious factor to be considered is the vocal use by a professional voice user. Actors are a group of professionals who can be affected by the long-term use of voice. There is a higher prevalence of inflammatory lesion in acting students and they were found to have poor vocal hygiene habits; which shows that these future elite vocal performers are at risk for developing a voice disorder. Aim: To study the objective and subjective changes in voice characteristics post vocal loading task in trainee actors. Method: A total 37 trainee actors (14 females and 23 males) participated in the study. The age range of the participants were 20 – 39 years and the range of the training period was 6 – 12 months. The participants were instructed to read a passage for 30 – 45 minutes at a loudness level of 70 – 80 dB SPL. Individuals with perceptually normal voice in terms of pitch and intensity and with a score less than 1 in GRBASI (Grade, Roughness, Breathiness, Asthenia, Strain, Instability) rating scale were included in the study. Acoustic, and perceptual evaluation were measured immediately before and after vocal loading task. Acoustic analysis was done using MDVP, whereas The Auditory Perceptual Rating Scale and GRABASI rating scale were used for perceptual analysis. Self-rating of the voice after vocal loading task was measured after the vocal loading task using Vocal Fatigue Index.1 Results and conclusion: The results revealed a significant difference in perceptual parameters post vocal loading task. The f0, jitter and HNR (Harmonic to Noise Ratio) showed a significant increase in the values after the vocal loading task. However, shimmer and RAP (Relative Amplitude Perturbation) did not show significant difference in the values post vocal loading task. The self-rating of the voice after the vocal loading task revealed that 54% of the trainee actors did not perceive vocal fatigue. The study hence shows significant effects of vocal loading in perceptual and acoustic analysis whereas the self-rating shows less perception of vocal changes in training actors. The acoustic, perceptual and self-rating of the voice quality before and after vocal loading task can aid in effective training and management of the trainee actors. However, the actors themselves are not equipped to measure the voice changes acoustically or perceptually and would take much longer time to perceive changes in their voice quality. Therefore, it is important to give a vocal hygiene programme in the preventive stage, that is, in the training period.

Presentation of the ATLETAS DA VOZ™ Conditioning Program

Objectives. To present a simple form of vocal and breathing conditioning for voice professionals based on concepts from vocal science. The vocal conditioning program called Voice Athletes Conditioning uses the principles of exercise physiology to gradually improve vocal and respiratory overload to achieve endurance, power, and flexibility. Methods. Due to our personal experience with high voice users, we synthesized a vocal conditioning program (AVCP) that combines voice science, exercise physiology, sports science and physical therapy principles. This is an 8-week program of daily vocal and breathing exercises with overload enhancement each week using different types of breathing devices and semi-occluded vocal tract exercises, designed and developed according to the specific requirements and performance of the voice professional. Reflections. Professional voice users often experience episodes of vocal fatigue that can directly affect their performance and vocal health. As with physical training for athletes, voice exercises can also contribute to improving vocal conditioning, preventing voice disorders, as well as helping to obtain better performance, greater tolerance to fatigue and shorter recovery time. Conclusions. AVCP is an approach that considers the principles of muscle training aimed objectively at the respiratory and vocal muscles, carried out with a variety of breathing devices and specific vocal exercises in search of greater performance time, less physiological stress, and shorter recovery time in the professional use of the voice.

Gender Differences in Benign Vocal Fold Mass Treatment

Abstract: Benign vocal fold masses are seen commonly in amateur and professional voice users. Data shows that patients presenting with similar benign vocal fold masses are treated with different modalities at different rates based on their gender identity and patient preference. Professional and amateur voice users are also found to have different rates of treatment. Singing teachers have unique longitudinal relationships with their students. Knowledge of the effects of benign focal fold masses on the voice and glottic function along with treatment modalities can help singing teachers provide extra surveillance to students who may be at risk of suboptimal treatment. This article focuses on benign vocal fold mass classification, causes, symptoms, medical diagnosis, and treatment relevant to singing teachers with respect to the patient’s gender. Professional voice use is discussed as a potentially confounding factor to seeking treatment of benign vocal fold masses in the context of gender differences.

Psychometric Properties of the Vocal Fatigue Handicap Questionnaire in Kannada Among Teachers

As the literature review suggests, most professional voice users, such as teachers and singers, are prone to vocal abuse or misuse and frequently experience vocal fatigue. Therefore, validating the Vocal Fatigue Handicap Questionnaire among professional voice users with and without the symptoms of vocal fatigue might provide appropriate external validity of the questionnaire. The objective of the study was to validate the Kannada version of the Vocal Fatigue Handicap Questionnaire (VFHQ-K) among a cohort of Kannada-speaking primary and secondary school teachers with and without self-reported vocal fatigue symptoms. This was a validation study. The study consisted of two groups of participants. Group 1 included 40 teachers with self-reported vocal fatigue symptoms, and Group 2 included 57 teachers without self-reported vocal fatigue symptoms. The VFHQ-K was administered to each participant after obtaining informed consent. The questionnaire was again readministered between 1 and 2weeks to assess the test-retest reliability. All the responses that were obtained were tabulated for analysis. The VFHQ-K demonstrated good test-retest reliability, internal consistency, and acceptable discriminant validity. The cutoff value of VFHQ-K obtained in the present study between the teachers with and without self-reported symptoms of vocal fatigue was much less than the cutoff values reported by the earlier version of VFHQ-K. The VFHQ-K can be a helpful tool in the early identification of teachers with vocal fatigue and in improving the vocal health of professional voice users.

Geriatric Voice: Distinctive Clinical Profiles of Working Seniors in a Tertiary Laryngology Clinic

ObjectivesVoice disorders have been reported in up to 47% of the geriatric population. Few studies have assessed dysphonia in the elderly, with none examining vocal function in working seniors. This study aims to profile the clinical characteristics of individuals aged 65 years and older, comparing working and non-working seniors. Study DesignRetrospective cohort study. MethodsMedical charts were reviewed for patients aged 65 years and older referred to the McGill University Health Centre Laryngology Clinic (January 2018 to March 2020). Variables studied included sociodemographics, comorbidities, voice complaints, lifestyle factors, diagnoses, voice acoustics [maximum phonation time (MPT), S/Z ratio, F0], GRBAS scale, VHI-10, RSI, and treatment modalities. ResultsA total of 267 patients were included, with a mean (SD) age of 74.2 (6.6) years and 61% of female patients. Occupation information was available in 148 cases, of which 31.1% were still working and 12.8% were professional voice users. The predominant voice complaint was dysphonia/hoarseness (48.8%) and the most prevalent diagnosis was presbyphonia (31.8%). The mean (SD) VHI-10 and RSI scores were 19.8 (9.0) and 18.7 (9.4) points, respectively. Voice therapy was prescribed for 155 patients (58.7%): 124 attended at least one session with significant post-treatment improvements in the GRBAS and VHI-10 scores (P<0.01). In the univariate analysis, working seniors had a significantly more prevalent singing habit (P=0.04) and laryngopharyngeal reflux diagnosis (P=0.01), displaying a significantly longer MPT (P<0.001) and lower G-B-S scores (P<0.05). After adjusting mean differences, only MPT and the G-S scores were significantly different between both groups. ConclusionsThe predominant diagnosis in elders with voice complaints was presbyphonia. Voice therapy proved effective in improving the VHI-10 and GRBAS scores for geriatric patients. Almost one-third of seniors remained in the workforce, demonstrating superior vocal profiles, specifically in the MPT and the grade and strain of perceptual voice quality.

Wound Healing and Special Considerations for the Professional and Performing Voice

Purpose: The purpose of this article is to review the wound healing process of the vocal fold following phonomicrosurgery to remove benign vocal fold lesions in professional voice users. Understanding this process and the risk of developing scar tissue at the injury site is important for treatment of these individuals. This review also highlights special considerations during the postinjury rehabilitation period and the unique vocal loading tasks and needs of performing voice users. The goal of this article is to provide clinical tools for wound healing education to nonvoice-specialized speech-language pathologists to inform their rehabilitation of the professional and performing voice user. Conclusions: Implications intrinsic to vocal fold physiology and the stages of wound healing necessitate the avoidance of scar tissue with a rehabilitation plan tailored to the unique vocal loading demands of professional and performing voice users. There is a need to develop specific rehabilitation protocols that are genre-specific to aid in the individual treatment of the elite vocal athlete.

전문 음성사용자와 직업적 음성사용자의 주관적 음성증상 비교

전문 음성사용자와 직업적 음성사용자의 주관적 음성증상 비교

A questionnaire survey on the prevalence of self-reported voice disorders in school teachers, and classroom noise in Japan

School teachers are known as professional voice users, hence any damage to their voice or throat could compromise their work as well as their lives. We conducted a questionnaire survey of 830 teachers working at elementary schools, junior-high schools, high schools and schools for children with special needs in Saitama prefecture in Japan. We investigated the prevalence of self-reported voice disorders in teachers and how their quality of life might be influenced. We also asked the teachers to share some of their experience with noise in classrooms. We found the following three points. Firstly, more than a quarter have consulted medical doctors for problems with their voice or throat. Secondly, quality of life of female teachers are slightly more affected by their voice problems than their male peers. Thirdly, approximately 20 percent of teachers are concerned about the noise in their classrooms.

Investigation of the Relationship Between Vocal Fatigue, Quality of Life, and Compliance With Vocal Hygiene in Professional Voice Users.

Intensive voice use may lead to the development of voice disorders or voice complaints, such as vocal fatigue, for professional voice users (teachers, academics, call center workers, actors, singers, speech and language therapists, voice trainers, and religious officials). Vocal fatigue has a detrimental effect on occupational, emotional, and social performance, besides the quality of life of the individual. The effect of voice hygiene interventions on voice fatigue is not fully known. The results of studies conducted with different occupational groups are inconsistent. The present study aims to analyze the relationship between vocal fatigue and voice-related quality of life (V-RQOL) in professional voice users, and the impact of vocal hygiene on vocal fatigue. Participants (24 male, 90 female), who were professional voice users without any diagnosis of voice disorders or voice complaints were divided into two groups low vocal hygiene compliance (LVH; n=66) and high vocal hygiene compliance (HVH; n=48). In this study, vocal fatigue was measured by the vocal fatigue index (VFI), and V-RQOL was measured by the voice handicap index (VHI-10) and V-RQOL. VFI subscales (tiredness, avoidance, physical discomfort) have a moderate positive correlation with VHI-10 and V-RQOL, which indicates that there is a significant relationship between vocal fatigue and quality of life amongst professional voice users. While there was no significant difference between the LVH and HVH groups in terms of quality of life, it was found that the vocal fatigue level of the LVH group was higher. This study of professional voice users with healthy voices reveals a relationship between vocal fatigue and V-RQOL. Vocal hygiene compliance may affect professional voice users' vocal fatigue symptoms; the low-compliant group has higher levels of tiredness, avoidance, and physical discomfort. The findings highlight the importance of raising awareness ofthe problems of professional voice users, even though they have healthy voices and the need for vocal hygiene education programs that target them.

Dysphonia in Pediatric Professional Voice Users: Is It Just Nodules?

Objectives/HypothesisProfessional voice users of any age are often concerned about nodules, particularly in pediatric singers. However, an accurate diagnosis allows formulation of an optimal management plan and a successful continuation of these young patients’ careers. There is very little literature regarding pediatric professional singers; we aimed to share our experience of over a decade of referrals to our tertiary pediatric voice clinic. Study DesignThis was a retrospective review. MethodsA retrospective review was undertaken of all consecutive patients aged 0–18 years who self-identified as professional voice users and attended our tertiary pediatric voice clinic between December 2010 and December 2021. We analyzed demographics, professional singing status, diagnosis, management, and clinical voice scores. The patients were subdivided into those aged 0–9, 10–16, and 17–18 years. ResultsA total of 113 pediatric professional voice users attended the tertiary voice clinic in the study period. The commonest self-reported voice use was as a singer. Within the 0–9 years age group, there was a strong male predominance (22 males and three females) and mostly organic (52%) causes. For ages 10–16 years, there was a noted female predominance (15 males and 29 females). In the 17–18 years age group, there was a strong female predominance (10 males and 34 females), with predominantly functional diagnoses (48%). Of significance, only five of the 113 patients had nodules (4.4%). ConclusionsWe present a large data set of pediatric professional voice users and demonstrate the numerous underlying diagnoses for their dysphonia, particularly functional disorders. Our experience highlights the need for adequate vocal training for pediatric professional voice users and the need for a multidisciplinary diagnostic and management approach.

Vocal Cord Monitoring by Flexible Fiberoptic Laryngoscopy During Thyroid Radiofrequency Ablation.

Introduction: Thermal injury to recurrent laryngeal nerve (RLN) during radiofrequency ablation (RFA) can produce temporary or permanent vocal cord paralysis.1 Hydrodissection with cold 5% glucose of "danger triangle" protects RLN during RFA.2 When RFA is performed under local anesthesia, RLN function is monitored by patients producing vocal sounds.3 Large lesions requiring longer RFAs warrant general sedation where voice cannot be assessed, therefore, an additional technique for RLN protection is advisable. Observation of passive symmetrical vocal cord movements during breathing by laryngeal ultrasonography is useful in assessing vocal cord function4; however, flexible-fiberoptic fibrolaringoscopy (FFL) is gold standard for assessing vocal cord movements,5 anticipating potential RLN damage. We report FFL monitoring during RFA under general sedation on a large thyroid nodule. FFL during RFA may detect RLN irritation and dysfunction if asymmetry in passive vocal cord movements is noted. Should asymmetry appear, RFA operator stops delivering energy and repositions electrode needle. Materials and Methods: Thyroid function tests, blood glucose, creatinine, transaminase, International-Normalized-Ratio, and electrocardiogram were performed. Operating room (OR) layout created sufficient space for ear-nose-throat (ENT) and RFA operators. An examination with a fiberscope camera demonstrated normal vocal cord adduction during phonation and abduction during breathing. The procedure was assisted by an anesthetist administering fentanyl 50 mcg, midazolam 1.5 to 5.0 mg, and propofol infusion 2 mg/(kg·h). General sedation was conducted so that reflexes were attenuated but still observable. Incorporating in OR by an anesthetist who performs general sedation reduces side effects and complications.6 Ultrasonography showed a 34-mL right lobe nodule abutting on the RLN area. After sedation with propofol, the ENT specialist inserted an endoscope until the glottic plane. During calm breathing, vocal cords moved symmetrically. After obtaining anterior nodule hydrodissection from strap and sternocleidomastoid muscles with 10 mL of 2% lidocaine, posterior hydrodissection was achieved by ultrasound-guided administration of 30 mL of 5% cold glucose. Anterior and posterior hydrodissections merged, separating nodule from neck structures. The radiofrequency electrode needle was then inserted into the nodule, initially positioned in inferior nodule portion adjacent to danger triangle previously isolated by hydrodissection. Initial power was 30 watts. Moving-shot technique was used. Results: FFL was performed throughout thyroid RFA. Symmetric vocal cord movements during breathing demonstrated no RLN irritation. FFL monitoring allowed observation of natural reflexive phenomena, including swallowing. Complete nodule ablation was achieved. FFL performed post-RFA confirmed normal vocal cord motility. Conclusions: We report the first-time use of FFL for vocal cord monitoring during RFA. FFL was easily performed by the ENT specialist and well tolerated by the patient. Avoiding danger triangle and precise RFA needle positioning is key in preventing RLN injury. Benign nodules regrow if total ablation is not achieved7 and some authors propose additional procedures to complete ablation8 that obviously incurs costs. Total RFA nodule ablation-assisted FFL monitoring eliminates the need for repetitive RFAs, thus reducing overall treatment costs. Finally, FFL monitoring does not prolong procedure, as it is performed simultaneously with RFA. FFL is a valid technique when used in conjunction with hydrodissection to further prevent RLN thermal injury during RFA, especially indicated for large thyroid nodule ablation and professional voice users. Patient Consent and Permission: The patient provided written consent for FFL monitoring and permission to use his portrayals and ultrasonographic images during RFA. The study was completed in accordance with the Declaration of Helsinki as revised in 2013. Adherence to institutional review board protocols was granted. Disclaimer: Representation of any instrumentation within the video does not indicate any endorsement of the product and/or company by the publisher, the American Thyroid Association, or the authors. No competing financial interests exist. Runtime of video: 9 mins 39 secs.

Hoarseness of voice and accompanying symptoms among patients at a tertiary hospital, Tanzania

Introduction: Hoarseness of voice is a common complaint in otolaryngological practice and is an early manifestation of a large variety of conditions directly or indirectly affecting the larynx, ranging from inflammatory to malignant. Hoarseness has a prevalence of 6% in the general population, rising to 11% for professional voice users (30% of the patients whose work requires excessive voice use). Despite the high prevalence many people are unaware that persistent hoarseness may be a red flag indicating cancer. Any patient with hoarseness lasting longer than two weeks, in the absence of an apparent benign cause, requires a thorough evaluation of the larynx by direct or indirect laryngoscopy. The purpose of this study was to determine the prevalence of hoarseness among patients attending otorhinolaryngology services at a tertiary hospital in Tanzania.&#x0D; Method: A descriptive cross-sectional study was conducted. A total of 427 patients were recruited. Standard questionnaires were used to collect clinical and socio-demographic information. If hoarseness was identified, further evaluation was carried out including indirect and direct laryngoscopy. Biopsies were taken from the patients with laryngeal mass after direct laryngoscopy under general anaesthesia. Data were analysed using SPSS version 20.0. Confidentiality was maintained.&#x0D; Results: The prevalence of hoarseness was 65 (15.2%), which was more common in males 40 (17%) and the age group above 60 years. Common laryngoscopic findings among patients with hoarseness were laryngeal mass 47 (63%) and the leading accompanying symptom was difficulty in breathing 25(32%).&#x0D; Conclusion: Hoarseness of voice is a common complaint and accompanies various symptoms. It can also be a red flag for upper aero-digestive malignancies. Therefore, these patients should be evaluated with a high degree of suspicion.

Comparison between Voice Disorders among Female Professional and Nonprofessional Voice Users Dealing with Early School Aged Children

Abstract Background Voice disorders are common among females; a main cause is their continuous communication with children as their caregivers. Teachers are exposed to voice abuse and misuse and so also housewives, both of them use their voice excessively to deal with children. Aim of the Work The aim of this study is to compare between voice disorders among female professional and non-professional voice users, in order to identify voice problems affecting nonprofessional voice users for prevention, early detection and proper management to avoid serious vocal health injuries. Study Design a comparative cross-sectional study. Patients and Methods This study included 100 adult female patients who complained of symptoms of voice disorders and were subjected for voice evaluation at the Phoniatrics Unit, Ain Shams University Hospitals. The participated patients were aged between 20 years to 50 years and were divided into 2 groups 50 in each group, group I (teachers) and group II (housewives). Detailed history taking, auditory perceptual assessment of voice (APA), video-laryngoscopic examination, documentation of the auditory perceptual assessment, acoustic analysis and application of Arabic VHI (voice handicap index) were done for all cases. Results The duration of the voice complaint was longer in teachers than housewives. There was nonsignificant difference between both groups regarding the presence of phonasthenic symptoms. The impact of compliant regarding patients own rating of the severity and effect on daily life was higher` in housewives than in teachers, but there was non-significant difference between both groups regarding the listener reaction. There was non-significant difference between teachers and housewives as regard the APA in the overall grade of dysphonia and voice quality. The most prevalent diagnosis of voice disorders among teachers was the vocal fold nodules, while phonasthenia was the most prevalent in housewives. There was a significant difference between the teachers and housewives as regard the total score, functional and emotional subscales of VHI. Results of the acoustic analysis revealed a significant difference between teachers and housewives as regard average F0, jitter % where teachers had higher scores than housewives. While there was non-significant difference as regard RAP, shimm%, APQ and NHR between both groups. A significant positive correlation was found between number of children and functional, emotional and total VHI score in housewives group. There was a significant positive correlation between number of students and patient’s own rating of severity and years of teaching in teachers group. Moreover, there was a highly significant positive relation between having children and emotional subscale of VHI in teachers group. Also, there was a significant positive relation between number of children and functional subscale of VHI in housewives group. Conclusion Voice disorders are common among housewives (Nonprofessional voice users) the same as in teachers (Professional voice users) especially when dealing with early school aged children. Recommendation There is need to increase awareness among the housewives about the importance of voice in their daily life, risk factors for voice problems, how to protect themselves from developing vocal pathologies and when to consult the medical professional.