Effect of an online Workplace Vocal Health and Low Stress Levels Promotion Program implemented in a Colombian university during COVID-19 pandemic.

PURPOSE: To determine the effect of an online Workplace Vocal Health and Low Stress Levels (WVHLS) Promotion Program implemented in a Colombian university during COVID-19 pandemic. METHODS: This research was a quasi-experimental study. Twenty-nine professors participated in this study within two groups: (1) intervention group (n=17) or (2) non-intervention group (n=12). Participants in the intervention group took part in four virtual sessions about how to improve vocal health and strategies to reduce stress levels during their homeworking and online classes. Teachers filled in a questionnaire including questions about working conditions, work-related stress, and the voice functioning (including the Vocal Fatigue Index-VFI). They also recorded a voice sample of a sustained vowel on two separate occasions (before and after the follow-up). RESULTS: At the end of the follow-up, there was a tendency to reduce Factor 1 of VFI in the intervention group. Although, all participants had a longer MPT at the end of the study compared with the baseline measures, males in the intervention group had longer MPT compared with other participants. CONCLUSION: Our results suggest a positive effect of a WVHLS promotion program on reducing vocal fatigue perception measured by means of the Vocal Fatigue Index and improving coordination and control of breathing speech measured MPT. These changes at the end of the follow-up may indicate that holistic programs that include voice care recommendations, breathing exercises, vocal warm-up, cold-down and laryngeal relaxation vocal exercises, and stress management may be beneficial for reducing work-related stress and voice symptoms among professors.

Investigation of the Effectiveness of a Holistic Vocal Training Program Designed to Preserve Theatre Students' Vocal Health and Increase Their Vocal Performances; A Prospective Research Study.

OBJECTIVE: The main purpose of this study is to investigate the effectiveness of a 12-week holistic vocal training program designed for theatre students. METHODS: The participants included 10 female and 8 male students, who were third- and fourth-year students of a state conservatory theatre department. Participants randomly selected from among those who were between the ages of 18-30 years, had no history of voice disorders, and had no systemic and neurological disorders. The study group (n = 9) was involved in the vocal training program. The control group (n = 9) has not received any training. During the program, 12 sessions of lectures and voice exercises were given to all participants of the study group for a period of 12 weeks. The sessions were planned to last for a duration of 30-45 minutes. Participants' knowledge of vocal health was assessed using a questionnaire that was developed in the present study and a multidimensional voice assessment protocol including acoustic analyses and audio-perceptual evaluation has been applied. RESULTS: Within-group comparisons indicated a significant increase in the study group participants' knowledge of vocal hygiene after training (P = 0.011). Similarly, the study group outperformed the control group in the vocal mechanism knowledge (P = 0.027). Multidimensional Voice Profile findings revealed that vocal qualities of the control group deteriorated, whereas no alterations were found in the study group. Audio-perceptual analysis conducted through the Consensus Auditory-Perceptual Evaluation of Voice did not introduce significant changes in the control group in overall severity and roughness parameters, these values were found significantly improved for the study group. CONCLUSION: It can be concluded that the Holistic Vocal Training Program designed in the present study is effective for preserving theatre students' vocal health and voice quality. It is important for future studies to search the long-term effects.

A Pilot Survey of Warm-Up Practices and Perceptions Among Indian Classical Singers.

OBJECTIVE: Studies have highlighted the importance of having an adequate vocal warm-up exercise regime for prevention of vocal fold injury among singers. Indian classical singing has several singing exercises aimed at improving vocal range and voice. Thus, a need was felt to survey these singers for the warm-up practices they follow and their perception about them. STUDY DESIGN: Cross-sectional study design. METHODS: A 20-item questionnaire was used comprising of questions on demographic details, vocal warm-up singing, and nonsinging-based practices, perceptions about importance of vocal warm-up, and perceptions about effects of vocal warm-up on voice. RESULTS AND CONCLUSION: Fifty Indian classical singers were surveyed. Sixty-four percent of them used vocal warm-up on a daily basis, whereas the remaining did it weekly. Among the singing-based vocal warm-ups, a combination of different singing notes and scales were most commonly used. The popular nonsinging-based warm-up exercises were breathing practice, humming, and meditation. Overall, the singers had a positive perception of the importance of vocal warm-up. Notably, 94% agreed to the importance of having a vocal warm-up regularly before singing. The findings of the present study will help in understanding the existing vocal warm-up regime and perception of the singers. It will benefit counseling singers regarding vocal hygiene, voice care, and management.

Vocal Health Practices Among School Teachers: A Study From Chennai, India.

INTRODUCTION: A healthy vocal system is a prerequisite to produce a serviceable voice for any vocal profession. The concept of vocal health (VH) among teachers is worth exploring considering their known risk of developing voice disorders. AIM: To provide socioculture-specific information on VH practices and nature of voice problems in teachers. METHOD: A VH questionnaire was developed to elicit opinions toward one's own voice health and factors that indicated and contributed to impaired/poor VH from 384 school teachers. RESULTS AND DISCUSSION: 'Flexible voice' (23%), 'enduring voice' (22%), and 'good voice' (22%) were descriptions to indicate good VH by teachers. 'Vocal fatigue' (13%), 'dry throat' (9.4%), 'throat irritation' (4.7%), and 'pain while swallowing/speaking' (3.1%) were frequently reported throat sensations to indicate poor VH. For 30.2% of the teachers, voice mattered for professional needs. However, most of them managed to cope with voice problems through several home remedies and 'intentional/self-imposed neglect' despite their vocal difficulties. Sociocultural factors influencing these findings and scope to escalate voice problems in teachers as a public health issue are discussed. CONCLUSION AND IMPLICATION: Insight and perception of VH based on self-reports and information on voice practices among teachers pertinent to this geographical location provide scope to develop models for counseling and preventive treatment for voice problems.

Evaluation of Singing Vocal Health in Yakshagana Singers.

INTRODUCTION: Yakshagana, a popular traditional folk art from Karnataka, India, includes singing and dancing. Yakshagana singer or Bhagavata plays an important role in singing and conducting the performance. The present study aims to assess the singing vocal health using Singing Voice Handicap Index-10 (SVHI-10) in these singers and to compare between those who report voice problem and those who do not. METHOD: A cross-sectional study was carried out on 26 Bhagavata using demographic questionnaire and SVHI-10 in the Kannada language. Descriptive statistics was used to summarize the data. Independent sample t test was used to compare the responses for demographic variables between the two groups of singers with and without voice problems. The difference in scores of SVHI-10 between the two groups was analyzed using Pearson's chi-square test. RESULTS: Of the Bhagavata, 38% reported to have experienced voice problems, which affected their singing, with higher total SVHI-10 score (31.2 ± 5.7) compared with those who did not report any problems (16.81 ± 9.56). A statistically significant difference between the groups was noted in the emotional domain and total scores. CONCLUSION: The present study provides preliminary information on the voice handicap reported by Bhagavata. The singers reporting voice problems scored higher on SVHI-10. A healthy singing voice is essential for Yakshagana singers, and voice problems can have a significant impact on their performance and livelihood. Hence, results of the present study indicate the need to understand these singers' voice problems and their impact more comprehensively, and educate them about voice care.

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.

Biofeedback on voice use in call center agents in order to prevent occupational voice disorders.

BACKGROUND: Call center agents (CCAs) are at high risk of voice disorders because of high-demanding vocal load and work-related stress factors. Goal of this prospective study was to examine the voice use at work and to introduce biofeedback software into real-life workplace situation to improve vocal performance. Individual fundamental frequency, sound pressure level (SPL) of speaking voice, and syllables per second should be optimized by visualization on-screen. Further, its impact on vocal attrition and vocal constitution should be investigated. METHODS: Over a period of 6 months, 76 call center advisors voluntarily participated in this study (37 female, 39 male, mean age 29.3 years). At the beginning of the study, all the subjects received voice range profile (VRP) measurements and acoustic voice analyses at the beginning and at the end of shift. Additionally, several questionnaires have been completed. The subjects were classified into either the study group (group 1) or the control group (group 2). Group 1 had open access to results of the biofeedback software program at their workplace, and group 2 did not. The VRP measurements, questionnaires, and acoustic voice analyses were repeated 4 weeks later again at the beginning and at the end of shift. RESULTS: All the subjects confirmed a rather high vocal load. In contrast, almost none of the subjects received any voice training before entering the floor. The percentage of voice-related hoarseness and regular throat clearing was rather high in both groups. The statistical analyses revealed a significant improvement of vocal performance in subjects with vocal fatigue in the study group when compared with the control group after a 4-week biofeedback intervention. All the subjects with vocal hypofunction defined as maximum SPLs lower than 90 dB in VRP measurements improved to normal voice constitution at the end of the study in contrast to the control group. CONCLUSION: Biofeedback is a suitable method to improve vocal awareness and vocal performance of CCAs.

[The prevention of voice disorders in the actor: protocol and follow-up nine months of professional theater]. / La prévention des troubles vocaux chez le comédien: protocole et suivi sur neuf mois de professionnels de théâtre.

In July 2009, at the beginning of this work, 26 theses addressing professional principles of voice were listed in the database of SUDOC (Système Universitaire de Documentation): 9 related to voices of teachers (about 900,000* professionals in France), 14 theses relating to singers (7500** professionals), and only 3 about the voice of actors (20 000*** professional actors in France in 2006). The latter pertaining to concerning rookie actors (sensibilisation vocale auprès du comédien débutant Bichet, Linda, Bordeaux II, 2006), the mechanical larynx (étude des mécanismes laryngés dans la voix projetée: cas particulier des comédiennes Guerin, Mélanie, Paris VI, 2009), vocal fatigue (Fatigue vocale après une tâche d'utilisation prolongée de la voix chez le comédien Canaan Baggioni, Brigitte, Aix-Marseille II, 2009). Professional actors are plentiful; their training in vocal technique is very heterogeneous, or non-existent: it is not a prerequisite to have a degree to work as an actor! This lack of vocal technique is associated with risk factors specific to the acting profession: numerous travels in air-conditioned vehicles, unsuitable workplaces; dusty or poorly heated, irregular working patterns, excessive demands from directors... All this makes the actors highly susceptible to voice disorders. The protocol for the prevention of voice disorders presented here is holistic and ecological. This work also examines the effectiveness of such a preventive protocol aimed at theatre comedians.

Calentamiento vocal en profesionales de la voz / Vocal warm up in voice professionals

El calentamiento vocal está constituido por una serie de ejercicios corporales, respiratorios y vocales con la finalidad de calentar la musculatura de los pliegues vocales, musculatura respiratoria, articulatoria y resonancial antes de una actividad más intensa para evitar la sobrecarga, el uso inadecuado o un cuadro de fatiga vocal. Dentro de los efectos fisiológicos del calentamiento vocal se describen el aumento de la temperatura muscular, el aumento del flujo sanguíneo, la disminución de la viscosidad y resistencia de los pliegues vocales, un incremento en la entrega de oxígeno, un aumento de la velocidad de evacuación de desechos de reacciones oxidativas y una disminución del riesgo de daño en el trabajo muscular, entre muchos otros. Desde el punto de vista subjetivo, después del calentamiento vocal la cualidad de la voz es mejor, requiere menos esfuerzo, y aumenta el grado de control y de flexibilidad. Se señala, además, que el calentamiento vocal tiene un efecto positivo en personas con alteraciones de la voz de variadas etiologías. Aunque los ejercicios específicos en las rutinas de calentamiento generalmente varían, éstos incluyen principalmente ejercicios de alineamiento corporal, entrenamiento respiratorio, ejercicios de emisión y ejercicios de resonancia. El calentamiento vocal efectivo es altamente individual, ya que cada voz responde en forma diferente a diferentes duraciones de calentamiento y en diferentes etapas de desarrollo vocal. Como objetivo final, el calentamiento vocal contribuye a la salud de la voz evitando el mal uso, disminuyendo el riesgo de fatiga vocal y evitando compensaciones musculares innecesarias, y aumenta la longevidad del órgano fonador en los profesionales de la voz (AU)

Vocal warm up consists of a series of body, breathing, and vocal exercises to heat the vocal folds and the muscles involved in breathing, articulation and resonance before more intense activity to prevent overloading, misuse or vocal fatigue. Some of the many physiological effects of vocal warm up are increased muscle temperature, blood flow and oxygen delivery, decreased viscosity and vocal fold resistance, a faster oxidative reaction disposal rate, and a reduced risk of muscle damage. From a subjective point of view, after a vocal warm up, voice quality is better, requires less effort, and control and flexibility are increased. Vocal warm up also has a positive effect on people with voice disorders of various etiologies. Although specific exercises in vocal warm up routines often vary, they mainly include body alignment exercises, breathing training, and resonance and phonation exercises. Effective vocal warm up is highly individual because each voice responds differently to distinct lengths of warm up exercises and at different stages of voice development. The main goal of vocal warm up is to contribute to vocal health by avoiding voice misuse, decreasing the risk of vocal fatigue, avoiding unnecessary muscle compensation and increasing voice longevity in voice professionals (AU)

A prospective, randomized trial of nerve monitoring of the external branch of the superior laryngeal nerve during thyroidectomy under local/regional anesthesia and IV sedation.

BACKGROUND: The aim of this study was to assess the impact of the neuromonitoring of the external branch of the superior laryngeal nerve (EBSLN) on the voice quality after mini-incision thyroidectomy under local/regional anesthesia and intravenous sedation. METHODS: Patients undergoing mini-incision thyroidectomy under local anesthesia were prospectively randomized for either nerve monitoring of the EBSLN (group 1) or no nerve monitoring (group 2). Voice and swallowing assessment were obtained by using the Voice Handicap Index-10 (VHI-10) and the Reflux Symptom Index questionnaires (RSI) before surgery and at 3 weeks and 3 months after surgery. RESULTS: Recruitment led to 22 patients in group 1 and 25 patients in group 2. The rate of visualized EBSLN was higher in group 1 (66% vs 21%; P = .003). Contrary to group 1, in group 2, the median total VHI-10 score was significantly higher 3 months after surgery (P = .034) compared with preoperatively, indicating a subjective voice handicap. In both groups, there was no difference in median total RSI score before surgery or at 3 weeks and 3 months after surgery. CONCLUSION: Nerve monitoring aids in the visualization of the EBSLN during mini-incision thyroidectomy under local/regional anesthesia and leads to an improvement in patient-assessed voice quality after surgery but does not impact swallowing.

Vocal hygiene for the voice professional.

PURPOSE: This article presents the current state of knowledge regarding vocal hygiene for the voice professional. RECENT FINDINGS: Research regarding vocal hygiene has primarily focused on two areas: vocal hygiene as a preventive strategy, and vocal hygiene as a management technique for individuals with voice disorders. It is difficult to assess the effectiveness of vocal hygiene as a preventive tool as programs are often expensive leading to limited data. Vocal hygiene as a sole strategy for the treatment of voice disorders has shown minimal, but favorable results. As a component of a comprehensive therapeutic program, it is difficult to isolate the influence of vocal hygiene. However, limited components of vocal hygiene including hydration and vocal rest have been associated with improved therapeutic outcomes. In addition, the current literature proposes a paradigm shift away from more restrictive therapy approaches to a holistic approach to vocal well being. SUMMARY: Vocal hygiene should be considered only as a component of a broad vocal rehabilitation program. The role of vocal hygiene as a means to prevent voice disorders remains unproven. Additionally, some of the findings may be applied to both dysphonic and healthy individuals in order to facilitate vocal well being.

[Diagnostics of occupational voice diseases following the amendment of the Polish Occupational Diseases Certification Act]. / Diagnostyka chorób zawodowych narzadu glosu po wprowadzeniu znowelizowanej ustawy dotyczacej orzekania o chorobach zawodowych.

BACKGROUND: The aim of the study was to assess whether the amended Polish Occupational Diseases Certification Act of 2002 has made an impact on the medico-legal process of the occupational voice diseases certification. MATERIAL AND METHODS: Nationwide reports on the number and types of occupational diseases diagnosed in Poland in 1999-2004, and the medical records of 267 teachers diagnosed for the occupational voice organ disease were analyzed. RESULTS AND CONCLUSIONS: A 4-fold gradual and continuous reduction (from 3521 to 881 cases) in the number of registered occupational voice diseases was noted in 1999-2004, which was not really associated with the date the amended Act came into force. The patients challenging the first instance refusals issued after 2002 were characterized by significantly worse phoniatric and videostroboscopic indices than those consulted before that date. Before 2002, the percentage of the second instance positive decisions, changing the first instance refusals was over 16%, while after 2002 the corresponding number was only 5%. This indicates that a consensus of decisions issued by the first and second instances has significantly increased since the amended Act came in effect.