Considerations and demands in the voice care of contemporary commercial singers in occupational health and safety aspects.

Singers, classified as "vocal performers" are at an increased risk of developing voice disorders. The area of contemporary commercial singing has not been studied as extensively as classical singing. Non-classical singing is generally considered detrimental to vocal health and thus the information on challenges contemporary commercial singers (CCS) pose to otolaryngologists and other healthcare professionals is scarce. The authors present an overview of contemporary commercial singing styles in comparison to classical singing, discuss the notion of non-classical style being harmful to vocal health, present major risk factors associated with developing voice disorders in contemporary commercial singers, and outline the diagnostic process of vocal health assessment in this group of occupational voice users. Given that contemporary commercial singers constitute a unique and vast group of elite vocal performers, the authors stress the importance of raising awareness among healthcare professionals of the fact that these patients require special considerations for voice evaluation and treatment in the occupational health and safety framework. Med Pr. 2022;73(1):33-41.

Auditory-vocal integration impairment: New challenges and opportunities for voice assessment and therapy / Alteración de la integración auditivo-vocal: nuevos retos y oportunidades para la evaluación y la terapia de la voz

This reflection paper addresses the importance of the interaction between voice perception and voice production, emphasizing the processes of auditory-vocal in-tegration that are not yet widely reported in the context of voice clinicians. Given the above, this article seeks to 1) highlight the important link between voice pro-duction and voice perception and 2) consider whether this relationship might be exploited clinically for diagnostic purposes and therapeutic benefit. Existing theories on speech production and its interaction with auditory perception provide context for discussing why the evaluation of auditory-vocal processes could help identify associ-ated origins of dysphonia and inform the clinician around appropriate management strategies. Incorporating auditory-vocal integration assessment through sensorimotor adaptation paradigm testing could prove to be an important addition to voice assess-ment protocols at the clinical level. Further, if future studies can specify the means to manipulate and enhance a person's auditory-vocal integration, the efficiency of voice therapy could be increased, leading to improved quality of life for people with voice disorders

Este artículo de reflexión aborda la importancia de la interacción entre la percepción y la producción de la voz, haciendo hincapié en los procesos de integración auditivo-vocal, los cuales aún no han sido muy divulgados en el contexto de los clínicos de voz. Dado lo anterior, este articulo busca: 1) destacar la importante relación entre la producción y la percepción de la voz y 2) considerar si esta relación pudiese explotarse clínicamente con fines diagnósticos y terapéuticos. Las teorías existentes sobre la producción de la voz y su interacción con la percepción auditiva proporcionan el contexto para discutir por qué la evaluación de los procesos auditivo-vocales podría ayudar a identificar los orígenes asociados a cierto tipo de disfonías e informar al clínico sobre las estrategias de abordaje adecuadas. La incorporación de la evaluación de la integración auditivo-vocal a través de la prueba del paradigma de adaptación sensoriomotora podría ser una importante adición a los protocolos de evaluación de la voz a nivel clínico. Además, si los estudios futuros pueden especificar los medios para manipular y mejorar la integración auditivo-vocal de una persona, la eficacia de la terapia de la voz podría aumentar, lo que llevaría a mejorar la calidad de vida de las personas con trastornos de la voz

[The comparative assessment of the vocal function in the professional voice users and non-occupational voice users in the late adulthood]. / Sravnitel'naia otsenka golosovoi funktsii u professionalov golosa pozhilogo vozrasta i lits negolosovykh professii.

The objective of the present study was to evaluate the clinical and functional condition of the voice apparatus in the elderly patients and to elaborate recommendations for the prevention of disturbances of the vocal function in the professional voice users. This comprehensive study involved 95 patients including the active professional voice users (n=48) and 45 non-occupational voice users at the age from 61 to 82 years with the employment history varying from 32 to 51 years. The study was designed to obtain the voice characteristics by means of the subjective auditory assessment, microlaryngoscopy, video laryngostroboscopy, determination of maximum phonation time (MPT), and computer-assisted acoustic analysis of the voice with the use of the MDVP Kay Pentaxy system. The level of anxiety of the patients was estimated based on the results of the HADS questionnaire study. It is concluded that the majority of the disturbances of the vocal function in the professional voice users have the functional nature. It is concluded that the method of neuro-muscular electrophonopedic stimulation (NMEPS) of laryngeal muscles is the method of choice for the diagnostics of the vocal function of the voice users in the late adulthood. It is recommended that the professional vocal load for such subjects should not exceed 12-14 hours per week. Rational psychotherapy must constitute an important component of the system of measures intended to support the working capacity of the voice users belonging to this age group.

[Assessment of vocal intensity in lecturers depending on acoustic properties of lecture rooms]. / Poziom natezenia glosu lektorów w zaleznosci od wlasciwosci akustycznych sal wykladowych.

BACKGROUND: Lombard's effect increases the level of vocal intensity in the environment, in which noise occurs. This article presents the results of the author's own study of vocal intensity level and A-weighted sound pressure level of background noise during normal lectures. The aim of the study was to define whether above-mentioned parameters depend on acoustic properties of rooms (classrooms or lecture rooms) and to define how many lectors speak with raised voice. MATERIAL AND METHODS: The study was performed in a group of 50 teachers and lecturers in 10 classrooms with cubature of 160-430 m3 and reverberation time of 0.37-1.3 s (group A consisted of 3 rooms which fulfilled, group B consisted of 3 rooms which almost fulfilled and group C consisted of 4 rooms which did not fulfill criteria based on reverberation time (maximum permissible value is 0.6-0.8 s according to PN-B-02151-4:2015). Criteria of raising voice were based on vocal intensity level (maximum value: 65 dB according to EN ISO 9921:2003). The values of above-mentioned parameters were determined from modes of A--weighted sound pressure level distributions during lectures. RESULTS: Great differentiation of vocal intensity level between lectors was found. In classrooms of group A lectors were not using raised voice, in group B--21%, and in group C--60% of lectors were using raised voice. CONCLUSIONS: It was observed that acoustic properties of classrooms (defined by reverberation time) exert their effect on lecturer's vocal intensity level (i.e., raising voice), which may contribute to the increased risk of vocal tract illnesses. The occurrence of Lombard's effect in groups of teachers and lecturers, conducting lectures in rooms, was evidenced.

An overview of occupational voice disorders in Poland.

Occupational voice disorders make the most frequently certified category of occupational diseases in Poland, making up approximately 20% of all cases. This study presents the current knowledge of the etiopathogenesis of occupational voice disorders. It stresses the importance of the evaluation of vocal loading by means of objective measurements. Furthermore, this study discusses the medico-legal aspects of the procedure of certifying occupational voice disorders in Poland. The paper also describes the preventive programs addressed particularly to teachers, including multidisciplinary and holistic management of occupational dysphonia. Their role in the improvement of occupational safety and health (OSH) arrangement for vocally demanding professions is emphasized.

The Traditional/Acoustic Music Project: a study of vocal demands and vocal health.

OBJECTIVE/HYPOTHESIS: The Traditional/Acoustic Music Project seeks to identify the musical and performance characteristics of traditional/acoustic musicians and determine the vocal demands they face with the goals of (1) providing information and outreach to this important group of singers and (2) providing information to physicians, speech-language pathologists, and singing teachers who will enable them to provide appropriate services. STUDY DESIGN: Descriptive cross-sectional study. METHODS: Data have been collected through administration of a 53-item questionnaire. The questionnaire was administered to artists performing at local venues in Knoxville, Tennessee and also to musicians attending the 2008 Folk Alliance Festival in Memphis, Tennessee. RESULTS: Approximately 41% of the respondents have had no vocal training, whereas approximately 34% of the respondents have had some form of formal vocal training (private lessons or group instruction). About 41% of the participants had experienced a tired voice, whereas about 30% of the participants had experienced either a loss of the top range of the voice or a total loss of voice at least once in their careers. Approximately 31% of the respondents had no health insurance. Approximately 69% of the respondents reported that they get their information about healthy singing practices solely from fellow musicians or that they do not get any information at all. CONCLUSION: Traditional/acoustic musicians are a poorly studied population at risk for the development of voice disorders. Continued research is necessary with the goal of a large sample that can be analyzed for associations, identification of subpopulations, and formulation of specific hypotheses that lend themselves to experimental research. Appropriate models of information and service delivery tailored for the singer-instrumentalist are needed.

[The teachers health damage and pension related to occupational voice disease]. / Uszczerbek na zdrowiu i renta z tytulu choroby zawodowej narzadu glosu u nauczycieli.

The current regulations allow in special cases for the acknowledgement of the occupational disease among teachers who suffer from voice disorders. The physician who acts as the adjudicator in ZUS (National Insurance System) usually consults a phoniatrician and determines the percent of the permanent or long-term health damage, which can vary between 10-40%. The aim of the paper was to analyze the evidence which is taken into consideration while determining the percent of health damage and granting the occupational disease pension. The authors present proposition in detail the rules which govern the process of health damage calculation due to advancement of voice disorders, which can be very useful to adjudicating physicians in government and commercial insurance companies.

Valedictory--why pediatric otorhinolaryngology is important.

The importance of the care given by the pediatric otolaryngologist to the individual child encompasses the traditional purposes of medicine. This field has its special focus on interventions that preserve, restore and/or otherwise improve hearing, speech, voice, gustation, olfaction, deglutition, respiration, appearances, etc. The value-added dimension of pediatric otolaryngology is of essential importance because it enhances communication-language--through the vehicles of hearing, voice, and speech. This critical role is manifest in two ways. The first relates to the economic bases of society. Comparison of the consequences of communications disorders in three different countries ranging, currently, from one very highly dependent upon communication skills (The Netherlands), to one highly dependent upon communication skills (the United States), to a developing nation less dependent upon communication skills (the Philippines) is presented. All three nations are adversely affected economically and socially by communication disorders. It is estimated that the United States loses between 2.5 and 3% of its gross domestic product from the economic sequel of communication disorders. It also appears that communication disorders contribute to crime, since the prevalence of communication disorders is many times greater in populations of juvenile delinquents than in the general population. Communication disorders may act synergistically with diminished economic and social resources and other factors in the causes of violent behavior and crime.

[Assessment of rehabilitation of teachers' voice disorders]. / Ocena skutecznosci rehabilitacji zaburzen glosu u nauczycieli czynnych zawodowo.

Results of treatment of teacher's voice disorders were presented. Patients except pharmacological treatment and physiotherapy realised the course of voice emission exercises under speech therapist supervision. Ninety teachers were examined before and after treatment. Laryngological, phoniatric and laryngostroboscopic studies were carried out. In most patients phoniatric assessment revealed elongation of phonation time, changing of breathing route from cleidocostal to phrenocostal and voice creation without neck muscle tension after completing of treatment. 6 weeks lasting period of exercises was determined to be sufficient in most patients to learn correct breathing and phonation but to establish normal voice emission patient strong motivation, discipline and regularity during several months lasting exercises is needed.

Chronic pediatric tracheotomy: assessment and implications for habilitation of voice, speech and language in young children.

The effect of chronic tracheotomy on the acquisition of voice, speech, and language skills was studied. Children with chronological ages of 16 months to 41 months were evaluated for Receptive Communication Age (RCA) and Expressive Communication Age (ECA). Results indicate a consistent deviation of (on the average) 4.8 months delay in RCA and 9 months delay in ECA. An habilitation program for early intervention in voice, speech and language stimulation is described, with follow-up data on 3 children. A progression from non-meaningful, non-vocal communication to more meaningful and functional communication is noted. The evidence indicates that, without therapeutic intervention, children with tracheotomies are at risk for delays in receptive and expressive language development, as well as deficits in oral/vocal speech and voice production.