Vocal Fatigue Research Articles

Differential Diagnosis of Dysphonia Looks Normal Larynx

Voice is a physical phenomenon, generated by vocal fold and expiratory airflow. Dysphonia should come from abnormal vocal fold and airflow. Occassionally larynx looks normal in show, but it is actually not. There should be undetected structural or functional abnormalities. So when ENT doctors face dysphonia patients who looks normal larynx, should make a diagnosis through close observation. In this review article we present some dysphonia diseases which looks normal larynx. For example vocal fatigue, vocal fold paresis, posterior glottic diastasis, muscle tension dysphonia and psychogenic dysphonia. Key words: Vocal fatigue ㆍ Vocal fold paresis ㆍ Posterior glottic diastasis ㆍ Muscle tension dysphonia ㆍ Psychogenic dysphonia 핵심용어: 성대피로 ㆍ ì„±ëŒ€ë¶€ì „ ㆍ 후방성문해리 ㆍ 근긴장성 ë°œì„±ìž¥ì• ã† 심인성 발성장ì•

Analysis of Voice and Swallowing Symptoms after Thyroidectomy in Patients without Recurrent Laryngeal Nerve Injury in Early Postoperative Period

Background and Objectives After thyroidectomy, many patients experience problems report such things as reduced voice range and vocal fatigue, swallowing problems without superior and recurrent laryngeal nerve injury. The purpose of this study was to evaluate voice and swallowing problems before and after thyroid surgery without laryngeal nerve injury. Materials and Methods Ninety-three patients who underwent thyroidectomy without laryngeal nerve injury and completed the follow-up evaluations were studied between June 2013 and December 2015. Each evaluation was performed preoperatively, as well as 1 week, 1 month postoperatively. Analysis was performed including voice handicap index (VHI), dysphagia handicap index (DHI), and acoustic voice analysis. Results Patients show significant variation of parameters in the fundamental frequency (F), maximal phonation time (MPT), shimmer, jitter and soft phonation index (SPI) early after operation, and most of them showed recovery of parameters after 1month of operation. Perceptive complaint of voice and swallowing also showed significant decreased after operation (p＜0.005). After 1month of operation, MPT, highest frequency and frequency ranges still showed significant decreased parameters. Comparing acoustic and perceptive parameters of total thyroidectomy and lobectomy, there was no significant changes between them except highest frequency (p=0.042). Conclusion The results from both subjective and objective evaluations show voice and swallowing disturbance after thyroidectomy even in the absence of laryngeal nerve and provide patients information about the recovery process after surgery. Highest frequency parameter showed most significant changes after operation. Key words: Thyroidectomy ㆍ Voice disorders ㆍ Dysphagia Key words: ê°‘ìƒì„ ì ˆì œìˆ ã† 음성 ìž¥ì• ã† 연하장ì•

Phonatory Symptoms and Acoustic Findings in Patients with Asthma: A Cross-Sectional Controlled Study.

To investigate the prevalence of phonatory symptoms, perceptual, acoustic and aerodynamic findings in patients with asthma compared to a control group. This study is a cross-sectional study. A total of 50 subjects, 31 asthmatic and 19 control subjects matched according to age and gender were enrolled in this study. All subjects were asked about the presence or absence of dysphonia, vocal fatigue, phonatory effort, cough, dyspnea, and respiratory failure. Perceptual evaluation, acoustic analysis and aerodynamic measurements were also performed. Patient's self assessment using the Voice Handicap Index 10 was reported. The mean age of patients was 43.5years with a female to male ratio of 2:1. There was a statistically significant difference in the prevalence of dysphonia between the two groups (32.3 vs. 5.3%, p value 0.025) with a non-significant higher prevalence of vocal fatigue and phonatory effort. The overall grade of dysphonia was significantly higher in asthmatics compared to controls (p value 0.002). Patients with asthma had also significantly higher degree of asthenia and straining (p value of 0.04 and 0.008, respectively) with borderline significant difference with respect to roughness. There was no significant difference in the means of any of the acoustic parameters between patients and controls except for Shimmer, which was higher in the asthmatic group (p value of 0.037). There was also no significant difference in the Maximum phonation time between the two groups. Dysphonia is significantly more prevalent in patients with asthma compared to controls.

Relationship between Voice Complaints and Subjective and Objective Measures of Vocal Function in Iranian Female Teachers

Teachers are at high risk of developing voice problems because of the excessive vocal demands necessitated by their profession. Teachers' self-assessment of vocal complaints, combined with subjective and objective measures of voice, may enable better therapeutic decision-making. This investigation compared audio-perceptual assessment and acoustic variables in teachers with and without voice complaints. Ninety-nine teachers completed this cross-sectional study and were assigned to one of two groups: those "with voice complaint (VC)" and those "without voice complaint (W-VC)." Voice samples were collected during reading, counting, and vowel prolongation tasks. Teachers were also asked to document any voice symptoms they experienced. Voice samples were analyzed using Dr. Speech program (4th version; Tiger Ltd., USA), and labeled "normal" or "abnormal" according to the "grade" dimension "G" from GRBAS scale. Twenty-one teachers were assigned to the VC group based on self-assessment data. There were statistically significant differences between the two groups with regard to self-reported voice symptoms of hoarseness, breathiness, pitch breaks, and vocal fatigue (P < 0.05). Fourteen participants in the VC group and 40 from the W-VC group were determined to demonstrate "abnormal" vocal quality on perceptual assessment. Only harmonic-to-noise ratio was significantly higher for the W-VC group (ES = 0.55). Teachers with and without voice complaints differed in the incidence, but not type of voice symptoms. Teachers' voice complaints did not correspond to perceptual and acoustic measures. This suggests a potential unmet need for teachers to receive further education on voice disorders.

High-speed Imaging of Vocal Fold Vibration Onset Delay: Normal Versus Abnormal

Vocal fold vibration onset delay (VFVOD) is heard frequently in spasmodic dysphonia and in muscle tension dysphonia. VFVOD changes due to other vocal pathologies have not been investigated. VFVOD during sustained vowel production was estimated with high-speed video in 10 normal and 40 pathologic subjects (scars, vocal fold paralysis, vocal fold nodules, and polyps). Analysis of high-speed video was done using digital kymography. VFVOD can be divided into two portions. Pre-phonation delay (PPD) is the duration when the vocal folds are nearly approximated to the time of first observed oscillation. Steady state delay (SSD) is the time when vocal folds are observed to come into oscillation until steady state of oscillation is observed. Normal subjects have almost zero PPD with vocal fold oscillation observed before full vocal fold adduction. Pathologic cases showed prolonged PPD because of (1) false cord adduction, (2) prolonged true vocal fold adduction, and (3) delay to onset of vocal fold vibration. Normal subjects have SSD of three to five cycles before steady state. Pathologic states result in increased SSD. Causes for increased SSD include (1) slow ramping up to steady state, (2) partial vibration of vocal folds, and (3) diplophonia with alternating beats before achieving steady state. There are significant differences between normal and pathology groups in both PPD and SSD. VFVOD is elevated in pathologic states. This can be due to increase in PPD or SSD. VFVOD is an under-recognized phenomenon that may contribute to complaints of vocal fatigue and dysphonia.

The Effectiveness of Low-Level Light Therapy in Attenuating Vocal Fatigue

Low-level light therapy (LLLT) is effective in reducing inflammation, promoting wound healing, and preventing tissue damage, but has not yet been studied in the treatment of voice disorders. The objective of this study was to investigate the possible effectiveness of LLLT in attenuating symptoms of vocal fatigue created by a vocal loading task as measured by acoustic, aerodynamic, and self-reported vocal effort. In a randomized, prospective study, 16 vocally healthy adults divided into four groups underwent a 1-hour vocal loading procedure, followed by infrared wavelength LLLT (828 nm), red wavelength LLLT (628 nm), heat, or no heat-light (control) treatment targeting the laryngeal region of the ventral neck surface. Phonation threshold pressure (PTP), relative fundamental frequency (RFF), and the inability to produce soft voice (IPSV) self-perceptual rating scale were recorded (1) at baseline, (2) immediately after vocal loading, (3) after treatment, and (4) 1 hour after treatment. Vocal loading significantly increased PTP and IPSV and decreased onset and offset RFFs, consistent with a shift toward vocal dysfunction. Red light significantly normalized the combination of PTP, IPSV, and RFF measures compared to other conditions. RFF is sensitive to a vocal loading task in conjunction with PTP and IPSV, and red LLLT may have a normalizing effect on objective and subjective measures of vocal fatigue. The results of this study lay the groundwork and rationale for future research to optimize LLLT wavelength combinations and overall dose.

Factors Involved in Vocal Fatigue: A Pilot Study

Objective: The purpose of this retrospective study was to determine the vocal characteristics of a treatment-seeking population with the primary complaint of vocal fatigue (VF). Methods: Forty-three men (mean age 42 years, range 19-69) and 145 women (mean age 34 years, range 18-68) were included. None of the subjects had received voice therapy or previous laryngeal surgery. A questionnaire, laryngeal and perceptual evaluations, aerodynamic and acoustic parameters, and the Dysphonia Severity Index (DSI) were used to determine vocal characteristics. Results: In 74% of the subjects, flexible laryngeal videostroboscopic evaluation revealed a vocal pathology, with vocal nodules and muscle tension dysphonia as the most frequently diagnosed pathologies. Vocal abuse/misuse was present in 65% of the subjects. A median DSI value of -0.4 and -0.8 was found in female and male patients, respectively. Aerodynamic and acoustic parameters and DSI scores were significantly different from normative data. Conclusion: VF is a vocal sign with a significant need for medical consultation, especially in future professional voice users. Understanding the occurrence and the influencing variables of VF may help to close the gap between early stages of a vocal problem and the starting point of a well-established disorder.

Speech Adjustments for Room Acoustics and Their Effects on Vocal Effort

The aims of the present study are (1) to analyze the effects of the acoustical environment and the voice style on time dose (Dt_p) and fundamental frequency (mean f0 and standard deviation std_f0) while taking into account the effect of short-term vocal fatigue and (2) to predict the self-reported vocal effort from the voice acoustical parameters. Ten male and ten female subjects were recorded while reading a text in normal and loud styles, in three rooms-anechoic, semi-reverberant, and reverberant-with and without acrylic glass panels 0.5 m from the mouth, which increased external auditory feedback. Subjects quantified how much effort was required to speak in each condition on a visual analogue scale after each task. (Aim1) In the loud style, Dt_p, f0, and std_f0 increased. The Dt_p was higher in the reverberant room compared to the other two rooms. Both genders tended to increase f0 in less reverberant environments, whereas a more monotonous speech was produced in rooms with greater reverberation. All three voice parameters increased with short-term vocal fatigue. (Aim2) A model of the vocal effort to acoustic vocal parameters is proposed. The sound pressure level contributed to 66% of the variance explained by the model, followed by the f0 (30%) and the modulation in amplitude (4%). The results provide insight into how voice acoustical parameters can predict vocal effort. In particular, it increased when SPL and f0 increased and when the amplitude voice modulation decreased.

Metabolic Mechanisms of Vocal Fatigue

This study aimed to identify potential metabolic mechanisms including (1) neuromuscular inefficiency, (2) cardiovascular recovery deficits, or (3) both, in individuals with complaints of vocal fatigue. Within- and between-subjects group design was used in this study. Three groups of women participated in the study, including (1) individuals with complaints of vocal fatigue; (2) vocally healthy sedentary individuals; and (3) vocally healthy, cardiovascularly conditioned individuals. Group assignment was based on results from the Vocal Fatigue Index, laryngeal examination, and self-report regarding exercise regimens. Metabolic profiles were obtained using gas exchange measures monitored during vocal task performance (reading) at two different loudness levels, and during recovery from reading. Statistical analyses did not reveal reliable group differences in metabolic cost for or recovery from vocal tasks. However, descriptive review of oxygen uptake and recovery kinetics revealed patterns indicating reliance on differential energy resources for the vocal task in individuals with vocal fatigue compared with cardiovascularly trained, vocally healthy individuals in particular. Slow oxygen uptake kinetics at task onset was a characteristic of the vocal fatigue group, indicating a general reliance on anaerobic resources to meet the demands of the vocal task, pointing to possible neuromuscular inefficiency. Individuals with vocal fatigue also demonstrated an increase in oxygen consumption following vocal task compared with cardiovascularly trained individuals, suggesting possible cardiovascular recovery deficits. This study provides initial data relevant to possible metabolic mechanisms of vocal fatigue and the potential relevance of aerobic conditioning in individuals with such fatigue.

Voice Habits and Behaviors: Voice Care Among Flamenco Singers

The purpose of this study is to analyze the vocal behavior of flamenco singers, as compared with classical music singers, to establish a differential vocal profile of voice habits and behaviors in flamenco music. Bibliographic review was conducted, and the Singer's Vocal Habits Questionnaire, an experimental tool designed by the authors to gather data regarding hygiene behavior, drinking and smoking habits, type of practice, voice care, and symptomatology perceived in both the singing and the speaking voice, was administered. We interviewed 94 singers, divided into two groups: the flamenco experimental group (FEG, n = 48) and the classical control group (CCG, n = 46). Frequency analysis, a Likert scale, and discriminant and exploratory factor analysis were used to obtain a differential profile for each group. The FEG scored higher than the CCG in speaking voice symptomatology. The FEG scored significantly higher than the CCG in use of "inadequate vocal technique" when singing. Regarding voice habits, the FEG scored higher in "lack of practice and warm-up" and "environmental habits." A total of 92.6% of the subjects classified themselves correctly in each group. The Singer's Vocal Habits Questionnaire has proven effective in differentiating flamenco and classical singers. Flamenco singers are exposed to numerous vocal risk factors that make them more prone to vocal fatigue, mucosa dehydration, phonotrauma, and muscle stiffness than classical singers. Further research is needed in voice training in flamenco music, as a means to strengthen the voice and enable it to meet the requirements of this musical genre.

Vocal effort and fatigue in virtual room acoustics

Vocal effort is a physiological entity that accounts for changes in voice production as vocal loading increases, which can be quantified in terms of Sound Pressure Level (SPL). It may have implications on potential vocal fatigue risk factors. This study investigates how vocal effort is affected by room acoustics. The changes in the acoustic conditions were artificially manipulated. Thirty-nine subjects were recorded while reading a text, 15 out of them used a conversational style while 24 were instructed to read as if they were in a classroom full of children. Each subject was asked to read in three different reverberation time RT (0.4 s, 0.8 s, and 1.2 s), in two noise conditions (background noise at 25 dBA and Babble noise at 61 dBA), in three different auditory feedback levels (-5 dB, 0 dB, and 5 dB), for a total of 18 tasks per subject presented in a random order. The subjects answered questions addressing their perception of vocal fatigue on a visual analog scale. Babble noise and the order of task presentation increased SPL and self-reported fatigue. The SPL increased when the RT and the auditory feedback level decreased further clarifying how vocal effort changes within various conditions.

Sintomas vocais auditivos e proprioceptivos pré e pós-terapia de grupo de pacientes com disfonia

RESUMO Objetivo: comparar os sintomas auditivos, proprioceptivos e os totais pré e pós-terapia de grupo de pacientes com disfonia, além de associar o número de sintomas vocais às variáveis sexo, faixa etária, uso profissional da voz e diagnóstico laríngeo. Métodos: participaram 27 pacientes inseridos em grupos terapêuticos. Todos responderam aos sintomas vocais auditivos, proprioceptivos e totais do Protocolo de Triagem Vocal (PTV) pré e pós-terapia de grupo, que constou de oito encontros, sendo o primeiro e último para aplicação do PTV; do segundo ao sétimo foram realizadas sessões terapêuticas fonoaudiológicas de abordagem eclética. Resultados: os participantes eram adultos, maioria do sexo feminino e diagnóstico laríngeo predominante de lesão na porção membranosa das pregas vocais. Pôde-se perceber que houve redução significante dos sintomas vocais proprioceptivos e totais quando se comparou pré e pós-terapia. Minimizaram significantemente pós-terapia os sintomas vocais: fadiga vocal, garganta seca, bolo na garganta, esforço e desconforto ao falar. Houve associação entre sintomas vocais (proprioceptivos, auditivos e totais) pós-terapia de grupo com as variáveis sexo feminino e diagnóstico laríngeo lesão de massa na porção membranosa das pregas vocais. Não houve associação dos sintomas vocais pós-terapia com faixa etária e nem uso profissional da voz. Conclusão: houve redução dos sintomas vocais totais e proprioceptivos relatados pelos pacientes ao comparar o pré e o pós-terapia. Houve associação entre sexo feminino e diagnóstico de lesão de massa na porção membranosa das pregas vocais com sintomas totais, proprioceptivos e auditivos pós-terapia de voz. A faixa etária e o uso profissional da voz não foram associados à redução dos sintomas vocais.

Teachers’ accumulation of silence and voicing periods of continuous speech in classroom with different reverberation times

The relationship between the distribution of continuous silence and voicing periods accumulated (duration of continuous voiced and unvoiced segments of 0.05 s) by teachers teaching in classrooms with different reverberation time (RT) was examined. Understanding the distributions of these accumulations and the relationship with the RT has implications on potential vocal fatigue risk factors and it can be a useful information for clinicians. Twenty-two primary school teachers were monitored over 1 or 2 four-hour workdays with the Ambulatory Phonation Monitor. The RT ranged between 0.58 s and 1.58 s, with a median equal to 0.9 s. The classrooms were classified as low RT (0.58 s < RT < 0.90 s) and high RT (0.90 s ≤ RT < 1.58 s). The values of silence accumulation in low RT classrooms were significantly shorter than the accumulation in high RT classrooms in almost the whole range of accumulation periods (0.2 s—10 s). The difference was negligible for time shorter than 1.5 s and longer than 8 s. The values of voice accumulation in low RT classrooms are significantly shorter than the accumulation in high RT classrooms in almost the whole range of accumulation periods (0.2 s—1.31 s).

Vocal Fatigue Symptoms and Laryngeal Status in Relation to Vocal Activity Limitation and Participation Restriction

The study aims to investigate the vocal fatigue symptoms and laryngeal status in relation to vocal activity limitations and vocal participation restrictions. This is a case-control study. Two hundred six teachers were divided into two groups based on the frequency of their self-reported vocal symptoms being more or less than the mean of reported frequency. The study compared odds for activity limitation and participation restriction in relation to frequency of vocal symptoms, number of vocal symptoms recurring weekly, and organic laryngeal changes. Activity limitation and participation restriction were studied using the Voice Activity and Participation Profile questionnaire. Increased odds were found for teachers with frequent vocal symptoms and especially those with one or more vocal symptom recurring weekly. Odds were found to be 2.6-8.5 times more likely in teachers with more frequent vocal symptoms. The odds increased dramatically with increase of the number of vocal symptoms recurring weekly. Laryngeal organic changes were found to increase the odds but insignificantly. Teachers with frequent vocal symptoms, especially those with vocal symptoms recurring weekly, have increased odds ratio for vocal activity limitation and vocal participation restrictions. High scores or frequent occurrence of self-reported vocal fatigue symptoms must be taken seriously in the evaluation of vocal working ability.

A Joyful Noise: The Vocal Health of Worship Leaders and Contemporary Christian Singers

Contemporary commercial music (CCM) is a term that encompasses many styles of music. A growing subset of CCM is contemporary Christian music, a genre that has outpaced other popular styles such as Latin, jazz, and classical music. Contemporary Christian singers (CCSs) and worship leaders (WLs) are a subset of CCM musicians that face unique vocal demands and risks. They typically lack professional training and often perform in acoustically disadvantageous venues with substandard sound reinforcement systems. The vocal needs and risks of these singers are not well understood, and because of this, their training and care may be suboptimal. The aim of the present study was to investigate the vocal health of this growing population and their awareness of standard vocal hygiene principles. An online questionnaire was designed and administered to participants in the Americas, Europe, Australia, and Asia. A total of 614 participants responded to the questionnaire, which is made available in English, Portuguese, and Spanish. Many participants reported vocal symptoms such as vocal fatigue (n = 213; 34.7%), tickling or choking sensation (n = 149; 24.3%), loss of upper range (n = 172; 28%), and complete loss of voice (n = 25; 4.1%). One third of the participants (n = 210; 34%) indicated that they do not warm up their voices before performances and over half of the participants (n = 319; 52%) have no formal vocal training. Results suggest that this population demonstrates low awareness of vocal hygiene principles, frequently experience difficulty with their voices, and may face elevated risk of vocal pathology. Future studies of this population may confirm the vocal risks that our preliminary findings suggest.

Voice Quality in Native and Foreign Languages Investigated by Inverse Filtering and Perceptual Analyses

Language shift from native (L1) to foreign language (L2) may affect speaker's voice production and induce vocal fatigue. This study investigates the effects of language shift on voice source and perceptual voice quality. This is a comparative experimental study. Twenty-four subjects were recorded in L1 and L2. Twelve of the subjects were native Finnish speakers and 12 were native English speakers, and the foreign languages were English and Finnish. Two groups were created based on reports of fatigability. Group 1 had the subjects who did not report more vocal fatigue in L2 than in L1, and in group 2 those who reported more vocal fatigue in L2 than in L1. Acoustic analyses by inverse filtering were conducted in L1 and L2. Also, the subjects' voices were perceptually evaluated in both languages. Results show that language shift from L1 to L2 increased perceived pressedness of voice. Acoustic analyses correlated with the perceptual evaluations. Also, the subjects who reported more vocal loading had poorer voice quality, more strenuous voice production, more pressed phonation, and a higher pitch. Voice production was less optimal in L2 than in L1. Speech training given in L2 could be beneficial for people who need to use L2 extensively.

Silence and Voicing Accumulations in Italian Primary School Teachers With and Without Voice Disorders

The relationship between the silence and voicing accumulations of primary school teachers and the teachers' clinical status was examined to determine whether more voicing accumulations and fewer silence accumulations were measured for the vocally unhealthy subjects than for the healthy subjects, which would imply more vocal loading and fewer short-term recovery moments. Twenty-six Italian primary school teachers were allocated by clinicians to three groups: (1) with organic voice disorders, (2) with subjectively mild organic alteration or functional voice symptoms, and (3) normal voice quality and physiology. Continuous silence and voicing periods were measured with the APM3200 during the teachers' 4-hour workdays. The accumulations were grouped into seven time intervals, ranging from 0.03-0.9 to 3.16-10 seconds, according to Italian prosody. The effects of group on silence and voicing accumulations were evaluated. Regarding silence accumulations, Group 1 accumulated higher values in intervals between 0.1 and 3.15 seconds than other groups, whereas Groups 2 and 3 did not differ from each other. Voicing accumulations between 0.17 and 3.15 seconds were higher for subjects with a structural disorder. A higher time dose was accumulated by these subjects (40.6%) than other subjects (Group 2, 31.9%; Group 3, 32.3%). Although previous research has suggested that a rest period of a few seconds may produce some vocal fatigue recovery, these results indicate that periods shorter than 3.16 seconds may not have an observable effect on recovery. The results provide insight into how vocal fatigue and vocal recovery may relate to voice disorders in occupational voice users.

Effects of speech style, room acoustics, and vocal fatigue on vocal effort.

Vocal effort is a physiological measure that accounts for changes in voice production as vocal loading increases. It has been quantified in terms of sound pressure level (SPL). This study investigates how vocal effort is affected by speaking style, room acoustics, and short-term vocal fatigue. Twenty subjects were recorded while reading a text at normal and loud volumes in anechoic, semi-reverberant, and reverberant rooms in the presence of classroom babble noise. The acoustics in each environment were modified by creating a strong first reflection in the talker position. After each task, the subjects answered questions addressing their perception of the vocal effort, comfort, control, and clarity of their own voice. Variation in SPL for each subject was measured per task. It was found that SPL and self-reported effort increased in the loud style and decreased when the reflective panels were present and when reverberation time increased. Self-reported comfort and control decreased in the loud style, while self-reported clarity increased when panels were present. The lowest magnitude of vocal fatigue was experienced in the semi-reverberant room. The results indicate that early reflections may be used to reduce vocal effort without modifying reverberation time.

Effect of the tracheoesophageal voice resistance test in total laryngectomees.

To analyze tracheoesophageal voice resistance in laryngectomized patients by comparing the acoustic, perceptive-auditory and self-evaluation measures before and after the voice resistance test. An observational, experimental study with a quantitative and descriptive approach. Nineteen total laryngectomees were submitted for capture of vocal intensity, self-assessment of signs and symptoms of voice fatigue using a visual analogue scale, and perceptive-auditory and acoustic analysis of the tracheoesophageal voice before and after the voice resistance test, which consisted of continuous repeated counting from one to 100. The mean time of execution of the test was 33.68 minutes. Type II sound signal, voice intensity, voice quality, degree of severity of dysphonia, and the pitch and loudness parameters were maintained after the test. There were no changes in signs and symptoms of vocal fatigue. Most of the total laryngectomees performed the voice resistance test for less than 30 minutes. However, the voice resistance test did not induce significant changes in the quality of tracheoesophageal voice of total laryngectomees or in the signs and symptoms of vocal fatigue. 4 Laryngoscope, 2016 127:405-410, 2017.

The effect of compromised pulmonary function on speech production among female school teachers

Females face a significantly higher risk than males of developing long-term voice problems with lifetime instances occurring in 46% of females compared to 37% of males. The higher incidence of prolonged problems among women has been associated with a number of gender differences, including physiological differences in the laryngeal system, differences in the endocrine system, and differences in pulmonary usage. Additionally, inefficient pulmonary utilization and reduced lung volume have been linked with vocal health concerns. Our study sought to use established spirometry measures and a relatively new questionnaire, the Vocal Fatigue Index (VFI), to determine if there is a relationship between pulmonary function and vocal fatigue among teachers. Additionally, if there is a relationship, to determine if that relationship is stronger in females than in males. 122 (96 females, 26 males) elementary and middle school teachers from the Jordan School District in northern Utah participated in this research. For females, VFI was a predictor of several spirometry measures; however, the same correlation was not found among male participants. These results indicate that reduced pulmonary function in combination with other gender differences in speech production may lead to increased incidences of vocal fatigue among female teachers than their male counterparts.