Voice dosimetry and monitoring, with emphasis on professional voice diseases: Critical review and framework for future research

Professional voice use in health and nursing care - Time for reconsideration? A scoping review

BACKGROUND

Communication is a key tool in the nursing profession. It is known that listeners are sensitive to the speaker's voice and interpret the speaker's intentions primarily from the non-verbal signal conveyed.

AIM

To map and discuss the current state of knowledge and research evidence on professional voice use in health and nursing care.

DESIGN AND METHOD

A scoping review adherent to the EQUATOR guidelines PRISMA-ScR.

DATA SOURCES

Searches in the EBSCO, CINAHL, Medline, PubMed, PsychInfo and PsycArticles databases were conducted between 1 and 28 February 2023.

RESULTS

According to the data (n =  23), health professionals use voice as a vital aspect of caring communication and caring relationships, and in leadership as well as inter-professional collaboration, to facilitate information exchange and understanding and promote shared decision-making. The data showed that there is also a rising tendency to explore vocal demands and problems among health professionals. No studies were found on the use of voice in digital health and nursing care services or by social robots. Most of the reviewed studies were cross-sectional, rather small, and focused primarily on the perspectives of healthcare professionals.

CONCLUSION

The use of voice should be explored as a vital aspect of caring communication and caring relationships from the patients' perspective, and the effects of voice use on listeners' emotions and actions should be examined in different contexts with modern, voice-specific data collection methods. Studies focusing on voice use in digital health care and by social robots are also needed. By integrating training programmes, education and technological innovations, health care can leverage the full potential of voice-based communication to promote a more coordinated and patient-centred care environment, true inter-professional collaboration and effective leadership.

IMPACT

Professional voice use is an essential part of all health and nursing care and an impressive method that should be used consciously. Therefore, the meaning and methods of voice use, including speech accommodation, should be systematically introduced into health and nursing care and included in nursing education.

Mapping the Landscape of Voice Complaints among Teachers: A Bibliometric Investigation

PURPOSE

With the significant and growing interest in voice disorders among teachers over the last several decades, there is value in having a comprehensive overview of the current state of the field and its related research productivity. This study aims to provide an updated and comprehensive mapping of the intellectual structure and research evolution in the field of occupational voice complaints among teachers.

METHODS

A systematic review of scientific articles on occupational voice complaints among teachers published in the last two decades was conducted using the preferred reporting items for systematic reviews and meta-analyses statements. A retrospective bibliometric analysis was then performed using the Web of Science core collection and VOSviewer to identify scientific productivity indicators, including publications per year, productivity by country, journals, and most cited articles.

RESULTS

Based on the search eligibility criteria, a total of 473 articles were initially screened, and from this selection, 157 articles were identified as meeting the inclusion criteria and therefore included in the analysis. The analysis revealed a strong trend in scientific productivity, with a 300% increase in the number of publications during the last decade. The leading countries in publications on this field were Brazil, the United States, and Finland. The Journal of Voice, CoDAS, and Folia Phoniatrica et Logopaedica were the most frequently published journals. Additionally, the literature on voice complaints among teachers primarily focused on five conceptual clusters: vocal demand response, voice disorders, vocal health promotion, individual-associated factors, and voice symptoms.

CONCLUSION

This study examines the growing literature on voice complaints among teachers over the past 20 years, identifying key countries, journals, and thematic clusters. The findings have important implications for researchers, policymakers, and practitioners, providing insights for collaboration and guiding future advancements in the field.

Which teachers are most at risk for voice disorders? Individual factors predicting vocal acoustic parameters monitored in situ during a workweek

PURPOSE

To identify the factors affecting teachers' vocal acoustic parameters, with the aim of detecting individuals at risk of phonotrauma.

METHOD

The voicing time, voice sound pressure level [SPL] and fundamental frequency [f_o] of 87 teachers were measured during one workweek using a voice dosimeter. We retrospectively investigated the impact of 10 factors (gender, age, teaching experience, teaching level, tobacco, gastro-esophageal problems, nonoccupational voice activity, voice education, past voice problems, and biopsychosocial impact of voice problems measured using the Voice Handicap Index [VHI]) on each voice parameter.

RESULTS

None of the above factors affected voicing time or SPL. f_o depended significantly on gender, teaching level, nonoccupational voice activity and VHI score. Specifically, f_o was higher in women (Δ = 69 Hz), in individuals without nonoccupational voice activities (Δ = 11 Hz), and in individuals with a lower VHI score (increase of 0.7 Hz for each additional point). For females, post hoc comparisons revealed a substantial impact of teaching level on f_o: university instructors had deeper voices than kindergarten (Δ = 66 Hz), elementary (Δ = 52 Hz), or secondary teachers (Δ = 41 Hz).

CONCLUSIONS

Since higher f_o increases the mechanical stress related to vocal fold vibration, the screening and prevention of phonotrauma should focus primarily on women, particularly those who teach at lower levels, and teachers with more self-rated voice problems. The lower f_o of teachers who engage in nonprofessional voice activities may suggest acute inflammation or muscle fatigue due to voice overload.

An ultrathin conformable vibration-responsive electronic skin for quantitative vocal recognition

Flexible and skin-attachable vibration sensors have been studied for use as wearable voice-recognition electronics. However, the development of vibration sensors to recognize the human voice accurately with a flat frequency response, a high sensitivity, and a flexible/conformable form factor has proved a major challenge. Here, we present an ultrathin, conformable, and vibration-responsive electronic skin that detects skin acceleration, which is highly and linearly correlated with voice pressure. This device consists of a crosslinked ultrathin polymer film and a hole-patterned diaphragm structure, and senses voices quantitatively with an outstanding sensitivity of 5.5 V Pa⁻¹ over the voice frequency range. Moreover, this ultrathin device (<5 μm) exhibits superior skin conformity, which enables exact voice recognition because it eliminates vibrational distortion on rough and curved skin surfaces. Our device is suitable for several promising voice-recognition applications, such as security authentication, remote control systems and vocal healthcare.

Though skin-attachable vibration sensors are promising for voice recognition applications, current technologies do not meet key performance requirements. Here, the authors report a flexible skin-attachable sensor with high sensitivity and flat frequency response over the vocal frequency range.

The difference between first and second harmonic amplitudes correlates between glottal airflow and neck-surface accelerometer signals during phonation

Miniature high-bandwidth accelerometers on the anterior neck surface are used in laboratory and ambulatory settings to obtain vocal function measures. This study compared the widely applied L₁-L₂ measure (historically, H1-H2)-the difference between the log-magnitude of the first and second harmonics-computed from the glottal airflow waveform with L₁-L₂ derived from the raw neck-surface acceleration signal in 79 vocally healthy female speakers. Results showed a significant correlation (r = 0.72) between L₁-L₂ values estimated from both airflow and accelerometer signals, suggesting that raw accelerometer-based estimates of L₁-L₂ may be interpreted as reflecting glottal physiological parameters and voice quality attributes during phonation.