Relationship Between Laryngeal Signs and Symptoms, Acoustic Measures, and Quality of Life in Finnish Primary and Kindergarten School Teachers.

OBJECTIVE: This study investigated the relationship between the acoustic measure smoothed cepstral peak prominence (CPPS), teacher's quality of life as measured by the voice activity and participation profile (VAPP), laryngeal signs and symptoms, voice related health problems and laryngoscopic findings in Finnish teachers. The relationship between CPPS and sound pressure level (SPL) was also assessed. METHODS: Vowel and text samples from 183 healthy Finnish teachers (99 kindergarten teachers [KT] and 84 primary school teachers [PST]) were analyzed for CPPS. Text reading was recorded in conversational loudness by PST, and KT were recorded wearing headphones, while listening to a masking noise of children talking to simulate their classroom voice and environment. CPPS values were correlated with the VAPP, self-reported laryngeal signs and symptoms, voice related health variables, and laryngoscopic findings. RESULTS: There was a significant difference between the two groups for CPPS text, PST showed significantly lower CPPS values (10.44) than KT (11.52). There was no difference between the two groups for CPPS vowel phonation. There was a significant correlation between SPL text and CPPS text for KT (P < 0.001, r = 0.43) but not for PST (P < 0.10, r = 0.16). There was a significant correlation between SPL vowel and CPPS vowel for both PST (P < 0.001, r = 0.47) and KT (P < 0.001, r = 0.45). CPPS did not correlate with the VAPP, laryngeal signs and symptoms, health variables or laryngeal findings. Factorial analysis of variance resulted in a significant relationship between the VAPP, laryngeal signs and symptoms, and teacher type. Teacher type and symptoms had a significant effect on VAPP scores. CONCLUSIONS: In the present work CPPS does not correlate with vocal health indicators of functionally healthy teachers. CPPS was significantly influenced by differences in speaking voice SPL, emphasizing the impact of recording conditions and technique. There was a significant relationship between laryngeal signs and symptoms, teacher type and the VAPP. Laryngeal signs and symptoms and teacher type are important variables and should be included in the clinical evaluation of occupational voice users, and voice problems.

The acoustic voice quality index version 02.02 in the Finnish-speaking population.

Background: The Acoustic Voice Quality Index (AVQI) is a multiparametric tool for objectively measuring the general acoustic characteristics of voice. The AVQI uses both sustained vowel and continuous speech in its analysis, and therefore, a validation is required for different languages. In the present study, validation was performed in the Finnish-speaking population.Methods: The study included 200 native Finnish-speaking participants of whom 115 were voice patients attending a phoniatric clinic, and the remaining 85 subjects participated in the study as healthy controls. Voice samples were recorded, and the auditory evaluation was performed by five speech therapists. An ordinal four-point interval scale was used to evaluate the degree of voice abnormality (Grade, G). Several statistical analyses were performed to test the validity and the diagnostic accuracy of the AVQI in the Finnish-speaking population.Results: The inter-rater reliability of four of the five raters was high enough to allow the use of Gmean in the validation. There was a statistically significant correlation between the AVQI scores and the evaluation of overall perceptual voice quality (r = 0.74).Conclusions: The results confirmed the good discriminatory power of the AVQI in differentiating between normal and abnormal voice qualities. The AVQI 02.02 threshold value for dysphonia was 2.87 in the Finnish-speaking population.

Cepstral and Perceptual Investigations in Female Teachers With Functionally Healthy Voice.

PURPOSE: The present study aimed at measuring the smoothed and non-smoothed cepstral peak prominence (CPPS and CPP) in teachers who considered themselves to have normal voice but some of them had laryngeal pathology. The changes of CPP, CPPS, sound pressure level (SPL) and perceptual ratings with different voice tasks were investigated and the influence of vocal pathology on these measures was studied. METHOD: Eighty-four Finnish female primary school teachers volunteered as participants. Laryngoscopically, 52.4% of these had laryngeal changes (39.3% mild, 13.1% disordered). Sound recordings were made for phonations of comfortable sustained vowel, comfortable speech, and speech produced at increased loudness level as used during teaching. CPP, CPPS and SPL values were extracted using Praat software for all three voice samples. Sound samples were also perceptually evaluated by five voice experts for overall voice quality (10 point scale from poor to excellent) and vocal firmness (10 point scale from breathy to pressed, with normal in the middle). RESULTS: The CPP, CPPS and SPL values were significantly higher for vowels than for comfortable speech and for loud speech compared to comfortable speech (P < 0.001). Significant correlations were found between SPL and cepstral measures. The loud speech was perceived to be firmer and have a better voice quality than comfortable speech. No significant relationships of the laryngeal pathology status with cepstral values, perceptual ratings, or voice SPLs were found (P > 0.05). CONCLUSION: Neither the acoustic measures (CPP, CPPS, and SPL) nor the perceptual evaluations could clearly distinguish teachers with laryngeal changes from laryngeally healthy teachers. Considering no vocal complaints of the subjects, the data could be considered representative of teachers with functionally healthy voice.

Vocal Fatigue Symptoms and Laryngeal Status in Relation to Vocal Activity Limitation and Participation Restriction.

OBJECTIVES: The study aims to investigate the vocal fatigue symptoms and laryngeal status in relation to vocal activity limitations and vocal participation restrictions. STUDY DESIGN: This is a case-control study. METHODS: Two hundred six teachers were divided into two groups based on the frequency of their self-reported vocal symptoms being more or less than the mean of reported frequency. The study compared odds for activity limitation and participation restriction in relation to frequency of vocal symptoms, number of vocal symptoms recurring weekly, and organic laryngeal changes. Activity limitation and participation restriction were studied using the Voice Activity and Participation Profile questionnaire. RESULTS: Increased odds were found for teachers with frequent vocal symptoms and especially those with one or more vocal symptom recurring weekly. Odds were found to be 2.6-8.5 times more likely in teachers with more frequent vocal symptoms. The odds increased dramatically with increase of the number of vocal symptoms recurring weekly. Laryngeal organic changes were found to increase the odds but insignificantly. CONCLUSIONS: Teachers with frequent vocal symptoms, especially those with vocal symptoms recurring weekly, have increased odds ratio for vocal activity limitation and vocal participation restrictions. High scores or frequent occurrence of self-reported vocal fatigue symptoms must be taken seriously in the evaluation of vocal working ability.

Electroglottographic contact quotient in different phonation types using different amplitude threshold levels.

Contact quotient (CQ), measured by electroglottogram (EGG), is a ratio which illustrates the duration of vocal fold contact during one vocal fold period. In the present study CQ(EGG) was calculated from a sustained vowel phonation in three different phonation types (breathy, normal, pressed) at three amplitude threshold levels (25%, 35%, 50%). CQ(EGG) values were compared with experts' perceptual evaluation of the firmness of phonation. The contact time of the vocal folds differed significantly between the different phonation types at all threshold levels (P < 0.01). Perceptual evaluation correlated best with CQ(EGG) at threshold levels 25% and 35%. The results of the linear regression model suggested that by using threshold level 25% the effect of F0 and SPL on CQ(EGG) were not significant.

One-year follow-up study of self-evaluated effects of voice massage, voice training, and voice hygiene lecture in female teachers.

This study collected data on self-reported symptoms of vocal fatigue among Finnish female primary school teachers (n = 90) before and 6 months and 12 months after three types of interventions that aimed at improving vocal well-being at work. All subjects were given a voice hygiene lecture (3 hours), and, additionally, a randomly chosen group of 30 subjects was given voice massage treatment and another group voice training (5 x 1 hour sessions) over 2 months. The subjects answered a questionnaire over the Internet concerning symptoms of vocal fatigue. The sum score of symptoms decreased significantly in all three groups through the period of investigation. All three interventions improved the teachers' vocal well-being over the long term.

A comparison of the effects of Voice Massage and voice hygiene lecture on self-reported vocal well-being and acoustic and perceptual speech parameters in female teachers.

This study compared the effects of Voice Massage (VM) and a voice hygiene lecture (VHL) on 60 female teachers. VM is a Finnish massage method which treats muscles related to voice production. All subjects attended the VHL (3 h). Half of them were randomly assigned to the VM group, the other half received only VHL. VM was given 5 times in 1-hour sessions at intervals of 1-2 weeks. At the beginning and end of the autumn school term, before and after a working day, (1) a 1-min reading sample was recorded at both the subject's habitual loudness and loudly, (2) a prolonged phonation on [a:] was recorded at habitual speaking pitch and (3) a questionnaire on voice quality, ease or difficulty of phonation, and tiredness of the throat was completed. The reading samples were analysed for the fundamental frequency (F0), equivalent sound level (Leq) and alpha-ratio [Leq (1-5 kHz)-Leq (50-1,000 Hz)]. The vowel samples were analysed for the F0 and Leq, as well as for jitter and shimmer. The reading samples were also evaluated perceptually by 3 speech trainers. The mean F0 and difficulty of phonation increased from the beginning to the end of the term in the VHL group (p = 0.026, p = 0.007, respectively). In the VM group, the perceived firmness of loud reading decreased (p = 0.026). The results suggest that VM may help in sustaining vocal well-being during a school term.

Relationships between self-evaluations of voice and working conditions, background factors, and phoniatric findings in female teachers.

Self-evaluations of voice, working conditions, and results of phoniatric examination were studied in 78 female primary school teachers. Most teachers evaluated their vocal capabilities as 'normal'; nevertheless 1/3 reported two or more weekly symptoms. Unsatisfactory air quality, background noise, and stressful working conditions were seen as the most harmful environmental factors. A total of 14% of the subjects had organic laryngeal changes, 37% had mild changes, and 49% were found to be healthy. These findings did not correlate with self-evaluation of voice, vocal symptoms, or voice-related quality of life. Teaching experience or teaching hours per week did not correlate with laryngeal findings or symptoms. The results illustrate the complex nature of voice assessment and the need of assessment tools specially suited for functionally healthy voice professionals.

Self-evaluation of voice as a treatment outcome measure.

This study addressed two self-evaluation questionnaires in investigating the effects of voice hygiene lecture (VHL, 3 h) and additional voice training (VT) or Voice Massage (VM; both 5 h) in 90 female teachers. The subjects assessed their voice quality, ease of phonation and tiredness of throat before and after a working day at the beginning and end of the school term using a visual analogue scale (VAS) (Questionnaire 1). At the end of the term, the degree of positive influence of the interventions was reported on VAS, and the type of influence was indicated by choosing one or more of three alternatives (voice quality, audibility and endurance) or by writing a free comment (Questionnaire 2). Questionnaire 1 was pretested and found to be reliable and valid for self-evaluation of voice. At the end of term, the VM and VT groups reported more positive influence of the interventions than did the VHL group. The reported influence did not correlate with working-day-related changes in sensations. Increased difficulty of phonation and tiredness of throat was found in the VHL group at the end of the term. However, the groups did not differ significantly from each other. The challenges of self-evaluations as outcome measures are discussed.

Effects of voice training and voice hygiene education on acoustic and perceptual speech parameters and self-reported vocal well-being in female teachers.

Voice education programs may help in optimizing teachers' voice use. This study compared effects of voice training (VT) and voice hygiene lecture (VHL) in 60 randomly assigned female teachers. All 60 attended the lecture, and 30 completed a short training course in addition. Text reading was recorded in working environments and analyzed for fundamental frequency (F0), equivalent sound level (Leq), alpha ratio, jitter, shimmer, and perceptual quality. Self-reports of vocal well-being were registered. In the VHL group, increased F0 and difficulty of phonation and in the VT group decreased perturbation, increased alpha ratio, easier phonation, and improved perceptual and self-reported voice quality were found. Both groups equally self-reported increase of voice care knowledge. Results seem to indicate improved vocal well-being after training.

Assessment of vocal capacity of Finnish university students.

This article summarizes the results for a total of 189 female and 63 male university students (mean age 23 and 26 years, respectively) from the following vocal capacity tests: measurement of (1) vital capacity, (2) average airflow in phonation (on [o:]), (3) maximum duration of sustained blowing, (4) maximum phonation time (on [o:, z:]), (5) maximum duration of [s:], (6) the ratio of the duration of [s:] to [z:] (s/z ratio), (7) phonation quotient (the ratio between vital capacity and maximum phonation time), (8) the lowest possible tone, (9) mean fundamental frequency (F0) in normal and loud text reading and in shouting, (10) difference between the lowest tone and mean F0 in text reading and in shouting, (11) F0 range in text reading, (12) equivalent sound level of normal and loud reading and of shouting in maximum loudness, (13) phonetogram (voice range profile) and (14) long-term average spectrum of text reading. Voice quality is also evaluated perceptually, and additionally, data on subjects' self-reported vocal fatigue symptoms in general or after a vocally loading task were collected. The value of these measurements from the point of view of assessment of vocal capacity will be discussed.

Acoustic measures and self-reports of vocal fatigue by female teachers.

This study investigated the relation of symptoms of vocal fatigue to acoustic variables reflecting type of voice production and the effects of vocal loading. Seventy-nine female primary school teachers volunteered as subjects. Before and after a working day, (1) a 1-minute text reading sample was recorded at habitual loudness and loudly (as in large classroom), (2) a prolonged phonation on [a:] was recorded at habitual speaking pitch and loudness, and (3) a questionnaire about voice quality, ease, or difficulty of phonation and tiredness of throat was completed. The samples were analyzed for average fundamental frequency (F0), sound pressure level (SPL), and phonation type reflecting alpha ratio (SPL [1-5 kHz]-SPL [50 Hz-1 kHz]). The vowel samples were additionally analyzed for perturbation (jitter and shimmer). After a working day, F0, SPL, and alpha ratio were higher, jitter and shimmer values were lower, and more tiredness of throat was reported. The average levels of the acoustic parameters did not correlate with the symptoms. Increase in jitter and mean F0 in loud reading correlated with tiredness of throat. The results seem to suggest that, at least among experienced vocal professionals, voice production type had little relevance from the point of view of vocal fatigue reported. Differences in the acoustic parameters after a vocally loading working day mainly seem to reflect increased muscle activity as a consequence of vocal loading.

Vocal symptoms among teachers with and without voice education.

This study investigates the amount of voice training received by teachers in Finland and compares the incidence of vocal symptoms among teachers with shorter, longer or no vocal education. Participating were 124 primary, secondary and upper secondary school teachers; 63% of the teachers had received no vocal training, 15% had received short-term and 22% longer-term training. The incidence of symptoms was lowest in teachers with long-term training and highest in teachers with short-term training. The differences were non-significant among all teachers and females, but significant among males. Speech training seems to protect male teachers from vocal problems better than female teachers. Short-term training may lead to increased awareness of vocal symptoms, which can be helpful in voice protection.