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Purpose: Hoarseness and voice problems are one of the chronic conditions experienced by children. The aim of this study was to investigate the prevalence of hoarseness, possible risk factors and effects of the remediation of school buildings to the prevalence of hoarseness among school children. Methods: The material was gathered from all the schools in a large city in the south of Finland and the collection method used was an e-mail survey sent to the parents of the pupils and a simultaneous survey sent to the personnel in the schools. Results: All 51 schools participated, and 5889 pupils returned the questionnaire (39%). The exposure data was obtained from two building experts who knew the repair history of the schools. A subjective estimation of the quality of the indoor air was obtained from teachers and the parents. The overall prevalence of hoarseness among pupils was 6.3%; prevalence being higher in unrepaired school buildings than in schools in a good condition or buildings with a thorough remediation. Hoarseness was associated with asthma and allergies, several respiratory symptoms, and respiratory infections. Exposure to tobacco smoke increased the risk, and consumption of caffeine containing drinks seemed to reduce the risk. Noise, stuffiness of the indoor air and microbial smells correlated strongly with the occurrence of hoarseness in a logistic regression model when controlled for age, gender, asthma, passive smoking, and caffeine consumption. Conclusions: We recommend renovations in school buildings with the aim of providing better acoustics, sufficient ventilation, and a reduction in exposure to moisture damage microbes.

Everyday observations indicate that creaky voice has become common in Finland in recent years. Previous studies suggest that this trend is also occurring in other countries. This cross-sectional study investigates the use of creaky voice among Finnish university students from the 1990's to the 2010's. Material was obtained from a sound archive. It consisted of 200 samples from normophonic speakers (95 males, 105 females; mean age 23.7 years, SD 3.3 years, range 19-35 years). Normophonia was checked by two speech therapists in a preliminary perceptual analysis. Thereafter, two voice specialists rated the amount of creak and strain. A scale of 0-4 was used (0 = none, 4 = a lot). The inter- and intrarater reliability for the listening evaluations were satisfactory (for creaky phonation, rho = 0.611, P < 0.001 for interrater reliability and rho = 0.540, P < 0.001 for intrarater reliability; for strain, rho = 0.463, P < 0.001 and rho = 0.697, P < 0.001 for inter- and intrarater reliability, respectively). These results revealed a significant increase in the amount of perceived creak in females (from 1.04, SD 0.69 to 1.55, SD 1.06; P < 0.05, Mann-Whitney U test). In males, no significant change was found. However, the frequency of creaky voice use increased in both genders. No male speakers from the 1990's were rated as using "a lot" of creaky voice, but 2.3% of male speakers from the 2010's received this rating. Male speakers who were rated "quite a lot" increased from 5.9% in the 1990's to 18.1% in the 2010's. Female speakers rated "a lot" increased from 0% to 6%, and female speakers rated "quite a lot" increased from 7% to 25.8% over the studied time periods. Creaky phonation and strain correlated slightly in males (rho = 0.24, P < 0.05) and moderately in females (rho = 0.55, P < 0.001). Age did not correlate with the amount of creaky phonation (rho = 0.005, P > 0.10 for males, rho = -0.011, P > 0.10 for females). It can be concluded that the prevalence of creaky voice has increased among young Finnish speakers, particularly females., (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: We aimed to study the association between self-reported voice disorders among teachers and indoor air quality in school buildings., Methods: We performed a questionnaire study of 538 Finnish teachers working in 67 school buildings utilizing both perceived and technical evaluations; the agreement between these two assessments was also studied. The technical assessment was provided by technical experts., Results: Teachers with voice disorders reported significantly more complaints from indoor air than those without voice disorders. The results also indicated a possible connection between the technical assessment and voice disorders. After adjustment for sex, stress and asthma, the prevalence of voice disorders was 47% higher in teachers working in renovated buildings compared to those working in the non-problem buildings (aRR1.47; CI 95% 1.11-1.95). The prevalence of voice disorders was 28% higher among teachers working in buildings with problems compared to those working in non-problem buildings (aRR 1.28; 95% CI 0.99-1.64)., Discussion: In our study, poor perceived indoor air was significantly associated with self-reported voice disorders in teachers and there was an agreement between the perceived and technical assessments. Our results also indicated a possible connection between the technical assessment and voice disorders. Our results imply the need for longitudinal research with technical assessment to study the effect of renovation on voice disorders.

The present study focused on the identification of emotions in cross-cultural conditions on different continents and among subjects with divergent language backgrounds. The aim was to investigate whether the perception of the basic emotions from nonsense vocal samples was universal, dependent on voice quality, musicality, and/or gender. Listening tests for 350 participants were conducted on location in a variety of cultures: China, Egypt, Estonia, Finland, Russia, Sweden, and the USA. The results suggested that the voice quality parameters played a role in the identification of emotions without the linguistic content. Cultural background may affect the interpretation of the emotions more than the presumed universality. Musical interest tended to facilitate emotion identification. No gender differences were found. [ABSTRACT FROM PUBLISHER]

Aims: This study investigated whether speaking a foreign language affects the subjective notions of vocal fatigue, and whether acoustic measurements reveal a higher vocal loading. Methods: The speech samples of 20 native Finnish-speaking and 23 native English-speaking subjects were recorded in Finnish and in English. From the speech samples, fundamental frequency, equivalent sound level, total duration of voiced speech, speech rate, alpha ratio and L1-L0 level difference were analyzed. Vocal doses were calculated. Results: According to subjective notions, the voice gets tired more quickly when speaking a foreign language. The mean fundamental frequency increased but the speech rate and total duration of voiced speech decreased significantly when speaking a foreign language. Thus, the vocal doses decreased. Conclusions: The subjective sensationsof increased vocal fatigue may be due to increased mental stress rather than to higher vocal loading. However, a trend that speaking a foreign language may involve more loading was found in L1-L0 level difference and in the doses normalized to time dose. Longer speech samples should be studied. Voice quality-based indicators of vocal loading are worth testing in addition to the measures based on the amount of voicing in speech. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study was to determine whether self-reported work ability is associated with voice disorders, stress at work, and the quality of the perceived indoor environment., Study Design: A cross-sectional study., Methods: We conducted a questionnaire study of 1 198 Finnish teachers utilizing the Work Ability Score., Results: The Work Ability Score median was 8 (Q 1 : 7, Q 3 : 9), and 71% (CI 95% 69%-74%) of the subjects reported that they had good work ability. Female teachers had a significantly lower Work Ability Score than male teachers. The median number of days absent due to sickness during the previous year was 4 (Q 1 : 2, Q 3 : 10). Voice disorders (adjusted odds ratio (aOR) 2.44; CI95% 1.73-3.44), stress at work (rather or very much vs. not at all or little; aOR 6.53; CI95% 4.31-9.90), and poor perceived indoor environment quality (aOR 2.63; CI95% 1.86-3.71) were all clear risk factors for the Work Ability Score., Conclusion: We determined that decreased work ability in teachers is connected to voice disorders, stress at work, and poor perceived indoor environment quality. Thus, in order to better maintain teachers' work ability, we recommend that special attention should be paid to occupational health care when there are problems in the indoor environment of teachers, and they suffer from voice disorders and stress., (Copyright © 2020 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

This study examines the relationship of voice quality and speech-based personality assessment of Finnish-speaking female speakers. Five Finnish-speaking female subjects recorded a text passage with eight different vocal qualities. Samples that passed the preselection test for the voice qualities were played to 50 Finnish-speaking listeners, who reported speaker impressions on a scale of 18 opposite trait pairs. Voices produced with forward placement received assessments of femininity and friendliness. Readers speaking with backward placement were considered less feminine, while breathy voice evoked assessments of emotionality and implausibility. Tense phonation as well as creakiness, nasality, and denasality gave rise to numerous negative notions. The results suggest that voice stereotypes have both internationality and cultural dependency. [ABSTRACT FROM AUTHOR]

Background: The Acoustic Voice Quality Index (AVQI) is a correlate of dysphonia. It has been found to differentiate between dysphonic and normophonic speakers and to indicate the effects of voice therapy. This study investigates how the AVQI reacts towards creak and strain, which are common in normophonic speakers., Methods: The material was obtained from an earlier study on 104 Finnish female university students (mean age 24.3 years, SD 6.3 years) with no known pathology of voice or hearing and a perceptually normal voice (G = 0 in GRBAS), who were recorded while reading aloud a standard text and sustaining the vowel [a:]. Perceptual analysis for the amount of creak and strain was carried out by 2 expert listeners. In this study, the AVQI v03.01 was analyzed and correlated with perceptual evaluations. Samples with low and high amounts of creak and strain were compared with t tests., Results: On average, the AVQI was below the threshold value of dysphonia in the Finnish population. The AVQI (ρ = 0.35, p = 0.000) and its subparameters, smoothed cepstral peak prominence (CPPS; ρ = -0.35, p = 0.000) and harmonics-to-noise ratio (HNR; ρ = -0.30, p = 0.002) showed low but significant correlations with creak. Strain had low but significant correlations with spectral Slope (ρ = 0.38, p = 0.000) and Tilt (ρ = -0.40, p = 0.009). The AVQI was lower (better) in samples that were evaluated as having a high amount of strain, but the difference was not significant. Only CPPS differentiated significantly between low and high amounts of creak., Conclusion: The AVQI does not seem to differentiate between high and low amounts of creak and strain in normophonic speakers., (© 2021 S. Karger AG, Basel.)

Objectives/hypothesis: Facial functional restoration is one of the main goals in face transplantation. We report the oromyofacial function outcomes of two bimaxillary face transplantation (FT) patients in Helsinki., Study Design: Outcome Study., Methods: Two male patients, aged 34 and 59, had severe functional facial disabilities following self-inflicted gunshot injuries sustained to their mid and lower faces several years earlier. Both underwent tooth-bearing maxillomandibular face transplantation in 2016 and 2018. We collected data regarding speech, swallowing, sensory recovery, motor recovery, and olfaction prior to transplantation. Patient charts were reviewed from the follow-up period of 4 and 2 years, respectively., Results: Speech intelligibility, acceptability, and articulation continued to improve during follow-up for both patients. Voice quality and resonance were mainly normal at last follow-up. Swallowing improved once lip occlusion was regained, with only minor aspiration evident on videofluorography. Both patients had significant improvement in facial mimic muscle function after FT. The first patient who only had buccal sensory nerves connected has only recovered protective facial sensation, whereas our second patient with buccal, infraorbital, and alveolar nerves connected has almost complete facial two-point discrimination., Conclusion: Both patients have regained satisfactory facial sensory and motor function. Sensory recovery seems to be faster and more precise if multiple sensory nerve coaptations are performed. Swallowing and speech have continued to improve over time although not reaching the level of the normal population. We demonstrate how speech-corrective surgery can safely be performed in a FT patient and can improve speech recovery., Level of Evidence: 4 Laryngoscope, 131:E2643-E2649, 2021., (© 2021 The American Laryngological, Rhinological and Otological Society, Inc.)

Purpose: To verify the auditory-perceptual and acoustic effects of the semioccluded vocal tract exercise with Finnish tube on the vocal quality of a deaf musician., Methods: A seven-day protocol with Finnish tube was performed with guidance for its home replication twice a day. A 46-years-old man with profound bilateral sensorineural hearing loss, musician and composer participated. Before and after the application of the protocol had undergone tonal audiometry, nasofibrolaryngoscopy, acoustic analysis with Praat and auditory-perceptual evaluation of the voice with Voice Profile Analysis Scheme for Brazilian Portuguese., Results: The postintervention auditory-perceptual analysis identified reduction of the deviation in lip spreading, extensive labial range, raised tongue body, pharyngeal expansion, nasal resonance, larynx height, larynx and vocal tract tension and irregularity, pitch, speech rate, and a better respiratory support. The maximum phonation time reduced, probably because of elimination of the abrupt vocal attack and tension, articulatory deviations, improvement in voicing and the absence of the use of expiratory reserve air. The fundamental frequency became lower, and the first, second, third, and fourth formants became higher. The jitter increased, and the shimmer reduced., Conclusion: The use of the Finnish tube might have facilitated the voicing sensations in the deaf musician, by enhancing the tactile-kinesthetic perception of the vocal tract and brought a greater source-filter interaction., (Copyright © 2019 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objectives: The present study aimed to investigate whether there are differences between Arabic-speaking and Finnish-speaking listeners in the impressions of a speaker's personality as evoked by various intentional voice qualities., Study Design: This is an experimental study., Methods: Samples (N = 55) were gathered from native Finnish-speaking males (N = 4) and females (N = 5), who read a text passage of 43 words using eight different voice qualities: (1) habitual speaking voice, speaking with (2) a forward or (3) backward placement of the tongue, or a (4) breathy, (5) tense, (6) creaky, (7) nasalized, or (8) denasalized voice. Native Arabic-speaking participants (34 males, 12 females; N = 46) were asked to evaluate the speech samples on a seven-point polarized scale by choosing 1-5 from a total of 18 contrasting pairs of personality traits. The listening tests were presented via Windows Media Player and a Genelec Biamp loudspeaker. Traits that had evaluations of 30% or more were selected for the final analysis. The results were compared to the results of native Finnish-speaking listeners (12 males, 38 females; N = 50). Statistical analyses were carried out using IBM SPSS Statistics 25., Results: On the whole, both listener groups perceived the speakers' voice qualities similarly, although the Finnish-speaking listeners linked many voice qualities, especially nasal and denasal voices, with unpleasant and other negative personality traits. Moreover, somewhat opposing evaluations were given by the two language groups for voices with forward and backward placements of the tongue, and breathy and tense voices. In many cases, the evaluations by the Arabic-speaking listeners were more scattered. The speakers' sex also seemed to affect perceptions of personality., Conclusions: There seem to be similar stereotypical tendencies to relate certain voice qualities with certain personality traits, which is explainable by how the voice types are produced and used to express emotions. Some opposing trends found between the two language groups may be related to language and cultural differences. A further study with larger listener groups and including also samples from Arabic language speakers is needed to confirm the results of the present study., (Copyright © 2019 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Introduction: To diminish the risk of voice disorders in people who are highly dependent on their voices, such as teachers, vocal screening is important already at the beginning of such individuals' professional studies. A reliable, specified screening tool is needed. The Acoustic Voice Quality Index (AVQI) has been found to differentiate normal voices from abnormal voices and to serve as a treatment outcome measure. This study investigated whether AVQI could be a screening tool in combination with auditory- and self-perception of the voice to discriminate normal from slightly poor voices., Type of Study: Experimental., Methods: Some 128 female teaching students (mean age 26.39 years, SD 9.80 years) with no diagnosed voice disorders participated in this study. They read aloud a text in Finnish, sustained the vowel /a:/, and filled the Voice Handicap Index (VHI) questionnaire. Voice samples were recorded with an AKG C544L headset microphone, iFocusrite soundcard, and Praat software using a 44100 sample rate and 16-bit amplitude quantization. Five expert voice therapists evaluated the samples to determine the grade of dysphonia (G) using a scale of 0-0.5 (=normal), 0.5-1 (=mild), 1-2 (=moderate), and 2-3 (=severe). Three medial seconds of [a:] and the first 31 syllables of the text were analyzed using AVQI script version 03.01 in Praat (5.3.55). The analysis gives one AVQI score per participant (scale 0-10). The AVQI threshold of normal and disordered voices for Finnish speakers is 1.83; a G mean  = 0.0-0.5 and VHI score <19 were considered normal. Statistical analysis was done using the receiver operating characteristic (ROC) curve, Spearman's correlation coefficient, and the independent samples t test., Results: According to the AVQI results, the area under the curve (A ROC ) was 0.554, which is fair. The Youden index gave a cutoff value of 0.30 with a sensitivity of 85% and a specificity of 81.1%. There were weak but significant correlations between G mean and AVQI and two AVQI parameters, smoothed cepstral peak prominence and harmonic-to-noise ratio (r = 0.27; --0.24; -0.20, respectively; |P < 0.05); and between total VHI and AVQI score and cepstral peak prominence (r = 0.21; 0.20, respectively; P < 0.05). Furthermore, the AVQI scores differed significantly between the groups with a VHI total score <19 and ≥19., Conclusions: AVQI did not differentiate between voices that had been perceptually judged as normal or slightly abnormal, but a combination of perceptual assessment in the form of AVQI and VHI could better screen slightly deviant voices., (Copyright © 2019 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Background: The Acoustic Voice Quality Index (AVQI) is a multiparametric tool for objectively measuring the general acoustic characteristics of voice. The AVQI uses both sustained vowel and continuous speech in its analysis, and therefore, a validation is required for different languages. In the present study, validation was performed in the Finnish-speaking population. Methods: The study included 200 native Finnish-speaking participants of whom 115 were voice patients attending a phoniatric clinic, and the remaining 85 subjects participated in the study as healthy controls. Voice samples were recorded, and the auditory evaluation was performed by five speech therapists. An ordinal four-point interval scale was used to evaluate the degree of voice abnormality (Grade, G). Several statistical analyses were performed to test the validity and the diagnostic accuracy of the AVQI in the Finnish-speaking population. Results: The inter-rater reliability of four of the five raters was high enough to allow the use of G in the validation. There was a statistically significant correlation between the AVQI scores and the evaluation of overall perceptual voice quality ( mean in the validation. There was a statistically significant correlation between the AVQI scores and the evaluation of overall perceptual voice quality ( r  = 0.74). Conclusions: The results confirmed the good discriminatory power of the AVQI in differentiating between normal and abnormal voice qualities. The AVQI 02.02 threshold value for dysphonia was 2.87 in the Finnish-speaking population.

Purpose: The present study aimed at measuring the smoothed and non-smoothed cepstral peak prominence (CPPS and CPP) in teachers who considered themselves to have normal voice but some of them had laryngeal pathology. The changes of CPP, CPPS, sound pressure level (SPL) and perceptual ratings with different voice tasks were investigated and the influence of vocal pathology on these measures was studied., Method: Eighty-four Finnish female primary school teachers volunteered as participants. Laryngoscopically, 52.4% of these had laryngeal changes (39.3% mild, 13.1% disordered). Sound recordings were made for phonations of comfortable sustained vowel, comfortable speech, and speech produced at increased loudness level as used during teaching. CPP, CPPS and SPL values were extracted using Praat software for all three voice samples. Sound samples were also perceptually evaluated by five voice experts for overall voice quality (10 point scale from poor to excellent) and vocal firmness (10 point scale from breathy to pressed, with normal in the middle)., Results: The CPP, CPPS and SPL values were significantly higher for vowels than for comfortable speech and for loud speech compared to comfortable speech (P < 0.001). Significant correlations were found between SPL and cepstral measures. The loud speech was perceived to be firmer and have a better voice quality than comfortable speech. No significant relationships of the laryngeal pathology status with cepstral values, perceptual ratings, or voice SPLs were found (P > 0.05)., Conclusion: Neither the acoustic measures (CPP, CPPS, and SPL) nor the perceptual evaluations could clearly distinguish teachers with laryngeal changes from laryngeally healthy teachers. Considering no vocal complaints of the subjects, the data could be considered representative of teachers with functionally healthy voice., (Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objectives: Voice disorders are considered to be more common among teachers than other occupations. However, epidemiological data are scarce and only a few researchers have studied stress as a risk factor in voice disorders in teachers. This paper presents data from a study on Finnish school teachers which investigated the prevalence of voice disorders and evaluated the risk factors for voice disorders, especially stress., Study Design: A cross-sectional study was conducted among primary and secondary education teachers across Finland., Methods: Voice disorders were assessed with a seven-item voice questionnaire and stress at work was measured with a validated single-item question., Results: The prevalence of voice disorders over the 12-month period was 54% in the sample of 1198 primary and secondary education teachers in Finland. Of the teachers, 81% were female, and they suffered more voice disorders than the males. Stress was the most significant explanatory variable with a 3.6-fold risk as regards voice disorders. The association between voice disorders and stress was even stronger than that of asthma, asthma medication, and allergic rhinitis, which are known to cause serious risks for voice disorders in general., Conclusions: Our results hypothesize that stress may be a multi-dimensional problem associated with various risk factors and result in an even more urgent risk of voice disorders in teachers than estimated. Longitudinal research is needed to investigate the causality between voice disorders and stress among teachers. In addition, it is recommended that in the occupational health care of teachers' consideration should be given to the fact that voice disorders and stress may have a multi-dimensional association., (Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objective: This study investigated the relationship between the acoustic measure smoothed cepstral peak prominence (CPPS), teacher's quality of life as measured by the voice activity and participation profile (VAPP), laryngeal signs and symptoms, voice related health problems and laryngoscopic findings in Finnish teachers. The relationship between CPPS and sound pressure level (SPL) was also assessed., Methods: Vowel and text samples from 183 healthy Finnish teachers (99 kindergarten teachers [KT] and 84 primary school teachers [PST]) were analyzed for CPPS. Text reading was recorded in conversational loudness by PST, and KT were recorded wearing headphones, while listening to a masking noise of children talking to simulate their classroom voice and environment. CPPS values were correlated with the VAPP, self-reported laryngeal signs and symptoms, voice related health variables, and laryngoscopic findings., Results: There was a significant difference between the two groups for CPPS text, PST showed significantly lower CPPS values (10.44) than KT (11.52). There was no difference between the two groups for CPPS vowel phonation. There was a significant correlation between SPL text and CPPS text for KT (P < 0.001, r = 0.43) but not for PST (P < 0.10, r = 0.16). There was a significant correlation between SPL vowel and CPPS vowel for both PST (P < 0.001, r = 0.47) and KT (P < 0.001, r = 0.45). CPPS did not correlate with the VAPP, laryngeal signs and symptoms, health variables or laryngeal findings. Factorial analysis of variance resulted in a significant relationship between the VAPP, laryngeal signs and symptoms, and teacher type. Teacher type and symptoms had a significant effect on VAPP scores., Conclusions: In the present work CPPS does not correlate with vocal health indicators of functionally healthy teachers. CPPS was significantly influenced by differences in speaking voice SPL, emphasizing the impact of recording conditions and technique. There was a significant relationship between laryngeal signs and symptoms, teacher type and the VAPP. Laryngeal signs and symptoms and teacher type are important variables and should be included in the clinical evaluation of occupational voice users, and voice problems., (Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objectives: The prevalence of voice problems has been investigated in various occupations, but research investigating sports coaches' voice problems seems to be limited even if coaches are an occupational group whose work requires heavy voice use. The aim of this study was to determine the prevalence of voice problems among soccer coaches and identify risk factors that can contribute to the problems., Methods/design: The data were collected with a web questionnaire that was sent to 500 soccer coaches. Overall, 109 male coaches, who practiced soccer coaching to various extents, responded to the questionnaire. The presence of six vocal symptoms was investigated, as well as environmental factors and health-related factors that may have an influence on the voice., Results: The results showed that the prevalence of voice problems among soccer coaches was high. In total, 28.4% of the participants reported two or more frequently occurring vocal symptoms. The most common symptom was throat clearing or coughing followed by voice becomes low or hoarse. The coaches who had vocally demanding main occupations alongside their coaching tasks had an increased risk for voice problems. Moreover, a significant association was found between chronic rhinitis and frequently occurring vocal symptoms, as well as between stress and frequently occurring vocal symptoms., Conclusions: Given the extent of voice problems and the fact that soccer coaches have a vocally demanding occupation, it would be important to increase the awareness of voice use among this group. Soccer coaches are in immense need of more information about voice ergonomics during their coaching education., (Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objectives: The purpose of the present study was to explore possible gender differences in the occurrence of vocal symptoms in smokers., Methods: A total of 1728 respondents, 68% women and 32% men completed a "Speech, language and voice" questionnaire. The questions concerning six vocal symptoms along with questions concerning smoking habits were used as the main data source for the present study., Results: About 24% of the men and 22% of the women were smokers. Male smokers did not differ from male nonsmokers in reporting vocal symptoms. In contrast, female smokers were more likely than female nonsmokers to report having vocal symptoms. Smoking seemed to have a significant effect on four of the six vocal symptoms in the female smokers., Conclusions: There appears to be a difference in the effects of smoking between men and women. The female vocal folds may be more vulnerable to cigarette smoke, probably due to anatomical and physiological differences. Nevertheless, it is yet to be demonstrated that the vocal symptoms in female smokers are causally related to smoking. It could be meaningful to use gender specific strategies when informing smokers about the risks for voice problems., (Copyright © 2015 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objectives: The purpose of this questionnaire study was to explore the prevalence and possible risk factors for voice problems in priests., Methods: About 2044 evangelical Lutheran priests received a link to an electronic questionnaire and 44.1% (n = 901) completed it. Of the participants, 53% were males and 47% were females., Results: The results showed that the prevalence of voice problems in priests was high. Of the participants, 24.5% had sought help for voice problems and 18% reported that they had been diagnosed with a voice disorder by a physician. Twenty-one percent considered themselves as having current voice problems, and 26.7% reported frequently occurring vocal symptoms. Voice-related absenteeism was reported by 11.6%. Significantly, more females than males reported voice problems. There were significant associations between frequently occurring vocal symptoms and several environmental- and health-related risk factors. More than half of the participants considered that they had received less than 5 hours of information on the voice and voice use. The association between frequently occurring vocal symptoms and the number of hours of information on the voice and voice use was significant., Conclusions: The results of this study indicate that the prevalence of voice problems among priests is high. Prevention of voice problems for priests is recommended. Voice training programs should be included in the curriculum for all those who are studying to become priests. For those already working as priests, practical courses on voice training could be arranged. Additionally, priests should get information on voice-related issues from the occupational health care or other health care services., (Copyright © 2015 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

The risk of developing laryngeal cancer increases after 50 years of age. Of the risk factors, smoking has decreased significantly, but alcohol consumption has increased. The significance of HPV infection is lower compared with oropharyngeal cancer. Early laryngeal cancer can be successfully treated with surgery or radiation therapy. For cancers that have spread further (T3 and T4), a combination of surgery and radiotherapy or a combination of radiotherapy and cytostatic chemotherapy are used. By using a voice prosthesis, most patients are able to achieve a fairly good speech quality after laryngectomy.

This study estimated vocal economy and investigated its relation to perceived voice quality and self-reported symptoms of vocal fatigue in kindergarten teachers. Quasi-output-cost ratio (QOCR) was calculated for sustained vowel [a:] at habitual loudness and at sound pressure level (SPL) of 90 dB(6cm). QOCR was calculated as (SPL/CQ(EGG)) × T/T(0), where CQ(EGG) is the contact quotient measured from the electroglottogram, T is the period length, and T(0) is arbitrarily set mean period length (0.005 s in females). QOCR correlated negatively with perceived firmness at standard SPL and with the evaluation of too high pitch for the subject at both SPLs. QOCR did not predict self-reported vocal fatigue. Further studies with connected speech and objectively stated loading symptoms are warranted.

This study investigated the relation of symptoms of vocal fatigue to acoustic variables reflecting type of voice production and the effects of vocal loading. Seventy-nine female primary school teachers volunteered as subjects. Before and after a working day, (1) a 1-minute text reading sample was recorded at habitual loudness and loudly (as in large classroom), (2) a prolonged phonation on [a:] was recorded at habitual speaking pitch and loudness, and (3) a questionnaire about voice quality, ease, or difficulty of phonation and tiredness of throat was completed. The samples were analyzed for average fundamental frequency (F0), sound pressure level (SPL), and phonation type reflecting alpha ratio (SPL [1-5 kHz]-SPL [50 Hz-1 kHz]). The vowel samples were additionally analyzed for perturbation (jitter and shimmer). After a working day, F0, SPL, and alpha ratio were higher, jitter and shimmer values were lower, and more tiredness of throat was reported. The average levels of the acoustic parameters did not correlate with the symptoms. Increase in jitter and mean F0 in loud reading correlated with tiredness of throat. The results seem to suggest that, at least among experienced vocal professionals, voice production type had little relevance from the point of view of vocal fatigue reported. Differences in the acoustic parameters after a vocally loading working day mainly seem to reflect increased muscle activity as a consequence of vocal loading.

This article summarizes the results for a total of 189 female and 63 male university students (mean age 23 and 26 years, respectively) from the following vocal capacity tests: measurement of (1) vital capacity, (2) average airflow in phonation (on [o:]), (3) maximum duration of sustained blowing, (4) maximum phonation time (on [o:, z:]), (5) maximum duration of [s:], (6) the ratio of the duration of [s:] to [z:] (s/z ratio), (7) phonation quotient (the ratio between vital capacity and maximum phonation time), (8) the lowest possible tone, (9) mean fundamental frequency (F0) in normal and loud text reading and in shouting, (10) difference between the lowest tone and mean F0 in text reading and in shouting, (11) F0 range in text reading, (12) equivalent sound level of normal and loud reading and of shouting in maximum loudness, (13) phonetogram (voice range profile) and (14) long-term average spectrum of text reading. Voice quality is also evaluated perceptually, and additionally, data on subjects' self-reported vocal fatigue symptoms in general or after a vocally loading task were collected. The value of these measurements from the point of view of assessment of vocal capacity will be discussed., (Copyright 2008 S. Karger AG, Basel.)

The occupational voice use of teachers has been an important research topic over the last 10 years. However, data collection on vocal loading in teachers at and away from the workplace poses significant challenges to the research protocol. The challenges include recruitment of subjects, voice data collection on the job, and subject compliance and retention. The present article offers recommendations for coping with these protocol difficulties. The recommendations are based on the authors' experiences with long-term, on-the-job voice dosimetry of large subject groups of teachers in the United States and Finland.

This study investigates the amount of voice training received by teachers in Finland and compares the incidence of vocal symptoms among teachers with shorter, longer or no vocal education. Participating were 124 primary, secondary and upper secondary school teachers; 63% of the teachers had received no vocal training, 15% had received short-term and 22% longer-term training. The incidence of symptoms was lowest in teachers with long-term training and highest in teachers with short-term training. The differences were non-significant among all teachers and females, but significant among males. Speech training seems to protect male teachers from vocal problems better than female teachers. Short-term training may lead to increased awareness of vocal symptoms, which can be helpful in voice protection.