Vocal Fatigue Research Articles

Comparative Study of Two Semi-Occluded Vocal Tract Protocols: A Randomized Clinical Trial.

Semi-occluded vocal tract exercises (SOVTEs) are widely used as a therapeutic tool to create flow resistance in the upper airway. The current study was a randomized controlled clinical trial to establish the efficacy of two SOVTE protocols, flow-resistant tube (FRT) and Lessac-Madsen Resonant Voice Therapy (LMRVT). Exploratory investigations included a noninferiority analysis of FRT to the widely adopted therapy protocol (LMRVT), as well as examining the dosing required to improve acoustic measures and subjective ratings. Sixty-seven participants with voice disorder were randomized into one of five groups: 4-week FRT (n = 14), 8-week FRT (n = 19), 4-week LMRVT (n = 15), 8-week LMRVT (n = 5), and control (n = 14). Voice Handicap Index (VHI) and Vocal Fatigue Index scores were collected pre- and posttreatment. Acoustic analysis using the Acoustic Voice Quality Index was completed. We compared VHI between controls and 8-week FRT and LMRVT, adjusting for pre-VHI using linear regression. We examined the efficacy of 4-week protocols relative to controls and conducted a noninferiority comparison of FRT (4 and 8 weeks) to LMRVT (4 and 8 weeks) using 5- and 10-point margins. Finally, we compared the 4- versus 8-week sessions for both therapies. A statistically significant reduction of VHI in both 8-week FRT relative to controls (-10.60, 95% CI [-19.80, -1.40], p = .025) and 8-week LMRVT (-15.74, 95% CI [-29.40, -2.08], p = .025) was found. We also found an improvement in 4-week FRT relative to controls (-10.11, 95% CI [-20.03, -0.20], p = .046), but the 4-week LMRVT result was not statistically significant (p = .057). FRT was found to be noninferior to LMRVT in terms of VHI using a 10-point margin (FRT - LMRVT: 0.69, 95% CI [-5.76, 7.15], p = .01), but not using a 5-point margin (p = .054). There were no statistically significant differences in VHI scores between 4- and 8-week sessions for either therapy. Both FRT and LMRVT improved VHI scores relative to controls. FRT was noninferior to LMRVT in terms of VHI scores. There were no statistically significant differences in VHI scores between 4- and 8-week therapy sessions.

Vocal Fatigue Index (VFI): Cross-Cultural Adaptation, Validation, and Cut-off Values of the Arabic Version

ObjectiveThis study aims to validate, cross-culturally and linguistically adapt the Vocal Fatigue Index (VFI) into Arabic. Study DesignCross-sectional study. MethodsThe VFI was translated into Arabic, reverse translated, and content validated. To assess its psychometric properties, 398 patients with voice disorders (199 males, 199 females, mean age = 46.2 ± 15.0 years) and 121 vocally healthy controls (57 males, 64 females, mean age = 42.1 ± 6.9 years) completed the VFI-Arabic. We calculated internal consistency and test-retest reliability using Cronbach’s alpha and intraclass correlation coefficients. Independent sample t-tests determined mean factor score differences between groups, while ROC curves analyzed sensitivity, specificity, and cut-off scores for the three factors. ResultsThe overall Cronbach’s alpha was 0.95, across all factors combined, it was 0.68; and for factors 1, 2, and 3, it was 0.95, 0.91, and 0.91, respectively. Test-retest reliability for the subscales was excellent (intraclass correlation: 0.97, 0.91, 0.82 for factors 1, 2, and 3). Mean subscale scores were significantly higher in the voice-disordered group than in controls. The AUC for factors 1, 2, and 3 was 0.824, 0.759, and 0.646, respectively. Best cut-off scores were ≥ 14.5 (69.8% sensitivity, 83.1% specificity) for factor 1, ≥ 3.5 (66.3% sensitivity, 74.4% specificity) for factor 2, and ≥ 5.5 (60.1% sensitivity, 64.5% specificity) for factor 3. ConclusionThe VFI-Arabic is a valid and reliable tool for identifying and quantifying vocal fatigue symptoms in Arabic speakers.

A Multiparametric Acoustic and Self-Perceptual Measure of Laryngeal Hydrations in Speech-Language Pathologists: A Preliminary Longitudinal Investigation

PurposeSpeech-language pathologists (SLPs) work with individuals with communication disorders. Their work can strain their voice, resulting in dysphonia, adversely affecting their career and quality of life. Laryngeal hydration can prevent vocal damage and improve vocal performance in SLPs. However, there is limited research on the effects of laryngeal hydration in SLPs using longitudinal studies. Hence, the present study aims to assess the longitudinal impact of laryngeal hydration in SLPs using multiparametric acoustic and self-perceptual measures. MethodThe research method lasted for six consecutive days, with each day lasting 2-3 hours for each participant. Ten SLPs, aged 18-30 years, were recruited. On alternate days, laryngeal hydration treatment (Systemic, surface, and combined hydration) was given while participants performed vocal loading tasks. Pre- and post-recordings of the Acoustic Voice Quality Index (AVQI) and its consistent parameters (CPPs, HNR, shimmer%, shimmer local, LTAS slope, LTAS Tilt) and self-perceptual measures [Perceived Phonatory Effort (PPE), Perceived Vocal Tiredness (PVT)] were taken. Kruskal-Wallis Test and the Wilcoxon Signed Rank Test were used to assess vocal changes in SLPs with laryngeal hydration. ResultsNo significant differences in overall AVQI scores were found between pre and post-tests for all types of laryngeal hydration treatment. However, there was a significant increase in CPPs and the LTAS slope for combined hydration and a decrease in HNR with an increase in shimmer local for systemic hydration in the post-test compared to the pre-test. Only systemic hydration in the post-test showed a rise in PPE and PVT compared to the pre-test, compared to surface and combined hydration. ConclusionVoice outcome measures of the present study demonstrated the immediate beneficial effects of surface hydration and combined hydration in SLPs by preserving voice quality during vocal loading. Systemic hydration had less of an immediate impact on voice quality. This study suggests empirical evidence for laryngeal hydration, which can enhance vocal performance and preserve voice quality in SLPs.

Item Hierarchy of Vocal Fatigue Index (VFI) in School Teachers—A Study from South India

AimThe study aimed to identify the item hierarchy of the Vocal Fatigue Index (VFI) in school teachers using Mokken Scaling Analysis (MSA). MethodA total of 362 school teachers from five zones in Chennai city, southern part of India, participated in the study. All subjects completed a subject information form that had details such as age, sex, duration of vocal demand per day, number of classes taken, grades taught, and years of experience and VFI. Based on the VFI factor I scores, teachers were segregated into three groups, viz., No fatigue (NF; <11), Low Fatigue (LF; 11-24), High Fatigue (HF; >24). Percentage analysis, Mann Whitney U, Pearson’s chi square was done for finding the association of variables (listed above) with vocal fatigue and MSA. ResultsTwo-hundred and seventy-five teachers (75.5%) identified themselves with vocal fatigue, and 87 (24%) others reported no vocal fatigue. The highest percentage of fatigue (63.18%) was documented in factor II, followed by factor III (48.90%), and factor I (40.38%). Mann Whitney U test revealed a significant difference in vocal fatigue experience between males and females (p=0.01). Pearson chi square showed a positive association between factor I and years of experience in teachers (p=0.02). No significant correlation was observed between other variables and factors of VFI. MSA divided the VFI scale into two, scale 1 (factor I & II) and scale 2 (factor III). On segregation, several reliable scales were obtained, however, all the scales had a low Loevinger’s coefficient. Discussion/ConclusionVFI, though a reliable tool, did not capture the underlying trait of vocal fatigue completely in school teachers as a population. This study ascertains the need to develop a tool that is specific to occupation/profession, geographic, socio-cultural, and ethnic group. Mere adaptations and translations of tools may not necessarily suffice for clinical utility and application.

Impact of Cultural-Linguistic Differences on Vocal Fatigue Perception: A Systematic Review and Meta-Analysis.

The perception of a clinical condition or disorder can vary across patients from different cultural-linguistic backgrounds. There is insufficient evidence to inspect this potential impact on the perception of vocal fatigue (VF) as a common condition perceived by patients with voice disorders. In order to more comprehensively explore this phenomenon, a systematic review was carried out to investigate the differences in perceived VF in a variety of cultural-linguistic contexts, based on a standard self-assessment instrument-the Vocal Fatigue Index (VFI), as translated in different languages. A thorough search was done in MEDLINE, CENTRAL, Web of Science, and Google Scholar by March 2024. Cross-sectional studies investigating the accuracy of the VFI to detect perceived VF in all available languages were considered. The VFI has three distinct parts or factors assessing: (a) tiredness of voice, (b) physical discomfort associated with voicing, and (c) improvement of symptoms with rest. The cutoff points and sensitivity and specificity of each factor were submitted to meta-analysis, and the summary receiver operating characteristic curves were used to determine pooled sensitivity and specificity of each factor of the VFI. Eight papers that examined the diagnostic accuracy of the VFI in English, Malayalam, Turkish, German, Mandarin Chinese, Polish, Cantonese, and Finnish languages were identified as being eligible for this meta-analysis. The pooled sensitivity and specificity along with their confidence intervals (CIs) were as follows: 0.91 CI [0.80, 0.96] and 0.88 CI [0.78, 0.94] for Factor 1, 0.83 CI [0.69, 0.91] and 0.84 CI [0.76, 0.89] for Factor 2, and 0.75 CI [0.67, 0.82] and 0.77 CI [0.59, 0.89] for Factor 3. The present research demonstrates medium to high but heterogeneous accuracy of the VFI for detecting perceived VF across cultural-linguistic contexts. Given the promising results, future studies should focus on (a) further investigating the underlying factors for the observed heterogeneity in diagnostic accuracy and (b) adapting and validating the VFI in more languages toward establishing its validity as a cross-linguistic diagnostic tool for the perception of VF. https://doi.org/10.23641/asha.26397106.

Cross-Cultural Adaptation and Validation of the Vocal Fatigue Index (VFI) to Danish

ObjectivesThe aim was to cross-culturally adapt and validate the Vocal Fatigue Index (VFI) to Danish (DK-VFI). Study designCross-sectional design. MethodsThe original American English VFI was cross-culturally adapted to Danish using a forward-backward translation procedure combined with focus group interviews. The DK-VFI was distributed to 26 patients with vocal fatigue and 103 vocally healthy controls. A matched subsample based on age and sex of the control group was included. Internal consistency was determined using Cronbach's alpha and test-retest reliability was determined using Spearman’s Rho as well as Wilcoxon signed-rank tests. Validity was confirmed using the Wilcoxon rank-sum test. Sensitivity and specificity were assessed using the Receiver Operating Characteristics (ROC) test and the discriminative ability was determined using the Area Under the Curve (AUC) test. The original VFI consists of three factors, and cut-off values were calculated for each separate factor in the DK-VFI. ResultsMinor changes were made in the phrasing of specific questions in order to appropriate the VFI to the Danish language. The internal consistency for the DK-VFI was high, with a Cronbach’s alpha of α =0.95. The results showed statistically significant differences (p<0.05) in mean scores of the DK-VFI between patients and controls. The cut-off values between patients and controls for each separate factor were ≥ 11.5 for factor 1, ≥ 2.5 for factor 2 and ≤ 5.5 for factor 3. The results of the AUC analysis showed that the DK-VFI has discriminative abilities of 0.94 for factor 1, 0.92 for factor 2 and 0.82 for factor 3. Analysis of test-retest reliability showed strong reliability for the patient group and acceptable reliability for the control group. ConclusionThe DK-VFI is a valid and reliable tool for identifying symptoms of vocal fatigue and can sensitively discriminate people with vocal fatigue from vocally healthy controls.

Voice Disorder Prevalence and Vocal Health Characteristics in Adolescents

Voice disorders impede communication and detract from quality of life, yet little is known about how voice problems present in adolescents. This study characterized the prevalence of voice problems and vocal health characteristics of adolescents throughout the US. To determine the prevalence of adolescent voice problems in the US as well as the symptoms, voice use patterns, and risk factors associated with these problems. This prospectively performed, cross-sectional survey study conducted from March to June 2023 included a probability sample of adolescents (aged 13-17 years) who were located across the US. Adolescents were surveyed concerning voice use, voice symptoms, demographic information, and substance use patterns. The Vocal Fatigue Index (VFI) was also completed. Fisher exact tests, χ2 tests, and logistic regression were used to compare those with and without reported voice problems. Five-hundred and two adolescents participated (51.6% participation rate), including 248 female (49.4%), 7 nonbinary (1.3%), 254 male (50.6%), 4 transfemale (0.7%), and 3 transmale individuals (0.5%) (mean [SD] age, 15.2 [1.3] years). The lifetime prevalence of voice problems was 24.3%, and current prevalence was 7.4%. Voice-related diagnoses included dysphonia associated with acute illness, vocal hyperfunction, benign lesions, and muscle tension. The mean (SD) VFI score was 4.7 (8.09) for part 1, 1.6 (3.2) for part 2, and 2.1 (3.2) for part 3. Adolescents with voice complaints presented with significantly higher VFI scores than those without voice problems (Cohen d for part 1 = 0.78, part 2 = 0.59, and part 3 = 0.79). Voice problems interfered with daily tasks, prevented participation in extracurricular activities, limited the ability to sing, and were associated with school absences. Voice use patterns associated with voice problems included frequent loud voice use, coughing, and/or throat clearing. Risk factors for increased voice problem prevalence included part-time employment in childcare (odds ratio [OR], 6.4; 95% CI, 1.6-26.3), singing (OR, 2.08; 95% CI, 1.3-3.1), performance-related extracurricular activities (ie, musical theater [OR, 2.67; 95% CI, 1.1-6.6 ], karaoke [OR, 3.08; 95% CI, 1.3-6.9]), vaping (OR, 1.99; 95% CI, 1.1-3.5), and/or secondhand smoke exposure (OR, 1.83; 95% CI, 1.2-2.7). Adolescents identifying as transgender were more than 4 times (OR, 4.44; 95% CI, 0.63-31.2) as likely to report voice problems compared with cisgender adolescents. The results of this survey study illuminate the nature of voice problems in adolescents and may guide clinicians in preventing and treating voice disorders in this population. Future work may define the mechanisms through which these factors are associated with the risk for voice disorders in adolescents and determine whether observed relationships are causal or associative.

Unveiling vocal profiles in adolescent anorexia nervosa: a Software Based, Multiparametric Analysis.

Dysphonia, characterized by disturbances in voice quality and modulation, has been sporadically observed in individuals with Anorexia Nervosa (AN), potentially stemming from both organic and psychopathological factors. This study seeks to employ software-based voice analysis to compare the voices of girls with AN to those of female healthy controls (HC). Case-control study adopting "Praat" software to assess voices. Various parameters, including Acoustic Voice Quality Index (AVQI), Fundamental Frequency (F0), Yanagihara's Spectrographic Dysphonia Classifications, and "GIRBAS" perceptual qualitative voice rating, were investigated. Participants completed questionnaires for Vocal Fatigue Index (VFI) and the Reflux Symptoms Index (RSI). Puberty-related voice spectrum changes were considered, and Bonferroni-corrected BMI-adjusted Analyses of Covariance (ANCOVAs) were conducted. The study enrolled 15 girls with AN and 23 girls with HC. AN patients demonstrated greater impairment in voice tiredness/voice avoidance (VFI-1, p < 0.001), vocal physical discomfort (VIF-2, p = 0.002), and rest as alleviation (VFI-3, p = 0.012). Reflux-related scores were higher in AN (p < 0.001). Differences were observed in voice quality (AVQI) (p = 0.001), and GIRBAS scales showed alterations in multiple parameters. Spectrograms documented more frequent pathological findings in AN patients (p = 0.021). No difference was observed in Fundamental Frequency. These group (AN/HC) differences were independent of weight measures. This study is the first to connect voice irregularities in AN by employing standardized, non-invasive tools and accounting for weight-related factors. Young AN patients demonstrated substantial voice quality changes and heightened self-reported symptoms. Future research should expand on these findings with prospective designs and invasive investigations.

Validity and Reliability of the German Vocal Fatigue Index in Adults With Voice Disorders.

Vocal fatigue-related symptoms, frequent in patients with voice disorders, are reliably quantifiable with the Vocal Fatigue Index (VFI) in several languages. The main aim of this work was to investigate the content and construct validity of the German Vocal Fatigue Index (VFI-D) by comparison with the German Voice Handicap Index 9 international (VHI9i) and the Vocal Tract Discomfort Scale (VTD). Moreover, the scale and retest reliability were investigated. In a prospective cohort study at two tertiary care hospitals, 93 adults with all types of voice complaints filled out the VFI-D, the VHI-9i, and the VTD. Eighty-one adults (Mage = 53.5 years, SD = 15.7) completed them one time, and additional 12 patients (Mage = 53.8 years, SD = 15.6) did a test-retest, completed them twice at an interval of 1 week. The validity was assessed by Spearman's rho and Mokken scaling and the reliability by a factor analysis and a two-tailed t test. Mokken scaling has proven the VFI-D as one-dimensional questionnaire (one cluster, r = .95). All VFI-D items could be assigned to one of three factors according to principal component and principal axis factor analysis. Although Factor 1 related best to the VHI9i (∅ rs = .76) and Factor 2 to the VTD (∅ rs = .74), Factor 3 correlated moderately with the VHI9i (rs = .34) and weakly with the VTD (rs = .25). Results from the first and second VFI-D completion agreed strongly (t = -1.78, p = .10). In this study, the content and construct validity of the VFI-D were confirmed. Also, both scale reliability with identical factors as those in the original study and retest reliability were verified. The VHI9i and VTD were highly indicative of VFI-D Factors 1 and 2, respectively. No correlation between Factor 3 and the other questionnaires was determined. Future research should evaluate which characteristics are specific to vocal fatigue versus general voice disorder-related symptoms.

Platelet Rich plasma injection of the vocal folds in benign vocal pathologies

PurposeThere are few options for treatment of dysphonia secondary to vocal pathology related to lamina propria scar, atrophy, sulcus, or inflammatory disorders. Platelet rich plasma (PRP) may provide anti-inflammatory and regenerative properties seen with other tissue engineering therapies without the risks associated with these treatments. We evaluated vocal fold (VF) injection of PRP for feasibility, phonatory effects, patient satisfaction and durability.MethodsPatients with dysphonia secondary to vocal fold scar, atrophy, sulcus and inflammatory lesions were included. PRP injections were administered in office, to bilateral vocal folds. Patients were followed up at 1 week, 1 month, 3 months and 6 months to assess outcomes (GRBAS scale, maximum phonation time, vocal fatigue index (VFI), voice handicap index (VHI-10) and stroboscopy).Results75 intracordal PRP injections were administered to 48 patients. All injections were completed, and no adverse reactions were experienced. Improvements in VHI-10 scores at 1,3,6 months were seen (mean VHI 21.73 at baseline, 15.62 at six months, p < 0.001). 72.3% rated improvement at 7 or above on Likert scale. 95.7% of patients would consider a future PRP injection. Secondary outcomes VFI, MPT, and GRBAS also demonstrated significant improvements over time. Patients receiving a single PRP injection (n = 26) still demonstrated significant VHI-10 improvements at 1,3 and 6 months.ConclusionsVF office PRP injections are feasible and safe and can provide phonatory benefit and reduce vocal effort in benign VF disorders. A single PRP injection is sufficient to provide sustained benefit in some cases.Level of evidenceLevel III: prospective cohort study.

Screening of voice and vocal tract changes in professional wind instrument players

PurposePlaying wind instruments is a strenuous task on the larynx, predisposing players to voice disorders. This study aims to evaluate potential vocal symptoms and vocal tract alterations in professional wind instrumentalists.MethodsIn this cross-sectional study, 26 male military subjects were interviewed, completed the voice handicap index (VHI) -10 questionnaire, and subjected to auditory-perceptual assessment, neck examination, rigid laryngostroboscopy and flexible nasofiberoscopy both before and during instrument playing.ResultsAll participants had vocal fatigue symptoms, around one-quarter complained of voice change, one-quarter complained of shortness of breath while or after performing, and one-third complained of neck symptoms. The average score of VHI-10 was 16.2 ± 6.5, and approximately three-quarters of participants scored above the cut-off point. There were no significant correlations between age, years of instrument playing, average hours of daily practice, and VHI-10. Participants with neck symptoms had significantly higher VHI-10 scores. Those (around one-fifth) with an external neck swelling during Valsalva maneuver had a significantly higher VHI-10 score. Dysphonia, mainly mild and of strained, leaky quality, was detected in almost one-third of participants. While the instrument was being played, the vocal folds were somewhat adducted, and the vocal tract became more compressed as the task became more demanding. The most frequent observations in the vocal tract examination were hyperemia of the vocal folds or all over the laryngeal and pharyngeal mucosa, excessive secretions over the vocal folds, signs of hyperadduction, arytenoid edema, and phonatory waste.ConclusionWind instrumentalists frequently experience voice disorders, which necessitate further care and investigation.

Effects of Voice Therapy using Semi-Occluded Ventilation Mask and Speech Tasks on Adults with Vocal Fatigue

Objectives: This study aimed to investigate the vocal changes in adults experiencing subjective vocal fatigue through a three-week intervention employing a semi-occluded ventilation mask (SOVM), which is a type of semi-occluded vocal tract exercise (SOVTE), and Korean speech materials. Methods: We implemented a three-week intervention program using an SOVM and a protocol based on Korean speech materials for 22 Korean adults (5 males and 17 females, aged 25.81 ± 7.31 years) reporting subjective vocal fatigue. The SOVM was fabricated by establishing a semi-occluded environment using a silicone plug with a central hole, which was inserted into the front opening of an air-cushion mask, typically used in medical context. Participants were also instructed to perform home training sessions twice a day until the subsequent intervention. The outcomes of multi-dimensional voice evaluations were compared pre- and post-intervention to assess vocal changes. Results: Post-intervention, significant improvements were observed in specific acoustic measurements (jitter percent, shimmer percent, noise-to-harmonic ratio, and cepstral peak prominence of vowel phonation) and the severity indices derived from those acoustic parameters. Additionally, a significant reduction in patient-reported outcome measures was noted following the intervention. Conclusion: The findings suggest that voice intervention using the SOVM and Korean speech materials has the potential to alleviate vocal fatigue and enhance vocal quality in individuals with vocal fatigue complaints.

AIM AND MEANING OF BREATHING EXERCISES: INTERDISCIPLINARY LITERATURE REVIEW

Respiration is an indispensable aspect of life that significantly influences both the physical and mental well-being of individuals, depending on such factors as depth and rhythm. Exploring the distinctions between chest and abdominal breathing is crucial for understanding their profound impacts, and embracing appropriate breathing exercises has proven to be advantageous for short-term relief and long-term holistic health. While acknowledged for diverse therapeutic applications, such as mitigating vocal cord fatigue, a comprehensive exploration of breathing exercises remains essential. Sport scientists and coaches are encouraged to acquire a set of breathing exercises for future implementation in the training routines. This study strives to conduct an interdisciplinary literature review to shed light on the aims, meaning, and classification of breathing exercises. Employing a literature review methodology, were analysed peer-reviewed articles from PubMed and ScienceDirect published during the years from 2000 to 2023, focusing on such keywords as breathing exercises, deep breathing, nasal breathing, abdominal breathing, thoracic breathing, pursed-lip breathing, breathing control, and respiratory muscle training. The research findings illustrate the multifaceted definitions, components, aims, and classifications of breathing exercises. This study establishes a foundation for identifying distinct subtypes, contributing to a more nuanced understanding of the significance and purpose of breathing exercises in enhancing overall well-being.

Effect of Vocal Function Exercises on the Voice Handicap Index, Vocal Fatigue Index, and Number of Vocal Fatigue Symptoms in Bank Workers: Single-Blinded Randomized Controlled Trial.

Vocal fatigue (VF) is a significant portion of occupational voice disorders. Researchers have proposed numerous therapeutic approaches to alleviate VF. However, the efficacy of vocal function exercises (VFEs) as a safe, effective, and simple method is unclear. The current study aims to investigate the effect of VFEs on occupational-related VF in Iranian bank workers. A single-blinded randomized controlled trial with four-level blocking After screening 444 workers, 43 persons with vocal fatigue (VF) were allocated between intervention and control groups. The gender of participants was considered a confounding parameter. Intervention group participants (IGP) (20 males and two females) practiced vocal function exercises (VFEs) (online training) for two weeks, while control group participants (CGP) (20 males and a female) continued their routine lifestyle. The Number of Vocal Fatigue Symptoms (NoVFS), Maximum Phonation Time (MPT), Voice Handicap Index (VHI), and Vocal Fatigue Index (VFI) at pre-intervention and post-intervention levels were gathered and compared. According to the intergroup, pre-/post-intervention differences, and intragroup analysis, the IGP experienced a significant reduction in the NoVFS (P = 0.006, P = 0.009), the mean score VHI (P:0.006, P: 0.001, P: 0.001), the total mean score of VFI (P < 0.001, P < 0.001, P < 0.001), and the first (P = 0.005, P = 0.002, P < 0.001) and second (P = 0.006, P < 0.001) factors' mean score of VFI. Additionally, there was an improvement in the MPT (P < 0.001, P < 0.001, P < 0.001) and the third factor (P = 0.01, P = 0.004, P = 0.021) mean score of VFI. Vocal function exercises can alleviate symptoms, voice handicaps, tiredness, avoidance, and physical discomfort of vocal fatigue in bank workers. Additionally, it can improve glottal (pulmonary) sufficiency and rest recovery of vocal fatigue in this group of workers.

Vocal Fatigue and Its Relationship with Vocal Hygiene and Work-Related Factors in Professional and Nonprofessional Voice Users: A Multiple Linear Regression Model Study

To investigate vocal fatigue severity between professional voice users (PVUs) and nonprofessional voice users (NPVUs), and across different levels of voice users. Also to examine the relationship between vocal hygiene and work-related factors with vocal fatigue. This is a cross-sectional descriptive study. Four hundred one individuals from different professions were included in total. Participants were divided into four levels of voice users by classification of Koufman and Isaacson. The top three levels of voice users further identified as PVU, and level 4 voice users identified as NPVU. An online questionnaire which included vocal hygiene checklist, work-related factors, and Turkish version of vocal fatigue index (VFI) was submitted by the participants. Vocal fatigue severity of PVUs were found higher than NPVUs in all VFI scores (P<0.05). Level 2 voice users were found to have more vocal fatigue severity than all other levels of voice users. Call center workers (CCWs) had the highest means of vocal fatigue severity. Based on the multiple linear regression model vocal hygiene and the number of vocal rest breaks were found to have related with vocal fatigue the most (P<0.05). There was also a relation with some VFI scores (P<0.05) with voice usage duration at work and vocal rest duration. We found no relationship between working experience and vocal fatigue. The data suggests the relation between vocal fatigue and vocal hygiene, and work-related factors explain a small proportion of the association. However, in CCWs r2 was found 0.44. The change in vocal fatigue severity did not match with Koufman and Isaacson's classification of voice users. We suggest that there may be other contributing factors to vocal fatigue than vocal hygiene, vocal rest, and voice usage duration even those factors may differ from profession to profession.

Effectiveness of a Voice Training Program for Religious Officials in Turkey.

This study examines the effectiveness of a voice training program designed for Islamic religious officials, who are occupational voice users with a significant vocal load. The participants included 34 healthy religious officials whose acoustic measures were within normal voice ranges for healthy adults (jitter < 1%; shimmer < 3%) and reported no voice complaints. Participants were randomly divided into two groups (experimental, n = 17; control, n = 17). The two-stage voice training program consisted of 32 sessions over 8 weeks with informative and voice exercise stages. Objective and subjective voice measurements were performed at the beginning and end of the research. Objective measurements included fundamental frequency, percentage of vocal pitch perturbation (jitter), percentage of vocal intensity perturbation (shimmer), and harmonics-to-noise ratio. Subjective voice measurements included the Singing Voice Handicap Index, Vocal Fatigue Index (VFI), and Voice-Related Quality of Life (V-RQoL) scores. All initial measurements other than VFI scores were within acceptable limits for both groups. There were no significant differences between the groups initially (p > 0.05) and no significant changes in the control group in the second evaluation (p > 0.05). However, there was significant improvement in the experimental group after the training program in all measures, including VFI scores (p < 0.05). This study shows the positive results of a voice training program. Voice training should be integrated into the formal education of occupational voice users or in-service training programs of relevant institutions.

A CASE REPORT ON THE MANAGEMENT OF SULCUS VOCALIS WITH REFER-ENCE TO SWARASADA

1Sulcus vocalis is a condition characterized by a groove or infolding of the mucosa along the surface of the vocal fold, disrupting the normal physiology of vocal fold vibration and impacting voice production. Common symptoms include hoarseness, vocal fatigue, voice weakness, and increased effort, particularly concerning working professionals who rely on speech for communication and quality of life. While treatment options like phono surgery and speech therapy exist, phono surgery often yields disappointing results, typically limited to increased voice loudness. In Ayurveda, this condition aligns with Swarasada, attributed to factors such as 2Athyucha bhasana(loud speaking) and abhighata(trauma), leading to dosha invasion in sabdhavahi siras and causing speech difficulties. Presented here is a case report involving a 33-year-old IT professional experiencing hoarseness, vocal fatigue, and weakness. Upon bronchoscopy, the diagnosis initially indicated muscle tension dysphonia, later revealing bilateral sulcus vocalis with GERD. The patient underwent Nasya, Gandusha, and Sneha Sweda procedures alongside internal medication. Following a one-month review, the patient exhibited marked improvement in voice clarity. Notably, modern treatments provided only temporary relief. This case report underscores the effective management of sulcus vocalis through Panchakarma treatments and internal medications, showcasing consistent relief over a three-month review period.

Effect of vocal loading on voice parameters in trainee actors

Introduction: Prolonged use of voice or vocal load can be a risk factor for individuals and can end up in vocal fatigue and dysphonia. Vocal loading can alter tissue structure and affect the voice quality forever. An obvious factor to be considered is the vocal use by a professional voice user. Actors are a group of professionals who can be affected by the long-term use of voice. There is a higher prevalence of inflammatory lesion in acting students and they were found to have poor vocal hygiene habits; which shows that these future elite vocal performers are at risk for developing a voice disorder. Aim: To study the objective and subjective changes in voice characteristics post vocal loading task in trainee actors. Method: A total 37 trainee actors (14 females and 23 males) participated in the study. The age range of the participants were 20 – 39 years and the range of the training period was 6 – 12 months. The participants were instructed to read a passage for 30 – 45 minutes at a loudness level of 70 – 80 dB SPL. Individuals with perceptually normal voice in terms of pitch and intensity and with a score less than 1 in GRBASI (Grade, Roughness, Breathiness, Asthenia, Strain, Instability) rating scale were included in the study. Acoustic, and perceptual evaluation were measured immediately before and after vocal loading task. Acoustic analysis was done using MDVP, whereas The Auditory Perceptual Rating Scale and GRABASI rating scale were used for perceptual analysis. Self-rating of the voice after vocal loading task was measured after the vocal loading task using Vocal Fatigue Index.1 Results and conclusion: The results revealed a significant difference in perceptual parameters post vocal loading task. The f0, jitter and HNR (Harmonic to Noise Ratio) showed a significant increase in the values after the vocal loading task. However, shimmer and RAP (Relative Amplitude Perturbation) did not show significant difference in the values post vocal loading task. The self-rating of the voice after the vocal loading task revealed that 54% of the trainee actors did not perceive vocal fatigue. The study hence shows significant effects of vocal loading in perceptual and acoustic analysis whereas the self-rating shows less perception of vocal changes in training actors. The acoustic, perceptual and self-rating of the voice quality before and after vocal loading task can aid in effective training and management of the trainee actors. However, the actors themselves are not equipped to measure the voice changes acoustically or perceptually and would take much longer time to perceive changes in their voice quality. Therefore, it is important to give a vocal hygiene programme in the preventive stage, that is, in the training period.

CPAP Treatment Improves Quality of Life and Self-perception of Voice Impairment in Patients with OSA

The purpose of this study is to examine vocal fatigue and impairment, gastroesophageal symptoms, dysphagia risk, and sleep-related quality of life in individuals with obstructive sleep apnea (OSA) who have been treated with continuous positive airway pressure (CPAP) compared to those who have not received treatment. Fifty-four participants diagnosed with OSA completed an online research form. Of these, 29 were receiving CPAP treatment, while 25 were not undergoing treatment. The following instruments were used: Vocal Fatigue Index, Voice Handicap Index, Gastroesophageal symptoms, Eating Assessment Tool, and Quebec Sleep Questionnaire. The group that received CPAP treatment had significantly lower scores in the functional domain and total Voice Handicap Index. They also experienced fewer symptoms of regurgitation, reduced daytime sleepiness, fewer nocturnal symptoms, and better emotional and social interactions in their quality of life compared to the untreated group. There were no significant differences in voice fatigue and dysphagia risk between the groups. Individuals treated with CPAP experience reduced vocal impairment, fewer regurgitation symptoms, and improvement in the emotional and social interactions domains of their quality of life compared to individuals without treatment.

Presentation of the ATLETAS DA VOZ™ Conditioning Program

Objectives. To present a simple form of vocal and breathing conditioning for voice professionals based on concepts from vocal science. The vocal conditioning program called Voice Athletes Conditioning uses the principles of exercise physiology to gradually improve vocal and respiratory overload to achieve endurance, power, and flexibility. Methods. Due to our personal experience with high voice users, we synthesized a vocal conditioning program (AVCP) that combines voice science, exercise physiology, sports science and physical therapy principles. This is an 8-week program of daily vocal and breathing exercises with overload enhancement each week using different types of breathing devices and semi-occluded vocal tract exercises, designed and developed according to the specific requirements and performance of the voice professional. Reflections. Professional voice users often experience episodes of vocal fatigue that can directly affect their performance and vocal health. As with physical training for athletes, voice exercises can also contribute to improving vocal conditioning, preventing voice disorders, as well as helping to obtain better performance, greater tolerance to fatigue and shorter recovery time. Conclusions. AVCP is an approach that considers the principles of muscle training aimed objectively at the respiratory and vocal muscles, carried out with a variety of breathing devices and specific vocal exercises in search of greater performance time, less physiological stress, and shorter recovery time in the professional use of the voice.