Vocal Demands Research Articles

Occupational Vocal Health of Elite Sports Coaches: An Exploratory Pilot Study of Football Coaches

To explore the occupational voice use and vocal health of elite football coaches. This pilot study explored coaches' voice use patterns and vocal demands across workplace environments. Each coach's experiences of voice symptoms and voice problems were also investigated. Twelve Australian professional football coaches participated in a mixed-methods data collection approach. Data were collected through acoustic voice measurement (Ambulatory Phonation Monitor), semistructured interviews, and a voice symptom questionnaire (Voice Capabilities Questionnaire). Acoustic measures suggested heavy vocal loads for coaches during player training. All participants reported experiencing voice symptoms. They also suggested that the structure of their working week, workplace tasks, and vocal demands impacted on their voices. Despite this, participants reported little previous reflection or awareness of what impacted on their voices. Coaches typically did not consider how to support their voices during daily work and discussed experiencing voice symptoms as an inevitable part of their jobs. This study demonstrates that occupational vocal demands may negatively impact on sports coaches' vocal health. This is particularly important, considering coaches' heavy vocal loads across coaching tasks and reported negative occupational vocal health experience. Furthermore, coaches' limited insight into voice use and vocal health management may impact on their vocal performance and health. Given the exploratory nature of this study, further research into coaches' occupational vocal health is warranted.

Sintomas vocais de futuros profissionais da voz

OBJETIVO: caracterizar os sintomas vocais de futuros profissionais da voz conforme as variáveis idade, sexo e índice de massa corporal. MÉTODOS: os participantes responderam a Escala de Sintomas Vocais, composta por 30 questões, sendo 15 do domínio limitação, oito do domínio emocional e sete do domínio físico. Os indivíduos foram orientados a assinalar a resposta que correspondesse à frequência de ocorrência para cada um dos sintomas questionados. Foram coletados também dados ocupacionais, antropométricos e de saúde geral.Os dados foram analisados descritivamente e estatisticamente por meio dos testes não paramétricos Correlação de Spearman, Mann Whitney e Kruskal-Wallis, com nível de significância de 5%. RESULTADOS: a amostra constituiu-se de 47 indivíduos, com idades entre 19 e 37 anos (média de 22,17 anos), sendo 28 (59,57%) do sexo feminino e 19 (40,43%) do sexo masculino,a média foi de 11,38 problemas vocais, de uma possibilidade total de 30. Houve maior frequência dos sintomas "você tosse ou pigarreia" e "você tem dificuldade para falar em locais barulhentos". CONCLUSÃO: o grupo de futuros profissionais da voz analisado apresentou alta média de sintomas vocais, salientando-se a tosse ou pigarro e a dificuldade para falar em locais barulhentos, diretamente relacionados a usos vocais incorretos. Com o aumento da demanda vocal profissional esses indivíduos poderão ser considerados de risco para o desenvolvimento de distúrbios vocais.

Prevalence and risk factors of voice disorders among attendants of the Speech Unit at King Abdulaziz Medical City, Riyadh, Saudi Arabia

Introduction: Voice disorders are defined as effortful or difficulties in phonation and deviant voice qualities that are often associated with discomfort and disability. The causes of voice disorders can be classified as congenital or acquired. Many authors have investigated the prevalence of voice disorders in the general population. Others have investigated the risk factors for voice disorders, such as high vocal demand, age, gender, smoking and gastro-oesophageal reflux. Objectives: To determine the prevalence of voice disorders among patients of the Speech Unit at King Abdulaziz Medical City (KAMC) and identify variables associated with increased risk for voice disorders. Materials and methods: A retrospective, cross-sectional study was conducted to estimate the prevalence of voice disorders among all patients who attended the Speech Unit at KAMC, Riyadh, Saudi Arabia, during the period from 2008 to 2013. Data were extracted from the QuadraMed (Reston, VA, USA) hospital information system and the database of the laryngeal videostroboscopy. Patient information was reviewed for key variables, such as age, gender, occupation, smoking history and history of known related diseases. Descriptive univariate analysis was carried out to identify variables associated with high risk of voice disorders. Results: The overall prevalence of voice disorders of all patients attending the Speech Unit was 12.1%. Of the sample studied, 52% were female and 48% were male. Only 16.2% of the patients with voice disorders were smokers. The analysis of occupation showed that 28.26% were housewives, 17.8% were students and 11.12% were teachers. Conclusions: The result of this study provides valuable information about the prevalence and risk factors and different aetiology of voice disorders. Acknowledgements: Dr Nasser Hassan for supervising this project.

Effects of Vocal Demands on Voice Performance of Student Singers

The objective of this study was to investigate the effect of cumulative vocal demands on the voices of music students majoring in voice throughout an academic semester. Acoustic and aerodynamic voice parameters captured across an academic semester were analyzed. This study was designed as a time-course investigation, in which all participants were tested individually at three separate times distributed equally over an academic semester. General effects were verified with the application of one-way within-participants analysis of variances with repeated measures. The equipment used for monitoring vocal behavior consisted of the Computerized Speech Lab, the Phonatory Aerodynamic System, and the Ambulatory Phonation Monitor, computer-based systems for the assessment of voice. Self-reported data regarding voice usage were also collected. In this study, comparisons of voice parameters of student singers repeatedly measured throughout an extended period of time did not lead to statistically significant differences. Self-reported information suggested a reasonable level of knowledge and awareness regarding voice concerns in this population. The results of this study indicated consistent stability of voice acoustic and aerodynamic parameters in this group throughout an academic semester.

Discriminant Capacity of Acoustic, Perceptual, and Vocal Self: The Effects of Vocal Demands

To analyze the discrimination ability of acoustic, auditory parameters, and perception of vocal effort during professional and social voice use, and the correlations of these parameters with the vocal demands. Longitudinal study. Seventy-three subjects participated in the study: 31 females aged from 28 to 65years (G1; professional voice users) and 42 females aged from 31 to 59years (G2, social voice users; ). All the subjects were subjected to acoustic voice analysis including F0 median, semiamplitude interquartile, quantile 99.5%, and skewness; first F0 derivate mean, standard deviation (SD), and skewness; intensity skewness; spectral slope mean, SD, and skewness; long-term average spectrum-frequency SD, perceptual parameters (GRBASI scale), and self-perception of vocal effort, before and after 2hours and 30 minutes of voice use. Statistical analyses were completed via multivariate discriminant analysis and canonical correlation analysis. Discriminant analysis of acoustic, perceptual, and self-rating variables and analysis of the grouped parameters did not differentiate the samples before and after vocal use. Higher levels of canonical correlation were found for the professional voice group after voice use, with a correlation between perceptual analysis and acoustic measures. The current measures could not discriminate the differences of the type of vocal demands, professional or social.

Teachers' Voice Disorders and Loss of Work Ability: A Case-Control Study

Teachers constitute a profession with a high occurrence of voice disorders due to the occupation's intense vocal demands and unfavorable work environment. To identify the association between voice disorders and work ability among teachers from public schools in São Paulo, Brazil. This is a case-control study. The case group comprised teachers with voice disorder complaints, vocal quality deviations in speech pathology evaluations, and vocal fold lesions according to an evaluation by an otorhinolaryngologist. The control group was randomly selected from the same schools as those in the case group. Both groups answered the following questionnaires: sociodemographic, lifestyles, working conditions, work organization, conditions of vocal production-teacher (CVP-T), and Work Ability Index (WAI). The analysis used the chi-square association test and univariate and multivariate regression models. The analyses of both groups showed comparable populations with no significant differences in the demographic and control variables. The groups differed, as expected, in vocal symptoms. Analyzing associations with the WAI, there was an association between decreased work ability and voice disorder (P<0.001). This association remained in multivariate analyses where decreased (OR=9.5, P=0.001) and moderate (OR=6.7, P<0.001) work ability were also associated with voice disorders. Analyzing the ability to work, age, and acoustics; decreased (OR=12.2, P<0.001) and moderate (OR=7.7, P<0.001) work ability, age 50-65years (OR=3.7, P=0.006) and poor acoustics (OR=2.7, P=0.007) were factors associated with voice disorders. The occurrence of voice disorders is significantly associated with work ability, which may eventually compromise teachers' ability to continue working.

Voice disorders in the workplace: Productivity in spasmodic dysphonia and the impact of botulinum toxin

The impact of the disordered voice on standard work productivity measures and employment trends is difficult to quantify; this is in large part due to the heterogeneity of the disease processes. Spasmodic dysphonia (SD), a chronic voice disorder, may be a useful model to study this impact. Self-reported work measures (worked missed, work impairment, overall work productivity, and activity impairment) were studied among patients receiving botulinum toxin (BTX) treatments for SD. It was hypothesized that there would be a substantial difference in work-related measures between the best and worst voicing periods. In addition, job types, employment shifts, and vocal requirements during the course of vocal disability from SD were investigated for each individual, and the impact of SD on these patterns was studied. A total of 145 patients with SD, either adductor or abductor, who were established in routine therapeutic BTX injections agreed to participate in a self-administered questionnaire study. Seventy-two participants were currently working and provided highly detailed information on work-related measures. Their answers characterized the effect of SD on their employment status, productivity at work, activity impairment outside of work, employment retention or change, and whether the individual perceived that BTX therapy affected these measures. Patients were asked to complete the Work Productivity and Activity Impairment (WPAI) instrument to determine these measures for their best and worst voicing weeks over the duration since their previous BTX injection. Voice-specific quality of life instruments (Voice Handicap Index-10) and perceptual assessments (Consensus Auditory Perceptual Evaluation of Voice) were elicited to provide correlations of work measures with patient-perceived voice handicap and clinician-perceived voice quality. Cross-sectional analysis using self-administered questionnaire. A total of 108 patients reported ever working during their diagnosis and treatment of SD, and 72 patients were currently working and had undergone BTX therapy for at least 1 year at the time of the analysis. Currently employed patients reported a mean 4.4% decrease in work missed (absenteeism), a 28.1% decrease in work impairment (presenteeism), a 29.4% decrease in work productivity, and a 21.4% decrease in activity impairment (P <.001) in their best, as compared to their worst voicing period over their last BTX injection cycle. Presenteeism accounted for the major component of the percent work productivity impairment calculation. There was neither apparent shift in job categories nor any change in the vocal demands of their employment over the course of their disease. Among patients that have worked during their diagnosis of SD, greater than 98% report that BTX injections helped them at work. Patients with SD reported that their vocal dysfunction caused a significant negative effect on work productivity and increase in activity impairment. There was a significant improvement in their voice-related work parameters from their worst to best voicing periods over their last BTX injection cycle. Patients undergoing long-term BTX treatment report a positive effect of this treatment in their workplace. Spasmodic dysphonia is a meaningful model in which to study the effects of voice disorders on work productivity and employment patterns.

Comparison of benign lesion regression following vocal fold steroid injection and vocal hygiene education

This study intends to objectively quantify and compare the regression rates of vocal lesions in patients receiving either vocal fold steroid injection (VFSI) or vocal hygiene education (VHE). Potential influence of occupational vocal demands on the treatment outcome was also investigated. Retrospective case series. This study enrolled 176 patients of vocal nodules and vocal polyps. Ninety-two patients received VFSI, while 84 patients received VHE. We measured the lesion area with correction by the length of vocal fold, according to videolaryngoscopic examinations before treatment and 1 and 2 months after treatment. VFSI was associated with a higher lesion reduction rate than VHE at 1 and 2 months (P <0.05). In vocal nodules and patients with ordinary occupational vocal demands, VFSI achieved a higher lesion regression rate than VHE at 1 month (P <0.05), while both modalities resulted in similar lesion reduction rates at 2 months (P >0.05). In vocal polyps, the lesion reduction rate after VFSI was higher than that following VHE at 1 and 2 months (P <0.01). In patients with high occupational vocal demands, the lesion sizes decreased significantly at 1 and 2 months following VFSI (P <0.01), but not for those receiving VHE (P >0.05). VHE remains the fundamental strategy for all dysphonic patients, while VFSI can be applied alternatively. Both VFSI and VHE are effective for vocal nodules and patients with ordinary occupational vocal demands, but VFSI achieves lesion regression earlier than VHE. VFSI is preferred over VHE for vocal polyps and patients with high occupational vocal demands. 4.

Voice Disorders in Actors

The purpose of this study was to investigate the prevalence of vocal pathology among first-year acting students. A retrospective review of 30 first-year graduate-level drama students between 2009 and 2011 was performed. Stroboscopy, Voice Handicap Index-10 questionnaires, and acoustic measures were analyzed. The prevalence of incomplete glottal closure, laryngeal hyperfunction, and decreased mucosal wave was 62%, 59%, and 55%, respectively. Laryngoscopic findings consistent with laryngopharyngeal reflux (LPR) were demonstrated in 48% of subjects. Subgroup analysis of laryngeal hyperfunctioning (HF) and nonhyperfunctioning drama students revealed an increased prevalence of all videostroboscopic abnormalities in the HF group. The increased prevalence of LPR stigmata in HF actors reached statistical significance (P=0.04). The vocal demands of actors are unique, requiring the effective use of volume, pitch control, and endurance. This is the first study that systematically analyzes the prevalence of vocal pathology in actors. This study will continue throughout their education, anticipating that our feedback along with their vocal training will improve outcomes.

Voice use in professional soccer management

Vocal load related to heavy voice use in particular professions increases the risk of occupational voice disorders. Research on professional voice use has primarily focused on educators, singers, and call-centre advisors. This paper describes the daily experiences of professional soccer managers’ occupational voice use through qualitative methods. Four global themes were identified: 1) voice uses, 2) factors affecting voice change, 3) impact of voice use, and 4) the importance of voice in soccer management. All describe the nature of soccer managers’ vocal demands. Risk factors for voice disorders include intense and prolonged voice use in environments with adverse acoustic properties for speakers and poor phonation methods. Research on vocal behaviours and early prevention programmes for this population group is warranted.

Vocal Problems of Group Fitness Instructors: Prevalence of Self-Reported Sensory and Auditory-Perceptual Voice Symptoms and the Need for Preventative Education and Training

To determine the prevalence and nature of both acute and chronic voice problems experienced by group fitness instructors (GFIs) and gather information about the level of education currently being received by fitness professionals, the source of their education, and their opinion on mandatory voice training to highlight potential training needs. Prospective self-completion questionnaire design. A total of 361 GFIs (81 males and 280 females), aged between 18 and 67 years currently active in the Australian fitness industry completed a self-report questionnaire distributed via SurveyMonkey. The prevalence of self-reported acute and chronic voice symptoms was high at 78.95% and 70.91%, respectively. Partial voice loss and hoarseness while instructing was experienced most often (57.62%), followed by partial voice loss and hoarseness immediately after instructing (46.81%). Aphonia after teaching was less frequently reported (9.97%). Over 25% of the total cohort reported chronic voice symptoms of increased hoarseness (39.61%), difficulty with high notes (31.58%), strained voice (32.13%), and limited singing range (27.7%). Only 30% of GFIs reported having received any voice education, with even fewer respondents (10%) receiving any practical voice training, despite 98.06% agreeing that formal voice education should be covered as a standard topic in all official GFI training. The results of this study confirm that voice problems represent a significant occupational hazard for GFIs. Speech-language pathologists and other voice professionals should consider taking a proactive stance in understanding the vocal demands of the profession and engage in training for instructors to prevent both acute and chronic voice problems.

Identification and Preservation of External Branch of Superior Laryngeal Nerve in Thyroidectomy

ABSTRACT The basic principle of head and neck surgery is based on the identification and preservation of important structures, rather than avoidance. This principle is also applicable to identification and preservation of external branch of the superior laryngeal nerve (EBSLN) as a standard routine in all thyroid surgeries. During thyroid surgery, the EBSLN is clearly at risk due to its close proximity to the superior thyroid artery (STA) and its branches that need to be ligated during dissection of the superior pole of the thyroid gland. Injury is detrimental to the patient by causing paralysis of the cricothyroid muscle which is the main tensor and pitch controlling mechanism of the vocal folds. Injury to the EBSLN during surgery can result in the voice changes, loss of upper range and easy fatigability of voice, the severity of which varies according to the vocal demand of the patient. Total 45 cases of thyroid swellings were treated with surgery, in the Department of ENT at a tertiary care hospital during the period from 1st October 2009 to 30th October 2010. Hemithyroidectomy was the most common operative procedure implemented in 24 patients (53.33%) in which right sided was common. Next common procedure performed was that of total thyroidectomy in 14 patients (31.11%). Four patients underwent total thyroidectomy with neck dissection. The position of EBSLN was classified according the Cernea et al classification. In our study we found the EBSLN to be type I in 46.66%, type IIa in 73.33% and type IIb in 02.22%. The anatomical landmark taken into consideration to identify EBSLN was the Joll's triangle with its relation to the superior pole of the thyroid gland and STA. How to cite this article Athavale PK, Bokare BD, Ekhar VR, Mahore DM. Identification and Preservation of External Branch of Superior Laryngeal Nerve in Thyroidectomy. Int J Phonosurg Laryngol 2013;3(2):39-41.

A comparison of vocal demands with vocal performance among classroom student teachers

PurposeThis investigation compared voice performance of student teachers across an academic semester in order to examine the effect of increasing demands on their voice. MethodA repeated measures design was applied to the data analysis: all participants were tested three separate times throughout the semester. The equipments used for monitoring vocal behavior were the Ambulatory Phonation Monitor (APM), the Computerized Speech Lab (CSL), and the Phonatory Aerodynamic System (PAS), which are computer-based systems for acoustic and aerodynamic assessment of voice. Additionally, participants completed surveys related to voice usage. ResultsIn this study, most voice parameters of student teachers measured in a natural setting and in a controlled environment indicated changes that revealed progressive instability and noise in the course of an academic semester. Additional comparisons demonstrated differences between voice usage in the school environment and voice produced in the voice lab. Self-reported information demonstrated overall reduced awareness regarding preventive methods for voice disorders. ConclusionsBased on the results of this study, increased teaching-related voice demands associated with reduced awareness of voice production and preventive measures of voice disorders may have a detrimental impact on voice performance, leading to a risk of developing voice disorders.Learning outcomes: Participants will recognize the importance of clarifying and quantifying the relationship of vocal demands and voice performance among student teachers.

Prevalence of Voice Symptoms and Risk Factors in Teacher Students

Teacher students seem to have low awareness of the vocal demands in their future professions, and students with vocal symptoms are at risk for developing voice disorders during their professional careers. The purpose of the present study was to determine the prevalence of voice problems in teacher students at the very beginning of their education at the university. Of 1636 students approached in the first couple of days, 1250 (76%) answered two questionnaires about voice symptoms, Screen6 and Swedish Voice Handicap Index (Sw-VHI), and one questionnaire about potential risk factors. A majority of the students were women, and their mean age was 23 years (range, 18-52 years). The results showed that 208 of 1250 students (17%) had voice problems, defined as at least two symptoms weekly or more often in Screen6. The proportion of women was larger in the group with voice problems than in the group without voice problems. Significant risk factors for voice problems were vocal fold problems in childhood and adulthood, frequent throat infections, airborne allergy, smoking, hearing problems, previous work as teacher or leader, voice demanding hobbies, and previous speech therapy or voice training. There was a clear association between the number of potential vocal risk factors and the number of voice symptoms. There was also a strong association between the scores of the two questionnaires, the Sw-VHI and the Screen6. Students with voice problems according to Screen6 scored 23.1 (mean Sw-VHI) compared with 7.8 for students without voice problems.

The Traditional/Acoustic Music Project: A Study of Vocal Demands and Vocal Health

The Traditional/Acoustic Music Project seeks to identify the musical and performance characteristics of traditional/acoustic musicians and determine the vocal demands they face with the goals of (1) providing information and outreach to this important group of singers and (2) providing information to physicians, speech-language pathologists, and singing teachers who will enable them to provide appropriate services. Descriptive cross-sectional study. Data have been collected through administration of a 53-item questionnaire. The questionnaire was administered to artists performing at local venues in Knoxville, Tennessee and also to musicians attending the 2008 Folk Alliance Festival in Memphis, Tennessee. Approximately 41% of the respondents have had no vocal training, whereas approximately 34% of the respondents have had some form of formal vocal training (private lessons or group instruction). About 41% of the participants had experienced a tired voice, whereas about 30% of the participants had experienced either a loss of the top range of the voice or a total loss of voice at least once in their careers. Approximately 31% of the respondents had no health insurance. Approximately 69% of the respondents reported that they get their information about healthy singing practices solely from fellow musicians or that they do not get any information at all. Traditional/acoustic musicians are a poorly studied population at risk for the development of voice disorders. Continued research is necessary with the goal of a large sample that can be analyzed for associations, identification of subpopulations, and formulation of specific hypotheses that lend themselves to experimental research. Appropriate models of information and service delivery tailored for the singer-instrumentalist are needed.

P1-209 Teaching factors associated to voice disorders: a case-control study

Introduction and Aims of the StudyTeachers constitute professional category with high occurrence of voice disorders due to this occupation's intense vocal demand and to unfavourable work environments. To identify job's...

The Vocal Load of Reform Jewish Cantors in the USA

Jewish cantors comprise a subset of vocal professionals that is not well understood by vocal health professionals. This study aimed to document the vocal demands, vocal training, reported incidence of voice problems, and treatment-seeking behavior of Reform Jewish cantors. The study used a prospective observational design to anonymously query Reform Jewish cantors using a 35-item multiple-choice survey distributed online. Demographic information, medical history, vocal music training, cantorial duties, history of voice problems, and treatment-seeking behavior were addressed. Results indicated that many of the commonly associated risk factors for developing voice disorders were present in this population, including high vocal demands, reduced vocal downtime, allergies, and acid reflux. Greater than 65% of the respondents reported having had a voice problem that interfered with their ability to perform their duties at some time during their careers. Reform Jewish cantors are a population of occupational voice users who may be currently unidentified and underserved by vocal health professionals. The results of the survey suggest that Reform Jewish cantors are occupational voice users and are at high risk for developing voice disorders.

Voice and vocal health in elite sports coaching: considerations for elite football coaching staff

BackgroundWhile voice is integral to sports coaching, currently there is a dearth of research considering coaches' occupational vocal health.ObjectiveTo investigate football coaches' occupational voice use and vocal health (including the...

School Teachers’ Vocal Use, Risk Factors, and Voice Disorder Prevalence: Guidelines to Detect Teachers with Current Voice Problems

Teachers’ voice problems are widely recognized as a consequence of their work. The measurement of vocal demands and risk factors is essential for adjusting occupational safety and health services to this population’s needs. Objectives: To correlate vocal behavior and symptomatology with risk factors and voice disorders, and to further analyze gender influence on these variables. Subjects and Methods: 282 kindergarten and elementary education teachers were surveyed in a cross-sectional study using a self-administered questionnaire. For the purpose of this study, voice disorder prevalence was estimated based on the presence of a vocal effort plus 2 frequent symptoms. Results: 81.5% of teachers reported some degree of vocal effort; more than 60% of subjects evidenced frequent throat paresthesias or vocal fatigue at the end of a working day, and about 55% reported hoarseness. Voice disorder prevalence was 59%. Multivariate logistic regression analysis revealed that female gender, time required to alleviate vocal symptoms, perceived general state of health, prolonged use of the voice, and pupils’ indiscipline significantly increased the odds of having vocal problems. Conclusions: Voice disorders affected most teachers and had a multifactorial nature. Vocal health care is particularly necessary for those subjects reporting vocal effort and more than 2 frequent symptoms.

Effect of Tonsillectomy on the Adult Voice

Anecdotal evidence suggests that tonsillectomy has no deleterious consequences on a person's voice under normal vocal demand. However, whether the enlarged dimensions of the oropharynx after tonsillectomy impair the quality of a professional voice user remains unclear. Therefore, we designed a study to determine whether adult tonsillectomy altered the resonance characteristics of the vocal tract in any way and whether these changes were transient or permanent. This is a prospective observational study with full institutional ethical approval. All adult patients presenting for tonsillectomy for recurrent tonsillitis in our institution were recruited. Their voice was recorded preoperatively, postoperatively, and at 4 weeks postoperatively. The values of the first four formants were calculated in all recordings. The oropharyngeal dimensions were measured preoperatively and postoperatively. Tonsillar weights and volumes were also measured. The first formant was noted to rise postoperatively. The average value of F2 and F3 did not alter postoperatively or at 4 weeks. However, it was noted that the fourth formant was not universally present preoperatively but was present in all patients postoperatively and at 4 weeks. Altering the dimensions of the oropharynx after tonsillectomy causes the first formant to rise but has no effect on the third and fourth formants. However, the fourth formant appears in patients who previously did not demonstrate it. The fourth formant was present in a greater proportion of male patients preoperatively than female patients, but it was universally present postoperatively and at 4 weeks in both sexes. This suggests that increasing the horizontal dimensions of the oropharynx has a nontransient effect on the higher order formants of the voice.