Professional Voice Users Research Articles

An Evaluation of Voice Hygiene in High School Choir Singers

Voice hygiene, including proper hydration and limiting phonotraumatic behaviors and refluxogenic foods when appropriate, is essential to voice care for singers. The purpose of this study was to evaluate voice care practices, knowledge, and factors correlating with improved voice hygiene and knowledge in adolescents, an understudied demographic within the singing population. 214 high school choir singers, ages 14 through 18, responded to a voice health questionnaire, which included questions about phonotraumatic behaviors and other lifestyle measures regarding voice care, perceived knowledge of the voice, and potential correlational factors such as past singing experience, having a friend or family member when is a professional voice user or possesses an in-depth knowledge of the voice, use of the Internet to sing better or improve understanding of the voice, and other factors. These data were analyzed using descriptive statistics and multivariable linear regressions. Results showed poor voice hygiene. Phonotraumatic behaviors were frequent and the mean daily water intake was only 5.24 cups. However, 94.4% of the respondents warmed up their voices before rehearsals or performances. The mean total knowledge score, from 0 to 6, was only 2.09. In addition, feeling that one took care of his/her voice well, and use of Internet to sing better or advance knowledge of the voice, were correlated with improved knowledge or measures of voice health. Data suggest that improved instruction regarding voice health in the high school setting is necessary and that the Internet or social media may be valuable resources for reaching adolescent singers.

Direct and Indirect Voice Therapy Approaches for Unloading the Laryngeal Mechanism in Professional Voice Users

Direct and Indirect Voice Therapy Approaches for Unloading the Laryngeal Mechanism in Professional Voice Users

Spasmodic Dysphonia Patients' Perception of Pain with Botulinum Toxin Injections.

To evaluate spasmodic dysphonia patients' perception of pain associated with laryngeal botulinum toxin (BTX) injections and to determine factors associated with higher pain scores relative to other included patients. Prospective cohort study. Adult patients with adductor spasmodic dysphonia that presented to a tertiary laryngology practice for BTX injections were recruited from March to July 2022. Patients completed the visual analog scale (VAS) pre-procedure to quantify predicted pain. Ten minutes post-procedure they completed VAS and the short form McGill Pain Questionnaire (SF-MPQ). Factors that may affect pain were extracted from charts. Descriptive statistics, univariate, and multivariate analyses were conducted (alpha = 0.05). One hundred and nineteen patients were included (63 ± 14 yo, 26% Male). SF-MPQ reported mild pain (4.12 ± 4.05 out of 45) with a pain intensity of none to mild (0.70 ± 0.89 out of 5). Bilateral injections yielded significantly higher SF-MPQ scores (5.19 ± 4.66) than unilateral injections (3.30 ± 3.30) (p = 0.012). There was a significant VAS reduction from pre 28.9 ± 24.6 mm (out of 10 mm) to post 24.5 ± 22.3 (p < 0.001). On multiple regression analyses, receiving a bilateral injection significantly (p < 0.05) contributed to a model that predicted higher pre-VAS (p = 0.013). Bilateral injections (p < 0.05) and higher VHI-10 (p < 0.05) contributed to a model that predicted higher total SF-MPQ (p = 0.001) and affective SF-MPQ (p = 0.001) scores. Not being a professional voice user (PVU) significantly (p < 0.05) contributed to a model that predicted higher post-VAS (p = 0.008) scores. BTX injections were well tolerated with low pain scores. Factors associated with higher relative predicted or experienced pain included bilateral versus unilateral injection, PVU status, and higher VHI-10. 4 Laryngoscope, 134:240-246, 2024.

The effects of transcutaneous electrical nerve stimulation on muscle activity pattern in professional voice users with muscle tension dysphonia using surface electromyography data: A pilot study

ObjectivesMuscle Tension Dysphonia is a voice disorder, which results in stiffness in the laryngeal extrinsic muscles, intense collision, painful contractions, and vibrations of the vocal cords. Due to the multifactorial identity of Muscle Tension Dysphonia, its therapeutic approach must be multidisciplinary. MethodsThe participants were divided into two groups: a control group (5participants) that received Circumlaryngeal Manual Therapy (CMT) + Placebo Transcutaneous Electrical Nerve Stimulation and an experimental group (5participants) that received Transcutaneous Electrical Nerve Stimulation + CMT. Both groups received 10 sessions of treatment, twice a week, for 40 min each. Before and after treatment, participants were assessed using the Dysphonia Severity Index (DSI) and surface electromyography for their ability to sustain the vowels /e& u/and count from 20 to30. ResultAfter therapy, there were substantial improvements in the DSI (2.72 ± 0.55, P < 0.05) and muscle electrical activity in the control group. The DSI (3.66 ± 0.63, P < 0.05) and muscle electrical activity were also significantly improved in the experimental group after treatment. The findings of the between-group comparison after treatment revealed a significantly greater increase in the Dysphonia Severity Index in the experimental group compared with the control group (P = 0.037). Although there was no significant difference between the two groups in terms of muscle electrical activity, clinically significant changes were more noticeable in the experimental group when compared with the control group. ConclusionsPositive results were seen in both groups. The results demonstrate that both approaches relax vocal tract muscles. As a result, Transcutaneous Electrical Nerve Stimulation was recommended as a complementary treatment for clients with Muscle Tension Dysphonia.

Looking for an Objective Parameter to Identify Early Vocal Dysfunctions in Healthy Perceived Singers

The finding of minimal laryngeal dysfunctions in professional voice users is essential to prevent the onset of organic vocal pathologies. The purpose of this study is to identify an objective parameter that supports the phoniatric evaluation in detecting minimal laryngeal dysfunctions in singers. 54 professional and non-professional singers have been evaluated with laryngostroboscopy, Multi-Dimensional Voice Program (MDVP), Dysphonia Severity Index (DSI), maximum phonation time (TMF), minimum intensity of sound emission (I-min), maximum frequency (F-max), voice handicap index (VHI), singing voice handicap index (SVHI), manual phonogram and audiometric examination. The SVHI of all the “healthy” singers was on average 23.7 ± 22.5, while that of the “dysfunctional” 20.9 ± 18. No statistically significant difference was found between the SVHI scores of the total of healthy singers compared to the scores of the dysfunctional ones on the VSL (p = 0.6). The between-group comparison of the means of individual parameter values of DSI, TMF, F-max, Jitter, Shimmer, NHR, and SPI was not statistically significant (respectively p = 0.315, 0.2, 0.18, 0.09, 0.2, 0.08, 0.3). The only parameter analyzed that was statistically significant was the I-min (p < 0.05). SVHI is a valid instrument for the evaluation after a therapy but in our experience, it is not useful in distinguishing healthy from dysfunctional patients. The minimum intensity of sound emission measured with the sound level meter (I-low2) resulted a reliable parameter to identify minimal laryngeal dysfunctions and a useful tool in supporting the phoniatric diagnostic-therapeutic process in singers.

Bhramari Pranayama - A Unique Voice Culturing Technique

A good voice is the basic need of humans. For professional voice users, voice governs their livelihood and social attraction. A good singing voice is attained by the regular vocal exercises and vocal training. Singing involves the skills like respiration, phonation, resonance and articulation. Bhramari Pranayama (BP) involves both humming and respiration. Humming is the resultant of the activity vocal structures which may have effect on the quality of the voice. Aim: To evaluate the effect of Bhramari Pranayama (BP) on voice quality&#x0D; Settings and Design: The study is an open clinical trial involving 30 healthy prospective singers fulfilling the inclusion and exclusion criteria, consenting for the study, who were enrolled through a survey in music schools in the region of Belagavi, Karnataka. Methods and Material: The voice of the 30 healthy prospective singers was recorded using PRAAT software with standard vocal tasks on day 0 of the study. Participants practiced 21 cycles of Bhramari Pranayama in the morning for 30 days. On Day 30, after the practice the voice was re-recorded with same vocal tasks and standard operative procedures being maintained. The recorded voice samples were saved and were subjected for voice analysis using softwares PRAAT, Vaghmi, CSL at AIISH, Mysuru. Statistical analysis used: Statistical analysis was done using SPSS 21 and Paired ‘t’ test was applied to derive the results. Statistical Significance was set up at p&lt;0.05. Results: Bhramari pranayama showed highly significant results in the root mean square values of the Singing power ratio - SPR (p&lt;0.01) and singing power difference (p&lt;0.01). Significant results in the lowest value of the singing amplitude (p&lt;0.05), singing amplitude range (p&lt;0.01) and mean formant frequency of second formant of vowel /u/(p&lt;0.05). Conclusion: Bhramari Pranayama improved the resonance characteristics of the voice and there by improved the quality of singing voice in prospective singers.

Is Cepstral Peak Prominence a Measure of Vocal Fatigue in Temple Priests: A Pilot Study

Considering cepstral analysis of voice as a measure of overall severity of dysphonia, we tried to investigate if these measures could be considered as a metric of vocal fatigue as well. Since voice quality changes are seen as a result of vocal fatigue, we wanted to find out if there were any correlations between the cepstral measures, vocal fatigue symptoms, and auditory perceptual evaluation of voice in professional voice users. The pilot study was conducted on 10 temple priests belonging to the Krishna Consciousness Movement. We conducted a pre-post voice evaluation, which included recording voices before the beginning of any temple preaching in the morning and after all the preaching sessions in the evening. The priests also filled in the Vocal Fatigue Index (VFI) questionnaire twice (morning and evening), and all the voice samples were analyzed for GRBAS (Grade, Roughness, Breathiness, Asthenia, and Strain voice quality) rating by speech language pathologists with voice expertise. Correlations were obtained between the acoustic measures, VFI responses, and auditory perceptual evaluations. The findings of our pilot study didn't show any correlations between the cepstral measures and the questionnaire responses or with the perceptual ratings. However, the cepstral measures were slightly higher for evening recordings than the morning recordings. Our participants did not experience or perceive any voice symptoms or vocal fatigue. Despite more than 10 hours of voice use per day for over 10 years, our participants did not experience any voice symptoms or vocal fatigue. This finding indicates that there may be diverse reasonings and opinions about the occurrence of voice problems in various professional voice users. This is particularly because the participants' responses to vocal fatigue symptoms had more of a psychological explanation (faith, self-power, etc.) rather than any physiological changes in the vocal apparatus.

Vocal Habilitation in Post-Acute Symptomatic COVID-19 Recovery: A Narrative Review of Strategies for Singing Teachers

The World Health Organisation declared a global health pandemic on March 11, 2020. Over two and a half years later, symptomatic COVID-19 infection and reinfection rates remain problematically high throughout the world. Singers, singing teachers, and other professional voice users affected by COVID-19 report significant vocal, respiratory, psychological, and stamina disturbances that impact their work. Mitigating recovery time is essential for the professional voice user. Limited research has been conducted on vocal health and production for singers affected by COVID-19. This narrative literature review aims to synthesise knowledge of symptoms that affect vocal health and production. Multidisciplinary literature from the vocology, speech pathology, otolaryngology, psychology, education, singing voice pedagogy, and voice science fields were comprehensively searched, screened, reviewed, and synthesised. Findings were used to frame practice-based strategies to support the vocal habilitation of singers recovering from symptomatic COVID-19. KEYWORDS: vocology, singing voice pedagogy, voice disorders, COVID-19

Persistent subjective voice symptoms for two years after thyroidectomy

BackgroundVoice change after thyroidectomy is an important issue in thyroid surgery. However, little is known about long-term voice outcomes after thyroidectomy. This study investigates the long-term voice outcomes of thyroidectomy up to two years after surgery. Also, we analyzed the pattern of recovery through acoustic tests over time. MethodsWe reviewed data from 168 patients who underwent thyroidectomy between January 2020 and August 2020 at a single institution. The Thyroidectomy-related Voice and Symptom Questionnaire (TVSQ) score and acoustic voice analysis results were examined preoperatively and postoperative one, three, and six months, and one and two years after surgery. We divided patients into two groups based on the TVSQ score (≥15 or <15) at two years postoperatively. We investigated the difference of acoustic characteristics between the two groups and analyzed correlations between acoustic parameters and various clinical and surgical factors. ResultsVoice parameters tended to recover, but some parameters and TVSQ scores exhibited deterioration two years after surgery. In the subgroups, among the many clinicopathologic factors examined, voice abuse history including professional voice users (p = 0.014), greater extent of thyroidectomy and neck dissection (p = 0.019, p = 0.029), and high pitch voice (F0; p = 0.005, SFF; p = 0.016) were associated with high TVSQ score at two years. ConclusionsPatients frequently experience voice discomfort after thyroidectomy. After surgery, voice abuse history including professional voice users, greater extent of surgery, and higher pitch voice are associated with worse voice quality and increased risk of persistent voice symptoms over the long-term.

Correlation Between Auditory-Perceptual Parameters and Acoustic Characteristics of Voice in Theater Actors

Background: Theater actors are a subgroup of professional voice users who may present their performances at a high-pressure vocal demand, like loud talking, shouting, or even stage singing. Disturbances in auditory-perceptual or acoustic parameters of voice are commonly experienced by theater actors and are known as a frequent occupational hazard for them. Objectives: This study aimed to examine the relationship between auditory-perceptual and acoustic parameters of the voice in Iranian theater actors. Methods: This descriptive-analytical study was conducted on 45 Iranian theater actors, including 22 females and 23 males, with a mean age of 30.76 ± 7 years. The auditory-perceptual evaluation was performed using the Persian version of the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V). Acoustic characteristics, including mean fundamental frequency (F0), local shimmer, local jitter, and harmonic-to-noise ratio (HNR), were extracted from the subjects’ “speech sample.” Correlation analyses were performed to examine the relationship between the measures of auditory-perceptual and acoustic voice characteristics. Results: The overall auditory-perceptual severity was negatively correlated with mean F0 (r = -0.592, P &lt; 0.05) and HNR (r = - 0.324, P &lt; 0.05). Roughness was also negatively correlated with voice mean F0 (r = -0.629, P &lt; 0.05) and HNR (r = -0.322, P &lt; 0.05) and positively correlated with voice local jitter (r = 0.310, P &lt; 0.05). We also found that pitch was negatively correlated with voice mean F0 (r = -0.309, P &lt; 0.05) and positively correlated with voice local jitter (r = 0.292, P = 0.050). Conclusions: Acoustic measures, including F0, HNR, and jitter, correlate with auditory perceptual parameters of the voice quality in Iranian theater actors. These findings highlight the significance of acoustic parameters in assessing voice quality in professional voice users such as theater actors.

Muscle Tension Dysphonia in Singers and Professional Speakers with Ankyloglossia: Impact of Treatment with Lingual Frenuloplasty and Orofacial Myofunctional Therapy

Introduction: Muscle tension dysphonia (MTD) describes a condition affecting the feeling or quality of the voice due to increased muscle tension in and/or around the neck and larynx. Ankyloglossia is a condition of restricted tongue mobility that has been shown to be associated with increased muscle tension. This case series explores outcomes for voice users with MTD who have been treated for ankyloglossia. Methods: Twelve professional or recreational voice users diagnosed with ankyloglossia were surveyed on their symptoms of MTD before and after treatment with lingual frenuloplasty and pre- and post-operative orofacial myofunctional therapy (OMT), a multidisciplinary approach known as functional frenuloplasty. Two investigators independently compiled a list of themes reported by participants and agreed upon common themes. Results: Eleven out of twelve patients (91.6%) reported clinical improvement in the use of their voice after functional frenuloplasty; one patient reported no change. Five primary themes were noted: improved voice quality, improved ease of singing and/or speaking, increased stamina, increased pitch range, and improved breath support. Discussion: OMT with lingual frenuloplasty can be an effective adjunctive intervention for treatment of symptoms of vocal tension and fatigue for singers and professional speakers with ankyloglossia. These findings suggest a possible association between MTD and restricted tongue mobility presumably due to underlying myofascial tension.

Safety of Laryngeal Electromyography and Repetitive Stimulation

Laryngeal Electromyography (LEMG) is a procedure used to assess electrical signals from laryngeal muscles. It is considered to be the gold standard test for examining vocal fold paresis/paralysis. Repetitive stimulation studies, which usually are performed at the time of LEMG, can aid in assessment of neuromuscular function. Electromyography poses risks to the patient due to the use of electricity and needles. The purpose of this paper was to evaluate the safety of LEMG and discuss the possible complications. This was a retrospective review of patients from January 2015 through February 2022. Information from patient charts included age, sex, chief complaint, past medical history, family medical history, medications, social history, strobovideolaryngoscopy results, type of paresis, professional voice user status, presence of pacemaker, laryngeal electromyography and repetitive stimulation study results, and reported complications. Complications were considered to be anything that differed from the norm. Pain was included as a complication. Data were analyzed for relationships and significance. Five hundred patients were included. Eighteen of the 500 (3.6%) experienced complications. Four (2.1%) males and 14 (4.5%) females experienced complications. Nine of the 18 (50%) reported pain after the procedure, 1 (5.56%) had excessive bleeding (controlled with pressure), 5 (27.78%) reported voice changes, and 3 (16.67%) experienced difficulty with completion of the procedure. No patients with pacemakers or patients taking anticoagulants had complications, but repetitive stimulation studies were not performed on patients with pacemakers. LEMG and repetitive stimulation studies are safe and effective procedures to examine laryngeal muscles. Repetitive stimulation studies are not recommended for patients with pacemakers.

Epidemiology Of Voice Disorders Among Government School Teachers - An Analytical Cross-Sectional Study from Kancheepuram District

Background: Voice disorders cause undesirable effects on school teachers such as reducing their quality of life, decrease in work performance affecting the quality of education, job absenteeism, and reduced social activities as well. Methodology: Voice disorder among teachers was assessed through the “Voice handicap Index”, which was developed by Jacobson et al in 1997 to self-assess the severity of voice disorder in dysphonia patients Results: The overall prevalence of voice disorder among government school teachers was found to be 46.5% with a 95% confidence interval from 41.5% to 51.5%. Using Backward Wald, the binary logistic regression analysis showed that female teachers (AOR 1.6, p&lt;0.01*), teaching experience less than 10 years (AOR 2.4, p&lt;0.01*), and teaching hours more than 21 hours per week (AOR 6.7, p&lt;0.01*) had a significant association with voice disorders. Conclusion: The prevalence of voice disorder was found to be high since teachers are professional voice users. The study also recommends that teachers must receive the required health education on the ergonomic risk factors that they will come into contact with in their daily lives as part of their jobs.

Prevalence of Voice Problems and Associated Risk Factors Among Tamil-Speaking Imams

Voice of Professional Voice Users (PVUs) are of particular interest to practicing Speech-Language Pathologists. There is a dearth of studies concerning the prevalence of voice disorders and the associated risk factors among Tamil-speaking Imams. We address this research gap using non-experimental survey research. A questionnaire was framed by reviewing earlier literature. The derived questionnaire was administered to one hundred Tamil-speaking Imams actively involved in religious service in Tamil Nadu. We analyzed the obtained responses quantitatively and qualitatively. We also examined the effect of age on the prevalence of voice disorders and associated risk factors. Based on survey responses, the career prevalence of voice problems among Tamil-speaking Imams was as high as 89%, and the point prevalence was 64%. The general health status of the Imams were good. However, vocal health was not satisfactory. This study identified several factors that contribute to voice problems, such as constant use of loud voice, acid reflux, unhealthy vocal habits, and insufficient hydration. A positive aspect observed during this study was the absence of smoking and consumption of alcohol among Imams. Even though the Imams presented good awareness of the voice production mechanism, they reported not seeking medical help when facing a voice problem. Current findings report a minimal impact of age-related differences on associated risk factors for voice disorders among the Imams. Voice disorders are prevalent among Tamil-speaking Imams. Several risk factors leading to voice disorders among these individuals need to be addressed.

다차원적 음성평가를 이용한 예비 직업적 음성사용자의 음성 특성 분석

The purpose of this study was to examine the differences in voice characteristics between pre-professional voice users, vocal college students and acting majoring college students, using self-voice evaluation and reflux and globus sensation scale. As test tools, the Korean version of the Voice Handicap Index (K-VHI), the Korean version of the Voice-Related Quality of Life (K-VRQOL), the Reflux Symptom Index (RSI), and the Glasgow-Edenburgh Thraot Scale (GETS) were used. The subjects of the study were 68 students, including 27 college students majoring in vocal and 41 college students majoring in acting. As a result of the study, K-VHI(F), RSI, and GETS scores of college students majoring in acting were significantly higher than college students majoring in vocals (p &lt;.05), and there was no significant difference in K-VRQOL. The students majoring in acting had more voice problems, reflux symptoms, and a globus symptoms in the throat than vocal students. These results were related to voice hygiene level and lifestyle habits. Therefore, education on the effects of lifestyle habits related to voice hygiene on voice can be helpful for prospective professional voice users.

The Effect of Vocal Hygiene Education Programs on Voice Quality in Professional Voice Users: A Systematic Review.

This study aimed to critically appraise recent peer-reviewed scientific evidence on the effect of vocal hygiene education on voice quality and function directly and indirectly measured by auditory-perceptual, acoustic, and self-report measures in professional voice users. A systematic review was conducted utilizing the Preferred Reporting Items for Systematic review and Meta-Analyses Protocols (PRISMA-P) guidelines. Five databases were searched using the keywords "vocal hygiene," "vocal hygiene education," "vocal health," "vocal quality," and "voice quality" with Boolean phrases "AND" and "OR." Twenty-three studies that met the eligibility criteria were included. Scoring was based on the American Speech-Language-Hearing Association's levels of evidence and quality indicators, as well as the Newcastle-Ottawa Scale for assessing the risk of bias. Four studies (17%) linked low awareness of vocal hygiene or insufficient vocal hygiene education to self-reported acute and chronic voice symptoms, as well as a greater perception of voice handicap among professional voice users. Numerous studies (n = 10; 43%) showed that adequate voice training or vocal hygiene education was linked to positive voice outcomes. Six studies (6.26%), however, demonstrated that vocal hygiene education is more effective when combined with direct voice therapy. When vocal hygiene education is presented in isolation, the superiority of a direct voice therapy approach, with or without vocal hygiene education, is seen over a vocal hygiene education program alone (indirect treatment). Recent literature demonstrates mixed results obtained through auditory-perceptual, acoustic, and self-rating measures on the effects of vocal hygiene instruction on vocal quality and function in professional voice users. However, the compelling positive outcomes presented do warrant implementation of vocal hygiene education programs in combination with direct voice therapy for professional voice users.

Voice Therapy Efficacy in Pediatric Professional Voice Users With Vocal Fold Nodules: A Preliminary Study

Vocal fold nodules are the most common diagnosis in children with dysphonia. It is also frequently seen in professional voice users who uses their voice as an occupational tool. It can be caused by excessive or hyperfunctional use of the voice leading to phonotrauma. Children who learn the Quran by heart and recite it use their voices excessively and it causes voice problems. Voice therapy can play an important role in regulating phonotraumatic behaviors and improving voice quality, thereby replacing surgical intervention in some cases or acting as a complementary therapy to improve eventual therapeutic outcomes. Our aim was to find the efficacy of group voice therapy compared to individual voice therapy in a group of pediatric professional voice users who go to the same religious school. To determine group therapy efficacy, 24 students between the age of nine and 14, were evaluated and 16 of them had vocal fold nodules. Therapy sessions started with 16 students whose ages ranged from nine to 14 with a mean of 11,3 ± 1,4 years old. They were divided into two groups: group and individual therapy groups. Treatment comprised both direct and indirect voice therapy and lasted 6 weeks. Three of the participants were dropped out due to absence. Pre- and post-therapy measures were collected from 13 participants using perceptual evaluation, videostroboscopy measures, and the pediatric voice handicap index to determine the efficacy of group voice therapy compared to individual voice therapy with a group of pediatric professional voice users with vocal fold nodules. As a result of our study, eight of participants were found to have healthy vocal folds; the s/z ratio was significantly different between groups and within group therapy participants pre- and post-therapy. No significant difference was found in other parameters; except noise harmonic ratio (NHR). NHR was found significantly different between pre- and post-therapy when individual therapy and group therapy were compared. Although both treatments were shown to be beneficial in the management of vocal fold nodules, individual therapy was found to be somewhat more effective. In pediatric voice therapy, group therapy is an effective option to reach out to more individuals with voice disorders. It can be beneficial for time management and cost effectiveness in voice therapy.

Menopausal Voice-Related Work Limitation Scale (MenoVWL): Development and Validation

Menopause has been reported to affect the voice of female professional voice users (FPVUs). The present study aims at the development and validation of a scale to measure self-perceived menopausal voice-related limitation to work in FPVUs, henceforth the Menopausal Voice-Related Work Limitation Scale (MenoVWL). Items were drawn from previous studies on impacts of sex steroid hormones on voice, available validated scales, and in-depth interviews with post-menopausal FPVUs. A preliminary version with 16 items was evaluated by a panel of 15 voice experts. The resulting revised version was filled in online, together with questions on current endocrinological reproductive status and related symptoms, history of amenorrhea, professional occupation, and demographic information. Responses concerning only professional voice users were selected and inclusive and exclusive criteria were applied for correct allocation of participants into pre- and post-menopausal stages within a restrict age range;192 responses were subject to factorial analysis for MenoVWL validation. Cronbach's alpha measured internal reliability. The scale was tested by comparing MenoVWL scores between pre- and post-menopausal FPVUs (98 and 94, respectively). Thirteen items were retained from the expert panel evaluation. Items presented a high Content Validity Index (.94 out of 1) and high Item Acceptance Ratio (86.25 %). Both exploratory and confirmatory factorial analysis rendered one dimension scale with an excellent internal consistency (Cronbach's alpha=.9). The results of a Mann-Whitney test showed a higher MenoVWL score for post- as compared to pre-menopausal FPVUs (Z=- 2.818; P=.005). MenoVWL is a comprehensive and validated scale with a known factor structure. It constitutes a health care and safety outcome self-perceived measure of value to the early detection of voice-related limitations to work in FPVUs during menopause.

Effect of Voice Projection Training on Acoustic and Auditory-Perceptual Characteristics of Voice in Tamil-Speaking Imams

Imams are professional voice users at risk of developing voice problems. Speech-Language Pathologists need to provide intervention programs to target risk factors associated with voice disorders and improve the voice quality of Imams. However, studies examining the effect of vocal training for Imams are limited in the literature. This study attempted to document the acoustic and auditory-perceptual changes in the voices of Tamil-speaking Imams with a voice projection training program. Eleven Tamil-speaking Imams participated in a voice projection training program. Voice samples were recorded at four specific time points before, during, and after the voice projection training. These recordings were subjected to various acoustic analyses (AVQI, Dr Speech, and MDVP) and auditory-perceptual analysis (CAPE-V) to determine the changes with the voice projection training. Auditory-Perceptual analysis carried out by five experienced SLPs suggested significant changes in the voice quality of the participants with voice projection training. High inter-rater reliability was observed across the judges as well. We observed positive changes in several acoustic measures indicated within AVQI, Dr Speech, and MDVP software. These primarily included changes in fundamental frequency, noise related measures (HNR, SNR), and perturbation measures. Voice projection training positively impacts the acoustic and auditory-perceptual characteristics of the voices of Tamil-speaking Imams.

Determining Knowledge Level, Attitude, Behaviors Regarding Vocal Hygiene and Use of Medical Drugs and Herbal Medicinal Products for Vocal Health in Second Level Professional Voice Users

This study aims to determine the knowledge level, attitude, and behaviors regarding vocal hygiene and use of medical drugs and herbal medicinal products for vocal health in second level professional voice users. The study examined second level professional voice users comprised of amateur singers, religious officials,voice instructors and vocal coaches consisting of academicians working in conservatories and education faculties, music teachers, conservatory students majoring in opera or choir, students majoring in music education, and amateur actors who were reached via online platforms and were administered a 32-item questionnaire RESULTS: A total of 406 participants consisting of conservatory students (26.8%), religious officials (23.2%), academicians (9.1%), amateur or self-taught musicians (14.8%), conservatory graduates (8.6%), and music teachers affiliated with the Ministry of National Education were recruited for the study. It was determined that 78.8% of the participants knew the definition of vocal hygiene, and 60.6% made an effort to maintain vocal hygiene. 57.9% of the participants declared that they had at least one disease affecting their vocal health. According to our research data, 8.9% of the participants were using one or more prescription drugs or over-the-counter products daily to protect their vocal health. Lozenges, vitamins, and allergy medications constituted a large portion of these medicinal products. In total, 62.3% of participants used herbal products for vocal health in their daily life. Participants mostly consumed products containing linden, sage, ginger, chamomile, and turmeric. It was determined that more than 20 different herbal products containing plants in different mixtures and contents were used. Furthermore, 40% of the participants using herbal medicinal products consulted a health care professional.It was found that these products were mostly obtained from herbalists (79.5%), and the source of information regarding these products was quite diverse. The rate of experiencing side effects due to the use of herbal products was 2%. There is a lack of knowledge regarding vocal hygiene and its application on real-life behavior among second-level sound professionals. In particular, the awareness of vocal hygiene should be increased among religious officials. It was observed that the rate of use of herbal products to protect vocal health or to treat hoarseness was quite high. Further studies are needed to prove the benefits of these herbal and medicinal products on vocal health.