An Evaluation of Voice Hygiene in High School Choir Singers.

BACKGROUND/OBJECTIVES: Voice hygiene, including proper hydration and limiting phonotraumatic behaviors and refluxogenic foods when appropriate, is essential to voice care for singers. The purpose of this study was to evaluate voice care practices, knowledge, and factors correlating with improved voice hygiene and knowledge in adolescents, an understudied demographic within the singing population. METHODS: 214 high school choir singers, ages 14 through 18, responded to a voice health questionnaire, which included questions about phonotraumatic behaviors and other lifestyle measures regarding voice care, perceived knowledge of the voice, and potential correlational factors such as past singing experience, having a friend or family member when is a professional voice user or possesses an in-depth knowledge of the voice, use of the Internet to sing better or improve understanding of the voice, and other factors. These data were analyzed using descriptive statistics and multivariable linear regressions. RESULTS: Results showed poor voice hygiene. Phonotraumatic behaviors were frequent and the mean daily water intake was only 5.24 cups. However, 94.4% of the respondents warmed up their voices before rehearsals or performances. The mean total knowledge score, from 0 to 6, was only 2.09. In addition, feeling that one took care of his/her voice well, and use of Internet to sing better or advance knowledge of the voice, were correlated with improved knowledge or measures of voice health. CONCLUSION: Data suggest that improved instruction regarding voice health in the high school setting is necessary and that the Internet or social media may be valuable resources for reaching adolescent singers.

Phonotraumatic Injury in Fitness Instructors: Risk Factors, Diagnoses, and Treatment Methods.

Fitness instructors are at risk for phonotraumatic injury caused by a combination of occupation-driven environmental and physiologic factors. OBJECTIVES: This study analyzes phonotraumatic injury in a cohort of fitness instructors to define the spectrum of disease, inform treatment, and make educational recommendations. STUDY DESIGN: Retrospective chart review. METHODS: Fitness instructors seen over a 2-year period comprised the study population. Stroboscopic findings, recommended treatment modalities, and treatment outcomes, including postoperative recurrence (when applicable) were analyzed. Demographic information (gender, age), past medical history, VHI-10 scores, and concurrent relevant vocal demands (performer vs. non-performer) were reviewed. Descriptive statistics and bivariate analyses with Fisher's exact test and Wilcoxon rank sum test were used to determine statistical significance of various factors in relation to phonotraumatic injury and response to treatment. Cochran-Armitage trend tests were performed to analyze trends in injuries across fitness types in relation to increased vocal demand. Occupational concerns reported by subjects were analyzed descriptively. RESULTS: The subject cohort consisted of 24 fitness instructors (20F; 4M) who taught a variety of fitness methods. Thirteen subjects (54.2%) were diagnosed with pseudocysts (five unilateral, eight bilateral), five (20.8%) with bilateral midfold masses, five (20.8%) with polyps (four unilateral, one bilateral), and one (4.2%) with cyst. Fourteen subjects (58.3%) were prescribed medication (oral steroids, reflux medication, and/or allergy medication). All were referred for behavioral management. Ten (41.7%) chose surgical intervention after failure to return to satisfactory function with behavioral management; Four (40%) experienced postoperative lesion recurrence. There were no statistically significant findings in relation to demographic information, past medical history, concurrent relevant vocal demands, or occupational vocal demands with choice for surgery. Trend test analysis found that lesions that are typically more likely to require surgical intervention (eg, polyps) tended to be found more frequently as vocal demand increased. The primary occupational concerns reported by subjects were related to amplification (lack of amplification, inadequate amplification/amplification problems) and scheduling (too many consecutive classes without adequate breaks). CONCLUSION: Fitness instructors are subject to a variety of phonotraumatic vocal fold injuries, nearly half which require surgical treatment. One in four recurs after such intervention. Instructors could benefit greatly from education on vocal health, strategies to improve and/or reduce voice use while in the fitness environment, and to help aid in recognizing early "red flags" for phonotraumatic injury. Occupational factors that place fitness instructors at risk for phonotraumatic injury (scheduling, environment, amplification) may be improved with education directed to studio owners and managers.

Keeping the Voice Fit in the Group Fitness Industry: A Qualitative Study to Determine What Instructors Want in a Voice Education Program.

OBJECTIVES: This study aimed to provide a descriptive summary of (1) group fitness instructors' (GFIs') experiences of occupational voice use and education, and (2) the content and mode of delivery desired by GFIs in an education and training program. STUDY DESIGN: This is a qualitative inductive approach using a semi-structured interview. METHOD: Semi-structured interviews were conducted with eight GFIs recruited via self-selection sampling. Participants were asked to comment on their experiences of voice use, voice education, and their preferences for future education and training. RESULT: Participants reported experiencing occupational voice difficulties, and cited inadequate voice education, faulty equipment, and apathetic fitness industry attitudes as core barriers to vocal health. Content focusing on vocal hygiene, safe occupational voice use, use of amplification equipment, and addressing industry attitudes to voice was desired by participants. A combination of face-to-face, web-based, and app-based delivery options was suggested. CONCLUSION: The data from this study should be considered when designing a vocal education and training package tailored to the needs of GFIs and the fitness industry.

The Effects of a Voice Education Program on VHI Scores of Elementary School Teachers.

INTRODUCTION: Teachers seem to be vulnerable to voice disorders because of excessive use of their voice. The purpose of this study was to investigate the effects of a voice education program on the Vocal Handicap Index (VHI) scores of elementary school teachers in the Persian education system. METHOD: This was a semi-experimental study, performed in Shiraz public schools. Ten schools were selected on their similarity in number of students and teachers, and allocated at random to training or control groups. Sixty-one teachers in the training group and 66 teachers in the control group completed the VHI in the first week. Teachers in the trained group received voice education for 4 weeks, and then continued to follow the program for a further 4 weeks. The control group received no training. After 8 weeks, all subjects completed the questionnaire again. RESULTS: Compliance was good for all practices except "breathing exercises" and "using amplifiers" where it was exceptionally poor. Teachers in the training group improved significantly in total VHI score (from 14.2 to 6.8), whereas the control group showed a significant worsening (from 10.1 to 13.7). These effects were significant (P < 0.05) for total VHI score and for all subscales. The corresponding effect sizes for the training group range from -0.53 to -0.84 (-0.83 in the overall VHI). CONCLUSION: A voice education program can have positive effects on the voice of teachers, even without dysphonia, in the middle of their teaching. Such a program may have a place in the Persian education system.