Vocal Fatigue and Its Relationship with Vocal Hygiene and Work-Related Factors in Professional and Nonprofessional Voice Users: A Multiple Linear Regression Model Study

OBJECTIVES

To investigate vocal fatigue severity between professional voice users (PVUs) and nonprofessional voice users (NPVUs), and across different levels of voice users. Also to examine the relationship between vocal hygiene and work-related factors with vocal fatigue.

METHODS

This is a cross-sectional descriptive study. Four hundred one individuals from different professions were included in total. Participants were divided into four levels of voice users by classification of Koufman and Isaacson. The top three levels of voice users further identified as PVU, and level 4 voice users identified as NPVU. An online questionnaire which included vocal hygiene checklist, work-related factors, and Turkish version of vocal fatigue index (VFI) was submitted by the participants.

RESULTS

Vocal fatigue severity of PVUs were found higher than NPVUs in all VFI scores (P < 0.05). Level 2 voice users were found to have more vocal fatigue severity than all other levels of voice users. Call center workers (CCWs) had the highest means of vocal fatigue severity. Based on the multiple linear regression model vocal hygiene and the number of vocal rest breaks were found to have related with vocal fatigue the most (P < 0.05). There was also a relation with some VFI scores (P < 0.05) with voice usage duration at work and vocal rest duration. We found no relationship between working experience and vocal fatigue. The data suggests the relation between vocal fatigue and vocal hygiene, and work-related factors explain a small proportion of the association. However, in CCWs r2 was found 0.44.

CONCLUSIONS

The change in vocal fatigue severity did not match with Koufman and Isaacson's classification of voice users. We suggest that there may be other contributing factors to vocal fatigue than vocal hygiene, vocal rest, and voice usage duration even those factors may differ from profession to profession.

Prevalence of and Risk Factors for Self-Reported Voice Problems in Tibetan Monks

BACKGROUND

It is observed that Tibetan monks pray for a long duration with inappropriate pitch and loudness. Hence, they may be prone to developing voice problems (VPs). However, the monks are not stressed and do not miss praying in the monastery (which is quite different from many other professional voice users in Western countries). Moreover, no studies have investigated the nature of VPs among Tibetan monks. Such a study may provide insight into the prevalence of and risk factors for VPs and may help enhance our knowledge of the VPs in Tibetan monks.

STUDY DESIGN

Cross-sectional survey.

METHOD

A self-reporting questionnaire was distributed among 300 Tibetan monks residing in Namdroling Nyingmapa Monastery, Karnataka, India, from February 2023 to June 2023.

RESULTS

39% of Tibetan monks experienced VPs in their careers; hoarseness, momentary voice loss/sudden voice changes, and dryness were the most frequently reported symptoms. Monks reporting the presence of VPs also exhibited significantly higher frequencies of different phonotraumatic behaviors like speaking with a loud voice, constantly altering the voice, frequent throat clearing, speaking/chanting during throat infections, or VPs than those who did not report VPs. The results of bivariate regression analysis identified factors such as more than 8hours of prayer duration per day, praying in the presence of musical instruments, not sipping water in between prayers, less than three liters of water intake, and the presence of acid reflux and dry throat, as significant risk factors responsible for VPs in Tibetan monks.

CONCLUSIONS

Current results suggest that monks are at a high risk of developing VPs, and several factors (vocational, environmental, lifestyle, and health-related) contribute to the development of VPs. Further, VPs in monks also affect them in terms of missing prayers, interacting less with family/friends, and avoiding social gatherings. Overall, there is a great need to educate the monks about vocal health and preventing VPs.

Knowledge, Attitude and Practices Towards Vocal Health Care Amongst Indian Carnatic Singers

OBJECTIVE

The knowledge, attitudes and practices of Indian Carnatic singers is a dimension that yet to be explored in detail. The aim of the current study was to explore these knowledge, attitudes, and practices amongst Indian Carnatic singers towards vocal health care.

STUDY DESIGN

  Cross-sectional online questionnaire-based study.

METHOD

A cross-sectional online questionnaire-based study design was used to explore the knowledge, attitudes, and practices of Indian Carnatic singers towards vocal health care. The study was conducted in two phases, phase I involved questionnaire development and validation while phase II involved collection of data and further analysis.

RESULTS

One hundred trained self-identified Indian Carnatic singers participated in this study. These singers displayed good knowledge and positive attitudes towards vocal health care. A preference (73%) towards home remedies was noted as compared to seeking medical attention. The measures reported by the singers for maintaining good vocal health revealed use of several home remedies, vocal as well as non-vocal measures.

CONCLUSION

The findings of the present study reveal the knowledge and attitude of Indian Carnatic singers towards vocal health care as well as highlight several interesting practices.

Home Remedies ("Paati Vaidyam") for Voice Disorders: Some Common Practices Among School Teachers

AIM

The study aimed to document the practices followed as home remedies to treat voice-related symptoms among school teachers.

STUDY DESIGN

Cross-sectional study.

METHOD

A total of 385 school teachers from Chennai, India, participated in the study. Data were collected through six open-ended questions to elicit information about conventional remedial practices for voice-related issues. Responses from the participants were recorded and analyzed.

RESULTS

Around 88% of the teachers in the study preferred to adhere to home remedies as their first treatment of choice when encountering a voice problem. A few of the reported home remedies were simple preparations using turmeric (Curcuma longa), ginger (Zingiber officinale), honey, sugar palm (Arenga pinnata), rock candy, mint (Mentha piperita), and cumin seeds (Cuminum cyminum), taken in singly or in combinations. The study also noted specific remedies for a range of vocal symptoms such as throat pain, irritation, or voice tiredness as per the belief systems of people speaking Tamil.

DISCUSSION/CONCLUSION

Home remedies, also known, as "Paati Vaidyam," are commonly used by Indian households to address health problems, including voice-related issues. The study indicated the prevalence and popularity of using home remedies for voice-related issues among teachers. The scientific logic or utility of these practices was explored in this study based on available information in voice literature. The information obtained is valuable for counseling (explaining local practice methods and available evidence) and education, keeping in mind the belief system, and practice methods of Tamils while imparting vocal hygiene education to the teachers.

Investigation of the Relationship Between Vocal Fatigue, Quality of Life, and Compliance With Vocal Hygiene in Professional Voice Users

PURPOSE

Intensive voice use may lead to the development of voice disorders or voice complaints, such as vocal fatigue, for professional voice users (teachers, academics, call center workers, actors, singers, speech and language therapists, voice trainers, and religious officials). Vocal fatigue has a detrimental effect on occupational, emotional, and social performance, besides the quality of life of the individual. The effect of voice hygiene interventions on voice fatigue is not fully known. The results of studies conducted with different occupational groups are inconsistent. The present study aims to analyze the relationship between vocal fatigue and voice-related quality of life (V-RQOL) in professional voice users, and the impact of vocal hygiene on vocal fatigue.

METHODS

Participants (24 male, 90 female), who were professional voice users without any diagnosis of voice disorders or voice complaints were divided into two groups low vocal hygiene compliance (LVH; n = 66) and high vocal hygiene compliance (HVH; n = 48). In this study, vocal fatigue was measured by the vocal fatigue index (VFI), and V-RQOL was measured by the voice handicap index (VHI-10) and V-RQOL.

RESULTS

VFI subscales (tiredness, avoidance, physical discomfort) have a moderate positive correlation with VHI-10 and V-RQOL, which indicates that there is a significant relationship between vocal fatigue and quality of life amongst professional voice users. While there was no significant difference between the LVH and HVH groups in terms of quality of life, it was found that the vocal fatigue level of the LVH group was higher.

CONCLUSION

This study of professional voice users with healthy voices reveals a relationship between vocal fatigue and V-RQOL. Vocal hygiene compliance may affect professional voice users' vocal fatigue symptoms; the low-compliant group has higher levels of tiredness, avoidance, and physical discomfort. The findings highlight the importance of raising awareness of the problems of professional voice users, even though they have healthy voices and the need for vocal hygiene education programs that target them.

An eclectic Voice Therapy Program for the Treatment of Hyperfunctional Voice Disorders (HFVD)

PURPOSE

An eclectic voice therapy program includes sequenced and structured set of exercises combining direct and indirect intervention methods. Tailor-made exercise prescription with specific cultural adaptations are needed to provide a holistic change to voice quality.1 This study detailed the construction of an exercise prescription for participants with hyperfunctional voice disorder [HFVD] in the Indian context.

METHOD

The exercise program was developed based on literature related to vocal therapy approaches and delivery methods. Adaptations were introduced to a selected set of exercises. Five voice experts verified the exercises and their prescription for content and feasibility of use in the Indian context. Modification suggested by the experts were included for framing the final version of the exercise program. This structured therapy program was planned for 6 weeks (30 minutes duration/session offered individually twice per week, with a gap of two days between sessions in a week) with the goals to improve voice quality, flexibility, and endurance while speaking. Five participants with HFVD partook in the study for pilot testing. Stroboscopy, perceptual voice analysis, Dysphonia Severity Index (DSI) and Vocal Fatigue Index in Tamil (VFI-T) were used to report the therapy outcomes. Participants' report on the learning process and generalization of the program were documented. Wilcoxon-signed rank test was used to test the pre-post outcome measures.

RESULTS

An eclectic voice therapy program, i.e., Comprehensive Voice Habilitation Program [CVHP] was constructed and it included vocal hygiene instructions, warm-up & cool-down, easy onset, resonant voice, and carry over exercises. Participants completed the program in 14-18 sessions (over 7 to 9 weeks of therapy). All participants showed significant changes in vocal fold movement patterns, reduction in ventricular hyperadduction, overall grade of voice quality, DSI and VFI-T. Participants reported that pictorial illustrations, feedback, and monitoring sheets were useful in learning the exercises.

CONCLUSION

CVHP showed significant change in the voice-related outcome measures and was a viable program for treating HFVD.

Voice-Related Problems, Vocal and Non-Vocal Habits in Naradiya Kirtankars: A Preliminary Study

OBJECTIVE

Naradiya kirtan is a part of India's rich folk heritage. Voice demands of the kirtankar (kirtan performer) include a combination of recitation, narration, and singing. Slight to moderate deviations in their voice could hamper their public image as well as endanger their career. A preliminary study was undertaken to explore the voice problems, vocal and non-vocal habits of Naradiya kirtankars.

STUDY DESIGN

Cross-sectional study design.

METHOD

A 22-item questionnaire was developed in English language and translated to Marathi language. This questionnaire was administered on 40 Naradiya kirtankars through purposive sampling. Participants included Naradiya kirtankars located in Mumbai and Pune cities with minimum of one-year training in the field and proficiency in Marathi language.

RESULTS

Statistical analysis revealed that kirtankars might be at a risk of developing voice problems. Among the kirtankars with voice problems, frequently pursued primary occupations involving extensive voice use, performed in a noisy environment, indulged in excessive talking, strained the neck muscles while voicing, impersonated voice, had reduced duration of sleep, and hearing difficulty as compared to kirtankars without voice problems.

CONCLUSION

Study findings highlight the need for dedicated efforts towards increasing the awareness among the kirtankars' about the vocal, non-vocal factors associated with voice problems and the role of voice health-care professionals in voice care.

A Survey of Vocal Health in Carnatic Singing Students

OBJECTIVE

Vocal health and hygiene are well addressed for professional singers, but less attention has been paid to singing trainees/students whose vocal demands vary significantly from trained singers. Studies conducted in the literature on singing trainees have reported a higher prevalence of voice problems in them; however, no such information is available from Indian classical singing trainees. Hence, the present study explored the frequency and nature of voice problems, self-reported vocal health and awareness of vocal hygiene and its practices in Carnatic singing trainees.

METHOD

This cross-sectional study was conducted using a purposive sampling method. The data were gathered from 135 Carnatic classical singing trainees. The participants completed a self-reported questionnaire addressing demographic and singing-related details, vocal symptoms, variables associated with increased risk reporting voice problems and knowledge about factors influencing vocal health.

RESULTS

The experience of past and point prevalence of voice problems in Carnatic singing students were found to be 29% and 15%, respectively. Difficulty singing higher notes, hoarseness, tired voice, loss of ability to sing/speak loudly, and breathiness in higher pitch range were the most prevalent vocal symptom reported by Carnatic singing trainees. Nasal allergies, dry mouth/throat, and excessive stress in daily routine activities raising voice many times a day, dry mouth/throat and excessive talking in social situations was found to have a significant association with singing trainees reporting voice problems. However, availing medical assistance for voice problems was found to be poor in this group of singing students.

CONCLUSION

Similar to trainees of other form of singing, Carnatic singing trainees also found to have a higher frequency of voice problems. Most of the singing trainees were found to be in their adolescent age period, and they face instability in their voice and are more vulnerable to develop voice problems. This indicates the need for in-depth understanding of voice problems experienced by Carnatic singing trainees aiming to promote their vocal health and prevent injury and be successful in their singing career.

Voice Complaints, Vocal and Non-vocal Behaviours Among Beatboxers - A Preliminary Study

INTRODUCTION

Beat boxing is an art of vocal percussion, which involves imitating musical instruments using oral structures. They use techniques like click rolls and trills which involves the usage of entire vocal apparatus for a longer period making use of the human body as a versatile physical instrument to recreate musical beats as well as vocal expressions. The aim and objectives of the present study were to develop a questionnaire and to profile the voice complaints, vocal and non-vocal habits among beatboxers in India.

METHOD

A cross-sectional study design was used to profile the voice complaints, vocal and non-vocal habits among beatboxers in India. Phase I involved questionnaire development and validation. Phase II involved data collection and analysis.

RESULTS

Thirty-seven beatboxers from India participated of which 70.27% were trained. The beatboxers reported of beatboxing musical instruments such as; flute/trumpet, harmonica, guitar, and drums. The commonly practiced vocal techniques was bass (22.07%). Most common vocal complaints included vocal fatigue after long usage of voice (72.97%) and breathing difficulty after performance (86.49%). Further, 76.38% reported of using loud voice during performances. Poor non-vocal habits such as muscle tension during beatboxing (56.76%), breathing difficulty during beatboxing (45.94%). Two most common good non-vocal habits included food intake on time (78.38%) and use of relaxation techniques (72.97%) prior to performance.

CONCLUSION

The present study was a preliminary attempt to profile the voice complaints, vocal and non-vocal habits observed in this upcoming profession of beatboxing. Further, studies are needed to explore the voice of these professionals from a multidimensional perspective.

Outcomes of Vocal Hygiene Program in Facilitating Vocal Health in Female School Teachers With Voice Problems

BACKGROUND

Teachers suffer greater impacts of voice problems due inappropriate voice use and other contributing factors such as physiological, environmental, and individual & work related issues. Structured vocal hygiene programs (VHP) prevent/reduce the risk of vocal trauma and promote vocal health in teachers. This study aimed to estimate the outcome of instituting a sociocultural relevant vocal hygiene program in facilitating vocal health among female school teachers using a comprehensive voice assessment protocol.

METHOD

VHP was developed emphasizing adequate hydration, healthy vocal diet, posture and alignment, vocal practices while teaching, and ideal speaking environment. This was administered via a face to face session to seventeen female teachers with voice concerns. All underwent a comprehensive voice assessment (subjective, objective, and self-perceptual vocal measures) before and four weeks after the VHP. Inter-rater reliability for perceptual and visual examination was estimated using Intra-Class Coefficient. Wilcoxon signed ranks test was used to compare the pre- and post-treatment measures of continuous variables (acoustic, Maximum phonation time, s/z ratio, Vocal Fatigue Index [VFI] & Voice Disorder Outcome Profile [V-DOP]), and McNemar test was used for categorical variables (vocal health questionnaire, visual examination of larynx and perceptual evaluation of voice).

RESULTS

Teachers reported reduction of unhealthy vocal & nonvocal practices after VHP. Improvements in vocal and related symptoms such as sensation of heart burn (P = 0.031), discomfort around the throat (P = 0.008), inadequate breath control while speaking (P = 0.016) were noticed. Perceptually, minimal improvement was seen in voice quality (overall grade). However, MPT & s/z ratio showed no significant difference. Improvement was observed in frequency range (P = 0.004), low I₀ (P = 0.044), shimmer (P = 0.017), and DSI (P = 0.013). Changes were evident in all parameters of stroboscopic evaluation (except nonvibratory portion & ventricular fold hyper-adduction). V-DOP scores indicated positive change in the overall severity (P = 0.002), physical (P = 0.003) and functional domain (P = 0.034). VFI indicated improvement in teachers voice after a period of voice rest (P = 0.048).

CONCLUSION

Though VHP facilitated in improving the teachers' awareness of at risk phono-traumatic behaviors and vocal health, its efficiency was limited in producing physiological improvement in teachers' voice. The comparison of vocal metrics before & after the treatment provides information on changes that can be expected in teachers after guiding them through a systematic VHP.

Prevalence of Voice Problems and Associated Risk Factors Among Tamil-Speaking Imams

PURPOSE

Voice of Professional Voice Users (PVUs) are of particular interest to practicing Speech-Language Pathologists. There is a dearth of studies concerning the prevalence of voice disorders and the associated risk factors among Tamil-speaking Imams. We address this research gap using non-experimental survey research.

METHODS

A questionnaire was framed by reviewing earlier literature. The derived questionnaire was administered to one hundred Tamil-speaking Imams actively involved in religious service in Tamil Nadu. We analyzed the obtained responses quantitatively and qualitatively. We also examined the effect of age on the prevalence of voice disorders and associated risk factors.

RESULTS

Based on survey responses, the career prevalence of voice problems among Tamil-speaking Imams was as high as 89%, and the point prevalence was 64%. The general health status of the Imams were good. However, vocal health was not satisfactory. This study identified several factors that contribute to voice problems, such as constant use of loud voice, acid reflux, unhealthy vocal habits, and insufficient hydration. A positive aspect observed during this study was the absence of smoking and consumption of alcohol among Imams. Even though the Imams presented good awareness of the voice production mechanism, they reported not seeking medical help when facing a voice problem. Current findings report a minimal impact of age-related differences on associated risk factors for voice disorders among the Imams.

CONCLUSIONS

Voice disorders are prevalent among Tamil-speaking Imams. Several risk factors leading to voice disorders among these individuals need to be addressed.

Linguistic and Cultural Adaptation and Validation of the Vocal Fatigue Index into Polish

OBJECTIVE

The purpose of the present study was the cross-cultural and linguistic adaptation and validation of the Vocal Fatigue Index (VFI) in the Polish language.

METHODS

The Vocal Fatigue Index was adapted into Polish and was administered to 323 subjects (216 with voice disorders, and 107 without voice disorders). One hundred and four participants with voice disorders completed the VFI a second time to evaluate test-retest reliability. VFI was assessed for internal consistency, test-retest reliability, discriminant validity, criterion validity, and sensitivity and specificity.

RESULTS

The Polish VFI exhibited satisfactory psychometric properties. A high Cronbach's alpha coefficient for the three factors (α=0.971 for Factor 1, α=0.929 for Factor 2, α=0.930 for Factor 3) was obtained. Significantly higher scores were revealed in subjects with voice disorders (48.88±11.73 [mean±SD]) in comparison with vocally healthy subjects (12.25±6.75 [mean±SD]) in the total VFI score as well as in the three factors (all P-values < 0.01). The best cut-off for VFI Total Score was set at a 32.5 score with sensitivity of 0.931 and specificity of 0.991.

CONCLUSIONS

The translated version of the VFI is a valid and reliable tool for identifying vocal fatigue symptoms in the Polish-speaking population.

An E-Survey of Current Voice Therapy Practices Amongst Speech Language Pathologists (SLPs) in India

In India, Speech Language Pathologists (SLPs) generally work with ENT surgeons and use a variety of treatment approaches, service delivery methods, feedback modes, and outcome measures in clinical practice while dealing with voice disorders. The practice preferences of the SLPs are based on theoretical and practical exposure during their graduate course, guidance from professional bodies, evidence-based practices, etc. The facilities in the work setting also determine the practice style of the SLP. This study reports information on demographics of the SLPs, nature of patients served, intervention methods, and evidence-based practices followed by the SLPs via an E-survey. Analysis of the survey from 55 SLPs in India, who work in the area of voice revealed that most SLPs had postgraduate (67.27%; n = 37) and doctorate degree (23.63%; n = 13) and worked in medical-related settings (81.81%; n = 45). Therapeutic approaches were practiced as stated in literature by 43.64% (n = 24) of SLPs. Although 56.36% (n = 31) of SLPs modified therapeutic approaches based on the client's needs (75%), literacy (16.66%) and cultural variations (8.33%). Attending Continuing Education Programs and training workshops were required to practice voice. Voice therapy methods (protocols) used by the SLPs were not uniform across India. The development of an indigenous protocol/method for voice therapy is the need of the hour.

Perception of Primary School Teachers Towards Voice Problems and Vocal Health-Seeking Behaviors: A qualitative study

OBJECTIVE

Teachers are the most common occupational group reporting to the voice clinics with dysphonia across the globe. However, less is known about teachers' perceptions about their voice and voice problems. Hence the present study aimed to explore teachers' perception about their teaching voice, voice problems and vocal health-seeking behaviors.

METHOD

A qualitative phenomenological research design using semi-structured interviews were conducted with fifteen female primary school teachers. Participants were asked to express their perception of teaching voice, vocal health care knowledge, and vocal hygiene practices. Using inductive analysis, the researchers converted the raw data into concepts or themes and discussed.

RESULT

The present study results showed that teachers perceive voice as the primary tool for their profession. However, teachers consider voice problems as part of their professional commitments. Despite knowing the harmful effects of voice problems, teachers' pay less attention to their voice problems and perceive them as usual, unavoidable and part of their profession. Due to their demanding work schedule and not getting enough support from the management, they hesitate to consult medical professionals unless it severely affects them.

CONCLUSIONS

The data obtained from this study can be used to improve the teachers' knowledge regarding vocal health and convince the school management to extend their support for the successful implementation of the vocal health training programs for teachers.

Social Representation of 'Vocal Hygiene' in India and Bhutan: A Cross-Sectional Survey

BACKGROUND

The study aimed to explore the professional and recreational and/or personal voice use patterns and social representation of 'vocal hygiene' in two culturally and geographically diverse societies: India and Bhutan.

METHODS

A total of 339 volunteers of Indian and Bhutanese nationality participated through snowball sampling. The responses were elicited using multiple-choice questions and a free association task. The data from the multiple-choice questions were analyzed using descriptive statistical methods. The free association task's responses underwent content and co-occurrence analysis to identify the most frequently occurring response categories.

RESULTS

The professional voice use pattern differed between the two populations but not the recreational and/or personal voice use pattern. The results also revealed diverse social representations of 'vocal hygiene' in India and Bhutan.

CONCLUSIONS

The present study sheds light on the voice use patterns and how the concept of vocal hygiene is represented in the two countries. These findings may have implications for developing and executing society specific awareness programs about vocal hygiene and its importance.

A survey of vocal health in church choir singers

Purpose

Choir singing is an important tradition of Christian worship across India. However, vocal health issues related to the church choir singers are less addressed in the literature. Hence, this study aimed to investigate the prevalence of vocal symptoms, identify the variables associated with increased risk of voice problems and knowledge of factors influencing vocal health in church choir singers.

Method

One hundred and forty-eight church choir singers (61 males and 85 females) between the age range of 18 and 70 years participated in the study. They completed a self-reported questionnaire addressing demographic and singing-related details, vocal symptoms, variables associated with increased risk reporting voice problems and knowledge about factors influencing vocal health.

Result

Eighty-four percent of the choir singers reported two or more vocal symptoms sometimes or more frequently while or after singing. More than half of the church choir singers had experienced vocal symptoms such as accessing notes in the upper range, loss of vocal endurance, pitch breaks, hoarseness, dryness in the throat, and discomfort in the throat. Among the different variables, systemic hydration found to have a significant association with reporting of voice problems in church choir singers. The overall knowledge regarding the factors influencing vocal health was found to be limited among the choir singers.

Conclusion

Choir singers like other professional singers experienced a higher prevalence of vocal symptoms during or after singing and exhibited limited knowledge about factors that negatively influence vocal health. Hence, there is a need to look into these singer’s vocal requirements, who usually go unnoticed.

Voice-related complaints and vocal and nonvocal habits of Hindustani classical singers: a questionnaire-based study

OBJECTIVE

This study aimed to profile voice-related complaints, as well as vocal and nonvocal habits among Hindustani classical singers.

METHOD

Cross-sectional study design was used to profile voice-related complaints and vocal and nonvocal habits among Hindustani classical singers. Phase I involved developing a questionnaire for exploring vocal and nonvocal habits. Phase II involved the administration of the survey to 61 Hindustani classical singers.

RESULTS

Based on the overall findings, 41% of singers reported of at least three vocal symptoms. The most common vocal symptoms included out of breath while singing, felling tired after singing and experiencing tension or tightness in neck/shoulder. The commonly reported vocal habits included excessive phone use, loud coughing/sneezing, throat clearing and excessive speaking. A high consumption of caffeinated beverages and spicy food were also reported.

CONCLUSION

This study helps to highlight the voice-related complaints and vocal and nonvocal habits of Hindustani classical singers. Further studies, need to explore the prevalence of voice problems incorporating other dimensions of voice evaluation such as acoustic, auditory perceptual, self-reported and laryngeal examination.

Risk Factors for Voice Problems in Professional Actors and Singers

Introduction

The purpose was to determine the incidence of voice disorders in a group of professional actors and singers, to compare the two groups, and to investigate the potential causes of their voice problems.

Methods

65 actors and 63 singers from professional theatres and choirs were included. The data concerning voice problems, their possible causes, and factors adversely affecting voice quality were obtained through a questionnaire. The results were compared between the groups of professional singers and actors, and between the subgroups of singers and actors both with and without frequent voice problems.

Results

The incidence of frequent voice problems over the entire career in singers and actors was lower than reported in the literature. Professional actors displayed more inappropriate life and vocal habits than the singers. Significant risk factors for voice disorders in singers turned out to be loud speech (p=0.029) and the presence of allergies or asthma (p=0.048). No such significant risk factors were found in actors.

Conslusion

The study confirmed the importance of preventive examination of the vocal tract function before enrolling in studies for an elite voice user. Professional singers and especially actors demonstrated insufficient knowledge of proper voice care. The results suggest that elite voice users require additional information on voice hygiene and occasional professional help from college to the end of career. Speech and language therapists can play a crucial role in such voice care in order to effectively prevent voice problems in elite voice users.

Cultural and Linguistic Adaptation of Vocal Fatigue Index for Tamil-Speaking Population (VFI-T)

OBJECTIVE

To adapt the vocal fatigue index (VFI) for the Tamil-speaking population.

STUDY DESIGN

Cross-sectional research design METHOD: VFI developed originally in English was translated in the Tamil language, a South Indian Dravidian language. Content validity and reverse translation of VFI in Tamil [VFI-T] was done. The final of VFI-T was administered on 251 subjects with voice concerns/ problems and on 100 individuals with perceptually normal voice for validity and reliability measures.

RESULTS

Factor analysis of VFI-T yielded four factors as opposed to three factors in the English version of VFI. The four factors were extracted based on Eigenvalue and variance contributed by each factor namely, I-physical discomfort; II-tiredness of voice and avoidance of voice use; III-increased effort and its effect on voice quality, and IV-Improvement of symptoms with rest. Varimax rotation and factor loading values for individual items identified five items under factor I; seven items under factor II; four items under factor III, and three items were preserved under factor IV. Overall Cronbach's alpha coefficient was 0.91 and alpha values for four factors ranged from 0.75 to 0.85. Item-to-total correlation revealed good internal consistency between the items. The median and interquartile range of VFI-T for cases and controls were viz., I-6.00 (10.00); 0.00 (1.00), factor II-12.00 (11.00); 1.00 (3.00), factor III-7.00 (8.00); 1.00 (2.00), and factor IV-6.00 (6.00); 1.00 (3.00), respectively. Mann-Whitney U test revealed a significant difference between the scores of cases and controls (P < 0.00). Logistic regression suggested sensitivity of 96% and a specificity of 79% for the inventory in the Tamil language.

CONCLUSION

VFI-T identified and documented vocal fatigue under four factors in subjects with voice disorders.

Vocal and Nonvocal Habits among Vedic Chanters

<b><i>Objectives:</i></b> The objective of the present study was to explore the voice concerns and vocal and nonvocal habits of Vedic chanters. <b><i>Participants and Method:</i></b> A cross-sectional design was used to study 200 Vedic chanters using a 36-item questionnaire. This questionnaire was developed and administered to explore their voice concerns and vocal and nonvocal habits. Descriptive statistics were used to summarize the findings and K-means cluster analysis was carried out to identify clusters concerning voice quality and influence of habits. <b><i>Results:</i></b> The majority of Vedic chanters were involved in certain vocal habits such as use of loud voice while chanting and frequent throat clearing. Further, approximately half of the chanters expressed a concern towards their voice, while a vast majority experienced vocal fatigue. Cluster analysis helped in identification of 4 clusters: Vedic chanters with (1) good lifestyle and good voice characteristics (<i>n</i> = 107), (2) good lifestyle but bad voice characteristics (<i>n</i> = 15), (2) poor lifestyle and good voice characteristics (<i>n</i> = 51), and (4) poor lifestyle leading to bad voice characteristics (<i>n</i> = 27). <b><i>Conclusion:</i></b> The findings of the present study provide useful information on voice concern and vocal and nonvocal habits among a unique population of individuals. The current study of Vedic chanters highlights the need to have a detailed understanding of their specific voice usage, demands, and voice characteristics.

Prevalence of Voice Disorders in School Teachers in a District in South India

BACKGROUND

Many professions tend to carry inherent risks for the practitioners. In such cases, it becomes mandatory for them to be aware of the risks and counselled about the preventive measures. The inevitable first step, however, is to ascertain the burden of risk. In the case of school teachers, it is known that they are prone to voice disorders of varying hues, at some point of their career. There should be an attempt to find the prevalence in the community. Presently, there is no such data documented from Kerala, a highly literate State in southern India.

AIM AND OBJECTIVES

The primary objective of this study was to document the prevalence of subjective dysphonia among the school teacher community. The secondary objective was to compare the prevalence and severity of dysphonia between primary and secondary school teachers.

MATERIALS AND METHODS

A cross-sectional study was conducted in 28 schools, using a screening questionnaire, based on similar ones used in other studies. All the schools were in the city of Kochi, the largest and most populous metropolitan area in Kerala. Teachers reporting a current voice complaint at the time of study were administered the validated vernacular version of the voice handicap index questionnaire (VHI 30). The completed questionnaires were collected and statistically analyzed.

RESULTS

The screening questionnaire was administered to 702 teachers; 165 were Primary school teachers (Class I-V), 242 Secondary (Class VI-XII), while 279 teachers had to take classes in both sections. The reported prevalence was 45.4% for present difficulty related to their voice, 52.8% for some voice problem in the last 1 year, and 70.1% for problems experienced during the duration of their teaching career. Possible risk factors like age, total years of teaching, hours of daily teaching and number of students taught did not show any significant association with voice problem.

CONCLUSIONS

Nearly, half of all the screened school teachers reported a current voice problem, increasing to nearly three-fourths for symptoms during entire career. This is clearly a significant burden which must be addressed at various levels. The secondary school teachers seem to bear a bigger burden in this study.

Level of physiological, anatomical and pathological knowledge of the singing voice on the part of professional and amateur singers

ABSTRACT Purpose: the knowledge concerning care of the voice on the part of professional and amateur singers in Chile is relevant for voice professionals and also for speech pathologists who work in disorder prevention and voice care. It is important to know if there are differences between both groups regarding the knowledge of voice care. Methods: the "Vocal Awareness Questionnaire for Singers'' was applied to a sample of 66 singers: 33 professional and 33 amateur singers. Three areas of knowledge were evaluated: anatomy and physiology of the larynx, vocal hygiene and voice pathologies. Results: there were no significant differences in the knowledge of voice care between professional and amateur singers both at a general level and in specific areas of knowledge. The topic of vocal hygiene obtained the highest percentage of correct answers in both groups, while the lowest percentage was in the area of voice pathologies. Conclusions: there were no differences in the level of knowledge on voice care between the professional and amateur singers included in this study. In both groups, the level of knowledge was from low to moderate. This could increase the incidence of vocal pathologies in both groups.

Vocal Health Practices Among School Teachers: A Study From Chennai, India

INTRODUCTION

A healthy vocal system is a prerequisite to produce a serviceable voice for any vocal profession. The concept of vocal health (VH) among teachers is worth exploring considering their known risk of developing voice disorders.

AIM

To provide socioculture-specific information on VH practices and nature of voice problems in teachers.

METHOD

A VH questionnaire was developed to elicit opinions toward one's own voice health and factors that indicated and contributed to impaired/poor VH from 384 school teachers.

RESULTS AND DISCUSSION

'Flexible voice' (23%), 'enduring voice' (22%), and 'good voice' (22%) were descriptions to indicate good VH by teachers. 'Vocal fatigue' (13%), 'dry throat' (9.4%), 'throat irritation' (4.7%), and 'pain while swallowing/speaking' (3.1%) were frequently reported throat sensations to indicate poor VH. For 30.2% of the teachers, voice mattered for professional needs. However, most of them managed to cope with voice problems through several home remedies and 'intentional/self-imposed neglect' despite their vocal difficulties. Sociocultural factors influencing these findings and scope to escalate voice problems in teachers as a public health issue are discussed.

CONCLUSION AND IMPLICATION

Insight and perception of VH based on self-reports and information on voice practices among teachers pertinent to this geographical location provide scope to develop models for counseling and preventive treatment for voice problems.

Prevalence of and Risk Factors for Self-reported Voice Problems Among Hindu Temple Priests

BACKGROUND

Hindu priests (purohits/purohits/) perform religious services, rites, and prayers primarily at the temples, during which there is a continuous recitation of shlokas, ʃlokas, and mantras/mæntrəs/ in a loud voice. Hence, the voice is the primary component of priests' profession and earning for livelihood. The present study was conducted to explore the prevalence and possible risk factors, and the impact of voice problems (VPs) in Hindu temple priests.

METHODS

This cross-sectional survey was conducted by distributing the self-reporting questionnaires to 140 Hindu temple priests in and around the Udupi/uɖupi/ and Mangaluru/maŋgalu:ru/ districts of Karnataka state, India, between January and April 2016.

RESULTS

The Hindu temple priests were found to have high career (43%) and point (19%) prevalence rates of VP. The length of work experience as a priest (>10years), modification of voice during chanting, speaking or chanting in the presence of throat infection, and experiencing dry mouth and throat were some of the risk factors found to have a significant association with high prevalence of self-reported VPs in priests. Around 43% of the priests missed their work at least 2-3 days because of VP.

CONCLUSIONS

Overall, the results of this study reveal a high prevalence of self-reported VPs in Hindu priests and suggest that VPs are associated with different risk factors. Further studies are needed to focus on understanding the impact of VPs and to develop awareness about preventive vocal measures in this population.

Clinical voice analysis of Carnatic singers

BACKGROUND AND OBJECTIVE

Carnatic singing is a classical South Indian style of music that involves rigorous training to produce an "open throated" loud, predominantly low-pitched singing, embedded with vocal nuances in higher pitches. Voice problems in singers are not uncommon. The objective was to report the nature of voice problems and apply a routine protocol to assess the voice.

METHODS

Forty-five trained performing singers (females: 36 and males: 9) who reported to a tertiary care hospital with voice problems underwent voice assessment. The study analyzed their problems and the clinical findings.

RESULTS

Voice change, difficulty in singing higher pitches, and voice fatigue were major complaints. Most of the singers suffered laryngopharyngeal reflux that coexisted with muscle tension dysphonia and chronic laryngitis. Speaking voices were rated predominantly as "moderate deviation" on GRBAS (Grade, Rough, Breathy, Asthenia, and Strain). Maximum phonation time ranged from 4 to 29 seconds (females: 10.2, standard deviation [SD]: 5.28 and males: 15.7, SD: 5.79). Singing frequency range was reduced (females: 21.3 Semitones and males: 23.99 Semitones). Dysphonia severity index (DSI) scores ranged from -3.5 to 4.91 (females: 0.075 and males: 0.64). Singing frequency range and DSI did not show significant difference between sex and across clinical diagnosis. Self-perception using voice disorder outcome profile revealed overall severity score of 5.1 (SD: 2.7). Findings are discussed from a clinical intervention perspective.

CONCLUSIONS

Study highlighted the nature of voice problems (hyperfunctional) and required modifications in assessment protocol for Carnatic singers. Need for regular assessments and vocal hygiene education to maintain good vocal health are emphasized as outcomes.

Multi parametric voice assessment: sri ramachandra university protocol

Emergence of "Voice specialty clinics" in ENT and Speech Language Pathologist (SLP) practice in India necessitates development of standard protocols for assessment and management of voice disorders. Based on recommendations from European Laryngological Society in Dejonckere (Eur Arch Otorhinolaryngol 258:77-82, 2001), a comprehensive voice assessment protocol was adapted for Indian population. This study aimed at verifying the face validity and feasibility of using the developed voice assessment protocol in a multi specialty tertiary care hospital. It included: history, clinical examination, visual analysis, perceptual analysis, aerodynamic measures, acoustic analysis and patients' self assessment of voice. The developed protocol was administered on 200 patients with voice concerns and problems. Correlation of self assessment with the assessment by the professionals was done using Kendaul tau_b correlation test. The scores of self assessment did not correlate significantly with acoustic measures. Differences in lab findings and self percept of voice indicated that these two were complementary measures in the protocol. Further, diagnosis and management decisions were arrived through a consensus discussion involving the ENT surgeon, SLP and the patient. Vocal hygiene and voice conservation were advised to all patients. Recommendations for voice therapy and/or surgery were provided based on findings from the protocol. The study demonstrated feasibility of using a comprehensive protocol for effective documentation, comparisons, review, training and treatment planning.