Summary
Introduction
Vocal fatigue is a clinical manifestation associated with a perception of negative
vocal adjustment. It is related to the increase in the sensation of excessive effort
when speaking and the lack of conditioning of the muscles and structures that involve
vocal production. Because it has a complex and multifactorial diagnosis, there is
still no consensus on the symptoms most commonly found in this clinical condition.
Objective
To review and analyze the symptoms that characterize the clinical condition of vocal
fatigue.
Methods
This study consists of a scoping review carried out in the Cochrane Library, Embase,
Lilacs, and Medline databases. Observational studies or clinical trials from the last
10 years. Studies with participants younger than 18 years of age were excluded; as
well as research that did not describe symptoms of vocal fatigue or that presented
vocal fatigue as a symptom; studies with patients with neurological, psychiatric,
syndromic conditions, or head and neck cancer. The Quality Assessment Tool for Observational
Cohort and Cross-Sectional Studies NHLBI-NIH scale was used to assess the methodological
quality of selected observational studies and the PEDro scale for the analysis of
experimental studies. The steps were performed by three blinded evaluators. Subsequently,
meta-analyses of global means were executed for each factor under study; a comparison
of the difference in the mean score for each factor between exposed and unexposed;
a comparison of the difference in the average score, among non-professional voice
users, for each factor between exposed and unexposed.
Results
In the searches performed, 956 articles were found and 29 articles were selected according
to the eligibility criteria. Of these, 93.11% of the studies were observational and
6.89% were clinical trials. Regarding the gender and age group of the study samples,
women aged between 30 and 45 years were predominant. As for the occupational use of
voice, 68.97% of the samples were composed of professional voice users and 31.03%
of non-professional voice users, with most professional voice users being teachers
and non-professional voice users, individuals with dysphonia or vocal complaint. To
assess vocal fatigue symptoms, 28 studies used the Vocal Fatigue Index (VFI) protocol,
and only one study used another assessment protocol, Self-Administered Voice Rating.
All studies were classified as regular, according to the scale used. As for the meta-analyses
performed, the mean scores of the VFI factors were higher among professional voice
users when compared to non-professional voice users and higher in dysphonic individuals
compared to non-dysphonic individuals.
Conclusion
The vocal fatigue symptoms found in this review were common in the populations of
professional voice users and non-professional voice users and dysphonic and non-dysphonic
individuals. These symptoms were related to vocal recovery after rest, physical discomfort,
and restricted vocal use.
Key Words
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REFERENCES
- Dynamically monitoring vocal fatigue and recovery using aerodynamic, acoustic, and subjective self-rating measurements.J Voice. 2019; 33: 809.e11-809.e18
- The therapeutic effects of straw phonation on vocal fatigue.Laryngoscope. 2020; 130: E674-E679
- Vocal fatigue and its relation to vocal hyperfunction †.Int J Speech Lang Pathol. 2008; 10: 254-266
- Self-assessment of vocal fatigue in muscle tension dysphonia and vocal nodules: a preliminary analysis of the discriminatory potential of the croatian adaptation of the vocal fatigue index (VFI-C).J Voice. 2021; 35: 325.e1-325.e15
- Cross-cultural adaptation and validation of the vocal fatigue index into persian.J Voice. 2019; 33: 947.e35-947.e41
- Metabolic mechanisms of vocal fatigue.J Voice. 2017; 31: 378.e1-378.e11
- Cepstral measures to analyze vocal fatigue in individuals with hyperfunctional voice disorder.J Voice. 2021; 35: 815-821
- The perceptual features of vocal fatigue as self-reported by a group of actors and singers.J Voice. 1994; 8: 207-214
- Vocal fatigue among teachers.Folia Phoniatr (Basel). 1993; 45: 120-129
- Vocal fatigue: current knowledge and future directions.J Voice. 2003; 17: 21-30
- Vocal fatigue index (VFI): development and validation.J Voice. 2015; 29: 433-440
- Adaptation and validation of vocal fatigue index (VFI) to malayalam language.J Voice. 2020; 34: 810.e19-810.e24
- Cross-cultural adaption and validation of the vocal fatigue index in German.J Voice. 2021; 35: 161.e1-161.e13
- Reliability and validity of the Turkish version of the vocal fatigue index.Turk J Med Sci. 2020; 50: e902-e909
- Cultural and linguistic adaptation of vocal fatigue index for tamil-speaking population (VFI-T).J Voice. 2021; 35: 662.e1-662.e8
- Validity and reliability of Spanish version of two questionnaires of vocal fatigue in female teachers.J Voice. 2021; 35: 159.e1-159.e9
- Vocal Fatigue Index: Validation and Cut-off Values of the Brazilian Version.J Voice. 2022; 36: 434.e17-434.e24
- PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation.Ann Intern Med. 2018; 169: 467-473https://doi.org/10.7326/M18-0850
National Heart, Lung, and Blood Institute; National Institutes of Health; U.S. Department of Health and Human Services.Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. 2014. Available online athttps://www.nhlbi.nih.gov/health-pro/guidelines/in-develop/cardiovascular-risk-reduction/tools/cohort (Accessed in July 5th, 2022).
- The PEDro scale is a valid measure of the methodological quality of clinical trials: a demographic study.Aust J Physiother. 2009; 55: 129-133https://doi.org/10.1016/S0004-9514(09)70043-1
- PEDro: The physiotherapy evidence database.Fisioter Mov. 2011; 24: 523-533https://doi.org/10.1590/S0103-51502011000300017
- The effect of classroom capacity on vocal fatigue as quantified by the vocal fatigue index.Folia Phoniatr Logop. 2017; 69: 85-93
- Gender differences in the reporting of vocal fatigue in teachers as quantified by the vocal fatigue index.Ann Otol Rhinol Laryngol. 2017; 126: 813-818
- Vocal fatigue in dysphonic teachers who seek treatment.Codas. 2019; 31e2018120
- Vocal fatigue in prospective vocal professionals.J Voice. 2021; 35: 247-258
- Vocal fatigue in professors at the beginning and end of the school year.Codas. 2019; 32e20180233
- Perception of fatigue in professors according to the level of knowledge of vocal health and hygiene.Audiol. Commun. Res. 2019; 24: e2163
- Fadiga e Sintomas Vocais em Professores Universitários.Distur. da Comunic. 2019; 31: 225-233
- The relationship between vocal fatigue index and voice handicap index in university professors with and without voice complaint.J Voice. 2020; 34: 809.e1-809.e5
- The effect of upper airway ailments on teachers’ experience of vocal fatigue.J Voice. 2020; 36: 226-231
- Pilot evaluation of community-based vocal health screenings.J Voice. 2021; 35: 666.e1-666.e5
- Vocal fatigue in doctors: evaluation with subjective and objective acoustic parameters.Logoped Phoniatr Vocol. 2021; 46: 35-41
- The effect of pulmonary function on the incidence of vocal fatigue among teachers.J Voice. 2020; 34: 539-546
- Investigation of vocal fatigue using a dose-based vocal loading task.Appl Sci (Basel). 2020; 10: 1-16
- Effect of wearing a face mask on vocal self-perception during a pandemic.J Voice. 2020; 36: 878.E1-878.E7
- Vocal self-perception of home office workers during the COVID-19 pandemic.J Voice. 2020; 37: 144.e15-144.e22
- The effect of superficial hydration, with or without systemic hydration, on voice quality in future female professional singers.J Voice. 2020; 35: 728-738
- Relation between musculoskeletal pain and voice self-assessment in tele-operators.J Voice. 2019; 33: 948.e11-948.e21
- Comparison of vocal fatigue in speech therapists with other rehabilitation therapists.J Voice. 2021; (S0892-1997(21)00014-X)
- Outcomes of vocal hygiene program in facilitating vocal health in female school teachers with voice problems.J Voice. 2021; (S0892-1997(21)00018-7)
- Behavioral dysphonia and depression in elementary school teachers.J Voice. 2015; 29: 712-717
- Effects of voice therapy on muscle tension dysphonia: a systematic literature review.J Voice. 2018; 32: 546-552
- Voice disorders: etiology and diagnosis.J Voice. 2016; 30 (761.e.1-761.e.9)
- Gender diferences in the prevalence of ocupacional voice disorders. organizador.in: Dejonckere PH Occupacional Voice: Care and Cure. v.1. Kugler Publications, The Hague2001: 11-20
- Gender-related differences of hyaluronic acid distribution in the human vocal fold.Laryngoscope. 2001; 111: 907-911
- Managing dysphonia in occupational voice users.Curr Opin Otolaryngol Head Neck Surg. 2014; 22: 188-194
- Diagnosis of dysphonia among municipal employees: individual and work factors.J Voice. 2015; 29 (389.e19-26)
- The prevalence and risk factors for occupational voice disorders in teachers.Folia Phoniatr Logop. 2006; 58: 85-101
- Observations of the relationship between noise exposure and preschool teacher voice usage in day-care center environments.J Voice. 2011; 25: 166-172
- Voice disorders in teachers. A review.J Voice. 2014; 28: 716-724
- Toward a consensus description of vocal effort, vocal load, vocal loading, and vocal fatigue.J Speech Lang Hear Res. 2020; 63: 509-532
- Factors involved in vocal fatigue: a pilot study.Folia Phoniatr Logop. 2016; 68: 112-118
- Pathophysiology and treatment of muscle tension dysphonia: a review of the current knowledge.J Voice. 2011; 25: 202-207
Article info
Publication history
Published online: February 02, 2023
Accepted:
December 21,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
