The Voice Handicap of Student-Teachers and Risk Factors Perceived to Have a Negative Influence on the Voice

A cross-sectional questionnaire survey was performed. The objectives of the study were to assess the psychosocial impact of current voice complaints as perceived by student-teachers with voice complaints in comparison with student-teachers without voice complaints, and to observe the pattern of risk factors in relation to their voice handicap. Subjects in the general population without a voice-demanding profession were selected as a reference group for limited comparison with the total group of student-teachers (future professional voice users). The respondents to the questionnaires were anonymous. Among the student-teachers, 17.2% reported current voice complaints in comparison with 9.7% of the reference group, and the odds ratio was 1.94, which showed the relative risk. Student-teachers had significantly greater total Voice Handicap Index (VHI) scores than the reference group (P = 0.034). The VHI subscale scores were not significantly different (P > 0.05). Student-teachers who reported current voice complaints had a significantly higher total VHI and subscale scores than student teachers without voice complaints (P < 0.001). Of the student-teachers without voice complaints, 17.0% had VHI scores greater than the 75th percentile. These persons may be neglecting their voice handicap and probably represent the false-negative cases in the estimation of voice complaints. Logistic regression analysis of each of the given risk factors with the VHI as the independent variable showed that the perceived negative influence of the given risk factors on their voices was significantly greater with increasing VHI scores across the VHI range. A significant correlation was observed between the number of perceived risk factors and increasing VHI scores across the VHI range. An increased awareness of risk factors in relation to their voice handicap would serve to motivate student-teachers to change factors that contributed to their voice problem. Attention to all risk factors, which the subjects perceive to be a risk, would aid in effective management of their voice handicap.     

Acoustic Measures of Phonatory Improvement Secondary to Treatment by Oral Corticosteroids in a Professional Singer: A Case Report

Short-term administration of corticosteriods is sometimes indicated for professional voice users experiencing laryngeal edema and/or inflammation. Unfortunately, no data are available to document the effectiveness of these medications to improve phonatory parameters. We present a case report of a 32-year-old male professional singer with vocal fold edema experiencing imminent vocal demands who was prescribed a 6-day course (dose-pack) of oral methyl prednisolone. Endoscopic and stroboscopic evaluations were completed premedication and postmedication, and acoustic measures of phonatory function were obtained premedication, 3 days during the dose cycle, 5 days during the dose cycle, and 1 day postmedication. Postmedication results revealed an increase in fundamental frequency (F0) and large decreases in jitter, shimmer, long-term frequency, and amplitude variability. These corresponded with patient and evaluator perceptual measures of improved voice, and with endoscopic observations of reduced edema. The benefits and risks of corticosteroid therapy are discussed, specific to their use in the professional voice population.     

Outcome of laryngeal manual therapy in four Dutch adults with persistent moderate-to-severe vocal hyperfunction: a pilot study

A relatively new management strategy for the treatment of voice disorders is the use of laryngeal manual therapy. The main purpose of the present pilot study is to document the outcome of vocal quality after a well-defined laryngeal manual therapy (LMT) program. Four Dutch professional voice users with a persistent moderate or severe muscle tension dysphonia were studied pretreatment (1 week before LMT) and posttreatment (1 week) after completion of manual therapy (25 sessions). These subjects had received several months of traditional voice therapy, without any success. To measure and compare, the effect of LMT objective and subjective assessment techniques were used. Perceptual voice assessment included a perceptual rating of the voice using the GRBAS scale. Furthermore, the vocal quality in this population was modeled by means of the Dysphonia Severity Index (DSI). All of the subjects selected for LMT showed improvement in perceptual vocal quality and DSI values. As the DSI is a weighted variable including aerodynamic and acoustic measures, small improvements (closer to 5) are very indicative of vocal quality improvement.¹ The use of LMT in professional voice users with persistent moderate-to-severe muscle tension dysphonia, especially in some subjects who have not responded to traditional voice therapy, is supported by this pilot study.     

Voice problems in a small swedish town: A retrospective study of the prevalence and a follow-up

The prevalence of voice problems among patients consulting the primary health care unit of a small Swedish town during 1984 was investigated. A study of the records of 11,606 patients indicated that 102 of them consulted their doctor mainly because of voice problems. The period prevalence of voice problems in the population of 20,049 people was 0.5%. A follow-up examination 1 year later indicated that 44% of these patients still had voice problems. Among the patients with a voice disorder diagnosis made by means of indirect laryngoscopy in 1984, 72% still had a voice disorder diagnosis at the follow-up. It is pointed out that the doctor who is seeing a patient with voice problems should make a thorough examination including indirect laryngoscopy. It is also important to discuss the patient's smoking habits and professional vocal strain to prevent recurrence.     

Treatment Outcomes for Professional Voice Users

Professional voice users comprise 25% to 35% of the U.S. working population. Their voice problems may interfere with job performance and impact costs for both employers and employees. The purpose of this study was to examine treatment outcomes of two specific rehabilitation programs for a group of professional voice users. Eighteen professional voice users participated in this study; half had complaints of throat pain or vocal fatigue (Dysphonia Group), and half were found to have benign vocal fold lesions (Lesion Group). One group received 5 weeks of expiratory muscle strength training followed by six sessions of traditional voice therapy. Treatment order was reversed for the second group. The study was designed as a repeated measures study with independent variables of treatment order, laryngeal diagnosis (lesion vs non-lesion), gender, and time. Dependent variables included maximum expiratory pressure (MEP), Voice Handicap Index (VHI) score, Vocal Rating Scale (VRS) score, Voice Effort Scale score, phonetogram measures, subglottal pressures, and acoustic and perceptual measures. Results showed significant improvements in MEP, VHI scores, and VRS scores, subglottal pressure for loud intensity, phonetogram area, and dynamic range. No significant difference was found between laryngeal diagnosis groups. A significant difference was not observed for treatment order. It was concluded that the combined treatment was responsible for the improvements observed. The results indicate that a combined modality treatment may be successful in the remediation of vocal problems for professional voice users.     

Normal strobovideolaryngoscopy: Variability in healthy singers

Strobovideolaryngoscopy has proven essential to accurate diagnosis of voice disorders. Clinical interpretation of stroboscopic images usually follows a standard assessment protocol. Features analyzed typically include symmetry of amplitude, symmetry of phase, regularity of periodicity, amplitudes and wave forms of individual vocal folds, presence or absence of a dynamic segments, and other features. Speed and smoothness of abduction and adduction are also assessed. In order for stroboscopic data to be used meaningfully in a clinical setting, it is essential for the laryngologist to recognize the range of normal variability of these parameters. This may be particularly important when trying to establish diagnoses for subtle voice disorders in professional voice users. This study investigates strobovideolaryngoscopic findings in a population of normal professional singers without voice complaints. “Abnormal” strobovideolaryngoscopic findings occur in this asymptomatic population of “volunteers”. These abnormalities might have been misinterpreted as causing voice complaints if seen for the first time when the singer sought medical care for a voice problem. Physicians must be aware of the range of laryngeal behavior that may be found among normal subjects and must be cautious when interpreting strobovideolaryngoscopic findings. This study also highlights the importance of obtaining “normal” baseline strobovideolaryngoscopic evaluations on professional voice users. The review of strobovideolaryngoscopy performed upon 65 healthy, asymptomatic professional singers revealed an incidence of 58% “abnormal” findings as six clinical entities.     

Plastic surgery in professional voice users: Special considerations

Many professional voice users undergo cosmetic plastic surgery. Cosmetic procedures can be especially important for the professional who needs to improve appearance to enhance his or her career. It is essential for any patient considering such surgery to fully define the cosmetic change desired, to choose the appropriate procedure, and to avoid complications as much as possible. It is especially important for the professional voice user planning plastic surgery to understand the special considerations that could affect both the voice and the ability to perform in general. He or she must be able to choose a surgeon who understands the special needs of the professional voice user, who can make the appropriate decisions regarding anesthesia and choice of surgical procedures, and who understands both the transient and potentially permanent sequelae of cosmetic plastic surgery. With this knowledge, surgery can be planned that minimizes potential complications involving the voice or the artist's performing schedule.     

Vocal fold hemorrhage associated with coumadin therapy in an opera singer

Vocal fold hemorrhage can represent a disastrous and potentially career ending injury to a singer or professional voice user. The risk factors of vocal fold hemorrhage, including laryngeal trauma, phonotrauma, aspirin and nonsteroidal antiinflammatories, and hormonal imbalances are well known. We present a case of an opera singer who developed recurrent vocal fold hemorrhage associated with coumadin anticoagulation therapy. This case highlights the importance of the risk of vocal fold hemorrhage to professional singers and professional voice users and offers an alternative to long-term coumadin therapy in this select population.     

Prevalence of voice problems in teachers

Teachers are frequently cited as experiencing a high rate of vocal dysfunction (1–7). Despite considerable research in the area of voice problems in teachers, the prevalence of voice disorders in this group is unknown. This study investigated the prevalence of self-reported voice problems in teachers using a mail survey of a simple random sample of 1168 state school teachers (preschool-Grade 12) in South Australia. As part of the survey, teachers were asked to report voice problems for the day of the survey, during the current teaching year, and during their careers. The response rate was 75%, with 16% of teachers reporting voice problems on the day of the survey, 20% reporting problems during the current teaching year, and 19% reporting problems at some time during their career. Females were twice as likely as males to report voice problems. These findings clearly indicate a need for further investigation of the causes of vocal dysfunction in teachers and for the development of educational programs aimed at preventing voice problems in this group of professional voice users.     

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

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

Poor Voice Quality in Future Elite Vocal Performers and Professional Voice Users

The voice quality of 86 occupational voice users, i.e., students of a high school for audiovisual communication, was assessed by means of a multidimensional test battery containing: the GRBAS scale, videolaryngostroboscopy, maximum phonation time, jitter, lowest intensity, highest frequency, dysphonia severity index (DSI), and voice handicap index (VHI). In a questionnaire on daily habits the prevalence of smoking, eating habits, and vocal abuse were recorded. A comparison of the voice characteristics of the future occupational voice users with a control group revealed significant differences. The results of the VHI and the DSI of these students revealed significantly worse scores than the score of a control group characterized by no vocal complaints. Moreover, the questionnaire on daily habits showed that the future elite vocal performers and professional voice users take less precautions for the care of their voices. These findings support the importance of a good balanced vocal coaching.     

The professional voice: Part II. Physical examination

Physical examination of professional voice users should incorporate not only a complete otolaryngologic evaluation and appropriate general physical examination, but also special studies. Evaluation of the patient during actual singing or projected speaking is important. Special instrumention including strobovideolaryngoscopy is invaluable, and objective measures of voice function add much to diagnosis and analysis of treatment results.     

Voice-over: Perceptual and Acoustic Analysis of Vocal Features

Voice-overs are professional voice users who use their voices to market products in the electronic media. The purposes of this study were to (1) analyze voice-overed and non-overed productions of an advertising text in two groups consisting of 10 male professional voice-overs and 10 male non-voice-overs; and (2) determine specific acoustic features of voice-over productions in both groups. A na?ve group of listeners were engaged for the perceptual analysis of the recorded advertising text. The voice-overed production samples from both groups were submitted for analysis of acoustic and temporal features. The following parameters were analyzed: (1) the total text length, (2) the length of the three emphatic pauses, (3) values of the mean, (4) minimum, (5) maximum fundamental frequency, and (6) the semitone range. The majority of voice-overs and non-voice-overs were correctly identified by the listeners in both productions. However voice-overs were more consistently correctly identified than non-voice-overs. The total text length was greater for voice-overs. The pause time distribution was statistically more homogeneous for the voice-overs. The acoustic analysis indicated that the voice-overs had lower values of mean, minimum, and maximum fundamental frequency and a greater range of semitones. The voice-overs carry the voice-overed production features to their non-voice-overed production.     

Voice Care Knowledge Among Clinicians and People With Healthy Voices or Dysphonia

An important clinical component in the prevention and treatment of voice disorders is voice care and hygiene. Research in voice care knowledge has mainly focussed on specific groups of professional voice users with limited reporting on the tool and evidence base used. In this study, a questionnaire to measure voice care knowledge was developed based on "best evidence." The questionnaire was validated by measuring specialist voice clinicians' agreement. Preliminary data are then presented using the voice care knowledge questionnaire with 17 subjects with nonorganic dysphonia and 17 with healthy voices. There was high (89%) agreement among the clinicians. There was a highly significant difference between the dysphonic and the healthy group scores (P = 0.00005). Furthermore, the dysphonic subjects (63% agreement) presented with less voice care knowledge than the subjects with healthy voices (72% agreement). The questionnaire provides a useful and valid tool to investigate voice care knowledge. The findings have implications for clinical intervention, voice therapy, and health prevention.     

Effect of Dysphonia and Cognitive-Perceptual Listener Strategies on Speech Intelligibility

There is a high prevalence of dysphonia among professional voice users and the impact of the disordered voice on the speaker is well documented. However, there is minimal research on the impact of the disordered voice on the listener. Considering that professional voice users include teachers and air-traffic controllers, among others, it is imperative to determine the impact of a disordered voice on the listener. To address this, the objectives of the current study included: (1) determine whether there are differences in speech intelligibility between individuals with healthy voices and those with dysphonia; (2) understand whether cognitive-perceptual strategies increase speech intelligibility for dysphonic speakers; and (3) determine the relationship between subjective voice quality ratings and speech intelligibility. Sentence stimuli were recorded from 12 speakers with dysphonia and four age- and gender-matched typical, healthy speakers and presented to 129 healthy listeners divided into one of three strategy groups (ie, control, acknowledgement, and listener strategies). Four expert raters also completed a perceptual voice assessment using the Consensus Assessment Perceptual Evaluation of Voice for each speaker. Results indicated that dysphonic voices were significantly less intelligible than healthy voices (P ≤ 0.001) and the use of cognitive-perceptual strategies provided to the listener did not significantly improve speech intelligibility scores (P = 0.602). Using the subjective voice quality ratings, regression analysis found that breathiness was able to predict 41% of the variance associated with number of errors (P = 0.008). Overall results of the study suggest that speakers with dysphonia demonstrate reduced speech intelligibility and that providing the listener with specific strategies may not result in improved intelligibility.     

The Effects of a Specific Speech and Language Training Program on Students of a Radio Announcing Course

The purpose of this study was to determine whether individuals show differences in speech and voice during reading of the same news before and after attending a radio announcing course. Twenty-five students of a Radio Announcing Course in Sao Paulo city, 17 men and 8 women, aged 19 to 55 years, participated in this study. The readings were recorded in a professional audio studio, and the speech samples were submitted to perceptual and acoustic analysis. For the perceptual analysis, the samples were randomly presented in pairs and five trained speech pathologists identified each recording as pre- and posttraining, and also justified their choices by indicating what parameters better based their judgment: type of voice, articulation and pronunciation, loudness, pitch, resonance, speech rate, respiratory coordination, and use of emphasis. The acoustic parameters analyzed were mean, minimum, and maximum fundamental frequency, frequency range, text duration, and pause duration. The perceptual analysis showed that the posttraining speech samples were considered the best productions in 80% of the evaluations. Emphasis characterized the readings (70.4%), followed by type of voice (44.8%) and pitch (40.8%). Acoustic analysis showed higher mean fundamental frequency and increase of frequency range posttraining. These results indicated richer modulation in the posttraining readings. There are differences in the readings of the same news pre- and posttraining in a radio announcing course, and the posttraining reading was considered the best production, indicating the positive effect of the training.     

Preparing the singing voice specialist revisited

In review of singing voice specialist preparation, discussion can be chronicled prior to the establishment of Arts Medicine in 1987. Although discussion began in 1984 (and earlier), no formal academic program currently exists to train the singing voice specialist. The need now is greater than ever for a formal program of study to prepare a person who seeks to be a singing voice specialist. The question of adequate preparation continues to be in need of an appropriate answer because no formal training programs or fellowships are available. It is essential to first define the role of singing voice specialists and the populations that they will encounter. To meet the needs of a diverse population, care of the professional voice demands cross-disciplinary training. Knowledge from the fields of music, science, medicine and communication disorders and experience/observation, clinical preparation, and research would provide for optimal preparation. To meet this need, development of a Masters degree program seems highly desirable. The structure of such a program is proposed, along with specific requirements outlined from the music and singing voice pathology components for a Masters Degree in Arts Medicine with a concentration in voice.     

The Speaker's Formant

The current study concerns speaking voice quality in two groups of professional voice users, teachers (n = 35) and actors (n = 36), representing trained and untrained voices. The voice quality of text reading at two intensity levels was acoustically analyzed. The central concept was the speaker's formant (SPF), related to the perceptual characteristics "better normal voice quality" (BNQ) and "worse normal voice quality" (WNQ). The purpose of the current study was to get closer to the origin of the phenomenon of the SPF, and to discover the differences in spectral and formant characteristics between the two professional groups and the two voice quality groups. The acoustic analyses were long-term average spectrum (LTAS) and spectrographical measurements of formant frequencies. At very high intensities, the spectral slope was rather quandrangular without a clear SPF peak. The trained voices had a higher energy level in the SPF region compared with the untrained, significantly so in loud phonation. The SPF seemed to be related to both sufficiently strong overtones and a glottal setting, allowing for a lowering of F4 and a closeness of F3 and F4. However, the existence of SPF also in LTAS of the WNQ voices implies that more research is warranted concerning the formation of SPF, and concerning the acoustic correlates of the BNQ voices.     

Prevalence of voice symptoms and risk factors in teacher students

Teacher students seem to have low awareness of the vocal demands in their future professions, and students with vocal symptoms are at risk for developing voice disorders during their professional careers. The purpose of the present study was to determine the prevalence of voice problems in teacher students at the very beginning of their education at the university. Of 1636 students approached in the first couple of days, 1250 (76%) answered two questionnaires about voice symptoms, Screen6 and Swedish Voice Handicap Index (Sw-VHI), and one questionnaire about potential risk factors. A majority of the students were women, and their mean age was 23 years (range, 18-52 years). The results showed that 208 of 1250 students (17%) had voice problems, defined as at least two symptoms weekly or more often in Screen6. The proportion of women was larger in the group with voice problems than in the group without voice problems. Significant risk factors for voice problems were vocal fold problems in childhood and adulthood, frequent throat infections, airborne allergy, smoking, hearing problems, previous work as teacher or leader, voice demanding hobbies, and previous speech therapy or voice training. There was a clear association between the number of potential vocal risk factors and the number of voice symptoms. There was also a strong association between the scores of the two questionnaires, the Sw-VHI and the Screen6. Students with voice problems according to Screen6 scored 23.1 (mean Sw-VHI) compared with 7.8 for students without voice problems.     

Analysis and Evaluation of a Voice-Training Program in Future Professional Voice Users

The goal of this study is to analyze and evaluate the effectiveness of a voice-training program. Twenty-three professional voice users received voice training for 2 years and vocal hygiene education for 1 year. The voice-training program consisted of lectures, technical workshops, and vocal coaching. The European Laryngological Society (ELS) protocol, including the Dysphonia Severity Index (DSI) and the Voice Handicap Index (VHI), was applied before and after, respectively, 9 and 18 months of voice training. A questionnaire on daily habits was presented at study onset and after 18 months. The DSI improvement is more significant after 9 months (P=0.005) than it is after 18 months (P=0.2). On the other hand, the perceptual evaluation remained unchanged after 9 months, whereas it improved significantly after 18 months. The results of the daily habit questionnaire are disturbing: the prevalence of smoking, vocal abuse, stress, and late meals were not influenced by the lectures and remained high. This study emphasizes the need for a well-organized voice-training program that is most effective after 9 months. Regarding the low effectiveness of the vocal hygiene program, the concept needs revision.