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The Impact of a Vocal Loading Task on Voice Characteristics of Female Speakers With Benign Vocal Fold Lesions

  • Nicole Free
    Correspondence
    Address correspondence and reprint requests to Nicole Free, Department of Surgery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Clayton, Victoria, Australia.
    Affiliations
    Department of Surgery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
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  • Joseph C. Stemple
    Affiliations
    Department of Communication Sciences and Disorders, and Rehabilitation Sciences PhD Program, University of Kentucky, Lexington, Kentucky
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  • Julian A. Smith
    Affiliations
    Department of Surgery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
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  • Debra J. Phyland
    Affiliations
    Department of Surgery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
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Published:December 23, 2021DOI:https://doi.org/10.1016/j.jvoice.2021.11.009

      Summary

      Objectives

      To examine the effect of a vocal loading task on measures of vocal structure and function in females with benign vocal fold lesions (BVFLs) and determine if change is observed in voice and lesion characteristics.

      Study Design

      Prospective cohort study.

      Methods

      Twenty-eight (n = 28) female subjects with phonotraumatic BVFLs completed a vocal loading task of 30 minutes of reading aloud at 75-85 dBA. Multidimensional voice evaluation was completed pre- and post-load, including audio and videostroboscopy recordings and images for expert perceptual ratings and acoustic and aerodynamic evaluation. Subjects also scored themselves using a 10 cm visual analogue scale for Perceived Phonatory Effort, and completed the Evaluation of Ability to Voice Easily, a 12 item self-report scale of current perceived speaking voice function. An exploratory rather than confirmatory approach to data analysis was adopted. The direction and magnitude of the change scores (pre- to post-load) for each individual, across a wide variety of instrumental and self-report measures, were assessed against a Minimal Clinically Important Difference criteria.

      Results

      Observations of change and the direction of change in vocal response of individuals with BVFLs to 30 minutes of loud vocal load was variable. Minimal to no change was noted for participants pre- to post-load as rated perceptually, for auditory and videostroboscopy samples. For most instrumental measures, change was shown for many participants including an overall improvement in aerodynamic and acoustic measures of function and efficiency post-load for 20 participants (77%) and decline in function for 4 participants (15%). Self-reported effort and vocal function post-load was multidirectional with similar numbers of participants reporting no change, improved function or a decline.

      Conclusion

      Subjects with BVFLs demonstrate change in vocal function following 30 minutes of vocal load. While this change can be variable and multidirectional, overall improvement was observed in instrumental measures of function and efficiency for most participants. Some participants perceived this change to be an increase in effort, some a reduction in effort and some perceived no change. Improved vocal function despite relative lesion stability can seemingly occur after loading in some pathological voices.

      Key Words

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      References

        • Phyland DJ.
        The measurement and effects of vocal load in singing performance. How much singing can a singer sing if a singer can sing songs?.
        Perspect. ASHA special interest groups SIG 3. 2017; 2: 79-88
        • Hunter EJ
        • Cantor-Cutiva LC
        • van Leer E
        • et al.
        Toward a consensus description of vocal effort, vocal load, vocal loading, and vocal fatigue.
        JSLHR. 2020; 63: 509-532
        • Lollgen H
        • Leyk D.
        Exercise testing in sports medicine.
        Dtsch Arztebl Int. 2018; 115: 409-416
        • Guazzi M
        • Bandera F
        • Ozemek C
        • et al.
        Cardiopulmonary exercise testing: What is its value?.
        J Am Coll Cardiol. 2017; 70: 1618-1636
        • Fujiki RB
        • Sivasankar MP.
        A review of vocal loading tasks in the voice literature.
        J Voice. 2017; 31: 388.e333-388.e339
        • Bottalico P
        • Graetzer S
        • Hunter EJ.
        Effects of speech style, room acoustics, and vocal fatigue on vocal effort.
        J Acoust Soc Am. 2016; 139: 2870
        • Aronsson C
        • Bohman M
        • Ternstrom S
        • et al.
        Loud voice during environmental noise exposure in patients with vocal nodules.
        Logoped Phoniatr Vocol. 2007; 32: 60-70
        • Erickson-Levendoski E
        • Sivasankar M.
        Investigating the effects of caffeine on phonation.
        J Voice. 2011; 25: e215-e219
        • Enflo L
        • Sundberg J
        • McAllister A.
        Collision and phonation threshold pressures before and after loud, prolonged vocalization in trained and untrained voices.
        J Voice. 2013; 27: 527-530
        • Laukkanen AM
        • Jarvinen K
        • Artkoski M
        • et al.
        Changes in voice and subjective sensations during a 45-min vocal loading test in female subjects with vocal training.
        Folia Phoniatr Logop. 2004; 56: 335-346
        • Remacle A
        • Morsomme D
        • Berrue E
        • et al.
        Vocal impact of a prolonged reading task in dysphonic versus normophonic female teachers.
        J Voice. 2012; 26 (820.e821-820.e813)
        • Stemple J
        • Stanley J
        • Lee L.
        Objective measures of voice production in normal subjects following prolonged voice use.
        J Voice. 1995; 9: 127-133
        • White A.
        Management of benign vocal fold lesions: current perspectives on the role for voice therapy.
        Curr Opin Otolaryngol Head Neck Surg. 2019; 27: 185-190
        • Branski RC
        • Verdolini K
        • Sandulache V
        • et al.
        Vocal fold wound healing: a review for clinicians.
        J Voice. 2006; 20: 432-442
        • Haben CM.
        Voice rest and phonotrauma in singers.
        Med Probl Perform Art. 2012; 27: 165-168
        • Lee M
        • Mau T
        • Sulica L.
        Patterns of recurrence of phonotraumatic vocal fold lesions suggest distinct mechanisms of injury.
        Laryngoscope. 2012; 131: 2523-2529
        • Vasconcelos D
        • Gomes AOC
        • Araujo CMT.
        Vocal fold polyps: Literature review.
        Int Arch Otorhinolaryngol. 2019; 23: 116-124
        • van der Merwe A.
        The voice use reduction program.
        Am J Speech Lang Pathol. 2004; 13: 208-218
        • Holmberg EB
        • Hillman RE
        • Hammarberg B
        • et al.
        Efficacy of a behaviorally based voice therapy protocol for vocal nodules.
        J Voice. 2001; 15: 395-412
        • Niebudek-Bogusz E
        • Kotylo P
        • Sliwinska-Kowalska M.
        Evaluation of voice acoustic parameters related to the vocal-loading test in professionally active teachers with dysphonia.
        Int J Occup Med Environ Health. 2007; 20: 25-30
        • Kelchner LN
        • Lee L
        • Stemple JC.
        Laryngeal function and vocal fatigue after prolonged reading in individuals with unilateral vocal fold paralysis.
        J Voice. 2003; 17: 513-528
        • Jilek C
        • Marienhagen J
        • Hacki T.
        Vocal stability in functional dysphonic versus healthy voices at different times of voice loading.
        J Voice. 2004; 18: 443-453
        • Deary IJ
        • Wilson JA
        • Carding PN
        • et al.
        VoiSS.
        J Psychosom Res. 2003; 54: 483-489
        • Wilson JA
        • Webb A
        • Carding PN
        • et al.
        The Voice Symptom Scale (VoiSS) and the Vocal Handicap Index (VHI): a comparison of structure and content.
        Clin Otolaryngol. 2004; 29: 169-174
        • Sanchez K
        • Oates J
        • Dacakis G
        • et al.
        Speech and voice range profiles of adults with untrained normal voices: methodological implications.
        Logoped Phoniatr Vocol. 2014; 39: 62-71
        • Oates J
        • Russel A.
        Learning voice analysis using an interactive multi-media package: development and preliminary evaluation.
        J Voice. 1998; 12: 500-551
      1. Phyland DJ, Pallant J, Free N, et al. On the EAVE: A new scale for self-evaluation of the physical aspects of speaking voice function In: IALP Voice Composium. 2021.

        • Balluerka N
        • Gómez J
        • Hidalgo D.
        The controversy over null hypothesis significance testing revisited.
        Methodology. 2005; 1: 55-70
        • Zraick RI
        • Smith-Olinde L
        • Shotts LL.
        Adult normative data for the KayPENTAX Phonatory Aerodynamic System Model 6600.
        J Voice. 2012; 26: 164-176
        • Leung Y
        • Oates J
        • Papp V
        • et al.
        Speaking fundamental frequencies of adult speakers of Australian English and effects of sex, age, and geographical location.
        J Voice. 2020; (In press): 1-15
        • Godino-Llorente JI
        • Osma-Ruiz V
        • Saenz-Lechon N
        • et al.
        The effectiveness of the glottal to noise excitation ratio for the screening of voice disorders.
        J Voice. 2010; 24: 47-56
        • Sivasankar MP
        • Erickson-Levendoski E.
        Influence of obligatory mouth breathing, during realistic activities, on voice measures.
        J Voice. 2012; 26 (813.e819-813.e813)
        • Solomon NP
        • Di Mattia MS.
        Effects of a vocally fatiguing task and systemic hydration on phonation threshold pressure.
        J Voice. 2000; 14: 341-362
        • McGlothlin AE
        • Lewis RJ.
        Minimal clinically important difference defining what really matters to patients.
        JAMA. 2014; 312: 1313-1322
        • Weels G
        • Beaton D
        • Shea B
        • et al.
        Minimal clinically important differences: Review of methods.
        J Rheumatology. 2001; 28: 406-412
        • Portney L
        • Watkins M.
        Foundations of Clinical Research: Applications to Practice.
        3rd Edition. Pearson Prentice Hall, New Jersey2009
        • Chang A
        • Karnell MP.
        Perceived phonatory effort and phonation threshold pressure across a prolonged voice loading task: a study of vocal fatigue.
        J Voice. 2004; 18: 454-466
        • Sundarrajan A.
        Hydration and vocal loading on voice measures.
        Open Access Dissertations. 855. Perdue University, 2016
        • Sundarrajan A
        • Huber JE
        • Sivasankar MP.
        Respiratory and laryngeal changes with vocal loading in younger and older individuals.
        J Speech Lang Hear Res. 2017; 60: 2551-2556
        • Whitling S
        • Lyberg-Ahlander V
        • Rydell R.
        Long-time voice accumulation during work, leisure, and a vocal loading task in groups with different levels of functional voice problems.
        J Voice. 2017; 31 (246.e241-246.e210)
        • Remacle A
        • Finck C
        • Roche A
        • et al.
        Vocal impact of a prolonged reading task at two intensity levels: objective measurements and subjective self-ratings.
        J Voice. 2012; 26: e177-e186
        • Silva-Ayçaguer LC
        • Suárez-Gil P
        • Fernández-Somoano A
        The null hypothesis significance test in health sciences research (1995-2006): statistical analysis and interpretation.
        BMC Med Res Methodol. 2010; 10: 1-9
        • Schmidt FL.
        Statistical significance testing and cumulative knowledge in psychology: implications for training of researchers.
        Psychol Methods. 1996; 1: 115-129
        • Lakens D.
        The practical alternative to the p value is the correctly used p value.
        Perspect Psychol Sci. 2021; 16: 639-648
        • Remacle A
        • Schoentgen J
        • Finck C
        • et al.
        Impact of vocal load on breathiness: perceptual evaluation.
        Logoped Phoniatr Vocol. 2014; 39: 139-146
        • Iwarsson J
        • Reinholt Petersen N
        Effects of consensus training on the reliability of auditory perceptual ratings of voice quality.
        J Voice. 2012; 26: 304-312
        • Linville SE.
        Changes in glottal configuration in women after loud talking.
        J Voice. 1995; 9: 57-65