Vocal Loading Research Articles

The Therapeutic Effects of Straw Phonation on Vocal Fatigue.

Straw phonation has been investigated for its vocal warm-up effects on healthy populations and therapeutic effects on voice patients. The purpose of this article was to determine whether it is beneficial for vocal fatigue. Prospective cohort study METHODS: Twenty-five healthy participants were recruited into 1-hour vocal loading tasks followed by 10-minute vocal rest or straw phonation on 2 different days. Various parameters including phonation threshold pressure (PTP), mean airflow, closed quotient (CQ), current speaking effort level (EFFT), and laryngeal discomfort (DISC) were acquired at baseline, after vocal load, and after the intervention. Increased PTP, EFFT, and DISC were observed after vocal load. Decreased PTP, EFFT, and DISC were then acquired after both vocal rest or straw phonation. More significant improvements were obtained in straw phonation when compared with vocal rest. Additionally, significantly increased mean flow and decreased CQ were obtained after straw phonation when compared to vocal rest. Straw phonation has the potential to adjust aerodynamics within the vocal tract leading to improved vocal efficiency, optimized vibration mode, and attenuated vocal fatigue. This study provided a promising treatment for vocal fatigue that could have wide clinical relevance to voice users with high voice demands. 4 Laryngoscope, 130:E674-E679, 2020.

Amateur Music Theatre Singers’ Perceptions of their Current Singing Voice Function

The primary aim of this study was to investigate amateur music theatre singers (MTS)' perceptions of their current singing voice function according to evaluation of ability to sing easily (EASE) scores while involved in a musical theatre production, to determine if scores were influenced by demographic or voice-related factors and to compare EASE scores of amateur MTS and previously published professional MTS. Amateur singers were recruited through the Townsville Choral Society during the preproduction of Les Misérables. A total of 51 amateur MTS completed an online questionnaire including the EASE scale and a supplementary demographic questionnaire. Nonparametric statistical analyses were conducted. Three singers reported they had a voice problem at the time they completed the questionnaire. The EASE did not detect significant differences in perceived vocal function among the singers according to demographic (age and gender) and voice-related characteristics. The amateur cohort reported lower current voice-use demands, such as current vocal load and number of shows over past week, than the previously described professional MTS and no significant differences were found between the two cohorts in the median EASE scores. The results of this study supported both the overall validity of the EASE scale and its use with amateur MTS. In addition, the findings suggest the value of future research investigating the potential use of the EASE for broader clinical application with other population groups.

Этиологические факторы нарушения голосовой функции у вокалистов музыкального театра

The analysis of the causes of the pathology of the vocal apparatus in vocalists is carried out. 136 singers were investigated in age from 23 till 70 years old with length of service from 3 till 42 years. It is shown that the occurrence of diseases of the larynx is affected by the state of the vocal apparatus itself, the volume and intensity of the vocal load. Of great importance is the quality of the singer’s vocal training, his age and length of service, the availability of additional work (concert, pedagogical activity), the correspondence of the performed parts to the singer’s technical and acting abilities, domestic and social living conditions. The structure of voice apparatus diseases also depend on type of singer’s voice and his nervous system status. Prevention of impaired voice function in musical theater vocalists should be aimed at eliminating all provoking factors.

Cross-Cultural Adaptation and Validation of the Evaluation of the Ability to Sing Easily (EASE) for Kannada-Speaking Carnatic Classical Singers

The present study aimed to cross-culturally adapt and validate the Evaluation of the Ability to Sing Easily (EASE) into Kannada for the benefit of Carnatic classical singers. Following a standard translation procedure, the original English version was translated to develop a prefinal EASE-K version. This was further field-tested on 12 Carnatic singers to obtain the final EASE-K version. Upon validating the same on 104 Carnatic singers, intercorrelation between EASE-K subscales- Vocal Fatigue (VF) and Pathologic Risk Indicators (PRI) were assessed using the Spearman correlation coefficient. The internal consistency of the subscales was obtained based on the Cronbach's alpha coefficient. Nonparametric tests were carried out to study the effect of age and gender on EASE-K subscales. Further, the raw scores of the English version were compared to the EASE-K. Spearman correlation coefficient indicated a statistically significant positive correlation (P < .01) between the two subscales (r=.745). Each scale showed good internal consistency (Cronbach's alpha was .84). Test-retest reliability carried on 12 singers indicated an excellent reliability for the subscales. Nonparametric tests indicated no significant effect of age and gender on the subscales of EASE-K (P > .05). Comparison across the original and EASE-K revealed significant differences for both VF (P=.02) and PRI (P=.00) subscales. Current findings indicate that EASE-K is a reliable and valid tool that can be used to document the subtle changes in voice in healthy Carnatic classical singers. Further, the current tool can be used to study the effect of vocal loading across different singing styles.

Vocal Tract Discomfort Scale (VTDS) and Voice Symptom Scale (VoiSS) in the Early Identification of Italian Teachers with Voice Disorders.

Introduction The current Italian law does not include any guidance regarding voice education, prevention of voice disorders and screening in subjects with high vocal loading such as teachers. Objectives We aimed to check the correlation between the Vocal Tract Discomfort Scale (VTDS) with the Voice Symptom Scale (VoiSS) for the evaluation of Italian teachers. In addition, we aimed to investigate whether there are differences in the frequency and intensity of discomfort symptoms in teachers with disabilities comparing vocal tract discomfort symptoms in teachers with high risk (HRVD) and low risk (LRVD) of vocal disorders according to the VoiSS cutoff (> 15.5). Methods We analyzed 160 Italian teachers (111 women and 49 men) that completed the VTDS and VoiSS at vocal evaluation. The Spearman correlation test was applied to all variables. The Mann-Whitney U test was used to compare the average number of discomfort symptoms among HRVD and LRVD teachers. Results A moderate positive correlation was observed between the average number, frequency, and intensity of discomfort symptom and the total score, physical domain score, and limitation domain score of the VoiSS. Only the emotional domain score of the VoiSS showed a weak positive correlation ( p < 0.001). Teachers considered in the HRVD group according to the VoiSS score had a higher number, frequency, and intensity of vocal tract discomfort symptoms. Conclusion There is correlation between the VTDS and VoiSS scales. Like the VoiSS, the VTDS is a questionnaire that detects HRVD teachers. Therefore, the results suggest that both questionnaires could be useful for a preventive voice program for Italian teachers

A Preliminary Exploration of Vocal Usage in Prospective Professional Voice Users (PPVUs): Students of the Alimah Course

Students of the Alimah degree are Prospective Professional Voice Users whose career involves teaching, preaching, and conducting religious activities. For them, a cultured and efficient voice is an important prerequisite for a successful career. This study aimed to explore vocal usage and knowledge of voice care among students pursuing the Alimah course. To check the period prevalence of voice problems among the students during the Alimah course, understand communication, and voice usage in daily situations, understand their lifestyle, assess their knowledge about voice and voice care through a self-reporting questionnaire. The data were obtained from 150 undergraduate students pursuing the Alimah degree in and around Nagapattinam and Thanjavur districts of Tamil Nadu, India, through a self-reporting questionnaire. The students pursuing the course were at a high risk for developing voice problems, with a period prevalence of 70%. Excessive vocal load, inappropriate diet, phonotraumatic behaviours and limited knowledge of voice care were found to be the threats to voice problems among the population. This population with a high prevalence rate of voice problems should be studied further. The authors suggest including lessons on vocal enhancement methods and voice care in the course curriculum of the Alimah degree.

Impact of Vocal Hygiene Training on Teachers’ Willingness to Change Vocal Behaviors

There is a high incidence of dysphonia reported in teachers, which has been shown to indicate the teacher's ability to instruct as well as students' ability to comprehend. Factors such as extra vocal load, poor classroom acoustics, and health issues may increase a teacher's risk of acquiring a voice disorder that impacts his or her career. A common approach to treating or preventing voice disorders is the use of vocal hygiene training. Many studies have addressed different types of voice training with mixed results due to lengthy training programs, poor implementation, and other factors related to teacher motivation. The purpose of this study was to determine whether education on vocal hygiene practices would impact teachers' willingness to modify vocal behaviors. A group of 26 teachers from preschool to high school was sent pre- and post-training surveys to determine demographics, daily vocal use, and history of voice issues. The survey also assessed participants' likelihood to modify their behaviors to incorporate vocal hygiene practices into their daily lives. Between the pre- and post-training surveys, teachers received a one-hour training on vocal hygiene practices. This training consisted of basic information regarding the anatomy and physiology of the voice, healthy, and unhealthy vocal behaviors and the impact of phonotrauma behaviors, and positive effects of vocal hygiene techniques. Results showed that the impact of vocal hygiene training on teachers' willingness to incorporate vocally hygienic behaviors was statistically significant (d ≥ 0.80). Increases in study participant perceived desire to engage in vocal hygiene behaviors by virtue of vocal hygiene training was manifested in nearly 90% of the targeted vocal hygiene behaviors. In conclusion, teachers appear to benefit from receiving education on voice use and vocal hygiene techniques and show willingness to incorporate these techniques into their repertoires.

Perceptual Recovery Effects of Thyme Drops after Vocal Loading for Professional Voice Users: A Randomized Placebo-controlled Single-blind Trial

Perceptual Recovery Effects of Thyme Drops after Vocal Loading for Professional Voice Users: A Randomized Placebo-controlled Single-blind Trial

Vocal Dose of Preservice Music Therapists, Preservice Music Teachers, and Other Undergraduate Students

Researchers have studied various populations with high vocal doses and prevalence of related voice disorders. Teachers, singers, and university students are three such populations that have been examined extensively. No studies to date, however, have examined the voice use of music therapists and compared their voice use to these other populations. The purpose of this investigation was to examine voice dosimeter data including phonation duration and percentage, amplitude, frequencies, and distance dose acquired over contiguous 7 day (1 week) periods by preservice music therapists, preservice music teachers, and other university students in concert with daily voice use surveys. This is a quantitative descriptive design. Eight female students of varied majors (music therapy, music education, vocal performance, elementary education, and "other") in their third year of university study wore a voice dosimeter during all waking hours for 7 days. The dosimeter recorded voicing time, percentage, frequency, and estimated amplitude. Participants also completed surveys related to several parameters of vocal health, the number of hours they slept, and their voice care. Participants experienced relatively low vocal doses during the week. Music majors experienced more voice use than nonmusic majors. Some of the highest doses occurred during teaching demonstrations and leading of music therapy practicum sessions. Preservice music therapists and preservice music teachers may experience extreme increases in vocal load when they enter the field. Absent training protocols, these increases could be detrimental to their vocal health and long-term viability as practitioners.

Occupational voice is a work in progress: active risk management, habilitation and rehabilitation.

Purpose of reviewThe current article reviews recent literature examining occupational voice use and occupational voice disorders (January 2018–July 2019).Recent findingsOur understanding of the prevalence of voice disorders and work-related vocal use, vocal load and vocal ergonomics (environmental and person influences) across different occupations is continuing to build. There is encouraging evidence for the value of intervention programs for occupational voice users, particularly of late with performers, teachers and telemarketers. Education and prevention programs are emerging for other ‘at risk’ occupations.SummaryOccupational health and workforce legislation does not adequately acknowledge and guide educational, preventive and intervention approaches to occupational voice disorders. Voice disorders are prevalent in certain occupations and there is an urgent need for research to support occupational voice health and safety risk measurement, prevention and intervention. Large population-based studies are required with a focus on the health and economic burden of occupational voice disorders.

The Effects of a Vocal Loading Task on the Acoustic and Electromyographic Measurements of Vocal Fatigue

The purpose of this study was to determine the effect of a vocal loading task on submandibular muscular activity and acoustic measures of vocal function. Surface electromyography (sEMG) directly assessed muscle activation related to extrinsic laryngeal muscles, and these findings were compared to the acoustic measurements of cepstral peak prominence, low to high spectral ratio, semitone range, and amplitude reflecting the function of intrinsic laryngeal muscles. These measurements were taken from 14 healthy, young adults of the Texas Christian University student population before and after reading Harry Potter and the Sorcerer’s Stone for 30 minutes at a volume of at least 75 decibels (dB). Results indicated consistent trends in which acoustic measurement showed more periodic vocal fold movement and reduced vocal range, and sEMG measurement showed reduced muscle activation. An elevated acoustic amplitude suggested that increasing vocal intensity could be a compensatory strategy for individuals with vocal fatigue, but further study is required to test this theory in a larger sample size.

Vocal Fatigue in Prospective Vocal Professionals

The goals of the study were to (a) examine vocal fatigue in speech-language pathology students through subjective and objective measures following a novel 30-minute vocal loading task (VLT) and (b) evaluate the effects of psychosocial factors on vocal fatigue. Seventeen speech-language pathology students completed a 30-minute VLT using the LingWAVES software program. In addition to maintaining target intensity goals during reading a text, participants were also required to modify their pitch and voice quality. Vocal fatigue was measured subjectively using Vocal Fatigue Index and Borg vocal effort scale and objectively using variations of relative sound pressure level, fundamental frequency, pitch strength, smoothed cepstral peak prominence (CPPS), and acoustic voice quality index before, during, and after VLT. Participants provided information on their sleep quantity, stress, and depression through nonstandardized and standardized surveys. Results revealed that perceived effort and fatigue increased significantly after the 30-minute VLT. Acoustic measures of relative sound pressure level and fundamental frequency and increased systematically during and after the completion of task. All students were moderately stressed and measures related to pitch were highly related with perceived stress. The results of this study provide support for altering multiple vocal parameters to induce measurable changes in vocal fatigue following a short-duration VLT.

Vocal Hygiene and Training of Professional Voice Users in Inclusive Education

The article considers the issues of the etiology of voice disorders in occupations with vocal load, teachers in particular. Modern ideas about the methods of vocal training and work on its improvement are considered. Recommendations on the prevention of professional voice disorders among teachers in inclusive education are given.

Validity and Reliability of Spanish Version of Two Questionnaires of Vocal Fatigue in Female Teachers

This study aimed to determine the reliability, validity, and the specificity and sensitivity of the Spanish version of two questionnaires, the Voice Fatigue Index (VFI) and the Voice Fatigue Handicap Questionnaire (VFHQ), in female teachers, analyze the influence of the sociodemographic factors on the questionnaires, and conduct a comparative study of the psychometric characteristics of the two questionnaires on vocal fatigue (VF). The VFI and VFHQ, Spanish version, was produced following a rigorous forward and backward translation. Seventy-one female teachers were recruited to complete the VFI and VFHQ Spanish version. They also completed Voice Handicap Index-10 in its Spanish version to validate the translation of the VF questionnaires. Finally, they completed a self-elaborated questionnaire to describe the factors that influenced their vocal load and other relevant biological, personal, and occupational data. The two questionnaires showed high indicators of reliability for VFI (factor 1 α = 0.92, factor 2 α = 0.85, and factor 3 α = 0.92) and for VFHQ (α = 0.95). The scores from VFIf1, VFIf2, and VFHQ attained high validity values in Pearson's correlation coefficient when compared to the Voice Handicap Index-10 reference questionnaire. VFIf3 showed low validity values in Pearson's when compared to the others VFI factors (f1, f2), the VFHQ, and the Voice Handicap Index-10 reference questionnaire. The present study showed good reliability and validity of the VFI and VFHQ in its Spanish version. Thus, it is suggested to use the VFHQ to identify and quantify the VF handicap. To identify individuals who suffer from VF or are at high risk of VF and vocal discomfort, we recommend the application of the VFI. Based on validity results, the VFI does not appear to be a valid tool in the detection of individuals who recuperate their voice after an episode of VF.

Measurement of blood lactate as a function of vocal loading and neuromuscular electrical stimulation: Proof of concept

The goal of the current investigation was to establish proof of concept regarding measurement of blood lactate levels as an indicator of laryngeal muscle activity and fatigue, as well as to examine the relationship between blood lactate levels and NMES intensity. Fifteen participants completed a vocal loading exercise while blood lactate was measured prior to, during, and upon completion of the exercise. Acoustic measures of voice production and subjective reports of fatigue/soreness were obtained pre- and post-vocal loading task. The participants were divided into three groups: those who did not receive laryngeal neuromuscular electrical stimulation (NMES), those who received laryngeal NMES at a minimally perceivable level of intensity, and those who received laryngeal NMES at a maximum tolerable level of intensity. Changes in blood lactate levels were observed during the vocal loading task, thus indicating that blood lactate measurements are sensitive enough to reflect laryngeal muscle activity. No consistent pattern between blood lactate levels and NMES intensity or fatigue emerged. Several factors may account for these findings.

Voice Disorders in Islamic Religious Officials: Is It Any Different Than Those of the Teachers, Another Well-Known Professional Voice Users?

This study explores Islamic religious officials' voice use, disorders, and treatment methods by comparing the officials with teachers, the largest group of voice professionals. This is a nonrandomized retrospective study. This study included 85 patients with voice disorder complaints; 42 were religious officials and 43 were teachers. We compared the two groups of patients in terms of demographic information, job descriptions, years in their professions, smoking histories, alcohol consumption, allergies and other systemic disorders, average weekly vocal loads, voice training, vocal abuse-misuse, reflux symptom index and voice handicap index scores, and voice disorder diagnosis and treatment methods. The study compared 39 male (92.85%) and three female (7.14%) religious officials with five male (11.62%) and 38 female (88.37%) teachers. The alcohol use, systemic diseases, and vocal loads were found to be statistically higher in the teachers than the religious officials (P < 0.05), while the vocal abuse-misuse, vocal hygiene knowledge, and voice handicap indices were determined to be statistically higher in the religious officials than the teachers (P < 0.05). A statistically significant difference in the distribution of the diagnoses exists between the two groups (P < 0.005). Voice therapy is the most common treatment method in both groups. Like teachers, Islamic religious officials appear to be at high risk of developing voice disorders. Because of the lack of research on the frequency of voice disorders among Islamic religious officials, it is important to raise awareness of the prevalence of voice disorders.

Vocal Fatigue—Do Young Speech-Language Pathologists Practice What They Preach?

PurposeSpeech-Language Pathologists can be categorized as Level II professional voice users who play the roles of voice therapist or vocal coach to treat voice problems. SLPs may be at the risk of experiencing vocal fatigue due to vocal loading and other contributing factors. The present study was undertaken to find the percentage of SLPs reporting vocal fatigue, the probable factors resulting in vocal fatigue, the measures that are taken to avoid/reduce the occurrence of vocal fatigue, its effect on their professional and personal life and the measures taken to tackle it. ResultsThe results of this study are based on data collected from 142 SLPs and 50 controls using a questionnaire. 71.13% SLPs reported that they experience vocal fatigue. Some of the contributing factors that are mainly reported are long durations of voice use, voice use for recreational purposes, speaking loudly, frequent throat clearing, lack of adequate hydration and working in noisy or air-conditioned environments. The major symptoms reported were dryness in throat, tightness in neck and shoulder, choking sensation, effortful speech and pain in the throat. 59% SLPs reported that vocal fatigue affected their professional life while 44% SLPs reported that it affects their personal life also to varying degrees. Measures taken to avoid/ reduce the occurrence of vocal fatigue included vocal warm up, break in between sessions, and play activities. Only a few SLPs took intervention measures like ENT consultation, voice therapy, and home remedies. ConclusionSLPs are inevitably at high risk of experiencing vocal fatigue which, if left untreated, will lead to organic voice problems. However, many young SLPs who experience vocal fatigue reported vocal abuse, do not follow vocal hygiene program and do not follow evidence-based preventive or intervention practices to treat vocal fatigue.

A rare case report: Ayurvedic management of vocal cord nodules

Vocal nodules are the consequence of functional voice disorders, which are also caused by vocal abuse or misuse. An increased vocal load, for example, due to the patient's profession, demands high-volume speech for the formation of nodules. In the present case report, a 26-year-old female patient acquired this disease followed by common cold cough. Her problems were aggravating by high-volume speech and getting fatigability also. This patient was given Anutaila Nasya with Sitopaladi Churna, Naradiya Laxmi vilasa Rasa, Yashtimadhu Ghanvati (for chewing), and Dashmoola Kwatha(Kavala). The patient was advised for strict voice rest and steam inhalation for better result. After 1 month of treatment, the patient got relief from all her complaints and gained normal voice. On examination, it was found that vocal nodules disappeared in direct laryngoscopy. Hence, this single case report shows that ayurvedic management of vocal cord nodules gives excellent result and improves patients' quality of voice.

How Much Loading Does Water Resistance Voice Therapy Impose on the Vocal Folds? An Experimental Human Study

Water resistance voice therapy applies phonation into water through a tube. This study investigates how strenuous this therapy can be for the vocal folds in terms of impact stress (IS). It further examines whether it is possible to estimate the IS using the contact quotient (CQ) and maximum derivative from an electroglottogram (EGG). Experimental study. A male participant sustained a rounded back vowel [u:] or [o:] at a comfortable speaking pitch and loudness, and phonated into a silicone "Lax Vox" tube submerged 2 cm in water. High-speed videolaryngoscopy was performed with a rigid scope. Oral air pressure (Poral) was registered in a mouthpiece through which an endoscope was inserted into the larynx. An EGG was recorded. The CQEGG from the EGG and the closed quotient from the glottal width (CQarea) increased, while the maximum glottal amplitude and absolute value of derivative minimum (dmin) and also the derivative maximum from the EGG decreased for phonation into water. Normalized amplitude quotient from the glottal width variation also decreased but the change was not significant. Based on the glottal area findings, water resistance therapy does not seem to increase vocal fold loading (in terms of increased IS) even if the increase of CQarea, and CQEGG suggest so. CQEGG may qualitatively correspond to that of area, but the reliability of CQ (from the glottal area or the EGG) and the maximum derivative from the EGG as estimates of IS in semiocclusion exercises warrant further studies.

Absolute or relative voice rest after phonosurgery: a blind randomized prospective clinical trial

Objectives: The first aim, was to compare participant compliance with postoperative voice rest advice in two groups. The second aim was to compare vocal function and recovery in the short-term, seven days post-surgery and in the long-term, 3–6 months post-surgery.Design: Preliminary randomized prospective blind clinical trial.Methods: Twenty patients scheduled for surgery for benign vocal fold lesions were randomized into seven days of absolute or relative voice rest. Compliance with voice rest advice was monitored with a voice accumulator for seven days following surgery. Vocal recovery was tracked through (a) self-perceived vocal function, (b) perceptual assessments of voice recordings and (c) visual assessment of high resolution and high speed digital imaging (d) vocal stamina and reaction to vocal loading, explored with a vocal loading task.Results: The absolute voice rest group phonated significantly less than the relative voice rest group during seven days post-surgery, but they were not silent. The absolute voice rest group self-reported more difficulty with compliance than the relative voice rest group. The relative voice rest group coped with significantly more vocal loading at long-term check-up. In the short-term the absolute voice rest group improved morphological recovery to a significant degree, however relative voice rest renders superior long-term recovery.Conclusions: Absolute voice rest is difficult to comply with. Neither short-term, nor long-term vocal recovery differed significantly between groups. Within-group comparisons showed significant improvements in vocal stamina, immediate recovery from vocal loading and self-assessments of voice problems only for the group with recommended relative voice rest.