Vocal Fatigue and Its Relationship with Vocal Hygiene and Work-Related Factors in Professional and Nonprofessional Voice Users: A Multiple Linear Regression Model Study.

OBJECTIVES: To investigate vocal fatigue severity between professional voice users (PVUs) and nonprofessional voice users (NPVUs), and across different levels of voice users. Also to examine the relationship between vocal hygiene and work-related factors with vocal fatigue. METHODS: This is a cross-sectional descriptive study. Four hundred one individuals from different professions were included in total. Participants were divided into four levels of voice users by classification of Koufman and Isaacson. The top three levels of voice users further identified as PVU, and level 4 voice users identified as NPVU. An online questionnaire which included vocal hygiene checklist, work-related factors, and Turkish version of vocal fatigue index (VFI) was submitted by the participants. RESULTS: Vocal fatigue severity of PVUs were found higher than NPVUs in all VFI scores (P < 0.05). Level 2 voice users were found to have more vocal fatigue severity than all other levels of voice users. Call center workers (CCWs) had the highest means of vocal fatigue severity. Based on the multiple linear regression model vocal hygiene and the number of vocal rest breaks were found to have related with vocal fatigue the most (P < 0.05). There was also a relation with some VFI scores (P < 0.05) with voice usage duration at work and vocal rest duration. We found no relationship between working experience and vocal fatigue. The data suggests the relation between vocal fatigue and vocal hygiene, and work-related factors explain a small proportion of the association. However, in CCWs r2 was found 0.44. CONCLUSIONS: The change in vocal fatigue severity did not match with Koufman and Isaacson's classification of voice users. We suggest that there may be other contributing factors to vocal fatigue than vocal hygiene, vocal rest, and voice usage duration even those factors may differ from profession to profession.

Population characteristics and self-assessment of speaking and singing voice in Polish contemporary commercial music singers-an exploratory, cross-sectional study.

Background: The domination of the Contemporary Commercial Music (CCM) industry in music markets has led to a significant increase in the number of CCM performers. Performing in a wide variety of singing styles involves exposing CCM singers to specific risk factors potentially leading to voice problems. This, in turn, necessitates the consideration of this particular group of voice users in the Occupational Health framework. The aim of the present research was threefold. First, it sought to profile the group of Polish CCM singers. Second, it was designed to explore the prevalence of self-reported voice problems and voice quality in this population, in both speech and singing. Third, it aimed to explore the relationships between voice problems and lifetime singing involvement, occupational voice use, smoking, alcohol consumption, vocal training, and microphone use, as potential voice risk factors. Materials and methods: The study was conducted in Poland from January 2020 to April 2023. An online survey included socio-demographic information, singing involvement characteristics, and singers' voice self-assessment. The prevalence of voice problems was assessed by the Polish versions of the Vocal Tract Discomfort Scale (VTDS) and the Singing Voice Handicap Index (SVHI). Also, a self-reported dysphonia symptoms protocol was applied. The perceived overall voice quality was assessed by a Visual Analogue Scale (VAS) of 100 mm. Results: 412 singers, 310 women and 102 men, completed the survey. Nearly half of the studied population declared lifetime singing experience over 10 years with an average daily singing time of 1 or 2 h. 283 participants received vocal training. For 11.4% of respondents, singing was the primary income source, and 42% defined their career goals as voice-related. The median scores of the VTDS were 11.00 (0-44) and 12.00 (0-40) for the Frequency and Severity subscales, respectively. The median SVHI score of 33 (0-139) was significantly higher than the normative values determined in a systematic review and meta-analysis (2018). Strong positive correlations were observed between SVHI and both VTD subscales: Frequency (r = 0.632, p < 0.001) and Severity (r = 0.611, p < 0.001). The relationships between most of the other variables studied were weak or negligible. Conclusion: The examined CCM singers exhibited substantial diversity with regard to musical genre preferences, aspirations pertaining to singing endeavors, career affiliations, and source of income. Singing voice assessment revealed a greater degree of voice problems in the examined cohort than so far reported in the literature, based on the SVH and VTDS.

Prevalence of and Risk Factors for Self-Reported Voice Problems in Tibetan Monks.

BACKGROUND: It is observed that Tibetan monks pray for a long duration with inappropriate pitch and loudness. Hence, they may be prone to developing voice problems (VPs). However, the monks are not stressed and do not miss praying in the monastery (which is quite different from many other professional voice users in Western countries). Moreover, no studies have investigated the nature of VPs among Tibetan monks. Such a study may provide insight into the prevalence of and risk factors for VPs and may help enhance our knowledge of the VPs in Tibetan monks. STUDY DESIGN: Cross-sectional survey. METHOD: A self-reporting questionnaire was distributed among 300 Tibetan monks residing in Namdroling Nyingmapa Monastery, Karnataka, India, from February 2023 to June 2023. RESULTS: 39% of Tibetan monks experienced VPs in their careers; hoarseness, momentary voice loss/sudden voice changes, and dryness were the most frequently reported symptoms. Monks reporting the presence of VPs also exhibited significantly higher frequencies of different phonotraumatic behaviors like speaking with a loud voice, constantly altering the voice, frequent throat clearing, speaking/chanting during throat infections, or VPs than those who did not report VPs. The results of bivariate regression analysis identified factors such as more than 8hours of prayer duration per day, praying in the presence of musical instruments, not sipping water in between prayers, less than three liters of water intake, and the presence of acid reflux and dry throat, as significant risk factors responsible for VPs in Tibetan monks. CONCLUSIONS: Current results suggest that monks are at a high risk of developing VPs, and several factors (vocational, environmental, lifestyle, and health-related) contribute to the development of VPs. Further, VPs in monks also affect them in terms of missing prayers, interacting less with family/friends, and avoiding social gatherings. Overall, there is a great need to educate the monks about vocal health and preventing VPs.

Development of a Voice Handicap Index for Clergymen: An Investigation of Its Validation and Reliability.

OBJECTIVE: This study aims to is to develop a disorder-specific patient-reported outcome measure to be used in Islamic clergymen with voice disorders and to investigate its validity and reliability. METHODS AND PROCEDURES: Employing an exploratory sequential mixed-methods design, this study conducted in two phases. Initially, semistructured interviews were conducted with 10 clergymen experiencing voice disorders. Subsequently, the questionnaire underwent rigorous validation, encompassing content, construct, and criterion validity assessments, in addition to test-retest reliability and internal consistency analyses. The index was administered to a sample of 110 male clergy, including imams, muezzins, and Quran course teachers, with an age range from 19 to 61years. RESULTS: Construct validity was established through factor analysis, resulting in a final 23-item scale categorized into two factors: physical-functional and emotional. Known group validity demonstrated a significant distinction between the study and control groups. Criterion validity reinforced the index's validity, displaying a correlation coefficient of 0.758 between the Voice Handicap Index for Clergymen and the well-established Voice Handicap Index. The questionnaire exhibited commendable internal consistency, with a Cronbach's Alpha (α) coefficient value of 0.971. Test-retest reliability analysis exhibited strong consistency, with a Pearson correlation coefficient of 0.863. CONCLUSIONS: It is recommended that the developed valid and reliable handicap index in the present study be included in the voice assessment batteries of Islamic clergymen with voice complaints with the clinical and research purposes. In future studies, the validity of the questionnaire can be investigated more by examining the difference between the Voice Handicap Index for Islamic Clergymen (CVHI) scores obtained before and after treatment. Identifying a cut-off point that discriminates between dysphonic and normophonic clergymen may allow the use of the CVHI as a screening tool for this population.

Effectiveness of Vocal Training Techniques in School-Aged Drama Students.

OBJECTIVES: The purpose of this study was to determine whether vocal hygiene education and direct vocal training would impact student self-reported preparedness for using voice for performance. STUDY DESIGN: A single-group, pretest-posttest research design was used. METHODS: Twenty-three drama students in middle and high school participated in a 1-hour vocal training workshop, which included vocal hygiene education and vocal training for performance. Changes in student self-reported preparedness for using voice for performance were examined following participation in the workshop. Data analysis involved comparison of pretest and posttest responses to a novel questionnaire. RESULTS: Participants demonstrated a statistically significant increase in self-reported preparedness for using voice for performance following participation (P < .001, d = 2.40), as measured by mean increase in survey scores. Additionally, significant group differences were found by grade level and report of prior vocal training. CONCLUSIONS: School-aged drama students appear receptive to direct vocal training and vocal hygiene education, with significant gains in self-reported preparedness for using voice for performance observed following intervention.

Investigation of the Relationship Between Vocal Fatigue, Quality of Life, and Compliance With Vocal Hygiene in Professional Voice Users.

PURPOSE: Intensive voice use may lead to the development of voice disorders or voice complaints, such as vocal fatigue, for professional voice users (teachers, academics, call center workers, actors, singers, speech and language therapists, voice trainers, and religious officials). Vocal fatigue has a detrimental effect on occupational, emotional, and social performance, besides the quality of life of the individual. The effect of voice hygiene interventions on voice fatigue is not fully known. The results of studies conducted with different occupational groups are inconsistent. The present study aims to analyze the relationship between vocal fatigue and voice-related quality of life (V-RQOL) in professional voice users, and the impact of vocal hygiene on vocal fatigue. METHODS: Participants (24 male, 90 female), who were professional voice users without any diagnosis of voice disorders or voice complaints were divided into two groups low vocal hygiene compliance (LVH; n = 66) and high vocal hygiene compliance (HVH; n = 48). In this study, vocal fatigue was measured by the vocal fatigue index (VFI), and V-RQOL was measured by the voice handicap index (VHI-10) and V-RQOL. RESULTS: VFI subscales (tiredness, avoidance, physical discomfort) have a moderate positive correlation with VHI-10 and V-RQOL, which indicates that there is a significant relationship between vocal fatigue and quality of life amongst professional voice users. While there was no significant difference between the LVH and HVH groups in terms of quality of life, it was found that the vocal fatigue level of the LVH group was higher. CONCLUSION: This study of professional voice users with healthy voices reveals a relationship between vocal fatigue and V-RQOL. Vocal hygiene compliance may affect professional voice users' vocal fatigue symptoms; the low-compliant group has higher levels of tiredness, avoidance, and physical discomfort. The findings highlight the importance of raising awareness of the problems of professional voice users, even though they have healthy voices and the need for vocal hygiene education programs that target them.

Preliminary Perceptual Findings of Singing After Flow Phonation Voice Exercises for Singers in Training.

INTRODUCTION: Goals of voice therapy and vocal pedagogy share similar principles and therefore, therapy approaches designed to improve the disordered voice may be equally effective when used to enhance healthy voice and vice versa. The purpose of this study was to investigate the effects of flow phonation voice exercises on vocal characteristics of students in undergraduate vocal music training programs and examine their potential use in vocal pedagogy. METHODS: A total of 10 cis females were recruited and were randomized into two groups: an experimental group (group 1, n = 6) receiving five sessions of flow phonation intervention across 5 weeks; and a control group (group 2, n = 4) that did not receive any direct intervention other than vocal hygiene education. Participants provided data pertaining to auditory perception, subjective respiratory measures, voice-related quality of life, and vocal fatigue before and after 5 weeks. Flow phonation exercises consisted of cup bubble blowing, gargling, and stretch and flow. Wilcoxon signed ranks test was administered to compare outcomes across time points and between groups. RESULTS: Data indicate statistically significant changes in auditory perception of the singing voice, and voice-related quality of life for the group that received flow phonation exercises alone. No other measures showed statistical significance. DISCUSSION AND CONCLUSION: Overall, this study indicates that the use of flow phonation voice exercises has the potential to improve voice instruction within the voice studio. While our target enrollments were not met to achieve optimal statistical power, our hypotheses were at least partially supported. In particular, positive intervention-related changes were observed in self-perceived voice handicap, and auditory perception of singing which were not observed in the control group.

An Exploration of the Risk Factors, Severity, and Sequelae of Vocal Fold Hemorrhage in a Population of Voice Patients Before and After Diagnosis.

BACKGROUND: Vocal fold hemorrhage (VFH) is the rupture (usually acute) of a blood vessel within the true vocal fold. The long-term sequelae of VFH on the mucosal wave (MW) and glottic gap on video stroboscopy remain understudied. The primary objective of this study was to investigate the short-term and long-term consequences of VFH through measured and rated analysis of the mucosal wave and glottic gap. METHODS: The presence of VFH and its extent (limited/moderate vs. extensive VFH) were identified. The primary outcome of this study was mucosal wave, which was assessed on an ordinal scale by three blinded raters pre and posthemorrhage. Only patients who had undergone strobovideolaryngoscopy before sustaining VFH were included. Mucosal wave and glottic gap also were measured using image pixel analysis using the open-access tool, ImageJ (NIH, Bethesda, MD). RESULTS: Twenty-three subjects were included in this study (mean age 39.78 ± 15.54). Intra-rater reliability for MW ratings was 81.48% ± 6.150% (minimum 77.78%) for all evaluators (κ = 0.519 [0.267-0.772], P < 0.001). Inter-rater reliability analysis revealed 75.56% agreement between evaluators (κ = 0.524 [0.425-0.623], P < 0.001). MWMeasured extrapolated from ImageJ methodology correlated significantly with MWRated (n = 70, r = 0.448, P < 0.001). ΔMWMeasured from baseline to follow-up evaluation were compared for both the initial follow-up visit (FU1) and the second follow-up visit (FU2) [-4.135 ± 31.01 vs. 36.50 ± 39.97, P = 0.025]. Hence, ΔMWMeasured was significantly better by FU2 than FU1, with the larger positive change from baseline representing a greater improvement in the measured mucosal wave. Additionally, there were significant differences in ΔMWRated between those with limited/moderate VFH and those with extensive VFH at FU1. Duration of absolute voice rest correlated significantly with time to VFH resolution. Long-term change in mucosal wave after hemorrhage was assessed using both ΔMWMeasured and MWRated. Based on ΔMWRater, 35.0% of subjects demonstrated ongoing and worse mucosal wave restriction compared to baseline at their most recent follow-up visit. Based on ΔMWMeasured, 50.0% of the subjects showed ongoing and worse mucosal wave restriction compared to baseline at their most recent follow-up visit. CONCLUSION: Overall long-term restrictions in MW after hemorrhage were present in 35.0% of the subjects based on ratings and 50.0% of the patients based on the measured MW using ImageJ, demonstrating the importance of ongoing study into this pathology and how to prevent it, especially in PVU and professional singers. Patients presenting with extensive hemorrhage were at risk for more prominent, detectable changes in mucosal wave compared to those with limited/moderate hemorrhage in the short-term, defined by a mean FU time of 3 months, but not long-term, characterized by a mean FU time 6 months or greater. Whether the severity of VFH is a true indicator of mucosal wave alterations requires additional study, as does the reliability and validity of ImageJ mucosal wave and glottic gap measurement techniques.

A Survey of Vocal Health in Carnatic Singing Students.

OBJECTIVE: Vocal health and hygiene are well addressed for professional singers, but less attention has been paid to singing trainees/students whose vocal demands vary significantly from trained singers. Studies conducted in the literature on singing trainees have reported a higher prevalence of voice problems in them; however, no such information is available from Indian classical singing trainees. Hence, the present study explored the frequency and nature of voice problems, self-reported vocal health and awareness of vocal hygiene and its practices in Carnatic singing trainees. METHOD: This cross-sectional study was conducted using a purposive sampling method. The data were gathered from 135 Carnatic classical singing trainees. The participants completed a self-reported questionnaire addressing demographic and singing-related details, vocal symptoms, variables associated with increased risk reporting voice problems and knowledge about factors influencing vocal health. RESULTS: The experience of past and point prevalence of voice problems in Carnatic singing students were found to be 29% and 15%, respectively. Difficulty singing higher notes, hoarseness, tired voice, loss of ability to sing/speak loudly, and breathiness in higher pitch range were the most prevalent vocal symptom reported by Carnatic singing trainees. Nasal allergies, dry mouth/throat, and excessive stress in daily routine activities raising voice many times a day, dry mouth/throat and excessive talking in social situations was found to have a significant association with singing trainees reporting voice problems. However, availing medical assistance for voice problems was found to be poor in this group of singing students. CONCLUSION: Similar to trainees of other form of singing, Carnatic singing trainees also found to have a higher frequency of voice problems. Most of the singing trainees were found to be in their adolescent age period, and they face instability in their voice and are more vulnerable to develop voice problems. This indicates the need for in-depth understanding of voice problems experienced by Carnatic singing trainees aiming to promote their vocal health and prevent injury and be successful in their singing career.

Hidratación combinada y efectos en la salud vocal en estudiantes de logopedia / Combined hydration and effects on the vocal health in speech language pathology students

Objetivo: Evaluar si la hidratación combinada (sistémico y superficial) disminuye síntomas vocales y mejora la eficiencia glótica en una muestra de estudiantes de Logopedia. Material y Métodos: Estudio cuasi-experimental con grupo Hidratación (N=20) y grupo Control (N=19) con valoración pre y post-hidratación (ingesta de agua 1.500 ml/día e inhalaciones dos veces/día durante una semana). Se analizaron factores deshidratantes relacionados con la voz (uso vocal, tabaco, alcohol, café, respiración bucal), síntomas vocales y eficiencia glótica a través del Tiempo Máximo Fonación, Fo, Jitter % y Shimmer %, usando Multi-Dimensional Voice Program (MDVP). Resultados: Grupo Hidratación disminuyó significativamente sequedad (p = 0,013), carraspeo (p = 0,005), fatiga vocal (p = 0,015), dolor faríngeo (p = 0,009), Shimmer % (p = 0,048) frente al grupo Control que sólo disminuyó el carraspeo (p = 0,02). Conclusiones: La hidratación combinada puede ser una medida útil para mejorar la salud vocal de los futuros logopedas. (AU

Objective: To evaluate if a combined hydration (systemic and superficial) decreases the vocal symptoms and improves the glottic efficiency in a sample of university students of Speech therapist. Material and Methods: Quasi-experimental study with Hydration group (N=20) and Control group (N=19) with pre and post-hydration assessment (water intake 1.500 ml/day and steam twice/day for a week). Voice-related dehydrating factors (vocal use, tobacco, alcohol, coffee, oral breathing), vocal symptoms and glottic efficiency through Maximum Phonation Time, Fo, Jitter % and Shimmer %, using Multi-Dimensional Voice Program (MDVP) were analyzed. Results: Hydration group significantly decreased dryness (p = .013=, throat clearing (p = .005), vocal fatigue (p = .015), pain throat (p = .009) and Shimmer % (p = .048) compared to the Control group, which only decreased throat clearing (p = .02). Discussion: The combined hydration may be a useful measure to improve vocal health for future speech-language-pathologists. (AU)

Immediate Effects of Straw Phonation in Water Exercises on Parameters of Vocal Loading in Carnatic Classical Singers.

OBJECTIVE: The present study aimed to investigate the effect of vocal loading and the immediate effects of straw phonation in water exercises on parameters of vocal loading in Carnatic classical singers. STUDY DESIGN: A within-subject pretest-posttest design. METHODS: Twelve healthy Carnatic classical singers participated in the vocal loading experiment for 2 days, referred to as no-treatment and treatment conditions. The vocal loading task consisted of 1 hour of continuous singing in the presence of background noise. For the treatment condition, the participants followed a 10-minute straw phonation in water exercises before the vocal loading task. Acoustic, electroglottographic, and self-rated perceptual voice measures were recorded before and after the vocal loading task on both days. RESULTS: Pretest and posttest comparison of various outcome measures during no-treatment day suggested a significant increase in shimmer percent, decrease in maximum phonation duration of vowel /a/, and increase in perceived phonatory effort, perceived vocal effort, and Evaluation of Ability to Sing Easily scores. Pretest and posttest comparisons during treatment day showed a significant increase in Mean F0, Highest F0, and Lowest F0, perceived phonatory effort, and perceived vocal effort scores. However, changes in Mean F0, Highest F0, and Lowest F0 measures were small in the posttest condition compared to pretest. CONCLUSION: The present results suggest that vocal loading did induce changes in Carnatic classical singers' voices. However, there is no substantial evidence that straw phonation is effective in reducing the vocal loading in Carnatic classical singers. Further studies are required to corroborate the current findings.

Objective and Subjective Voice Examination in Turkish Imams.

OBJECTIVE: Imams are professional voice users and they are at high risk of developing voice problems. The aim of the present study was to investigate vocal acoustic parameters and voice handicap index (VHI) scores in Turkish imams and comparing these paramaters with a control group of male nonprofessional voice users. METHODS: A total of 62 active working Turkish imams that never applied to our clinic with voice problems volunteered as subjects for the study and the control group consisted of 47 male nonprofessional voice users. Every participant completed a VHI questionnaire. A voice analysis was performed using computer program Dr.Speech Version 4 in an acoustically treated setting. Mean fundamental frequency, jitter, shimmer, harmonics to noise ratio values were recorded during the phonation and were analyzed. RESULTS: All imams were active working men aged 27-57 and the control group was comprised of male nonprofessional voice users of a similar age group. The measure of mean fundamental frequency, harmonics to noise ratio, jitter and shimmer rates were similar between two groups. In comparison of VHI between the groups no significant differences were found. CONCLUSION: Even though imams in the study group stated that they experienced voice problems in their professional lives, this did not cause any adverse changes in acoustic and subjective parameters (VHI) compared with control group.

Airway Management in Singers: A Cross-sectional Survey.

OBJECTIVE: To review and establish current practices regarding airway management in vocal professionals undergoing surgery. STUDY DESIGN: Cross-sectional survey SETTING: The setting included practitioners that treat vocal professionals across international sub-specialty societies. SUBJECTS AND METHODS: A twenty-one-item survey was sent to practitioners that routinely treat vocal professionals including the American Broncho-Esophagological Association, European Laryngological Society, and 2017 Fall Voice Conference attendees. It included questions regarding the respondents' demographics, preferences for airway control in non-laryngeal and laryngeal surgery, and peri-operative management. RESULTS: Total respondents (n = 163): 82.8% were Laryngologists, 4.3 % were General Otolaryngologists, 3.1% were Head & Neck Oncologists, and 6.8% were Speech-Language Pathologists. One hundred twenty-five of the participants (76.7%) classified their experience with vocal professionals as 'extensive' or 'often.' For non-laryngeal surgery, there was a tendency towards laryngeal mask airway (53.1%) over endotracheal intubation (46.9%). For professional singers, a smaller endotracheal tube was recommended. Size varied based on sex. For males, 88.5% recommended a tube ≤7.0 in non-singers; 98.2% recommended a tube ≤7.0 in singers. In females 76.1% recommended a tube ≤6.0 for non-singers; 94.6 % recommended a size ≤6.0 in a female singer. For laryngeal surgery, 14% of providers personally intubated patients over 90% of the time. Of the providers who work with trainees, 60.5% did not allow resident intubation. CONCLUSION: Objective data regarding precautions in airway management of professional voice users is scarce. This is the largest survey to date on current practices. Survey results indicate that smaller ETTs are preferred for singers, and that more experienced practitioners are preferred for the intubation.

Vocal Health, Working Conditions and Their Implications on the Occupational Health of Telemarketers: An Integrative Review.

OBJECTIVE: To analyze the national and international literature on vocal health, working conditions and occupational health of telemarketers. METHODS: A literature review was conducted using the LILACS, PubMed and SciELO databases. The term "telemarketing" was used for all searches, along with the following descriptors: voice, vocal disorders, work condition and occupational health. Articles published in English, Portuguese or Spanish from 2009- 2019 were included. The variables selected for organizing the data were authors, region, first author's education, affiliation, journal, objective, sample, design, and result. RESULTS: A total of 540 publications were identified in the databases, and after applying the eligibility criteria, 14 articles were included in the final analysis. DISCUSSION: Of the articles selected for final analysis, there was a concentration of studies in 2014, with a new peak of resumption of research in 2019. Regarding Brazilian studies, there was a concentration of studies from the Southeast region, mostly developed by speech therapists. CONCLUSION: In the analyzed articles, it was possible to verify the interference of telemarketers' working conditions in their vocal and occupational health.

Menopausal Voice-Related Work Limitation Scale (MenoVWL): Development and Validation.

OBJECTIVES: Menopause has been reported to affect the voice of female professional voice users (FPVUs). The present study aims at the development and validation of a scale to measure self-perceived menopausal voice-related limitation to work in FPVUs, henceforth the Menopausal Voice-Related Work Limitation Scale (MenoVWL). METHODS: Items were drawn from previous studies on impacts of sex steroid hormones on voice, available validated scales, and in-depth interviews with post-menopausal FPVUs. A preliminary version with 16 items was evaluated by a panel of 15 voice experts. The resulting revised version was filled in online, together with questions on current endocrinological reproductive status and related symptoms, history of amenorrhea, professional occupation, and demographic information. Responses concerning only professional voice users were selected and inclusive and exclusive criteria were applied for correct allocation of participants into pre- and post-menopausal stages within a restrict age range;192 responses were subject to factorial analysis for MenoVWL validation. Cronbach's alpha measured internal reliability. The scale was tested by comparing MenoVWL scores between pre- and post-menopausal FPVUs (98 and 94, respectively). RESULTS: Thirteen items were retained from the expert panel evaluation. Items presented a high Content Validity Index (.94 out of 1) and high Item Acceptance Ratio (86.25 %). Both exploratory and confirmatory factorial analysis rendered one dimension scale with an excellent internal consistency (Cronbach's alpha = .9). The results of a Mann-Whitney test showed a higher MenoVWL score for post- as compared to pre-menopausal FPVUs (Z = - 2.818; P = .005). CONCLUSIONS: MenoVWL is a comprehensive and validated scale with a known factor structure. It constitutes a health care and safety outcome self-perceived measure of value to the early detection of voice-related limitations to work in FPVUs during menopause.

Effects of Resonant Voice Therapy on Perceptual and Acoustic Source and Tract Parameters - A Preliminary Study on Indian Carnatic Classical Singers.

PURPOSE: The aim of the study was to examine the effects of resonant voice therapy (RVT) on the vocal resonance of trained Carnatic singers. The specific objectives were to evaluate the effects of resonant voice therapy on the auditory perceptual judgments and acoustic source and tract parameters before and after RVT on phonation and sung voice samples. METHOD: Six vocally healthy trained Carnatic singers, three males and three females aged 18-25 years (M = 23; S.D = 2.09) participated in the study. All the participants were assigned to a 21-days-long Resonance Voice Therapy (RVT) training program. The participants' pre and post training phonation and sung samples were subjected to auditory perceptual analysis and acoustic analysis. RESULTS: The results revealed that the post training auditory perceptual ratings of the phonation task showed a statistically significant difference from the pre training scores (Z= 2.35; P = 0.019). While for the singing task, the post training perceptual ratings were not significantly different from the pre training perceptual rating scores (Z= 2.66; P = 0.08). A significant difference was observed between the pre and post training values for all the measured acoustic parameters of the phonation task. In singing task, though the fundamental frequency, third and fourth formant frequencies showed no significant difference in the pre and post training conditions (P > 0.05), the parameter of- difference between the first formant frequency and the fundamental frequency showed a significant decrease (P = 0.028). CONCLUSION: The effects of resonant voice production led to a high vocal economy, as evidenced from the improved source and filter acoustic parameters. Indication for formant tuning through vocal tract modifications, probably an enlarged pharyngeal area resulting in increased resonant voice quality in both phonation and singing tasks, is inferred from these results.

Listening to Video Game Voices: A Call for Action for Research into the Vocal Health of Video Game Voice Actors.

Video game voice actors (VGVAs) are a professional voice user (PVU) population whose occupation relies on their ability to reliably deliver extremes in vocal performance. In their work VGVAs are required to perform solo for extended durations, producing highly complex character performances that not only include extremes of vocal parameters and qualities but also highly demanding vocal acts (ie, screaming, singing) within those voice archetypes. Based on the vocal demands of their work and current understandings of occupational voice disorder, it is reasonable to consider that VGVAs may be at increased risk of vocal fatigue, injury, and disorder, as manifestations of occupational disease. This risk is of primary concern to VGVAs who recently organized industrial action to highlight their concerns regarding vocal health within their industry. As a group that is not well represented within voice research, there is little literature currently available to inform clinical support of the population. Due to the unique nature of VGVA work and the highly specific nature of occupational voice use among PVUs, we cannot necessarily generalize research from other populations to VGVAs. As such, research utilising frameworks designed to capture the complexity of voice use, demands on the voice, and experiences of its use are required to support the concerns of the population. This paper introduces VGVAs as an emerging PVU population, describes the concerns of this population within the context of current understandings of vocal fatigue, occupational voice problems and PVU populations, and details the approaches required in the development of research into the population.

Mitigating Dysphonia, Pain, and Vocal Handicap after Violent Video Game Voice Overs: A Pilot Investigation into Vocal Combat Technique Training.

OBJECTIVE: to investigate how the Vocal Combat Technique (VCT) may mitigate vocal symptoms in voice over actors using vocal violence. METHODS: Five voice over actors (3 male, 2 females, Mean = 29.6 years) completed two study sessions of 45 minutes-to-1 hour of vocally violent voice over work held approximately 4 weeks apart. During session one, participants completed voice over work as they typically would, whereas they received 3-hours of VCT training to improve/assist in healthy vocal techniques prior to session two. Pre- and post-session measures for both sessions included self-perceptual ratings of vocal symptoms, auditory-perceptual evaluation, and traditional acoustic measures of frequency and perturbation. RESULTS: Participants showed substantial mitigating effects of VCT training on acoustic perturbation measures (jitter, shimmer, harmonics-to-noise ratio), and self-ratings of vocal symptoms (Vocal-Handicap Index-10, McGill Pain Scale for vocal discomfort, and Evaluation of the Ability to Sing Easily) with calculated medium to large effect sizes (d = 0.61-1.95). There were no changes in auditory perceptual ratings across sessions. CONCLUSION: Our pilot investigation yielded positive improvements in vocal symptomology in five voice over actors who were trained in VCT. Next steps should include a larger enrollment of voice actors to determine optimal preventative and recovery techniques.

The Effects of Mask Usage on Reported Vocal Health of Educators.

OBJECTIVE: To investigate the self-reported effects of mask usage on vocal fatigue and number of vocal complaints of high school and college educators. METHOD: Forty teachers at high schools and universities who reported using masks to teach in person during the Spring 2020 to Fall 2020 semesters completed an anonymous survey regarding self-report of teaching history, vocal use, vocal complaints, and vocal health. Responses were analyzed using descriptive statistics and t tests. RESULTS: Survey participants reported an increase in all forms of vocal complaints investigated despite an increase in amplification use. Participants also reported a decrease in daily water consumption between eight and 16 ounces of water when wearing a mask in the classroom compared to teaching prior to coronavirus disease 2019. Participants also reported a significant increase in vocal effort while teaching in a mask (P < 0.001). CONCLUSION: Educators reported a significant effect of increased vocal complaints and decreased water intake while wearing masks. The decrease in water consumption and increase in vocal effort may lead to more frequent vocal complaints in teachers at the high school and college level.

Performers' Perceptions of Vocal Function During Oral Steroid Treatment of Vocal Fold Edema.

OBJECTIVES: Acute vocal fold edema (VFE) is often a consequence of illness, allergy, or voice overuse, causing dysphonia. Although VFE typically resolves with voice rest and treatment of predisposing causes, oral glucocorticoids are often considered for performers with imminent performance demands. There are limited data about performers' perceptions of vocal change during treatment and how this relates to their ability to perform. This study aims to examine performers' self-perceptions of vocal function with steroid treatment. METHODS: Fifty-five performers (34 F; 21 M) diagnosed with VFE who chose treatment with a 6-day methylprednisolone taper were prospectively assessed. They completed the Evaluation of the Ability to Sing Easily (EASE) and reported on their voice use, regimen, performance obligations, and ability to perform. Findings were compared between Day 1 and Day 6 using paired t-tests and nonparametric Wilcoxon signed-rank tests. RESULTS: Nearly all subjects completed scheduled performances without interruption. Following treatment, all subscales of the EASE were decreased at Day 6 (Vocal Function 29.78-20.59; Pathologic Risk Indicator 26.60-17.33; Vocal Concerns 6.10-4.20). These differences were statistically significant (p < 0.0001) and greater in subjects with performances scheduled and subjects who consistently completed vocal warmups. These findings demonstrate significant improvement in several facets of performers' self-perception of function. CONCLUSION: Subjects reported significant improvement in vocal function with oral steroid treatment and were able to meet performance obligations. It remains important that steroids are not prescribed without laryngeal examination. Examination should be repeated when dysphonia persists, recurs swiftly, or when patients seek repeated treatment, as there may be increased risk of adverse outcomes, and continued steroid use may mask underlying chronic pathology that is best treated by other means. LEVEL OF EVIDENCE: 4 Laryngoscope, 132:2434-2441, 2022.