Vocal Health Research Articles

Principal dimensions of laryngeal vocal control in a computational model of voice production

Voice production is constrained by laryngeal physiology and physics. Such constraints may present themselves as principal dimensions that are shared among speakers in how they produce and perceive voice. In this study, we attempt to identify such principal dimensions in voice outcome measures and the underlying laryngeal control mechanisms in a three-dimensional computational model of voice production. A large-scale voice simulation was performed with parametric variations in vocal fold geometry, stiffness, glottal gap, and subglottal pressure. Principal component analysis was applied to data combining both the laryngeal control parameters and acoustic and aerodynamic voice outcome measures. The results showed two dominant dimensions of vocal control. The first dimension describes interaction between respiration and vocal fold adduction in a way that increases glottal flow amplitude and vocal intensity at the cost of decreasing high-frequency harmonic production. The second dimension mainly describes control of medial surface thickness and glottal closure, which allows simultaneous increase in vocal intensity and high-frequency harmonic production but also increases risk of vocal fold injury. A third dimension with a reduced weight describes control of the fundamental frequency. The importance of these principal control dimensions to vocal expression of emotion and vocal health is discussed.

A Conversation with Michele Pawk

Abstract: In a video interview with Journal of Singing Associate Editor Melissa Treinkman on May 26, 2023, Tony-award winner Michele Pawk discussed her versatile career as a performer and teacher. She revealed a period in her life when she struggled with vocal health issues, described her unexpected joy in teaching, and expressed her delight in working alongside her husband, actor and singer John Dossett, in the Broadway cast of Wicked . A QR code is included at the end of the article which contains the link to the recorded interview with Michele Pawk.

Voice Disorders Among Teachers in Taif City, Kingdom of Saudi Arabia.

Background Voice disorders (VD) pose significant challenges for teachers as they impact their professional and personal lives. Teaching requires extensive use of the voice, making teachers particularly susceptible to vocal health issues.VD can hinder the quality of education. Objectives This study aimed to comprehensively explore the prevalence, associated factors, and impact of VD among teachers and their health-seeking behavior regarding VD. Methodology A cross-sectional observational study was conducted in Taif City, Kingdom of Saudi Arabia (KSA), between November and December 2023. The data were collected through a questionnaire covering demographic variables, occupational factors, voice-related symptoms, associated health conditions, and the impact of VD. The statistical analysis was performed using SPSS Statistics version 26 (IBM Corp. Released 2019. IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY: IBM Corp.), and chi-squared tests were used to assess associations. Results The study involved 568 teachers, 61.8% of whom had VD. The study identified significant associations between VD and demographic characteristics, habits, and teaching-related variables. Age, gender, teaching subject, class size, and weekly teaching load were associated with the prevalence of VD. Hoarseness, throat pain, and throat dryness were prevalent symptoms among teachers with VD. The impact of VD on teachers was evident, with a considerable proportion reporting work absenteeism (28.7%) and even contemplating retirement due to voice problems (6.3%). Conclusion This study offers a nuanced understanding of VD among teachers in the Taif region, emphasizing the complex interplay of demographic, symptomatic, and behavioral factors. The findings underscore the need for targeted interventions, including awareness campaigns, preventive strategies, and streamlined healthcare access, to address the unique challenges that different subgroups of teachers face. Future research should further explore longitudinal trajectories and objective measures to enhance our understanding of VD in educational settings.

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.

Special Education Teachers’ Self-Assessed Voice Health Regarding Voice Use Habits

ObjectivesSpecial education teachers (SETs) work with students with disabilities. To get and keep these students' attention during the lesson, they may use their voices with high loudness and frequent pitch changes. These situations can be tiring for their voices and affect their vocal health. This study aimed to compare SETs' voice fatigue, reflux symptoms, and self-assessments according to their voice use habits in their work and social lives. MethodsA total of 208 SETs were included. A Teacher Voice Use Habits Questionnaire was developed by considering the literature, taking expert opinion, and conducting a pilot study. In addition, the Vocal Fatigue Index (VFI), Voice Handicap Index-30 (VHI-30), and Reflux Symptom Index (RSI) were used. One-way ANOVA, Mann-Whitney U, Kruskal Wallis-H, and Pearson correlation analyses were performed. ResultsOf SETs, 37.5% reported frequent hoarseness, and 65.4% reported voice fatigue during/at the end of the day. Those who answered "yes" to the questions about talking loudly at home, having the television on at home, feeling stressed in the work environment, eating and drinking before going to bed at night, smoking, having frequent colds, talking loudly during the day, and voice fatigue during/at the end of the day had significantly higher scores in all scales. Those who used their voice for more than six hours were found to have significantly higher scores on the VFI and RSI. In all scales, the scores of those who made very frequent long phone calls were significantly higher. ConclusionAccording to the SETs' reports, it was concluded that they did not comply with the rules of vocal hygiene, although they used their voices for a long time. This situation should be considered an occupational health problem in schools, and it may be helpful to screen this group's voice disorders and design preventive programs.

O que cantores amadores que se apresentam em cultos religiosos conhecem sobre saúde e higiene vocal?

ABSTRACT Purpose To describe the knowledge of amateur singers who perform in religious services, about vocal health and hygiene, and compare these findings at two different moments. Methods Descriptive, longitudinal research with 100 participants who practice amateur singing in religious services; ages between 18 and 82 years (average 33.72 years), 54 women and 46 men. Participants answered the Initial Questionnaire (Q1), which includes personal data and vocal self-assessment, and the Vocal Health and Hygiene Questionnaire (QSHV), on two occasions with an interval of 20 days and with the questions randomized. The participants were given a feed-back of the QSHV after each application i.e. the correct answers to each item. The data were analyzed descriptively and inferentially. Results Most singers reported some degree of self-assessed vocal alteration and reported at least one vocal symptom (mainly throat clearing and voice failure). The score was higher in the second application of the QSHV and there was no correlation between the vocal self-assessment and the score obtained in the QSHV. Conclusion Amateur singers of both sexes who perform in religious services demonstrated knowledge about vocal health and hygiene corresponding to that of vocally healthy individuals, above the cutoff point in both applications; however, the majority reported vocal changes and symptoms. There was an increase in knowledge about vocal health and hygiene in the second application, however discreet. The level of knowledge about vocal health and hygiene did not correlate with the degree of vocal alteration.

An Evaluation of Quality, Reliability, and Accuracy of Vocal Health Content on TikTok

Social media plays an ever-growing part in modern life and is a frequent source of health information for patients. Singers are particularly likely to receive health information solely from fellow musicians and may experience barriers to seeking vocal healthcare. However, there have been no studies to date evaluating vocal health information on social media. Our study aimed to assess the quality, reliability, and accuracy of vocal health content on TikTok. Cross-sectional analysis. Three searches were carried out on Tiktok, using the terms "vocal health," "vocal injury," and "voice tips." The top 50 videos in each category were cataloged for extraction of data and for analysis on three discrete scales. Two independent reviewers rated each video using the Global Quality Scale (GQS), modified DISCERN scale, and Accuracy in Digital-health Instrument (ANDI). After the removal of duplicates and unavailable content, 146 videos were analyzed. The mean (range) length was 59.8seconds (5-239), and number of views per video was 886,265 (432-36,700,000). The vast majority of videos (94.5%) were created by non-clinicians; only two videos (1.37%) were posted by otolaryngologists. The mean (SD) GQS score was 2.34 (0.75) out of a maximum of five, the DISCERN score was 0.97 (0.56) out of five, and the ANDI score was 2.85 (0.87) out of four. Video length was positively correlated with GQS and DISCERN scores, but views, likes, and shares were either not associated or negatively associated with GQS, DISCERN, and ANDI. Most videos were of low quality and reliability and moderate accuracy. Measures of popularity were either uncorrelated or negatively correlated with quality, reliability, and accuracy, suggesting that TikTok users are more likely to engage with lower-quality content online. This implies a potential role for vocal health professionals to fill a crucial gap with reliable information on social media.

Health actions and occupational vocal conservation: how are they being implemented?

The actions in Occupational Speech Therapy are becoming more evident with the emergence of new experiences and interventions that aim to intercept the disease process, emphasizing the prevention and protection of vocal health in the occupational context. This work aims to analyze how health and occupational vocal conservation actions are being implemented. This is an integrative literature review, whose survey was carried out from June to October 2020, in the Capes Periódicos platform, using the descriptors "worker's health" and voice. After applying the defined exclusion and inclusion criteria and subtraction of repeated publications, a total of 16 articles were selected. The teacher's voice has been a priority object in Brazilian speech therapy research in recent years. The results presented show the importance of health promotion actions that aim at the well-being of workers as a whole, in an integral and multidisciplinary way. Occupational vocal health and conservation actions encompass activities related to vocal health surveillance and risk conditions for the development of voice disorders, vocal health education, direct vocal interventions, voice assessment, laryngological assessment, referrals and assessment of workers' perception of the proposed actions.

Vocal Fatigue Experiences and Mitigation Strategies in the Sacred Harp Singing Community

Sacred Harp singers sing at a high volume for sustained periods of time without collective warm-up or cool-down exercises, ostensibly putting them at elevated risk for vocal fatigue (VF) and associated vocal pathologies. Participants are also likely to lack formal vocal training. The purpose of this study was to (1) assess singers' experiences with VF, (2) document singers' strategies for mitigating VF, and (3) determine whether vocal training was associated with decreased vocal difficulties. Self-reporting via online questionnaire containing quantitative and qualitative items. This study employed an online questionnaire that combined demographic items, open-ended questions, and the Evaluation of the Ability to Sing Easily (EASE). Participants were recruited at one in-person event and via social media and a mailing list. This study returned 134 valid responses. Singers with formal choral experience scored lower on the EASE and two subscales, but length of experience had no impact. There were no correlations between vocal training and EASE scores. Women scored higher on the EASE than men and nonbinary individuals, while age, length of experience with Sacred Harp singing, and frequency of attendance at annual singing events were all negatively correlated with EASE score. Singers reported a wide range of mitigation strategies, most of which are unique to the Sacred Harp context. Sacred Harp singers do not appear to struggle more with VF than other populations of singers. However, a few characteristics of their practice put them at risk, and many singers would benefit from professional guidance concerning vocal health.

What do amateur singers who perform in religious services know about vocal health and hygiene?

RESUMO Objetivo Descrever o conhecimento de cantores amadores que se apresentam em cultos religiosos sobre saúde e higiene vocal e comparar esses achados em dois momentos distintos. Métodos Pesquisa descritiva, longitudinal, com 100 participantes que praticavam canto amador em cultos religiosos; idades entre 18 e 82 anos (média 33,72 anos), 54 mulheres e 46 homens. Os participantes responderam ao Questionário Inicial, que inclui dados pessoais e autoavaliação vocal, e ao Questionário de Saúde e Higiene Vocal, este em dois momentos, com intervalo de 20 dias e com as questões aleatorizadas. Foi dada devolutiva desse questionário após cada aplicação, por meio da apresentação das respostas corretas de cada um de seus itens. Os dados foram analisados de forma descritiva e inferencial. Resultados A maior parte dos cantores referiu algum grau de alteração vocal e relatou ao menos um sintoma vocal (principalmente pigarro e falha na voz). A pontuação foi maior na segunda aplicação do questionário e não houve correlação entre a autoavaliação vocal e a pontuação obtida. Conclusão Cantores amadores de ambos os gêneros que se apresentam em cultos religiosos demonstraram conhecimento sobre saúde e higiene vocal correspondente ao de indivíduos vocalmente saudáveis, acima do ponto de corte em ambas as aplicações do Questionário de Saúde e Higiene Vocal. Contudo, a maioria referiu alterações e sintomas vocais. Verificou-se aumento do conhecimento sobre saúde e higiene vocal na segunda aplicação, ainda que discreto. O nível de conhecimento sobre saúde e higiene vocal não se correlacionou com o grau de alteração vocal.

Vocal Self-Perception of Singers During COVID-19 Pandemic.

to compare the self-perception of vocal fatigue and use of singing voice during the COVID-19 pandemic between professional and amateur singers and to relate this self-perception with vocal use characteristics during this period. Participants were 121 singers divided into professional singers group (PSG) (12 men and 20 women) comprising singers who depended exclusively on singing as a profession and an amateur singers group (ASG) (37 men and 52 women) of singers who did not depend exclusively on singing for their livelihood. All answered online questionnaires through Google Forms ®. Sociodemographic and vocal characteristics were investigated before and during the pandemic; symptoms of vocal fatigue were assessed through the vocal fatigue index (VFI); and self-perception of use of singing voice through the evaluation of the ability to sing easily protocol for Brazil (EASE-Br). In the comparison between groups, the PSG presented higher scores of vocal fatigue in fatigue and vocal limitation (P=0.045), vocal restriction (P=0.002), and recovery with vocal rest (P=0.008) domains than did the ASG. There was no difference between the groups regarding the use of singing voice. Based on the relationship between self-perception and vocal use characteristics during the pandemic, it was observed that the presence of vocal complaint was the only factor associated with self-perception of fatigue symptomatology in both groups. Regarding the self-perception of the current status of the singing voice, singing time, the presence of vocal complaints, the need to increase visual concentration, and the perception of vocal worsening during the pandemic were considered predictive for amateur singers. For professional singers, vocal complaints and vocal training were predictors for self-perception of the current status of the singing voice. Professional singers presented with higher scores of vocal fatigue than did amateur singers. The symptomatology of vocal fatigue was associated with the presence of vocal complaints in both groups. However, self-perception of the current status of the singing voice was different between the groups and was associated with vocal training for professional singers and characteristics of vocal demand of singing voice during the pandemic period for amateur singers.

Autopercepção da voz e conhecimento em saúde e higiene vocal de líderes religiosos do Candomblé no Brasil

ABSTRACT Purpose To verify possible complaints, voice and aerodigestive symptoms, singing voice handicap, and knowledge of vocal health and hygiene in Candomblé religious leaders in Brazil. Methods The study comprised 112 individuals who filled out a questionnaire with their identification and characterization, the stratified classification of their professional activities, and their self-perception of voice. Three self-assessment protocols - VoiSS, QSHV, and MSHI - were also used. Results The self-assessment of voice ranged from average to good. VoiSS mean total score was 23.04, which is above the cutoff. QSHV mean score was 23.54 points, which is near the cutoff. MSHI mean score (the perception of singing voice handicap) was 25.66 points. There was a substantially strong positive correlation between VoiSS and MSHI total scores (0.789; p<0.001). Women had higher limitation scores (p=0.012) and total scores (p=0.012) in VoiSS and higher handicap scores (p=0.038) in MSHI. Level I professionals - vocal elite (singers and actors) - had significantly higher QSHV scores than those in levels IV (p=0.010) and V (p=0.008). Most respondents had not visited an otorhinolaryngologist (89.29%) within the last year and had not been submitted to speech therapy (83.04%) for voice complaints. Conclusion Candomblé leaders, particularly women, perceived voice symptoms and singing voice handicaps, with no relationship with their knowledge of vocal health and hygiene. Despite the complaints, most subjects reported not having visited health professionals responsible for voice care within the last year.

Propostas de promoção da saúde e prevenção de distúrbios vocais para profissionais da voz: revisão de escopo

ABSTRACT Purpose: to characterize the actions of vocal health promotion and/or prevention of vocal disorders applied to voice professionals. Methods: a scoping review following the PRISMA-ScR guidelines in SciELO and PubMed databases was conducted. Articles that had as participants voice professionals without concomitant vocal treatment, that described proposals for health promotion or vocal disorders prevention, published between 2010 and 2023, were included. They were grouped into categories and data were presented descriptively. Literature Review: eighteen articles with artistic and non-artistic voice professionals, mostly teachers, were included. Most of the studies focused on healthy voices, aiming at primary prevention. Many articles presented guidance on vocal hygiene and health and used resources such as vocal enhancement, voice workshop, voice amplifiers and apps. All the articles positively mentioned their results, especially with regard to self-perception in relation to voice, vocal quality and quality of life, awareness of positive and harmful practices to the voice. Conclusion: the proposals contemplated different levels of prevention, but most focused on primary prevention, including vocally healthy participants; all articles indicated positive results in voice self-perception, voice quality and quality of life, and awareness of positive and harmful voice practices.

Psychometric Properties of the Vocal Fatigue Handicap Questionnaire in Kannada Among Teachers

As the literature review suggests, most professional voice users, such as teachers and singers, are prone to vocal abuse or misuse and frequently experience vocal fatigue. Therefore, validating the Vocal Fatigue Handicap Questionnaire among professional voice users with and without the symptoms of vocal fatigue might provide appropriate external validity of the questionnaire. The objective of the study was to validate the Kannada version of the Vocal Fatigue Handicap Questionnaire (VFHQ-K) among a cohort of Kannada-speaking primary and secondary school teachers with and without self-reported vocal fatigue symptoms. This was a validation study. The study consisted of two groups of participants. Group 1 included 40 teachers with self-reported vocal fatigue symptoms, and Group 2 included 57 teachers without self-reported vocal fatigue symptoms. The VFHQ-K was administered to each participant after obtaining informed consent. The questionnaire was again readministered between 1 and 2weeks to assess the test-retest reliability. All the responses that were obtained were tabulated for analysis. The VFHQ-K demonstrated good test-retest reliability, internal consistency, and acceptable discriminant validity. The cutoff value of VFHQ-K obtained in the present study between the teachers with and without self-reported symptoms of vocal fatigue was much less than the cutoff values reported by the earlier version of VFHQ-K. The VFHQ-K can be a helpful tool in the early identification of teachers with vocal fatigue and in improving the vocal health of professional voice users.

Self-perception of voice and knowledge of vocal health and hygiene in Candomblé religious leaders in Brazil.

To verify possible complaints, voice and aerodigestive symptoms, singing voice handicap, and knowledge of vocal health and hygiene in Candomblé religious leaders in Brazil. The study comprised 112 individuals who filled out a questionnaire with their identification and characterization, the stratified classification of their professional activities, and their self-perception of voice. Three self-assessment protocols - VoiSS, QSHV, and MSHI - were also used. The self-assessment of voice ranged from average to good. VoiSS mean total score was 23.04, which is above the cutoff. QSHV mean score was 23.54 points, which is near the cutoff. MSHI mean score (the perception of singing voice handicap) was 25.66 points. There was a substantially strong positive correlation between VoiSS and MSHI total scores (0.789; p<0.001). Women had higher limitation scores (p=0.012) and total scores (p=0.012) in VoiSS and higher handicap scores (p=0.038) in MSHI. Level I professionals - vocal elite (singers and actors) - had significantly higher QSHV scores than those in levels IV (p=0.010) and V (p=0.008). Most respondents had not visited an otorhinolaryngologist (89.29%) within the last year and had not been submitted to speech therapy (83.04%) for voice complaints. Candomblé leaders, particularly women, perceived voice symptoms and singing voice handicaps, with no relationship with their knowledge of vocal health and hygiene. Despite the complaints, most subjects reported not having visited health professionals responsible for voice care within the last year.

Prevalence of Voice Disorders among University Teachers

Background: Voice disorders pose a significant occupational hazard for individuals in voice-demanding professions, notably university professors. The complexity and frequency of these disorders highlight the need for a deeper understanding of their prevalence, severity, and the impact on affected individuals. Objective: This study aimed to investigate the prevalence and severity of voice disorders among university professors, examining the differences in occurrence between genders and identifying potential risk factors contributing to these conditions. Methods: Employing an observational cross-sectional study design, data were collected from a sample of 390 university professors from various institutions. Participants were assessed for voice disorders using a comprehensive voice handicap questionnaire. The severity of voice disorders was categorized into mild, moderate, and severe based on self-reported symptoms. Statistical analysis was conducted using SPSS version 26 to analyze demographic information, with percentages calculated for qualitative data and mean and standard deviation for quantitative data. Results: The study found that 57.7% of participants experienced mild voice disorders, 22.8% moderate, and 19.5% severe, indicating a significant prevalence of voice issues among university professors. Gender analysis revealed that males exhibited a higher prevalence (58.5%) compared to females (41.5%), yet females reported greater severity in their conditions. Additionally, age-related differences suggested younger professors were more susceptible to voice disorders. Conclusion: Voice disorders are notably prevalent among university professors, with significant variations in severity observed between genders. These findings underscore the importance of implementing preventive measures and vocal hygiene programs tailored to the needs of those in voice-intensive occupations. Addressing these issues is vital for maintaining vocal health and ensuring the longevity of professionals' careers in education.

Impact of a Three-Week Workplace Vocal Health Promotion Program on a Teacher and Students' Voice Parameters

Objective. To determine the effect on voice parameters in pupils and their teacher of a three-week Workplace Vocal Health Promotion Program (WVHPP) in a school setting. Methods. Longitudinal study with a design phase and a pilot phase. Voice recordings of connected speech were used to collect information on voice functioning before and after the implementation of the program. The workplace vocal health promotion program was implemented with two purposes: (1) to reduce noisy conditions inside the classrooms that may cause loud voice production, which has been found associated with voice disorders among teachers and students and (2) to increase awareness about the relationship between noise and voice inside the classrooms. Results. The WVHPP was found to be statistically associated with a decrease in the fundamental frequency, standard deviation of the fundamental frequency, sound pressure levels, and SPL standard deviation among both pupils and their teacher. However, there was no statistically significant effect on cepstral peak prominence smoothed. Conclusion. The three-week WVHPP was found to have a significant impact on several acoustic parameters, such as the fundamental frequency and sound pressure levels. These findings highlight the potential of the WVHPP as an effective intervention for improving the vocal health of both teachers and students. However, the lack of a significant effect on cepstral peak prominence smoothed suggests that further research is needed to fully understand the impact of the WVHPP on voice quality.

Acoustics and the well-being of children and personnel in early childhood education and care

Studies implementing a multimethod perspective in evaluating the acoustics of early childhood education and care (ECEC) spaces both quantitatively and qualitatively are still scarce. In this study the acoustic environments (noise levels and reverberation times) of seven Finnish ECEC group’s premises were examined in association with personnel’s (N = 22) and children’s (N = 71) well-being. Personnel’s well-being and vocal health and children’s well-being were assessed with questionnaires. The findings were further elaborated by documentation of the ECEC spaces and semi-structured interviews with the ECEC personnel detailing their views on the acoustic environment of the daycare buildings and how and if the acoustics should be improved. The results showed that noise exceeding 70 dB affected personnel’s vocal health negatively, whereas no associations were found regarding acoustics and children’s or personnel’s well-being. Based on the interviews, sound spreading, poor insulation, and hard surfaces add to negative experiences of noisiness. ECEC groups need spaces that can be closed and acoustically separated from each other and from other groups. The possibility to close a space supports the perceived well-being of the users and provides a more varied and individualized use of the spaces.

The impact of a speaker's voice quality on auditory perception and cognition: a behavioral and subjective approach.

Our voice is key for conveying information and knowledge to others during verbal communication. However, those who heavily depend on their voice, such as teachers and university professors, often develop voice problems, signaled by hoarseness. The aim of this study was to investigate the effect of hoarseness on listeners' memory for auditory-verbal information, listening effort, and listening impression. Forty-eight normally hearing adults performed two memory tasks that were auditorily presented in varied voice quality (typical vs. hoarse). The tasks were Heard Text Recall, as part of a dual-task paradigm, and auditory Verbal Serial Recall (aVSR). Participants also completed a listening impression questionnaire for both voice qualities. Behavioral measures of memory for auditory-verbal information and listening effort were performance and response time. Subjective measures of listening effort and other aspects of listening impression were questionnaire rating scores. Results showed that, except for the aVSR, behavioral outcomes did not vary with the speaker's voice quality. Regarding the aVSR, we found a significant interaction between voice quality and trial, indicating that participants' recall performance dropped in the beginning of the task in the hoarse-voice condition but not in the typical-voice condition, and then increased again toward the end. Results from the listening impression questionnaire showed that listening to the hoarse voice resulted in significantly increased perceived listening effort, greater annoyance and poorer self-reported performance. These findings suggest that hoarseness can, at least subjectively, compromise effective listening. Vocal health may be particularly important in the educational context, where listening and learning are closely linked.

Evaluating the effect of masks on the vocal health and speech intelligibility of healthcare workers in various hospital unit

The COVID-19 pandemic has enforced mandatory mask usage, particularly in hospitals, and its impact on the vocal problems and speech intelligibility of healthcare workers was examined in this study. A total of 76 healthcare workers from various units, including emergency, inpatient, outpatient, and intensive care, participated in an online questionnaire survey to assess vocal issues experienced while wearing masks. The participants' self-assessed vocal handicaps were quantified using the Vocal Handicap Index (VHI) score. The findings revealed that healthcare workers in emergency units faced the most severe vocal problems, followed by those in outpatient units. The most reported vocal symptoms were clearing the throat and throat dryness. Additionally, noise levels were measured continuously for four hours in each unit, and sources of noise were identified. The measured sound pressure levels (SPL) in emergency, inpatient, outpatient, and intensive care units were 68.64, 63, and 72 dBA, respectively. These values exceeded the World Health Organization's recommended limit of 30-40 dBA, indicating significant discomfort. Lastly, to delve deeper into the increased vocal effort required when wearing masks, the Speech Transmission Index (STI) parameter was analyzed using the recorded SPL as background noise and audio recordings of healthcare workers in different mask-wearing conditions. The study discovered that using a mask considerably reduced speech intelligibility compared to not wearing a mask. Keyword: healthcare workers, vocal problems, noise level, pandemic