Marina Gilman

The Vocal Load of Reform Jewish Cantors in the USA

OBJECTIVE Jewish cantors comprise a subset of vocal professionals that is not well understood by vocal health professionals. This study aimed to document the vocal demands, vocal training, reported incidence of voice problems, and treatment-seeking behavior of Reform Jewish cantors. METHODS The study used a prospective observational design to anonymously query Reform Jewish cantors using a 35-item multiple-choice survey distributed online. Demographic information, medical history, vocal music training, cantorial duties, history of voice problems, and treatment-seeking behavior were addressed. RESULTS Results indicated that many of the commonly associated risk factors for developing voice disorders were present in this population, including high vocal demands, reduced vocal downtime, allergies, and acid reflux. Greater than 65% of the respondents reported having had a voice problem that interfered with their ability to perform their duties at some time during their careers. CONCLUSION Reform Jewish cantors are a population of occupational voice users who may be currently unidentified and underserved by vocal health professionals. The results of the survey suggest that Reform Jewish cantors are occupational voice users and are at high risk for developing voice disorders.

Human papillomavirus, abstinence, and the other risks

A century after syphilis first appeared in London, William Shakespeare knew the risk of trusting your sexual partner. Neither abstinence nor the marriage bed was a space safe from such diseases. Honesty, as Shakespeare observes in As You Like It, is rarely found in human sexual relations.

Analysis of voice change during cellular phone use: a blinded controlled study.

It is a growing belief that cellular phone use may be hazardous to the voice. This study aims to assess voice production in different conversational scenarios to identify any changes in vocal production that may be specific to cellular phone use. Twenty healthy participants were randomized to seven conversational scenarios: quiet conditions face to face; quiet conditions over a landline; quiet conditions using a cellular phone (QCP); quiet conditions using cellular phone with earpiece (QCPE); noisy conditions face to face (NFF); noisy conditions using cellular phone (NCP); and noisy conditions using cellular phone with earpiece (NCPE). In each condition, participants performed spontaneous speech, a standardized reading passage, and sustained voicing. Sound pressure levels (dB SPL) and fundamental frequencies (F(0)[Hz]) were measured. Subjects completed a 100-mm visual analog scale measuring vocal effort after each speaking scenario. Statistical analysis was performed using analysis of variance (ANOVA). There was a significant difference in dB SPL and F(0) between all quiet conditions relative to all noisy conditions (P<0.001). There was no difference in cellular phone use relative to any other conversational condition in mean dB SPL, respective of ambient noise. Vocal effort was rated greater for noisy conditions compared with quiet conditions. Cellular phone use does not lead to a significant change in voice production relative to other speaking conditions. Voice problems associated with cellular phone use may simply be a function of the increased amount of voice use and increased vocal loudness (Lombard effect) associated with speaking in noisy situations rather than a variable inherent to the phone.

The Effect of Head Position and/or Stance on the Self-perception of Phonatory Effort

BACKGROUND Vocal fatigue is a common but poorly defined complaint of patients presenting with voice disorders. Definitions of vocal fatigue generally include increased self-perceived phonatory effort resulting from references to vocal loading or prolonged voice use resulting in deterioration of function. The present study looks at the role of posture, specifically head position and stance, in self-perceived phonatory effort. METHODS Forty-six healthy adults, 13 males and 33 females (mean age was 27.5), with no history of vocal problems/disorders within the past year were recruited. Subjects were asked to sustain the vowel /a/ at a comfortable pitch and loudness for 5-10 seconds in each of six positions: sitting and standing in the manner habitual for each subject, two exaggerated positions of the head (head back and head forward), and two exaggerated positions in standing (standing with knees locked and with knees soft). Each position was repeated three times in randomized order, resulting in 18 trials for each subject. After each repetition of the sustained /a/, subjects were asked to rate their experience of vocal effort using a 100-mm visual analog scale (0-40 least effort, 40-60 habitual effort, and 60-100 increased effort). RESULTS Repeated measures analysis of variance revealed significant difference in the self-perceived phonatory effort levels across positions (P value < 0.001). The exaggerated forward and back head positions in both sitting and standing positions showed the greatest significance on the Tukey post hoc tests (P < 0.000). CONCLUSIONS Based on the findings, posture may play a more important role in vocal fatigue than previously thought.

Airflow Patterns of Running Speech in Patients With Voice Disorders

OBJECTIVE Aerodynamic measures of voice have historically been acquired using sustained phonation tasks. This study seeks to determine whether there are differences in airflow during sustained phonation (MFs), in running speech (MFrs), or during phonation in running speech (MFvrs). We also seek to determine whether these patterns are diagnostically significant. METHODS Data were collected on 40 subjects (15 men, 25 women), ages 20-79, with a mean age of 53 in this prospective study. All participants received a comprehensive videostroboscopic evaluation and were deemed appropriate for voice evaluation and trial therapy. The Phonatory Aerodynamic System 6600 was used for data collection. The Comfortable Sustained Phonation and Running Speech protocols were used for data acquisition. Patient diagnoses were divided into five subgroups: benign lesions, vocal fold paralysis or paresis, muscle tension dysphonia, edema or laryngitis, and chronic cough. Statistical methods such as analysis of variance and Tukey tests assessed pairwise differences in the airflow rate. Pairwise Tukey multiple comparisons of means testing using a 95% family-wise confidence level were completed to determine the interrelationships of the pairs. RESULTS Differences were found among airflow measures (P value = 0.0152), pairwise comparisons of MFs-MFvrs pair (P value = 0.012), and diagnosis. No significance was found in MFs-MFrs (P = 0.051) or MFvrs-MFrs (P = 0.94) pairs. Mean flow rates were higher than the norms in MFs. The overall range of mean airflow was similar to those of published norms. CONCLUSION Assumptions about mean airflow of connected speech should not be made based on sustained phonation tasks alone. No salient diagnostic characteristics were found by diagnosis.

Breath holding: an elusive obstacle

Actors and singers sometimes experience vocal fatigue, increased effort, and sometimes hoarseness that cannot be attributed to poor technique. Symptoms appear randomly. Voice coaches and trainers often are at a loss as to how to help. Laryngeal examination by a qualified laryngologist generally does not reveal any pathology so they are referred for voice therapy. Since these performers are experienced and have good technique, it is often difficult to get to the root of the problem. Very often the problem is related to breath holding or constriction of the airflow related to poor body dynamics and respiratory–phonatory coordination. Breath holding or restricting the airflow is difficult to identify because it can manifest in many different ways. The most obvious indications include audible release of air at the end of phrases such as we hear in some pop singing, squeezing, or “pushing” the sound at the ends of phrases sometimes disintegrating into a rough popping quality known as glottal fry. More subtle indications include a sense of constriction in the throat, throat or neck pain, increased fatigue, or increased effort on exertion. This article explores the somatic implications of breath holding and provides a sample lesson for retraining maladaptive patterns.