Jennifer M. Oates

Voice disorders in teachers have a significant impact on their occupational functioning and well being. Teachers are believed to have a high prevalence of voice problems because of the unfavourable acoustic environments in which they work and the high vocal demands and stress levels associated with teaching. Although the types of voice problems teachers experience should be preventable because they are caused by factors that teachers can change, there is limited information available regarding the effectiveness of different preventative strategies. Therefore, the aim of this study was to investigate the effectiveness of vocal hygiene training (VH) and vocal function exercises (VFE) in reducing vocal symptoms and vocal misuse, and increasing knowledge of voice care, maximum phonation time, and maximum phonational frequency range in school teachers. Thirty-seven teachers from four schools in Melbourne, Australia, participated in the study. Schools were randomly allocated to one of three groups: VH, VFE, and no-treatment control. The VH and VFE participants reported improved vocal characteristics and voice knowledge after training while the control group showed deterioration on most variables. The VH participants showed greater improvements than the VFE participants. These fundings indicate that preventative voice training for teachers is likely to be effective.

... Journal of Psychosomatic Research, 54: 483–489. [CrossRef], [PubMed], [Web of Science ®], [CSA]; 4. Dejonckere, PH, Bradley, P, Clemente, P, Cornut, G, Crevier ... [CrossRef], [PubMed], [Web of Science ®]; 5. Hakkesteegt, MM, Wieringa, MH, Gerritsma, EJ and Feenstra, L. 2006. ...

... Address for correspondence: Dr. Jennifer Oates, Associate Professor, School of Human Communication Sciences, La Trobe University, Bundoora, Victoria ... perceptual evaluation can be reliable and learn-able (see, for example, Gerratt, Kreiman, Antnanzas-Barroso, & Berke ...

Taking the preceding five papers in this special issue of the International Journal of Speech-Language Pathology as a starting point, this paper synthesizes key aspects of hyperfunctional voice disorders (HFVD). Aetiological and contributing factors, defining features, prevention, assessment and intervention are canvassed, while controversial issues and future directions in research and clinical practice are discussed. Despite disagreements and inconsistencies in terminology surrounding HFVD, there is broad agreement that musculoskeletal tension is the hallmark of these voice disorders. There is also reasonable consensus that the pathogenesis and persistence of HFVD are associated with multiple and overlapping factors, some of which are likely to interact in as yet unknown ways. In addition to dysregulated laryngeal muscle functioning, key processes in the psychosocial and sensory domains are canvassed as likely contributors to HFVD. Vocal fatigue is considered as an intriguing relative of HFVD, the role of laryngopharyngeal reflux is debated and the proposition that particular individuals are psychologically and/or physiologically predisposed to HFVD is discussed. New directions in assessment highlight the use of client-centred measures to consider insider perspectives of psychological factors, vocal effort and vocal fatigue. Emerging psychosocial and physical-manipulative interventions are emphasized and the future educational needs of voice care professionals are considered.

Voice disorders in teachers have a significant impact on their occupational functioning and well being. Teachers are believed to have a high prevalence of voice problems because of the unfavourable acoustic environments in which they work and the high vocal demands and stress levels associated with teaching. Although the types of voice problems teachers experience should be preventable because they are caused by factors that teachers can change, there is limited information available regarding the effectiveness of different preventative strategies. Therefore, the aim of this study was to investigate the effectiveness of vocal hygiene training (VH) and vocal function exercises (VFE) in reducing vocal symptoms and vocal misuse, and increasing knowledge of voice care, maximum phonation time, and maximum phonational frequency range in school teachers. Thirty-seven teachers from four schools in Melbourne, Australia, participated in the study. Schools were randomly allocated to one of three groups: VH, VFE, and no-treatment control. The VH and VFE participants reported improved vocal characteristics and voice knowledge after training while the control group showed deterioration on most variables. The VH participants showed greater improvements than the VFE participants. These fundings indicate that preventative voice training for teachers is likely to be effective.

This study investigated changes in maximum phonation time and acoustic and perceptual measures of voice following topical anesthesia and laryngeal endoscopy with the flexible endoscope. Forty-four females, aged 18-33 years and with normal voices, performed four vocal tasks: (a) 3-second /i/ prolongation, (b) maximum phonation time on /i/, (c) stepwise scale-singing, and (d) reading a standard passage. Subjects performed these tasks prior to anesthesia, after anesthesia, and again during laryngeal endoscopy. Voice samples were analyzed forjitter, shimmer, harmonic-to-noise ratio, speaking fundamental frequency, maximum phonational frequency range, maximum phonation time, harshness, and breathiness. Results demonstrated significant reductions in maximum phonational frequency range following anesthesia and, during laryngeal endoscopy, reductions in maximum phonation time and increases in speaking fundamental frequency, minimum fundamental frequency on scale-singing, and breathiness. Clinicians using laryngeal endoscopy for evaluation and management of vocal dysfunction should, therefore, consider the possible effects of these procedures on vocal functioning.

Trained choral tenors performed a series of vocal tasks before and after a "live" performance. Acoustic (perturbation, harmonic-to-noise ratio, pitch and amplitude ranges) and perceptual analyses (auditory and proprioceptive/kinesthetic) were undertaken to detect changes from pre- to postperformance. Individuality of response to the performance was revealed, with the majority of subjects showing vocal deterioration after performance. The most sensitive vocal tasks were the comfortably pitched notes, high soft notes, and the bottom notes in scale singing. The most sensitive acoustic measure in detecting change from pre- to postperformance was harmonic-to-noise ratio. In contrast to the demonstrated acoustic changes, no significant differences in perceptual ratings were evident after the performance. Perceptual ratings did not reflect the acoustic analysis results. The present study highlights the need to establish further normative data for the singing voice and to consider individual differences in vocal characteristics in future studies of the singing voice.

An important outcome of education for speech-language pathology practice is the ability to analyze voices perceptually, a complex task that is often difficult for novices. This article describes an interactive multi-media package, "A Sound Judgement," that is designed to help students develop skills in perceptual voice analysis and to link their perceptions to laryngeal physiology. The package presents a range of clients with vocal impairments at increasing levels of complexity. Each case has a videoed interview, endoscopic views and animations of the larynx, and case history information. Students make perceptual ratings of clients' voices on a format designed specifically for this package and feedback is provided using ratings made by expert speech-language pathologists. High levels of consensus for the perceptual judgments were achieved among the expert raters. Preliminary evaluations by students have demonstrated that "A Sound Judgement" is likely to be a valuable educational tool.

Voice disorders are thought to be one of the major occupational hazards of school teaching. The resulting symptoms can affect teachers' ability to function in the classroom and prevent them from developing effective working relationships with other staff and students. Sick leave, speech pathology management, and surgical intervention can be costly. Severe voice problems can also result in a teacher permanently leaving the classroom. Despite the significant implications of voice disorders for teachers, this review of published research demonstrates that findings concerning the prevalence of voice problems in teachers and the causes and contributing factors of those voice problems are inconclusive. Similarly, previous research on the efficacy of prevention programs and treatment of voice problems in teachers provide few firm conclusions. Further research based on sound empirical data is needed, as many past studies have relied on anecdotal or self-report data. More operational definitions of what constitutes a voice disorder and the associated contributing factors should be adopted, along with the use of more instrumental measures and careful attention to methodology and appropriate statistical analyses. Only then will we have a sound basis for the development of effective prevention and education programs for teachers.

The human voice undergoes changes associated with normal physiological aging after the age of approximately 65 years. These voice changes indicate an overall decline in vocal function, which can have diverse vocal and psychosocial impacts for the aging individual. At present, there is limited evidence as to whether vocal exercise can alleviate negative vocal changes arising from physiological aging, in particular for aging individuals who sing. The aim of this study was to investigate the effectiveness of a 5-week Vocal Function Exercise (VFE) program on measures of vocal function in a sample of aging community choral singers. Prospective quasi-experimental design. A group of 22 aging community choral singers (eight men and 14 women) were randomly assigned to either the VFE program or control group. Pretraining and posttraining comparisons were made of auditory-perceptual, aerodynamic, acoustic, and self-evaluation voice measures. After VFE training, significant improvements in perceived roughness, maximum phonation time, jitter, shimmer, and noise-to-harmonics ratio were found for participants in the VFE group. However, evaluations of perceived breathiness and strain and phonational frequency range did not reveal significant changes. The VFE program was also generally perceived by the participants to have a positive effect on their voices. The results of this preliminary study suggest that VFE has the potential to mitigate the effects of physiological vocal aging and deserves further research attention as a mode of vocal training for aging individuals, particularly for those who sing.

This review addresses speech therapy interventions for older adults experiencing voice impairments. The prevalence, impact, and nature of voice impairments in older people are outlined. Intervention methods and their effectiveness are discussed, with particular focus on behavioral treatments for presbyphonia. The strength of current evidence is discussed and recommendations for future research are presented. There has been a substantial increase in the number of older people seeking voice management over the last 10-20 years. Reduced vocal effectiveness in older people is likely to be multifactorial and associated with normal physiological aging, maladaptive responses to vocal aging, and medical and psychosocial conditions that are common in older age. Although several authors have claimed that behavioral intervention for presbyphonia is effective, few studies were reported until 2008. Since then, 10 studies have been published as to the effectiveness of behavioral interventions for age-related dysphonia. Voice therapy techniques evaluated include vocal function exercises, phonation resistance training exercise, Lessac-Madsen resonant voice therapy, Lee Silverman voice treatment, neuromuscular electrical stimulation, semi-occluded vocal tract, and flow phonation. Findings suggest that behavioral interventions for presbyphonia have the potential to mitigate effects of vocal aging, but the overall evidence base is inadequate to allow definitive conclusions. Because vocal effectiveness diminishes as people age and because diminished vocal capabilities are associated with negative impacts, the importance of establishing whether behavioral interventions are effective is now acknowledged. Although the number of studies on speech therapy interventions has increased, the body of evidence is limited and further research is required.

This study determined the prevalence and nature of voice problems in New Zealand (NZ) teachers using a national self-report questionnaire. Epidemiological cross-sectional survey. Participants were 1879 primary and secondary teachers (72.5% females). Three prevalence timeframes were estimated. Severity of voice problems, recovery time, days away from work, symptoms, health assistance, and voice education were also investigated. Prevalence of self-reported vocal problems was 33.2% during their teaching career, 24.7% over the teaching year, and 13.2% on the day of the survey. Primary teachers (P<0.001; odds ratio [OR]=1.74; confidence interval [CI]=1.33-2.40), females (P=0.008; OR=1.63; CI=1.13-2.37), and those aged 51-60 years (P=0.010; OR=1.45; CI=1.11-3.00) were more likely to report problems. Among teachers reporting voice problems during the year, 47% were moderate or severe; for 30%, voice recovery took more than 1 week. Approximately 28% stayed away from work 1-3 days owing to a vocal problem and 9% for more than 3 days. Women reported longer recovery times and more days away. Symptoms associated with voice problems (P<0.001) were voice quality alteration (OR=4.35; CI=3.40-5.57), vocal effort (OR=1.15; CI=0.96-1.37), voice breaks (OR=1.55; CI=1.30-1.84), voice projection difficulty (OR=1.25; CI=1.04-1.50), and throat discomfort (OR=1.22; CI=1.02-1.47). Of the teachers reporting voice problems, only 22.5% consulted a health practitioner. Only 38% of the teachers with chronic voice problems visited an otolaryngologist. Higher hours of voice training/education were associated with fewer voice problems. Voice problems are of concern for NZ teachers, as has been reported for teachers in other countries. There is still limited awareness among teachers about vocal health, potential risks, and specialized health services for voice problems.

To determine whether emotional expression, alexithymia, illness behavior, and coping strategies differed between women with muscle tension voice disorder (MTVD) and those without voice disorder and between women with and without mucosal pathology of the vocal folds, and to explore possible links between psychosocial constructs and clinical features in women with MTVD. A within-subjects design matched 20 women with MTVD and 20 women without voice disorder on validated self-report measures of the psychosocial constructs. The effect of mucosal pathology was assessed using between-groups analyses. Correlations assessed relationships between psychosocial constructs and clinical features. Comparisons between women with MTVD and those without voice disorder showed an elevated sense of illness identity and greater belief in the presence of somatic illness in women with MTVD. There was a trend toward women with MTVD showing lower levels of emotional awareness. Women without vocal fold pathology reported lower levels of emotional awareness than those with pathology, whereas women with pathology reported greater use of a mixed pattern of adaptive and maladaptive coping strategies than those with no pathology. Low vocal load was associated with higher scores on alexithymia, higher numbers of vocal symptoms were associated with the use of adaptive coping, and greater impact of symptoms was associated with higher levels of emotional awareness and greater belief in the presence of somatic illness. These findings encourage further investigation of relationships between emotional awareness, illness behavior, and coping in women with functional voice disorders.