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Echternach M, Ava Hermann L, Gantner S, Tur B, Peters G, Westphalen C, Benthaus T, Köberlein M, Kuranova L, Döllinger M, Kniesburges S. The Effect of Singers' Masks on the Impulse Dispersion of Aerosols During Singing. J Voice 2024; 38:247.e1-247.e10. [PMID: 34610881 DOI: 10.1016/j.jvoice.2021.08.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/24/2021] [Accepted: 08/26/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND During the Covid-19 pandemic, singing activities were restricted due to several super-spreading events that have been observed during rehearsals and vocal performances. However, it has not been clarified how the aerosol dispersion, which has been assumed to be the leading transmission factor, could be reduced by masks which are specially designed for singers. MATERIAL AND METHODS Twelve professional singers (10 of the Bavarian Radio-Chorus and two freelancers, seven females and five males) were asked to sing the melody of the ode of joy of Beethoven's 9th symphony "Freude schöner Götterfunken, Tochter aus Elisium" in D-major without masks and afterwards with five different singers' masks, all distinctive in their material and proportions. Every task was conducted after inhaling the basic liquid from an e-cigarette. The aerosol dispersion was recorded by three high-definition video cameras during and after the task. The cloud was segmented and the dispersion was analyzed for all three spatial dimensions. Further, the subjects were asked to rate the practicability of wearing the tested masks during singing activities using a questionnaire. RESULTS Concerning the median distances of dispersion, all masks were able to decrease the impulse dispersion of the aerosols to the front. In contrast, the dispersion to the sides and to the top was increased. The evaluation revealed that most of the subjects would reject performing a concert with any of the masks. CONCLUSION Although, the results exhibit that the tested masks could be able to reduce the radius of aerosol expulsion for virus-laden aerosol particles, there are more improvements necessary to enable the practical implementations for professional singing.
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Affiliation(s)
- Matthias Echternach
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology, University Hospital, LMU Munich, Germany.
| | - Laila Ava Hermann
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology, University Hospital, LMU Munich, Germany
| | - Sophia Gantner
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology, University Hospital, LMU Munich, Germany
| | - Bogac Tur
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology, Head & Neck Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Gregor Peters
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology, Head & Neck Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Caroline Westphalen
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology, University Hospital, LMU Munich, Germany
| | - Tobias Benthaus
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Germany
| | - Marie Köberlein
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology, University Hospital, LMU Munich, Germany
| | - Liudmila Kuranova
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology, University Hospital, LMU Munich, Germany
| | - Michael Döllinger
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology, Head & Neck Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Stefan Kniesburges
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology, Head & Neck Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
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Kniesburges S, Schlegel P, Peters G, Westphalen C, Jakubaß B, Veltrup R, Kist AM, Döllinger M, Gantner S, Kuranova L, Benthaus T, Semmler M, Echternach M. Effects of surgical masks on aerosol dispersion in professional singing. J Expo Sci Environ Epidemiol 2022; 32:727-734. [PMID: 34611302 PMCID: PMC8491963 DOI: 10.1038/s41370-021-00385-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 09/09/2021] [Accepted: 09/10/2021] [Indexed: 05/02/2023]
Abstract
BACKGROUND In the CoVID-19 pandemic, singing came into focus as a high-risk activity for the infection with airborne viruses and was therefore forbidden by many governmental administrations. OBJECTIVE The aim of this study is to investigate the effectiveness of surgical masks regarding the spatial and temporal dispersion of aerosol and droplets during professional singing. METHODS Ten professional singers performed a passage of the Ludwig van Beethoven's "Ode of Joy" in two experimental setups-each with and without surgical masks. First, they sang with previously inhaled vapor of e-cigarettes. The emitted cloud was recorded by three cameras to measure its dispersion dynamics. Secondly, the naturally expelled larger droplets were illuminated by a laser light sheet and recorded by a high-speed camera. RESULTS The exhaled vapor aerosols were decelerated and deflected by the mask and stayed in the singer's near-field around and above their heads. In contrast, without mask, the aerosols spread widely reaching distances up to 1.3 m. The larger droplets were reduced by up to 86% with a surgical mask worn. SIGNIFICANCE The study shows that surgical masks display an effective tool to reduce the range of aerosol dispersion during singing. In combination with an appropriate aeration strategy for aerosol removal, choir singers could be positioned in a more compact assembly without contaminating neighboring singers all singers.
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Affiliation(s)
- Stefan Kniesburges
- Division of Phoniatrics and Pediatric Audiology at the Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany.
| | - Patrick Schlegel
- Department of Head and Neck Surgery, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, USA
| | - Gregor Peters
- Division of Phoniatrics and Pediatric Audiology at the Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Caroline Westphalen
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology, University Hospital, LMU Munich, Munich, Germany
| | - Bernhard Jakubaß
- Division of Phoniatrics and Pediatric Audiology at the Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Reinhard Veltrup
- Division of Phoniatrics and Pediatric Audiology at the Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Andreas M Kist
- Department of Artificial Intelligence in Biomedical Engineering, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Michael Döllinger
- Division of Phoniatrics and Pediatric Audiology at the Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Sophia Gantner
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology, University Hospital, LMU Munich, Munich, Germany
| | - Liudmila Kuranova
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology, University Hospital, LMU Munich, Munich, Germany
| | - Tobias Benthaus
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Marion Semmler
- Division of Phoniatrics and Pediatric Audiology at the Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Matthias Echternach
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology, University Hospital, LMU Munich, Munich, Germany
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Köberlein MC, Hermann L, Gantner S, Tur B, Westphalen C, Kuranova L, Döllinger M, Kniesburges S, Kruse SA, Echternach M. The Effect of Water Resistance Therapy on the Impulse Dispersion of Aerosols During Sustained Phonation. J Voice 2022:S0892-1997(22)00153-9. [PMID: 35803772 PMCID: PMC9256517 DOI: 10.1016/j.jvoice.2022.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/27/2022] [Accepted: 05/31/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Group singing has been associated with higher transmission risks via exhaled and spread aerosols in the CoVID19 pandemic. For this reason, many musical activities, such as rehearsals and lessons, but also voice therapy sessions, have been restricted in many countries. Consequently, transmission risks and pathways have been studied, such as aerosol amounts generated by exhalation tasks, convectional flows in rooms, or the impulse dispersion of different kinds of phonation. The use of water resistance exercises such as those utilizing LAX VOX®, are common in voice lessons and as vocal warm-ups. With this context, this study investigates the impulse dispersion characteristics of aerosols during a voiced water resistance exercise in comparison to normal singing. METHODS Twelve professional singers (six male, six female) were asked to phonate a stable pitch through a silicone tube into a bottle filled with water, holding the end of the tube 5 cm below the surface. Before performing the tasks, the singers inhaled the vapor consisting of 0.5 L base liquid from an e-cigarette. The exhaled gas cloud coming out of the bottle was recorded in all three spatial directions and the dispersion was measured as a function of time. RESULTS At the end of the phonation task, the median distance to the front was 0.55 m and the median of the lateral expansion of the cloud was 0.89 m, the maximum to the front reached 0.88 m, and the maximum of lateral expansion 1.05 m. For the upwards direction of the clouds a median of 1.00 m and a maximum of 1.34 m from the mouth were measured. Three seconds after the end of the task, the medians were declining. CONCLUSION The exhaled aerosol cloud can expand despite the obstacle of the water when using LAX VOX® during phonation.
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Affiliation(s)
- Marie Christine Köberlein
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany.
| | - Laila Hermann
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Sophia Gantner
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Bogac Tur
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology, Head & Neck Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Caroline Westphalen
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Liudmila Kuranova
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Michael Döllinger
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology, Head & Neck Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Stefan Kniesburges
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology, Head & Neck Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | | | - Matthias Echternach
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
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Gantner S, Echternach M, Veltrup R, Westphalen C, Köberlein MC, Kuranova L, Peters G, Jakubaß B, Benthaus T, Döllinger M, Kniesburges S. Impulse dispersion of aerosols during playing wind instruments. PLoS One 2022; 17:e0262994. [PMID: 35239657 PMCID: PMC8893631 DOI: 10.1371/journal.pone.0262994] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 01/10/2022] [Indexed: 12/24/2022] Open
Abstract
Musical activities, especially singing and playing wind instruments, have been singled out as potentially high-risk activities for the transmission of SARS CoV-2, due to a higher rate of aerosol production and emission. Playing wind instruments can produce condensation, droplets of saliva, and aerosol particles, which hover and spread in the environmental air's convectional flows and which can be potentially infectious. The aim of this study is to investigate the primary impulse dispersion of aerosols that takes place during the playing of different wind instruments as compared to breathing and to speaking. Nine professional musicians (3 trumpeters, 3 flautists and 3 clarinetists) from the Bavarian Symphony Orchestra performed the main theme from the 4th movement of Ludwig van Beethoven's 9th symphony in different pitches and loudness. The inhaled air volume was marked with small aerosol particles produced using a commercial e-cigarette. The expelled aerosol cloud was recorded by cameras from different perspectives. Afterwards, the dimensions and dynamics of the aerosol cloud were measured by segmenting the video footage at every time point. Overall, the flutes produced the largest dispersion at the end of the task, reaching maximum forward distances of 1.88 m. An expulsion of aerosol was observed in different directions: upwards and downwards at the mouthpiece, at the end of the instrument, and along the flute at the key plane. In comparison, the maximum impulse dispersions generated by the trumpets and clarinets were lower in frontal and lateral direction (1.2 m and 1.0 m towards the front, respectively). Also, the expulsion to the sides was lower.
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Affiliation(s)
- Sophia Gantner
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology, University Hospital, LMU Munich, Munich, Germany
| | - Matthias Echternach
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology, University Hospital, LMU Munich, Munich, Germany
| | - Reinhard Veltrup
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology, Head & Neck Surgery, University Hospital Erlangen, Medical School, Friedrich-Alexander-University Erlangen-Nueremberg, Erlangen, Germany
| | - Caroline Westphalen
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology, University Hospital, LMU Munich, Munich, Germany
| | - Marie Christine Köberlein
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology, University Hospital, LMU Munich, Munich, Germany
| | - Liudmila Kuranova
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology, University Hospital, LMU Munich, Munich, Germany
| | - Gregor Peters
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology, Head & Neck Surgery, University Hospital Erlangen, Medical School, Friedrich-Alexander-University Erlangen-Nueremberg, Erlangen, Germany
| | - Bernhard Jakubaß
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology, Head & Neck Surgery, University Hospital Erlangen, Medical School, Friedrich-Alexander-University Erlangen-Nueremberg, Erlangen, Germany
| | - Tobias Benthaus
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Michael Döllinger
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology, Head & Neck Surgery, University Hospital Erlangen, Medical School, Friedrich-Alexander-University Erlangen-Nueremberg, Erlangen, Germany
| | - Stefan Kniesburges
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology, Head & Neck Surgery, University Hospital Erlangen, Medical School, Friedrich-Alexander-University Erlangen-Nueremberg, Erlangen, Germany
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Echternach M, Westphalen C, Köberlein MC, Gantner S, Peters G, Benthaus T, Jakubaß B, Kuranova L, Döllinger M, Kniesburges S. Reply to Philip et al.: Aerosol Transmission of SARS-CoV-2: Inhalation as well as Exhalation Matters for COVID-19. Am J Respir Crit Care Med 2021; 203:1042-1043. [PMID: 33529548 PMCID: PMC8048754 DOI: 10.1164/rccm.202101-0051le] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | | | | | - Sophia Gantner
- Ludwig Maximilian University of MunichMunich, Germanyand
| | - Gregor Peters
- Friedrich–Alexander University Erlangen–NürnbergErlangen, Germany
| | | | - Bernhard Jakubaß
- Friedrich–Alexander University Erlangen–NürnbergErlangen, Germany
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Echternach M, Gantner S, Peters G, Westphalen C, Benthaus T, Jakubaß B, Kuranova L, Döllinger M, Kniesburges S. Impulse Dispersion of Aerosols during Singing and Speaking: A Potential COVID-19 Transmission Pathway. Am J Respir Crit Care Med 2020; 202:1584-1587. [PMID: 33064957 PMCID: PMC7706156 DOI: 10.1164/rccm.202009-3438le] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | - Sophia Gantner
- Ludwig-Maximilians-University Munich, Munich, Germanyand
| | - Gregor Peters
- Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | | | | | - Bernhard Jakubaß
- Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
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Echternach M, Döllinger M, Köberlein M, Kuranova L, Gellrich D, Kainz MA. Vocal fold oscillation pattern changes related to loudness in patients with vocal fold mass lesions. J Otolaryngol Head Neck Surg 2020; 49:80. [PMID: 33228812 PMCID: PMC7686765 DOI: 10.1186/s40463-020-00481-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 11/17/2020] [Indexed: 11/10/2022] Open
Abstract
Introduction Vocal fold mass lesions can affect vocal fold oscillation patterns and therefore voice production. It has been previously observed that perturbation values from audio signals were lower with increased loudness. However, how much the oscillation patterns change with gradual alteration of loudness is not yet fully understood. Material and methods Eight patients with vocal fold mass lesions were asked to perform a glide from minimum to maximum loudness on the vowel /i/, ƒo of 125 Hz for male or 250 Hz for female voices. During phonation the subjects were simultaneously recorded with transnasal high speed videoendoscopy (HSV, 20,000 fps), electroglottography (EGG), and an audio recording. Based on the HSV material the Glottal Area Waveform (GAW) was segmented and GAW parameters were computed. Results The greatest vocal fold irregularities were observed at different values between minimum and maximum sound pressure level. There was a relevant discrepancy between the HSV and EGG derived open quotients. Furthermore, the EGG derived sample entropy and GAW values also evidenced different behavior. Conclusions The amount of vocal fold irregularity changes with varying loudness. Therefore, any evaluation of the voice should be performed under different loudness conditions. The discrepancy between EGG and GAW values appears to be much stronger in patients with vocal fold mass lesions than those with normal physiological conditions. Level of evidence 4.
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Affiliation(s)
- Matthias Echternach
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology Head & Neck Surgery, Munich University Hospital (LMU), Marchioninistr. 15, 81377, Munich, Germany.
| | - Michael Döllinger
- Division of Phoniatrics and Pediatric Audiology at the Department of Otorhinolaryngology Head & Neck Surgery, University Hospital Erlangen, Medical School, Bohlenplatz 21, 91054, Erlangen, Germany
| | - Marie Köberlein
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology Head & Neck Surgery, Munich University Hospital (LMU), Marchioninistr. 15, 81377, Munich, Germany.,Institute of Musicians' Medicine, Freiburg University Hospital and Faculty of Medicine Freiburg University, Elsässerstr 2m, Freiburg, Germany
| | - Liudmila Kuranova
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology Head & Neck Surgery, Munich University Hospital (LMU), Marchioninistr. 15, 81377, Munich, Germany
| | - Donata Gellrich
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology Head & Neck Surgery, Munich University Hospital (LMU), Marchioninistr. 15, 81377, Munich, Germany
| | - Marie-Anne Kainz
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology Head & Neck Surgery, Munich University Hospital (LMU), Marchioninistr. 15, 81377, Munich, Germany
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