Home Remedies ("Paati Vaidyam") for Voice Disorders: Some Common Practices Among School Teachers.

AIM: The study aimed to document the practices followed as home remedies to treat voice-related symptoms among school teachers. STUDY DESIGN: Cross-sectional study. METHOD: A total of 385 school teachers from Chennai, India, participated in the study. Data were collected through six open-ended questions to elicit information about conventional remedial practices for voice-related issues. Responses from the participants were recorded and analyzed. RESULTS: Around 88% of the teachers in the study preferred to adhere to home remedies as their first treatment of choice when encountering a voice problem. A few of the reported home remedies were simple preparations using turmeric (Curcuma longa), ginger (Zingiber officinale), honey, sugar palm (Arenga pinnata), rock candy, mint (Mentha piperita), and cumin seeds (Cuminum cyminum), taken in singly or in combinations. The study also noted specific remedies for a range of vocal symptoms such as throat pain, irritation, or voice tiredness as per the belief systems of people speaking Tamil. DISCUSSION/CONCLUSION: Home remedies, also known, as "Paati Vaidyam," are commonly used by Indian households to address health problems, including voice-related issues. The study indicated the prevalence and popularity of using home remedies for voice-related issues among teachers. The scientific logic or utility of these practices was explored in this study based on available information in voice literature. The information obtained is valuable for counseling (explaining local practice methods and available evidence) and education, keeping in mind the belief system, and practice methods of Tamils while imparting vocal hygiene education to the teachers.

Outcomes of Vocal Hygiene Program in Facilitating Vocal Health in Female School Teachers With Voice Problems.

BACKGROUND: Teachers suffer greater impacts of voice problems due inappropriate voice use and other contributing factors such as physiological, environmental, and individual & work related issues. Structured vocal hygiene programs (VHP) prevent/reduce the risk of vocal trauma and promote vocal health in teachers. This study aimed to estimate the outcome of instituting a sociocultural relevant vocal hygiene program in facilitating vocal health among female school teachers using a comprehensive voice assessment protocol. METHOD: VHP was developed emphasizing adequate hydration, healthy vocal diet, posture and alignment, vocal practices while teaching, and ideal speaking environment. This was administered via a face to face session to seventeen female teachers with voice concerns. All underwent a comprehensive voice assessment (subjective, objective, and self-perceptual vocal measures) before and four weeks after the VHP. Inter-rater reliability for perceptual and visual examination was estimated using Intra-Class Coefficient. Wilcoxon signed ranks test was used to compare the pre- and post-treatment measures of continuous variables (acoustic, Maximum phonation time, s/z ratio, Vocal Fatigue Index [VFI] & Voice Disorder Outcome Profile [V-DOP]), and McNemar test was used for categorical variables (vocal health questionnaire, visual examination of larynx and perceptual evaluation of voice). RESULTS: Teachers reported reduction of unhealthy vocal & nonvocal practices after VHP. Improvements in vocal and related symptoms such as sensation of heart burn (P = 0.031), discomfort around the throat (P = 0.008), inadequate breath control while speaking (P = 0.016) were noticed. Perceptually, minimal improvement was seen in voice quality (overall grade). However, MPT & s/z ratio showed no significant difference. Improvement was observed in frequency range (P = 0.004), low I0 (P = 0.044), shimmer (P = 0.017), and DSI (P = 0.013). Changes were evident in all parameters of stroboscopic evaluation (except nonvibratory portion & ventricular fold hyper-adduction). V-DOP scores indicated positive change in the overall severity (P = 0.002), physical (P = 0.003) and functional domain (P = 0.034). VFI indicated improvement in teachers voice after a period of voice rest (P = 0.048). CONCLUSION: Though VHP facilitated in improving the teachers' awareness of at risk phono-traumatic behaviors and vocal health, its efficiency was limited in producing physiological improvement in teachers' voice. The comparison of vocal metrics before & after the treatment provides information on changes that can be expected in teachers after guiding them through a systematic VHP.

Comparison of Client-Led Asynchronous and Clinician-Led Synchronous Online Methods for Evaluation of Subjective Vocal Measures in Teachers: A Feasibility Study.

BACKGROUND: COVID-19 has transformed face to face teaching in classrooms to online and hybrid modes. Increased vocal intensity/ pitch to call attention of students and transact in the online class, inappropriate posture (head, neck & upper trunk) while using the laptop and other online tools cause vocal loading leading to voice related concerns in teachers. Tele voice assessment is a feasible alternative means to seek professional help in the current situation and possibly in the future too. Client-led asynchronous and clinician-led synchronous voice recordings for clinical vocal measures among school teachers were compared in this study. METHOD: Twenty-five school teachers (21 females & four males) from Chennai consented to the study. Information of voice use, its impact on the day-to-day situations, self-perception of vocal fatigue, and their recorded voice sample (phonation & speaking) were obtained online (asynchronous mode). Within a period of ten days, the clinician-led synchronous session was planned on a mutually convenient time for obtaining voice samples through zoom call. The voice samples obtained were compared for clinical measures and perceptual voice evaluation. RESULTS: Participants reported of vocal symptoms and increased vocal fatigue scores. The maximum phonation time values obtained through synchronous mode were lesser when compared to asynchronous mode. Also, variability was noted in the perceptual vocal measures of voice samples obtained through synchronous mode. During synchronous voice recording & evaluation, the background noise, internet stability, audio enhancement feature, and microphone placement & quality could be monitored, and immediate feedback was provided. Additionally, the asynchronous recording can be supplemented for synchronous recording, with clear instructions & demonstration. CONCLUSION: This study explored the feasibility of using synchronous and asynchronous voice recording for voice analysis in school teachers. The findings could serve as a base to understand the advantages and challenges of using client-led asynchronous and clinician-led synchronous methods for estimating vocal measures.

Frequency Range Measures in Carnatic Singers.

BACKGROUND: Frequency range measures in singers reflect their physiological capacity, vocal flexibility, training effects, strengths, and limitations in singing. Since this information is vital for pedagogic and clinical purposes, this study aimed to measure the frequency range in Carnatic singers while singing different aspects of the vocal music. METHOD: Practice task (gliding from lowest to highest note) and performance task (singing a song with vocal ornaments) were recorded from 55 trained Carnatic singers (40 females and 15 males). The auditorily verified portions of various vocal ornaments in Carnatic singing (such as aalapanai, pallavi, anupallavi, charanam, and niraval) were coded as separate tokens. A total of 385 tokens were analyzed using PRAAT software for estimating frequency range in semitones during practice task (SFRprac) and performance task (SFRperf). Descriptive, ANOVA, Tukey HSD, independent t, and Mann-Whitney U were used for statistical analysis. RESULTS: SFRprac was higher than SFRperf in Carnatic singers. During practice, singers explored their physiological range to improve their vocal ability. However, during performance they tend to maintain a comfortable singing range to have a flawless rendition. Aalapanai (most creative portion) had the highest frequency range (females: 22.96 ST, males: 24.57 ST) than other types of vocal ornaments in performance signing. Practice frequency range (SFRprac) and performance frequency range (SFRperf) were not statistically different across male and female singers. CONCLUSION: This study described the frequency range measures in various aspects and nuances of Carnatic singing. Its clinical and pedagogic importance are discussed.

Vocal Health Practices Among School Teachers: A Study From Chennai, India.

INTRODUCTION: A healthy vocal system is a prerequisite to produce a serviceable voice for any vocal profession. The concept of vocal health (VH) among teachers is worth exploring considering their known risk of developing voice disorders. AIM: To provide socioculture-specific information on VH practices and nature of voice problems in teachers. METHOD: A VH questionnaire was developed to elicit opinions toward one's own voice health and factors that indicated and contributed to impaired/poor VH from 384 school teachers. RESULTS AND DISCUSSION: 'Flexible voice' (23%), 'enduring voice' (22%), and 'good voice' (22%) were descriptions to indicate good VH by teachers. 'Vocal fatigue' (13%), 'dry throat' (9.4%), 'throat irritation' (4.7%), and 'pain while swallowing/speaking' (3.1%) were frequently reported throat sensations to indicate poor VH. For 30.2% of the teachers, voice mattered for professional needs. However, most of them managed to cope with voice problems through several home remedies and 'intentional/self-imposed neglect' despite their vocal difficulties. Sociocultural factors influencing these findings and scope to escalate voice problems in teachers as a public health issue are discussed. CONCLUSION AND IMPLICATION: Insight and perception of VH based on self-reports and information on voice practices among teachers pertinent to this geographical location provide scope to develop models for counseling and preventive treatment for voice problems.