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Morawska J, Pietruszewska W, Politański P, Niebudek-Bogusz E. Population characteristics and self-assessment of speaking and singing voice in Polish contemporary commercial music singers-an exploratory, cross-sectional study. Front Public Health 2024; 12:1256152. [PMID: 38813421 PMCID: PMC11133608 DOI: 10.3389/fpubh.2024.1256152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 04/30/2024] [Indexed: 05/31/2024] Open
Abstract
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.
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Affiliation(s)
- Joanna Morawska
- Department of Otolaryngology, Head and Neck Oncology, Medical University of Lodz, Łódź, Poland
| | - Wioletta Pietruszewska
- Department of Otolaryngology, Head and Neck Oncology, Medical University of Lodz, Łódź, Poland
| | - Piotr Politański
- Department of Electromagnetic Hazards, Nofer Institute of Occupational Medicine, Łódź, Poland
| | - Ewa Niebudek-Bogusz
- Department of Otolaryngology, Head and Neck Oncology, Medical University of Lodz, Łódź, Poland
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Hockey K, Kennedy E. Clinical Characteristics of Individuals Presenting to Physiotherapy for Voice and Throat Care: A Retrospective Case Notes Review. J Voice 2024:S0892-1997(24)00009-2. [PMID: 38429117 DOI: 10.1016/j.jvoice.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 01/16/2024] [Accepted: 01/17/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND Currently, little is known about the characteristics of individuals presenting for physiotherapy care with voice and throat problems. PURPOSE The aim of this study is to describe the demographic and clinical characteristics of individuals presenting to physiotherapy for voice and throat-related problems, and to use this information to clarify the role of physiotherapy in the management of people with voice and throat problems. METHODS A retrospective clinical case notes review was conducted of all clients who accessed physiotherapy for voice and throat problems at a private practice based in Christchurch within a 12-month period from 1st October 2020 to 1st October 2021. RESULTS Data were analyzed from 53 patient charts. The typical profile of an individual accessing physiotherapy for voice and throat problems were female (n = 37), NZ European (n = 26), singer (n = 43), with chronic problems (n = 20), of a nontraumatic origin (n = 45). Voice problems were present in 39 cases and muscle-related problems were present in 42 cases. Treatment primarily included manual therapy and various modes of exercise therapy. CONCLUSIONS The clinical characteristics described offer insight into the demographic and clinical characteristics of individuals accessing physiotherapy services for voice and throat problems. A high prevalence of muscle-related problems and wider issues were identified, consistent with the physiotherapy skill set. Physiotherapy appears to complement existing ENT or SLT services by identifying and managing muscle-related voice problems and addressing wider factors contributing to voice and throat problems.
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Mathmann P, Konerding U, Deuster D, Neumann K. The Influence of Age, Gender, Health-Related Behaviors, and Other Factors on Occupationally Relevant Health Complaints of Singers. J Voice 2024; 38:170-180. [PMID: 34583882 DOI: 10.1016/j.jvoice.2021.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 07/31/2021] [Accepted: 08/02/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Professional singers' careers are usually associated with health-relevant factors that they themselves may or may not be able to influence. We have therefore investigated the effect of modifiable health-related behaviors and non-modifiable factors on singers' occupational health. METHODS In an explorative, questionnaire-based study, self-reported, occupationally relevant health complaints and behaviors, along with singer-specific characteristics, were surveyed from 349 professional singers and voice teachers (116 men, 233 women; age 18-73 years) and the influence of age, gender, duration of daily and lifelong singing, voice category, and health-related behaviors (smoking, alcohol consumption, physical activity) on occupationally relevant health complaints were analyzed using bi- and multivariate statistical methods. RESULTS Singers reported less risky alcohol consumption (5.4% versus ≈15%) and smoking (15.5% versus 29.7%) than the general population, and too little physical activity was described in two thirds of both populations. After controlling for multiple testing, no effect was found for these behaviors, the time spent singing daily, gender, or voice categories on singers' complaints. Health complaints were significantly fewer for males (P < .001) and older women and were reported more frequently for higher-pitched male voices, a trend not found in females. CONCLUSION Singers seem to smoke and drink less than members of the general population. These factors did not affect their complaints. Female singers described more work-related health complaints than males, a finding that corresponds to women in the general population. Older singers reported fewer complaints than younger singers, possibly because of selection effects or older singers acquiring strategies to avoid health-damaging behavior.
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Affiliation(s)
- Philipp Mathmann
- Department of Phoniatrics and Pedaudiology, University Hospital Münster, University of Münster,Münster, Germany.
| | - Uwe Konerding
- Trimberg Research Academy, University of Bamberg,Bamberg, Germany; Department of Psychology and Psychotherapy, Witten/Herdecke University, Witten, Germany
| | - Dirk Deuster
- Department of Phoniatrics and Pedaudiology, University Hospital Münster, University of Münster,Münster, Germany
| | - Katrin Neumann
- Department of Phoniatrics and Pedaudiology, University Hospital Münster, University of Münster,Münster, Germany
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Saeedi S, Baghban K, Seifpanahi MS, Nazari MA, Moshtagh A, Manoosi M, Ayubi E. The Vocal Hygiene Treatment Programs for Singers: A Systematic Review. J Voice 2023:S0892-1997(23)00349-1. [PMID: 38052688 DOI: 10.1016/j.jvoice.2023.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 10/22/2023] [Accepted: 10/23/2023] [Indexed: 12/07/2023]
Abstract
OBJECTIVES This systematic review aims to explore the effectiveness of voice health education interventions among singers, particularly focusing on vocal hygiene treatment programs tailored for professional voice users. STUDY DESIGN Systematic review. METHODS Preferred Reporting Items on Systematic Reviews and Meta-Analysis guidelines were followed to conduct this systematic review. Comprehensive searches were conducted in PubMed, Web of Science, Scopus, Science Direct, and Cochrane Library databases. Four articles were selected for detailed review. The studies were evaluated using the Effective Public Health Practice Project tool for quality assessment. RESULTS The four reviewed studies primarily utilized the pretest-posttest design to examine the effectiveness of vocal hygiene interventions on singers' vocal health. Two studies investigated the effect of hydration as a treatment method, while the remaining two focused on vocal hygiene instruction. Significant improvements were observed in various vocal health parameters, including maximum phonation time, intensity, Dysphonia Severity Index, and number of daily vocal breaks taken. CONCLUSION This systematic review provides valuable insights into the efficacy of vocal hygiene treatment programs for singers. The positive outcomes observed in the reviewed studies underscore the importance of voice health education tailored to singers' specific needs. However, the limited number of eligible studies and the common limitation of small sample sizes highlight the need for further research in this area. Vocal health practitioners, educators, and researchers can utilize the findings of this review to develop evidence-based vocal hygiene interventions that promote the well-being and longevity of singers' vocal performance careers.
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Affiliation(s)
- Soheila Saeedi
- Department of Health Information Technology, School of Allied Medical Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Kowsar Baghban
- Department of Speech and Language Pathology, School of Rehabilitation Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mohammad-Sadegh Seifpanahi
- Department of Speech and Language Pathology, School of Rehabilitation Sciences, Autism Spectrum Disorders Research Center, Hamadan University of Medical Sciences, Hamadan, Iran.
| | - Mohammad-Amin Nazari
- Department of Speech and Language Pathology, School of Rehabilitation Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Ali Moshtagh
- Department of Speech and Language Pathology, School of Rehabilitation Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Motahareh Manoosi
- Department of Speech and Language Pathology, School of Rehabilitation Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Erfan Ayubi
- Department of Epidemiology, Hamadan University of Medical Sciences, Hamadan, Iran
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Robotti C, Schindler A, Lechien JR, Di Sabatino A, Capobianco S, Schindler A, Ottaviani F, Sims HS, Bertino G, Benazzo M, Mozzanica F. Prevalence of Laryngopharyngeal Reflux Symptoms, Dysphonia, and Vocal Tract Discomfort in Amateur Choir Singers. J Voice 2023; 37:932-944. [PMID: 34404581 DOI: 10.1016/j.jvoice.2021.06.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 06/15/2021] [Accepted: 06/20/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Vocal tract discomfort (VTD), dysphonia, and laryngopharyngeal reflux (LPR) symptoms are complaints frequently reported by amateur singers. There are two aims of this study. The first is to evaluate the prevalence of these symptoms using validated questionnaires. The second is to correlate singing-related variables with the questionnaire responses. METHODS A total of 392 amateur choir singers (ACS) and 514 control subjects completed an online survey divided into four parts: (1) clinical and demographic characteristics, (2) training in singing and singing experience, (3) history of gastroesophageal reflux disease and LPR symptoms, (4) validated questionnaires. Specifically, the reflux symptom index (RSI), the vocal tract discomfort scale (VTDS), and the voice symptom scale (VoiSS) were included to analyze the actual burden related to LPR symptoms, VTD, and dysphonia. RESULTS ACS demonstrated a healthier lifestyle and a lower prevalence of gastroesophageal reflux disease symptoms in comparison with control subjects. ACS scored significantly higher in VTDS and VoiSS than control subjects, while no differences in the RSI results were found. Significant correlations among the questionnaires' results were demonstrated. Occasional professional singing was the variable influencing VTDS and VoiSS results the most. CONCLUSION ACS do not evidently manifest a higher impairment connected to LPR (RSI score), while they do report higher levels of voice (VoiSS score) and vocal tract (VTDS score) impairments, in comparison with control subjects. The relevant correlations among the PRO measures suggest that LPR symptoms, VTD, and dysphonia are related to each other. Given the relevant repercussion on the severity of VTD and dysphonia, providers should specifically ask about occasional professional singing when treating amateur singers.
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Affiliation(s)
- Carlo Robotti
- Department of Otolaryngology - Head and Neck Surgery, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy; Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Antonio Schindler
- Department of Biochemical and Clinical Science "L. Sacco", Luigi Sacco University Hospital, University of Milan, Milan, Italy
| | - Jerome R Lechien
- Department of Otolaryngology - Head and Neck Surgery, Foch Hospital, Paris Saclay University, Paris, France
| | - Antonio Di Sabatino
- Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Silvia Capobianco
- Department of Surgical Pathology, Medical, Molecular and Critical Area, ENT section, Pisa, Italy
| | - Antonio Schindler
- Department of Biochemical and Clinical Science "L. Sacco", Luigi Sacco University Hospital, University of Milan, Milan, Italy
| | - Francesco Ottaviani
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; Department of Otorhinolaryngology, IRCCS Multimedica, Milan, Italy
| | - H Steven Sims
- Chicago Institute for Voice Care, Department of Otolaryngology, University of Illinois Medical Center, Chicago, Illinois
| | - Giulia Bertino
- Department of Otolaryngology - Head and Neck Surgery, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Marco Benazzo
- Department of Otolaryngology - Head and Neck Surgery, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy; Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Francesco Mozzanica
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; Department of Otorhinolaryngology, IRCCS Multimedica, Milan, Italy.
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Wang Z, Müller M, Caffier F, Caffier PP. Harnessing Machine Learning in Vocal Arts Medicine: A Random Forest Application for "Fach" Classification in Opera. Diagnostics (Basel) 2023; 13:2870. [PMID: 37761237 PMCID: PMC10528521 DOI: 10.3390/diagnostics13182870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/28/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023] Open
Abstract
Vocal arts medicine provides care and prevention strategies for professional voice disorders in performing artists. The issue of correct "Fach" determination depending on the presence of a lyric or dramatic voice structure is of crucial importance for opera singers, as chronic overuse often leads to vocal fold damage. To avoid phonomicrosurgery or prevent a premature career end, our aim is to offer singers an improved, objective fach counseling using digital sound analyses and machine learning procedures. For this purpose, a large database of 2004 sound samples from professional opera singers was compiled. Building on this dataset, we employed a classic ensemble learning method, namely the Random Forest algorithm, to construct an efficient fach classifier. This model was trained to learn from features embedded within the sound samples, subsequently enabling voice classification as either lyric or dramatic. As a result, the developed system can decide with an accuracy of about 80% in most examined voice types whether a sound sample has a lyric or dramatic character. To advance diagnostic tools and health in vocal arts medicine and singing voice pedagogy, further machine learning methods will be applied to find the best and most efficient classification method based on artificial intelligence approaches.
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Affiliation(s)
- Zehui Wang
- Institute for Digital Transformation, University of Applied Sciences Ravensburg-Weingarten, Doggenriedstraße, 88250 Weingarten, Germany;
| | - Matthias Müller
- Occupational College of Music BFSM Krumbach, Mindelheimer Str. 47, 86381 Krumbach, Germany;
| | - Felix Caffier
- School of Computing, Communication and Business, HTW Berlin University of Applied Sciences, Treskowallee 8, 10318 Berlin, Germany;
| | - Philipp P. Caffier
- Department of Audiology and Phoniatrics, Charité—Universitätsmedizin Berlin, Campus Charité Mitte, Charitéplatz 1, 10117 Berlin, Germany
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Bretl MM, Gerhard J, Rosow DE, Anis M, Landera MA, Libman D, Marchman J, Ragsdale F, Moore S, Ma R, Hoffman B, Ivey C, Johns MM, Menton SM, Lloyd AT. Vocal Fold Pathologies Among Undergraduate Singing Students In Three Different Genres. Laryngoscope 2023; 133:2317-2324. [PMID: 36567624 DOI: 10.1002/lary.30533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 11/04/2022] [Accepted: 11/29/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVE This study aimed to compare the prevalence and incidence of vocal fold pathologies among undergraduate classical, musical theatre, and contemporary commercial music (CCM) students over two-time points. METHODS This study is part of a longitudinal investigation. Videostroboscopic examinations were rated, with consensus among three of four expert blinded raters confirming the presence of pathology. Association between genre of singer and the presence of pathology, interrater reliability, and intra-rater reliability were calculated. Prevalence and incidence of pathologies were compared across genres. RESULTS During first-year evaluations, 32% of musical theatre, 18% of CCM, and 0% of classical students had vocal pathologies. The prevalence at third-year evaluations showed 22% of classical, 39% of musical theatre, and 27% of CCM participants having vocal fold pathologies. The incidence of pathologies was 67% of musical theatre students compared to 22% of classical students and 27% of CCM students. The four raters demonstrated fair to moderate interrater agreement. Singing Voice Handicap Index-10 scores were normal for CCM singers at both time points but elevated for musical theatre and classical singers. CONCLUSION No classical singers were found to have pathology during first-year evaluations, although CCM and musical theatre singers showed evidence of vocal fold pathologies. At third-year evaluations, all three genres had an apparent increase in prevalence of pathologies. Implications of this study suggest that more time in the field and intense voice usage may lead to a greater risk of pathology for all singers, regardless of genre. LEVEL OF EVIDENCE 2 Laryngoscope, 133:2317-2324, 2023.
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Affiliation(s)
- Michelle M Bretl
- Department of Otolaryngology, Division of Laryngology and Voice and Division of Speech Pathology, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Julia Gerhard
- Department of Otolaryngology, Division of Laryngology and Voice and Division of Speech Pathology, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - David E Rosow
- Department of Otolaryngology, Miller School of Medicine, Department of Otolaryngology, Division of Laryngology and Voice, University of Miami, Miami, Florida, USA
- Division of Vocal Performance, University of Miami, Frost School of Music, Miami, Florida, USA
| | - Mursalin Anis
- Department of Otolaryngology, Miller School of Medicine, Department of Otolaryngology, Division of Laryngology and Voice, University of Miami, Miami, Florida, USA
| | - Mario A Landera
- Department of Otolaryngology, Division of Laryngology and Voice and Division of Speech Pathology, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Dana Libman
- Department of Otolaryngology, Division of Audiology, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Judy Marchman
- School of Music, Hardin-Simmons University, Abilene, Texas, USA
| | - Frank Ragsdale
- Division of Vocal Performance, University of Miami, Frost School of Music, Miami, Florida, USA
| | - Stephannie Moore
- Division of Vocal Performance, University of Miami, Frost School of Music, Miami, Florida, USA
| | - Ruixuan Ma
- Department of Public Health Sciences, Division of Biostatistics, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Bari Hoffman
- School of Communication Sciences and Disorders, University of Central Florida, Orlando, Florida, USA
| | - Chandra Ivey
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Michael M Johns
- University of Southern California, Keck School of Medicine of USC, Department of Otolaryngology, Division of Laryngology, California, Los Angeles, USA
| | - Stacey M Menton
- Department of Otolaryngology, Mayo Clinic, Jacksonville, Florida, USA
| | - Adam T Lloyd
- Department of Otolaryngology, Division of Laryngology and Voice and Division of Speech Pathology, University of Miami, Miller School of Medicine, Miami, Florida, USA
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Hersh D, Fereday L, Palmer F, Hall D, Andrade PA, Cornelius P, Nang C, White J. Seeing Voices: A Dynamic, Interprofessional Approach to Teaching Performing Arts and Speech-Language Pathology Students About Vocal Anatomy and Physiology. J Voice 2023:S0892-1997(23)00240-0. [PMID: 37643947 DOI: 10.1016/j.jvoice.2023.07.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 07/31/2023] [Accepted: 07/31/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVES Seeing Voices was an interprofessional, technology-enabled, large-scale, teaching and learning event developed to address the need to improve voice students' knowledge of laryngeal anatomy and physiology toward understanding and maintaining vocal health. Seeing Voices trialed a novel interprofessional educational approach, collected both quantitative and qualitative data about student experiences of laryngostroboscopic examination, and built a databank of laryngeal recordings for future student learning. METHODS Seeing Voices involved two 3-hour seminars in a large, university lecture space, run by an interprofessional team (speech-language pathologists, vocal coach, Ear Nose and Throat consultant) with quality equipment projecting laryngeal images to large screens with expert commentary in real time. Participants were 18 students who volunteered for laryngeal examination (9 per seminar) and student attendees (n = 175) from performing arts courses (classical singing, contemporary, jazz, musical theater, acting) and a speech-language pathology course. A quantitative evaluation of knowledge gained was undertaken using a Qualtrics survey. Results from pre (n = 175; performing arts = 120; speech-language pathology (SLP) = 55) and postevent (n = 99; performing arts = 56; SLP = 43) questionnaires were received from the students who attended. Interviews were collected from 15 of the 18 student volunteers about their experiences of nasendoscopic evaluation and data were analyzed using qualitative description and qualitative content analysis. RESULTS Quantitative results demonstrated a strong trend toward increased knowledge following attendance at the event across year cohorts for both student groups. Qualitative interviews highlighted the value in seeing multiple examples of normal laryngeal functioning across different vocal techniques in real time. For those undertaking nasendoscopic examination, simultaneously seeing and feeling laryngeal maneuvers used in training appeared to promote understanding of their own vocal mechanism and the purpose of different vocal techniques. CONCLUSIONS Seeing Voices offers a novel way to improve interprofessional collaboration, and engagement with, and understanding of, laryngeal anatomy and vocal health by students in performing arts and speech-language pathology courses.
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Affiliation(s)
- Deborah Hersh
- Speech Pathology, School of Allied Health, Curtin University, Perth, Australia; Speech Pathology, School of Medical and Health Sciences, Edith Cowan University, Perth Australia; School of Allied Health Science and Practice, Adelaide University, Adelaide, Australia.
| | - Luzita Fereday
- Western Australian Academy of the Performing Arts (WAAPA), Edith Cowan University, Perth Australia
| | | | - David Hall
- Perth ENT Centre, Subiaco, Perth, Australia
| | | | | | - Charn Nang
- Speech Pathology, School of Medical and Health Sciences, Edith Cowan University, Perth Australia
| | - Jane White
- Speech Pathology, School of Medical and Health Sciences, Edith Cowan University, Perth Australia
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9
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Kenny HL, Friedman L, Blake Simpson C, McGarey PO. Vocal Fold Polyps: A Scoping Review. J Voice 2023:S0892-1997(23)00180-7. [PMID: 37433709 DOI: 10.1016/j.jvoice.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 06/08/2023] [Accepted: 06/09/2023] [Indexed: 07/13/2023]
Abstract
OBJECTIVE This review aims to summarize the current understanding of vocal fold polyp etiology, pathophysiology, and prognosis, as well as recent developments in management. STUDY DESIGN Scoping literature review. REVIEW METHODS OVID Medline, PubMed, Google Scholar, Conference Papers Index, and Cochrane Library were searched for publications within the last 5 years using terms including "vocal," "cord," "fold," and "polyp." All abstracts were screened. Relevant studies pertaining to the etiology, pathophysiology, diagnosis, management, and prognosis of vocal fold polyps (VFPs) were included for review. RESULTS Eight-hundred and sixty-five citations resulted from database review. Seven-hundred and thirty citations remained after the exclusion of duplicates. One hundred and ninety-three papers underwent abstract review, with 73 citations undergoing full-text review. Fifty-nine papers were included in the review. CONCLUSIONS VFPs are one of the most common subtypes of benign vocal fold lesions. Phonotrauma contributes significantly to the development of these lesions, with laryngopharyngeal reflux and smoking also contributing. Correct diagnosis relies on a careful history, stroboscopy, response to voice therapy, and, in some cases, intraoperative findings. Phonosurgery is a definitive means of treatment, though more recently, in-office procedures have demonstrated efficacy and are potentially less costly and less invasive treatment options. Treatment modalities can be tailored based on the type and size of the lesion, the patient's vocal needs, medical comorbidities, and initial response to voice therapy. Voice specialists can anticipate greater emphasis placed on minimally invasive office-based procedures for the management of vocal pathology.
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Affiliation(s)
- Hannah L Kenny
- University of Virginia School of Medicine, Charlottesville, Virginia; Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Lisa Friedman
- Department of Pathology, University of Virginia Health System, Charlottesville, Virginia
| | - C Blake Simpson
- Department of Otolaryngology-Head and Neck Surgery, University of Alabama-Birmingham, Birmingham, Alabama
| | - Patrick O McGarey
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia.
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10
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Zuim AF, Gerhard J, Lloyd AT, Rosow DE, Lundy DS. Independence of Vocal Load From Vocal Pathology Across Singing Genres. J Voice 2023; 37:294.e15-294.e20. [PMID: 33500198 DOI: 10.1016/j.jvoice.2020.12.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/17/2020] [Accepted: 12/21/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To investigate the extent to which vocal load is associated with previous diagnosis of a vocal pathology among four major genres of singers (primarily classical, primarily musical theatre (MT), classical and MT combined, and contemporary commercial music only). STUDY DESIGN Cross sectional survey. METHODS/DESIGN An anonymous online survey was sent out to about 1000 professional singers through convenience sampling to touring companies, opera companies, MT companies, agents, directors and musical directors. Social media and email were used to solicit participation in the study. We utilized means and standard deviations for continuous characteristics and frequencies and percentages for categorical characteristics and calculated P values to assess whether differences were statistically significant. RESULTS A total of 396 professional singers completed the survey, yielding a 40% response rate. Nonprofessional singers, incomplete surveys, and respondents <18 years old were excluded, resulting in a total of 238 responses. Among the 238 participants, 32% were performing in the classical style primarily, 33% in the MTstyle primarily, 15% in both classical and MT, and 20% in other contemporary styles only. Mean age was highest among CV + MT and lowest among primarily MT. Combined classical/MT singers were most likely to have a career outside of vocal performance and continue to work in that career followed by other contemporary styles, classical and MT (P = 0.02). Participants in the combined classical/MT group were most likely to have a reported history of vocal pathology followed by classical, other contemporary styles and MT (not statistically significant). However, participants in the contemporary styles were most likely to have a history of more than one type of vocal pathology. Mean vocal load was highest for the MT group. Other nonsinging factors proved significant such as allergy, hydration and acid reflux. Symptoms of allergies were found to be significant across singing genres. A possible reverse causality association was identified in regards to water intake. Participants with acid reflux were three times more likely to have ever reported vocal pathology. CONCLUSION Vocal load was not significantly associated with vocal pathology across singing genres; however other nonsinging factors such as allergy, reflux and water intake were significantly associated with vocal pathology.
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Affiliation(s)
- Ana Flavia Zuim
- New York University Steinhardt School of Culture, Education, and Human Development, Department of Music and Performing Arts Professions, New York, New York.
| | | | - Adam T Lloyd
- University of Miami Miller School of Medicine, Department of Otolaryngology, Miami, Florida
| | - David E Rosow
- University of Miami Miller School of Medicine, Department of Otolaryngology, Miami, Florida
| | - Donna S Lundy
- University of Miami Miller School of Medicine, Department of Otolaryngology, Miami, Florida
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Unterhofer C, Marscheider J, Auer S, Jeleff-Wölfler O, Graf S. Prevalence of Dysphonia in Metal Singers and the Impact of Vocal Education: A Subjective Analysis. J Voice 2023:S0892-1997(22)00395-2. [PMID: 36658035 DOI: 10.1016/j.jvoice.2022.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 12/06/2022] [Accepted: 12/07/2022] [Indexed: 01/20/2023]
Abstract
On average, the prevalence of subjectively indicated dysphonia in singers is higher than in the general population. When using extreme vocal techniques supraglottic structures are involved to protect the vocal folds. Most of the metal singers learn this specific singing style autodidactically. Vocal training can have a positive effect on the voice and prevent voice problems. The aim of the study was to find out the prevalence of dysphonia in metal singers and the impact this has on the profession or the vocal education. The subjects had to fill out an online questionnaire including two validated and standardized questionnaires about the speaking and singing voice: The short version of the Voice Handicap Index (VHI 12) and the Singing Voice Handicap Index (SVHI). The prevalence of dysphonia in metal singers is 12.2%. 9 out of 74 participants showed an increased (S)VHI score. 6 of these participants learned singing autodidactically. No dysphonia was found in any singer who sings full-time or studied singing. The correlation between education or profession and dysphonia was statistically not significant. More women than men studied or took singing lessons. This difference was statistically significant. The prevalence of 12.2% in our study is quite low and contrary to our assumption. We can assume, that a vocal education for the metal singing style is useful but not mandatory and the number of persons with dysphonia through metal singing is low. A healthy vocal technique does not necessarily have to be the result of voice lessons.
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Affiliation(s)
- Carmen Unterhofer
- Department of Otorhinolaryngology, Technical University of Munich, School of Medicine, University hospital rechts der Isar, Munich, Bavaria, Germany
| | - Judith Marscheider
- Department of Otorhinolaryngology, Technical University of Munich, School of Medicine, University hospital rechts der Isar, Munich, Bavaria, Germany
| | - Sophie Auer
- Department of Otorhinolaryngology, Technical University of Munich, School of Medicine, University hospital rechts der Isar, Munich, Bavaria, Germany
| | - Olivia Jeleff-Wölfler
- Department of Otorhinolaryngology, Technical University of Munich, School of Medicine, University hospital rechts der Isar, Munich, Bavaria, Germany
| | - Simone Graf
- Department of Otorhinolaryngology, Technical University of Munich, School of Medicine, University hospital rechts der Isar, Munich, Bavaria, Germany
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12
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Mavraj G, Balouch B, Alnouri G, Sataloff RT. Alternative and Complimentary Medication Use in Singers: A Pilot Survey. J Voice 2022:S0892-1997(22)00261-2. [PMID: 36270919 DOI: 10.1016/j.jvoice.2022.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/12/2022] [Accepted: 08/17/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Cannabidiol (CBD) is an active ingredient in marijuana that has demonstrated anti-inflammatory properties. It's therapeutic potential and accessibility has made the product popular. Over the counter products (OTC) products have also demonstrated therapeutic potential and have been accessible in public markets for a long time. The objective was to better understand the use of CBD and OTC products amongst singers with varying singing styles. METHODS An anonymous online survey was distributed to 1053 singers via The Research Electronic Data Capture (RED-Cap) program in association with Drexel University. The survey aimed to obtain information regarding singing proficiency, styles, if respondents used CBD/OTC products, reasons for use, perceived effects on the voice due to use of these products, and how informed were they in regards to use of these products. RESULTS From 1053 singers, we obtained 144 respondents (response rate of 13.7%). The average age of respondents was 51.8 years; There were 47 males, 93 females, and four who were nonbinary or preferred not to provide their gender. The majority of respondents (63.2%) were professional singers. Primary singing styles included operatic (18.1%), sacred (20.8%), and musical theater (20.1%). Eighty-seven point five percent of respondents reported warming up before singing and 22.9% reported cooling down after singing. Thirteen respondents reported use of a cannabidiol (CBD) product. Information resources for CBD used primarily came from an online website (38.5%). Among the 13 respondents who reported use of CBD products, 46.2% of these respondents did not notice any positive effects and 46.2% reported no negative effects on the voice when using CBD products. Eighty-two respondents (56.9%) reported use of an OTC, supplement, or alternative medicine product. Majority received Information resources from a physician or other healthcare provider (81.7%). The most frequently reported OTC or complimentary medications used were reflux medications, antihistamines, acetaminophen, and NSAIDs. Reduced inflammation, improved voice recovery, improved voice quality, and improved voice endurance were commonly reported positive effects on the voice with OTC/AM use. Vocal strain, hoarseness, and dryness were the most commonly reported negative effects on the voice with OTC/AM use. CONCLUSIONS Stress, anxiety, or chronic pain was often the primary reason for CBD use amongst singers. The most common OTC medications were used reflux medications, antihistamines, acetaminophen, and NSAIDs.
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Affiliation(s)
| | | | - Ghiath Alnouri
- Department of Otolaryngology - Head and Neck Surgery, Drexel University College of Medicine
| | - Robert T Sataloff
- Department of Otolaryngology - Head and Neck Surgery, Senior Associate Dean for Clinical Academic Specialties, Drexel University College of Medicine, Director of Otolaryngology and Communication Sciences Research, Lankenau Institute for Medical Research, Philadelphia, PA.
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13
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Aiken P, Rumbach A, Madill C. Listening to Video Game Voices: A Call for Action for Research into the Vocal Health of Video Game Voice Actors. J Voice 2022:S0892-1997(22)00282-X. [PMID: 36244865 DOI: 10.1016/j.jvoice.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 09/08/2022] [Accepted: 09/09/2022] [Indexed: 11/06/2022]
Abstract
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.
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Affiliation(s)
- Patrick Aiken
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.
| | - Anna Rumbach
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Catherine Madill
- Discipline of Speech Pathology, The University of Sydney, Sydney, Australia; Dr Liang Voice Program, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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14
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Searl J, Dargin T, Fritz A, Kuza G. Voice and Lifestyle Behaviors of Student Singers: Impact of History Gathering Method on Self-Reported Data. J Voice 2022; 36:735.e7-735.e18. [PMID: 32981808 DOI: 10.1016/j.jvoice.2020.08.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/27/2020] [Accepted: 08/31/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study described voice use and lifestyle information about student singers with a focus on describing differences in self-reported information at study intake compared to data from 21 consecutive days of a voice Log. METHODS Twenty-seven student singers estimated voice and lifestyle behaviors at study initiation including daily speaking time, singing/performance time, vocal warm-up, and cool-down minutes; fluid intake; perceived effort when talking, and when singing, among other items. These same parameters were tracked for 21 consecutive days in a voice log kept by the singer at home. Study intake data was compared to the median estimates from the 21-day voice log on each variable using nonparametric statistics. RESULTS Student singers reported warming up the voice regularly at study intake (100%), but several logged ≥ 7 days out of 21 without warming up even though all days had singing minutes. Less than half reported voice cool downs at intake, and even fewer logged minutes of cool down in the daily tracking. High occupational voice demands not involving singing were reported by 37%. Large percentages of students reported frustration (63%), worry/anxiety (41%), and depression (26%) regarding their voice in the prior 2 weeks. Estimates at study intake statistically overestimated daily speaking minutes, effort during singing and number of nights eating within 2 hours of sleep compared to the 3-week log. CONCLUSION Student singers reported several voice use and behavior items that could impact vocal health. Additionally, how the information was obtained (intake estimate vs. daily log) did alter what was reported for some parameters.
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Affiliation(s)
- Jeff Searl
- Michigan State University, East Lansing, Michigan.
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15
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Lopes TFR, Lobo BPL, Gama ACC. The Copenhagen Neck Functional Disability Scale: an analysis of singers with dysphonia and without vocal complaints. Codas 2022; 34:e20210095. [PMID: 35894307 PMCID: PMC9886291 DOI: 10.1590/2317-1782/20212021095pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 01/31/2022] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To analyze and compare the degree of cervical disability in singers with dysphonia and in singers without self-reported vocal complaints. METHODS A cross-sectional observational analysis. Sixty-two singers participated in the study: Thirty-two singers without vocal complaints and 30 singers with a speech-language pathology and otorhinolaryngological diagnosis of dysphonia. For singers without vocal complaints, two questionnaires were applied via Google Forms: A three-question questionnaire regarding vocal complaints and how each singer perceived their speaking and singing voice, and the Copenhagen Neck Functional Disability Scale (CNFDS). Data on singers with dysphonia were extracted from a database previously collected by a team of researchers at the speech-language pathology department of the Federal University of Minas Gerais. The difference in data collection methodology between the two groups was due to restrictions presented by the coronavirus pandemic. The Mann-Whitney test was used to compare the two groups, at a significance level of 5%. RESULTS There was a significant difference between the groups (p=0.0001), demonstrating that singers with dysphonia suffered more from cervical pain and discomfort than singers without vocal complaints. CONCLUSION Singers with dysphonia have more cervical pain and discomfort than singers without vocal complaints, thus presenting with greater cervical disability.
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Affiliation(s)
| | - Bárbara Pereira Lopes Lobo
- Departamento de Fonoaudiologia, Universidade Federal de Minas Gerais – UFMG - Belo Horizonte (MG), Brasil.
| | - Ana Cristina Côrtes Gama
- Departamento de Fonoaudiologia, Universidade Federal de Minas Gerais – UFMG - Belo Horizonte (MG), Brasil.
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16
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Childs LF, Rao A, Mau T. Profile of Injured Singers: Expectations and Insights. Laryngoscope 2022; 132:2180-2186. [PMID: 35023577 DOI: 10.1002/lary.30015] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/19/2021] [Accepted: 12/23/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To discover patterns of phonotraumatic lesions in singers and investigate factors that differentiate those who underwent surgery from those who did not. We hypothesized that 1) lesion type distribution differs by age, sex, singer classification (professional/amateur), and history of formal voice training; 2) the likelihood of surgery is associated with singer classification and voice training. STUDY DESIGN Retrospective. METHODS Retrospective review of 438 singers with phonotraumatic lesions over a 9-year period. Lesion type distribution was analyzed with respect to sex, age, singer classification, and voice training. The association of eventual surgery with these factors was also analyzed. RESULTS Nodules accounted for over half of the cohort (58%), followed by pseudocysts (20%), polyps (14%), and cysts (4%). Nearly two of every three injured female singers, but fewer than one out of every three injured male singers, had nodules. In contrast, over half of the injured males had polyps, whereas only 6% of injured females had polyps. In females, polyps occurred at a later age, and in males, nodules occurred at a younger age compared to other lesion types. Only 14% of the total cohort eventually underwent surgery. Professional singers without formal voice training were almost eight times more likely to have undergone surgery than amateur singers with voice training. CONCLUSIONS Professional singers were more likely to undergo surgery than amateurs, and formal voice training was associated with a lower likelihood of surgery. The observation that polyps tended to occur in older women may have implications for the pathogenesis of vocal fold polyps. LEVEL OF EVIDENCE 4 Laryngoscope, 2022.
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Affiliation(s)
- Lesley F Childs
- Clinical Center for Voice Care, Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A
| | - Ashwin Rao
- Clinical Center for Voice Care, Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A
| | - Ted Mau
- Clinical Center for Voice Care, Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A
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17
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Lopes TFR, Lobo BPL, Gama ACC. The Copenhagen Neck Functional Disability Scale: an analysis of singers with dysphonia and without vocal complaints. Codas 2022. [DOI: 10.1590/2317-1782/20212021095en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Purpose To analyze and compare the degree of cervical disability in singers with dysphonia and in singers without self-reported vocal complaints. Methods A cross-sectional observational analysis. Sixty-two singers participated in the study: Thirty-two singers without vocal complaints and 30 singers with a speech-language pathology and otorhinolaryngological diagnosis of dysphonia. For singers without vocal complaints, two questionnaires were applied via Google Forms: A three-question questionnaire regarding vocal complaints and how each singer perceived their speaking and singing voice, and the Copenhagen Neck Functional Disability Scale (CNFDS). Data on singers with dysphonia were extracted from a database previously collected by a team of researchers at the speech-language pathology department of the Federal University of Minas Gerais. The difference in data collection methodology between the two groups was due to restrictions presented by the coronavirus pandemic. The Mann-Whitney test was used to compare the two groups, at a significance level of 5%. Results There was a significant difference between the groups (p=0.0001), demonstrating that singers with dysphonia suffered more from cervical pain and discomfort than singers without vocal complaints. Conclusion Singers with dysphonia have more cervical pain and discomfort than singers without vocal complaints, thus presenting with greater cervical disability.
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18
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Jeffery T, Postavaru GI, Matei R, Meizel K. 'I Have Had to Stop Singing Because I Can't Take the Pain': Experiences of Voice, Ability, and Loss in Singers With Hypermobility Spectrum Disorders. J Voice 2021:S0892-1997(21)00407-0. [PMID: 34973894 DOI: 10.1016/j.jvoice.2021.11.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/25/2021] [Accepted: 11/30/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE This study explored the voice experience, singing ability, and wellbeing of singers diagnosed with Hypermobility Spectrum Disorder (HSD) or hypermobile Ehlers-Danlos Syndrome (h-EDS). STUDY DESIGN This was a mixed-method study. A purposive sampling strategy was used. Data were collected via an online survey, using written closed and open-ended questions. METHODS 276 adults completed the survey. This study focuses on a subset of professionally-trained singers (n=71). Responses elicited information about participants' voice health and function, symptoms of hypermobility, singing experiences and training. Data were analysed using template analysis. RESULTS Many participants reported wide vocal ranges and enjoyment of singing but 74.6% of participants across all age groups (18-60 years) experienced voice difficulties. Three common themes were identified: (1) 'My unreliable voice': The ups and downs; (2) Wider effects of HSD/h-EDS on singers, and (3) Need for acknowledgment and support. CONCLUSIONS Voice difficulties and hypermobility-related health conditions affected the participants' abilities to sing and perform; this impacted their professional and personal opportunities, communication, relationships, and wellbeing. Our results indicate that symptoms of voice disorder worsen over time. We suggest practical strategies that singers and training providers could implement to support hypermobile singers. More research is needed to fully understand voice difficulties in singers with HSD/H-EDS and to inform tuition and support.
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Affiliation(s)
- Tracy Jeffery
- Department of Education and Lifelong Learning, Bishop Grosseteste University, Lincoln, UK.
| | | | - Raluca Matei
- Department of Organizational Psychology, Birkbeck, University of London, London, UK
| | - Katherine Meizel
- College of Musical Arts, Bowling Green State University, Ohio, USA
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19
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Perrine BL, Monzón K, Weber LM, Funderburk LK. The Impact of Fish Oil Supplementation on Self-Perception of the Voice in Vocal Performers: A Randomized, Single-Blind, Placebo-Controlled Study. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:4784-4790. [PMID: 34705542 DOI: 10.1044/2021_jslhr-21-00295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE Physically active adults have experienced training benefits from fish oil-derived omega-3 fatty acid (FO n3), which may also be of benefit to singers. The purpose of this research study was to determine if self-reported vocal adaptations and body composition changes occur in singers following FO n3 supplementation in conjunction with a singer's normal training regimen. METHOD Twenty college students, currently enrolled in vocal lessons at a university, were randomized to receive either 3.0 g of FO n3 or placebo, which they took during a 10-week study period. Participants were blinded to group assignment. Participants completed the Reflux Symptom Index (RSI), Singing Voice Handicap Index-10 (SVHI-10), and the Evaluation of Ability to Sing Easily (EASE) and submitted to body composition measures (weight, skeletal mass, and body fat mass) before and after the study period. RESULTS Sixteen participants completed all parts of the study protocol. Mean compliance for the placebo group (83.9%) and the supplement group (75.2%) was similar. There were no significant differences in body composition measures, RSI scores, and EASE scores between groups. Scores on the SVHI-10 decreased significantly over time for all participants. CONCLUSIONS Improvements seen in the SVHI-10 were not meaningfully different between the supplement and placebo group, pointing to the benefit of weekly lessons. The lack of changes in the questionnaire scores in the supplement group are partially attributed to the low compliance rate and low sample size, which is supported by the lack of change in the body composition measures.
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Affiliation(s)
- Brittany L Perrine
- Department of Communication Sciences and Disorders, Baylor University, Waco, TX
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20
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Beaud M, Amy de la Bretèque B, Pillot-Loiseau C, Henrich Bernardoni N. Clinical characteristics of singers attending a phoniatric outpatient clinic. LOGOP PHONIATR VOCO 2021; 47:209-218. [PMID: 34110262 DOI: 10.1080/14015439.2021.1924853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Purpose: Studies suggest that singers are over-represented in voice clinics and present a high risk of developing voice disorders. This retrospective study aims to describe the characteristics of 78 singers consulting a phoniatrician.Methods: In their medical files, data related to age, gender, occupational status, singing training, musical style, voice complaint, diagnosis, voice-quality grading (GRBAS) and treatment were gathered.Results: The patients were mostly female singers (87%). Non-professional singers (semi-professional included) represented 64%, professional singers 25% and students of singing 11%. The majority of singers were choristers (27%) and 22% were classical-style/oratorio-style singers. Two-thirds of the population had intensive vocal activity in speech or singing. Vocal endurance, somatosensory signs and difficulties with high pitches were the most frequent symptoms. Among the patients, 79% presented with singing-voice disorders with 85% of these having vocal fold lesions. Generally, their speaking voices were preserved. Vocal-folds nodules were the most prevalent pathology (37%) followed by sulcus (26%) and voice therapy was the main treatment.Conclusions: This study emphasizes the fact that singers have specific voice complaints related to their voice usage. The high occurrence of sulcus and other congenital-lesion suspicions, unusual in the general population consulting an ENT phoniatrician, seems to be rather specific for singers in agreement with the literature.
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Affiliation(s)
- Marion Beaud
- Univ. Grenoble Alpes, CNRS, Grenoble INP, GIPSA-lab, Grenoble, France
| | | | - Claire Pillot-Loiseau
- Phonetics and Phonology Lab, CNRS UMR 7018, Paris 3 Sorbonne Nouvelle University, Paris, France
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21
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Boles RW, Gao WZ, Johns MM, Daniero JJ, Grant NN, Rubin AD, Bhatt NK, Hapner ER, O'Dell K. Flexible Versus Rigid Laryngoscopy: A Prospective, Blinded Comparison of Image Quality. J Voice 2021; 37:440-443. [PMID: 33775470 DOI: 10.1016/j.jvoice.2021.02.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 01/28/2021] [Accepted: 02/02/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To compare flexible distal-chip laryngoscopy (FDL) and rigid telescopic laryngoscopy (RTL) in image quality and diagnostic ability. STUDY DESIGN Prospective cohort study; blinded comparison. METHODS Eighteen normal adult subjects were recruited to undergo both FDL and RTL and normalized videos were recorded. Three blinded laryngologists compared the videos for color fidelity, illumination, resolution, and vascularity, and indicated superiority with FDL, RTL, or no difference. Raters also reported if an abnormality was seen and in which video it was better visualized. Videos for two subjects were repeated to assess intra-rater reliability, making 20 video comparisons across 3 raters for a total of 60 ratings. Differences in responses were analyzed via Mann-Whitney U and Pearson Χ2. Inter-rater reliability was assessed via Fleiss' kappa, and intra-rater reliability was assessed via percent agreement. RESULTS RTL was rated superior in all categories of image quality (47 vs 5 vs 8, P < 0.01; 47 vs 7 vs 6, P < 0.01; 51 vs 5 vs 4, P<0.01; 44 vs 9 vs 7, P < 0.01, respectively). An abnormality was seen 33 times with both modalities and 6 times with RTL only. When seen with both modalities, visualization was superior in RTL compared with FDL (29 vs 4, P <0.01). CONCLUSIONS There was significant superiority of RTL in all categories of image quality, with slight inter-rater agreement for color fidelity, resolution, and vascularity. RTL was also significantly better for visualization of abnormalities. These findings suggest superior image quality in RTL compared with FDL, but further research is required to determine if this difference is clinically significant.
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Affiliation(s)
- Roger W Boles
- Keck School of Medicine of USC, Los Angeles, California
| | - William Z Gao
- Department of Otolaryngology-Head and Neck Surgery, Georgetown University Medical Center, Washington, District of Columbia
| | - Michael M Johns
- Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, California
| | - James J Daniero
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Nazaneen N Grant
- Department of Otolaryngology-Head and Neck Surgery, Georgetown University Medical School, Washington, District of Columbia
| | - Adam D Rubin
- Lakeshore Ears, Nose, Throat Center, St. Clair Shores, Michighan
| | - Neel K Bhatt
- Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, California
| | - Edie R Hapner
- Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, California
| | - Karla O'Dell
- Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, California.
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22
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Wu P, Klein L, Rozema Z, Haderlein N, Cai J, Scholp A, Xu X, Jiang JJ, Zhuang P. The Influence of Voice Training on Vocal Learner's Objective Acoustic Voice Components. J Voice 2021; 37:355-361. [PMID: 33653622 DOI: 10.1016/j.jvoice.2021.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 01/12/2021] [Accepted: 01/13/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Acoustic parameters of voice were studied in music majors throughout 18 months of training to understand the influence of voice training on voice. METHODS Twenty-three students from Xiamen Music School between 12 and 15 years old were enrolled. Acoustic examination was performed three times- every 6 months for 18 months. Various traditional acoustic parameters were measured, including dysphonia severity index (DSI), jitter, and D-value of vocal range. Nonlinear dynamic measures were also measured, including diffusive chaos to construct voice type component profiles (VTCPs), spectrum convergence ratio, and nonlinear energy difference ratio. The results were analyzed by multivariate analysis of variance. RESULTS Over the study duration, there was an improvement of DSI (P = 0.002), and D-value of vocal range (P = 0.000). Among nonlinear parameters, only voice type component data demonstrated significant changes during the study duration. Both Voice Type Component 1(VTC1) and VTC3 values differed from Time 1 to Time 2 as well as from Time 1 to Time 3. The proportion of VTC1 in samples generally decreased, while VTC3, representative of aperiodicity, increased. Both nonlinear energy difference ratio and spectrum convergence ratio exhibited no significant changes throughout the study. CONCLUSION Professional voice training can improve DSI and D-value of vocal range in singers' voices. These parameters have potential to be used for voice training evaluation and screening. Many nonlinear parameters did not detect differences in the healthy voices studied, but VTCPs created using intrinsic dimension present a valuable new method, visualizing increases in aperiodicity of the speaking voices after professional voice training.
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Affiliation(s)
- Pinhong Wu
- Barnard College of Columbia University, New York, NY, USA
| | - Logan Klein
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Zoe Rozema
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Nicole Haderlein
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Jie Cai
- School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Austin Scholp
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Xinlin Xu
- Department of Voice, Xiamen University Zhongshan Hospital, Xiamen, Fujian, China
| | - Jack J Jiang
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Peiyun Zhuang
- Department of Voice, Xiamen University Zhongshan Hospital, Xiamen, Fujian, China.
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23
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Matta RSD, Santos MAR, Plec EMRL, Gama ACC. Multidimensional voice assessment: the immediate effects of Lax Vox® in singers with voice complaints. REVISTA CEFAC 2021. [DOI: 10.1590/1982-0216/20212324520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Purpose: to multidimensionally assess the effect of the Lax Vox® vocal technique on singers with voice complaints. Methods: a comparative intrasubject study that assessed 30 singers - 13 males and 17 females, aged 18 to 55 years - who self-reported voice complaints and had voice problems symptoms. The participants were submitted to voice assessment with perceptive-auditory, acoustic, aerodynamic, and electroglottographic voice analysis, as well as laryngeal assessment with high-speed videolaryngoscopy. The participants were assessed at two moments: 1) at the beginning of the data collection; and 2) five minutes after performing the Lax Vox® vocal technique. The groups were compared with appropriate statistical tests, with a 5% significance level. Results: in the acoustic analysis, there was an increase in the fundamental frequency for males, after using the Lax Vox® vocal technique. In the aerodynamic assessment, there was an increase in the airflow mean values during vocalization, as well as in aerodynamic power after using the Lax Vox® vocal technique in both groups. Conclusion: the Lax Vox® vocal technique, in the studied singers with a complaint of dysphonia, promoted an increase in the fundamental frequency, for males. In the aerodynamic parameters, in both sexes, it promoted an increase in the airflow and aerodynamic power.
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Rotsides J, Chen S, Winchester A, Amin MR, Johnson AM. Laryngeal Pathologies Associated with the Genre of Singing and Professional Singing Status in a Treatment-Seeking Population. Laryngoscope 2020; 131:2076-2080. [PMID: 33270237 DOI: 10.1002/lary.29303] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 10/17/2020] [Accepted: 11/10/2020] [Indexed: 11/05/2022]
Abstract
OBJECTIVES/HYPOTHESIS Singers have high vocal demands and are at increased risk of developing voice disorders. Different singing genres place different technical demands on the voice. However, differences in laryngeal pathology based on genre have not been well-researched. The purpose of this study was to determine the prevalence of laryngeal pathology in different genres of professional and amateur singers who present with a voice complaint. STUDY DESIGN Retrospective review. METHODS Retrospective review of patients seen at a tertiary laryngology practice. Self-identified singers who reported their primary singing genre and categorized their singing as a full-time job, part-time job, or amateur involvement were included. Type and prevalence of pathology were calculated based on genre and professional status. RESULTS Of the 302 self-identified singers, 54% (n = 164) had laryngeal pathology. Among those with pathology, the most common finding was fibrotic lesion (38.4%, 63/164). Genres in which a majority of singers had pathology were other (69.2%, 9/13), choral (64.7%, 11/17), pop (63.2%, 12/19), musical theater (61.4%, 43/70), country (100%, 4/4), and Latin (100%, 2/2). The highest prevalence of pathology was seen in part-time professional singers (62.2%, 41/66) and full-time professionals (60.8%, 62/102), compared to amateurs (45.1%, 60/133). CONCLUSIONS Laryngeal pathology is prevalent in singers presenting with a voice complaint. Regardless of genre or professional status, fibrotic lesions were the most common pathological finding. This study provides preliminary data on the prevalence of different laryngeal pathologies found in singers by genre and degree of professional involvement. LEVEL OF EVIDENCE 4 Laryngoscope, 131:2076-2080, 2021.
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Affiliation(s)
- Janine Rotsides
- Department of Otolaryngology - Head and Neck Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Sophia Chen
- Department of Otolaryngology - Head and Neck Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Arianna Winchester
- Department of Otolaryngology - Head and Neck Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Milan R Amin
- Department of Otolaryngology - Head and Neck Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Aaron M Johnson
- Department of Otolaryngology - Head and Neck Surgery, New York University Langone Health, New York, New York, U.S.A
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Occupational voice is a work in progress: active risk management, habilitation and rehabilitation. Curr Opin Otolaryngol Head Neck Surg 2020; 27:439-447. [PMID: 31651425 PMCID: PMC6867679 DOI: 10.1097/moo.0000000000000584] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The current article reviews recent literature examining occupational voice use and occupational voice disorders (January 2018–July 2019).
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Kim BH, Nam HJ. A case of vocal polyps improved with herbal medicine: A case report. Explore (NY) 2020; 17:220-222. [PMID: 32253082 DOI: 10.1016/j.explore.2020.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 03/03/2020] [Indexed: 10/24/2022]
Abstract
Vocal polyps are benign vocal cord lesions, which mainly manifest as a hoarse voice. Laryngeal microsurgery is the most common treatment. However, because of anxiety regarding invasive treatment, it is necessary to have a non-invasive treatment option. A 43 year old female patient who is a teacher visited a Korean medical hospital for persistent hoarseness with a vocal polyp. After taking herbal medicine for hoarseness (Kyung-Hee-cheong-um-whan) and pharyngitis (cheong-in-li-gyok-tang and cheong-in-ryu-que-whan) for almost 10 weeks, the vocal polyp was reduced and symptoms improved. Herbal prescription for pharyngitis and hoarseness can be applied to vocal polyps as non-invasive treatment.
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Affiliation(s)
- Bong Hyun Kim
- Department of Ophthalmology and Otolaryngology of Korean Medicine, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea; Department of Ophthalmology and Otolaryngology of Korean Medicine, Kyung Hee University Korean Medicine Hospital, Seoul, Republic of Korea.
| | - Hae Jeong Nam
- Department of Ophthalmology and Otolaryngology of Korean Medicine, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea; Department of Ophthalmology and Otolaryngology of Korean Medicine, Kyung Hee University Korean Medicine Hospital, Seoul, Republic of Korea.
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DeVore EK, Carroll TL, Shin JJ. Is a voice‐specific instrument more indicative of stroboscopy results than common clinical queries? Laryngoscope 2020; 130:992-999. [DOI: 10.1002/lary.28207] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 06/14/2019] [Accepted: 07/09/2019] [Indexed: 02/04/2023]
Affiliation(s)
- Elliana Kirsh DeVore
- Department of Otolaryngology–Head and Neck SurgeryHarvard Medical School Boston Massachusetts U.S.A
| | - Thomas L. Carroll
- Department of Otolaryngology–Head and Neck SurgeryHarvard Medical School Boston Massachusetts U.S.A
| | - Jennifer J. Shin
- Department of Otolaryngology–Head and Neck SurgeryHarvard Medical School Boston Massachusetts U.S.A
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DeVore EK, Carroll TL, Rosner B, Shin JJ. Can voice disorders matter as much as life-threatening comorbidities to patients' general health? Laryngoscope 2019; 130:2405-2411. [PMID: 31794064 DOI: 10.1002/lary.28417] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 08/13/2019] [Accepted: 10/23/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE National initiatives and funding agencies may deprioritize voice disorders relative to conditions such as malignancy, pulmonary, or cardiac disease. It is unknown whether the impact of voice problems is outweighed by other potentially more serious disease states. Our objective was thus to quantify the extent to which voice contributes to general health status when adjusting for concurrent, more life-threatening comorbidities. METHODS Adults (n = 430) presenting to a tertiary care academic center with a primary voice complaint completed the Voice Handicap Index-10 (VHI-10) and the Patient-Reported Outcomes Measurement Information System global health short-form instrument (PROMIS). Medical comorbidities were categorized via the Deyo modification of the Charlson Comorbidity Index. The influence of voice and comorbid conditions on general health scores was assessed through multivariate ordinal regression. The potential for effect modification was also evaluated. RESULTS VHI-10 mean scores were 11.4 (95% confidence interval [CI], 10.5 to 12.4). PROMIS physical and mental health t scores were 49.0 (95% CI, 48.0 to 49.9) and 51.6 (95% CI, 50.6 to 52.5), respectively. Global and social item scores were 3.4 (95% CI, 3.3 to 3.5) and 3.7 (95% CI, 3.6 to 3.8), respectively. The most prevalent comorbid conditions were pulmonary disease, malignancy, and connective tissue disorders. In all analyses, voice handicap was a significant predictor of general health, even when adjusting for comorbid conditions (VHI-10 β = -1.349, P < 0.001 for physical health; β = -1.278, P < 0.001 for mental health; β = -1.691, P < 0.001 for social health; β = -0.956, P < 0.001 for the global overview item). CONCLUSION In the observed population, voice health has a significant, multi-dimensional impact on general health, which is not subsumed by the presence of comorbidities. LEVEL OF EVIDENCE 4 Laryngoscope, 130:2405-2411, 2020.
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Affiliation(s)
- Elliana Kirsh DeVore
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Thomas L Carroll
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, U.S.A.,Division of Otolaryngology, Brigham and Women's Hospital, Boston, Massachusetts, U.S.A
| | - Bernard Rosner
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, U.S.A.,Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts, U.S.A
| | - Jennifer J Shin
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, U.S.A.,Division of Otolaryngology, Brigham and Women's Hospital, Boston, Massachusetts, U.S.A
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Lloyd AT, Gerhard J, Baker P, Lundy DS, Diaz J, Bretl MM, Landera MA, Anis M, Marchman J, Rosow DE. Prevalence of Vocal Fold Pathologies Among First‐Year Singing Students Across Genres. Laryngoscope 2019; 130:1996-2002. [DOI: 10.1002/lary.28354] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 08/21/2019] [Accepted: 09/19/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Adam T. Lloyd
- Department of Otolaryngology, Division of Laryngology and Voice and Division of Speech Pathology Miller School of Medicine, University of Miami Miami Florida U.S.A
| | - Julia Gerhard
- Division of Speech–Language Pathology Florida Hospital Winter Park Florida U.S.A
| | - Paul Baker
- University of Miami, School of Medicine Miami Florida U.S.A
| | - Donna S. Lundy
- Department of Otolaryngology, Division of Laryngology and Voice and Division of Speech Pathology Miller School of Medicine, University of Miami Miami Florida U.S.A
| | - Jennylee Diaz
- Department of Otolaryngology, Division of Laryngology and Voice and Division of Speech Pathology Miller School of Medicine, University of Miami Miami Florida U.S.A
| | - Michelle M. Bretl
- Department of Otolaryngology, Division of Laryngology and Voice and Division of Speech Pathology Miller School of Medicine, University of Miami Miami Florida U.S.A
| | - Mario A. Landera
- Department of Otolaryngology, Division of Laryngology and Voice and Division of Speech Pathology Miller School of Medicine, University of Miami Miami Florida U.S.A
| | - Mursalin Anis
- Department of Otolaryngology, Division of Laryngology and Voice and Division of Speech Pathology Miller School of Medicine, University of Miami Miami Florida U.S.A
| | - Judy Marchman
- Division of Vocal Performance Frost School of Music, University of Miami Miami Florida U.S.A
| | - David E. Rosow
- Department of Otolaryngology, Division of Laryngology and Voice and Division of Speech Pathology Miller School of Medicine, University of Miami Miami Florida U.S.A
- Division of Vocal Performance Frost School of Music, University of Miami Miami Florida U.S.A
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DeVore EK, Shrime MG, Wittenberg E, Franco RA, Song PC, Naunheim MR. The health utility of mild and severe dysphonia. Laryngoscope 2019; 130:1256-1262. [DOI: 10.1002/lary.28216] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 07/03/2019] [Accepted: 07/15/2019] [Indexed: 12/27/2022]
Affiliation(s)
- Elliana K. DeVore
- Department of OtolaryngologyHarvard Medical School Boston Massachusetts
- Department of OtolaryngologyMassachusetts Eye and Ear Infirmary Boston Massachusetts
| | - Mark G. Shrime
- Department of OtolaryngologyHarvard Medical School Boston Massachusetts
- Department of OtolaryngologyMassachusetts Eye and Ear Infirmary Boston Massachusetts
- Center for Global Surgery EvaluationMassachusetts Eye and Ear Infirmary Boston Massachusetts
| | - Eve Wittenberg
- Center for Health Decision ScienceHarvard T. H. Chan School of Public Health Boston Massachusetts U.S.A
| | - Ramon A. Franco
- Department of OtolaryngologyHarvard Medical School Boston Massachusetts
- Department of OtolaryngologyMassachusetts Eye and Ear Infirmary Boston Massachusetts
| | - Phillip C. Song
- Department of OtolaryngologyHarvard Medical School Boston Massachusetts
- Department of OtolaryngologyMassachusetts Eye and Ear Infirmary Boston Massachusetts
| | - Matthew R. Naunheim
- Department of OtolaryngologyHarvard Medical School Boston Massachusetts
- Department of OtolaryngologyMassachusetts Eye and Ear Infirmary Boston Massachusetts
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