What are the Symptoms that Characterize the Clinical Condition of Vocal Fatigue? A Scoping Review and Meta-Analysis.

INTRODUCTION: Vocal fatigue is a clinical manifestation associated with a perception of negative vocal adjustment. It is related to the increase in the sensation of excessive effort when speaking and the lack of conditioning of the muscles and structures that involve vocal production. Because it has a complex and multifactorial diagnosis, there is still no consensus on the symptoms most commonly found in this clinical condition. OBJECTIVE: To review and analyze the symptoms that characterize the clinical condition of vocal fatigue. METHODS: This study consists of a scoping review carried out in the Cochrane Library, Embase, Lilacs, and Medline databases. Observational studies or clinical trials from the last 10 years. Studies with participants younger than 18 years of age were excluded; as well as research that did not describe symptoms of vocal fatigue or that presented vocal fatigue as a symptom; studies with patients with neurological, psychiatric, syndromic conditions, or head and neck cancer. The Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies NHLBI-NIH scale was used to assess the methodological quality of selected observational studies and the PEDro scale for the analysis of experimental studies. The steps were performed by three blinded evaluators. Subsequently, meta-analyses of global means were executed for each factor under study; a comparison of the difference in the mean score for each factor between exposed and unexposed; a comparison of the difference in the average score, among non-professional voice users, for each factor between exposed and unexposed. RESULTS: In the searches performed, 956 articles were found and 29 articles were selected according to the eligibility criteria. Of these, 93.11% of the studies were observational and 6.89% were clinical trials. Regarding the gender and age group of the study samples, women aged between 30 and 45 years were predominant. As for the occupational use of voice, 68.97% of the samples were composed of professional voice users and 31.03% of non-professional voice users, with most professional voice users being teachers and non-professional voice users, individuals with dysphonia or vocal complaint. To assess vocal fatigue symptoms, 28 studies used the Vocal Fatigue Index (VFI) protocol, and only one study used another assessment protocol, Self-Administered Voice Rating. All studies were classified as regular, according to the scale used. As for the meta-analyses performed, the mean scores of the VFI factors were higher among professional voice users when compared to non-professional voice users and higher in dysphonic individuals compared to non-dysphonic individuals. CONCLUSION: The vocal fatigue symptoms found in this review were common in the populations of professional voice users and non-professional voice users and dysphonic and non-dysphonic individuals. These symptoms were related to vocal recovery after rest, physical discomfort, and restricted vocal use.

Self-perception of insomnia, sleep quality, and musculoskeletal pain in dysphonic women: preliminary study.

OBJECTIVE: To evaluate the association between musculoskeletal pain, insomnia indices, and sleep quality with voice functioning among women. METHODS: Thirty women aged between 18 and 50 years old participated in two groups: dysphonic group (DG) - composed of 15 women diagnosed with behavioral dysphonia; and control group (CG) - composed of 15 vocally healthy women. All participants answered the Musculoskeletal Pain Investigation Questionnaire, Pittsburgh Sleep Quality Index (PSQI), and Insomnia Severity Index (ISI) questionnaires. Statistical tests were applied to compare groups and to relate outcome variables, with a significance of 5% (p<.05). RESULTS: Dysphonic women presented a higher frequency of musculoskeletal pain in the posterior neck, lower back, masseter, submandibular, and larynx regions. There was no statistically significant difference for the other compared variables. We observed that there was a difference in the comparison between pain in some head and neck regions and the quality of sleep and evidence of insomnia, both in DG and CG. CONCLUSIONS: Dysphonic women have a higher frequency of pain in the head and neck regions when compared to vocally healthy women. There is a difference between sleep quality, insomnia, and musculoskeletal pain, regardless of the presence of vocal and laryngeal alterations.

Effects of transcutaneous electrical nervous stimulation (TENS) associated with vocal therapy on musculoskeletal pain of women with behavioral dysphonia: A randomized, placebo-controlled double-blind clinical trial.

Recently, electrical stimulation in vocal rehabilitation has been the subject of studies. This treatment has shown promising results regarding the decrease of vocal/laryngeal symptoms, pain and the improvement of vocal tension. In addition to decreasing pain symptoms, TENS treatments may lead to muscle relaxation. There is no data on the effects of this resource as a vocal therapy in women with behavioral dysphonia. Research in this area may provide evidence to assist the clinical decision related to the treatment of women with complaints of behavioral dysphonia and musculoskeletal pain. OBJECTIVE: To verify the effects of low-frequency TENS in association with vocal therapy on musculoskeletal pain in women with behavioral dysphonia. METHODS: Participants included 27 women with vocal nodules randomized into two groups. The experimental group (EG) - 13 women received 12 sessions of TENS (pulse of 200 µs, frequency at 10 Hz, in motor threshold) with electrodes placed bilaterally on the trapezius muscle and submandibular area for 20 min followed by 30 min of vocal therapy, and the control group (CG) - 14 women received 12 sessions of 20 min of a placebo TENS followed by 30 min of vocal therapy. We investigated the frequency and intensity of the musculoskeletal pain in several body regions, as well as the intensity of pain at rest and in the application of pressure with an algometer applied to the descending fibers of the trapezius muscle. The pressure-pain threshold (PPT) was also investigated. All evaluations occurred before, immediately after, and at one and three months after treatment in both groups. RESULTS: We observed a reduction in the frequency of pain in the larynx after treatment of both groups, but only the EG showed a decrease in pain intensity in this region. It was verified with an algometer to the trapezius muscle that the electrical stimulation associated with the vocal therapy decreased the intensity of pain during the application of pressure and increased the PPT. There were no significant differences with regard to variables investigated in the comparison between the interventions. On the other hand, there was decreased pain in the trapezius muscle for the EG in comparison to the pre- and post-intervention. CONCLUSION: The vocal therapyprogram reduced the frequency and intensity of the musculoskeletal pain in the regions proximal to the larynx of women with behavioral dysphonia. In addition, TENS followed by vocal therapy increased the threshold of sensitivity to muscular pain in the trapezius, demonstrating that it is a good resource to use in conjunction with traditional vocal therapy in cases of behavioral dysphonia associated with pain and muscle tension.

Evaluating effectiveness of dynamic soundfield system in the classroom.

Research has reported on the use of soundfield amplification devices in the classroom. However, no study has used standardized tests to determine the potential advantages of the dynamic soundfield system for normally hearing students and for the teacher's voice. Our aim was to evaluate the impact of using dynamic soundfield system on the noise of the classroom, teacher's voice and students' academic performance. This was a prospective cohort study in which 20 student participants enrolled in the third year of basic education were divided into two groups (i.e., control and experimental); their teacher participated. The experimental group was exposed to the dynamic soundfield system for 3 consecutive months. The groups were assessed using standardized tests to evaluate their academic performance. Further, questionnaires and statements were collected on the participants' experience of using the soundfield system. We statistically analyzed the results to compare the academic performance of the control group with that of the experimental group. In all cases, a significance level of P < .05 was adopted. Use of the dynamic soundfield system was effective for improving the students' academic performance on standardized tests for reading, improving the teacher's speech intelligibility, and reducing the teacher's vocal strain. The dynamic soundfield system minimizes the impact of noise in the classroom as demonstrated by the mensuration of the signal-to-noise ratio (SNR) and pupil performance on standardized tests for reading and student and teacher ratings of amplification system effectiveness.

Effect of application of transcutaneous electrical nerve stimulation and laryngeal manual therapy in dysphonic women: clinical trial.

OBJECTIVE: To verify the effect of the Transcutaneous Electrical Nerve Stimulation (TENS) and of Laryngeal Manual Therapy (LMT) and to compare the two techniques in relation to vocal/laryngeal symptoms, pain, and vocal quality after these resources were administered in dysphonic women. STUDY DESIGN: Control trial. METHOD: A total of 20 women with bilateral vocal nodules participated. All of the volunteers underwent investigation of vocal/laryngeal symptoms, musculoskeletal pain, and vocal register. The volunteers were subdivided into: 1. TENS Group (10 volunteers)-TENS application; 2. LMT Group (10 volunteers)-LMT application; both groups received 12 sessions of treatment, twice a week, lasting 20 minutes each. After treatment, the initial assessments were repeated. Data were statistically analyzed by Wilcoxon and signal test (P < 0.05). RESULTS: After TENS, there was significant improvement in the "high pitched voice" and "effort to speak" symptoms; there was significantly lower frequency of pain in the posterior neck and shoulder; TENS significantly reduced the intensity of pain in the posterior neck, shoulder, and upper back. The auditory perceptual analysis showed improvement only in the strain parameter after TENS. After LMT, there was improvement of the "sore throat," significantly lower incidence of pain in the anterior neck, and the pain intensity in the posterior neck decreased. CONCLUSION: When compared with the LMT, TENS appeared to be a treatment method intended to be used as a complement to voice therapy, considering the parameters evaluated and controlled.