Background Occupational voice health is becoming more important as more people rely on their voices for their work. A number of studies have identified certain occupational groups at increased risk of developing occupational voice disorders, namely teachers, singers and aerobics instructors. Aim The paper aims to review the literature on occupational groups at risk of voice disorders and identify areas for future research. Method A literature review of key databases using key words such as 'occupational', 'voice health', 'voice loss', 'dysphonia' and 'work related' was undertaken. Results The review identified case reports, studies of attendees at hospital voice clinics and a few cross-sectional studies of occupational groups in the workplace. There were no longitudinal studies found or intervention studies looking at reduction of risk. Conclusion Further research on occupational voice disorders needs to be based in the workplace, and to look at the risk factors for the development of voice problems and for the efficacy of controls.

Occupational groups at risk of voice disorders: a review of the literature

A study of the effectiveness of voice therapy in the treatment of 45 patients with nonorganic dysphonia

Objectives To assess the overall efficacy of voice therapy for dysphonia. Design Single blind randomised controlled trial. Setting Outpatient clinic in a teaching hospital. Participants 204 outpatients aged 17›87 with a primary symptom of persistent hoarseness for at least two months. Interventions After baseline assessments, patients were randomised to six weeks of either voice therapy or no treatment. Assessments were repeated at six weeks on the 145 (71%) patients who continued to this stage and at 12›14 weeks on the 133 (65%) patients who completed the study. The assessments at the three time points for the 70 patients who completed treatment and the 63 patients in the group given no treatment were compared. Main outcome measures Ratings of laryngeal features, Buffalo voice profile, amplitude and pitch perturbation, voice profile questionnaire, hospital anxiety and depression scale, clinical interview schedule, SF›36. Results Voice therapy improved voice quality as assessed by rating by patients (P = 0.001) and rating by observer (P < 0.001). The treatment effects for these two outcomes were 4.1 (95% confidence interval 1.7 to 6.6) points and 0.82 (0.50 to 1.13) points. Amplitude perturbation showed improvement at six weeks (P = 0.005) but not on completion of the study. Patients with dysphonia had appreciable psychological distress and lower quality of life than controls, but voice therapy had no significant impact on either of these variables. Conclusion Voice therapy is effective in improving voice quality as assessed by self rated and observer rated methods.

https://www.bmj.com/content/bmj/323/7314/658.full.pdf

Is voice therapy an effective treatment for dysphonia? A randomised controlled trial

Objective To evaluate the effectiveness of interventions for treating functional dysphonia or preventing voice disorders in adults. Data Sources We searched MEDLINE (1950 to 2006), EMBASE (1974 to 2006), CENTRAL (Issue 2 2006), CINAHL (1983 to 2006), PsychINFO (1967 to 2006), Science Citation Index (1986 to 2006), and the Occupational Health databases OSH-ROM (February 2006). Review Methods Systematic review and meta-analysis of randomized controlled trials. Included studies evaluated the effectiveness of interventions for 1) treating functional/nonorganic dysphonia or 2) preventing voice disorders. We identified six randomized controlled trials about treatment and two about prevention. Two authors independently extracted data and assessed trial quality. Results A combination of direct and indirect voice therapy, compared with no intervention, improves self-reported (standardized mean difference −1.07; 95% CI −1.94 to −0.19), observer-rated (weighted mean difference [WMD] −13.00; 95% CI −17.92 to −8.08), and instrumentally assessed vocal functioning (WMD −1.20; 95% CI −2.37 to −0.03) in adults with functional dysphonia. Effects are reported to remain for at least 14 weeks. Effects are similar in patients and in teachers and student teachers screened for voice problems. We found two studies that did not show voice training, compared with no intervention, to have a preventive effective in improving self-reported vocal functioning. Assessment of publication bias showed that the real effect sizes are probably smaller. Conclusion Comprehensive voice therapy is effective in improving vocal performance in adults with functional dysphonia. There is no evidence of effectiveness of voice training in preventing voice disorders.

Systematic review of the treatment of functional dysphonia and prevention of voice disorders

Objective This report aims to study the prevalence of features of laryngeal muscle tension in a population of patients with functional dysphonia (FD) and nondysphonic control subjects.



Study Design Prospective control-blinded, cross-sectional study.



Methods We reported on a prospective control-blinded, cross-sectional study of the prevalence of the six features described by Van Lawrence and the six features incorporated in the Morrison-Rammage classification. A senior laryngologist and senior speech pathologist independently rated sound-free, random-sequence video laryngoscopies of 51 patients with FD and 52 nondysphonic control subjects. Assessments were made of the presence or absence of the 12 laryngoscopic features of laryngeal dysfunction, and an overall rating made of the vocal technique as “normal” or “abnormal.”



Results More than 60% of the control population demonstrated 1 or more of the 12 features of hyperfunction. There was no significant difference in the prevalence of the six Van Lawrence features, the six Morrison-Rammage features, or the total number of abnormal features between patients with FD and control subjects. On overall assessment, both assessors noted a high prevalence (50% and 36%, respectively) of abnormal vocal technique in the control population. There was no statistical difference in the total number of abnormal features observed between patients with FD and control subjects. Positive predictive value calculations showed that the presence of a clinical feature, at best, presented a 75% chance of correctly identifying a patient with FD and, at worst, a 50% chance.



Conclusion The laryngoscopy features commonly associated with FD are frequently prevalent in the nondysphonic population and fail to distinguish patients with FD from normal subjects.

The clinical features of functional dysphonia.

Feel lonely? What about reading books? Book is one of the greatest friends to accompany while in your lonely time. When you have no friends and activities somewhere and sometimes, reading book can be a great choice. This is not only for spending the time, it will increase the knowledge. Of course the b=benefits to take will relate to what kind of book that you are reading. And now, we will concern you to try reading voice problems of children as one of the reading material to finish quickly.

G Marjanović

Papers

Voice problems in children