UNASSIGNED: Voice disorders in occupations connected with excessive voice use can be attributed to the inappropriate use of voice and poor vocal hygiene. Therefore, it is essential for persons in such occupations to be aware of vocal abuse, vocal hygiene, practices and their influence on maintaining healthy voice.
UNASSIGNED: To assess knowledge, attitude and practice on vocal abuse and vocal hygiene among diverse occupational voice users in Jodhpur.
UNASSIGNED: A cross-sectional study was conducted in Jodhpur district, Rajasthan. Data was collected from 424 participants (106 Doctors, 106 Teachers, 106 Advocates, 106 Vendors) from May 2023 to July 2023 by administrating a pretested semi structured questionnaire. Microsoft Excel and IBM SPSS (V. 23) statistical software were used for descriptive and inferential statistical analysis.
UNASSIGNED: Majority (92%) of the participants felt that their quality of voice was good. About 55% participants were not aware about the term vocal abuse (Doctors 17.9%, Teachers 39.6%, Advocates 79.2%, Vendors 44.3%). Around 56% participants (Doctors 63.3%, Teachers 66.0%, Advocates 32.1%, Vendors 61%) had negative attitude towards vocal hygiene practices. About 47% of the participants preferred home remedies and 44.3% (Doctors 72.6%, Teachers 48.1%, Advocates 41.5%, Vendors 15.1%) preferred to consult ENT specialist for their voice related problem. Perception of vocal abuse on vocal health and hygiene practices was found to statistically significant (p = 0.001) among the different category of occupations.
UNASSIGNED: In this perception-based, cross-sectional study it was found that majority of the participants were neither aware about term vocal abuse nor followed vocal hygiene practices. In view of the above findings it is strongly recommended that excessive voice users should be made aware of vocal hygiene practices & repeated reinforcement of the same is required to prevent voice related problem.

OBJECTIVE: To verify possible complaints, voice and aerodigestive symptoms, singing voice handicap, and knowledge of vocal health and hygiene in Candomblé religious leaders in Brazil.
METHODS: The study comprised 112 individuals who filled out a questionnaire with their identification and characterization, the stratified classification of their professional activities, and their self-perception of voice. Three self-assessment protocols - VoiSS, QSHV, and MSHI - were also used.
RESULTS: The self-assessment of voice ranged from average to good. VoiSS mean total score was 23.04, which is above the cutoff. QSHV mean score was 23.54 points, which is near the cutoff. MSHI mean score (the perception of singing voice handicap) was 25.66 points. There was a substantially strong positive correlation between VoiSS and MSHI total scores (0.789; p<0.001). Women had higher limitation scores (p=0.012) and total scores (p=0.012) in VoiSS and higher handicap scores (p=0.038) in MSHI. Level I professionals - vocal elite (singers and actors) - had significantly higher QSHV scores than those in levels IV (p=0.010) and V (p=0.008). Most respondents had not visited an otorhinolaryngologist (89.29%) within the last year and had not been submitted to speech therapy (83.04%) for voice complaints.
CONCLUSIONS: Candomblé leaders, particularly women, perceived voice symptoms and singing voice handicaps, with no relationship with their knowledge of vocal health and hygiene. Despite the complaints, most subjects reported not having visited health professionals responsible for voice care within the last year.
OBJECTIVE: Verificar a autopercepção de sintomas vocais e aerodigestivos, desvantagem vocal no canto e o conhecimento em saúde e higiene vocal em líderes religiosos do Candomblé do Brasil.
UNASSIGNED: Participaram deste estudo 112 indivíduos, que preencheram virtualmente um questionário de identificação, caracterização, classificação das atividades profissionais em níveis e autoavaliação vocal no momento atual, além de três protocolos de autoavaliação: Escala de Sinais e Sintomas (ESV), Questionário de Saúde e Higiene Vocal (QSHV) e Índice de Desvantagem para o Canto Moderno (IDCM). Foram utilizados os testes de correlação de Spearman, teste de Mann-Whitney e teste de Kruskal-Wallis.
RESULTS: A autoavaliação vocal no momento atual variou de razoável a boa. A média do escore total na ESV foi de 23,04, acima da nota de corte. O QSHV apresentou valor médio de 23,54 pontos, próximo à nota de corte. O Índice de Desvantagem para o Canto Moderno (IDCM) mostrou média de 25,66 pontos. Houve correlação positiva de força substancial entre os escores totais da ESV e IDCM (0,789). Mulheres apresentaram maiores escores no ESV total e ESV limitação, além de maior escore no IDCM desvantagem. Profissionais do nível I - elite vocal (cantores e atores) apresentaram escores significativamente maiores para o QSHV que os profissionais do grupo IV (usuário não profissional não-vocal) e os do nível V (pessoas que estão fora do mercado de trabalho). A maioria dos respondentes não consultou Otorrinolaringologista (89,29%) no último ano e nem realizou fonoterapia (83,04%) por queixas vocais.
UNASSIGNED: Líderes do Candomblé apresentaram percepção de sintomas vocais e desvantagem vocal no canto, mais evidente nas mulheres, não havendo relação com o conhecimento de saúde e higiene vocal. Apesar da identificação de sintomas vocais, a maior parte dos sujeitos relatou não ter acessado profissionais de saúde responsáveis por esses cuidados com a voz no último ano.

UNASSIGNED: Hemihypertrophy (HH) is a rare congenital malformation usually recognized at birth. It is often diagnosed due to impaired aesthetics and mobility caused by asymmetry of the face, body, or limbs. Some patients are diagnosed due to the presence of tumors and mental abnormalities.
UNASSIGNED: A 14-year-old boy with hoarseness since infancy and progressively increasing with age. Laryngoscopy and CT of the larynx suggested bilateral asymmetry of the laryngeal structures, and voice analysis suggested severe voice disorders. The boy had no history of trauma or other medical conditions, but had physical asymmetry since birth, which coincided with the laryngeal asymmetry. After a detailed examination and evaluation, we considered that his voice disorders were unexpectedly caused by crossed idiopathic HH. Since the boy in his growth spurts is not a candidate for surgery, we implemented individualized voice correction therapy. After practicing, the boy\'s voice disorders were significantly relieved.
UNASSIGNED: Congenital HH can cause asymmetrical development of the larynx, which leads to voice disorders. Voice correction therapy is an effective treatment for patients unsuitable for surgery.

UNASSIGNED: Voice disorders impede communication and limit quality of life for many children. However, research demonstrating the prevalence of pediatric voice problems and associated voice use patterns is scarce. This investigation examined the prevalence of voice problems and vocal health characteristics of school-aged children.
UNASSIGNED: To examine the prevalence of voice problems in school-aged children throughout the US with reference to lifestyle, demographic characteristics, and voice use patterns.
UNASSIGNED: This study used a cross-sectional design to survey a probability sample of caregivers of children aged 4 to 12 years living throughout the US in 2023.
UNASSIGNED: Caregivers were surveyed regarding their children\'s voice use, voice symptoms, voice problems, extracurricular activities, and demographic information. Caregivers also competed the Pediatric Voice-Related Quality of Life questionnaire. The Fisher exact test, χ2 tests, and logistic regression were used to compare children with and without voice problems.
UNASSIGNED: Overall, 6293 panelists were invited to complete screening questions for the survey, and 1789 individuals were screened for eligibility between March and April 2023. Of these, 1175 parents (65.7%) completed the survey. Twenty-one (1.8%) were excluded for a combination of either high refusal rates (n = 16), speeding (n = 2), or straight lining (n = 12). The final number of participants included in analysis was 1154 caregivers of children aged 4 to 12 years (559 female children [48.4%]; 595 male children [51.6%]; mean [SD] age, 8.02 [2.49] years). The prevalence of voice problems in children was 6.7% (n = 78), and the lifetime prevalence was 12% (n = 138). Benign vocal fold lesions was the most common diagnosis underlying voice complaints, and other causes included respiratory illness, allergies, autism-related voice issues, and other neurological conditions. Risk factors for pediatric voice problems included being male (odds ratio [OR], 1.47; 95% CI, 1.0-2.1), having more than 4 individuals living in the household (OR, 2.30; 95% CI, 1.2-4.4), poor speech intelligibility (OR, 2.26; 95% CI, 1.2-4.3), maternal history of voice problems (OR, 4.54; 95% CI, 1.2-16.4), participating in online gaming (OR, 1.56; 95% CI, 1.0-2.3), and secondhand smoke exposure (OR, 1.7; 95% CI, 1.1-2.6). Voice use-related risk factors included frequent talking, coughing, throat clearing, tantrums/crying, and vocal strain. Voice problems were associated with substantially detracted quality of life as measured by the Pediatric Voice-Related Quality of Life questionnaire, limited social/extracurricular interactions, increased school absences, and negative attention from adults.
UNASSIGNED: The results of this survey study suggest that pediatric voice problems are relatively common and detract from quality of life. Specific environmental and behaviorial factors are associated with increased risk for voice disorders.

OBJECTIVE: To map the vocal risk in professional classical singers, analyzing their self-assessment of voice and self-perception of singing voice handicap and vocal fatigue.
METHODS: The study sample comprised of 52 professional classical choir singers, aged 31 to 72 years. They answered an online questionnaire in Google Forms, addressing their characterization, self-assessment of voice, the Voice Handicap Index-10 (VHI-10), Classical Singing Handicap Index (CSHI), and Vocal Fatigue Index (VFI).
RESULTS: The mean self-assessment of voice was between \"Good\" and \"Very good\" (1.2). The mean total VHI-10 score was 1.35, which is below the cutoff. The mean total CSHI score was 10.04. The mean total VFI score was 10.83, near the cutoff value. Classical singers who use their voice to give examples to students in their classes had higher scores in VHI-10 (p = 0.013), VFI voice restriction (p = 0.011), and VFI total score (p = 0.015). Besides, classical singers who already visited a Speech-Language Pathologist for voice problems had higher scores in VFI voice restriction (p = 0.040) and VFI recovery with voice rest (p = 0.019), in addition to correlations between instrument scores.
CONCLUSIONS: Professional classical singers did not have voice handicaps. However, their self-perception of vocal fatigue was more present when the singing voice was used, such as giving examples with their own voice in class. Having had voice problems and visited a Speech-Language Pathologist in the past led to a greater perception of vocal recovery with rest.
OBJECTIVE: Mapear o risco vocal em cantores eruditos profissionais, analisando sua autoavaliação vocal e autopercepção de desvantagem vocal no canto e fadiga vocal.
UNASSIGNED: Participaram deste estudo 52 cantores eruditos de coros profissionais, entre 31 e 72 anos, que preencheram online (Formulários Google) um questionário de caracterização, autoavaliação vocal, bem como os instrumentos Índice de Desvantagem Vocal 10 - IDV-10, Índice de Desvantagem para o Canto Clássico - IDCC e Índice de Fadiga Vocal - IFV.
RESULTS: A média da autoavaliação vocal ficou entre “Boa” e “Muito boa” (1,2). A média do escore total do IDV-10 foi 1,35, abaixo da nota de corte. A média do escore total do IDCC foi 10,04. A média do escore total do IFV foi de 10,83, próxima da nota de corte. Cantores eruditos que, em suas aulas, dão exemplos aos alunos com a própria voz apresentam maiores escores nos instrumentos IDV-10 (p=0,013), IFV restrição vocal (p=0,011) e IFV escore total (p=0,015). Cantores eruditos que já procuraram fonoaudiólogo devido a problemas de voz apresentam maiores escores no IFV fator restrição vocal (p=0,040) e no IFV fator recuperação com repouso vocal (p=0,019), além de terem correlações entre os escores dos instrumentos.
UNASSIGNED: Cantores eruditos profissionais não apresentam desvantagem vocal. Porém, questões relacionadas à autopercepção de fadiga vocal se mostram mais presentes quando relacionadas às atividades de uso da voz cantada, como dar exemplos em aulas com a própria voz. Ter tido problema vocal e procurado fonoaudiólogo no passado proporciona maior percepção de recuperação vocal com repouso.

UNASSIGNED: The aim of this study is to evaluate the presence of laryngopharyngeal reflux in patients with voice disorders thereby aiding in the early management and improving the quality of life.
UNASSIGNED: Cross Sectional study.
UNASSIGNED: This cross sectional study was carried out in a tertiary care hospital, patients with history of voice change for more than 3 weeks were included, and divided into 4 groups depending upon the level of voice use. Patients were asked to fill Koufmann Reflux Symptom Index questionnaire followed by video laryngoscopy and findings were plotted according to Reflux Finding Score. Based on the scoring, impact of LPRD in patient with voice disorders was analysed.
UNASSIGNED: Among the 90 study participants, 74 (82.2%) were found to have LPRD. The mean age was 42.76 ± 10.33 years. Majority (43.2%) belong to the age group of 41-50 years, with female predominance (70.3%). Majority (41.9%) of them were level IV voice users. 59.5% were positive Koufman reflex symptom index, 67.6% were positive Reflex finding score. Hoarseness (58.1%) the most common symptom.
UNASSIGNED: Laryngopharyngeal reflux disease has to be considered in patients presenting with hoarseness of voice for more than three weeks. Simple and highly reproducible scores like Reflux Symptom Index and Reflux Finding Score proven useful and valuable tools in diagnosing LPRD thereby aiding in early diagnosis and prompt management and improves the patient\'s quality of life.
UNASSIGNED: Level 1.

UNASSIGNED: Although different factors and voice measures have been associated with phonotraumatic vocal hyperfunction (PVH), it is unclear what percentage of individuals with PVH exhibit such differences during their daily lives. This study used a machine learning approach to quantify the consistency with which PVH manifests according to ambulatory voice measures. Analyses included acoustic parameters of phonation as well as temporal aspects of phonation and rest, with the goal of determining optimally consistent signatures of PVH.
UNASSIGNED: Ambulatory neck-surface acceleration signals were recorded over 1 week from 116 female participants diagnosed with PVH and age-, sex-, and occupation-matched vocally healthy controls. The consistency of the manifestation of PVH was defined as the percentage of participants in each group that exhibited an atypical signature based on a target voice measure. Evaluation of each machine learning model used nested 10-fold cross-validation to improve the generalizability of findings. In Experiment 1, we trained separate logistic regression models based on the distributional characteristics of 14 voice measures and durations of voicing and resting segments. In Experiments 2 and 3, features of voicing and resting duration augmented the existing distributional characteristics to examine whether more consistent signatures would result.
UNASSIGNED: Experiment 1 showed that the difference in the magnitude of the first two harmonics (H1-H2) exhibited the most consistent signature (69.4% of participants with PVH and 20.4% of controls had an atypical H1-H2 signature), followed by spectral tilt over eight harmonics (73.6% participants with PVH and 32.1% of controls had an atypical spectral tilt signature) and estimated sound pressure level (SPL; 66.9% participants with PVH and 27.6% of controls had an atypical SPL signature). Additionally, 77.6% of participants with PVH had atypical resting duration, with 68.9% exhibiting atypical voicing duration. Experiments 2 and 3 showed that augmenting the best-performing voice measures with univariate features of voicing or resting durations yielded only incremental improvement in the classifier\'s performance.
UNASSIGNED: Females with PVH were more likely to use more abrupt vocal fold closure (lower H1-H2), phonate louder (higher SPL), and take shorter vocal rests. They were also less likely to use higher fundamental frequency during their daily activities. The difference in the voicing duration signature between participants with PVH and controls had a large effect size, providing strong empirical evidence regarding the role of voice use in the development of PVH.

UNASSIGNED: The domination of the Contemporary Commercial Music (CCM) industry in music markets has led to a significant increase in the number of CCM performers. Performing in a wide variety of singing styles involves exposing CCM singers to specific risk factors potentially leading to voice problems. This, in turn, necessitates the consideration of this particular group of voice users in the Occupational Health framework. The aim of the present research was threefold. First, it sought to profile the group of Polish CCM singers. Second, it was designed to explore the prevalence of self-reported voice problems and voice quality in this population, in both speech and singing. Third, it aimed to explore the relationships between voice problems and lifetime singing involvement, occupational voice use, smoking, alcohol consumption, vocal training, and microphone use, as potential voice risk factors.
UNASSIGNED: The study was conducted in Poland from January 2020 to April 2023. An online survey included socio-demographic information, singing involvement characteristics, and singers\' voice self-assessment. The prevalence of voice problems was assessed by the Polish versions of the Vocal Tract Discomfort Scale (VTDS) and the Singing Voice Handicap Index (SVHI). Also, a self-reported dysphonia symptoms protocol was applied. The perceived overall voice quality was assessed by a Visual Analogue Scale (VAS) of 100 mm.
UNASSIGNED: 412 singers, 310 women and 102 men, completed the survey. Nearly half of the studied population declared lifetime singing experience over 10 years with an average daily singing time of 1 or 2 h. 283 participants received vocal training. For 11.4% of respondents, singing was the primary income source, and 42% defined their career goals as voice-related. The median scores of the VTDS were 11.00 (0-44) and 12.00 (0-40) for the Frequency and Severity subscales, respectively. The median SVHI score of 33 (0-139) was significantly higher than the normative values determined in a systematic review and meta-analysis (2018). Strong positive correlations were observed between SVHI and both VTD subscales: Frequency (r = 0.632, p < 0.001) and Severity (r = 0.611, p < 0.001). The relationships between most of the other variables studied were weak or negligible.
UNASSIGNED: The examined CCM singers exhibited substantial diversity with regard to musical genre preferences, aspirations pertaining to singing endeavors, career affiliations, and source of income. Singing voice assessment revealed a greater degree of voice problems in the examined cohort than so far reported in the literature, based on the SVH and VTDS.

OBJECTIVE: This study aimed to translate and cross-culturally adapt the \"Voice-related Experiences of Nonbinary Individuals\" (VENI) to Brazilian Portuguese (BP).
METHODS: Cross-cultural adaptation was performed based on the combined guidelines of the World Health Organization\'s (WHO) Translation Recommendations and the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). The process included five stages: a) Translation of the instrument into BP by a translator specialized in the construct and a non-specialist, both native BP speakers and fluent in English; b) Synthesis of the two translations by consensus; c) Back-translation by a translator specialized in the construct and a non-specialist, both native English speakers and fluent in BP; d) Analysis by a committee of five speech-language pathologists voice specialist and the creation of the final version; e) Pre-testing with 21 individuals from the target population, conducted virtually.
RESULTS: During the translation stage, there were disagreements regarding the title, instructions, response key, and 15 items. In the back-translation stage, there were discrepancies in the format of 12 items and the content of four items. The expert committee\'s analysis led to changes in the title, instructions, one option in the response key, and eight items to meet the equivalence criteria. In the pre-test, a significantly higher proportion of usual responses to the instrument was observed when compared to the non-applicable option; this is frequently observed in instrument adaptations.
CONCLUSIONS: The cross-cultural adaptation of VENI into Brazilian Portuguese was successful, resulting in the \"Experiências relacionadas à Voz de Pessoas Não Binárias - VENI-Br\" version.
OBJECTIVE: Traduzir e adaptar transculturalmente o Voice-related Experiences of Nonbinary Individuals – VENI para o português brasileiro.
UNASSIGNED: Os procedimentos de adaptação transcultural foram baseados na combinação das recomendações e diretrizes da World Health Organization (WHO) Guidelines on Translation com o COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). Foram realizadas cinco etapas: a) tradução do instrumento para o Português Brasileiro (PB) por um tradutor especialista no construto e um não-especialista, nativos do PB e fluentes em inglês; b) elaboração da síntese das duas traduções por consenso; c) retrotradução por um tradutor especialista no construto e um não-especialista, nativos do inglês e fluentes em PB; d) análise de um comitê formado por cinco fonoaudiólogos especialistas em voz e elaboração da versão final; e) pré-teste com 21 pessoas da população-alvo, aplicado virtualmente.
RESULTS: Na tradução houve discordância no título, instruções, chave de resposta e em 15 itens. Na retrotradução, houve discordância quanto à forma em 12 itens e ao conteúdo em 4 itens. A análise do comitê de especialistas indicou mudanças no título, instruções de resposta, uma opção da chave de resposta, e em oito itens, para atender aos critérios de equivalência. No pré-teste houve proporção significativamente maior de respostas habituais do instrumento quando comparadas com a opção não-aplicável, usada regularmente nas adaptações de instrumentos.
UNASSIGNED: A adaptação transcultural para o português brasileiro do VENI foi bem sucedida e resultou na versão denominada “Experiências relacionadas a Voz de Pessoas Não Binárias - VENI-Br”.

OBJECTIVE: To compare the acoustic measurements of Cepstral Peak Prominence Smoothed (CPPS) and Acoustic Voice Quality Index (AVQI) of children with normal and altered voices, to relationship with auditory-perceptual judgment (APJ) and to establish cut-off points.
METHODS: Vocal recordings of the sustained vowel and number counting tasks of 185 children were selected from a database and submitted to acoustic analysis with extraction of CPPS and AVQI measurements, and to APJ. The APJ was performed individually for each task, classified as normal or altered, and for the tasks together defining whether the child would pass or fail in a situation of vocal screening.
RESULTS: Children with altered APJ and who failed the screening had lower CPPS values and higher AVQI values, than those with normal APJ and who passed the screening. The APJ of the sustained vowel task was related to CPPS and AVQI, and APJ of the number counting task was related only to AVQI and CPPS numbers. The cut-off points that differentiate children with and without vocal deviation are 14.07 for the vowel CPPS, 7.62 for the CPPS numbers and 2.01 for the AVQI.
CONCLUSIONS: Children with altered voices, have higher AVQI values and lower CPPS values, when detected in children with voices within the normal range. The acoustic measurements were related to the auditory perceptual judgment of vocal quality in the sustained vowel task, however, the number counting task was related only to the AVQI and CPPS. The cut-off points that differentiate children with and without vocal deviation are 14.07 for the CPPS vowel, 7.62 for the CPPS numbers and 2.01 for the AVQI. The three measures were similar in identifying voices without deviation and dysphonic voices.
OBJECTIVE: Comparar as medidas acústicas de Cepstral Peak Prominence Smoothed (CPPS) e Acoustic Voice Quality Index (AVQI) de crianças com vozes normais e alteradas, relacionar com o julgamento perceptivo-auditivo (JPA) da voz e estabelecer pontos de corte.
UNASSIGNED: Gravações vocais das tarefas de vogal sustentada e contagem de números de 185 crianças foram selecionadas em um banco de dados e submetidas a análise acústica com extração das medidas de CPPS e AVQI, e ao JPA. O JPA foi realizado individualmente para cada tarefa e as amostras foram classificadas posteriormente como normal ou alterada, e para as tarefas em conjunto definindo-se se a criança passaria ou falharia em uma situação de triagem vocal.
RESULTS: Crianças com JPA alterado e que falharam na triagem apresentaram valores menores de CPPS e maiores de AVQI, do que as com JPA normal e que passaram na triagem. O JPA da tarefa de vogal sustentada se relacionou ao CPPS e AVQI, e da tarefa de contagem de números relacionou-se apenas ao AVQI e CPPS números. Os pontos de corte que diferenciam crianças com e sem desvio vocal são 14,07 para o CPPS vogal, 7,62 para o CPPS números e 2,01 para o AVQI.
UNASSIGNED: Crianças com JPA alterado apresentaram maiores valores de AVQI e menores valores de CPPs. O JPA da tarefa de vogal previu todas as medidas acústicas, porém, de contagem previu apenas as medidas extraídas dela. As três medidas foram semelhantes na identificação de vozes sem desvio e vozes disfônicas.