Analysis of factors on voice quality in thyroidectomy patients.

OBJECTIVE: Vocal cord paralysis (VCP) is a serious complication in thyroidectomy operations; however, its management remains unclear. The present study evaluated the voice parameters of patients who underwent surgery using Intraoperative Neurophysiologic Monitoring (IONM). PATIENTS AND METHODS: A total of 52 patients (41 females and 11 males) who underwent a total thyroidectomy operation were evaluated using objective and subjective voice analysis examinations before and after surgery. Acoustic parameters, such as Fundamental Frequency (F0), Shimmer, Jitter, Noise-to-Harmonic ratio (NHR), and aerodynamic parameters, including S/Z ratio and maximum phonation time (MPT), were analyzed. Objective findings, including the VHI-10 (Voice Handicap Index) and V-RQOL (Voice-Related Quality of Life), were also analyzed. The relationship between voice parameters and IONM values was investigated. RESULTS: The objective analysis (acoustic and aerodynamic parameters) showed no difference (p>0.05). However, the subjective analysis, which involved the VHI-10 and V-RQOL measures, revealed a significant difference before and after the operation (p<0.05). The Spearman correlation analysis showed that the NHR postoperative 1st-month parameter negatively correlated (rho=-0.317, p<0.059), while the F0 postoperative 6th-month parameter positively correlated (rho=0.347) with the amplitude difference before and after dissection (Right R2-R1 difference) for the right RLN measured in IONM. CONCLUSIONS: Patients who are planning to undergo a thyroidectomy procedure should undergo voice assessment during both the preoperative and postoperative periods. IONM could improve voice quality outcomes.

Biomechanical Parameters of Voice in Parkinson's Disease Patients.

INTRODUCTION: Previous research on voice in Parkinson's disease (PD) has consistently demonstrated alterations in acoustic parameters, including fundamental frequency (F0), maximum phonation time, Shimmer, and Jitter. However, investigations into acoustic parameter alterations in individuals with PD are limited. METHODS: We conducted an experimental study involving 20 PD patients (six women and fourteen men). Subjective measures of voice (VHI-30 scale and GRBAS) and objective measures using the OnlineLAB App tool for analyzing biomechanical correlates of voice were recorded. The app analyzed a total of 22 biomechanical parameters of voice. RESULTS: The results of subjective measures were consistent with findings from previous studies. However, the results of objective measures did not align with studies that employed acoustic measures. CONCLUSIONS: The biomechanical analysis revealed alterations in various parameters according to gender. These findings open up a new avenue of research in voice analysis for patients with PD, whether through acoustic or biomechanical analysis, aiming to determine whether the observed changes in these patients' voices are attributable to age or disease progression. This line of investigation will help elucidate the relative contribution of these factors to vocal alterations in PD patients and provide a more comprehensive understanding of the underlying mechanisms.

Vocal Problems and Burnout Syndrome in Nonuniversity Teachers in Galicia, Spain.

INTRODUCTION: Voice disorders and burnout syndrome are common among teachers. This study aimed to explore the relationship among vocal problems, burnout syndrome, and some personal work factors. METHODS: This cross-sectional descriptive study enrolled 90 nonuniversity teachers who completed the Multidimensional Vocal Scale for Teachers (EVM-D) to evaluate vocal problems and an adapted Spanish version of the Maslach Burnout Inventory-Educators Survey (MBI-ES) to detect burnout syndrome. RESULTS: Overall, 16% of teachers expressed symptoms compatible with burnout, and 60% of them were in the interval above the 75th percentile of the EVM-D, i.e., they had a high risk of vocal problems. An association between burnout and more vocal problems was established among teachers, particularly between the vocal symptoms and vocal abuse dimensions with the emotional exhaustion subscale of the MBI-ES. A history of anxiety/depression and fewer years of professional experience were associated with more vocal problems. The burnout group perceived more "loss of vocal power," "vocal fatigue," "vocal effort," and "hoarseness." Vocal abuse items received the highest scores of EVM-D. However, only "shouting" in the classroom was significantly different between the groups with and without burnout. CONCLUSION: Emotional exhaustion of burnout syndrome, history of anxiety/depression, and a shorter professional experience were associated with vocal problems, which could limit the performance of teachers. Reducing classroom noise, establishing strategies to avoid shouting, or strengthening personal accomplishments in teachers could be useful in breaking the cycle of vocal problems and emotional exhaustion, particularly at the beginning of their professional experience.

Self-perception of the Immediate Impact on the Voice of Gospel Singers after a one-hour Presentation. / Autopercepção do Impacto Imediato na Voz de Cantores Gospel após uma Apresentação de uma hora.

PURPOSE: To investigate the immediate impact on the voice of gospel singers with and without vocal complaints after a one-hour individual presentation. METHODS: Application of an online questionnaire that addressed the following aspects: 1 - Sociodemographic data; 2 - Self-assessment of the ability to sing using the Evaluation of the Ability to Sing Easily (EASE-BR) protocol; 3 - Self-assessment of vocal fatigue symptoms using the Vocal Fatigue Index (VFI) protocol; and 4 - Self-assessment of voice handicap using the Voice Handicap Index 10 (VHI-10) protocol. Participants were divided into two groups: Group with Vocal Complaint (WVC) and Group with no Vocal Complaint (WnVC) based on the total score of the IDV-10. Data underwent descriptive and inferential statistical analysis with a significance level of 5%. RESULTS: The study included 43 gospel singers with a median age of 34 years: 32 were in the WnVC group and 11 were in the WVC group. The WVC group reported hoarseness and experienced more difficulty while singing in the EASE, resulting in higher scores in both the VHI-10 and VFI protocols. A positive correlation was observed between singing difficulty and vocal handicap due to fatigue in amateur gospel singers, with this correlation being stronger within the WnVC group. CONCLUSION: After one hour of performance, singers with vocal complaints exhibited higher rates of vocal fatigue, vocal disadvantage, and greater difficulty in singing. Singers without complaints may have their ability to sing impaired by vocal fatigue. Variations in singing ability and vocal handicaps in amateur gospel singers may be directly related to vocal fatigue.

OBJETIVO: Investigar o impacto imediato na voz de cantores gospel com e sem queixa vocal após uma apresentação individual de uma hora. MÉTODO: Aplicação de um questionário online que abordou os seguintes aspectos: 1 - Dados sociodemográficos; 2 ­ Autoavaliação da habilidade de cantar pelo protocolo Evaluation of the Ability to Sing Easily (EASE-BR); 3 - Autoavaliação de sintomas de fadiga vocal pelo Índice de Fadiga Vocal (IFV); e 4 - Autoavaliação da desvantagem vocal pelo protocolo Índice de Desvantagem Vocal 10 (IDV-10). Os participantes foram divididos em dois grupos: Grupo Com Queixa (CQ) e Grupo Sem Queixa (SQ) com base no escore total do IDV-10. Os dados passaram por análise estatística descritiva e inferencial considerando o nível de significância de 5%. RESULTADOS: Participaram 43 cantores gospel com idade mediana de 34 anos, divididos entre 32 do grupo SQ e 11 do grupo CQ. O grupo CQ autorrelatou rouquidão e maior dificuldade ao cantar no EASE e maiores escores nos protocolos IDV-10 e IFV. Foi evidenciada correlação positiva entre a dificuldade ao cantar e a desvantagem vocal com a fadiga de cantores amadores gospel, sendo que essa correlação foi maior para o grupo SQ. CONCLUSÃO: Cantores com queixa vocal apresentaram maiores índices de fadiga vocal, desvantagem vocal e maior dificuldade para cantar após uma hora de apresentação. Cantores sem queixa podem ter a habilidade de cantar prejudicada pela fadiga vocal. Variações na habilidade ao cantar e desvantagens vocais de cantores amadores gospel podem ter relação direta com a fadiga vocal.

Percepção de professores quanto ao impacto do ruído no ambiente escolar / Teachers' perception of the impact of noise in the school environment / Percepción del docente sobre el impacto del ruido en el entorno escolar

Introdução: a poluição sonora está presente na escola, sendo assim, é importante conhecer as fontes de ruído, o impacto na saúde do professor e no ensino. Objetivo: avaliar a percepção de professores do ensino fundamental I quanto ao impacto do ruído no ambiente escolar, bem como seus sintomas vocais. Método: estudo observacional, descritivo, analítico, transversal. Aplicou-se inventário, do qual participaram 26 professoras da rede municipal da cidade de Santo Amaro da Imperatriz, SC. Aplicou-se um questionário com questões referentes à idade, sexo, tempo de trabalho, carga horária diária, impacto e percepção do ruído no ambiente escolar. Utilizou-se o Índice de Triagem para Distúrbios da Voz, uma triagem para identificação de risco para distúrbio de voz em professores. Para a análise de associação dos resultados foi utilizado o teste de Qui Quadrado, com nível de significância de 5%. Resultados: 53,57% das professoras responderam que há excesso de ruído na escola e 57,14% consideram que o ruído dentro da sala prejudica as atividades. As fontes externas e internas de ruído que mais atrapalham são: pátio, corredor, conversas paralelas e ventilador. Quanto aos sintomas vocais referidos, destacaram-se: garganta seca, cansaço ao falar, pigarro e rouquidão. Professoras que lecionam em período integral apresentaram mais queixas para o pigarro. Conclusão: os sujeitos têm a percepção de que o ambiente escolar é excessivamente ruidoso e causa prejuízos no desenvolvimento das atividades. As participantes têm poucas queixas relacionadas à voz, sendo a mais frequente, garganta seca. Além disso, professoras que lecionam em período integral apresentaram, significativamente, mais queixas de pigarro. (AU)

Introducción: la contaminación acústica está presente en la escuela, entonces es importante conocer las fuentes del ruido, el impacto en la salud del docente y en la enseñanza. Propósito: evaluar la percepción de docentes sobre el impacto del ruido en el ambiente escolar, así como sus síntomas vocales. Método: estudio observacional, descriptivo, analítico, transversal. Se aplicó un inventario, en el que participaron 26 docentes de la red municipal de la ciudad de Santo Amaro da Imperatriz, (SC). con preguntas relacionadas con edad, género, tiempo de trabajo, carga diaria de trabajo, impacto y percepción del ruido en el ambiente escolar. Se utilizó el Índice de Detección de Trastornos de la Voz para identificar el riesgo de trastornos de la voz. Para el análisis de asociación se utilizó la prueba de chi-cuadrado, con un nivel de significación del 5%. Resultados: 53,57% respondió que en la escuela hay exceso de ruido y 57,14% consideram que el ruido dentro del salón perjudica las actividades. Las fuentes de ruido más molestas son: patio, pasillo, conversaciones paralelas y ventilador. En cuanto a los síntomas vocales reportados destacan sequedad de garganta, cansancio al hablar, carraspeo y ronquera. Los maestros de tiempo completo se quejaron más de carraspear. Conclusión: los sujetos tienen la percepción de que el ambiente escolar es excesivamente ruidoso y provoca perjuicios para el desarrollo de las actividades. Los participantes tienen pocas quejas relacionadas con la voz, siendo la garganta seca la más frecuente. Además, los maestros que enseñan a tiempo completo tenían muchas más quejas de carraspeo. (AU)

Introduction: noise pollution is present at school; therefore, it is important to know the sources of noise, the impact on the teacher's health and on teaching. Purpose: to evaluate the perception of elementary school teachers regarding the impact of noise in the school environment, as well as their vocal symptoms. Method: observational, descriptive, analytical, cross-sectional study. An inventory was applied, in which 26 teachers from the municipal network of the city of Santo Amaro da Imperatriz, (SC). participated. A questionnaire was applied with questions related to age, gender, working time, daily workload, impact and perception of noise in the school environment. The Voice Disorders Screening Index was used, a screening to identify risk for voice disorders in teachers. For the analysis of the association of results, the chi-square test was used, with a significance level of 5%. Results: 53.57% of the teachers answered that there is excessive noise in the school and 57.14% consider that the noise inside the room harms the activities. The most disturbing external and internal sources of noise are courtyard, corridor, parallel conversations and fan. As for the reported vocal symptoms, the following stand out: dry throat, tiredness when speaking, throat clearing and hoarseness. Full-time teachers complained more about throat clearing. Conclusion: the subjects have the perception that the school environment is excessively noisy and causes damage to the development of activities. The participants have few voice-related complaints, the most frequent being dry throat. In addition, teachers who teach full-time had significantly more complaints of throat clearing. (AU)

Prevalence of voice handicap among nurses in intensive care units due to occupational noise during pandemic.

Background: Healthcare workers have been identified as being at risk of occupational voice disorders. Among them, nurses working in intensive care units (ICUs) are particularly vulnerable due to the risk factors that are associated with their exposure to high levels of noise. Thus, this study aimed to determine the prevalence of voice disorders among ICU nurses. Methods: A questionnaire was administered to 100 ICU nurses from four hospitals in China. The questionnaire assessed vocal-related symptoms, perceived voice handicap, frequently heard noise sources, and the quality of communications. Results: Results indicate that the most frequently reported voice symptoms were 'voice tiredness' and 'voiceless'. Nurses working more than 50 h per week experienced voice symptoms more frequently than nurses working for 40-50 h per week. The median value of the perceived voice handicap score (VHI-30) was 23, indicating mild voice handicap, while 24% of the nurses reported severe voice handicap. Longer working hours and working at patient wards were significantly associated with higher VHI-30 scores. The nurses also reported that the quality of verbal communication with patients and colleagues and voice problems worsened during the COVID-19 pandemic. Conclusion: More than 20% of nurses reported severe voice handicap, however, voice handicap among ICU nurses did not appear universally to all nurses. Further research is necessary to identify the risk factors associated with voice disorders and the mechanism behind such heterogeneity among ICU nurses.

Feasibility and efficacy of video-call speech therapy in patients with Parkinson's disease: A preliminary study.

BACKGROUND: Speech therapy is highly effective for patients with Parkinson's disease (PD) who have speech difficulties; however, its accessibility is limited. Online video-call speech therapy has been explored as an alternative option for PD patients. OBJECTIVES: To evaluate the feasibility and efficacy of video-call speech therapy for PD patients. METHODS: This prospective, comparative study was conducted between July and September 2022. PD patients with speech difficulties were divided into two groups, online speech therapy via video call and in-person therapy at hospital, based on their willingness to visit the hospital frequently. The patients underwent 12 sessions of speech therapy, focusing on respiration and phonation. Acoustic assessments, auditory-perceptual assessment, and voice handicap index (K-VHI10) were evaluated at baseline, post-therapy, and follow-up. RESULTS: Eleven patients were enrolled in the study, though one patient from the online group withdrew. Ten patients completed the therapy (five in each group) without missing a session. The baseline acoustic measurements did not differ between the two groups. After therapy, both group showed an increase in voice intensity and improvement in overall loudness. The post-therapy change from baseline in the acoustic measurements was not significantly different between the two groups. The effect of therapy were maintained in the follow-up evaluation in both groups. The K-VHI10 decreased significantly from baseline to post-therapy and further at follow-up in both groups, with no significant difference between two groups. CONCLUSION: The online speech therapy via video call is feasible in PD patients with speech difficulties and as effective as in-person therapy.

Voice improvement following conventional speech therapy combined with singing intervention in people with Parkinson's disease: A three-arm randomised controlled trial.

BACKGROUND: Although speech and voice disorders are common in Parkinson's disease (PD), there is insufficient evidence to support the effectiveness of behavioural speech therapies in these patients. AIMS: This study aimed to examine the effects of a new tele-rehabilitation program, a combining of conventional speech therapy and singing intervention, on voice deficits in patients with PD. METHODS & PROCEDURES: This study was a three-armed, assessor-masked, randomised controlled trial. Thirty-three people with PD were randomly assigned to the combination therapy, conventional speech therapy, or singing intervention group. This study followed the Consolidated Standards of Reporting Trials guidelines for non-pharmacological treatment. Each patient participated in 12 tele-rehabilitation sessions over 4 weeks. The combination therapy group received speech and singing interventions simultaneously (respiratory, speech, voice, and singing exercises). Voice intensity as a primary outcome and the voice handicap index (VHI), maximum frequency range, jitter and shimmer as secondary outcomes were evaluated 1 week before the first intervention session, 1 week after the last intervention session and 3 months after the last evaluation. OUTCOMES & RESULTS: The results of repeated measures analysis of variance showed a significant main effect of time on all outcomes in all three groups after treatment (p < 0.001). There was a significant group effect for voice intensity (p < 0.001), VHI (p < 0.001), maximum frequency range (p = 0.014) and shimmer (p = 0.001). The combination therapy group demonstrated a significant outperformance in the VHI and shimmer than the speech therapy (p = 0.038) and singing intervention (p < 0.001) groups. The results of this study also indicated that combination therapy group compared to singing intervention group had a larger effect on voice intensity (p < 0.001), shimmer (p < 0.001) and maximum frequency range (p = 0.048). CONCLUSIONS & IMPLICATION: The results demonstrated that combining speech therapy with a singing intervention delivered through tele-rehabilitation might be more effective in improving voice problems in patients with PD. WHAT THIS PAPER ADDS: What is already known on the subject Parkinson's disease (PD) is a neurological disorder that frequently causes disturbances in speech and voice, which negatively affect patients' quality of life. Although speech difficulties occur in 90% of patients with PD, evidence-based treatment options for speech and language problems in these patients are limited. Therefore, further studies are required to develop and assess evidence-based treatment programs. What this study adds The findings of this study showed that a combination therapy program including conventional speech therapy approaches and individual singing intervention provided through tele-rehabilitation may have a greater effect on the improvement of voice problems in people with PD compared to speech therapy and singing intervention alone. What are the clinical implications of this work? Tele-rehabilitation combination therapy is an inexpensive and enjoyable behavioural treatment. The advantages of this method are that it is easy to access, appropriate for many stages of voice problems in PD, requires no prior singing training, encourages voice health and self-management and maximises treatment resources available to people with PD. We believe that the results of this study can provide a new clinical basis for treatment of voice disorders in people with PD.

Impact of Sternothyroid Muscle Division on Patient-Reported Voice Outcomes After Thyroid Surgery: A Prospective Study.

OBJECTIVE: Division of the sternothyroid muscle during thyroidectomy is a widely accepted surgical technique to provide improved exposure of the thyroid gland, thus facilitating the ligation of superior pole vessels and identification of the laryngeal nerves. However, few have examined the impact on voice outcomes. We evaluate the impact of sternothyroid muscle division on patient-perceived voice outcomes after thyroidectomy. STUDY DESIGN: Prospective cohort study. SETTING: Tertiary academic institution. METHODS: A prospective cohort study was conducted comparing pre- and postoperative voice outcome data after thyroidectomy, measured using Voice Handicap Index-10. The cohort of 109 patients underwent lobectomy or total thyroidectomy by a single surgeon at 1 institution. The sternothyroid muscle was fully divided in all surgeries. The integrity of the recurrent laryngeal and external branches of the superior laryngeal nerve was assessed using intraoperative nerve monitoring and postoperative laryngoscopy. Pre- and postoperative Voice Handicap Index-10 scores were compared. RESULTS: No statistically significant difference was found between total pre- and postoperative Voice Handicap Index-10 scores (µpreop = 1.92, µpostop = 1.83, p = .87). There were no questions yielding statistically significant responses between pre- and postoperative groups. This was consistent regardless of whether the sternothyroid muscle was cut unilaterally or bilaterally. Men showed a statistically significant improvement in score after surgery. CONCLUSION: These findings support no difference in postoperative voice outcomes after the intraoperative division of the sternothyroid muscle. This supports the usage of this technique as a safe means to facilitate exposure during thyroid surgery and will serve as important information to guide intraoperative surgical decision-making.

Oropharyngeal geometry and acoustic parameters of voice in healthy and Parkinson's disease subjects. / Geometria orofaríngea e parâmetros acústicos vocais de indivíduos hígidos e com doença de Parkinson.

PURPOSE: to verify whether there are differences in acoustic measures and oropharyngeal geometry between healthy individuals and people with Parkinson's disease, according to age and sex, and to investigate whether there are correlations between oropharyngeal geometry measures in this population. METHODS: 40 individuals participated, 20 with a diagnosis of Parkinson's disease and 20 healthy individuals, matched by age, sex, and body mass index. Acoustic variables included fundamental frequency, jitter, shimmer, glottal-to-noise excitation ratio, noise, and mean intensity. Oropharyngeal geometry variables were measured with acoustic pharyngometry. RESULTS: geometry variables were smaller in the group with Parkinson's disease, and older adults with Parkinson's disease had a smaller oropharyngeal junction area than healthy older adults. Regarding acoustic parameters of voice, fundamental frequency values were lower in males with Parkinson's disease, and jitter values ​​were higher in the non-elderly subjects with Parkinson's disease. There was a moderate positive correlation between oral cavity length and volume, pharyngeal cavity length and vocal tract length, and pharyngeal cavity volume and vocal tract volume. CONCLUSION: individuals with Parkinson's disease had smaller glottal areas and oropharyngeal junction areas than healthy individuals. When distributed into sex and age groups, the fundamental frequency was lower in males with Parkinson's disease. There was a moderate positive correlation between oropharyngeal length and volume measures in the study sample.

OBJETIVO: verificar se existem diferenças nas medidas acústicas e da geometria orofaríngea entre indivíduos hígidos e pessoas com Doença de Parkinson, segundo a idade e sexo e investigar se há correlações entre as medidas geométricas orofaríngeas nessa população. MÉTODO: participaram 40 indivíduos, sendo 20 com diagnóstico de Doença de Parkinson e 20 indivíduos hígidos, pareados por faixa etária, sexo e índice de massa corporal. As variáveis acústicas estudadas foram frequência fundamental, jitter, shimmer, glottal-to-noise excitation ratio, ruído e média da intensidade. As variáveis geométricas da orofaringe foram aferidas por faringometria acústica. RESULTADOS: as variáveis geométricas foram menores no grupo com Doença de Parkinson e os idosos com Doença de Parkinson apresentaram menor área da junção orofaríngea que os idosos hígidos. Com relação aos parâmetros acústicos vocais, o valor da frequência fundamental foi menor no sexo masculino, no grupo com Doença de Parkinson e os valores de jitter foram maiores no grupo não idoso dos sujeitos com Doença de Parkinson. Houve correlação positiva moderada entre o comprimento e volume da cavidade oral, comprimento da cavidade faríngea e o comprimento do trato vocal e do volume da cavidade faríngea e o volume do trato vocal. CONCLUSÃO: indivíduos com Doença de Parkinson apresentaram menores valores de área glótica e área da junção orofaríngea, comparativamente aos hígidos. Quando distribuídos por faixa etária e sexo, a frequência fundamental foi menor no grupo com doença de Parkinson, na população masculina. Houve correlação positiva moderada entre as medidas de comprimento e volume da orofaringe, na amostra estudada.

Social Determinants of Health: Implications for Voice Disorders and Their Treatment.

PURPOSE: Adverse childhood experiences (ACEs) and related conditions, such as discrimination, are social determinants of health (SDOHs). Critical race theory (CRT) is a lens through which to understand SDOHs in a way that may impact our clinical care. When prolonged or chronic, SDOHs might cause toxic stress and trauma, which, in turn, adversely affect health and are shown to be relevant for some voice disorders. The goals of this tutorial are to (a) review the literature on SDOHs that potentially contribute to disparities; (b) discuss explanatory models and theories that describe how psychosocial factors influence health; (c) relate the foregoing information to voice disorders, highlighting functional voice disorders (FVDs) as a particular case in point; and (d) describe how trauma-informed care can improve patient outcomes and advance health equity for vulnerable populations. CONCLUSIONS: This tutorial concludes with a call for heightened awareness of the role that SDOHs such as structural and individual discrimination may play in voice disorders, and a call for research into SDOHs, traumatic stress, and health disparities in this patient population. A call is also made for more universal practice of trauma-informed care in the clinical voice domain.

Effects of Occupation-Specific Vocal Stress on the Mental Health of Day Care Teachers.

INTRODUCTION: Kindergarten teachers are exposed to numerous kinds of strains, such as noise, which can negatively affect their voices. This cross-sectional study investigates whether and to what extent the profession-specific high vocal demand is associated with the educators' mental health. METHODS: One hundred and ninety-two kindergarten teachers from Magdeburg, Germany and its surrounding areas aged 43.4 ± 12.8 years, voluntarily participated in a survey. Vocal demand and vocal demand response, general strain factors, and mental health were assessed by using questionnaires (self-check on voice demands, Rudow checklist, General Health Questionnaire, and Maslach Burnout Inventory). The statistical analyses were carried out using SPSS. RESULTS: The interviewed educators felt stressed by the excessive number of work tasks and children in each class, noisy work environment, and loud conversations. In addition, educators complained of headaches and neck pain (66%), while 28% of them experienced hoarseness and a burning throat. The mental health of 39 of the educators was impaired, and nine were at an increased risk of burnout. Self-reported voice effort correlated low with mental health (r = 0.287; p < 0.001) and burnout risk (r = 0.306; p < 0.001). CONCLUSION: The vocal demands on educators in day care settings are very high, which is a major associated factor for the development of burnout syndrome and is also associated with headaches and neck pain. Measures for the prevention of occupational voice disorders and voice training should be a mandatory part of the educators' training and must be offered as in-service training.

Amateur choir singers - Does good vocal health matter?

BACKGROUND: Many amateur singers enjoy singing in choirs. They are likely to lack the training and expertise of professional singers and this may have an impact on their vocal health. AIMS: To assess the experiences of amateur singers, their use of warm-up and cool-down sessions, their vocal health, their sources of help and advice and their reactions to receiving a diagnosis and treatment. METHODS AND PROCEDURES: A questionnaire was sent to amateur choir singers. Quantitative data on their use of warm-up and cool-down activities were collected and the singers rated how frequently they experienced adverse voice symptoms after singing. Qualitative data were collected from singers who had sought advice about their voice and from those who had received a diagnosis and treatment. OUTCOME AND RESULTS: Most choirs used warm-up sessions but few used cool-down. Singers who participated in choir warm-ups experienced significantly less vocal symptoms. Individual warm-ups were ineffective. Singers who had previously had a diagnosis continued to have significantly higher symptom scores. A quarter of the singers who had neither sought help nor had a diagnosis had high scores. Singers appeared uncertain about who to consult for help. Those who saw a speech and language therapist were much more likely to receive a diagnosis and treatment either by the therapist or by referral to an ear, nose and throat specialist. Those receiving treatment were mainly positive about it and likely to complete a course of therapy. CONCLUSIONS AND IMPLICATIONS: Warm-up sessions performed by choirs are helpful in avoiding voice symptoms and are recommended. The presence of singers who are unaware of potential damage to their voices is a concern. A simple rating system, as used in this research, may act to alert them to the dangers. Choir leaders could be more active in advising singers and refer them to professionals where necessary. Speech and language therapists appear more sensitive to their problems and could be a first point of contact. WHAT THIS PAPER ADDS: What is already known on this subject Poor vocal health may occur in amateur singers and lead to voice disorders which will reduce the demonstrated benefits of regular singing. They may be less aware than professional singers of potential hazards and may not know how to sing in a way that ensures good vocal health. There has been less research on the extent of voice problems in amateurs or of the actions they may take to resolve the vocal difficulties they encounter. What this paper adds to the existing knowledge This survey demonstrates that choir warm-ups were effective in helping to avoid common symptoms associated with voice problems. A large minority of singers who had not sought help for voice problems had high symptom scores on our assessment. Singers frequently turned to a singing teacher for help. Those who consulted a speech and language therapist were much more likely to be referred for further investigation and treatment. What are the potential or actual clinical implications of this work? We present a simple subjective measure of symptom severity which succeeds in distinguishing between singers who warm up their voices and those who do not and between singers who have received a past diagnosis and those who have not. There are a number of indications in this research that amateur singers are unsure if they need help and are uncertain who can offer it. In these circumstances the use of a simple measure of the severity of vocal abuse may be useful.

Update on the pediatric adverse vocal behavior voice disorders: a clinical practice review.

The main causes of voice disorders in children with adverse vocal behavior include benign lesions of the vocal folds caused by voice abuse or misuses, such as vocal fold nodules, vocal fold polyps, and laryngitis. Long-term voice disorders can affect the physical and mental health of children. Reviewing the literature of the last two decades on "Vocal Fold Nodules," "Vocal Fold Polyp," "Voice disorder," "Voice Abuse," "Voice Misuse," "Pediatrics," and "Children" with the appropriate Boolean operators.  Conclusion: A total of 315 results were returned on an initial PubMed search. All articles from 2000 to 2022 written in English or Chinese were screened. Duplicate articles, those relating to adults only or concerned with the malignant lesion of the vocal cord, were excluded, resulting in 196 articles of interest. Relevant references and books have also been consulted, and we provide a review of the pathogenesis, diagnosis, and treatment of these maladaptive vocal behavioral voice disorders. What is Known: • Hoarseness is the most common voice symptom in children, and there are various causes of hoarseness in children. However, there is a lack of reviews on voice disorders caused by adverse vocal habits in children. • Voice training is a conservative treatment method for children with voice disorders , and it is important to clarify the factors that influence the effectiveness of voice training for children. What is New: • This review of the personality and family characteristics of children with adverse vocal behavioural voice disorders provides a valuable guide to the clinical planning of subsequent treatment. • This article discusses and summarises some of the factors that may influence the effectiveness of voice training in children and collates some of the scales and questionnaires currently used in children that are important in predicting the effectiveness of voice training.

Persistent subjective voice symptoms for two years after thyroidectomy.

BACKGROUND: Voice change after thyroidectomy is an important issue in thyroid surgery. However, little is known about long-term voice outcomes after thyroidectomy. This study investigates the long-term voice outcomes of thyroidectomy up to two years after surgery. Also, we analyzed the pattern of recovery through acoustic tests over time. METHODS: We reviewed data from 168 patients who underwent thyroidectomy between January 2020 and August 2020 at a single institution. The Thyroidectomy-related Voice and Symptom Questionnaire (TVSQ) score and acoustic voice analysis results were examined preoperatively and postoperative one, three, and six months, and one and two years after surgery. We divided patients into two groups based on the TVSQ score (≥15 or <15) at two years postoperatively. We investigated the difference of acoustic characteristics between the two groups and analyzed correlations between acoustic parameters and various clinical and surgical factors. RESULTS: Voice parameters tended to recover, but some parameters and TVSQ scores exhibited deterioration two years after surgery. In the subgroups, among the many clinicopathologic factors examined, voice abuse history including professional voice users (p = 0.014), greater extent of thyroidectomy and neck dissection (p = 0.019, p = 0.029), and high pitch voice (F0; p = 0.005, SFF; p = 0.016) were associated with high TVSQ score at two years. CONCLUSIONS: Patients frequently experience voice discomfort after thyroidectomy. After surgery, voice abuse history including professional voice users, greater extent of surgery, and higher pitch voice are associated with worse voice quality and increased risk of persistent voice symptoms over the long-term.

Closed-loop network of skin-interfaced wireless devices for quantifying vocal fatigue and providing user feedback.

Vocal fatigue is a measurable form of performance fatigue resulting from overuse of the voice and is characterized by negative vocal adaptation. Vocal dose refers to cumulative exposure of the vocal fold tissue to vibration. Professionals with high vocal demands, such as singers and teachers, are especially prone to vocal fatigue. Failure to adjust habits can lead to compensatory lapses in vocal technique and an increased risk of vocal fold injury. Quantifying and recording vocal dose to inform individuals about potential overuse is an important step toward mitigating vocal fatigue. Previous work establishes vocal dosimetry methods, that is, processes to quantify vocal fold vibration dose but with bulky, wired devices that are not amenable to continuous use during natural daily activities; these previously reported systems also provide limited mechanisms for real-time user feedback. This study introduces a soft, wireless, skin-conformal technology that gently mounts on the upper chest to capture vibratory responses associated with vocalization in a manner that is immune to ambient noises. Pairing with a separate, wirelessly linked device supports haptic feedback to the user based on quantitative thresholds in vocal usage. A machine learning-based approach enables precise vocal dosimetry from the recorded data, to support personalized, real-time quantitation and feedback. These systems have strong potential to guide healthy behaviors in vocal use.

Duration of Clinical Response After In-Office Steroid Injection for Vocal Fold Scar.

OBJECTIVE: To assess the duration of clinical response after in-office vocal fold steroid injection (VFSI) for vocal fold (VF) scar. METHODS: Demographic and clinical data for in-office VFSI occurring from 2017 to 2020 were collected. Two Speech-Language Pathologists (SLPs) used perceptual evaluation of voice and functional scales to evaluate blinded voice and laryngovideostroboscopy (LVS) samples collected pre- and post-injection across multiple timepoints. RESULTS: Blinded SLP ratings were used for 30 individual VFs undergoing initial injection in 18 patients. Persistent improvement in voice past 6 months was seen in 57% of patients after VFSI. Multiple measures of voice and amplitude, percent vibrating tissue, and closed phase predominance significantly improved at various follow-up timepoints on average. CONCLUSION: Accounting for patient heterogeneity and disease progression, in-office VFSI for VF scar is associated with sustained improvement in a subset of patients. Approximately half of patients can expect to experience a lasting improvement in voice. Future studies of larger scale are required to identify patient factors associated with long-term benefit. LEVEL OF EVIDENCE: 4 Laryngoscope, 133:2333-2339, 2023.

Self-perceived affective, behavioral, and cognitive reactions associated with voice use in people with Parkinson's disease: a pilot study.

PURPOSE: This study aimed to compare the affective, behavioral, and cognitive reactions related to vocal function in people with Parkinson's disease (PWPD) and healthy controls using the Behavior Assessment Battery - Voice (BAB-Voice). The test's internal consistency was also described. METHODS: 31 PWPD and 19 healthy controls were recruited from September 2020 to March 2021. Participants completed four BAB-Voice subtests: Speech Situation Checklist - Emotional Reaction (SSC-ER), the Speech Situation Checklist - Speech Disruption (SSC-SD), Behavior Checklist (BCL), and Communication Attitude Test for Adults (BigCAT), describing the experienced negative emotional reaction, voice disruptions, coping behaviors, and negative attitude regarding communication respectively. Subtest scores were calculated and analyzed. RESULTS: The scores of the PWPD were significantly different from those of the controls (Pillai's Trace = 0.344, F[4] = 5.508, p = .001, ηp2 = .344): PWPD showed more negative emotions and voice problems, more coping behaviors, and more negative speech-related attitude compared to healthy controls. All subtests showed excellent internal consistency. CONCLUSIONS: The BAB-Voice proved a tool with a good internal consistency that measured different psychosocial reactions in PWPD versus controls. PWPD exhibited significantly more negative emotions and voice problems in specific speech situations, more coping behaviors, and a more negative speech-related attitude. The specificity of information obtained from the BAB-Voice may aid in improving the treatment planning of voice disorders in PWPD.