Voice Hygiene Research Articles

Yang Xiinzi as a Representative of the Jin Telin Vocal and Performing School: Adapting the Principles of Bel Canto for the National Repertoire

The article highlights the work of the Chinese singer Yang Xiinzi, who gained popularity as a performer of mainly national vocal repertoire. The article examines the creative path of the singer, especially noting the successive relation of her performing principles with the school of Jin Telin, an outstanding teacher who produced a whole galaxy of famous vocalists playing iconic roles in the panorama of modern vocal culture in China. Special attention is paid in the article to the adaptation of the principles of bel canto for the performance of the national Chinese repertoire, which, using the example of Yang Xiinzi’s work, seems relevant and promising both professionally and in terms of voice hygiene.

Surgical management of vocal cord nodules in children: Trends and outcomes

ObjectivesVocal cord nodules (VCNs) are the most common cause of dysphonia in school-aged children, with potential negative impacts on quality of life including diminished self-esteem and academic performance. The standard of care for VCNs is conservative management which ranges from voice hygiene to speech therapy with a focus on voice otherwise known as voice therapy, with surgical excision reserved for refractory cases. Thus, few studies have analyzed outcomes of surgical management of VCNs. The purpose of this study is to assess the prevalence and efficacy of surgical excision of VCNs when compared to speech therapy. MethodsChildren with VCNs seen at a single tertiary care institution between 2015 and 2020 were identified by ICD-9 code 478.5 and ICD-10 code J38.2. Demographics, objective voice assessment, intervention, and follow-up assessment data were reviewed. Frequencies, medians, and interquartile ranges were calculated. Time to resolution and improvement were assessed by Cox proportional hazards model. Univariate logistic regression was performed. A P value of <0.05 was considered statistically significant. ResultsThree hundred sixty-eight patients diagnosed with VCNs were identified. 169 patients received intervention for VCNs, with 159 (43.2 %) receiving speech therapy alone and 5 (1.4 %) receiving surgery alone. On bivariate analysis, there was no significant difference in demographic features between treatment groups, however speech therapy patients did have a longer follow-up time. 154 patients underwent objective voice assessment at the time of VCN diagnosis. Among these patients, 95 (61.7 %) received speech therapy and 59 (40.3 %) received no intervention. Speech therapy patients had significantly higher pVHI scores, however there was no significant difference in CAPE-V Overall Severity scores or computerized voice assessment analysis. On Cox proportional hazards analysis, surgical intervention was associated with faster resolution and faster improvement of dysphonic symptoms. On binary logistic regression, surgery was associated with a significantly greater proportion of patients reporting resolution of dysphonic symptoms, however there was no significant difference in proportion of patients reporting improvement of dysphonia. ConclusionFor most patients with VCNs, conservative measures such as voice hygiene and speech therapy remain first line, however certain patients may benefit from the rapid improvement and resolution of symptoms that surgical intervention may provide.

Clinical analysis of 102 cases of pediatric vocal fold nodules

Objective:To evaluate the impact of vocal fold nodules on the quality of life of children, and to compare the efficacy between conservative management（voice hygiene education, etc.） and laryngeal microsurgery. Methods:A retrospective study was performed on 102 children with vocal fold nodules, who received treatment in Children's Hospital of Fudan University during the period from January 2020 to December 2022. According to the regime, the patients were divided into conservative management group and surgical treatment group; Cases are divided into pre-school age group （2-5 years old） and school-age group （6-12 years old） based on age. The pediatric voice-related quality of life （pVRQOL） was used to evaluate the impact of vocal fold nodules on the quality of life of children and differences in efficacy between two treatment regimens. Results:The pVRQOL scores of vocal fold nodule grades 1, 2, and 3 were 91.58±8.17, 78.87±12.49, 72.50±12.08, respectively. There were statistical differences between grade 1 and grade 2, and between grade 2 and grade 3. There were statistical differences between grade 1 grade 2, grade 2 and grade 3 （P<0.001）, suggesting that the higher the rating of vocal cord nodules, the lower the pVRQOL score of patients was. The pVRQOL score of the school-age group was 69.83±11.11, which is lower than that of the preschool group（87.59±8.63）, and the difference was statistically significant （P=0.042）. Vocal fold nodules had a significant impact on the pVRQOL score of school-age children. In the conservative management group, the pVRQOL scores before and after treatment were 83.99±12.66 and 87.26±9.58, respectively, and there was significant difference between the two groups（P=0.046）. Indirect voice therapy such as voice hygiene education could improve children's pVRQOL scores and was more effective for school-age children（P<0.001）. The microsurgical treatment had a more significant improvement in the pVRQOL score of children. Conclusion:The higher the rating of vocal fold nodules, the greater the impact on the quality of life of patients. Vocal fold nodules had a greater impact on the quality of life of school-age children than that of preschool children. Voice hygiene education could improve the quality of life of children, which was more evident in the school-age group. Compared with voice hygiene therapy, laryngeal microsurgery had a more significant effect on improving the pVRQOL score of patients. It is recommended to undergo laryngeal microsurgery for the treatment of vocal fold nodules for the requirement of improving the quality of life related to voice. During the 6-month follow-up period after surgery in this study, the short-term efficacy of laryngeal microsurgery in treating vocal cord nodules in children is clear, but the long-term efficacy needs further research.

Voice Outcomes of Intensive Voice Feminization Therapy for Transgender Women Delivered via Telepractice: Pilot Study

ObjectivesThe aim of this pilot study is to investigate the efficacy of an intensive voice feminization therapy program provided via telepractice. MethodsA total of 10 transgender women participated, with 9 completing the therapy program. All participants received 12 sessions of resonant voice therapy in combination with Vocal Function Exercises and voice hygiene, which were completed within four weeks. Acoustic and aerodynamic measures, auditory-perceptual ratings, Trans Woman Voice Questionnaire (TWVQ) and self-rated voice femininity were conducted before and after treatment. ResultsStatistical analysis showed significant improvements in acoustic measures such as fundamental frequency and semitones, TWVQ scores, auditory-perceptual ratings and self-perception of voice femininity after intensive voice therapy. ConclusionsThis study provides preliminary evidence to suggest that transgender women can benefit from intensive voice therapy when provided via telepractice, with a more feminine voice and better self-perceived voice-related quality of life. The limitations of this study were that the single-group study design lacked a control group for comparison, and the small sample size. Therefore, a randomize controlled and follow-up study with a larger sample size, exploring the effects of different treatment modalities on transgender women's voices is warranted.

Investigation of the Relationship Between Vocal Fatigue, Quality of Life, and Compliance With Vocal Hygiene in Professional Voice Users.

Intensive voice use may lead to the development of voice disorders or voice complaints, such as vocal fatigue, for professional voice users (teachers, academics, call center workers, actors, singers, speech and language therapists, voice trainers, and religious officials). Vocal fatigue has a detrimental effect on occupational, emotional, and social performance, besides the quality of life of the individual. The effect of voice hygiene interventions on voice fatigue is not fully known. The results of studies conducted with different occupational groups are inconsistent. The present study aims to analyze the relationship between vocal fatigue and voice-related quality of life (V-RQOL) in professional voice users, and the impact of vocal hygiene on vocal fatigue. Participants (24 male, 90 female), who were professional voice users without any diagnosis of voice disorders or voice complaints were divided into two groups low vocal hygiene compliance (LVH; n=66) and high vocal hygiene compliance (HVH; n=48). In this study, vocal fatigue was measured by the vocal fatigue index (VFI), and V-RQOL was measured by the voice handicap index (VHI-10) and V-RQOL. VFI subscales (tiredness, avoidance, physical discomfort) have a moderate positive correlation with VHI-10 and V-RQOL, which indicates that there is a significant relationship between vocal fatigue and quality of life amongst professional voice users. While there was no significant difference between the LVH and HVH groups in terms of quality of life, it was found that the vocal fatigue level of the LVH group was higher. This study of professional voice users with healthy voices reveals a relationship between vocal fatigue and V-RQOL. Vocal hygiene compliance may affect professional voice users' vocal fatigue symptoms; the low-compliant group has higher levels of tiredness, avoidance, and physical discomfort. The findings highlight the importance of raising awareness ofthe problems of professional voice users, even though they have healthy voices and the need for vocal hygiene education programs that target them.

Microsurgery of chronic laryngeal diseases using fiber optic lasers. A review

Background. The treatment of chronic diseases of the larynx is an urgent issue. Chronic larynx masses account for up to 5570% of the upper respiratory tract proliferative diseases. The incidence of vocal apparatus disorders is stable due to increased load on the vocal apparatus, neuro-emotional stress, non-compliance with voice hygiene (smoking, alcohol consumption), nasal and pharyngeal inflammatory diseases, sensibilization, and gastrointestinal disorders. Dysphonia, voice timbre changes, and vocal fatigue are presented in 712% of otorhinolaryngologist patients. Delayed treatment of chronic larynx diseases can lead to upper respiratory obstruction, reduced exercise and self-care tolerance, and disablement in people with voice and speech professions.&#x0D; Aim. To address current treatment methods for chronic diseases of the larynx. Modern surgical and non-surgical treatments of chronic larynx diseases aim to restore voice quality and respiratory function. Over the past 50 years, laser-assisted phonosurgery has gained popularity due to the many benefits of biological tissue exposure to electromagnetic energy and low rates of intra- and postoperative complications.&#x0D; Materials and methods. The literature review was performed using electronic medical libraries and professional printed papers. According to local and foreign data, laryngeal laser surgery is highly precise, minimally invasive, associated with no blood loss, and highly effective. Historically, CO2 laser has been used for the longest time in laryngeal surgery. Modern medical technology has recently introduced surgical systems with novel technicalities for clinical use. In such devices, the laser energy is transmitted through a flexible optical fiber instead of a mirror system, as in the CO2 laser, which has made new surgical high-energy systems more affordable for equipping medical institutions. Currently, the following fiber-optic laser systems are most often used to treat chronic diseases of the larynx: potassium-titanyl-phosphate, diode laser, and "blue" laser with a wavelength of 445 nm.&#x0D; Results. The literature review and analysis of surgical treatment outcomes using fiber-optic laser devices in patients with chronic larynx diseases showed high safety and effectiveness of modern treatments, providing fast recovery of voice and respiratory function.&#x0D; Conclusion. The development of laser devices, including domestic ones, with new wavelengths, makes it possible to work in contact mode in an inert gas environment, which opens up new opportunities for phonosurgery.

An Evaluation of Voice Hygiene in High School Choir Singers

Voice hygiene, including proper hydration and limiting phonotraumatic behaviors and refluxogenic foods when appropriate, is essential to voice care for singers. The purpose of this study was to evaluate voice care practices, knowledge, and factors correlating with improved voice hygiene and knowledge in adolescents, an understudied demographic within the singing population. 214 high school choir singers, ages 14 through 18, responded to a voice health questionnaire, which included questions about phonotraumatic behaviors and other lifestyle measures regarding voice care, perceived knowledge of the voice, and potential correlational factors such as past singing experience, having a friend or family member when is a professional voice user or possesses an in-depth knowledge of the voice, use of the Internet to sing better or improve understanding of the voice, and other factors. These data were analyzed using descriptive statistics and multivariable linear regressions. Results showed poor voice hygiene. Phonotraumatic behaviors were frequent and the mean daily water intake was only 5.24 cups. However, 94.4% of the respondents warmed up their voices before rehearsals or performances. The mean total knowledge score, from 0 to 6, was only 2.09. In addition, feeling that one took care of his/her voice well, and use of Internet to sing better or advance knowledge of the voice, were correlated with improved knowledge or measures of voice health. Data suggest that improved instruction regarding voice health in the high school setting is necessary and that the Internet or social media may be valuable resources for reaching adolescent singers.

Evaluation of the Effectiveness of Resonant Voice Therapy in Patients with Functional Voice Disorder

This study aims to determine the effectiveness of resonant voice therapy (RVT) in patients with functional voice disorder and to examine the subjective and objective voice changes after the therapy. This study adopted an experimental research design with a pretest-posttest control group. Thirty-four women participated in the study-17 in the experimental group and 17 in the control group. Voice hygiene training and RVT were applied to the experimental group. The Turkish version of the Voice Handicap Index (VHI-10) and GRBAS (Grade, Roughness, Breathiness, Asthenia, and Strain)scale were used for subjective voice assessment. Voice recordings were subjected to acoustic analysis on the PRAAT program. After an 8-week therapy program, the same process was repeated for post-test assessment. In the voice analyses performed after RVT, which was applied to patients with functional voice disorders, the results of the acoustic analysis showed statistically significant differences in jitter, PPQ5, RAP, shimmer, APQ11, and NHR parameters. Subjective voice analysis indicated a statistically significant decrease in VHI-10 scores from 20.88±5.33-9.06±3.3 in the experimental group. The GRBAS score was 4.29±1.2 before the therapy and 1.71±1.1 after the therapy, which is a statistically significant decrease. The results point out that RVT has been effective in improving the objective and subjective parameters of patients with functional voice disorders. RVT applied to patients with functional voice disorders provides significant improvement in acoustic and perceptual voice parameters. The RVT is an effective therapy method in the treatment of patients with functional voice disorders and should be considered as a therapeutic option.

갑상선 절제술 전후 음성치료

Many patients undergone thyroidectomy show subjective voice changes, neck and throat discomfort, lower pitched voice &amp; high pitch difficulty, and hoarseness. These patients need preoperative and postoperative voice therapy. Using TVSQ and PSVT, subjective voice problems and the need for voice therapy were recognized. Before surgery, it is necessary to alleviate psychological difficulties through voice hygiene education and counseling. After surgery, muscle relaxation exercise and massage of the larynx and neck &amp; shoulder, laughing approach, humming, and SOVTE(lip trill) can induce high-pitched voice and reduce the glottal gap.

Voice Outcomes of Straw Phonation Exercises for Telephone Customer Service Staff

This study aimed to investigate the effectiveness of a straw phonation exercise program in preventing voice problems in telephone customer service staff. Prospective study. Twenty-eight participants with no obvious voice problems were placed into two groups: the experimental (n=13) and control (n=15) groups. The experimental group received voice hygiene instructions and participated in a 3-week straw phonation exercise program, while the control group only received voice hygiene instructions. The acoustic parameters and Mandarin Chinese version of the Vocal Fatigue Index (CVFI) scores were statistically analyzed before training, immediately after training, followed up one and 3 months after training. The results showed that speaking fundamental frequency (SF0), shimmer, and cepstral peak prominence (CPP) of the experimental group improved immediately after the straw phonation exercise program, and shimmer of the experimental group after training was also significantly lower than that of the control group. A higher SF0 and lower shimmer were noted in the experimental group during the follow-up phase, whereas factors 1 (voice load and fatigue) and 2 (physiological symptoms) of the CVFI did not differ significantly until the third month after training. The study results suggest that the straw phonation exercise program can help telephone service staff to establish an appropriate speaking pitch and prevent voice fatigue.

How to speak and vocal hygiene.

An abnormal tongue shape, pitch difference or voice quality can lead to difficulty communicating effectively. Common among teachers are voice issues, which can be uncomfortable and make it challenging to carry out daily tasks and work-related activities. 1 Teacher who suffers from voice disorders may have trouble communicating clearly with their students. Voice disorders affect negatively a teacher's ability to communicate effectively throughout the day and their emotions, leading them to feel inadequate and frustrated at times. Voice misuse is inappropriate voice usage. It includes speaking involving hard glottal attacks and cheerleading for an extended period. 2 Vocal abuse is defined as activities having a detrimental effect on the larynx and voice. These include yelling and screaming, excessive talking or singing, excessive talking with an upper respiratory infection or allergy. It is important to identify and reduce the phono traumatic behaviours (for example loud voice use, speaking over background noise, throat clearing, cheering and screaming, and unconventional voice production), awareness about the vocal mechanism, and address high-risk situations associated with speech. In addition, it involves controlling how much you talk, monitoring your pitch and intensity (The speech of a typical adult male will have a basic frequency from 85 to 155 Hz, and a typical adult female ranges from 165 to 255 Hz.) 3 and conserving your voice by resting it. A healthy voice is dependent upon several factors, including local lubrication (About 15.5 cups (3.7 litres) of fluids per day are recommended for men. 11.5 cups (2.7 litres) of fluids per day is recommended for women)4, necessary dietary choices; as well as eliminating the effect of medications, environment, and healthy lifestyle choices (reduction of alcohol, recreational drugs, tobacco, and caffeinated beverages,). 5.Voice hygiene has two primary goals: to improve communication effectiveness and to promote vocal health. Additionally, by fostering optimal vocal habits as a precautionary measure, your voice will be maintained healthily, reducing the risk of vocal injury. Voice hygiene awareness can help all professionals, especially teachers, to maintain voice quality. We believe regular voice use is a right of every individual, and understanding is needed to make people aware of voice disorders and how to prevent them. As professionals, we can assist and help out people with voice disorders or professionals at risk of acquiring voice disorders to rule out possible causes and treatment strategies.

Voice Problems Among School Teachers employing the Tele-teaching Modality

To assess the prevalence of voice problems among teachers in Riyadh during tele-teaching and examine the relationship between the Voice Handicap Index 10 (VHI10) scores and a variety of risk factors believed to be related to voice problems. We also assessed awareness of voice hygiene and therapy among teachers. An observational cross-sectional study conducted using a multistage random sampling method among Riyadh school teachers who taught by tele-teaching for a minimum of one year. A self-assessment questionnaire which included demographic information about teachers, factors related to their teaching backgrounds, tele-teaching settings, effects of tele-teaching on the voice, medical and social histories, reports of voice and reflux symptoms, VHI10, and general knowledge about voice hygiene. This was distributed to school teachers using an SMS link through the Ministry of Education's IT department. A total 495 were included in the study after exclusions. The prevalence of teachers who had significant voice problems during tele-teaching (VHI10>11) was 21.6%. Multiple risk factors significantly increased the risk of voice problems during tele-teaching. These factors included being female, teacher age, the presence of background noise from both teachers and students, loud voices, using an open camera during the teaching, stress and anxiety, allergies, respiratory disease, reflux, hearing problems, and a family history of voice problems. Only 4.6% of respondents were familiar with voice hygiene and voice therapy, but 65% believe that it is important for teachers to be knowledgeable about them. Due to the lower prevalence of voice disorders among tele-teaching compared to traditional teaching methods, tele-teaching may be a viable option for teachers who have voice problems. There are still several factors influencing voice problems among tele-teachers. To attenuate potential risks, it is crucial that teachers are aware of the concepts of voice hygiene and voice therapy.

The Effect of Vocal Hygiene Training Via Videoconference in Teachers’ Voices

Voice disorders are frequently seen among teachers. Intense and inappropriate use of the voice is the most frequent reason. In the literature, studies supporting the positive effect of voice hygiene behaviors to the voice in teachers exist. In the v pandemic era that we pass through, it's being observed that teaching via videoconference is becoming widespread all around the world. The primary aim of this study is to evaluate the risk factors for self-assessed "not normal" voice in teachers, in the light of their demographic and vocational information and voice hygiene behaviors. Our second aim in this study is to evaluate the effect of voice hygiene training via videoconference on teachers' voice. We believe this will contribute in shaping today's therapy modalities in vocal training. One hundred nine teachers, working as primary, secondary or high school teacher actively in different cities in Turkey, between 25 and 55 years of age participated and self-assessed their voice by filling the survey including demographic, occupational, medical history and voice symptoms and vocal behaviors data as well as Voice Handicap Index (VHI)-10 ve voice self rating scale (VSRS). The teachers with VHI-10 score below 5 and VSRS score "normal" were assumed to have "Normal Voice." The teachers with VHI-10 score 5 or above and VSRS "Not Normal" (mild, moderate or severe) (N=52) were assigned to "Voice Hygiene Group" and were invited to videoconference for a voice hygiene session. Four weeks after this session, the survey, VHI-10 and VSRS were repeated and the results were compared. In the first phase of the study, risk factors for not being in "Normal Voice" group for the teachers have been assessed. "Having chronic disease" and "having experienced voice problem before" have been found to be risk factors. In the second phase of the study, 52 teachers have been invited to online "Voice Hygiene" videoconference session; only 18 teachers have attended in total of three attempts of sessions. When vocal behaviors before and after the videoconference were compared, positive changes have been observed in five vocal behaviors including "avoiding smoking," "drinking enough water daily," "eating healthy food," "avoiding excessive meals," "avoiding frequent throat clearing," however VHI-10 and VSRS scores have not showed a meaningful change. Only one teacher has progressed to "normal voice" from "Voice Hygiene Group." We believe further controlled studies with more participants adherent to videoconference sessions will be needed in order to shape today's therapy modalities.

Predictive Risk Factors and Occupational Impact of Self-Perceived Voice Problems in Preschool-Kindergarten versus First- to Sixth-Grade Teachers

Aim: The aim of this investigation was to complete a further analysis of existing data to compare risk factors of voice problems as well as create a hierarchical ranking of risk factors in preschool-kindergarten and 1st- to 6th-grade teachers in order to develop a voice hygiene program and prioritize its goals for each group of teachers. Methods: An online survey was completed by 148 preschool-kindergarten and 301 1st- to 6th-grade public school teachers. Participants were divided into four groups, preschool-kindergarten and 1st- to 6th-grade teachers with no self-perceived voice disorders and preschool-kindergarten and 1st- to 6th-grade teachers with self-perceived voice disorders. A χ2 test and a multivariate logistic regression model were used to examine the differences in answers between the preschool-kindergarten teachers with and without voice disorders and the 1st- to 6th-grade teachers with and without voice disorders and to identify the most important predictors. Results: The significant predictors for preschool-kindergarten teachers are frequently or sometimes continuing to talk after a breath cycle and being exposed to an excessive or a lot of noise generated in the classroom. The significant predictors for 1st- to 6th-grade teachers include having short breaks between classes and continuing to talk frequently after a breath cycle. Conclusions: Job-related risk factors in preschool-kindergarten and in 1st- to 6th-grade teachers may vary. Therefore, a preventative vocal hygiene education program specifically tailored for each population of teachers is suggested.

Competences of the interpreter

The article describes the practical skills of the interpreter. It reviews necessary professional skills essential for the interpreter. The author describes professional and innate abilities as vital when mastering and improving one’s skills of the simultaneous interpretation: mental alertness, long-term and operational memories, diaphragm breathing, and communication skills. The presentation plays a decisive role in the interpretation, in this regard, the author speaks about the problem of the working tool of the interpreter: voice hygiene. A special place in the article is devoted to the concept of the background knowledge, cultural competence, and their practical significance for the interpreter. The author concludes that range and richness of the background knowledge means more than recent news from media. The article also depicts the grounds of common mistakes in studying interpretation. In conclusion, the author emphasises the necessity of interpreters’ motivation and qualified training that together with personal development and experience of intercultural communication can result in a competent professional interpreter.

Effect of a Workplace Vocal Health Promotion Program and Working Conditions on Voice Functioning of College Professors

To determine the effect of a Workplace Vocal Health Promotion Program (WVHPP) and working conditions on voice functioning of college professors. This is a pre-post intervention study. College professors were randomly assigned in a control group or an intervention group. Participants filled out a questionnaire and recorded a voice sample at baseline and at the end of the follow-up. This program contains four sessions (2 face-to-face and 2 virtual sessions; one per week) focused on voice hygiene, vocal training, and strategies to modify teaching-learning process. The Intervention group (n=15) showed increased scores in V-RQOL in comparison with the control group (n=14), but the effect was not statistically significant. After the program, shimmer decreased (P=0.05), whereas MPT and HNR increased (P=0.02 and 0.04 respectively) among professors in the intervention group after the implementation of the WVHPP. Concerning working conditions, number of students per class was statistically associated with SPL. MPT was statistically associated with age and good acoustics inside the classroom. Our results indicate that implementation of a WVHPP, as well as working conditions, influence voice functioning measured by means of instrumental voice measures and voice-related quality of life. Therefore, workplace promotion programs may be good approaches to decrease the high prevalence of voice disorders among professors.

A study of voice quality in obese Egyptian children

BackgroundObesity is considered a health problem that affects many systems of the body among which the respiration and voice. The objective of the study was to analyze the impact of obesity in children on quality of their voice. Thirty obese children were included in this cross-sectional study and compared to 30 age- and sex-matched healthy children as a control group. Voice of cases and controls were assessed subjectively by auditory perceptual assessment and objectively by studying acoustic parameters using Computerized Speech Lab. Flexible laryngoscopy was done for cases with dysphonia.ResultsDysphonia perceived in 60% of cases, voice analysis revealed increased jitter and noise to harmonic ratio with significant difference than controls.ConclusionThe voice of children with morbid obesity reveals significant modifications pertaining to vocal characteristics in comparison to non-obese persons, so voice hygiene and voice therapy could be added to their therapy program as prophylactic or therapeutic management of voice disorder.

Pediatric Unilateral Vocal Fold Paralysis: Workup and Management

This paper will examine recent advances in the assessment and management of pediatric unilateral vocal fold motion impairment (VFMI). Unilateral VFMI can have a considerable impact on pediatric voice, swallowing, and pulmonary hygiene. In addition, postoperative VFMI in children undergoing congenital cardiac procedures is associated with longer lengths of stay. Laryngeal ultrasound (LUS) is an adjunctive tool that can be used to assess vocal fold mobility in patients who cannot tolerate traditional flexible nasolaryngoscopy (FNL) or for those in whom FNL is non-diagnostic. Laryngeal electromyography (LEMG) can help differentiate neuronal causes of vocal fold paralysis from mechanical cricoarytenoid joint fixation. Recent data suggests that preoperative LEMG may be used to predict voice outcomes after non-selective laryngeal reinnervation (NSLR). NSLR is a promising treatment modality for permanent vocal fold medialization in children. An emphasis on early diagnostic and prognostic techniques, such as the use of LUS and LEMG, can inform decision-making in unilateral VFMI treatment. NSLR is emerging as the preferred treatment modality for pediatric unilateral VFMI due to neuronal injury.

Self-Perception of Vocal Loading Effects and Short-Term Voice Care Outcomes in Egyptian Soccer Fans Volunteers

Background: Soccer fans create violent vocalizations for hours and not adjust their voices as professional voice users. Acute phonotrauma is the result of sound produced when one's voice is shouted or strained. To our knowledge, no further studies are available in the research area performed on a related group of samples in Egypt.Objective: Self-assessment of acute changes in voices of soccer fans who volunteered to the current study after a soccer match as a vocal loading challenge and assessed in three different times (pre-match, post-match) and 1 week post-match after receiving vocal hygiene measures and investigate the impact of voice hygienic measures in overloading vocal tasks.Patients and Methods: During the 2019 Africa Cup of Nations a longitudinal follow-up was conducted among volunteer soccer fans. Clinical laryngoscopic examination (CLE) was performed to all participants to exclude vocal fold lesions before the match. Auditory perceptual voice analysis (APA), and Voice Handicap Index (VHI) questionnaire were adminstered in three time points apart: before the match, within 9 to 15 h post-match, and 1 week after the match. All participants were subjected to voice hygiene instructions post-match and reevaluated after 1 week.Results: VHI scores increased statistically significantly after the match, compared with pre-match scores (P < 0.05). There was a significant positive correlation between post-match VHI scores and post-match dysphonia grade (P < 0.05). Positive statistical significance was found when comparing grade of dysphonia post-match and follow-up.Conclusion: Phono-traumatic behaviors are the likely source of vocal impairment. It is thought that VHI and perceptual voice analysis should be done together for diagnosis and follow-up of voice changes in vocal loading tasks. Short-term vocal hygiene program was beneficial in improving vocal quality.

Lung volume affects the decay of oscillations at the end of a vocal emission

At the end of a vocal emission, when the voicing is not interrupted by a laryngeal closure, a damped oscillatory motion of each vocal fold can be observed after the last contact phase of the two fold edges on the midline. It can be precisely analysed using a measure of transglottal light intensity (photoglottography). Actually, during modal phonation, the vocal oscillator mainly comprises two components: the vocal folds themselves and the vibrating air mass. A simple calculation suggests that the internal air mass set into vibration is larger than the vocal fold mass. In order to investigate the effect of the vibrating air mass, a voicing protocol was elaborated for validly measuring and comparing damping characteristics in two conditions: at high and at low lung volume, ceteris paribus. Glottal area, intraoral pressure, electroglottogram and sound were recorded simultaneously. Elaborated voicing protocol consisted in series of fast repetitions (3–4 s−1) of the vowel /ε/, each vocalization being followed by an abrupt bilabial occlusion with complete airflow interruption. The average difference in lung volume between the two conditions is approximately 2410 mL. The results show that the decay of vocal fold oscillation is influenced by the amount of lung air that is set into oscillation. A reduction of the air volume leads to a significant increase in the rate of decay, thus voicing at low lung volume requires more energy, which is of importance for voice hygiene.