International Journal of Head and Neck Surgery

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VOLUME 13 , ISSUE 1 ( January-March, 2022 ) > List of Articles

INVITED REVIEW ARTICLE

Care of the Professional Voice

Michelle M Bretl, David E Rosow

Keywords : Occupational voice, Professional voice, Vocal folds, Voice evaluation, Voice rest, Voice therapy

Citation Information : Bretl MM, Rosow DE. Care of the Professional Voice. Int J Head Neck Surg 2022; 13 (1):18-26.

DOI: 10.5005/jp-journals-10001-1520

License: CC BY-NC 4.0

Published Online: 25-05-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Abstract

Aim: This article aims to identify the unique requirements in evaluating and treating professional voice users with voice complaints. Background: Professional or occupational voice users make up a large portion of a laryngological caseload. These individuals, including teachers, performers, salespeople, etc., rely on proper vocal function every day to carry out the demands of their job. As a result, these patients may require a more comprehensive clinical evaluation and intervention given the nature of their careers. Patient care/Techniques: Otolaryngologists should consider the use of videolaryngostroboscopy to assess the subtleties of vocal fold function and vibration. Often, close collaboration with a speech pathologist is most beneficial to these patients to improve the overall health and functioning of the voice and promote longevity of proper voice use. A variety of vocal pathologies are seen in the professional voice population, including laryngitis, benign vocal fold lesions, and functional disorders such as muscle tension dysphonia. Management and treatment will depend not only on the findings from the evaluation, but also access to a collaborative voice team and the patient's wishes related to their profession. Voice rest is generally only implemented in specific cases where avoiding vocal fold collision is crucial to healing. Voice therapy is often warranted both for rehabilitation and learning appropriate compensatory strategies and healthier voicing behaviors. Depending on the evaluation findings and the comfort level of the provider, medication or surgical intervention may be most appropriate for certain patients. Clinical significance/Conclusion: Professional voice users are frequently seen by otolaryngologists due to the essential role of their voices and the high demands often required. Providers should be knowledgeable in the assessment and treatment of voice disorders. If necessary, providers should establish a voice care team in the area that can appropriately assist these patients.


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  1. Behlau M, Zambon F, Madazio G. Managing dysphonia in occupational voice users. Curr Opin Otolaryngol Head Neck Surg 2014;22(3):188–194. DOI: 10.1097/MOO.0000000000000047
  2. Titze IR, Lemke J, Montequin D. Populations in the US workforce who rely on voice as a primary tool of trade: a preliminary report. J Voice 1997;11(3):254–259. DOI: 10.1016/s0892-1997(97)80002-1
  3. Roy N, Merrill RM, Gray SD, et al. Voice disorders in the general population: prevalence, risk factors, and occupational impact. Laryngoscope 2005;115(11):1988–1995. DOI: 10.1097/01.mlg.0000179174.32345.41
  4. Bhattacharyya N. The prevalence of voice problems among adults in the United States. Laryngoscope 2014;124(10):2359–2362. DOI: 10.1002/lary.24740
  5. Smith E, Lemke J, Taylor M, et al. Frequency of voice problems among teachers and other occupations. J Voice 1998;12(4):480–488. DOI: 10.1016/s0892-1997(98)80057-x
  6. Roy N, Merrill RM, Thibeault S, et al. Prevalence of voice disorders in teachers and the general population. J Speech Lang Hear R 2004;47(2):281–293. DOI: 10.1044/1092-4388(2004/023)
  7. Angelillo M, Di Maio G, Costa G, et al. Prevalence of occupational voice disorders in teachers. J Prev Med Hyg 2009;50(1):26–32. DOI: 10.15167/2421-4248/jpmh2009.50.1.152
  8. Pestana PM, Vaz-Freitas S, Manso MC. Prevalence of voice disorders in singers: systematic review and meta-analysis. J Voice 2017;31(6): 722–727. DOI: 10.1016/j.jvoice.2017.02.010
  9. Phyland DJ, Oates J, Greenwood KM. Self-reported voice problems among three groups of professional singers. J Voice 1999;13(4): 602–611. DOI: 10.1016/s0892-1997(99)80014-9
  10. Lloyd AT, Gerhard J, Baker P, et al. Prevalence of vocal fold pathologies among first-year singing students across genres. Laryngoscope 2020;130(8):1996–2002. DOI: 10.1002/lary.28354
  11. Kitch JA, Oates J. The perceptual features of vocal fatigue as self-reported by a group of actors and singers. J Voice 1994;8(3):207–214. DOI: 10.1016/s0892-1997(05)80291-7
  12. Long J, Williford HN, Olson MS, et al. Voice problems and risk factors among aerobics instructors. J Voice 1998;12(2):197–207. DOI: 10.1016/s0892-1997(98)80039-8
  13. Rumbach AF. Vocal problems of group fitness instructors: prevalence of self-reported sensory and auditory-perceptual voice symptoms and the need for preventative education and training. J Voice 2013;27(4):524.e11–21. DOI: 10.1016/j.jvoice.2013.01.016
  14. Fontan L, Fraval M, Michon A, et al. Vocal problems in sports and fitness instructors: a study of prevalence, risk factors, and need for prevention in France. J Voice 2017;31(2):261.e33–261.e38. DOI: 10.1016/j.jvoice.2016.04.014
  15. Lerner MZ, Paskhover B, Acton L, et al. Voice disorders in actors. J Voice 2013;27(6):705–708. DOI: 10.1016/j.jvoice.2013.05.006
  16. Devadas U, Rajashekhar B. The prevalence and impact of voice problems in call center operators. J Laryngol Voice 2013;3(1):3–9. DOI: 10.4103/2230-9748.118696
  17. Jones K, Sigmon J, Hock L, et al. Prevalence and risk factors for voice problems among telemarketers. Arch Otolaryngol Head Neck Surg 2002;128(5):571–577. DOI: 10.1001/archotol.128.5.571
  18. Phyland D, Miles A. Occupational voice is a work in progress: active risk management, habilitation and rehabilitation. Curr opin otolaryngo 2019;27(6):439–447. DOI: 10.1097/MOO.0000000000000584
  19. Dietrich M, Abbott KV, Gartner-Schmidt J, et al. The frequency of perceived stress, anxiety, and depression in patients with common pathologies affecting voice. J Voice 2008;22(4):472–488. DOI: 10.1016/j.jvoice.2006.08.007
  20. Hirano M. Structure and vibratory behavior of the vocal folds. In: Sawashima T, Cooper D, eds. Dynamic aspects of speech production. Tokyo, Japan: University of Tokyo Press; 1977. pp. 13–27.
  21. Rousseau B, Sohn J, Tateya I, et al. Functional outcomes of reduced hyaluronan in acute vocal fold scar. Ann Otol Rhinol Laryn 2004;113(10):767–776. DOI: 10.1177/000348940411301001
  22. Cantor-Cutiva LC. Association between occupational voice use and occurrence of voice disorders: a meta-analysis. Areté 2018;18(2):1. DOI: 10.33881/1657-2513.art.18201
  23. Kapre, Gauri; Nerurkar, Nupur K. Anatomy of the Larynx. In: Nerurkar, Nupur K.; Roychoudhury, Amitabha, editors. Textbook of Laryngology. 1st ed. New Delhi: Jaypee Brothers Medical Publishers; 2017. p. 21.
  24. Verdolini K. The language we use in clinical voice. Perspectives on Voice and Voice Disorders 1998;8(2):3–4. DOI: 10.1044/vvd8.2.3
  25. Behrman A. Facilitating behavioral change in voice therapy: the relevance of motivational interviewing. Am J Speech Lang Pathol 2006;15(3):215–225. DOI: 10.1044/1058-0360(2006/020)
  26. Jacobson BH, Johnson A, Grywalski C, et al. The voice handicap index (VHI) development and validation. Am J Speech Lang Pathol 1997;6(3):66–70. DOI: 10.1044/1058-0360.0603.66
  27. Rosen CA, Lee AS, Osborne J, et al. Development and validation of the voice handicap index-10. Laryngoscope 2004;114(9):1549–1556. DOI: 10.1097/00005537-200409000-00009
  28. Hogikyan ND, Sethuraman G. Validation of an instrument to measure voice-related quality of life (V-RQOL). J Voice 1999;13(4):557–569. DOI: 10.1016/s0892-1997(99)80010-1
  29. Available at: https://www.pentaxmedical.com/pentax/en/92/1/ENT-Speech
  30. Available at: https://www.fon.hum.uva.nl/praat/
  31. Hillenbrand JM. Acoustic analysis of voice: a tutorial. Perspectives on Speech Science and Orofacial Disorders 2011;21(2):31–43. DOI: 10.1044/ssod21.2.31
  32. Eckel FC, Boone DR. The s/z ratio as an indicator of laryngeal pathology. J speech hear disord 1981;46(2):147–149. DOI: 10.1044/jshd.4602.147
  33. Isshiki N, Okamura H, Tanabe M, et al. Differential diagnosis of hoarseness. Folia Phoniat (Basel) 1969;21(1):9–19. DOI: 10.1159/000263230
  34. Kempster GB, Gerratt BR, Abbott KV, et al. Consensus auditory-perceptual evaluation of voice: development of a standardized clinical protocol. Am J Speech Lang Pathol 2009;18(2):124–132. DOI: 10.1044/1058-0360(2008/08-0017)
  35. Nemr K, Simoes-Zenari M, Cordeiro GF, et al. GRBAS and Cape-V scales: high reliability and consensus when applied at different times. J Voice 2012;26(6):812.e17–22. DOI: 10.1016/j.jvoice.2012.03.005
  36. Paul BC, Chen S, Sridharan S, et al. Diagnostic accuracy of history, laryngoscopy, and stroboscopy. Laryngoscope 2013;123(1):215–219. DOI: 10.1002/lary.23630
  37. Casiano RR, Zaveri V, Lundy DS. Efficacy of videostroboscopy in the diagnosis of voice disorders. Otolaryng Head Neck 1992;107(1): 95–100. DOI: 10.1177/019459989210700115
  38. Cohen SM, Kim J, Roy N, et al. Change in diagnosis and treatment following specialty voice evaluation: A national database analysis. Laryngoscope 2015;125(7):1660–1666. DOI: 10.1002/lary.25192
  39. Altman KW, Atkinson C, Lazarus C. Current and emerging concepts in muscle tension dysphonia: a 30-month review. J Voice 2005;19(2):261–267. DOI: 10.1016/j.jvoice.2004.03.007
  40. Izadi F, Salehi A. Comparison between palpatory findings of the hyoid position and their acoustic, videostroboscopic, and perceptual attributes in patients with muscle tension dysphonia (with and without organic lesions). J Voice 2013;27(1):78–83. DOI: 10.1016/j.jvoice.2012.06.008
  41. Lee EK, Son YI. Muscle tension dysphonia in children: voice characteristics and outcome of voice therapy. Int J Pediatr Otorhinolaryngol 2005;69(7):911–917. DOI: 10.1016/j.ijporl.2005.01.030
  42. Bless DM, Hirano M, Feder RJ. Videostroboscopic evaluation of the larynx. Ear Nose Throat J 1987;66(7):289–296. DOI: https://journals.sagepub.com/home/Ear
  43. Shoffel-Havakuk H, Lava CX, Reuven Y, et al. Effect of vitamin B12 injection on the vocal performance of professional singers: a randomized, double-blind, placebo-controlled, crossover trial. JAMA Otolaryngol Head Neck Surg 2021;147(1):9–15. DOI: 10.1001/jamaoto.2020.4026
  44. Roy N, Barkmeier-Kraemer J, Eadie T, et al. Evidence-based clinical voice assessment: a systematic review. Am J Speech Lang Pathol 2013;22(2):212–226. DOI: 10.1044/1058-0360(2012/12-0014)
  45. Misono S, Marmor S, Roy N, et al. Multi-institutional study of voice disorders and voice therapy referral: Report from the CHEER Network. Otolaryngol Head Neck Surg 2016;155(1):33–41. DOI: 10.1177/0194599816639244
  46. Watts CR, Hamilton A, Toles L, et al. A randomized controlled trial of stretch-and-flow voice therapy for muscle tension dysphonia. Laryngoscope 2015;125(6):1420–1425. DOI: 10.1002/lary.25155
  47. Cohen SM, Garrett CG. Utility of voice therapy in the management of vocal fold polyps and cysts. Otolaryng Head Neck 2007;136(5): 742–746. DOI: 10.1016/j.otohns.2006.12.009
  48. Sulica L, Behrman A. Management of benign vocal fold lesions: a survey of current opinion and practice. Ann Oto, Rhinol Laryn 2003;112(10):827–833. DOI: 10.1177/000348940311201001
  49. Verdolini-Marston K, Burke MK, Lessac A, et al. Preliminary study of two methods of treatment for laryngeal nodules. J Voice 1995;9(1): 74–85. DOI: 10.1016/s0892-1997(05)80225-5
  50. Behlau M, Zambon F, Guerrieri AC, et al. Epidemiology of voice disorders in teachers and nonteachers in Brazil: prevalence and adverse effects. J Voice 2012;26(5):665.e9–18. DOI: 10.1016/j.jvoice.2011.09.010
  51. Gaskill CS, O'Brien SG, Tinter SR. The effect of voice amplification on occupational vocal dose in elementary school teachers. J Voice 2012;26(5):667.e19–27. DOI: 10.1016/j.jvoice.2011.10.010
  52. Johns MM. Update on the etiology, diagnosis, and treatment of vocal fold nodules, polyps, and cysts. Curr Opin Otolaryngol Head Neck Surg 2003;11(6):456–461. DOI: 10.1097/00020840-200312000-00009
  53. Rosen CA, Gartner-Schmidt J, Hathaway B, et al. A nomenclature paradigm for benign midmembranous vocal fold lesions. Laryngoscope 2012;122(6):1335–1341. DOI: 10.1002/lary.22421
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