Multiparametric analysis of voice following prolonged voice use and voice rest in teachers: evidence from discriminant analysis

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.

Psychometric Properties of the Vocal Fatigue Handicap Questionnaire in Kannada Among Teachers

BACKGROUND

As the literature review suggests, most professional voice users, such as teachers and singers, are prone to vocal abuse or misuse and frequently experience vocal fatigue. Therefore, validating the Vocal Fatigue Handicap Questionnaire among professional voice users with and without the symptoms of vocal fatigue might provide appropriate external validity of the questionnaire.

OBJECTIVE

The objective of the study was to validate the Kannada version of the Vocal Fatigue Handicap Questionnaire (VFHQ-K) among a cohort of Kannada-speaking primary and secondary school teachers with and without self-reported vocal fatigue symptoms.

STUDY DESIGN

This was a validation study.

METHOD

The study consisted of two groups of participants. Group 1 included 40 teachers with self-reported vocal fatigue symptoms, and Group 2 included 57 teachers without self-reported vocal fatigue symptoms. The VFHQ-K was administered to each participant after obtaining informed consent. The questionnaire was again readministered between 1 and 2 weeks to assess the test-retest reliability. All the responses that were obtained were tabulated for analysis.

RESULTS

The VFHQ-K demonstrated good test-retest reliability, internal consistency, and acceptable discriminant validity. The cutoff value of VFHQ-K obtained in the present study between the teachers with and without self-reported symptoms of vocal fatigue was much less than the cutoff values reported by the earlier version of VFHQ-K.

CONCLUSION

The VFHQ-K can be a helpful tool in the early identification of teachers with vocal fatigue and in improving the vocal health of professional voice users.

Cross-Linguistic Adaptation of Vocal Fatigue Handicap Questionnaire into Kannada (VFHQ-K)

BACKGROUND

It is often considered appropriate to assess vocal fatigue using a self-reported tool or a subjective measure, as vocal fatigue is primarily described through self-reported symptoms. The vocal fatigue handicap questionnaire (VFHQ) is a self-rated questionnaire that addresses the concern of vocal fatigue in persons with voice disorders. Adapting and validating this questionnaire into the Kannada language can be helpful in assessing the physical, emotional, and functional effects of vocal fatigue among Kannada-speaking individuals.

OBJECTIVE

Adaptation and Validation of the VFHQ into the Kannada language.

STUDY DESIGN

A validation study.

METHOD

Initially, the VFHQ was translated into Kannada. The translated questionnaire was given to two SLPs and two Linguists for content validation and to assess the cultural and linguistic equivalency. 65 participants (34 males and 31 females) were diagnosed with voice disorders, and 65 participants who were age and gender-matched and had healthy voices were administered the Kannada version of VFHQ (VFHQ-K).

RESULTS

The results showed that the VFHQ-K had good test-retest reliability, internal consistency, and known groups' discriminative validity. The cut-off point of the VFHQ-K was equal to 26.50, indicating that the VFHQ-K had acceptable discrimination between the patients with and without dysphonia.

CONCLUSION

VFHQ-K is a valid, reliable, and sensitive questionnaire to assess the emotional, physical, and functional effects of vocal fatigue in the Kannada-speaking population.

Adaptation and Validation of the Voice Symptom Scale into Kannada (VoiSS-K)

BACKGROUND

The Voice Symptom Scale (VoiSS) is a self-assessment tool that assesses vocal symptoms and measures the effect of dysphonia. Adapting VoiSS into Kannada can be beneficial in evaluating dysphonia-related symptoms, especially in the Kannada-speaking population.

OBJECTIVES

To adapt the VoiSS into Kannada and to assess the reliability, validity, and cut-off values of the VoiSS Kannada version (VoiSS-K).

STUDY DESIGN

The study used a prospective nonrandomized standard group comparison.

METHODS

Initially, the VoiSS was translated into Kannada. The VoiSS-K was administered to 76 participants (34 females and 42 males) with a mean age of 46.4 ± 14.5 years having voice disorders. The VoiSS-K was also administered to 76 respondents having clinically normal voice who were age and gender-matched to the participants with voice disorders.

RESULTS

Cronbach's alpha was utilized to evaluate the internal consistency, and the intraclass correlation coefficient to evaluate the test-retest reliability. The findings indicated that the VoiSS-K had excellent test-retest reliability and internal consistency. The study group participants had significantly higher VoiSS-K scores than the control group participants. Thus, the outcomes indicated that the VoiSS-K had good discriminative validity. Receiver operating characteristic curve analysis was conducted, and the cut-off score of VoiSS-K was 40.50.

CONCLUSION

As the VoiSS-K is a rigorous, robust, and detailed self-assessment questionnaire, it can be used as a clinically sensitive tool to evaluate voice symptoms in Kannada-speaking individuals.

Multiparametric Analysis of Dysphonic Voice - An Evidence from the Discriminant Analysis

Even though earlier studies have investigated the relationship between various subjective and instrumental measures of voice, determining a standardized set of voice parameters in evaluating dysphonic voices can help in better diagnostic distinctions and judgment of the treatment outcomes in voice disorders. Thus, the primary objective was to examine the differences in the objective and subjective measures of voice between the participants with dysphonia and participants with a clinically normal voice. The subsequent objective was to identify the group of parameters sensitive to vocal changes in dysphonia using discriminant analysis. Two groups of participants were included in the study. Group 1 comprised of 15 participants with dysphonia. Group 2 included 15 participants with a clinically normal voice. Sustained phonations of vowels were recorded from the participants of both groups and were analyzed perceptually using the GRBAS rating scale. Acoustic, cepstral, spectral, and electroglottographic measures were analyzed from dysphonic voices and normal controls. There were significant differences in both instrumental and perceptual measures between the participants with and without dysphonia. The set of five parameters that were significant predictors that discriminated the dysphonic voice from the clinically normal voice with 100% accuracy was also determined using discriminant analysis. Future investigations on the relation between the specific instrumental and perceptual measures of voice identified in the present study among individuals with various voice disorders can deliver more promising and comprehendible insights into better diagnostic distinctions of voice disorders.

Adaptation and Validation of the Voice-Related Quality of Life Measure into Kannada

BACKGROUND

Earlier researchers have developed various objective tools to document the impact of dysphonia on the patient's daily living and quality of life. Of all these available tools, Voice Related Quality of Life (V-RQOL) is one of the essential self-reported tools to document the quality of life related to voice. Thus, developing the Kannada version of V-RQOL can be a useful tool in the clinical assessment of Kannada-speaking dysphonic patients.

OBJECTIVES

To translate the V-RQOL into Kannada and to evaluate the psychometric properties and the cut off scores for the Kannada version of the V-RQOL.

STUDY DESIGN

This investigation deployed a non-randomized, prospective standard group comparison.

METHODS

V-RQOL was translated to Kannada and was administered to 70 patients with voice disorders (42 males and 28 females) with a mean age of 43.2 ± 15.8 years, and 70 age and gender-matched participants with a clinically normal voice.

RESULTS

Spearman's correlation coefficient was more than 0.94 indicating a good test-retest reliability. Therefore, the Kannada version of VRQOL had a good level of reproducibility. The test also showed a Cronbach alpha coefficient of 0.92, indicating a strong internal consistency of the Kannada version of VRQOL. Receiver Operating Characteristic (ROC) curve analysis revealed that the cut off score for the Kannada version of VRQOL was 93.75 indicating that Kannada version of VRQOL had an excellent construct validity.

CONCLUSION

The present study findings revealed that the Kannada version of VRQOL is a reliable, valid and sensitive self-assessment tool to document the impact of voice problems on the patient's quality of life.

Voice Problems Among School Teachers employing the Tele-teaching Modality

OBJECTIVES

To assess the prevalence of voice problems among teachers in Riyadh during tele-teaching and examine the relationship between the Voice Handicap Index 10 (VHI10) scores and a variety of risk factors believed to be related to voice problems. We also assessed awareness of voice hygiene and therapy among teachers.

STUDY DESIGN

An observational cross-sectional study conducted using a multistage random sampling method among Riyadh school teachers who taught by tele-teaching for a minimum of one year.

METHODS

A self-assessment questionnaire which included demographic information about teachers, factors related to their teaching backgrounds, tele-teaching settings, effects of tele-teaching on the voice, medical and social histories, reports of voice and reflux symptoms, VHI10, and general knowledge about voice hygiene. This was distributed to school teachers using an SMS link through the Ministry of Education's IT department.

RESULTS

A total 495 were included in the study after exclusions. The prevalence of teachers who had significant voice problems during tele-teaching (VHI10>11) was 21.6%. Multiple risk factors significantly increased the risk of voice problems during tele-teaching. These factors included being female, teacher age, the presence of background noise from both teachers and students, loud voices, using an open camera during the teaching, stress and anxiety, allergies, respiratory disease, reflux, hearing problems, and a family history of voice problems. Only 4.6% of respondents were familiar with voice hygiene and voice therapy, but 65% believe that it is important for teachers to be knowledgeable about them.

CONCLUSIONS

Due to the lower prevalence of voice disorders among tele-teaching compared to traditional teaching methods, tele-teaching may be a viable option for teachers who have voice problems. There are still several factors influencing voice problems among tele-teachers. To attenuate potential risks, it is crucial that teachers are aware of the concepts of voice hygiene and voice therapy.