The study aimed to describe the outcomes of the voice use reduction (VUR) program on voice quality and vocal fatigue (VF) in occupational voice users (OVUs). A within-subject, quasi-experimental, pre-test, post-test research design was performed on 30 OVUs. Perceptual and acoustic outcome measures were employed pre-and post-implementation of the VUR, including the GRBASI 4-point rating scale, jitter, shimmer, fundamental frequency (F0), harmonic-to-noise ratio (HNR), maximum phonation time (MPT), frequency min and max, intensity min and max, the dysphonia severity index (DSI), and the vocal fatigue index (VFI). The pre-and post-test outcomes revealed significant (p < .001) decreases in perceptual G (Grade of hoarseness), R (Roughness), A (Asthenia), S (Strain), and I (Instability). Perceptual normality in these areas increased significantly (p < .001). Acoustic measures revealed significant (p < .05) decreases in Jitter%, Intensity (dB) Min, and DSI scores as well as significant (p < .05) increases in MPT /a/, /s/, and /z/, Frequency (Hz) Max, and F0 (Hz) Max, indicating improved voice quality at post-test. The VUR program positively affected and improved OVUs’ perception of VF in the areas of tiredness of voice and physical discomfort. OVUs strongly perceive improvement of VF symptoms with rest regardless of the current level of VF they are experiencing. When approaching OVUs, clinicians are encouraged to use a combination of direct voice therapy and vocal hygiene accompanied by VUR to help develop healthier use of the voice, facilitate healing, and prevent further/future injury or disorder.
AikenP. J.RumbachA. F. (2018). Keeping the voice fit in the group fitness industry: A qualitative study to determine what instructors want in a voice education program. Journal of Voice, 32(2), 256.e25–256.e34. https://doi.org/10.1016/j.jvoice.2017.04.014
2.
AwanS. N.ShaikhM. A.AwanJ. A.AbdallaI.LimK. O.MisonoS. (2023). Smartphone recordings are comparable to “gold standard” recordings for acoustic measurements of voice. Journal of Voice, S0892–1997(23), 00031–00030. https://doi.org/10.1016/j.jvoice.2023.01.031
3.
BarrettE. A.LamW.YuiE. M. L. (2020). Elicitation of minimum and maximum fundamental frequency and vocal intensity: Discrete half steps versus glissando. Journal of Voice, 34(2), 179–196. https://doi.org/10.1016/j.jvoice.2018.09.023
4.
BehlauM.OliveiraG. (2009). Vocal hygiene for the voice professional. Current Opinion in Otolaryngology & Head and Neck Surgery, 17(3), 149–154. https://doi.org/10.1097/MOO.0b013e32832af105
BottalicoP.AstolfiA. (2012). Investigations into vocal doses and parameters pertaining to primary school teachers in classrooms. The Journal of the Acoustical Society of America, 131(4), 2817–2827. https://doi.org/10.1121/1.3689549
8.
CantarellaG.IofridaE.BoriaP.GiordanoS.BinattiO.PignataroL.ManfrediC.FortiS.DejonckereP. (2014). Ambulatory phonation monitoring in a sample of 92 call center operators. Journal of Voice, 28(3), 393e1–393e6. https://doi.org/10.1016/j.jvoice.2013.10.002
9.
ChristmannM. K.SchererT. M.CieloC. A.HoffmanC. F. (2013). Maximum phonation time of future professional voice users. Revista CEFAC, 15(3), 622–630. https://doi.org/10.1590/S1516-18462013005000019
10.
Côrtes GamaA. C.CamargoZ.Rocha SantosM. A.Carlos RusiloL. (2015). Discriminant capacity of acoustic, perceptual, and vocal self: The effects of vocal demands. Journal of Voice, 29(2), 260.e45–260.e50. https://doi.org/10.1016/j.jvoice.2014.06.012
11.
DevadasU.HegdeM.MaruthyS. (2019). Prevalence and risk factors of self-reported voice problems among yakshagana artists. Journal of Voice, 33(1), 124e35–124e47. https://doi.org/10.1016/j.jvoice.2017.09.010
12.
De WinterJ. F.DodouD. (2010). Five-point Likert items: t test versus Mann-Whitney-Wilcoxon (Addendum addedOctober2012). Practical Assessment, Research, and Evaluation, 15(1), Article 11. https://doi.org/10.7275/bj1p-ts64
13.
FahamM.AhmadiA.DrinnanM.SaadatmandN.FatahiE.JalalipourM. (2016). The effects of a voice education program on VHI scores of elementary school teachers. Journal of Voice, 30(6), 755.e1–755.e11. https://doi.org/10.1016/j.jvoice.2015.09.009
14.
FairbanksG. (1960). Voice and articulation drill book (2nd ed.). Harper & Row.
15.
FieldA. (2018). Discovering statistics using IBM SPSS statistics (5th ed.). Sage.
FrancoR. A.AndrusJ. G. (2007). Common diagnoses and treatments in professional voice users. Otolaryngologic Clinics of North America, 40(5), 1025–1061. https://doi.org/10.1016/j.otc.2007.05.008
18.
Garzón GarcíaM.Muñoz LópezJ.y Mendoza LaraE. (2017). Voice habits and behaviors: Voice care among flamenco singers. Journal of Voice, 31(2), 246.e11–246.e19. https://doi.org/10.1016/j.jvoice.2016.08.007
GoyH.FernandesD. N.Pichora-fullerM. K.Van LieshoutP. (2013). Normative voice data for younger and older adults. Journal of Voice, 27(5), 545–555. https://doi.org/10.1016/j.jvoice.2013.03.002
21.
GunasekaranN.BoominathanP.SeethapathyJ. (2016). Voice needs and voice demands of professional newsreaders in southern India. Journal of Voice, 30(6), 756.e9–756.e20. https://doi.org/10.1016/j.jvoice.2015.09.001
KanekoM.ShiromotoO.Fujiu-KurachiM.KishimotoY.TateyaI.HiranoS. (2017). Optimal duration for voice rest after vocal fold surgery: Randomized controlled clinical study. Journal of Voice, 31(1), 97–103. https://doi.org/10.1016/j.jvoice.2016.02.009
25.
KayPENTAX. (2006). KayPENTAX software instruction manual: Multi-Dimentional Voice Program (MDVP), model 5105, January.
26.
KoufmanJ. A.AminM. R.PanettiM. (2000). Prevalence of reflux in 113 consecutive patients with laryngeal and voice disorders. Otolaryngology–Head and Neck Surgery, 123(4), 385–388. https://doi.org/10.1067/mhn.2000.109935
LeedyP. D.OrmrodJ. E. (2023). Practical research: Planning and design, global edition (13th ed.). Pearson Education Limited.
29.
LehtoL.LaaksonenL.VilkmanE.AlkuP. (2008). Changes in objective acoustic measurements and subjective voice complaints in call center customer-service advisors during one working day. Journal of Voice, 22(2), 164–177. https://doi.org/10.1016/j.jvoice.2006.08.010
30.
LiuH.ChenS. H.GaoL.LiJ.LiuB.RajH.XieQ.DuanH.JiangZ.LiuY.ChenB.LiuY.JiangJ. (2020). Comparison between combination of resonant voice therapy and vocal hygiene education and vocal hygiene education only for female elementary school teachers. Journal of Voice, 36(6), 814–822. https://doi.org/10.1016/j.jvoice.2020.09.028
31.
MorrowS. L.ConnorN. P. (2011). Voice amplification as a means of reducing vocal load for elementary music teachers. Journal of Voice, 25(4), 441–446. https://doi.org/10.1016/j.jvoice.2010.04.003
32.
MunierC.FarrellR. (2016). Working conditions and workplace barriers to vocal health in primary school teachers. Journal of Voice, 30(1), 127.e31–127.e41. https://doi.org/10.1016/j.jvoice.2015.03.004
33.
NallamuthuA.BoominathanP.ArunachalamR.MariswamyP. (2021). Outcomes of vocal hygiene program in facilitating vocal health in female school teachers with voice problems. Journal of Voice, 37(2), 295.E11–295.E22. https://doi.org/10.1016/j.jvoice.2020.12.041
34.
NanjundeswaranC.JacobsonB. H.Gartner-SchmidtJ. (2015). Vocal Fatigue Index (VFI): Development and validation. Journal of Voice, 29(4), 433–440. https://doi.org/10.1016/j.jvoice.2014.09.012
35.
NusseckM.ImmerzA.SpahnC.EchternachM.RichterB. (2019). Long-term effects of a voice training program for teachers on vocal and mental health. Journal of Voice, 35(10), 1016. https://doi.org/10.1016/j.jvoice.2019.11.016
36.
PachecoC.BehlauM. (2019). Immediate impact of vocal demand on musical theater singers in Brazil. Journal of Voice, 33(5), 804.e13–804.e22. https://doi.org/10.1016/j.jvoice.2018.04.013
37.
PomavilleF.TekerlekK.RadfordA. (2019). The effectiveness of vocal hygiene education for decreasing at-risk vocal behaviors in vocal performers. Journal of Voice, 34(5), 709–719. https://doi.org/10.1016/j.jvoice.2019.03.004
38.
PorcaroC. K.HoweryS.SuhandronA.GolleryT. (2019). Impact of vocal hygiene training on teachers’ willingness to change vocal behaviors. Journal of Voice, 35(3), 499.e1–499.e11. https://doi.org/10.1016/j.jvoice.2019.11.011
39.
RangarathnamB.ParambyT.McCulloughG. H. (2018). “Prologues to a bad voice””: Effect of vocal hygiene knowledge and training on voice quality following stage performance. Journal of Voice, 32(3), 300–306. https://doi.org/10.1016/j.jvoice.2017.05.026
40.
ReedJ. P.SimsH. S. (2017). Comparative analysis of characteristics of voice use amidst clergy. Journal of Voice, 31(2), 256.e7–256.e11. https://doi.org/10.1016/j.jvoice.2016.06.005
41.
SchlonegerM. J. (2011). Graduate student voice use and vocal efficiency in an opera rehearsal week: A case study. Journal of Voice, 25(6), e265–e273. https://doi.org/10.1016/j.jvoice.2010.09.010
42.
SezinR. K.ÖzcebeE.AydinliF. E.KöseA.GünaydinR. Ö. (2020). Investigation of the effectiveness of a holistic vocal training program designed to preserve theatre students’ vocal health and increase their vocal performances; a prospective research study. Journal of Voice, 34(2), 302.e21–302.e28. https://doi.org/10.1016/j.jvoice.2018.08.009
43.
SobolM.Sielska-BadurekE. M.Osuch-WójcikiewiczE. (2020). Normative values for singing voice handicap index–systematic review and meta-analysis. Brazilian Journal of Otorhinolaryngology, 86(4), 497–501. https://doi.org/10.1016/j.bjorl.2018.12.004
TimmermansB.De BodtM.WuytsF.VandeHeyningP. (2004). Voice quality change in future professional voice users after 9 months of voice training. European Archives of Oto-Rhino-Laryngology, 261(1), 1–5. https://doi.org/10.1007/s00405-003-0652-5
Van LierdeK. M.Van EvelienD.WuytsF. L.De LeyS. (2010). The objective vocal quality, vocal risk factors, vocal complaints, and corporal pain in Dutch female students training to be speech-language pathologists during the 4 years of study. Journal of Voice, 24(5), 592–598. https://doi.org/10.1016/j.jvoice.2008.12.011
48.
Van OvermeirenT.MeerschmanI.D’haeseleerE.Van LierdeK. (2018). The vocal symptoms and habits of professional voice users. B-ENT, 14, 271–280. http://hdl.handle.net/2263/75132
49.
VasilakisM.StylianouY. (2009). Voice pathology detection based on short-term jitter estimations in running speech. Folia Phoniatrica et Logopaedica, 61(3), 153–170. https://doi.org/10.1159/000219951
50.
WhitlingS.Lyberg-ÅhlanderV.RydellR. (2018). Absolute or relative voice rest after phonosurgery: A blind randomized prospective clinical trial. Logopedics Phoniatrics Vocology, 43(4), 143–154. https://doi.org/10.1080/14015439.2018.1504985
51.
WuytsF. L.De BodtM. S.MolenberghsG.RemacleM.HeylenL.MilletB.Van LierdeK.RaesJ.VanDeHeyningP. H. (2000). The dysphonia severity index: An objective measure of vocal quality based on a multiparameter approach. Journal of Speech, Language, and Hearing Research, 43(3), 796–809. https://doi.org/10.1044/jslhr.4303.796
52.
YamauchiE. J.ImaizumiS.MaruyamaH.HajiT. (2010). Perceptual evaluation of pathological voice quality: A comparative analysis between the RASATI and GRBASI scales. Logopedics Phoniatrics Vocology, 35(3), 121–128. https://doi.org/10.3109/14015430903334269
53.
YuP.OuaknineM.RevisJ.GiovanniA. (2001). Objective voice analysis for dysphonic patients: A multiparametric protocol including acoustic and aerodynamic measurements. Journal of Voice, 15(4), 529–542. https://doi.org/10.1016/S0892-1997(01)00053-4
