Vocal Fatigue Research Articles

Does Postthyroidectomy Syndrome Really Exist Following Thyroidectomy? Prospective Comparative Analysis of Open vs. Endoscopic Thyroidectomy.

ObjectivesThis study prospectively evaluated postthyroidectomy syndrome (PTS) through objective and subjective voice changes following thyroidectomy of open vs. endoscopic thyroidectomy.MethodsA prospective clinical trial (SCHBC IRB 09 26) was performed from Jan 2008 to Aug 2010 to compare the open thyroidectomy (OPEN group) and endoscopic thyroidectomy (ENDO group). Of the 110 patients, 75 completed the evaluation before and 1 and 6 months after surgery. Subjective parameters included perceptual analysis (GRBAS [grade, roughness, breathiness, asthenia, and strain] scale), stroboscopic or flexible fiberscopic analysis, voice handicap index, and 5-point visual analog scales for vocal fatigue, singing difficulty, difficulty with high-pitch phonation, and neck discomfort. Objective parameters included acoustic, aerodynamic analysis and the electroglottograph.ResultsFor the ENDO group (n=36), the operation time was longer than in the OPEN group (n=39; P<0.01). For the OPEN group, two objective and five subjective parameters were worse 1 month postoperatively; of these, two subjective parameters persisted for 6 months (P<0.05). For the ENDO group, three objective and six subjective parameters were worse 1 month postoperatively, and three of the subjective parameters persisted 6 months postoperatively (P<0.05).ConclusionPTS really exists following simple thyroidectomy and are very common for both OPEN and ENDO groups. Most of the parameters improved gradually over time, but some subjective changes persisted 6 months postoperatively.

Design of a Clinical Vocal Loading Test With Long-Time Measurement of Voice

The aim of this study was to design a clinical vocal loading task (VLT) and to track vocal loading and recovery in voice-healthy subjects. Pilot study. Voice-healthy subjects (six female, five male) took part in a controlled VLT in the voice clinic. The VLT was designed to induce vocal fatigue. The subjects read aloud while making themselves heard through ambient speech-babble aired at 85dB sound pressure level (SPL). Reading was terminated by the subjects when or if they felt any discomfort from the throat. The subjects wore a voice accumulator and filled out a voice activity questionnaire 1day preceding and for 2days following the VLT. Expert panels assessed vocal quality and laryngeal physiology from recordings. The subjects endured the VLT for 3-30minutes. All subjects perceived vocal loading in the VLT. All subjects raised the fundamental frequency and SPL of their speech during the VLT. No match was shown between assessment of voice quality and laryngeal physiology. The subjects showed phonation quotients of 64-82% in the task. Measurements of phonation threshold pressure (PTP) were unstable and were not used. Self-perceived vocal loading receded after 24hours. An authentic vocal load was simulated through the chosen method. Onset and recovery from self-perceived vocal loading was traceable through the voice activity questionnaire. The range of endurance in the VLT was an unexpected finding, indicating the complexity of vocal loading.

Work-related voice disorder

IntroductionDysphonia is the main symptom of the disorders of oral communication. However, voice disorders also present with other symptoms such as difficulty in maintaining the voice (asthenia), vocal fatigue, variation in habitual vocal fundamental frequency, hoarseness, lack of vocal volume and projection, loss of vocal efficiency, and weakness when speaking. There are several proposals for the etiologic classification of dysphonia: functional, organofunctional, organic, and work-related voice disorder (WRVD). ObjectiveTo conduct a literature review on WRVD and on the current Brazilian labor legislation. MethodsThis was a review article with bibliographical research conducted on the PubMed and Bireme databases, using the terms “work-related voice disorder”, “occupational dysphonia”, “dysphonia and labor legislation”, and a review of labor and social security relevant laws. ConclusionWRVD is a situation that frequently is listed as a reason for work absenteeism, functional rehabilitation, or for prolonged absence from work. Currently, forensic physicians have no comparative parameters to help with the analysis of vocal disorders. In certain situations WRVD may cause, work disability. This disorder may be labor-related, or be an adjuvant factor to work-related diseases.

Measuring Vocal Function in Professional Music Theater Singers: Construct Validation of the Evaluation of the Ability to Sing Easily (EASE)

Overview: Working music theater singers (MTS) typically have a heavy vocal load and little is known about their perception of vocal function. The Evaluation of the Ability to Sing Easily (EASE) was used to assess professional MTS' perceptions of current singing voice status and to compare scores across demographic and performance characteristics and to evaluate the construct validity of the EASE and its subscales (VF = Vocal Fatigue, PRI = Pathologic-Risk Indicators). Methods: Professional MTS (n = 284) completed an online survey including the EASE and two additional Vocal Concern (VC) items. Scores were compared across age, gender, whether currently working, role, perceived vocal load over the past 24 h and self-reported voice problem. Results: For the whole cohort, statistically significant differences were found on all subscales according to whether or not singers perceived themselves to have a voice problem (p < 0.001). Currently performing singers were significantly different from those not performing in a show on the EASE Total (p = 0.014) and VF (p = 0.002), but not for PRI and VC. In the currently performing singer group, significant differences were found for gender, role and perceived voice problem on the EASE Total and all subscales (p < 0.01). Significantly higher VF scores were recorded for singers with heavy vocal load (p = 0.01), but there were no differences on the EASE Total (p = 0.57), PRI (p = 0.19) or VC subscales (p = 0.53). Among these performing singers, no significant age differences were found for any EASE subscales. Conclusions: These findings provide further validation of the EASE as a useful tool for measuring singers' perceptions of vocal function and suggest that the subscales should be scored separately. Future evaluation of the EASE against objective clinical assessments (e.g., videostroboscopy) is recommended. © 2014 S. Karger AG, Basel

Development and Validation of the Voice Fatigue Handicap Questionnaire (VFHQ): Clinical, Psychometric, and Psychosocial Facets

Development and validation of the vocal fatigue handicap questionnaire (VFHQ), a self-administered brief instrument for the assessment of functional, emotional, and physical vocal fatigue (VF). "Outcomes research" with item generation, item reduction, and psychometric evaluation of instrument's key properties involving different subsamples of patients in content generation and item-selection pilot testing, followed by a main validation study. Questionnaire content generation and item reduction by selection of 30 items from an initial pool of 60 during pilot testing, followed by psychometric assessment of VFHQ's internal consistency, test-retest reliability, construct validity, criterion validity, and clinical efficacy in a main validation study with 87 patients with voice disorders. Internal consistency was evaluated by means of Cronbach-alpha coefficients; construct and criterion validity through multiple regression analyses; test-retest reliability by administering 35 questionnaires to pathologic respondents after a 15days' time-interval from first questionnaire administration; clinical efficacy, (ie, instrument's usefulness and responsiveness) by administering 20 questionnaires to patients with voice disorders before and after clinical intervention. Statistical analyses established VFHQ's high internal consistency, reliability, construct, and criterion validity, as well as efficacy, and usefulness in therapeutic practice for the assessment of clinical and psychosocial consequences of VF (spoken voice). VFHQ is a useful tool for the assessment of VF, which is able to quantify its functional, emotional, and physical components.

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

Objectives: Investigate the prevalence of phonatory symptoms, perceptual, acoustic, and aerodynamic findings in patients with asthma compared to a control group. Methods: A total of 50 subjects, 31 asthmatic and 19 control subjects matched according to age and sex, were enrolled in this study. All subjects were asked about the presence or absence of cough, dyspnea, respiratory failure, dysphonia, degree of vocal fatigue, and phonatory effort. Perceptual evaluation, acoustic analysis, and aerodynamic measurements were also performed. Patient self-assessment using the Voice Handicap Index 10 was reported. Results: The mean age of patients was 43.5 years with a female to male ratio of 2:1. There was a statistically significant difference in the prevalence of dysphonia between the 2 groups (32.3% vs 5.3%, P = .025) with a significant difference in the mean score of respiratory effort and vocal fatigue ( P = .019, .041, respectively). The overall grade of dysphonia was significantly higher in asthmatics compared to controls ( P = .002). Patients with asthma also had significantly higher degree of asthenia and straining 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 jitter. There was also no significant difference in the maximum phonation time between the 2 groups. Conclusions: Phonatory symptoms are significantly more prevalent in patients with asthma compared to controls.

Prevalence of Phonatory Symptoms and Acoustic Findings in Patients with Chronic Obstructive Lung Disease

Objectives: Investigate phonatory symptoms and acoustic and aerodynamic findings in patients with chronic obstructive lung disease (COPD) compared to a control group. Methods: A total of 40 subjects, 27 COPD and 13 control subjects matched according to age and sex, were enrolled in this study. All subjects were asked about the presence or absence of dysphonia, degree of vocal fatigue, and phonatory effort. Perceptual evaluation, acoustic analysis, and aerodynamic measurements were also performed. Patient self-assessment using the Voice Handicap Index 10 was reported. Results: There was a statistically significant difference in the prevalence of dysphonia between the 2 groups (12% vs 0%, P &lt; .05) with a significant difference in the mean score of respiratory effort and vocal fatigue ( P = .011, .012, respectively). There was no significant difference in any of the perceptual parameters between the 2 groups except for roughness ( P = .009). There was no significant difference in the means of any of the acoustic parameters between patients and controls. There was also no significant difference in the maximum phonation time between the 2 groups ( P = .916). Conclusions: Dysphonia is significantly more prevalent in patients with COPD compared to controls.

Effect of Weight Loss on Voice After Bariatric Surgery

To investigate the effect of weight loss on voice. Prospective study. A total of 15 subjects undergoing bariatric surgery were investigated. Six subjects were lost to follow-up, and nine subjects were evaluated preoperatively and 3-6months postoperatively. The evaluation included a questionnaire on voice quality filled by the patient, laryngeal examination, perceptual evaluation, and acoustic analysis. The questionnaire consisted of four questions: change in vocal pitch, change in vocal loudness, increase or decrease in phonatory effort, and the presence or absence of vocal fatigue. For the perceptual evaluation, a simplified version of the Grade, Roughness, Breathiness, Asthenia, Strain scale classification was used. These parameters were rated using a score ranging from zero to three where zero stands for none and three for severe. For the acoustic analysis, the following variables were measured: fundamental frequency, habitual pitch, jitter, shimmer, noise-to-harmonics ratio, voice turbulence index, and maximum phonation time. The mean age was 35.56±9.93years. The mean weight preoperatively and postoperatively was 112.17 and 83.61kg, respectively. The body mass index dropped by eight points from 38.06 to 30.83. Only three of the nine patients have reported change in voice quality. The latter was described as an increase in vocal pitch in the three cases, reduced loudness and increased phonatory effort in two, and the presence of vocal fatigue in one. There was no significant difference in the mean score of any of the perceptual parameters in patients preoperatively versus postoperatively. There was also no significant difference in any of the acoustic parameters or in the laryngeal findings before and after surgery. One-third of the patients with weight loss reported change in voice quality that was not documented acoustically. The laryngeal examination is nonrevealing.

Voice disorders in Nigerian primary school teachers.

The prolonged use or abuse of voice may lead to vocal fatigue and vocal fold tissue damage. School teachers routinely use their voices intensively at work and are therefore at a higher risk of dysphonia. To determine the prevalence of voice disorders among primary school teachers in Lagos, Nigeria, and to explore associated risk factors. Teaching and non-teaching staff from 19 public and private primary schools completed a self-administered questionnaire to obtain information on personal lifestyles, work experience and environment, and voice disorder symptoms. Dysphonia was defined as the presence of at least one of the following: hoarseness, repetitive throat clearing, tired voice or straining to speak. A total of 341 teaching and 155 non-teaching staff participated. The prevalence of dysphonia in teachers was 42% compared with 18% in non-teaching staff. A significantly higher proportion of the teachers reported that voice symptoms had affected their ability to communicate effectively. School type (public/private) did not predict the presence of dysphonia. Statistically significant associations were found for regular caffeinated drink intake (odds ratio [OR] = 3.07; 95% confidence interval [CI]: 1.51-6.62), frequent upper respiratory tract infection (OR = 3.60; 95% CI: 1.39-9.33) and raised voice while teaching (OR = 10.1; 95% CI: 5.07-20.2). Nigerian primary school teachers were at risk for dysphonia. Important environment and personal factors were upper respiratory infection, the need to frequently raise the voice when teaching and regular intake of caffeinated drinks. Dysphonia was not associated with age or years of teaching.

Reducing the Negative Vocal Effects of Superficial Laryngeal Dehydration With Humidification

Environmental humidification is a simple, cost-effective method believed to reduce superficial laryngeal drying. This study sought to validate this belief by investigating whether humidification treatment would reduce the negative effects of superficial laryngeal dehydration on phonation threshold pressure (PTP). Phonation threshold pressure data analysis may be vulnerable to bias because of lack of investigator blinding. Consequently, this study investigated the extent of PTP analysis reliability between unblinded and blinded investigators. Healthy male and female adults were assigned to a vocal fatigue (n = 20) or control group (n = 20) based on their responses to a questionnaire. PTP was assessed after 2 hours of mouth breathing in low humidity (dehydration challenge), following a 5-minute break in ambient humidity, and after 2 hours of mouth breathing in high humidity (humidification). PTP significantly increased following the laryngeal dehydration challenge. After humidification, PTP returned toward baseline. These effects were observed in both subject groups. PTP measurements were highly correlated between the unblinded and blinded investigator. Humidification may be an effective approach to decrease the detrimental voice effects of superficial laryngeal dehydration. These data lay the foundation for future investigations aimed at preventing and treating the negative voice changes associated with chronic, surface laryngeal drying.

A study of classroom acoustics and school teachers’ noise exposure, voice load and speaking time during teaching, and the effects on vocal and mental fatigue development

The study investigated the noise exposure in a group of Danish school teachers. The aims were to investigate if noise posed a risk of impairment of hearing and to study the association between classroom acoustical conditions, noise exposure, vocal symptoms, and cognitive fatigue. Background noise levels, vocal load and speaking time were measured on 35 teachers during actual classroom teaching. The classrooms were characterized acoustically by measurements of reverberation time. Before and after the workday, the teachers answered a questionnaire on fatigue symptoms and carried out two cognitive test tasks sensitive to mental fatigue. The average noise level during the lessons was 72 dB(A), but during indoor sports activities the average noise level increased 6.6 dB(A). Room reverberation time (range 0.39-0.83 s) had no significant effect on the noise level. The teachers were talking with a raised voice in 61% of the time, and the vocal load increased 0.65 dB(A) per dB(A) increase in the average lesson noise level. An increase in voice symptoms during the workday correlated significantly with individual average noise exposure, and a decrease in performance in the two-back test correlated significantly with individual average vocal load. Noise exposure in general classrooms posed no risk of noise-induced hearing impairment in school teachers. However, the results provide evidence for an association between noise exposure and vocal load and development of vocal symptoms and cognitive fatigue after work.

Fundamental frequency, phonation maximum time and vocal complaints in morbidly obese women.

BackgroundObese people have abnormal deposition of fat in the vocal tract that can interfere with the acoustic voice.AimTo relate the fundamental frequency, the maximum phonation time and voice complaints from a group of morbidly obese women.MethodsObservational, cross-sectional and descriptive study that included 44 morbidly obese women, mean age of 42.45 (±10.31) years old, observational group and 30 women without obesity, control group, with 33.79 (±4.51)years old. The voice recording was done in a quiet environment, on a laptop using the program ANAGRAF acoustic analysis of speech sounds. To extract the values ​​of fundamental frequency the subjects were asked to produce vowel [a] at usual intensity for a period in average of three seconds. After the voice recording, participants were prompted to produce sustained vowel [ a] , [ i] and [ u] at usual intensity and height, using a stopwatch to measure the time that each participant could hold each vowel.ResultsThe majority, 31(70.5%), had vocal complaints, with a higher percentage for complaints of vocal fatigue 20(64.51%) and voice failures 19(61.29%) followed by dryness of the throat in 15 (48.38%) and effort to speak 13(41.93%). There was no statistically significant difference regarding the mean fundamental frequency of the voice in both groups, but there was significance between the two groups regarding maximum phonation.ConclusionIncreased adipose tissue in the vocal tract interfered in the vocal parameters.

Perceived vocal fatigue and effort in relation to laryngeal functional measures in paresis patients

To determine if differences in objective measures of laryngeal function can meaningfully explain different levels of self-perceptions of effort or fatigue in patients with vocal fold paresis. A retrospective chart review of 72 patients with vocal fold paresis diagnosed using laryngeal electromyography, who had either been observed (n=21), treated only by injection (n=24), or treated only by surgery (n=27). Before and after treatment/observation, patients' subjective ratings of severity of vocal effort and fatigue were assessed using the Glottal Function Index. Laryngeal function was assessed using maximum phonation time and translaryngeal flow. None of the variables demonstrated a significant linear change across time. Post hoc Tukey analyses following analysis of variance (ANOVA) found significant differences in flow among three groups, those rating symptoms of effort as no problem, moderate problem, or severe problem. Post hoc Tukey analyses following ANOVA found significant differences in the amount that flow changed among three groups, those demonstrating no difference, minor differences, or major differences in ratings of effort before and after treatment. Changes in reported symptom severity of effort were related to changes in translaryngeal midvowel flow that were not explained by passage of time. 4.

Factors Associated With Singers' Perceptions of Choral Singing Well-Being

Choral singing is a popular vocational pastime across cultures. The potential health benefits associated with choral singing, including positive effect on well-being, are a topic of interest in health research. However, anecdotal reports from voice professionals suggest that the unique demands of choral singing may enforce unhealthy singing habits. This study explores suboptimal vocal behaviors that are sometimes associated with choral singing, which include singing outside comfortable pitch range, singing too loudly, and singing too softly for blend. The relationships between suboptimal choral singing habits, vocal warm-ups (WUs), vocal fatigue, and singing-related well-being were assessed via a 14-item Likert-based response format questionnaire. Participants consisted of 196 attendees of the international World Choir Games. The final study group consisted of 53 male and 143 female international amateur singers aged 10-70. Results indicated a positive correlation between vocal fatigue and suboptimal singing behaviors (r = 0.34, P < 0.0001). Participants who did not engage in suboptimal singing behavior experienced increased singing-related well-being (r = -0.32, P < 0.0001, N = 141). Vocal WUs were not related to vocal fatigue or singing well-being. Substantially, more participants from this demographic preferred choir over solo singing (X²[1, N = 196] = 22.93, P < 0.0001). Suboptimal choral singing behaviors may result in vocal fatigue and reduction of choral singing well-being and should therefore be considered when examining the effect of choral singing on singing-related well-being and health. Future research will compare the amateurs' perceptions of choral singing with perceptions from professional singers and will look at determinants of choral singing well-being.

Pediatric Arytenoid Dislocation: Diagnosis and Treatment

Arytenoid dislocation and subluxation are well-described injuries in adults but are poorly documented in children. The most commonly cited etiology is intubation trauma although external blunt trauma also is recognized. Symptoms include dysphonia, vocal fatigue, loss of vocal control, breathiness, odynophagia, dysphagia, dyspnea, and cough. Prompt diagnosis and treatment lead to the best chance for recovery, and delayed treatment is likely to result in scarring and possibly ankylosis. The mean age of our study group was 12.3 years and consisted of six males (55%) and five females (45%). The most commonly presenting symptom was hoarseness (81.8%). Six of the 11 patients underwent surgical correction of the dislocated arytenoid cartilage. Four patients refused any treatment and one patient received voice therapy alone. Two patients who refused surgical intervention had spontaneous reduction of their dislocations. After surgical intervention, one patient regained normal voice, four patients had substantial voice improvement without return to preinjury vocal function, and one patient had only slight voice improvement. Pediatric symptoms are similar to these in adults, yet these may be less noticeable to the patient and clinician. A high index of suspicion is needed to diagnose and treat pediatric arytenoid dislocation.

Quantitative High-Speed Laryngoscopic Analysis of Vocal Fold Vibration in Fatigued Voice of Young Karaoke Singers

The present study aimed to determine whether there were physiological differences in the vocal fold vibration between nonfatigued and fatigued voices using high-speed laryngoscopic imaging and quantitative analysis. Twenty participants aged from 18 to 23 years (mean, 21.2 years; standard deviation, 1.3 years) with normal voice were recruited to participate in an extended singing task. Vocal fatigue was induced using a singing task. High-speed laryngoscopic image recordings of /i/ phonation were taken before and after the singing task. The laryngoscopic images were semiautomatically analyzed with the quantitative high-speed video processing program to extract indices related to the anteroposterior dimension (length), transverse dimension (width), and the speed of opening and closing. Significant reduction in the glottal length-to-width ratio index was found after vocal fatigue. Physiologically, this indicated either a significantly shorter (anteroposteriorly) or a wider (transversely) glottis after vocal fatigue. The high-speed imaging technique using quantitative analysis has the potential for early identification of vocally fatigued voice.

Voice Symptoms and Voice-Related Quality of Life in College Students

The purpose of this study was to examine the prevalence of voice disorders in college students and their effect on the students as shown by quality-of-life indicators. A cross-sectional survey was completed by 545 college students in 2012. The survey included 10 questions from the Voice-Related Quality of Life (V-RQOL), selected voice symptoms, and quality-of-life indicators of functional health and well-being based on the Short Form 36-item Health Survey (SF-36). Twenty-nine percent of the college students (mean age, 22.7 years) reported a history of a voice disorder. Hoarseness was the most prevalent voice symptom, but was not correlated with V-RQOL scores. A wobbly or shaky voice, throat dryness, vocal fatigue, and vocal effort explained a significant amount of variance on the social-emotional and physical domains of the V-RQOL index (p < 0.05). Voice symptoms limited emotional and physical functioning as indicated by SF-36 scores. Voice disorders significantly influence psychosocial and physical functioning in college students. These findings have important implications for voice-care services in this population.

Collision and Phonation Threshold Pressures Before and After Loud, Prolonged Vocalization in Trained and Untrained Voices

The phonation threshold pressure (PTP) is defined as the lowest subglottal pressure needed for obtaining and sustaining vocal fold oscillation. It has been found to increase during vocal fatigue. In the present study, PTP is measured together with the threshold pressure needed for vocal fold collision; henceforth, the collision threshold pressure (CTP). PTP and CTP are compared before and after loud, prolonged vocalization in singer and nonsinger voices. Ten subjects repeated the vowel sequence /a, e, i, o, u/ at a Sound Pressure Level of at least 80 dB at 0.3 m for 20 minutes. Audio and electroglottography signals were recorded before and after this exercise. At the same time, oral pressure was registered while the subjects produced a diminuendo repeating the syllable /pa:/, thus acquiring an approximate of the subglottal pressure. CTP and PTP increased significantly after the vocal loading in the nonsinger subjects. On the other hand, singers reported no substantial effect of the exercise, and most singers had a mean after-to-before ratio close to 1 for both CTP and PTP.

Voice Outcome in Patients Treated for Laryngeal Cancer: Efficacy of Voice Rehabilitation

To investigate the efficacy of voice rehabilitation regarding acoustically measured voice quality as well as self-perceived function after radiotherapy for laryngeal cancer. Prospective intervention study. Twenty male patients irradiated for laryngeal cancer participated in the study. Voice recordings and self-assessment of voice function (hoarseness, vocal fatigue, and vocal loudness) were made one and 6 months after completion of radiotherapy. The recordings were analyzed with the program Praat. Ten of the patients received 10 sessions of structured voice rehabilitations between the recordings and 10 worked as a control group. Jitter and shimmer improved for both groups. Harmonics-to-noise-ratio and maximum phonation time improved for the patients who received voice rehabilitation while it deteriorated for the control group. The self-assessment questions about vocal fatigue and vocal loudness showed improvement for both groups while hoarseness showed no change. General improvement was seen for both the study group and the control group. Despite the lack of statistical significant difference, there are trends where greater improvement in perturbation and self-assessment measures are noted in the study group. The results suggest positive effects of voice rehabilitation in both voice quality and self-perceived function.

SAT0050 Voice Impairment in Rheumatoid Arthritis Patients: A Disease Activity Marker Often Overlooked

BackgroundRheumatoid arthritis (RA) may lead to voice impairment through several anatomical and functional alterations.ObjectivesTo evaluate the prevalence of voice impairment in RA patients and to determine the correlation with disease...