The Effects of Telerehabilitation in Patients with Voice Disorders: A Systematic Review and Meta-Analysis.

OBJECTIVES: To compare the effects of telerehabilitation (TR) and face-to-face rehabilitation (FTF) methods on the outcomes of adults with voice disorders and to analyze the effectiveness of TR. METHODS: Following Boolean Logic, a search strategy was devised, combining subject terms and keywords based on the interventions and populations outlined in the inclusion criteria. We searched PubMed, Cochrane Library, Embase, Web of Science, Scopus, CNKI, Wanfang, CQVIP databases, and manually screened academic conference papers, journal articles, and gray literature to identify eligible randomized controlled trials (RCTs) on remote voice therapy. Two researchers assessed the risk of bias in the included studies using the risk of bias assessment tool for RCTs outlined in the Cochrane Handbook for Systematic Reviews of Interventions version 5.1.0. RESULTS: Five trials with a total of 233 patients with voice disorders were included in the study after screening. The results revealed a significant difference in Jitter change values (mean difference [MD]=-0.12, 95%CI [-0.23,-0.01], P = 0.04) between TR and FTF, maximum phonation time (MD=0.76, 95%CI [-0.60,2.13], P = 0.27), Shimmer (MD=-0.04, 95%CI [-0.11,0.03], P = 0.27), voice handicap index (MD=0.87, 95%CI [-1.77,3.50], P = 0.52), and GRBAS(G) (MD=-0.00, 95%CI [-0.01,0.01], P = 0.99) had no significant difference. CONCLUSION: TR demonstrates comparable efficacy to FTF in voice treatment and is associated with higher levels of patient satisfaction, making it a viable and effective therapeutic modality. However, given the limited sample size analyzed in this study, further validation of this conclusion necessitates additional RCTs with larger sample sizes. Furthermore, researchers should remain cognizant of the constraints associated with TR and consistently refine treatment protocols to enhance the efficacy of voice therapy.

Voice Disorder, Job Stress, and COVID-19 in Teachers: Impacts in Times of Pandemic

Introduction: The conditions of teachers' work during the COVID-19 pandemic affected teachers' lives regarding voice disorder and stress, even in emergency remote classroom situation. Objective: To analyze the relationship between the presence of voice disorder, job stress, and COVID-19 in teachers when in emergency remote classroom teaching situation at the time of the pandemic. Method: This is a primary, exploratory, observational cross-sectional study with the use of survey forwarded online during the period of emergency classes after the arrival of COVID-19 pandemic in Brazil. The teachers answered the sociodemographic questions about the presence of COVID-19 and the following instruments: Condition of Vocal Production-Teacher [Condição de Produção Vocal - Professor (CPV-P)], Screening Index for Voice Disorder (SIVD), and Job Stress Scale (JSS). Results: Of the 118 teachers analyzed, 94.1% were female; the average age was 44 years. The SIVD recorded the presence of voice disorder in 66.9% of the participants. Regarding the JSS, which are the findings related to stress at work in the demand domain, the teachers showed high levels, a fact which presupposes the existence of pressure of psychological nature to perform their work. Conclusion: The teachers self-reported the presence of voice disorder even in remote class situation, on the occasion of COVID-19, which were more common in older teachers. When comparing the presence of voice disorders, coronavirus symptoms, and stress domains in relation to demand, control, and social support, there was no significance. It is hoped that this study will help to reflect on the need to improve teachers' working conditions, strengthening work-related voice disorder actions and guiding actions for vocal care and well-being.

Introducción: Las condiciones de trabajo de los profesores durante la pandemia de COVID-19 afectaron sus vidas en lo que respecta al trastorno de la voz y el estrés, incluso en situaciones de emergencia en aulas remotas. Objetivo: Analizar la relación entre la presencia de trastorno de la voz, estrés laboral y COVID-19 en profesores cuando se encontraban en situación de emergencia de enseñanza en aulas remotas en la época de la pandemia. Método: Se trata de un estudio primario, exploratorio, observacional de tipo transversal, con el uso de encuesta remitida online durante el periodo de clases de emergencia tras la llegada de la pandemia de COVID-19 en Brasil. Los profesores respondieron a las preguntas sociodemográficas sobre la presencia de COVID-19 y a los siguientes instrumentos: Condición de Producción Vocal-Profesor (CPV-P), Índice de Detección de los Trastornos de la Voz (SIVD) y Escala de Estrés Laboral (JSS). Resultados: De los 118 profesores analizados, el 94,1% eran mujeres; la mediana de edad era de 44 años. El (SIVD) registró la presencia de trastorno de la voz en el 66,9% de los participantes. En cuanto a la JSS, que son los hallazgos relacionados con el estrés laboral en el dominio de la demanda, los profesores mostraron niveles elevados, hecho que presupone la existencia de presiones de naturaleza psicológica para realizar su trabajo. Conclusión: Los profesores autoinformaron de la presencia de trastornos de la voz incluso en situación de clase a distancia, con ocasión del COVID-19, que fueron más frecuentes en los profesores de más edad. Al comparar la presencia de trastornos de la voz, los síntomas del coronavirus y los dominios de estrés en relación con la demanda, el control y el apoyo social, no hubo resultados significativos. Se espera que este estudio ayude a reflexionar sobre la necesidad de mejorar las condiciones de trabajo de los docentes, fortaleciendo las acciones de Trastorno de la voz relacionado con el trabajo (WRVD) y orientando acciones para el cuidado y bienestar vocal.

Vocal Load of University Professors: Preliminary Results

Purpose: To describe the acoustic characteristics of a classroom, voice quality, fatigue, and vocal load of university professors. Methods: Exploratory, observational, longitudinal, and descriptive study with a single group of participants, including vocal monitoring data over two weeks. Acoustic characterization of the classroom, perceptual-auditory evaluation, and acoustic analysis of voice samples were conducted before and after classes. Vocal dosimetry was performed during classes, and the Vocal Fatigue Index (VFI) was assessed at the beginning of each week. Descriptive analysis of the findings was conducted, and randomization test was performed to verify the internal reliability of the judge. Results: All participants reported speaking loudly in the classroom, with the majority reporting vocal changes in the past six months, and only one participant reported a current vocal change. The classroom had acoustical measures and estimations that deviated from established standards. The professors used high vocal intensities during classes. After the classes, an increase in the absolute values of the aggregated data for CAPE-V, jitter, and fundamental frequency was found, varying within the range of normality. Furthermore, there was an observed increase in both post-lesson intensity and VFI when comparing the two-week period. Conclusions: Vocal intensities and VFI were possibly impacted by the acoustics of the classroom. The increase in average VFI between the weeks may be attributed to a cumulative fatigue sensation. Further research with a larger number of participants and in acoustically conditioned classrooms is suggested in order to evaluate collective intervention proposals aimed at reducing the vocal load on teachers.

Objetivo: Describir las características acústicas, calidad vocal, fatiga y carga vocal de profesores universitarios. Métodos: Estudio exploratorio, observacional, longitudinal, descriptivo con un solo grupo de participantes y datos de monitoreo vocal durante dos semanas. Se realizó caracterización acústica de la sala, evaluación auditiva-perceptiva y acústica de muestras de voz antes y después de las clases. Se realizó dosimetría vocal durante las clases y se verificó el Índice de Fatiga Vocal (IFV) en dos semanas. Se realizó un análisis descriptivo de los hallazgos y una prueba de aleatorización para verificar la confiabilidad interna del juez. Resultados: Todos los participantes informaron hablar en voz alta en clase, la mayoría informó cambios vocales en los últimos seis meses y solo uno informó cambios vocales actuales. La sala presentó mediciones y estimaciones acústicas fuera de las normas establecidas. Los profesores utilizaron intensidades vocales altas durante las clases. Hubo un aumento en los valores absolutos de los datos agrupados para CAPE-V, jitter y frecuencia fundamental, variando dentro de los límites normales, después de las clases. La intensidad después de las clases y el IFV, en la comparación entre las dos semanas, mostraron un aumento. Conclusiones: La dosis vocal y el IFV posiblemente se vieron afectados por la acústica del aula. El aumento del IFV medio entre semanas pudo deberse a la sensación de cansancio acumulada. Se sugieren nuevas investigaciones con un mayor número de participantes y que se realicen en la sala acondicionada acústicamente para evaluar propuestas de intervención colectiva, con el objetivo de reducir la carga vocal de los docentes.

Impact of Laryngopharyngeal Reflux in Patients with Voice Disorders.

Objective: The aim of this study is to evaluate the presence of laryngopharyngeal reflux in patients with voice disorders thereby aiding in the early management and improving the quality of life. Study Design: Cross Sectional study. Methods: This cross sectional study was carried out in a tertiary care hospital, patients with history of voice change for more than 3 weeks were included, and divided into 4 groups depending upon the level of voice use. Patients were asked to fill Koufmann Reflux Symptom Index questionnaire followed by video laryngoscopy and findings were plotted according to Reflux Finding Score. Based on the scoring, impact of LPRD in patient with voice disorders was analysed. Results: Among the 90 study participants, 74 (82.2%) were found to have LPRD. The mean age was 42.76 ± 10.33 years. Majority (43.2%) belong to the age group of 41-50 years, with female predominance (70.3%). Majority (41.9%) of them were level IV voice users. 59.5% were positive Koufman reflex symptom index, 67.6% were positive Reflex finding score. Hoarseness (58.1%) the most common symptom. Conclusion: Laryngopharyngeal reflux disease has to be considered in patients presenting with hoarseness of voice for more than three weeks. Simple and highly reproducible scores like Reflux Symptom Index and Reflux Finding Score proven useful and valuable tools in diagnosing LPRD thereby aiding in early diagnosis and prompt management and improves the patient's quality of life. Level of Evidence: Level 1.

The Efficacy of Voice Therapy via Hybrid Group Telepractice Program with Asynchronous Components for Primary School Teachers: A Pilot Study.

PURPOSE: To determine the efficacy of a hybrid group telepractice program in voice therapy for primary school teachers. METHOD: The participants, consisting of 12 teachers with voice disorders (three males and nine females), participated in 11 sessions of the telepractice program, divided into one training session on vocal hygiene, five practice sessions by themselves, and five group practice sessions in 5weeks. Data on the vocal handicap index (VHI) measure was obtained pre- and post-intervention. The voice analysis included fundamental frequency (local), jitter (local), shimmer (local), harmonic-to-noise ratio (local), and maximum phonation time assessed by Praat software. RESULT: The VHI assessment revealed a statistically significant difference (P < 0.05) in the emotional domain. There was no statistically significant difference (P > 0.05) in physical, functional, and total scores. Both males and females had no statistically significant difference (P > 0.05) in mean fundamental frequency. However, there was a statistically significant difference (P < 0.05) in jitter (local), shimmer (local), harmonics-to-noise ratio (local), and the maximum phonation time. CONCLUSION: The group telepractice program in voice therapy for primary school teachers was effective. It could be utilized for voice therapy to prevent voice disorder problems in teachers.

Voice Handicap and Public Speaking Anxiety in Self-Assessment among Children with and without Vocal Fold Nodules.

PURPOSE: Vocal fold (VF) nodules are very common laryngeal lesion that affects people, including children as well. However, it has a negative impact on the communication and voice quality which is why it is important to study and measure it. Unfortunately, there may be factors which disturb examining process especially during questionnaire self-assessment. This study aimed to investigate whether public speaking anxiety (stage fright) correlates with scores on the Children's Voice Handicap Index-10 (CVHI-10) and to determine if children with VF nodules assess their voice similarly to those without such lesions. METHOD: Thirty-seven respondents at age 8-12 participated in the study. It was conducted the surveys: Children Voice Handicap Index-10 (CVHI-10), Stage Fright Scale - Children & Youth (SFS-CY), and Neuroticism subscale of the Big Five Questionnaire - Children (BFQ-C-Neu) and endoscopy laryngeal examination. The text describes the reliability analysis, means comparison, and correlation analysis. RESULTS: The measures used achieved a high level of reliability. There were no statistically significant differences in voice self-assessment scores between groups with and without VF nodules. Significant relationships were found between the CVHI-10 scores and all factors of the SFS-CY. CONCLUSIONS: The results reveal that children with VF nodules assess their voice similarly to those without laryngeal lesions. Correlation analysis shows significant relationships between voice handicap in self-assessment and stage fright factors. This may explain the lack of differences in CVHI-10 scores among groups; however, further research is needed to clarify this phenomenon.

Prevalence of Perceived Voice Disorders and Associated Risk Factors in Teachers and General Population in Croatia.

OBJECTIVES: There is no available data on the prevalence of voice disorders in Croatia. The objective of this research was to determine the prevalence of perceived voice disorders (PVD) in teachers and general population in Croatia using the Croatian Voice Handicap Index (VHI-HR) questionnaire. METHODS: This research was divided into two phases. In phase I, the potential of the VHI-HR questionnaire to distinguish individuals with and without voice disorders was assessed. A total of 113 participants completed the VHI-HR. Receiver operating characteristic analysis was performed. In phase II, a cross-sectional study was conducted. A total of 1898 participants, including 1088 teachers from 434 Croatian schools, and 810 nonteachers were included in the study. The questionnaire on sociodemographic factors, potential risk factors associated with voice disorders, and the VHI-HR was administered. The differences in the PVD prevalence in teachers and nonteacher adults and adverse effects of PVD were investigated. The multiple logistic regression model was used to examine the factors associated with PVD occurrence. RESULTS: In phase I, the cut-off point of 18.32 with 93.44% sensitivity and 98.08% specificity for VHI-HR was determined. In phase II, higher lifetime PVD prevalence was found among teachers. The point prevalence of PVD was 45.68% for teachers, and 21.11% for nonteachers. This study demonstrated that being a teacher, a woman, having a family history of voice disorders, reflux, working in environment with elevated noise levels, and having more than 30years of employment are associated with PVD occurrence. CONCLUSIONS: VHI-HR score of 19 and higher proves effective in distinguishing individuals with voice disorders from those without. The odds of having PVD for teachers are 2.83 times higher than for nonteachers. Risk factors for voice disorders, among others, include occupational use of voice and working in environments with elevated noise levels.

Accuracy and Cut-Off Values of Cepstral Measures in the Clinical Evaluation of Brazilian Portuguese Speakers.

OBJECTIVE: To identify the accuracy and cut-off values of the cepstral peak prominence (CPP) and cepstral peak prominence-smoothed (CPPS) obtained from different speech tasks, to identify dysphonic voices in Brazilian Portuguese speakers, and to verify the correlation between these measures and the overall severity of dysphonia (OS). METHOD: In a study with 376 subjects-277 with dysphonia and 99 controls-we recorded four speech tasks and assessed OS with a visual analog scale. We extracted CPP and CPPS from these recordings and analyzed them using receiver operating characteristic curves to determine cut-off values and other performance metrics (area under curve, accuracy, sensitivity, specificity, predictive values, and likelihood ratios). RESULTS: CPP values below 28.15 dB (sustained vowel [Ɛ]), 28.77 dB (sustained vowel [a]), 28.58 dB (all Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) sentences), and CPPS values below 16.42 dB (sustained vowel [Ɛ]), 17.02 dB (sustained vowel [a]), and 11.30 dB (all CAPE-V sentences) are indicative of the presence of dysphonia. CPPVE, CPPVA, CPPCAPE-V, CPPVS, CPPSVE, CPPSVA, CPPSCount, CPPSCAPE-V e CPPSVS, and CPPSVS can explain the variability of OS from 19% to 57.9%. CONCLUSIONS: The cut-off values for CPPVE, CPPVA, CPPCAPE-V, CPPSVE, CPPSCAPE-V, and CPPSVA obtained from Praat software can be used as a reference for the clinical voice assessment of Brazilian Portuguese speakers in the respective speech tasks. Analysis of the correlation coefficients of the cepstral measures investigated provided us with a predictive model of OS perception based on each measure/speech task.

A Scoping Review of Artificial Intelligence Detection of Voice Pathology: Challenges and Opportunities.

OBJECTIVE: Survey the current literature on artificial intelligence (AI) applications for detecting and classifying vocal pathology using voice recordings, and identify challenges and opportunities for advancing the field forward. DATA SOURCES: PubMed, EMBASE, CINAHL, and Scopus databases. REVIEW METHODS: A comprehensive literature search was performed following the Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Reviews guidelines. Peer-reviewed journal articles in the English language were included if they used an AI approach to detect or classify pathological voices using voice recordings from patients diagnosed with vocal pathologies. RESULTS: Eighty-two studies were included in the review between the years 2000 and 2023, with an increase in publication rate from one study per year in 2012 to 10 per year in 2022. Seventy-two studies (88%) were aimed at detecting the presence of voice pathology, 24 (29%) at classifying the type of voice pathology present, and 4 (5%) at assessing pathological voice using the Grade, Roughness, Breathiness, Asthenia, and Strain scale. Thirty-six databases were used to collect and analyze speech samples. Fourteen articles (17%) did not provide information about their AI model validation methodology. Zero studies moved beyond the preclinical and offline AI model development stages. Zero studies specified following a reporting guideline for AI research. CONCLUSION: There is rising interest in the potential of AI technology to aid the detection and classification of voice pathology. Three challenges-and areas of opportunities-for advancing this research are heterogeneity of databases, lack of clinical validation studies, and inconsistent reporting.

Water Resistance Therapy in Individuals with Parkinson's Disease: A Session-by-Session Analysis of the Vocal Quality.

OBJECTIVES: Verify session-by-session effects of the water resistance therapy (WRT) on the vocal quality of individuals with Parkinson's disease (PD). METHODS: This is a retrospective analytical study. Then, the samples were acquired from a database composed of 10 men aged between 50 and 90 years old diagnosed with PD. The participants underwent WRT with a resonance tube; then, they were guided to perform the following phonatory tasks: comfortable pitch and loudness, high pitch, low pitch, ascending and descending glissandos, and sentence uttering. Furthermore, tube depth ranged from 2 cm to 9 cm. Finally, WRT was implemented twice per week, totaling eight sessions, each lasting 45 minutes. Participants were assessed before and after each therapy session. Hence, the data were assessed with spectrographic analysis, vocal intensity, cepstral peak prominence-smoothed, alpha ratio, L1-L0, oscillatory frequency, and auditory-perceptual assessment of overall degree, roughness, breathiness, and instability. One-way repeated measures analysis of variance and Friedman tests were applied (P < 0.05). Furthermore, Holm-Sidak and Tukey tests were used as posthoc tests. RESULTS: After the sixth session, the spectrographic analysis revealed that the tracing color intensity of medium frequencies darkened, whereas a better result could be observed after the eighth session. Regarding vocal intensity, the improvement could be observed from the third session. Additionally, L1-L0 followed the same results. The overall degree auditory-perceptual assessment revealed the best results only after the second, third, and fourth sessions; however, after the eighth session, the instability increased. CONCLUSIONS: WRT allowed better results from the third session, with some improvements in the sixth session. However, the instability increased after the eighth session; thus, it is important to review the phonatory tasks and session numbers to avoid an overload in the phonatory system.

Laryngeal features in Lipoid proteinosis: a systematic review and meta-analysis of individual participant data.

PURPOSE: Lipoid proteinosis (LP) or Urbach-Wiethe disease (OMIM 247100) is a rare syndrome characterised by early vocal folds infiltration and subsequent multi-organ involvement. LP is often unrecognised and its associated hoarseness is overlooked. The main objective of the study was to investigate hoarseness in LP and implement a diagnosis among otolaryngologists. METHODS: PubMed/MEDLINE and OMIM databases were systematically searched. Authors concentrated the search on published articles starting from the discovery of the pathogenesis of LP by Hamada et al. in 2002. Only cases in which a diagnosis was reported both clinically and through biopsy and/or genetic molecular testing were included. Characteristics of the LP cases were extracted from each included study. Results were obtained through Generalized Estimating Equations. RESULTS: The search strategy yielded 217 articles, of which 74 (34.1%) met the selection criteria. A total of 154 cases were included. Hoarseness was described in all LP cases and clearly stated as the onset symptom in 68.8%. The onset was on average at 19 months of age (CI: 3.00-20.00), while the mean age at diagnosis was 15 years (CI: 10.00-30.00). Therefore, the diagnostic delay amounted to 13.42 years (CI: 8.00-23.83). Hoarseness alone was responsible for an LP diagnosis in only 14.3% of cases. In 43.5% of cases, genetic analysis of the ECM1 gene was performed and exon 6 was the most frequently altered portion. CONCLUSION: Analysing the largest number of published cases, the study underlined that hoarseness is the key symptom for diagnosing LP since early childhood, though frequently overlooked.

Temporal and Spectral Models as Correlates to Auditory-Perceptual Judgments of Overall Severity and Listener Comfort in Tracheoesophageal Voice.

INTRODUCTION: This study pursued two objectives: (1) to determine the potential association between listener (n = 51) judgments of 20 male tracheoesophageal speaker samples for two auditory-perceptual dimensions of voice, overall severity (OS) and listener comfort (LC); and (2) to assess the temporal and spectral acoustic correlates for these auditory-perceptual dimensions. METHODOLOGY: Three separate correlation analyses were performed to evaluate the association between OS and LC. First, scores of OS and LC from all listeners were pooled together, and then the correlation between OS and LC was computed. Second, scores of OS and LC were averaged over all listeners to derive a single estimate of OS and LC for each TE speaker sample; the correlation between the average OS and LC was then computed. Third, listener-to-listener variability in the association between OS and LC was evaluated by computing the correlation between OS and LC scores from each listener across all TE samples. Finally, two stepwise multiple regression models were created to relate the average LC score to spectral and temporal variation in the acoustic signal. RESULTS: While the pooled OS and LC scores had a moderate positive correlation (r = 0.66, p < 0.00001), the averaged OS and LC exhibited a near perfect positive correlation (r = 0.99, p < 0.00001). The significant differences between the pooled and averaged scores were explained by significant listener-to-listener variability in the association between OS and LC. OS and LC scores from 5 listeners had non-significant correlations, 10 had moderate correlations (r < 0.7), 35 listeners had high correlations (0.7 < r < 0.9), and 1 listener had a very high correlation (r < 0.9 < 1). Finally, the acoustic models created based on the spectral and temporal variations in the signal were able to account for 87.7% and 61.8% of variation in the average LC score. CONCLUSIONS: The strong correlations between OS and LC suggest that LC may, in fact, provide a more comprehensive auditory-perceptual surrogate for the voice quality of TE speakers. Although OS and LC are distinct conceptual dimensions, LC appears to have the advantage of assessing the social impact and potential communication disability that may exist in interactions between TE speakers and listeners.

Rearranging Voice Disorders: Refining the New Two-Dimensional Continuous Model.

BACKGROUND: Voice and laryngeal pathologies are traditionally arranged in categories. A recent study has suggested an alternative approach, using two continuous scales, Organicity and Tonicity, which form a two-dimensional plane on which all pathologies/conditions can be arranged. OBJECTIVES: This study was designed to examine the validity and reliability of the new continuous 2D model and to learn how it is affected by experts' background characteristics. METHODS: Ninety-three international experts from 16 countries participated in the study and rated a comprehensive list of 35 laryngeal and voice pathologies/conditions on two continuous scales. On the Organicity scale, 0 represented "nonorganic," and 10 defined "organic." Similarly, on the Tonicity scale, 0 described "hypotonic" and 10 represented "hypertonic." RESULTS: Cronbach's alphas were high for Organicity and Tonicity (0.99), with varied interexpert agreement scores. Pathologies/conditions populated all four quadrants of the constructed two-dimensional plane, with a majority of 21 of the 35 located in the first quadrant (high-Tonicity, high-Organicity). Results showed strong replicability when compared to the preliminary study. In addition, ratings on the two scales were found consistent and statistically unaffected by the experts' background characteristics. CONCLUSIONS: The new two-dimensional model is valid and reliable, and it provides a simple yet comprehensive approach for arranging voice disorders using a continuous perspective rather than a categorical one. Furthermore, the new model offers a framework that facilitates examination of the differences in how professional experts view different laryngeal pathologies and conditions.

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.

Noninvasive Management of Voice Disorders: An Umbrella Review.

OBJECTIVES: The aim of this study was to assess published systematic reviews that discussed noninvasive management of voice disorders. An umbrella review was conducted to collect, organize, and summarize narratively all available pharmacologic and voice therapy interventions. STUDY DESIGN: Umbrella review of systematic reviews. METHODS: Pertinent systematic reviews were identified by searching Pubmed/Medline and Embase. A primary screen identified studies related to voice. The second round of screening focused on studies that involved noninvasive management of voice disorders such as pharmacologic or voice therapy interventions. Variables of interest included study design, number of studies included in the review, target population, method of intervention, and outcomes. RESULTS: Forty-three systematic reviews were eligible and included in the umbrella review. Ten studies focused on pharmacologic interventions, and 33 studies focused on voice therapy. Individual studies included in the systematic reviews ranged from 2-47, with a total of 601 studies overall. CONCLUSIONS: This study provides a detailed review of all available systematic reviews on noninvasive management of voice disorders. Explored medications included proton pump inhibitors, calcium channel blockers, tricyclic antidepressants, antibiotics, corticosteroids, and hormone replacement. Explored voice therapy techniques included hydration, vocal function exercises, laryngeal manual therapy, respiratory exercise, biofeedback, phonation, coping strategies, and others. This may be utilized to guide therapeutic decision-making and identify current gaps in the literature that may warrant future investigation.

Clinical Experiences of Voice Therapists in the Rehabilitation of Pediatric Vocal Fold Nodules.

OBJECTIVES: The purpose of this study was to identify common clinical practices and experiences of voice therapists regarding the treatment of pediatric vocal fold nodules (VFNs) in Flanders, Belgium. STUDY DESIGN: Observational survey study. METHODS: A 38-item online survey was completed by 35 voice therapists (32 females, 3 males) with experience in treating pediatric VFNs. Demographic characteristics, occupational characteristics, educational characteristics, therapy content, therapy delivery model, and experience of the voice therapist were explored. Experiences of voice therapists were measured using visual analog scales (score 0-100). An extensive descriptive analysis was performed using IBM SPSS version 28. RESULTS: The majority of voice therapists (93.9%) provide a combination of direct and indirect therapy techniques when treating children with VFNs. The most commonly used direct techniques are breathing exercises (84.4%), semioccluded vocal tract exercises (71.9%) with a clear preference for resonance tube in water and resonant voice therapy, and relaxation exercises (65.6%). On average, Flemish voice therapists provide 24.80 (SD: 11.5, range: 10-50) half-hour sessions, usually at a frequency of once a week. No respondents had experience with intensive therapy or group therapy in the treatment of pediatric VFNs. Regarding the experience of voice therapists with treating VFNs in children, respondents give a mean score of 77.28 (SD: 13.7, range: 50-100) on a scale of 0 (negative experience) to 100 (positive experience). Furthermore, 96.2% of voice therapists experience difficulties during treatment and 40% feel there are not enough targeted training opportunities on the topic of pediatric VFNs. CONCLUSION: Flemish voice therapists generally feel comfortable treating pediatric VFNs. They usually provide a combination of direct and indirect therapy and use a wide range of different direct therapy techniques. However, there is still some need to organize more focused and tailor-made training initiatives.

Prevalence and Risk Factors of Voice Disorders Among Teachers in Saudi Arabia.

Introduction Voice is a crucial tool for communication, and voice problems are more likely to occur in professionals who frequently use their voice for work. Teachers, whose profession requires sustained vocal use, are particularly susceptible to occupation-related voice disorders. This study aimed to quantify the prevalence of voice disorders among teachers in Saudi Arabia, with the general population serving as a control group, and to identify associated risk factors. Methods A cross-sectional study was conducted utilizing an online self-administered questionnaire, which was completed by both teachers and the general population in Saudi Arabia. The latter group acted as a control. The questionnaire included sections on sociodemographic data, teaching patterns, symptoms of voice issues, and the Voice Handicap Index-10 (VHI-10) for assessing voice disorders among participants. Results The study included 640 participants, with 438 (68.4%) being teachers, the majority of whom were females (N = 406; 63.4%). The most common voice-related symptoms reported by teachers were hoarseness (N = 210; 37.9%) and dry throat (N = 147; 26.9%). Voice disorders, as determined by the VHI, affected 355 (55.5%) of the teachers. A high VHI score was associated with a diagnosis of voice disorders and GERD. There was no significant difference in the VHI scores between teachers and the general population (p > 0.05). Conclusion Teachers in Saudi Arabia exhibited a higher prevalence of voice disorders compared to the general population. Risk factors, such as smoking, longer teaching experience, and more teaching hours per week, were more common among teachers with voice disorders. Further investigative studies are warranted to elucidate the causal relationships between these variables and voice disorders.

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.

Screen11: validating a screening instrument for voice disorders in accordance with the COSMIN framework.

PURPOSE: Although numerous patient-reported outcome measures have been developed and validated to quantify the impact of voice problems on different aspects of life, to our knowledge no screening instrument exists that specifically captures voice disorders in a retrospective fashion. The aim of the present study was to examine the psychometric properties and diagnostic validity of a retrospective voice screening method, Screen11, according to the COSMIN framework for health-related, patient-reported outcome measures. The items in Screen11 have been used to establish the prevalence of voice disorders in both general and occupation-specific populations in the Nordic countries. However, the instrument has not been validated. METHODS: The voice patient group (n = 54) in this study comprised of patients from the Turku University Central Hospital phoniatric outpatient clinic seeking help for their voice problems. For these voice patients, we recruited voice-healthy controls (n = 61) who matched in terms of gender, age, and occupation. The participants responded to the Screen11 questionnaire along with the VHI and the VAPP. RESULTS: The results of the initial exploratory factor analysis showed that all the Screen11 items loaded on a common underlying latent factor. Furthermore, Screen11 had high internal consistency (α = .93) and correlated sufficiently with other voice questionnaires. CONCLUSIONS: The results indicate that Screen11, which screens for possible voice disorders at an early stage, was successfully validated. With respect to its diagnostic validity, the Screen11 sum score is preferable. A threshold of ≥ 15 should be used for differentiating patients with possible voice disorders from those with healthy voices.

Patients' Demographics and Risk Factors in Voice Disorders: An Umbrella Review of Systematic Reviews.

OBJECTIVES: This study aimed to provide a comprehensive overview of the systematic reviews that focus on the prevalence of voice disorders (VDs), associated risk factors, and the demographic characteristics of patients with dysphonia. An umbrella review was conducted to identify general research themes in voice literature that might guide future research initiatives and contribute to the classification of VDs as a worldwide health concern. STUDY DESIGN: Umbrella review of systematic reviews. METHODS: Pubmed/Medline and Embase were searched for eligible systematic reviews by two authors independently. Extracted data items included the study publication details, study design, characteristics of the target population, sample size, region/country, and incidence and/or prevalence of the VD(s) of interest. RESULTS: Forty systematic reviews were included. Sixteen reported a meta-analysis. Great heterogeneity in methods was found. A total of 277,035 patients across the included studies were included with a prevalence ranging from 0%-90%. The countries represented best were the United States and Brazil, with 13 studies each. Aging, occupational voice use, lifestyle choices, and specific comorbidities, such as obesity or hormonal disorders, seem to be associated with an increased prevalence of dysphonia. CONCLUSIONS: This review underscores the influence of VDs on distinct patient groups and the general population. A variety of modifiable or non-modifiable risk factors, having varied degrees of impact on voice qualities, have been identified. The overall effect of VDs is probably underestimated due to factors, such as sample size, patient selection, underreporting of symptoms, and asymptomatic cases. Employing systematic reviews with consistent methodologies and criteria for diagnosing VDs would enhance the ability to determine the prevalence of VDs and their impact.