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A well-functioning voice is part of the professional skills needed in many occupations. Although voice is an important communication tool, it is more than that: it is something which reflects human identity. The need for speech and voice is growing in spite of increasing technology applications; even instruments and technical equipment are guided by voice. The number of people having voice problems is increasing, which implies that voice does not always function according to the speakers’ needs. Voice ergonomics has been developed for improving voice health and care. This book offers background knowledge and concrete guidelines on how to improve communication environments and practices for decreasing voice loading.
Introduction The concept of occupational voice disorders Philippe H. Dejonckere "People using their voice professionally are at risk for occupational voice diseases, and require specific prevention and treatment" was the topic focused on by the third Pan European Voice Conference, organized in August 1999 at Utrecht University. The present book includes the main tutorial lectures, with reviews of the most relevant research data and opinions regarding this specific area of concern. Occupational voice users include not only singers and actors, but also teachers, politicians, lawyers, clergymen, telephone operators, etc.(1). The pathogenesis of voice disorders in such patients can be primarily related to their occupation, and thus, after adequate differential diagnosis, these need to be recognized as true occupational diseases, in the same way as, for example, occupational hearing loss (2). A surfeit of information is available on the potential damage from exposure to excessive noise levels(3,4). Noise-induced hearing loss is generally recognized as a typical occupational disease. The relationship between dose and effect is clear, as is documented in publications by the International Organization of Standardization (ISO) (5). The dose combines intensity and duration, and therefore, the concept of dosimetry is of major importance. Also of importance is the definition of the safe limits for exposure to noise. However, factors regarding individual susceptibility to noise and the reversibility of early effects also have to be considered, as well as possible preventive indices of noise-induced hearing loss (6). In some - but not all - respects, noise-induced hearing loss may be considered as a useful model for occupational voice disorders. Epidemiology Titze (7) compared the percentage of the US working population and of the voice-clinic load for different occupation categories: for example, telephone marketers constitute only 0.78% of the total workforce, but 2.3% of the clinic load; teachers represent 4.2% of the US workforce and 20% of the voice-clinic load. Studies based on questionnaires have suggested that teachers and aerobic instructors are at high risk for disabilities from voice disorders, and that these health problems may have significant work-related and economic effects (8,9). For example, Russel et al.(10) investigated the prevalence of self-reported voice problems in teachers: 16% of teachers reported voice problems on the day of the survey, 20% during the current teaching year, and 19% at some time during their career. Roughly speaking, we can conclude from the several studies published during the 1990s that about 20% of teachers experience voice disorders (11). Voice dosimetry Objective measurement of vocal use and vocal load is necessary for the identification of activities and working conditions that are at risk. Voice dosimeters can provide information on the total vocalization time and sound pressure level over a whole working day, in a real life situation (12-14). Just as noise dosimeters define acceptable levels of noise exposure, voice dosimeters help to define the average acceptable limits for vocal load. Hyperphonation Repeated mechanical vibrations transmitted to the body tissues by engines or machines are known to be able of eliciting - in certain conditions - specific kinds of pathology, which are also considered to be occupational diseases (15,16). The vibration may involve the whole body (e.g., in a vehicle) or mainly the hand, wrist, elbow, or shoulder (hand-held power tools). There are standards in the field of occupational health that stipulate the acceptable limits for tissue acceleration values, depending on the frequency (17). Titze's calculations suggest that the risk of damage from tissue vibration is exceeded by occupational vocalists, such as telephone marketers and teachers (18). In the last few years, much new and important information has materialized on the dangers of 'hyperphonation', i.e., loud and prolonged phonation beyond the physiological range. Laboratory experiments on canine larynges, hyper-phonated in vivo under anesthesia, demonstrated obvious damage to vocal fold epithelia (19). The basement membrane shows early lesions and seems to be particularly sensitive (20). A clinical study by Mann et al.(21) in drill sergeants, demonstrated significant increases in vocal fold edema, erythema and edge irregularity, and decreases in vocal fold mucosal wave and amplitude of excursion, following a five-day training period Voice fatigue, relief and recovery According to Titze (18) , two different aspects must be considered: Muscle fatigue: the muscle chemistry needs to be reset for the following contractions. Epithelial cells may die and be shed, due to repeated traumata. New cells have to develop underneath. Collagen and elastin fibers may have separated from the structural matrix of the lamina propria, and have to be removed and replaced by the fibroblasts. Detached protein debris will be removed and re-used by the fibroblasts to make new protein fibers that will support the connective tissue structure. Therefore, minor destruction and repair is continuous. Can the regenerative processes keep up with the destructive process, and what are the physiological time constants in these processes? When there is damage to the joints, ligaments, tendons, or other connective tissue, the recovery time will be proportional to the amount of localized tissue injury that has occurred. If muscle fatigue is the only complaint, the recovery period required will probably be shorter. Hypothetical curves for tissue injury and the recovery period for human phonation have been suggested by Titze (18). Nevertheless, vocal fatigue is still difficult to identify in practical and clinical situations, and Buekers has questioned the clinical relevance of voice endurance tests (13,14). Environmental factors The relative humidity of the air affects vocal function: the most common subjective complaints of teachers with regard to their working environment are the dryness and dustiness of the air. Professional singers note that singing is more difficult in a dry environment: dry air puts an increased strain on the phonatory apparatus and raises the demands on its efficacious and appropriate use (22). The human voice is very sensitive to decreases in the relative humidity of inhaled air because, in experimental conditions, even after short provocation, a significant increase in perturbation measures has been found (23). Noise is also a very common and relatively well-known risk factor in the working environment of professional voice users. It has been observed that the sound level of the speaking voice significantly increases in ambient noise levels starting from 40 dB (A) (about 3 dB for each 10 dB increase in ambient noise), due to the Lombard effect (24,25). In kindergartens, for example, noise levels have been found to vary between 75 and 80 dB (A) (26,27). Effects of stress Mendoza and Carballo investigated the effects of experimentally induced stress on voice characteristics (28). In conditions of stress, induced by means of a stressful environment and cognitive workload tasks, they observed: 1. an increase in F o with respect to baseline; 2. a decrease in pitch perturbation quotient and in amplitude perturbation quotient; 3. a lower presence of turbulent noise in the spectral zone in which the existence of harmonic components is not expected (2800-5800 Hz), with respect to harmonic energy in the 70-4500 Hz range; 4. an increase in harmonic energy in the 1600-4500 Hz range with respect to harmonic energy in the 70-1600 Hz range. The increase in F o seems to be considered a universal indicator of stress and of cognitive workload, as is the lowering of F o perturbation. The response to a stressful stimulus demands a high level of activation, which in turn produces elevated ergotropic arousal that would cause an increase in the tension of the vocal muscles, producing a higher and more tense voice. Mattiske et al. (29) report that teachers seem to experience a significant degree of stress during their work (30) , and there is some research evidence that anxiety and stress are associated with the development of voice problems (31). Marks (32) compares teachers' voices with those of nurses, and finds that psychological stress is reported more frequently by teachers. There are indications that stress, psychological tension, personality, and other psychological factors, may play an important role in voicing problems among teachers (30,33,34). Vocal fold lesions Phonotrauma may result in typical vocal fold lesions, to be interpreted as a direct consequence of mechanical stress and/or as tissue reaction to that stress. Vocal fold nodules and polyps are classical examples (35,36) , but also contact ulcerations/ granulomas of the vocal processes (35,36,37) , if not induced by acid re-flux. Vocal fold hemorrhage is generally consecutive to acute phonotrauma (35). Depending on reversibility and context, microsurgery may become indicated as an important element of the treatment (38,39). Care and cure Patients with occupational voice disorders should benefit from specific medical and paramedical treatments, as well as from technical aids, with respect to their particular pathogenesis. There are major economical aspects at stake, and occupational rehabilitation plays an important role. In a few cases, compensation and professional re-orientation is necessary. Outcomes of the various possible treatment strategies have still to be investigated. However, prevention is still essential. There are indications that vocal hygiene education programs could improve the voice by reducing vocal abuse in daily life and by practising specific strategies to maintain classroom order and to reduce the use of the voice during teaching (40). Further research is needed to demonstrate the usefulness of prevention strategies on the incidence of actual voice disorders.
The first guide to cover aspects of voice loss from an occupational health perspective, this reference covers procedures to detect, assess, and prevent voice loss in schools, industrial facilities, and other workplace environments, as well as covers occupational groups at risk and risk factors for developing voice loss-analyzing various chemical, e
Voice Work: Art and Science in Changing Voices is a key work that addresses the theoretical and experiential aspects common to the practical vocal work of the three major voice practitioner professions - voice training, singing teaching, and speech and language pathology. The first half of the book describes the nature of voice work along the normal-abnormal voice continuum, reviews ways in which the mechanism and function of the voice can be explored, and introduces the reader to an original model of voice assessment, suitable for all voice practitioners. The second half describes the theory behind core aspects of voice and provides an extensive range of related practical voice work ideas. Throughout the book, there are a number of case studies drawn from the author's own experiences and a companion website, providing audio clips to illustrate aspects of the text, can be found at www.wiley.com/go/shewell.
Voice Training Programs for Professional Speakers: Global Outcomes is a professional resource for voice education and training programs used to care for the voice of different professional speakers and occupational voice users. This includes teachers, media reporters, fitness instructors, telemarketers, clergy, speech pathologists, and more. Each chapter is authored by an experienced voice clinician who provides a clear description of a target population and its challenges, as well as a detailed roadmap describing a unique global experience in developing, implementing, and advocating for these programs in academic institutions, professional unions, and workplaces. This book provides detailed steps and outcomes of globally tested health care and voice training programs for each of the professional speaker populations addressed. Voice Training Programs for Professional Speakers can thus be used by phoniatricians, logopedists, speech-language pathologists, and vocal coaches as a comprehensive resource for tailored preventative and management programs. It can also be used by future and current professional speakers as a great self-education resource to help them better care, develop, and advocate for their own voices and careers.
Singer and actors are a unique group of performers, relying almost entirely on their voice for the professional livelihood. Jet lag, amplification, allergens, stress, pollution, and vocal strain all affect vocal performance. Written for the performer, the teacher, and the vocal coach, Care of the Professional Voice offers clear explanations and medical advice on vocal problems and vocal health. Care of the Professional Voice is written by experts in laryngology in the United States and Great Britain. This second edition includes a singer's guide to self-diagnosis.
The most comprehensive reference on voice care and science ever published! Substantially revised and updated since the previous edition published in 2005, Professional Voice: The Science and Art of Clinical Care, Fourth Edition provides the latest advances in the field of voice care and science. In three volumes, it covers basic science, clinical assessment, nonsurgical treatments, and surgical management. Twenty new chapters have been added. These include an in-depth chapter on pediatric voice disorders, chapters detailing how hormonal contraception, autoimmune disorders, and thyroid disorders affect the voice, as well as chapters on the evolution of technology in the voice care field, and advances in imaging of the voice production system. The appendices also have been updated. They include a summary of the phonetic alphabet in five languages, clinical history and examination forms, a special history form translated into 15 languages, sample reports from a clinical voice evaluation, voice therapy exercise lists, and others. The multidisciplinary glossary remains an invaluable resource. Key Features With contributions from a Who's Who of voice across multiple disciplines120 chapters covering all aspects of voice science and clinical careFeatures case examples plus practical appendices including multi-lingual forms and sample reports and exercise listsComprehensive indexMultidisciplinary glossary What's New Available in print or electronic format20 new chaptersExtensively revised and reorganized chaptersMany more color photographs, illustrations, and case examplesFully updated comprehensive glossaryMajor revisions with extensive new information and illustrations, especially on voice surgery, reflux, and structural abnormalities New Chapters 1. Formation of the Larynx: From Hox Genes to Critical Periods 2. High-Speed Digital Imaging 3. Evolution of Technology 4. Magnetic Resonance Imaging of the Voice Production System 5. Pediatric Voice Disorders 6. The Vocal Effects of Thyroid Disorders and Their Treatment 7. The Effects of Hormonal Contraception on the Voice 8. Cough and the Unified Airway 9. Autoimmune Disorders 10. Respiratory Behaviors and Vocal Tract Issues in Wind Instrumentalists 11. Amateur and Professional Child Singers: Pedagogy and Related Issues 12. Safety of Laryngology Procedures Commonly Performed in the Office 13. The Professional Voice Practice 14. Medical-Legal Implications of Professional Voice Care 15. The Physician as Expert Witness 16. Laryngeal Neurophysiology 17. The Academic Practice of Medicine 18. Teamwork 19. Medical Evaluation Prior to Voice Lessons 20. Why Study Music? Intended Audiences Individuals While written primarily for physicians and surgeons, this comprehensive work is also designed to be used by (and written in language accessible to) speech-language pathologists, singing voice specialists, acting voice specialists, voice teachers, voice/singing performers, nurses, nurse practitioners, physician assistants, and others involved in the care and maintenance of the human voice. Libraries It is a must-have reference for medical and academic libraries at institutions with otolaryngology, speech-language pathology, music, nursing and other programs related to the human voice.
A major new reference work with entries covering the entire field of communication and speech disorders.
Now in a fully revised and updated third edition, Working with Voice Disorders offers practical insight and direction into all aspects of voice disorders, from assessment and diagnosis to intervention and case management. Using evidence-based material, it provides clinicians with pragmatic, accessible support, facilitating and informing decision-making along the clinical journey, from referral to discharge. Key features of this resource include: A wealth of new, up-to-date practical and theoretical information, covering topics such as the prevention, assessment, intervention and treatment of a wide spectrum of voice disorders. A multi-dimensional structure, allowing the clinician to consider both specific aspects of patient management and aspects such as clinical effectiveness, clinical efficiencies and service management. Photocopiable clinical resources, from an at-a-glance summary of voice disorders to treatment and assessment protocols, and practical exercises and advice sheets for patients. Sample programmes for voice information groups and teacher workshops. Checklists for patients on topics such as the environmental and acoustic challenges of the workplace. Self-assessed personalised voice review sheets and weekly voice diaries encourage patients to monitor their voice quality and utilise strategies to prevent vocal misuse. Combining the successful format of mixing theory and practice, this edition offers a patient-centred approach to voice disorders in a fully accessible and easy-to-read format and addresses the challenges of service provision in a changing world. This is an essential resource for speech and language therapists of varying levels of experience, from student to specialist.