Effects of vocal fatigue on voice parameters of Indian Teachers

Phonatory Tasks and Outcome Measures for Assessing Vocal Fatigue: A Scoping Review

OBJECTIVES

To map the phonatory tasks and the result measures used to evaluate vocal fatigue in vocally healthy individuals.

METHODS

This is a scoping review based on the following research question: What are the phonatory tasks and outcome measures used for the evaluation of vocal fatigue in vocally healthy individuals? The construction of the search strategy followed the PCC strategy; population: vocally healthy adult individuals; concept: phonatory tasks and vocal evaluation measures; and context: vocal fatigue. The search was performed electronically in the databases Medline (PubMed), LILACS (BVS), SCOPUS (Elsevier), Web of Science (Clarivate), EMBASE, and COCHRANE. A manual search in the references of the selected articles and in the journal with the highest number of publications was also performed. The selection of articles was based on reading the titles, abstracts, and full text, applying the eligibility criteria. The selected articles were related to the evaluation of vocal fatigue in healthy individuals from a predetermined vocal load task. Data regarding the characteristics of the publication, sample, phonatory tasks, and outcomes were extracted. The results were presented in a descriptive format, due to a frequency distribution analysis.

RESULTS

In total, 3756 studies were identified during the search, of which 60 were selected. The most used vocal load activity was the reading task, with duration ranging from 46 to 120 minutes. The (1) sustained vowel /a/ and (2) the reading of texts and phrases, both in usual intensity and frequency without the interference of the researcher, were the most used evaluation tasks. The most used outcome measures are the following: (1) acoustic parameters-fundamental frequency [fo] (mean, variance), sound pressure level (mean), local jitter (%), local shimmer (%), cepstral peak prominence (mean); (2) vocal self-assessment by the validated instruments-Perceived Phonatory Effort Scale, Visual Analog Scale, Borg-CR-10 Scale.

CONCLUSIONS

There is a diversity of phonatory tasks and outcome measures recurrently used in scientific articles to evaluate the signs of vocal fatigue in vocally healthy individuals. The most used vocal sample to evaluate vocal fatigue was the sustained vowel /a/ in habitual intensity and frequency without the interference of the researcher. The most frequently reported outcome measures for the assessment of immediate vocal fatigue effects were the acoustic analysis and vocal self-assessment.

Examining Therapy Duration in Adults With Voice Disorders

PURPOSE

This study examined the number of voice therapy sessions and the number of weeks in treatment to achieve desired voice outcomes in adults with voice disorders. Factors that may predict therapy duration were examined, as was the percentage of patients returning to the clinic for additional voice therapy after initial discharge.

METHOD

An observational cohort design was utilized. Data from 558 patients were extracted from the University of Wisconsin-Madison Voice and Swallow Outcomes Database. Patients diagnosed with muscle tension dysphonia, vocal fold paralysis, benign vocal fold lesions, laryngospasm/irritable larynx, and presbyphonia were examined. Patient demographics, auditory-perceptual assessments, acoustics, aerodynamics, videostroboscopy ratings, self-reported scales, and medical comorbidities were collected.

RESULTS

Patients required an average of 5.32 (SD = 3.43) sessions of voice therapy before voice outcomes were sufficiently improved for discharge. Average number of sessions ranged from 4.3 for presbyphonia to 6.7 for benign vocal fold lesions. Baseline overall Grade Roughness Breathiness Asthenia and Strain rating (p < .001), Dysphonia Severity Index (p < .001), Voice Handicap Index score (p < .01), age (p = .006), and occupational voice user status (p < .001) significantly predicted the number of therapy sessions required. Overall, 14.5% of patients returned for additional voice therapy following an initial discharge from treatment.

CONCLUSIONS

Findings inform our understanding of how many sessions patients with voice disorders require to achieve desired voice outcomes. Additional research is needed to optimize the efficacy of voice treatment and determine how recurrence of dysphonia might best be prevented.

Toward a Consensus Description of Vocal Effort, Vocal Load, Vocal Loading, and Vocal Fatigue

Purpose The purpose of this document is threefold: (a) review the uses of the terms "vocal fatigue," "vocal effort," "vocal load," and "vocal loading" (as found in the literature) in order to track the occurrence and the related evolution of research; (b) present a "linguistically modeled" definition of the same from the review of literature on the terms; and (c) propose conceptualized definitions of the concepts. Method A comprehensive literature search was conducted using PubMed/MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Scientific Electronic Library Online. Four terms ("vocal fatigue," "vocal effort," "vocal load," and "vocal loading"), as well as possible variants, were included in the search, and their usages were compiled into conceptual definitions. Finally, a focus group of eight experts in the field (current authors) worked together to make conceptual connections and proposed consensus definitions. Results The occurrence and frequency of "vocal load," "vocal loading," "vocal effort," and "vocal fatigue" in the literature are presented, and summary definitions are developed. The results indicate that these terms appear to be often interchanged with blurred distinctions. Therefore, the focus group proposes the use of two new terms, "vocal demand" and "vocal demand response," in place of the terms "vocal load" and "vocal loading." We also propose standardized definitions for all four concepts. Conclusion Through a comprehensive literature search, the terms "vocal fatigue," "vocal effort," "vocal load," and "vocal loading" were explored, new terms were proposed, and standardized definitions were presented. Future work should refine these proposed definitions as research continues to address vocal health concerns.

Fadiga vocal em professores disfônicos que procuram atendimento fonoaudiológico

RESUMO Objetivo Verificar a autopercepção de fadiga vocal de professores disfônicos em atividade letiva que procuram atendimento fonoaudiológico. Método Participaram desta pesquisa 60 professores com queixa vocal, dentre estes, 30 que buscaram tratamento no Programa de Saúde Vocal do Sindicato dos Professores de São Paulo – SinproSP (G1) e 30 professores que não buscaram atendimento (G2). Todos os participantes responderam a um questionário de identificação, a um de caracterização pessoal e do trabalho, a uma lista de sinais e sintomas vocais e ao Índice de Fadiga Vocal - IFV. Além disso, foram registradas contagem de números de 1 a 10 e vogal sustentada “é” para definição do grau de desvio vocal por meio da análise perceptivo-auditiva. Resultados Os professores que procuraram o atendimento (G1) apresentaram piores escores nos protocolos IFV, maior número de sinais e sintomas, além de pior autoavaliação da voz quando comparados aos professores que não procuraram tratamento (G2). Além disso, os docentes dos dois grupos estudados apresentaram desvios de voz de leve a moderado. Conclusão Professores disfônicos que procuram atendimento fonoaudiológico apresentam maior sensação de fadiga vocal, principalmente em relação aos domínios restrição vocal e desconforto físico do IFV. Além disso, apresentaram maior número de sintomas e pior autoavaliação vocal em relação àqueles que não procuraram o atendimento, apesar de ambos os grupos apresentarem vozes desviadas.

Cross-Cultural Adaptation and Validation of the Vocal Fatigue Index into Persian

INTRODUCTION

The aim of the present study was the cross-cultural adaptation and validation of the Vocal Fatigue Index (VFI) in Persian.

METHODS

The English version of the VFI was translated to Persian using the guidelines of International Quality of Life Assessment. Eighty participants with voice disorders and 50 healthy controls without any voice disorders completed the Persian version of the VFI. The 80 participants with voice disorders completed the VFI a second time a week from the initial completion to evaluate test-retest reliability.

RESULTS

The VFI measure demonstrated a strong internal consistency. Cronbach alpha coefficient was 0.95 for tiredness and avoidance of voice use, 0.86 for physical discomfort and 0.83 for improvement or lack thereof of symptoms with voice rest. VFI also showed a high test-retest reliability (r = 0.75-0.89).

CONCLUSIONS

The Persian version of the VFI is considered to be a valid and reliable questionnaire for identifying individuals with probable vocal fatigue. The VFI can be utilized in clinics across Iran in the assessment and treatment of individuals with vocal fatigue.

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.

Equivalência cultural da versão brasileira do Vocal Fatigue Index – VFI

RESUMO O objetivo deste estudo foi desenvolver a equivalência cultural da versão brasileira do protocolo Vocal Fatigue Index – VFI. Dois fonoaudiólogos brasileiros bilíngues traduziram a versão original do VFI do inglês para o português. As traduções foram revisadas pelos pesquisadores e por um comitê de cinco fonoaudiólogos especialistas em voz, chegando-se a uma versão final do instrumento. Um terceiro fonoaudiólogo bilíngue retrotraduziu essa versão final e o mesmo comitê reviu as diferenças em relação à versão original. A versão final em português do protocolo VFI, assim como o original em inglês, é respondida de acordo com a frequência de ocorrência em que se experienciam os sintomas: 0 = nunca, 1 = quase nunca, 2 = às vezes, 3 = quase sempre e 4 = sempre. Para a equivalência cultural da versão em português, a opção “não aplicável” foi acrescida na chave de respostas e 20 indivíduos com queixa vocal e disfonia completaram o instrumento. Se alguma questão fosse considerada “não aplicável”, seria eliminada da versão brasileira do protocolo; nenhuma questão foi eliminada do instrumento. A versão em português brasileiro foi intitulada Índice de Fadiga Vocal – IFV e apresenta 19 questões, da mesma forma que o instrumento original. Dos 19 itens, 11 referem-se à fadiga e restrição vocal, 5, ao desconforto físico associado à voz e 3 à recuperação dos sintomas com o repouso. A versão para o português brasileiro do VFI apresenta equivalência cultural e linguística em relação ao instrumento original. A validação do IFV para o português brasileiro está em andamento.