The Effect of Unilateral Hearing Protection on Vocal Intensity With Varying Degrees of Background Noise.

INTRODUCTION: The Lombard effect (LE) is a phenomenon in which speakers adjust their vocal production by raising the volume in noisy environments. As a result, the LE can create problems of vocal strain, fatigue and potential injury. OBJECTIVES: This study aims to examine the difference in vocal intensity output in subjects wearing unilateral hearing protection versus no hearing protection in the presence of background noise. METHODS: Each subject was seated inside a sound booth wearing a head-mounted microphone. Subjects were asked to read an excerpt from "The Rainbow Passage" while various levels of background noise were played: 50, 60, 70, and 80 dBA (Multitalker Babble). Each noise level was played while the subject was with and without unilateral ear protection (Optime 98 Earmuff [3M]) in random order. The earmuff has a noise reduction rating of 25 dB. After each reading of the text, subjects were asked to rate communication disturbance, vocal clarity, and discomfort during talking using a 10 cm visual analogue scale. RESULTS: The LE is reduced from 0.38 dB/dB to 0.29 dB/dB with unilateral ear occlusion. However, self-perception of disturbance, clarity and comfort were not affected by unilateral occlusion, only by noise level. CONCLUSIONS: Unilateral hearing protection reduces the LE and may protect against phonotrauma when speaking in an environment with loud background noise.

Straw vs Cup Use in Patients with Symptoms of Oropharyngeal Dysphagia.

CONTEXT: This study aims to determine whether straw or cup use is superior for the control of a single thin liquid bolus in patients with symptoms of oropharyngeal dysphagia to liquids. METHODS: This is a prospective, randomized, single-blinded study. Patients were studied at a Professional Voice and Swallowing Center by a laryngologist between April 2017 and April 2018. Twenty-five patients, 18 years of age or older, who presented with symptoms of oropharyngeal dysphagia the clinic were included in the study. Each patient complained of difficulty with choking on liquids. Informed consent was obtained from each patient. Patients that were unable to follow one to two step commands and patients with dysphagia that lack oral strength or respiratory strength to facilitate straw or cup usage were not included. Patients with dysphagia that are tracheostomy tube dependent were also not included. RESULTS: The average PAS for straw versus cup drinking at 10mL was 1.08 and 1.04 respectively with a p-value of 0.33. For straw versus cup at 20mL, the PAS was 1.04 and 1.26 respectively with a p-value of 0.13. For 30mL, the PAS was 1.0 and 1.4 for straw and cup use respectively with a p-value of 0.16. And for 40mL, the PAS was 1.0 and 1.09 with a p-value of 0.27. CONCLUSIONS: No statistical significant difference was demonstrated in risk of penetration or aspiration of thin liquids between cup and straw usage in patients with mild oropharyngeal dysphagia.