Systematic Review of Literature on Vocal Demand Response: Understanding Physiology, Measurements, and Associated Factors.

PURPOSE: Considering the conceptual migration from vocal load and vocal loading to vocal demand and vocal demand response, this review of literature aimed to identify physiological explanations, reported measurements, and associated factors (vocal demands) reported in the literature when considering the phonatory response to a vocal demand. METHODS: A systematic review of literature, following the PRISMA Statement, was conducted using Web of Science, PubMed, Scopus, and ScienceDirect. Data were analyzed and presented in two parts. First, a bibliometric analysis, co-occurrence analysis, and content analysis were performed. Three criteria that got article inclusion were defined: (1) written in English, Spanish, and Portuguese; (2) published between 2009 and 2021; and (3) focused on vocal load and loading, vocal demand response, and voice assessment parameters. A total of 54 publications met the criteria and were included in this review. The second part included a conceptual framework based on the content analysis of three aspects of vocal demand response: (1) physiological explanations, (2) reported measurements, and (3) vocal demands. RESULTS AND CONCLUSION: As would be expected since vocal demand response is a relatively new term and not yet commonly used in literature when discussing way that the speakers respond to communicative scenarios, most of the studies reviewed (both historical and recent) still use the term of vocal load and vocal loading. Although there is a broad variety of literature discussing a wide range of vocal demands and voice parameters used to characterize the vocal demand response, results show that there is consistency across the studies. While vocal demand response is unique and intrinsic to the talker, associated factors that contribute to this response include both internal talker and external talker factors. Internal factors include muscle stiffness, viscosity in the phonatory system, vocal fold tissue damage, elevated sound pressure levels during occupational voice demands, extended periods of voice use, suboptimal body posture, difficulties in breathing technique, and sleep disturbances. Associated external factors include the working environment (noise, acoustics, temperature, humidity). In conclusion, although vocal demand response is intrinsic to the speaker, the speaker's response is affected by external vocal demands. However, due to the wide methods to evaluate vocal demand response, it has been difficult to establish its contribution to voice disorders in the general population and, specifically, among occupational voice users. This literature review identified commonly reported parameters and factors that may help clinicians and researchers define vocal demand response.

Four-day-follow-up study on the voice monitoring of primary school teachers: Relationships with conversational task and classroom acoustics.

The present study has investigated the occupational voice use of 27 female primary school teachers over a four-day-follow-up. Sixty-one working-day voice samples were acquired with two contact sensor-based vocal analyzers in four schools with highly different classroom acoustics. The vocal parameters were compared with a conversational task that the teachers performed before each lesson and with the measured classroom acoustic parameters. The average equivalent sound pressure level at 1 m from the mouth, which refers to the teacher's vocal effort, and the voicing time percentage were 71.2 dB [standard error (SE) 1.0 dB] and 29%, respectively. The teachers' mean voice level and fundamental frequency were significantly higher in the occupational setting than in the conversational one, which is by 5.5 dB (SE 0.5 dB) and 50 Hz (SE 3 Hz), respectively. Higher voice levels were observed for higher background noise levels, at a rate of 0.53 dB/dB, and a tendency of the background noise to increase with increasing reverberation time was observed at a rate of 13 dB/s. An optimal reverberation time of 0.7 s was found to minimize the voice level, since teachers raised their voice at lower and higher reverberation times, the latter presumably due to higher background noise levels.

Vocal Fry and Vowel Height in Simulated Room Acoustics.

PURPOSE: The purpose of this study was to investigate the influence of room acoustics in the relationship between vowel height and vocal fry. METHODS: This was a cross-sectional study. Participants (college students, n = 40) read the first six sentences of "The Rainbow Passage" under nine simulated room acoustic conditions. Using two words with low vowels (act, pot) and two words with high vowels (shape, strikes) preceding a voiceless stop, the presence/absence of vocal fry was assessed using an automatic detection script. Generalized estimation equations were used to investigate the relationship between percentage of vocal fry, vowel height, and room acoustics. RESULTS: The percentage of vocal fry was significantly higher for the low-height vowels compared with the high-height vowels (ß = 1.21; standard er ror = 0.35), and for pink background noise present (ß = 0.89; standard error = 0.35) compared with the condition without artificial noise added. CONCLUSION: The results of this study indicate that young college students are more likely to produce fry phonation when producing low-height vowels under pink background noise condition compared with no noise conditions and high-height vowels. This result is of special interest for voice clinicians when designing therapy plans and vocal assessment protocols with fry-like components.

Voice as a Working Tool for Teachers: A Qualitative Study of Work-Related Perceptions and Impact.

BACKGROUND: Teachers rely heavily on their voices, making them susceptible to voice disorders affecting their teaching efficacy and well-being. This study explores the role of voice as a working tool for teachers and its impact on their professional lives, a necessary step in designing intervention points. METHODS: Using a phenomenological approach, we conducted qualitative interviews with 18 teachers (13 females, 5 males) from diverse backgrounds. They represented diverse teaching areas, grade levels, and school districts. Data were analyzed through content analysis. In this process, 52 codes were identified, totaling 753 code references. FINDINGS: This study uncovered insights into the role of voice as a working tool for teachers and its impact on their professional lives. In-depth analysis of the interviews with 18 teachers resulted in 6 key themes: (1) Voice is a crucial occupational tool for teachers for instruction, engagement, and classroom management; (2) working conditions significantly impact teachers' vocal health, with environmental factors and vocal load contributing to voice problems; (3) vocal health concerns are frequently reported by teachers, emphasizing the need for comprehensive health management strategies; (4) there are notable best practices and gaps in vocal care, with teachers expressing the need for more resources and formal training; (5) amplification devices play a significant role in sustaining teachers' vocal health, although access to and use of these tools is inconsistent; and (6) voice-related problems have a significant emotional and psychosocial impact on teachers, affecting their self-perception, professional identity, and well-being. DISCUSSION: This study highlights the critical role of vocal health in teachers' professional lives, revealing its impact on teaching efficacy, well-being, and professional identity. The findings highlight the need for comprehensive support systems, including vocal health programs, resources like amplification devices, and counseling for emotional impacts. The six identified themes emphasize the necessity of holistic interventions to enhance teachers' well-being and effectiveness.

Personality Traits and Self-Reported Vocal Fatigue and Other Voice Measures Among Teachers.

BACKGROUND: Previous research has examined the correlation between certain personality traits and specific voice disorders. These studies indicated that a predictive relationship exists between an individual's personality and their likelihood of experiencing certain types of voice disorders. The personality type classified as "extravert" was most commonly correlated with voice problems associated with high vocal use such as inflammation or nodules. AIM: The purpose of this study was to determine if a relationship exists between self-reported vocal fatigue, demographic characteristics, such as assigned sex at birth and age, perception of current voice condition, aerodynamic measures, and voice acoustic parameters with any of the five personality traits measured by the Big Five Personality Index: Extraversion, Agreeableness, Conscientiousness, Neuroticism, and Openness. We hypothesized that vocal fatigue scores and spirometry measurements may be good predictors of specific personality traits, and therefore, can be useful measures to complement vocal assessment. METHODS: Participants in this cross-sectional correlational study included 73 full-time elementary and middle school teachers. Participants completed the Vocal Fatigue Index (VFI) and the Big Five Inventory (BFI)-10 personality index; further, microphone recordings were collected from a battery of voice tasks in addition to spirometry. Descriptive analyzes of the dependent variables (BFI personality traits) and independent variables (demographics, acoustics, spirometry, and VFI total score) were performed, calculating frequency values. Kruskal-Wallis tests were conducted to evaluate independent variables' differences across the scores of the five BFI personality traits. The association between the independent and dependent variables was then investigated using a Generalized Estimating Equations multinomial logit model. The level of significance was defined at 0.05, and the associations are expressed as betas and standard error. RESULTS AND CONCLUSION: The results suggest that high scores for the traits of extraversion and agreeableness were both predicted by lower scores on the VFI (P ≤ 0.05), indicating that individuals with lower perception of vocal fatigue may be more likely to be identified as extraverted and/or agreeable personalities. These results support previous study's conclusion as well as add additional insights that could be translated into screening protocols and additional supportive care of occupational voice users.

Persuasion Through Focus Groups: Helping Teachers Maintain Healthy Voices.

This study was designed to determine whether participation in a single, 1-hour focus group would spur a change in health-related behavior. All the respondents were teachers who had participated in a focus group designed to learn about teachers' understanding that voice is a working tool. In the discussions, health-related behaviors were discussed as ways to deal with possible vocal strain or injury. Two months later, a follow-up survey was distributed to these participants asking them if they recalled the discussion and if they had sought out more information and/or had changed their vocal behavior due to their participation in the focus group. The qualitative data shows that the majority of these respondents both recalled the messages and had engaged in some type of health-related behavior change due to their participation in the focus group. Behavior change included such modifications as drinking more water and use of voice-amplification equipment in the classroom. Implications of this finding are discussed.

Behind the Headset: Predictive Accuracy of Patient-Reported Outcome Measures for Voice Symptoms in Call Centers.

Objective: This study examines factors predicting self-reported voice symptoms in call center workers. Methods: Multivariate analysis and predictive modeling assess personal, work-related, acoustic, and behavioral factors. Generalized Linear Models (GLMs) and Receiver Operating Characteristic (ROC) curves are employed. Results: Age and sleep patterns impacted voice quality and effort, while workplace factors influenced symptom perception. Unhealthy vocal behaviors related to tense voice and increased effort, while hydration was protective. Voice acoustics showed diagnostic potential, supported by ROC data. These findings emphasize voice symptom complexity in call center professionals, necessitating comprehensive assessment. Limitations: This study recognizes its limitations, including a moderate-sized convenience sample and reliance on PROM metrics. Future research should incorporate more objective measures in addition to self-reports and acoustic analysis. Value: This research provides novel insights into the interplay of personal, occupational, and voice-related factors in developing voice symptoms among call center workers. Predictive modeling enhances risk assessment and understanding of individual susceptibility to voice disorders. Conclusion: Results show associations between various factors and self-reported voice symptoms. Protective factors include sleeping more than six hours and consistent hydration, whereas risk factors include working conditions, such as location and behaviors like smoking. Diagnostic models indicate good accuracy for some voice symptom PROMs, emphasizing the need for comprehensive models considering work factors, vocal behaviors, and acoustic parameters to understand voice issues complexity.

Objetivo: Este estudio examina los factores que predicen los síntomas de voz en los trabajadores de call centers. Métodos: Se utilizan análisis multivariados y modelos predictivos para evaluar factores personales, laborales, acústicos y de comportamiento. Se emplean Modelos Lineales Generalizados (GLM) y curvas ROC. Resultados: La edad y los patrones de sueño afectaron la calidad vocal y el esfuerzo, mientras que los factores laborales influyeron en la percepción de síntomas. Los comportamientos vocales no saludables se relacionaron con voz tensa y mayor esfuerzo, mientras que la hidratación fue protectora. Los parámetros acústicos de voz mostraron potencial diagnóstico respaldado por datos de ROC. Los hallazgos subrayan complejidad de síntomas vocales en profesionales de centros de llamadas, requiriendo una evaluación integral. Limitaciones: Este estudio reconoce sus limitaciones, que incluyen una muestra de conveniencia de tamaño moderado y la dependencia de medidas PROMs. Futuras investigaciones deberían incorporar medidas objetivas, además de los autorreportes y análisis acústico. Importancia: Esta investigación aporta nuevos conocimientos sobre factores personales, laborales y síntomas de voz en trabajadores de call centers. El modelado predictivo mejora la evaluación de riesgos y la comprensión de la susceptibilidad individual a trastornos de la voz. Conclusión: Los resultados muestran asociaciones entre diversos factores y los síntomas vocales reportados. Los factores de protección incluyen dormir más de seis horas y una hidratación constante; los factores de riesgo incluyen las condiciones de trabajo, como la ubicación y comportamientos como fumar. Los modelos de diagnóstico indican una buena precisión para algunas PROMs de síntomas de la voz, lo que subraya la necesidad de modelos integrales que tengan en cuenta los factores laborales, los comportamientos vocales y los parámetros acústicos para comprender la complejidad de los problemas de la voz.

Prospective Teacher's Voice Questionnaire (PTVQ): Development of a Questionnaire to Assess Training-Related Voice Symptoms Among Prospective Teachers.

AIM: To develop and validate a self-administered population-specific survey, available in Spanish, Portuguese, and English, which investigates the prevalence of voice symptoms and perceptions of risk factors associated with training among prospective teachers. METHODS: The present study had three stages: the first stage included a literature review and content validation by experts that supported the survey development. From this phase, we defined five aspects of the Prospective Teacher's Voice Questionnaire (PTVQ): (1) target population, (2) research objectives, (3) questions to be included, (4) scales for the answers, and (5) relevance, comprehensiveness, clarityclarity, and understandability of the questions. This process was performed in parallel for the three languages (Spanish, Portuguese, and English). The second stage included pilot testing. This involved administering the first draft of the survey to a group of 120 students to evaluate the feasibility and effectiveness of the survey instrument, identify any potential problems with the survey, and refine the instrument based on feedback from the pilot participants. The third stage includes the restructuring of the questionnaire's voice quality section to eliminate redundant questions. Through Principal Component Analysis, multicollinear variables were condensed, facilitating the removal of redundant items, and ensuring that the final questionnaire comprised only the most relevant and discriminative questions. RESULTS AND DISCUSSION: The final version of the survey, available in Spanish, Portuguese, and English, consists of four sections with a total of 57 questions. The development of the PTVQ represents a significant step toward better understanding and addressing voice disorders among prospective teachers. Future research could further refine the questionnaire and explore its predictive validity in identifying individuals at risk of voice disorders early in their teaching careers. Additionally, interventions based on the findings from the PTVQ could be developed to support the voice health and well-being of prospective teachers, ultimately improving teaching quality and job satisfaction in educational settings.

The Effects of Room Acoustics on Self-reported Vocal Fatigue: A Systematic Review.

PURPOSE: The main objective of the present systematic review is to quantify the relationship between the room acoustics and self-reported vocal fatigue. METHODS: A comprehensive literature search and systematic review were conducted using PubMed/MEDLINE, Science Direct, Web of Science, EBSCO, and Scopus databases. Two inclusion criteria were defined: (1) description of a relationship between the room acoustics and self-reported vocal fatigue; and (2) reporting of raw data and/or a statistic of the association between the variables. Risk of bias in the included studies was assessed via the Quality Assessment Tool for Quantitative Studies Effective Public Health Practice Project. The occurrences and frequencies of the most common parameters in the literature are presented, and a quantitative summary of their relationships is reported. RESULTS: In total, 12 publications met the inclusion criteria. The most relevant measures of self-reported vocal fatigue were the Vocal Fatigue Index (n = 3), Vocal Signs and Symptoms Questionnaire (n = 1), and vocal fatigue visual analog scales (n = 2). The most relevant room acoustic parameters include noise conditions (n = 6) and reverberation time (n = 2). The relationships between the room acoustic parameters and self-reported vocal fatigue are quantified and reported while maintaining the concepts stated in the original articles and outlining their similarities. CONCLUSION: Overall, background noise and reverberation time were determined to be the most significant independent variables associated with self-reported vocal fatigue. A primary limitation of the evidence was inconsistent measures of self-reported vocal fatigue.

Work-Related Vocal Challenges of Online Teaching: A Study of Female College Professors.

BACKGROUND: College professors are at an elevated risk of developing voice disorders due to increased vocal demands associated with their working conditions, including high background noise levels, long reverberation times, prolonged voice use duration, and large class sizes. However, the impact of online classes on vocal health among college professors remains unclear. OBJECTIVE: This longitudinal study aimed to characterize voice changes associated with online teaching among female Colombian college professors. METHODS: Thirteen female college professors teaching online classes completed an online survey that included questions about voice functioning, working conditions, the Spanish translation of the Vocal Fatigue Index (VFI), and the Spanish translation of the Voice-Related Quality of Life. Instrumental measurements were also performed, including environmental background noise levels, hearing screening, and voice recordings before and after a synchronous online class. RESULTS: This study found a decreased fundamental frequency in connected speech (reading) associated with the number of students per class, the number of classes per week, and background noise levels measured with a sound level meter. L1L0 was statistically smaller among experienced teachers with higher background noise levels compared with less-experienced colleagues in quieter classes. 1558kHz was statistically associated with the average number of students, whereas HNR was slightly higher for professors with more students and more classes per week. CONCLUSION: The findings suggest that online teaching has important implications for voice production among participating teachers. This study highlights the importance of considering working conditions during online classes when designing workplace prevention programs for college professors.

Mapping the Landscape of Voice Complaints among Teachers: A Bibliometric Investigation.

PURPOSE: With the significant and growing interest in voice disorders among teachers over the last several decades, there is value in having a comprehensive overview of the current state of the field and its related research productivity. This study aims to provide an updated and comprehensive mapping of the intellectual structure and research evolution in the field of occupational voice complaints among teachers. METHODS: A systematic review of scientific articles on occupational voice complaints among teachers published in the last two decades was conducted using the preferred reporting items for systematic reviews and meta-analyses statements. A retrospective bibliometric analysis was then performed using the Web of Science core collection and VOSviewer to identify scientific productivity indicators, including publications per year, productivity by country, journals, and most cited articles. RESULTS: Based on the search eligibility criteria, a total of 473 articles were initially screened, and from this selection, 157 articles were identified as meeting the inclusion criteria and therefore included in the analysis. The analysis revealed a strong trend in scientific productivity, with a 300% increase in the number of publications during the last decade. The leading countries in publications on this field were Brazil, the United States, and Finland. The Journal of Voice, CoDAS, and Folia Phoniatrica et Logopaedica were the most frequently published journals. Additionally, the literature on voice complaints among teachers primarily focused on five conceptual clusters: vocal demand response, voice disorders, vocal health promotion, individual-associated factors, and voice symptoms. CONCLUSION: This study examines the growing literature on voice complaints among teachers over the past 20 years, identifying key countries, journals, and thematic clusters. The findings have important implications for researchers, policymakers, and practitioners, providing insights for collaboration and guiding future advancements in the field.

The Effect of Bilingualism on Production and Perception of Vocal Fry.

AIMS: (1) Determine the difference in vocal fry phonation in English and Spanish productions among bilingual young adults, (2) Characterize the effect of spoken language and native language on vocal fry production among English-Spanish bilingual speakers, (3) Identify the effect of first and second language knowledge of the listener in the voice perceptual assessment, and (4) Define the effect of the environment of the assessment (in situ vs. online), in the voice perceptual assessment. METHOD: Exploratory cross-sectional study of 34 bilingual (Spanish-English) speakers and six inexperienced listeners. Participating speakers produced two speech samples (one in English and one in Spanish). Six inexperienced monolingual and bilingual listeners performed the voice perceptual assessment of vocal fry, General grade of hoarseness, and Roughness using a 4-point rating scale. RESULTS: Bilingual speakers used vocal fry more often when they were speaking in English (around 3%) compared with their production in Spanish (around 2%). Bilingual native English speakers used vocal fry more often during their productions in both languages compared with bilingual native Spanish speakers. Bilingual listeners had the highest agreement when identifying vocal fry in both languages. CONCLUSIONS: Differences in production of vocal fry between native speakers of American English and native speakers of Spanish may be evidence of transferring of vocal behavior (such as vocal fry) from one language to the second one. In addition, being a bilingual listener may have an important effect on the perceptual identification of voice quality in English and Spanish, as well as vocal fry in English.

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.

Association Between Bilingualism, Vocal Effort, and Background Noise With Voice Fundamental Frequency and LTAS Among Spanish-English Bilingual Teachers.

BACKGROUND: As the world becomes increasingly interconnected, the demand for bilingual teachers has grown exponentially. However, the unique combination of being a bilingual occupational voice user establishes challenges that warrant careful examination. OBJECTIVE: To investigate the association between bilingualism, vocal effort, and background noise with fundamental frequency and long-term spectrum average among Spanish-English bilingual teachers. METHODS: Exploratory cross-sectional correlational study with the participation of eight Spanish-English proficient bilingual teachers (native Spanish speakers) who were teaching online classes during the quarantines established to mitigate the propagation of COVID-19. Participants were asked to read two standardized texts (one in English and one in Spanish) under two background noise conditions (with and without background white noise). RESULTS: There was a significant interaction between language and vocal effort considering that the association of vocal effort with fo was different for Spanish and English. There was also a significant main effect of background noise on fo. There were significant differences in voice spectral characteristics between productions in Spanish and English and between productions with and without background noise. The alpha ratio was significantly higher in productions in English and with background noise compared with productions in Spanish without background noise. The mid to high spectral energy ratio (1-5 K/5-8 K) was significantly lower in productions in English and with higher perceived vocal effort compared with productions in Spanish and with lower scores on the Borg Scale. CONCLUSION: Our findings introduce a need perspective by emphasizing the impact of speaking a second language on the work-relatedness of voice disorders among teachers. These findings stress the necessity to factor in language and environmental conditions for the comprehensive evaluation and management of work-related voice disorders.

Bilingualism and Voice Production. Differences Between Bilingual Latin-American Spanish- English Female Speakers and Monolingual Spanish Female Speakers During Spanish Productions.

BACKGROUND: Speaking a second language influences jitter and shimmer when comparing monolingual English speakers with bilingual English-Spanish speakers. However, there is little information about differences on voice acoustic parameters when comparing monolingual Spanish speakers with bilingual Spanish-English speakers during their productions in Spanish. AIM: Determine differences in five voice acoustic parameters commonly used in voice assessments (fundamental frequency, jitter, shimmer, Harmonics-to-Noise Ratio and Cepstral Peak Prominence Smoothed) which may be influenced by bilingualism. METHODS: Exploratory cross-sectional study with two groups of female participants: monolingual Spanish speakers (n = 17), and bilingual Spanish-English speakers (n = 11). Participants filled out a questionnaire and recorded two voice samples (sustained vowel /a/ and reading). For this study, all the participants reported that their native language was Spanish. RESULTS: Being a female bilingual speaker had a significant effect on Shimmer (%) with a Beta = -0.7. Similar tendency was found on harmonics-to-noise ratio (B = 0.2) and cepstral peak prominence smoothed (B = 0.2). CONCLUSIONS: Our results indicate that being a native Spanish female speaker, speaking English as a second language, has significant small effects on voice acoustic parameters, such as shimmer, harmonics-to-noise ratio and cepstral peak prominence smoothed, during their productions in Spanish. This information is of interest for assessment and intervention plans of bilingual speakers at clinical and work-related settings.

Screening of Voice Pathologies: Identifying the Predictive Value of Voice Acoustic Parameters for Common Voice Pathologies.

BACKGROUND: Voice acoustic analysis is important for objectively assessing voice production and diagnosing voice disorders. AIM: This study aimed to investigate the sensitivity of various voice acoustic parameters in differentiating common voice pathology types. METHODS: Data from the publicly available Perceptual Voice Qualities Database were analyzed; the database includes recordings of participants with and without voice disorders. A wide range of acoustic parameters was estimated from the recordings, such as alpha ratio, harmonics-to-noise ratio (HNR), cepstral peak prominence smoothed (CPPS), pitch period entropy (PPE), fundamental frequency, jitter, shimmer, and sound pressure levels. The predictive capabilities of the parameters were evaluated using receiver operating characteristic curves. Linear regression analysis determined the associations between parameters and voice disorders. Principal component analysis was conducted to identify important parameters for distinguishing voice disorders. RESULTS AND CONCLUSION: This study has identified significant differences in acoustic parameters between those with and without voice disorders. Notably, the combination of five parameters-namely, PPE, shimmer, jitter, CPPS, and HNR-was identified as a strong predictor in voice disorder screening. These findings contribute substantially to the field of voice disorders, offering valuable insights for screening and diagnosis.

Clinical Utility and Validation of the Acoustic Voice Quality and Acoustic Breathiness Indexes for Voice Disorder Assessment in English Speakers.

BACKGROUND: While several acoustic voice metrics are available for clinical voice assessment, there remains a significant need for reliable and ecologically valid tools. The Acoustic Voice Quality Index version 03.01 (AVQI-3) and Acoustic Breathiness Index (ABI) hold potential due to their comprehensive assessment approach, incorporating diverse voice aspects. However, these tools still need to be validated in English-speaking populations. METHODS: This study assessed the discriminatory accuracy and validity of AVQI-3 and ABI in 197 participants, including 148 with voice disorders. Voice samples were collected, followed by AVQI-3 and ABI calculations. Additionally, auditory-perceptual assessments were conducted by a panel of speech-language pathologists. RESULTS: AVQI-3 and ABI effectively identified disordered voice quality, evidenced by high accuracy (AUCs: 0.84, 0.89), sensitivity, and specificity (thresholds: AVQI-3 = 1.17, ABI = 2.35). Strong positive correlations were observed with subjective voice quality assessments (rs = 0.72, rs = 0.77, p < 0.001). CONCLUSIONS: The study highlights AVQI-3 and ABI as promising instruments for clinically assessing voice disorders in U.S. English speakers, underscoring their utility in clinical practice and voice research.

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

OBJECTIVE: To determine the effect of a Workplace Vocal Health Promotion Program (WVHPP) and working conditions on voice functioning of college professors. STUDY DESIGN: This is a pre-post intervention study. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

Relationship Between Room Acoustics With Voice Symptoms and Voice-Related Quality of Life Among Colombian School and College Teachers During Online Classes in Times of COVID-19 Pandemic.

AIM: To determine the relationship between working conditions, especially room acoustics, with voice symptoms and voice-related quality of life among Colombian school and college teachers during online classes in times of COVID-19 pandemic. METHOD: Exploratory cross-sectional study. Participants were thirty-two primary, secondary and university Colombian teachers, who were invited to fill in an online survey about working conditions and voice symptoms during online classes in times of COVID-19 pandemic. In the statistical analysis, four dependent variables and eight independent variables were defined. We used Generalized Linear Model with a Gamma distribution and Binary Logistic Regression to determine the association between voice with working conditions. RESULTS: High reverberation time and stress during online classes in times of the COVID-19 pandemic reduced slightly the VRQOL scores. For Factor 3 of the VFI, high reverberation time and months teaching online classes were associated at the multivariate analysis. Stress and years of experience were statistically associated with an increased odds of reporting hoarseness. CONCLUSION: Similar to pre-COVID-19, teachers with online classes during the COVID-19 pandemic are affected by two work-related factors namely high reverberation time and stress. These two factors are increasing their likelihood of reporting hoarseness and having lower voice-related quality of life, which may confirm the relationship between reverberation, stress, and voice also during online classes. This highlights the need of implementing workplace vocal and mental health programs to decrease the occurrence of voice problems among teachers in times of and post-COVID-19 pandemic.

Systematic Review of Literature on Prevalence of Vocal Fatigue Among Teachers.

BACKGROUND: Previous results suggest that teaching is a high-risk profession for developing voice disorders. OBJECTIVE: This study aims to determine the prevalence of vocal fatigue among teachers and its relationship with voice acoustic parameters reported in previous studies. METHOD: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement Guidelines, we performed a systematic literature review including five databases: Scopus, Scielo, ScienceDirect, PubMed, and Web of Science. Information on study population, definition and evaluation of vocal fatigue, and teaching characteristics were extracted from each paper. The quality of the included publications was assessed using the "Quality assessment tool for quantitative studies". RESULTS: In total, 14 publications met the inclusion criteria. The two most common work-related factors of vocal fatigue were high levels of noise inside classrooms and loud speaking voice use. Some investigations reported voice acoustic parameters such as fundamental frequency and vocal Sound Pressure Levels as associated with vocal fatigue. CONCLUSION: Vocal fatigue is a prevalent symptom among teachers associated with teaching vocal demands. However, studies on objective parameters that complement self-reports, to quantify vocal fatigue are needed to determine permissible values for healthy occupational voice use.