Vocal Problems Research Articles

Correlações entre ruído ambiental em sala de aula e voz do professor

OBJETIVO: Identificar se existe correlação entre ruído ambiental no interior da sala de aula, intensidade da voz e presença de alteração vocal em professores. MÉTODOS: Foi realizada medição do ruído ambiental em dez salas de escolas municipais de ensino fundamental. A intensidade das vozes das professoras foi medida durante atividade de ensino. Amostras de vogal prolongada [é] e contagem de 1 a 20 emitidas pelas professoras foram analisadas utilizando escala GRBASI. Os resultados obtidos foram correlacionados. RESULTADOS: A média de ruído ambiental sem a presença das crianças em sala de aula variou de 40 a 51 dB(A) e com a presença das crianças de 45 a 65 dB(A). Entre as professoras, houve 70% de ocorrência de vozes alteradas no grau geral (G) e 90% com tensão na voz (S), variando entre graus discreto e moderado. Constatou-se variação entre 52 dB(A) e 68 dB(A) na intensidade da voz das professoras, atingindo 7,48 dB(A) acima do nível do ruído ambiental. Houve correlação entre a intensidade vocal das professoras e ruído ambiental na presença das crianças durante a aula. CONCLUSÃO: Os níveis de ruído ambiental em sala de aula são altos e se correlacionam com o aumento da intensidade das vozes das professoras. Embora com alta ocorrência de vozes alteradas, não é possível correlacioná-las com o nível de ruído ambiental.

Optimal Selection of Long Time Acoustic Features Using GA for the Assessment of Vocal Fold Disorders

In recent times, vocal fold problems have been increasing dramatically due to unhealthy social habits and voice abuse. Non-invasive methods like acoustic analysis of voice signals can be used to investigate such problems. Various feature extraction techniques are used to classify the voice signals into normal and pathological. Among them, long-time acoustical parameters are used by many researchers. The selection of best long-time acoustical parameters is very important to reduce the computational complexity, as well as to achieve better accuracy with minimum number of features. In order to select best long-time acoustical parameters, different feature reduction methods or feature selection methods are proposed by researchers. In this work, genetic algorithm (GA) based optimal selection of long-time acoustical parameters is proposed to achieve higher accuracy with minimum number of features. The classification is carried out using k-nearest neighbourhood (k-NN) classifier. In comparison with other works in the literature, the simulation results show that a minimum of 5 features are required to classify the voice signals by GA and a better accuracy of 94.29% is achieved.

Evaluating Voice Characteristics of First-Year Acting Students in Israel: Factor Analysis

Acting students require diverse, high-quality, and high-intensity vocal performance from early stages of their training. Demanding vocal activities, before developing the appropriate vocal skills, put them in high risk for developing vocal problems. A retrospective analysis of voice characteristics of first-year acting students using several voice evaluation tools. A total of 79 first-year acting students (55 women and 24 men) were assigned into two study groups: laryngeal findings (LFs) and no laryngeal findings, based on stroboscopic findings. Their voice characteristics were evaluated using acoustic analysis, aerodynamic examination, perceptual scales, and self-report questionnaires. Results obtained from each set of measures were examined using a factor analysis approach. Significant differences between the two groups were found for a single fundamental frequency (F(0))-Regularity factor; a single Grade, Roughness, Breathiness, Asthenia, Strain perceptual factor; and the three self-evaluation factors. Gender differences were found for two acoustic analysis factors, which were based on F(0) and its derivatives, namely an aerodynamic factor that represents expiratory volume measurements and a single self-evaluation factor that represents the tendency to seek therapy. Approximately 50% of the first-year acting students had LFs. These students differed from their peers in the control group in a single acoustic analysis factor, as well as perceptual and self-report factors. No group differences, however, were found for the aerodynamic factors. Early laryngeal examination and voice evaluation of future professional voice users could provide a valuable individual baseline, to which later examinations could be compared, and assist in providing personally tailored treatment.

A lifetime of professional singing: Voice parameters and age in the Netherlands Radio Choir

In professional choirs one would like to identify the incidence and severity of vocal problems due to ageing, and know how to influence them. The aim of the current study was to investigate to what extent easily obtainable voice parameters were age-related. From 47 singers of the Netherlands Radio Choir the Voice Range Profile parameters and the vibrato characteristics were measured. Dysphonia Severity Index (DSI) was calculated.We found that the age of male and female singers correlated negatively to the highest fundamental frequency and the Dysphonia Severity Index. No signs of slower and wider vibrato were found. These findings can lead to identifying adequate parameters e.g. for the ageing voice, useful in larger groups of professional singers.

Estrategias para potenciar el aprendizaje motor en el tratamiento vocal de las enfermedades neurodegenerativas

Sensorimotor deficits have a devastating effect on the quality of life of people with neurodegenerative diseases, especially disruptions of craniofacial nerves. These disorders affect voice, speech, facial expression and deglutition. Scientific evidence indicates that targeted training of laryngeal and respiratory muscle groups may reverse or slow disease progression as well as its cranial sensorimotor deficits. However there is still a lack of specifically designed strategies to achieve motor learning and to enhance the generalization of therapeutic results; e.g. there is a need for specific treatment protocols that improve the transfer of motor abilities from the clinical setting to the patient's actual environment. The purpose of this study is primarily aimed at reviewing the principles, phases and forms of motor learning and the application of motor learning requisites to the treatment of vocal problems in neurodegenerative diseases. In the second part of the article we analyze how the Lee Silverman Voice Treatment (LSVT®) method applies theories of motor learning to the treatment of voice problems in persons with Parkinson's disease. This method has been shown to improve the neurological lesion, vocal function, speech intelligibility and deglutition, with most of its effects being maintained in the short, medium and long term.

The Role of Rest

The article by Haben in this issue of Medical Problems of Performing Artists describes one expert clinician’s approach to the use of rest in treating voice problems in singers. In the absence of well-designed randomized controlled trials of voice rest for various vocal problems (and little in the way of other research on the topic), expert opinion is the best guidance available. Performing artists of all types have to make decisions on a daily basis about how to balance practicing and performing versus resting and recovering from those activities.

Speech and language therapy versus placebo or no intervention for speech problems in Parkinson's disease

Parkinson's disease patients commonly suffer from speech and vocal problems including dysarthric speech, reduced loudness and loss of articulation. These symptoms increase in frequency and intensity with progression of the disease). Speech and language therapy (SLT) aims to improve the intelligibility of speech with behavioural treatment techniques or instrumental aids. To compare the efficacy of speech and language therapy versus placebo or no intervention for speech and voice problems in patients with Parkinson's disease. Relevant trials were identified by electronic searches of numerous literature databases including MEDLINE, EMBASE, and CINAHL, as well as handsearching of relevant conference abstracts and examination of reference lists in identified studies and other reviews. The literature search included trials published prior to 11(th) April 2011. Only randomised controlled trials (RCT) of speech and language therapy versus placebo or no intervention were included. Data were abstracted independently by CH and CT and differences settled by discussion. Three randomised controlled trials with a total of 63 participants were found comparing SLT with placebo for speech disorders in Parkinson's disease. Data were available from 41 participants in two trials. Vocal loudness for reading a passage increased by 6.3 dB (P = 0.0007) in one trial, and 11.0 dB (P = 0.0002) in another trial. An increase was also seen in both of these trials for monologue speaking of 5.4 dB (P = 0.002) and 11.0 dB (P = 0.0002), respectively. It is likely that these are clinically significant improvements. After six months, patients from the first trial were still showing a statistically significant increase of 4.5 dB (P = 0.0007) for reading and 3.5 dB for monologue speaking. Some measures of speech monotoni city and articulation were investigated; however, all these results were non-significant. Although improvements in speech impairments were noted in these studies, due to the small number of patients examined, methodological flaws, and the possibility of publication bias, there is insufficient evidence to conclusively support or refute the efficacy of SLT for speech problems in Parkinson's disease. A large well designed placebo-controlled RCT is needed to demonstrate SLT's effectiveness in Parkinson's disease. The trial should conform to CONSORT guidelines. Outcome measures with particular relevance to patients with Parkinson's disease should be chosen and patients followed for at least six months to determine the duration of any improvement.

Prevalence of vocal problems: Speech-language pathologists’ evaluation of music and non-music teacher recordings

The current study, a preliminary examination of whether music teachers are more susceptible to vocal problems than teachers of other subjects, asked for expert evaluation of audio recordings from licensed speech-language pathologists. Participants ( N = 41) taught music ( n = 23) or another subject ( n = 18) in either elementary ( n = 21), middle ( n = 10), or high school ( n = 10), and had a mean of 14 years’ teaching experience. Each teacher read a poem while being audio recorded. Nine licensed speech-language pathologists with a mean of 20 years’ clinical experience served as expert evaluators by listening to the 41 recordings while manipulating the Continuous Response Digital Interface (CRDI) dial. Results showed no significant differences between music and non-music teacher evaluations. The individual variations in scores showed no trends for any particular group, but rather pointed out how personal vocal hygiene (care of the voice) is for individual teachers. Suggestions for future research include ways to best help teachers manage individual vocal problems.

Clinical outcomes in the management of congenital adrenal hyperplasia

Congenital adrenal hyperplasia (CAH) is a group of disorders affecting adrenal steroid synthesis. The most common form, 21-hydroxylase deficiency, leads to decreased production of cortisol and aldosterone with increased androgen secretion. In classic CAH glucocorticoid treatment can be life-saving, and provides symptom control, but must be given in an unphysiological manner with the risk of negative long-term outcomes. A late diagnosis or a severe phenotype or genotype has also a negative impact. These factors can result in impaired quality of life (QoL), increased cardiometabolic risk, short stature, osteoporosis and fractures, benign tumors, decreased fertility, and vocal problems. The prognosis has improved during the last decades, thanks to better clinical management and nowadays the most affected patients seem to have a good QoL. Very few patients above the age of 60 years have, however, been studied. Classifying patients according to genotype may give additional useful clinical information. The introduction of neonatal CAH screening may enhance long-term results. Monitoring of different risk factors and negative consequences should be done regularly in an attempt to improve clinical outcomes further.

Habilidades sociais em crianças disfônicas

To obtain and analyze data from the social skills evaluation of dysphonic children. This is a cross-sectional and prospective study. Participants were 38 children enrolled in a public school, ranging in age from 7 to 11 years. They were separated into two groups: Study Group (SG)--19 dysphonic children; Control Group (CG)--19 non-dysphonic children. The groups were matched by gender and age range. Children with any history of organic vocal problems, according to the identification and investigation of general and vocal health questionnaire, which was answered by the legal guardian, were excluded. The Multimedia Social Skills Inventoire for Children (MUSSIC) was applied, which consists of 21 social interaction situations represented by photos, having a child as the leading figure. For each situation, the participant should select one out of three behaviors, putting themselves in the place of the main character. Each response corresponds to one out of three types of reaction: assertive, passive and aggressive. Data were statistically analyzed. There was no difference between the groups on the social skills evaluation results, that is, SG and CG children presented similar scores regarding assertiveness, aggressiveness and passiveness. Consequently, there was no difference on the subscales of the inventory regarding social skills. As for the SG, there was no relationship between the scores obtained on the MUSSIC and the severity of the voice disorder. It is not possible to determine specific behaviors of dysphonic children concerning social skills.

Dor em cantores populares

To identify and characterize the presence of body pains in popular singers, to observe the differences in the reported pains according to gender, and to relate with data regarding vocal behavior and usage in this population. A self-explanatory questionnaire was applied to 100 popular singers (50 men and 50 women), in order to collect information about personal identification, voice use and presence of pains. Pains were divided into two groups: proximal pains (TMA, tongue, throat, nape, shoulders, neck, and pain during speech), and distal pains (arms, back/column, chest, hands, ear, and headache). The mean value of pain presence referred by popular singers was 2.9. There was no difference in reported pain according to gender. Predominant pains were on the throat (66%), during speech (41%) and on the neck (35%), all classified as proximal to the larynx. The least predominant pains were in arms, hands and chest (4%), all classified as distal pains. Popular singers reported presence of body pains mainly proximal to the larynx. There is no difference in reported pain according to gender. The presence of body pain is related to the presence of voice disorders, the need to stop singing, the absence of vocal training, and search for professional advice (otolaryngologists and speech-language pathologist) due to vocal problems. These data justify the investigation and attention to body pain symptoms by the professionals responsible for the treatment of this population.

Alterações vocais e cuidados de saúde entre professoras

OBJETIVO: conhecer os fatores associados à busca de assistência vocal entre professoras. MÉTODO: participaram 1.980 professoras do ensino fundamental diurno de 76 escolas públicas. Os dados foram coletados entre maio de 2004 e julho de 2005 por meio de questionário. A variável dependente referiu-se a questão "Nas duas últimas semanas, você procurou médico/fonoaudiólogo por causa de problemas na voz?" As variáveis independentes foram: sintomas de cansaço vocal e de piora na qualidade vocal, aspectos sociodemográficos, aspectos de saúde, percepção de ruído na sala de aula e na escola, ausência e afastamento do trabalho por problemas de voz, trabalho em outra atividade com uso intensivo da voz. A regressão logística foi utilizada para a análise das associações entre a variável dependente e os fatores de interesse com magnitudes estimadas usando-se o odds ratio, com intervalo de confiança de 95%. RESULTADOS: apenas 7% das professoras buscaram assistência no período de 15 dias. A procura por assistência foi associada ao ruído elevado na sala de aula, relato de piora na voz, problemas de vias aéreas superiores e ausência do trabalho por causa da voz. O presente trabalho mostrou que o comportamento recente é precipitado pela piora ou superposição de problemas vocais e respiratórios. CONCLUSÃO: a procura ou não pela assistência à saúde articula-se a fatores relacionados a outras dimensões além do adoecimento. Portanto, questões referentes ao uso de serviços de saúde como um processo dinâmico e relacionado ao distúrbio da voz devem ser abordadas em pesquisas futuras.

Comportamento vocal de cantores populares

OBJETIVO: investigar aspectos do histórico, hábitos e comportamentos vocais de cantores populares, conforme o sexo e as categorias profissional e amador. MÉTODO: entrevista com 47 cantores, 25 homens e 22 mulheres. RESULTADOS: significância estatística nos seguintes achados: MASCULINO - microfone nos ensaios, ausência de problemas vocais diagnosticados, ausência de orientações sobre higiene vocal, dor ou desconforto após cantar, ausência de alergias e problemas respiratórios; FEMININO - aulas de canto e conhecimento sobre postura; AMADOR - não cantar dançando, não imitar vozes, ausência de avaliação otorrinolaringológica, ausência de problemas vocais diagnosticados, ausência de terapia fonoaudiológica, ausência de orientações de anatomofisiologia vocal e não utilização de álcool nos ensaios; PROFISSIONAL - rouquidão, conhecimento sobre articulação, álcool durante os shows, "garganta suja" ou pigarro, dor após cantar. CONCLUSÕES: a comparação entre os sexos evidenciou que os homens utilizavam microfone no ensaio, não apresentavam problemas alérgicos ou respiratórios, nem problemas vocais diagnosticados, mas apresentavam sensação de dor ou desconforto após o canto e não possuíam noções sobre higiene vocal; e que as mulheres realizavam aulas de canto e possuíam orientações de postura. A comparação entre amadores e profissionais mostrou que os amadores não cantavam dançando, não imitavam vozes, não utilizavam álcool nos ensaios, e não apresentavam problemas vocais diagnosticados, mas não possuíam avaliação otorrinolaringológica, não realizavam terapia fonoaudiológica, e não possuíam conhecimento sobre anatomofisiologia vocal; e os profissionais apresentavam queixa de rouquidão, de "garganta suja" ou pigarro e de dor após cantar, e usavam álcool durante os shows, apesar de possuir conhecimento sobre articulação.

Health Information-Seeking Behaviors Among Classically Trained Singers

Understanding health information-seeking behaviors (HISBs) within a particular patient demographic group is an important part of effective clinical outreach and education efforts. Although the community of classically trained singers has long been recognized by specialized health care providers, no studies have yet addressed the processes by which they search for voice-related health information, and little is known about how they use and access medical care. An electronic questionnaire focusing on HISB and voice-related health care issues was administered to 151 self-identified classically trained singers and 49 nonsinger controls. Outcomes of interest were tested for association with groups of singers and controls, followed by tests of association between demographic variables (age, gender, insurance status) with each outcome of interest. Results showed significant differences in specialty care access including point of first contact (P=0.0085), gender-associated delay of treatment initiation (P=0.0324), and use of home remedies for vocal problems (P≤0.0001). Significant differences in HISB were noted as well, including history of having undertaken an information search (P≤0.0001), likelihood of having concerns about information quality (P≤0.0001), and difficulty knowing where to find information (P≤0.0001). Differences were influenced by singing status, age, and gender. The insights provided by these data may inform decision-making processes regarding patient care, patient education, and clinical outreach to the target population.

Vocal Problems: Teachers’ Attitudes and Healthseeking Behavior

Objective: Teachers are at high risk for vocal disorders due to their intrinsic occupational requirements. Numerous studies have reported on the prevalence and risk factors. Less is known about teachers’ ideas and attitudes. We aimed to explore teachers’: 1) attitudes towards voice problems and 2) health seeking behavior. Method: A cross-sectional study was conducted by cluster sampling method across 6 primary schools in Singapore in 2008. 214 full time teachers were recruited. Self-administered questionnaires were answered during each school’s teachers meeting after informed consent. Results: A total of 89.9% of teachers agree that losing one’s voice is an occupational hazard. A total of 92.8% agree that their profession depends on the health of their voices. A total of 79.6% think that attending voice workshops will help to prevent voice problems. A total of 65.4% have had taken medical leave for voice problems in the past 12 months, of which 9.3% of them had taken 6 days or more of leave. A total of 81.7% consulted a general practitioner, 3.6% an otolaryngologist, 0% a speech therapist, and 14.8% others. Conclusion: The surveyed teachers have very similar demographics compared with the national teaching population and are hence broadly representative. The results showed that teachers do value their voices and deem them essential for carrying out their professional duties. Productivity losses to the education system and emotional losses are real entities.

Identificação de problemas vocais enfrentados por cantores de igreja

OBJETIVO: identificar possíveis problemas vocais enfrentados por cantores evangélicos de Irati-PR. MÉTODO: foram analisados 42 questionários respondidos por cantores de Igreja, onde constavam dados de identificação e um questionário referente a 30 problemas vocais que poderiam ser enfrentados pelos cantores, tanto referentes aos problemas de saúde vocal, quanto relacionados à utilização específica da voz cantada. O questionário já é amplamente utilizado na literatura brasileira. RESULTADOS: a média de problemas referidos foi de 7,78. Mulheres referiram maior quantidade média de problemas vocais (média:9,65) do que homens (média:6,19), havendo diferença estatisticamente significante entre eles (p=0,03). Das 30 questões, apenas uma não foi assinalada por nenhum cantor. Os problemas vocais mais citados foram: dificuldades para atingir notas agudas ou graves (n=29;58%), falta de ar para terminar frases musicais (n=27;54%), sensação de aperto ou bola na garganta (n=25;50%), sensação de voz fraca ou forte demais para o canto coral (n=22;44%), e desafinação (n=18;42%). Além disso, foi possível observar que não houve aumento de problemas vocais com o avanço da idade ou do tempo de canto (p=0,003 e p=0,573, respectivamente). CONCLUSÃO: mulheres referiram mais problemas do que homens no que se refere à utilização da voz no canto coral. A quantidade de problemas vocais independeu da idade e do tempo de canto, o que pode indicar que a falta de técnica pode ser prejudicial até mesmo para indivíduos que cantam há pouco tempo. As queixas mais frequentes parecem ter maior relação com a falta de técnica vocal.

Reconsidering the role of psychosocial factors in functional dysphonia

Functional dysphonia, defined as alteration or loss of voice in the absence of physical pathology, is known to be associated with a variety of psychosocial factors including anxiety, depression and reduced quality of life. Models of functional dysphonia have tended to conceptualize the voice disorder as being the result of a failure to acknowledge and/or express this associated distress. The current literature was reviewed to identify psychosocial factors that predispose to, precipitate and perpetuate functional dysphonia and to assess the evidence for these models. Recent studies have identified evidence of genetic susceptibility, occupational susceptibility, a history of sexual and/or physical abuse and perfectionism as being predisposing factors. Precipitants include life events, frequency of vocal use and infections. General fatigue is identified as being a potential perpetuating factor. A recent novel theoretical model of functional dysphonia is reported, which proposes deficits in emotional processing as the core process in voice loss. Current research confirms that functional dysphonia is associated with multiple psychosocial factors. However, these findings are shown to be true of other medically unexplained symptoms in which vocal problems are absent. It is argued that, whilst intuitively appealing, there is insufficient evidence to support the popular notion that the loss of voice is the consequence of unexpressed emotion.

音響分析ソフト「ＶＡ」の開発―軽度嗄声の音響分析―

The voice analyzer (VA) software program we developed for quantitatively analyzing voice quality uses zero-cross-picking to find individual basic pitch periods. Two such periods extracted from a voice waveform were analyzed to calculate the acoustic energy of harmonics separately from that of noise components. The program determines the ratio of harmonics to noise (Ra), F0, jitter, shimmer, APQ, and PPQ. Sustained vowel /a/ from 28 subjects without evident vocal problems such as hoarseness and 49 subjects with hoarseness were examined. Average female and male Ra among the nonhoarse were 31.9 dB and 34.4 dB, jitter 0.254% and 0.246%, and shimmer 0.168% and 0.116%. Among those with hoarseness, all parameter scored worse than in the nonhoarse in proportion to auditory impression.

Type-D personality, psychosomatic symptoms and voice handicap in female voice patients: A perspective on vocal communication

AbstractObjectives: The association between vocal communication and personality was studied in 82 female voice patients with a mean age of the 39.3 years (range 18–65 years). Study design: The relation between type-D personality (Type-D Scale-16), psychosomatic symptoms (Symptom Check List–90) and the biopsychosocial impact of the voice problem (Voice Handicap Index) was assessed. Results: The findings indicate that type-D voice patients are relatively more handicapped by their voice problem, predominantly in the emotional domain, and have a relatively higher level of psychosomatic symptoms compared to non-type-D patients. Conclusions: Apparently, the well-being of females with a voice problem is more at risk in type-D than in non-type-D personalities. These results lead to the suspicion that voice patients with a type-D personality are especially at risk because they are prone to be involved in a circular negatively reinforcing process. This process influences the vocal problem in such a way that a detri...

School Teachers’ Vocal Use, Risk Factors, and Voice Disorder Prevalence: Guidelines to Detect Teachers with Current Voice Problems

Teachers’ voice problems are widely recognized as a consequence of their work. The measurement of vocal demands and risk factors is essential for adjusting occupational safety and health services to this population’s needs. Objectives: To correlate vocal behavior and symptomatology with risk factors and voice disorders, and to further analyze gender influence on these variables. Subjects and Methods: 282 kindergarten and elementary education teachers were surveyed in a cross-sectional study using a self-administered questionnaire. For the purpose of this study, voice disorder prevalence was estimated based on the presence of a vocal effort plus 2 frequent symptoms. Results: 81.5% of teachers reported some degree of vocal effort; more than 60% of subjects evidenced frequent throat paresthesias or vocal fatigue at the end of a working day, and about 55% reported hoarseness. Voice disorder prevalence was 59%. Multivariate logistic regression analysis revealed that female gender, time required to alleviate vocal symptoms, perceived general state of health, prolonged use of the voice, and pupils’ indiscipline significantly increased the odds of having vocal problems. Conclusions: Voice disorders affected most teachers and had a multifactorial nature. Vocal health care is particularly necessary for those subjects reporting vocal effort and more than 2 frequent symptoms.