Vocal Professionals Research Articles

Quebec French Translation, Cultural Adaptation, and Validation of the Singing Voice Handicap Index-10 Questionnaire for Singers with Dysphonia

OBJECTIVES/HYPOTHESISDysphonia is a common voice disorder that can significantly impact a person’s life; it requires a collaborative evaluation by both speech-language pathologists and otolaryngologists that takes the patient’s perspective into account. The aim of this study was to translate and culturally adapt the Singing Voice Handicap Index questionnaire (SVHI-10), a reliable patient-reported outcome evaluation tool for dysphonia, for the Quebec French population. The result is the Singing Voice Handicap Index-10-QC (SVHI-10-QC). STUDY DESIGNThis study was a prospective translation and validation process. METHODSThe translation process complied with international recommendations and followed a standard forward-backward translation procedure and cognitive debriefing with ten singers. The Quebec French version was administered to two study samples: 30 vocal professionals with no dysphonia and 53 vocal professionals with dysphonia as one of their primary complaints. The SVHI-10-QC was assessed for construct validity, internal consistency, discriminatory capacity, and test-retest reliability. RESULTSThe SVHI-10-QC is valid, reliable, and ready for use with singer-patients suffering from dysphonia. CONCLUSIONSThe SVHI-10-QC is a reliable and valid tool for assessing the impact of dysphonia on French Quebec singers’ quality of life.

Voice condition assessment and the effect of rehabilitation in vocal professionals

Voice condition assessment and the effect of rehabilitation in vocal professionals

Airway Management in Singers: A Cross-sectional Survey

To review and establish current practices regarding airway management in vocal professionals undergoing surgery. Cross-sectional survey SETTING: The setting included practitioners that treat vocal professionals across international sub-specialty societies. A twenty-one-item survey was sent to practitioners that routinely treat vocal professionals including the American Broncho-Esophagological Association, European Laryngological Society, and 2017 Fall Voice Conference attendees. It included questions regarding the respondents' demographics, preferences for airway control in non-laryngeal and laryngeal surgery, and peri-operative management. Total respondents (n=163): 82.8% were Laryngologists, 4.3 % were General Otolaryngologists, 3.1% were Head & Neck Oncologists, and 6.8% were Speech-Language Pathologists. One hundred twenty-five of the participants (76.7%) classified their experience with vocal professionals as 'extensive' or 'often.' For non-laryngeal surgery, there was a tendency towards laryngeal mask airway (53.1%) over endotracheal intubation (46.9%). For professional singers, a smaller endotracheal tube was recommended. Size varied based on sex. For males, 88.5% recommended a tube ≤7.0 in non-singers; 98.2% recommended a tube ≤7.0 in singers. In females 76.1% recommended a tube ≤6.0 for non-singers; 94.6 % recommended a size ≤6.0 in a female singer. For laryngeal surgery, 14% of providers personally intubated patients over 90% of the time. Of the providers who work with trainees, 60.5% did not allow resident intubation. Objective data regarding precautions in airway management of professional voice users is scarce. This is the largest survey to date on current practices. Survey results indicate that smaller ETTs are preferred for singers, and that more experienced practitioners are preferred for the intubation.

Do Voice-Over Artists Convey Emotion Better Than Untrained Voice Users?

ABSTRACT Voice is an invaluable asset for vocal professionals such as actors, singers, dubbing artists, etc. Among these, voice-over artists have rarely been the focus of research related to voice in India. These professionals need to convey emotions solely through the voice, and their vocal training must be suited to meet these demands. This study compares vocal capability of voice-over artists to those of untrained voice users. Each of 10 participants (five voice-over artists, five untrained vocal users) were asked to verbalize a target sentence to convey four different emotions. Their voice samples were recorded and given to 30 naive listeners to investigate whether the listeners perceived the emotion being conveyed. Results revealed that although voice-over artists were recognized by listeners as trained vocal users, there was no statistically significant difference in the number of sentences where the emotion was correctly conveyed through their voice, as outlined in the study. Among the emotions studied, “excitement” was maximally perceived correctly by listeners. While highlighting a lack of training by vocologists, the study also brings into focus a relatively neglected sub-population of vocal professionals in India.

Effect of Vitamin B12 Injection on the Vocal Performance of Professional Singers

One-third of singers and vocal professionals report experiencing a benefit from empirical vitamin B12 injections for improvement of mild singing-related symptoms (eg, reduced stamina, vocal fatigue, and effort). However, there is no objective evidence to support or refute these claims. To assess the presence and magnitude of the effect of empirical vitamin B12 injection on the vocal performance of singers. A randomized, double-blind, placebo-controlled, crossover trial was conducted from November 7, 2017, to November 30, 2018, at an academic voice center among 20 active adult singers without dysphonia but with mild vocal symptoms. Individuals with known or suspected vitamin B12 deficiency or active or recent vitamin B12 treatment were excluded. Analysis was on a per-protocol basis. Participants were randomized to receive an intramuscular (deltoid) injection of either vitamin B12 (1000 μg of cyanocobalmin) or placebo (0.9% sodium chloride). After a washout period of at least 4 weeks, participants were crossed over to receive the opposite injection. Both the investigators and participants were blinded to the order of injections. The participants completed the Singing Voice Handicap Index-10 (SVHI-10), the Voice Fatigue Index (VFI), and the Evaluation of the Ability to Sing Easily (EASE) before each injection and at intervals of 1 hour, 3 hours, 24 hours, 72 hours, and 1 week after the injection. The primary time point assessment was 72 hours after injection, and the SVHI-10 score was the primary outcome measure. Twenty singers (10 men; median age, 22 years [range, 19-42 years]) were enrolled. The improvements after either placebo or vitamin B12 injections were comparable to each other. At 72 hours after the vitamin B12 injection, the median difference in the SVHI-10 score was 1 (95% CI, -1 to 2) compared with 3 (95% CI, 0-4) after placebo. The median difference between differences at 72 hours between placebo and vitamin B12 injections were 1.5 (95% CI, -2 to 5) for the SVHI-10, 1 (95% CI, -9 to 9) for the VFI, and -1 (95% CI, -3 to 2) for the EASE. The improvements after both injections failed to reach the estimated minimal clinically important difference. Of the 20 participants, 4 (20%) reached the estimated minimal clinically important difference in their SVHI-10 score after 72 hours for both vitamin B12 and placebo injections. This randomized, double-blind, placebo-controlled, crossover trial found that after empirical vitamin B12 injection to improve mild voice-related symptoms, the improvement in self-reported voice measures in singers shows no meaningful difference compared with placebo. ClinicalTrials.gov Identifier: NCT03437824.

Vokalni zamor kod djelatnika u pozivnim centrima

Cilj je ovog istraživanja primijeniti hrvatsku verziju upitnika Indeks vokalnog zamora (VFI-C), radi ispitivanja i usporedbe pojave vokalnog zamora u skupini zagrebačkih djelatnika pozivnih centara (N=80) i skupini vokalnih neprofesionalaca (N=80), starijih od 18 godina. Rezultati samoprocjene u skupini vokalnih profesionalaca uspoređeni su u odnosu na demografske značajke. Statističkom analizom potvrđene su značajne razlike u prijavljenom vokalnom zamoru između vokalnih profesionalaca i neprofesionalaca, kao i utjecaj spola na neke aspekte samoprocjene vokalnog zamora u skupini vokalnih profesionalaca.

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.

Association Between Occupational Voice Use and Occurrence of Voice Disorders: A meta-analysis

Purpose: This meta-analysis has two aims: 1) to provide a quantitative assessment of the occurrence of voice disorders among different occupational voice users, 2) and to determine whether being an occupational voice user (teacher, broadcaster, call-center worker, etc.) is associated with an increased occurrence of voice disorders. Method: A random-effect meta-analysis of the available scientific literature was conducted on the occurrence of voice disorders among occupational voice users. Comprehensive literature searches were conducted using two computerized databases: PubMed/MEDLINE, and Scielo. As a measure of association, the odds ratio (OR) with corresponding 95% confidence interval (95% CI) was used. Heterogeneity was assessed by chi-square and I2 and draw in forest plots. Results: Voice disorders are related with occupational voice use independently of type of prevalence with a pool OR of 2.39 for current voice disorders, 1.88 for 12-months prevalence, and 2.43 for life-time and unspecified recall period. Heterogeneity test (I2) among these articles is 68% for current voice disorders, 0% for 12-months voice disorders, and 66% for life-time and unspecified recall period. Although around 70% of the total number of included publications assessed the occurrence of voice disorders among teachers as occupational voice users, an analysis per occupation was performed to identify possible influence of this factor in the occurrence of voice disorders. Studies that include just teachers as the group of occupational voice users (n=12) reported ORs ranging from 1.20 to 4.61. Heterogeneity test (I2) among these articles is 17%. Studies that include telemarketers, newsreaders, and sellers as the group of occupational voice users (n=6) reported ORs ranging from 0.85 when future vocal professionals were compared future non-vocal professionals to 4.58 when newsreaders were compared with non-newsreaders. Heterogeneity test (I2) among these articles is 40%. Conclusion: Occupational voice users have a higher likelihood of having voice disorders. Results of this meta-analysis show that teachers had a slightly lower likelihood (pool OR=1.95) than telemarketers, broadcasters, and sellers (pool OR=2.75) for having a voice disorder regardless the type of prevalence. Nevertheless, due the weak to moderate quality of the included studies, the results should be taken with caution.

Association between occupational voice use and occurrence of voice disorders: a meta-analysis

Purpose: This meta-analysis has two aims: 1) to provide a quantitative assessment of the occurrence of voice disorders among different occupational voice users, 2) and to determine whether being an occupational voice user (teacher, broadcaster, call-center worker, etc.) is associated with an increased occurrence of voice disorders. Method: A random-effect meta-analysis of the available scientific literature was conducted on the occurrence of voice disorders among occupational voice users. Comprehensive literature searches were conducted using two computerized databases: PubMed/MEDLINE, and Scielo. As a measure of association, the odds ratio (OR) with corresponding 95% confidence interval (95% CI) was used. Heterogeneity was assessed by chi-square and I2 and draw in forest plots. Results: Voice disorders are related with occupational voice use independently of type of prevalence with a pool OR of 2.39 for current voice disorders, 1.88 for 12-months prevalence, and 2.43 for life-time and unspecified recall period. Heterogeneity test (I2) among these articles is 68% for current voice disorders, 0% for 12-months voice disorders, and 66% for life-time and unspecified recall period. Although around 70% of the total number of included publications assessed the occurrence of voice disorders among teachers as occupational voice users, an analysis per occupation was performed to identify possible influence of this factor in the occurrence of voice disorders. Studies that include just teachers as the group of occupational voice users (n=12) reported ORs ranging from 1.20 to 4.61. Heterogeneity test (I2) among these articles is 17%. Studies that include telemarketers, newsreaders, and sellers as the group of occupational voice users (n=6) reported ORs ranging from 0.85 when future vocal professionals were compared future non-vocal professionals to 4.58 when newsreaders were compared with non-newsreaders. Heterogeneity test (I2) among these articles is 40%. Conclusion: Occupational voice users have a higher likelihood of having voice disorders. Results of this meta-analysis show that teachers had a slightly lower likelihood (pool OR=1.95) than telemarketers, broadcasters, and sellers (pool OR=2.75) for having a voice disorder regardless the type of prevalence. Nevertheless, due the weak to moderate quality of the included studies, the results should be taken with caution.

Acoustical Evaluation of Voice across Different Levels in Vocal Professionals

Acoustical Evaluation of Voice across Different Levels in Vocal Professionals

Akustičke značajke vokalnoga zamora

Vocal fatigue is characterized by self-perceived increased laryngeal strain and voice quality changes. The condition can have organic or/and functional causes. Typically, it affects vocal professionals, and teachers are most numerous among them. Despite great number of studies, many questions about vocal fatigue such as its acoustic characterstics are still open. The hypothesis of the present study conducted on female teachers was that there are significant differences in acoustic variables between vocally fatigued teachers (N=23) and teachers without it (N=27). Running speech and prolonged phonation of the vowel /a/ were analyzed in PRAAT software calculating the long-term average speech spectrum LTASS and harmonic spectrum. The average speech F0 and series of spectral variables were calculated: the strength of the strongest spectral peak L0, the α ratio of the level difference above and bellow 1 kHz for the 0-5 kHz range analyzed, and the variables Δ1, Δ2, Δ3 and Δ4 showing the ratios of the respective spectral energy bands of 1-2 kHz, 2-3 kHz, 3-4 kHz and 4-5 kHz relative to the 0-1 kHz reference. The average H1/H2 ratio based on harmonic spectrum of three samples of the prolonged vowel /a/ production was calculated as well. The hypothesis was tested by multivariate and univariate analyzes of variance and discriminant analysis. The results showed that there are no significant differences in the set of acoustic variables between the two teacher groups, thus the hypothesis was rejected. However, the average speech F0 showed to be strong single discriminator. Its mean value in the group of teachers with vocal fatigue, that is 176 Hz, suggests dysfunction. Several factors may explain the absence of acoustic differences between the two groups, one of the most compelling of which is the fact that both groups reported similar numbers of subjective vocal and physical complaints. The results confirm the complex phenomenology of vocal fatigue syndrome, and suggest that acoustic analysis may have limited power to detect it.

The treatment of exacerbations of chronic laryngitis in the vocal professionals

The objective of the present study was to develop a method for the comprehensive and uniform evaluation of the results of the treatment of vocal professionals experiencing exacerbations of chronic laryngitis under effect of physical factors. We propose the system of quantitative gradation of the main clinical and functional characteristics that should be taken into consideration for the assessment of the health status of the patients presenting with exacerbations of chronic laryngitis. In addition, the aggregate health index was calculated the dynamics of which can be used to estimate the results of the treatment. The quantitative criteria were developed for the expert evaluation of the temporary incapacity for work in the vocal professionals experiencing exacerbations of chronic laryngitis. It is concluded that the proposed approach can be employed by otorhinolaryngologists, phoniatrists, physiatrists, and developers of new technologies for the treatment of exacerbations of chronic laryngitis. Moreover, it is recommended for the application in out-patient and in-patient healthcare facilities, centresof restorative and rehabilitative medicine, medical research and development institutions.

Voice Needs and Voice Demands of Professional Newsreaders in Southern India

Newsreaders are elite vocal professionals who are highly dependent on their voice quality to meet professional commitments. Globally, the voice needs and demands of newsreaders could vary depending on technology and cultural variations. This study documents voice demands, voice needs, and vocal and nonvocal habits of professional newsreaders in Chennai, southern India through a questionnaire-based interview. Prospective, case-control study design. Forty-seven professional newsreaders and 47 non-newsreaders participated in the questionnaire-based interview that elicited information relevant to their profession and voice use. Majority of the newsreaders were not formally trained for newsreading. A significantly larger percentage of female newsreaders felt their jobs to be vocally demanding. Most newsreaders also had other full-time jobs that required a lot of speaking. Ninety-four percent of newsreaders consciously altered their voices while rendering news, and majority of them reported their voices to have changed considerably since they began newsreading. When compared with non-newsreaders, a significantly larger number of newsreaders were aware of voice problems, and many experienced some type of vocal technical difficulties. Seventy-seven percent of newsreaders took active measures to conserve their voice as opposed to non-newsreaders. Majority reported that sitting upright and erect while reading news helped produce the best vocal output for newsreading. The findings on voice needs and vocal and nonvocal habits among newsreaders in Chennai, India, provide valuable first-time information from this part of the world. These have potential application for voice professionals, voice trainers, and prospective aspirant newsreaders in developing strategies for voice care and in preventing voice problems.

Voice Disorders in Occupations with Vocal Load in Slovenia.

AimThe aim of this paper is to compare the prevalence of voice disorders and the risk factors for them in different occupations with a vocal load in Slovenia.MethodsA meta-analysis of six different Slovenian studies involving teachers, physicians, salespeople, catholic priests, nurses and speech-and-language therapists (SLTs) was performed. In all six studies, similar questions about the prevalence of voice disorders and the causes for them were included.ResultsThe comparison of the six studies showed that more than 82% of the 2347 included subjects had voice problems at some time during their career. The teachers were the most affected by voice problems. The prevalent cause of voice problems was the vocal load in teachers and salespeople and respiratory-tract infections in all the other occupational groups. When the occupational groups were compared, it was stated that the teachers had more voice problems and showed less care for their voices than the priests. The physicians had more voice problems and showed better consideration of vocal hygiene rules than the SLTs. The majority of all the included subjects did not receive instructions about voice care during education.ConclusionsIn order to decrease the prevalence of voice disorders in vocal professionals, a screening program is recommended before the beginning of their studies. Regular courses on voice care and proper vocal technique should be obligatory for all professional voice users during their career. The inclusion of dysphonia in the list of occupational diseases should be considered in Slovenia as it is in some European countries.

Backstage at Broadway: A Demographic Study

To provide insight into the demographics and vocal habits of current Broadway musical theater performers. Prospective, Questionnaire. Adult musical theater performers in Broadway Productions as defined by the League of American Theater Producers and the Actors' Equity Association were asked to complete a survey collecting demographic information, vocal health and habits, alcohol, tobacco, and drug use and information regarding their level of vocal comfort and threshold to miss performances based on their voice. Data were subjected to descriptive and statistical analysis based on sex and role type (lead vs. ensemble). One hundred thirty-five performers completed the survey from seven actively running shows. Ensemble members were younger and had not been in the business as long as performers in lead roles. Over 25% of respondents had been diagnosed with a vocal injury, yet the number of days missed per year due to voice problems was relatively low (1.7-4.7). Across all respondents, only approximately 54.8% reported consistently warming up before a performance and 7.4% reported consistently cooling down afterward. Nearly 91% of respondents reported regular alcohol consumption and tobacco use was 10.4%; 23.0% reported illicit drug use. This study marks the first time that vocal health has been addressed in this elite group of vocal professionals. The performer's low self-reported numbers of missed days is interesting particularly given that they appear to participate in harmful vocal health activities at the same rate as the general public.

Vocal therapy of hyperkinetic dysphonia.

Hyperkinetic (hyperfunctional) dysphonia is a common pathology. The disorder is often found in vocal professionals faced with high vocal requirements. The objective of this study was to evaluate the effects of vocal therapy on voice condition characterized by hyperkinetic dysphonia with prenodular lesions and soft nodules. The study included 100 adult patients and 27 children aged 4-16 years with prenodular lesions and soft nodules. A subjective acoustic analysis using the GIRBAS scale was performed prior to and after vocal therapy. Twenty adult patients and 10 children underwent objective acoustic analysis including several acoustic parameters. Pathological vocal qualities (hoarse, harsh and breathy voice) were also obtained by computer analysis. The subjective acoustic analysis revealed a significant (p<0.01) reduction in all dysphonia parameters after vocal treatment in adults and children. After treatment, all levels of dysphonia were lowered in 85% (85/100) of adult patients and 29% (29/100) had a normal voice. Before vocal therapy 9 children had severe, 13 had moderate and 8 slight dysphonia. After vocal therapy only 1 child had severe dysphonia, 7 had moderate, 10 had slight levels of dysphonia and 9 were without voice disorder. The objective acoustic analysis in adults revealed a significant improvement (p≤0.025) in all dysphonia parameters except SD FO and jitter %. In children, the acoustic parameters SD FO, jitter % and NNE (normal noise energy) were significantly improved (p=0.003-0.03). Pathological voice qualities were also improved in adults and children (p<0.05). Vocal therapy effectively improves the voice in hyperkinetic dysphonia with prenodular lesions and soft nodules in both adults and children, affectinq diverse acoustic parameters.

Perioperative Voice Recovery and the Vocal Folds: Perspectives From the Voice Care Team

Information regarding the significance of wound healing in laryngology is steadily increasing. Vocal fold tissue may be injured by phonotrauma (excessive impact from the opposing vocal fold), chemical agents (e.g., stomach acid), trauma, or iatrogenic causes (i.e., intubation, vocal fold surgery). Following injury, the affected area becomes inflamed. The body initiates cell proliferation and matrix deposition to begin the process of healing. Matrix remodeling during the healing process determines the degree of scar formation. Vocal fold scar has well-documented structural and functional consequences, and is notoriously difficult to manage (Hirano, 2005). Our roles as vocal professionals in relationship to the stages of wound healing change at key time points: before creating a wound, when making a wound, acute management (0–2 weeks), subacute management (2–8 weeks), and late management (8 weeks and beyond)..

Nurse Educators and the Future of Nursing

Calls for transformation in nursing education and practice abound. Nurses are part of a trusted profession, but they have been under-represented in conversations about health care compared with other, more vocal professionals. Nurses may not consider that they already have many leadership skills, and nurse educators in staff development roles are positioned to foster growth in other nurses. The relationship between nurse educators and their constituents provides the context for support that can motivate staff nurses to move beyond their concerns and accept challenges that may cause them some discomfort, such as writing for publication or public speaking. The leadership of nurse educators is essential to support colleagues who will shape the future of nursing.

Risk factors for the appearance of minimal pathologic lesions on vocal folds in vocal professionals

An excessive use or misuse of voice by vocal professionals may result in symptoms such are husky voice, hoarse voice, total loss of voice, or even organic changes taking place on vocal folds--minimal pathological lesions--MAPLs. The purpose of this study was to identify the type of MAPLs which affects vocal professionals, as well as to identify the risk factors that bring about these changes. There were 94 vocal professionals who were examined altogether, out of whom 46 were affected by MAPLs, whereas 48 of them were diagnosed with no MAPLs, so that they served as the control group. All these patients were clinically examined (anamnesis, clinical examination, bacteoriological examination of nose and pharynx, radiography of paranasal cavities, allergological processing, phoniatric examination, endo-video-stroboscopic examination, as well as gastroenterologic examination, and finally endocrinological and pulmological analyses). The changes that occurred most often were identified as nodules (50%; n = 23/46) and polyps (24%; n = 11/46). Risk factors causing MAPLs in vocal professionals were as follows: age, which reduced the risk by 23.9% [OR 0.861 (0.786-0.942)] whereas the years of career increase the risk [OR 1.114 (1.000-1.241)], as well as the presence of a chronic respiratory disease [OR 7.310 (1.712-31.218)], and the presence of gastro-oesophageal reflux disease [OR 4.542 (1.263-16.334)]. The following factors did not contribute to development of MAPLs in vocal professionals: sex, a place of residence, irritation, smoking, endocrinologic disease and the presence of poly-sinusitis. It is necessary to introduce comprehensive procedures for prevention of MAPLs, particularly in high-risk groups. Identification of the risk factors for MAPLs and prevention of their influence on vocal professionals (given that their income depends on their vocal ability) is of the highest importance.

The Vocal Load of Reform Jewish Cantors in the USA

Jewish cantors comprise a subset of vocal professionals that is not well understood by vocal health professionals. This study aimed to document the vocal demands, vocal training, reported incidence of voice problems, and treatment-seeking behavior of Reform Jewish cantors. The study used a prospective observational design to anonymously query Reform Jewish cantors using a 35-item multiple-choice survey distributed online. Demographic information, medical history, vocal music training, cantorial duties, history of voice problems, and treatment-seeking behavior were addressed. Results indicated that many of the commonly associated risk factors for developing voice disorders were present in this population, including high vocal demands, reduced vocal downtime, allergies, and acid reflux. Greater than 65% of the respondents reported having had a voice problem that interfered with their ability to perform their duties at some time during their careers. Reform Jewish cantors are a population of occupational voice users who may be currently unidentified and underserved by vocal health professionals. The results of the survey suggest that Reform Jewish cantors are occupational voice users and are at high risk for developing voice disorders.