Self-reported Voice Disorders Research Articles

Effectiveness and Feasibility of Telepractice on Voice Therapy for Female Teachers in Elementary Schools with Self-Reported Voice Disorders.

The purpose of this study is to explore the effectiveness of telepractice in voice intervention for female teachers in elementary schools with self-reported voice disorders. Thirty-five female elementary school teachers with self-reported voice disorders volunteered to participate in the study. They were divided into a telepractice voice intervention group (experimental group N=18) and a face-to-face voice intervention group (control group N=17) based on their employment setting. The exact same treatment protocol was applied to both groups of subjects, except that the intervention group was seen through telepractice, and the control group was seen face-to-face. The treatment protocol includes vocal hygiene education and resonant voice therapy twice a week for a total of eight sessions. Auditory perceptual analysis, acoustic assessment, aerodynamic assessment and self-assessment protocol were conducted before the intervention and one week after the last intervention, and the differences before and after interventions within each group and between groups were compared. There was no significant difference in baseline data including age, working years, and voice symptoms between the two groups. Both groups showed significant improvement (P<0.05) in all voice assessment before and after the treatment sessions, except for the Voice Handicap Index-10 (VHI-10) assessment. No statistical difference was found in other pre- and post-intervention voice assessment changes between the two study groups. The control group presented higher improvement in the total score, and the two subdomain assessments of physiology and emotion. Telepractice voice intervention can effectively improve the voice quality of female teachers in elementary schools, and telepractice therapy can be an effective alternative to face-to-face voice intervention.

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.

Prevalence of Self-Reported Voice Concerns and Associated Risk Markers in a Nonclinical Sample of Military Service Members.

Difficult communication environments are common in military settings, and effective voice use can be critical to mission success. This study aimed to estimate the prevalence of self-reported voice disorders among U.S. military service members and to identify factors that contribute to their voice concerns. A nonclinical sample of 4,123 active-duty service members was recruited across Department of Defense hearing conservation clinics. During their required annual hearing evaluation, volunteers provided responses to voice-related questions including a slightly adapted version of the Voice Handicap Index-10 (VHI-10) as part of a larger survey about communication issues. Changepoint detection was applied to age and years of service to explore cohort effects in the reporting of voice concerns. Logistic regression analyses examined multiple available factors related to communication to identify factors associated with abnormal results on the VHI-10. Among the respondents, 41% reported experiencing vocal hoarseness or fatigue at least several times per year, and 8.2% (n = 336) scored above the recommended abnormal cut-point value of 11 on the VHI-10. Factors independently associated with the greatest risk for self-reported voice concerns were sex (female), cadmium exposure, vocal demands (the need for a strong, clear voice), and auditory health measures (frequency of experiencing temporary threshold shifts; self-reported hearing difficulties). Based on self-reported voice concerns and false negative rates reported in the literature, the prevalence of dysphonia in a large sample of active-duty service members is estimated to be 11.7%, which is higher than that in the general population. Certain predictors for voice concerns were expected based on previous literature, like female sex and voice use, but frequency of temporary threshold shifts and exposure to cadmium were surprising. The strong link between voice and auditory problems has particular implications regarding the need for effective communication in high-noise military and other occupational environments.

Introduction of Voice Type Component (VTC) as an Effective Acoustic Voice Analysis Method in Tele-evaluation

Telepractice in voice healthcare and evaluation services has attracted much attention in recent years. Multiple studies have proven the effectiveness of voice therapy with telepractice. However, voice evaluations are still mostly conducted in person due to the lack of sensitive acoustic analysis methods. This study examined various acoustic analysis methods for voice evaluation in telepractice. Eighteen female elementary school teachers with self-reported voice disorders volunteered to participate in the study. Speech samples were collected before and after the interventions using two voice sampling methods concurrently. One set of data was collected using the traditional voice sample collection method by the therapist in person. The second set of data was collected on the same speech samples using the clients' own smartphones, and the collected voice samples were later sent to the researcher for further acoustic analysis. The voice type component (VTC) measurement represented the proportion of different VTCs in a voice by measuring the chaos and intrinsic dimension. Voice analyses were conducted on both sets of data, and the correlation between the two sampling procedures was analyzed. It appears that the VTC could be a more reliable method for producing acoustic analysis results with voice samples collected from smartphones compared to other objective voice assessment procedures. This reliability has been demonstrated via statistical analysis, including correlation coefficient, pairwise t test, d-prime,and area under the curve. The results of this study highlighted the VTC as an effective and accurate acoustic analysis method in tele-evaluation. This feasible voice sampling method, which utilizes participants' own smartphones, will reduce barriers to accessing limited voice specialists due to distance and will decrease the cost of care by minimizing expenses associated with travel and additional equipment for voice sampling. Ultimately, this approach will enhance the effectiveness of voice care delivered through telepractice to patients in remote and underserved areas.

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

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

Self-reported voice disorders of teachers and indoor air quality in schools: a cross-sectional study in Finland

Objective We aimed to study the association between self-reported voice disorders among teachers and indoor air quality in school buildings. Methods We performed a questionnaire study of 538 Finnish teachers working in 67 school buildings utilizing both perceived and technical evaluations; the agreement between these two assessments was also studied. The technical assessment was provided by technical experts. Results Teachers with voice disorders reported significantly more complaints from indoor air than those without voice disorders. The results also indicated a possible connection between the technical assessment and voice disorders. After adjustment for sex, stress and asthma, the prevalence of voice disorders was 47% higher in teachers working in renovated buildings compared to those working in the non-problem buildings (aRR1.47; CI 95% 1.11–1.95). The prevalence of voice disorders was 28% higher among teachers working in buildings with problems compared to those working in non-problem buildings (aRR 1.28; 95% CI 0.99–1.64). Discussion In our study, poor perceived indoor air was significantly associated with self-reported voice disorders in teachers and there was an agreement between the perceived and technical assessments. Our results also indicated a possible connection between the technical assessment and voice disorders. Our results imply the need for longitudinal research with technical assessment to study the effect of renovation on voice disorders.

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.

Preliminary Findings on Self-Reported Voice Disorders in Urban Ghana: A Qualitative Description Study

This preliminary qualitative description study explored knowledge from urban Ghanaians about the nature and impact of their self-reported voice problem. Ten Ghanaians were screened for a self-reported voice disorder using the Voice Handicap Index–10 (VHI-10), and they also completed a structured interview with a speech-language therapist. Content analysis was completed from interview responses using quantification of data. Four out of 10 adult Ghanaians demonstrated high VHI-10 scores that indicated a self-reported voice disorder. Themes that emerged included a recurring problem with voice, multiple vocal impairments, limitations with participating in vocal activities, and other health problems. Lack of financial resources and little knowledge about voice disorders were barriers to accessing care. In summary, four adult Ghanaians with a self-reported voice disorder described multiple problems with their voice, limiting their participation in vocal activities. Implications of these preliminary findings include early identification and improving voice care access to avoid handicapping voice problems.

Investigating voice differences in teachers with and without self-reported voice disorders, and healthcare workers without self-reported voice disorders

Objective The present study had two objectives: (1) to investigate differences in voice parameters between teachers with and without self-reported voice disorders and (2) to find differences in voice parameters between teachers and healthcare workers without self-reported voice disorders. Method Three respondents’ groups were formed: teachers with self-reported voice disorders (mean age, 47 years; range, 34–60 years), teachers without self-reported voice disorders (46; 27–64), and healthcare workers without self-reported voice disorders (45; 31–63). All participants were women. Maximum Phonation Time (MPT), fundamental frequency (F 0), jitter, shimmer, frequency and intensity range, Dysphonia Severity Index (DSI), Voice Handicap Index-30 (VHI), and perceived stress (PSS) were assessed in respondents. Results Twenty-nine percent of teachers noted two or more vocal symptoms daily or weekly. Teachers with self-reported voice disorders had a higher degree of perceived stress (18 vs. 13, p = .009), higher score on the VHI (25 vs. 13, p = .001), and lower score on the DSI (2.65 vs. 3.21, p = .037), than teachers without self-reported voice disorders. The VHI-30 score of 15 points could be a cut off value describing voice disorders in female teachers. Differences between teachers and health care workers without self-reported voice disorders were found in MPT (p = .001), F 0 (p = .012), jitter (p = .009), DSI (p = .023), and the perceived stress score (p = .041). Conclusions The teaching profession can influence the voice, and the presence of psycho-emotional factors can lead to the development of voice disorders in teachers.

The Prevalence of Self-Reported Voice Disorders in Israel

Data on the prevalence of voice disorders is vital in order to describe and understand the phenomenon. The aim of this study was to estimate the prevalence of voice disorders in Israel, and perform a preliminary comparison between the two major societies in the country. A sample of 1146 people participated in a survey on voice disorders. This sample comprised 510 Israeli Jews and 627 Israeli Arabs. Each participant completed a questionnaire concerned with voice and its disorders as well as the shortened Voice Handicap Index-10 (VHI-10). The overall prevalence of voice disorders within our sample was 13.90%. In addition, 30.26% of the participants reported experiencing a voice problem over the last year, while 12.81% reported seeing a physician for that reason. No significant differences were found in the prevalence of voice disorders between participants who identified themselves as either Jews or Arabs. A higher prevalence of voice disorders was found in the older age groups, and among people who reside in the southern region of the country. In contrast, no significant differences in the prevalence of reported voice disorders were found between men and women. The prevalence of reported voice disorders in Israel is comparable with previous prevalence reports from other regions and societies. Data show that despite cultural, religion, language, and other factors, the prevalence of voice disorder among Israeli Jews and Arabs is very similar.

Prevalence, Characterization, and Impact of Voice Disorders in Fado Singers

Fado is a genre of urban folk music from Portugal characterized by some particularities. Some indictions in the study point this population of singers to be at higher risk of developing voice disorders. This study aims to provide estimates of the prevalence of voice disorders in Fado singers, and to characterize the professional practice and the impact of voice disorders on their careers. This is a cross sectional study based on a self-administered questionnaire split into six parts and 55 questions. A gender-balanced sample of 111 singers was achieved. Most of them recorded at least once. Winter and spring were found to be the most difficult seasons in which to sing. The overall prevalence of self-reported voice disorders was 39.6%, significantly higher in females. Almost all sought clinical guidance. Vocal fold nodules, functional dysphonia, and vocal fold polyp were the most common diagnoses. Vocal fatigue and hoarseness were the main symptoms reported. Nearly half of the singers had to cancel shows due to voice disorders. Fado singers reveal both a relative high prevalence of voice disorders and related concerns, even though some discrepancies were found regarding other apparently similar singer populations. These results lead support the need for further investigation regarding the risk or protective factors influencing voice disorders.

THE INVESTIGATION OF VOICE HANDICAP INDEX IN TEACHERS WITH AND WITHOUT SELF-RATED VOICE DISORDERS

Voice disorders restrict daily activity and impact the quality of life. The purpose of the study was to find out the impact of voice disorders on functional, physical and emotional condition of teachers with and without self-reported voice disorders. Two hundred thirty-five teachers with self-reported voice problems (Voice disorder group) and 174 teachers with no voice problems (Control group) in anamnesis completed Latvian version of Voice Handicap Index-30 (VHI-30). Teachers with voice disorders demonstrated higher median scores in VHI-30 total scale and functional, physical, and emotional subscales (P0.001). In teachers, voice disorders have a more significant impact on their physical comfort and have a smaller impact on their emotional sphere. 76.4% of the voice disorder group respondents acquired the total score within 12 to 33 points. In the control group, 75.3% of teachers had the VHI score of up to 17 points. Conclusions: In teacher population of Latvia mild voice disorders are encountered more often. Activity and participation in everyday life situations are limited in teachers with voice disorders. Voice disorders mostly impact physical comfort in teachers.

Prevalence of Voice Disorders in Singers: Systematic Review and Meta-Analysis

The study aimed to review the prevalence of self-reported voice disorders in singers. The study is a systematic review and meta-analysis. A systematic review of five major scientific databases was conducted. An extensive search strategy was used considering the rules of each database. Original articles were included only if they had data related to self-perception of dysphonia in the past. Furthermore, heterogeneity and its relative significance were assessed. There were 2371 articles identified; duplicates were deleted, screenings were conducted, and inclusion and exclusion criteria were applied. The final analysis was conducted on 11 studies. The most implemented instruments for the study were customized questionnaires. The findings about singing styles, voice use, and age were found to be different among subjects. The overall prevalence of self-reported dysphonia in singers was 46.09% (95% confidence interval: 38.16-54.12). The heterogeneity was considerable among the studied samples (I2 = 90.59%). Four groups were then established-students, teachers, classical, and nonclassical-and compared regarding overall prevalence (21.76% in students, and significantly higher and nondifferent in the other three groups, 55.15%, 40.53%, and 46.96%, respectively) and heterogeneity (low only for the students' studies). Although with low homogeneity, singers present a high prevalence of self-perceived dysphonia over their careers. Singing students were the group with a lower prevalence. On the other hand, traditional and popular music singers, as well as singing teachers, revealed significantly higher prevalence of self-perceived dysphonia. Overall, singers are likely to report voice disorders, no matter their singing style or skills. This highlights the need of a preventive approach to address voice disorders in traditional and untrained singers.

Associations between self-perceived voice disorders in teachers, perceptual assessment by speech-language pathologists, and instrumental analysis

Purpose: The three aims of this study were to assess agreement between self-perceived voice disorders, perceptual and instrumental assessment; to determine factors associated with perceptual voice assessment; and to determine which associated factors would serve as an initial screening tool for ascertainment of the presence or absence of voice disorders among teachers.Method: A cross-sectional study was conducted among 574 Colombian teachers. Participants filled in a questionnaire and recorded a voice sample. The voice samples were perceptually evaluated by a speech-language pathologist with the Grade, Roughness, Breathiness, Asthenia, and Strain (GRBAS) scale and objectively with an automated voice analysis for fundamental frequency, jitter, shimmer and maximum phonation time. Agreements between GRBAS scale, self-reported voice disorders and instrumental analysis were determined by unweighted Coheńs Kappa coefficients and receiver operating characteristic curves. Multivariate logistic regression analysis was used to identify variables associated with the perceptual assessment. Diagnostic performance of these variables was assessed by the area under the curve.Result: There was no agreement between self-reported voice disorders and GRBAS assessments. Maximum phonation time showed a slight agreement with perceptual assessment of voice disorders.Conclusion: Since these three methods offer different information, it is advisable to include all methods in ascertainment of voice disorders among teachers at work.

Correlation Between Acoustic Measurements and Self-Reported Voice Disorders Among Female Teachers

Many studies focused on teachers' voice problems and most of them were conducted using questionnaires, whereas little research has investigated the relationship between self-reported voice disorders and objective quantification of voice. This study intends to explore the relationship of acoustic measurements according to self-reported symptoms and its predictive value of future dysphonia. This is a case-control study. Voice samples of 80 female teachers were analyzed, including 40 self-reported voice disorders (VD) and 40 self-reported normal voice (NVD) subjects. The acoustic measurements included jitter, shimmer, and noise-to-harmonics ratio (NHR). Levene's t test and logistic regression were used to analyze the differences between VD and NVD and the relationship between self-reported voice conditions and the acoustic measurements. To examine whether acoustic measurements can be used to predict further voice disorders, we applied a receiver operating characteristic (ROC) curve to determine the cutoff values and the associated sensitivity and specificity. The results showed that jitter, shimmer, and the NHR of VD were significantly higher than those of NVD. Among the parameters, the NHR and shimmer demonstrated the highest correlation with self-reported voice disorders. By using the NHR ≥0.138 and shimmer ≥0.470dB as the cutoff values, the ROC curve displayed 72.5% of sensitivity and 75% of specificity, and the overall positive predictive value for subsequent dysphonia achieved 60%. This study demonstrated a significant correlation between acoustic measurements and self-reported dysphonic symptoms. NHR and ShdB are two acoustic parameters that are more able to reflect vocal abnormalities and, probably, to predict subsequent subjective voice disorder. Future research recruiting more subjects in other occupations and genders shall validate the preliminary results revealed in this study.

Vocal Tract Discomfort in Teachers: Its Relationship to Self-Reported Voice Disorders

To verify vocal tract discomfort (VTD) in teachers and determine its relationship to the presence of self-reported voice problems (S-rVPs), vocal signs and symptoms, voice self-assessment, and perceptual analysis of voice quality. Thirty-two teachers with vocal complaints and 30 teachers with no complaints. Demographic questionnaire, signs and symptoms questionnaire, VTD scale, vocal self-assessment, and perceptual analysis of voice. The S-rVPs group was presented with higher frequency of all vocal signs and symptoms and also had greater frequency and intensity of discomfort than the teachers without complaint, for all the analyzed items (P<0.05). The group with S-rVPs experienced more than twice the level of discomfort than the group without S-rVPs (mean 6.3 vs 2.8 symptoms, P<0.05). Teachers with voice problems felt at least three symptoms of discomfort, whereas some teachers without complaint did not have any discomfort. We found a correlation between self-perceived voice and VTD. On the other hand, there is little correlation between discomfort and perceptual analysis of voice quality. VTD is also associated with specific voice signs/symptoms that might indicate an incipient voice disorder. This study reveals the importance of understanding the subjects' perception of their own problems so that issues experienced by patients that are not directly apparent to the clinician can be addressed in the treatment. Symptoms related to the vocal tract must therefore be given consideration to ensure a comprehensive and more relevant approach to the needs of patients.

Distúrbio de voz em professores: autorreferência, avaliação perceptiva da voz e das pregas vocais

OBJETIVO: Analisar a presença do distúrbio de voz em professores na concordância entre autorreferência, avaliação perceptiva da voz e das pregas vocais. MÉTODOS: Deste estudo transversal, participaram 60 professores de duas escolas públicas de ensino fundamental e médio. Após responderem questionário de autopercepção (Condição de Produção Vocal do Professor - CPV-P) para caracterização da amostra e levantamento de dados sobre autorreferência ao distúrbio de voz, foram submetidos à coleta de amostra de fala e exame nasofibrolaringoscópico. Para classificar as vozes, três juízes fonoaudiólogos utilizaram à escala GRBASI e, para pregas vocais (PPVV), um otorrinolaringologista descreveu as alterações encontradas. Os dados foram analisados descritivamente, e a seguir submetidos a testes de associação. RESULTADOS: No questionário, 63,3% dos participantes referiram ter ou ter tido distúrbio de voz. Do total, 43,3% foram diagnosticados com alteração em voz e 46,7%, em prega vocal. Não houve associação entre autorreferência e avaliação da voz, nem entre autorreferência e avaliação de PPVV, com registro de concordância baixa entre as três avaliações. Porém, houve associação entre a avaliação da voz e de PPVV, com concordância intermediária entre elas. CONCLUSÃO: Há maior autorreferência a distúrbio de voz do que o constatado pela avaliação perceptiva da voz e das pregas vocais. A concordância intermediária entre as duas avaliações prediz a necessidade da realização de pelo menos uma delas por ocasião da triagem em professores.