The Voice and Its Care: Survey Findings From Actors'' Perspectives

There is a need for research that would determine how the speech-language-voice pathologist could best be of service to actors who are experiencing vocal dysfunction or in furnishing preventive educational information. A questionnaire investigating interest and knowledge levels of vocal function and dysfunction was distributed to 543 subjects from the Pacific Northwest and British Columbia. A total of 345 questionnaires, including those completed by 79 professional actors, 73 amateur actors, 124 acting students, and 69 controls, were analyzed. Professional actors and amateur actors indicated the highest levels of interest in gaining further knowledge regarding the role of the speech-language pathologist (SLP) and the voice and vocal hygiene. Professional actors and amateur actors also reported higher perceived knowledge levels than the other groups in these areas, although very few claimed to have a thorough knowledge in the areas under investigation. Professional actors answered more knowledge-based questions correctly than amateur actors, acting students, and controls in the areas regarding the role of the SLP and voice and vocal hygiene. However, the professional actors' scores were not significantly higher than amateur actors in either area and were only significantly higher than acting students on the vocal hygiene items. Implications for a preventive approach to vocal health are discussed.     

Voice Problems of Future Speech-Language Pathologists

Students training to be educators frequently exhibit voice disorders prior to employment. To date, there exist no similar studies of future speech-language pathologists (SLPs). The study is designed as a prospective, nonrandomized survey. The objective of this study is to determine the voice problems of first year graduate students training to be SLPs. Participants were 104 first year graduate students majoring in speech-language pathology at two universities. The Quick Screen for Voice was administered. Participants who failed completed a questionnaire regarding voice problems, medical history, daily habits, and voice use. When responses further indicated voice-related problems, endoscopic examination was completed. Fourteen percent (N=15) of the participants failed the screening by demonstrating two or more abnormal voice characteristics. These included persistent glottal fry (present in all who failed), low habitual pitch, juvenile resonance, hoarse, breathy, or strained phonation, abnormally low pitch on sustained vowels, and voice breaks during the frequency range. Twelve percent (N=12) failed both the screening and follow-up questionnaire. Responses included self-reported dysphonia, medical history with voice-related side effects, difficulty with excessive voice use, and voice problems occurring daily or weekly. Endoscopic evaluation showed one participant with bilateral vocal nodules. The results suggest that voice problems among future SLPs (12%) are more common than the 3-9% reported in the general population and similar to the 11% previously reported for teachers. However, future SLP voice problems are less frequent than those reported among education majors (21%) and all college students (17%). Faculty should identify students with voice problems and emphasize optimal voice use in classroom and clinical settings.     

Vocal Problems Among Teachers: Evaluation of a Preventive Voice Program

Vocal education programs for teachers may prevent the emergence of vocal disorders; however, only a few studies have tried to evaluate the effectiveness of these preventive programs, particularly in the long term. Two hundred and sixty-four subjects, mostly kindergarten and primary school female teachers, participated in a course on voice care, including a theoretical seminar (120 minutes) and a short voice group therapy (180 minutes, small groups of 20 subjects). For 3 months, they had to either attend the vocal ergonomics norms and, as psychological reinforcement, they had to make out a daily report of vocal abuse, or to follow the given exercises for a more efficient vocal technique, reporting on whether the time scheduled was respected or not. The effectiveness of the course was assessed in a group of 21 female teachers through a randomized controlled study. Evaluation comprehended stroboscopy, perceptual and electro-acoustical voice analysis, Voice Handicap Index, and a course benefit questionnaire. A group of 20 teachers matched for age, working years, hoarseness grade, and vocal demand served as a control group. At 3 months evaluation, participants demonstrated amelioration in the global dysphonia rates (P=0.0003), jitter (P=0.0001), shimmer (P=0.0001), MPT (P=0.0001), and VHI (P=0.0001). Twelve months after the course, the positive effects remained, although they were slightly reduced. In conclusion, a course inclusive of two lectures, a short group voice therapy, home-controlled voice exercises, and hygiene, represents a feasible and cost-effective primary prevention of voice disorders in a homogeneous and well-motivated population of teachers.     

An investigation of the Voice Handicap Index with Speakers of Portuguese: Preliminary data

Although the Voice Handicap Index (VHI) has been recognized as a useful tool for quantifying American English speakers' perceived consequences of voice disorder, it has not yet been widely applied in the clinic to study dysphonic patient populations, or tested with a normally speaking population. The purpose of this investigation was to obtain information about the VHI in a group of Portuguese speakers with voice complaints compared with an age- and gender-matched group of speakers without voice complaints. The results demonstrate that speakers with voice complaints have overall VHI total scores significantly higher than speakers without voice complaints (p < 0.001). This is also true for all VHI subscores in the emotional (p < 0.001), functional (p < 0.05), and physical (p < 0.001) domains. So, the assumption that a group with voice complaints has higher voice handicap impact than the matched control comparison group is justified for Portuguese speakers.     

Common Practices of Voice Therapists in the Evaluation of Patients

This study surveys voice therapists regarding common diagnostic practices in patients referred for therapy with the diagnosis of muscle tension dysphonia (broadly defined as the "hyperfunctional" component of the dysphonia). Through postings on the e-mail list of the ASHA special interest division on voice, speech pathologists with at least 3 years' experience in stroboscopy and acoustic instrumentation were invited to complete the survey. Results from 53 completed surveys demonstrated that voice quality and patient self-perception are the sole assessments performed by all therapists. Voice quality, observation of body posture and movement, and probing the patient's ability to alter voice production are each significantly more likely to be performed than the more objective stroboscopic, acoustic, aerodynamic, and EGG assessments. Further, the tasks of defining specific therapy session goals and helping the patient to achieve a particular target skill are considered best served by measures of vocal quality, observation of body position and movement, and judging the patient's ability to alter voice production. For definition of the overall therapy goal, stroboscopy and patient perception scales are added to all of the subjective assessment measures as being important. Acoustic data are considered most important for patient reinforcement and outcomes assessment. Implications of these findings are discussed, and topics for further exploration are identified.     

The Voice Handicap Index: Correlation Between Subjective Patient Response and Quantitative Assessment of Voice

The aim of this prospective study is to elucidate the relationship between the Voice Handicap Index (VHI) and several voice laboratory measurements in the network of the multidimensional voice assessment. Fifty-eight patients were included. Each patient replies to the questionnaire and performs a voice assessment during the same time. The following parameters were measured: minimum frequency, maximum frequency, range, minimum intensity, subglottic pressure, mean flow, maximum phonation time, jitter, and dysphonia severity index. Regarding the relationship with the scores of the VHI, poor correlations with the minimal frequency for all the scores except the emotional one (total and subscales) and with the range for only the physical one are found. Seventeen questions correlate with the voice laboratory measurements we performed, with a decreased distribution between physical, functional, and emotional subscales. We observe that acoustic parameter is correlated with the emotional subscale, the parameters of the profile range are more often involved in the emotional subscale, as is the minimal frequency, but never with the physical subscale, and all the subscales are interesting despite the smaller number of differences with the emotional one. The VHI and the laboratory measurements give independent informations in practice.     

Impact and Prevention of Voice Problems in the Teaching Profession: Embracing the Consumers'' View

Teachers are vulnerable to developing voice problems due to their specific occupational demands during teaching. Information on how the teaching profession is impacted by voice problems and what the profession perceives to be useful information for preventing voice problems is important for health care service providers. A total of 122 subjects from the teaching profession (55 practicing teachers and 67 prospective teachers) were therefore surveyed to ascertain their perception of their voice condition and the impact of voice problems on their communication, social life, personal emotions, and occupation. The results showed that the practicing teachers perceived their voice to be significantly worse than the prospective teachers. In addition, the teachers also faced significantly more difficulties in their daily communication than the prospective teachers. These two groups of subjects believed that information on breathing exercises and specific vocal hygiene strategies would help them prevent voice problems.     

Multidimensional Scaling of Breathy Voice Quality: Individual Differences in Perception

Experiments on disordered voice quality with multidimensional scaling (MDS) have resulted in solutions with low R-square and have failed to show consistent dimensions across different listeners. These findings have been suggested to indicate large individual differences in the perception of voice quality. However, these inconsistencies may originate from several factors, including random stimulus selection, instructions that encourage listeners to respond to global difference in pairs of voices, and noisy perceptual data. This experiment used MDS techniques to study individual differences in perception of breathiness. The voices in the experiment were selected to have a relatively wide variation in breathiness but only minimal variation in roughness, strain, and fundamental frequency. Additionally, listeners were instructed specifically to rate similarities in breathiness rather than judging global differences in voices, and several judgments from each listener were averaged to minimize noise in the data. It was hypothesized that these modifications would result in an MDS solution that accounted for greater variance in perceptual data than previously shown. Results show that averaging multiple responses from each listener increased the R-square from 45% to approximately 75%. The poor R-square and large individual differences in voice quality perception observed in past research may have partly resulted from the experimental procedures in previous studies. These findings suggest that individual differences in the perception of voice quality are not as large as previously thought, and a model of voice quality perception for an "average" listener may be a good representation for the general population.