Risk of dysphonia and voice quality in performing arts students

Ferrari, Eloisa Pinheiro; Simões-Zenari, Marcia; Master, Suely; Nemr, Katia

doi:10.1590/2317-1782/20232022036pt

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Original Article • CoDAS 35 (4) • 2023 • https://doi.org/10.1590/2317-1782/20232022036en linkcopy

Risk of dysphonia and voice quality in performing arts students

Authorship SCIMAGO INSTITUTIONS RANKINGS

Purpose To analyse the relationship between the risk of dysphonia and vocal quality in undergraduate performing arts students.

Methods Observational cross-sectional study with 38 undergraduate students in Performing Arts. We applied screening protocols for general and specific risk of dysphonia for actors and made recordings of sustained emission of the vowel /a/, spontaneous speech and reading a text, used for perceptual analysis performed by three evaluators using the GRBASI scale. After intra and inter-rater reliability tests it was obtained final classification of the general degree of vocal deviation parameter for each participant. Comparisons were made considering groups that had or did not have other profession/activity with the use of voice, and the groups were formed from the general grade.

Results Most students were at high risk for dysphonia. All had vocal alteration, with a predominance of mild degree. Students who had another profession/activity with voice use scored higher in the specific protocol for actors, and in the sum of this protocol with the general screening protocol. There was no relationship between the degree of vocal alteration and the risk of dysphonia. Students who did not yet work professionally had more moderate or severe vocal alterations, and those who did work professionally had a higher frequency of mild vocal alterations.

Conclusion Most students were at high risk for dysphonia. All had vocal alteration, with a predominance of mild alteration. There was no relationship between the risk of dysphonia and the degree of vocal alteration.

Keywords:
Voice; Voice Quality; Voice Disorders; Dysphonia; Art

Instruments	Other occupations/activities using the voice	n	Mean	SD	Median	Min.	Max.	p	E.S.
SPRD-G	No	23	36.13 [33.37. 38.94]	7.36	37.00 [33.00. 39.00]	22.00	51.00	0.308^a	0.408d
SPRD-G	Yes	15	39.13 [33.93. 43.87]	10.59	41.00 [37.00. 44.00]	15.00	56.00	0.308^a	0.408d
SPRD-A	No	23	22.91 [20.87. 25.04]	5.05	23.00 [20.00. 25.00]	15.00	34.00	<0.001^a *	1.640^d
SPRD-A	Yes	15	31.20 [28.40. 34.27]	6.50	28.00 [26.00. 36.00]	25.00	43.00	<0.001^a *	1.640^d
SPRD-Final	No	23	59.13 [55.89. 62.61]	9.57	57.00 [56.50. 58.00]	37.00	86.00	0.004^a*	1.170^d
SPRD-Final	Yes	15	70.33 [64.20. 75.80]	12.59	73.00 [68.00. 73.00]	40.00	90.00	0.004^a*	1.170^d
EAV	No	23	4.00 [3.61. 4.41]	1.09	4.00 [4.00. 4.00]	2.00	6.50	0.718^b	0.061r
EAV	Yes	15	3.87 [3.07. 4.60]	1.55	4.00 [3.00. 5.86]	0.00	7.00	0.718^b	0.061r

Variables	Conclusion	Other occupations/activities using the voice						p
		No		Yes		Total
		n	%	n	%	n	%
Risk of dysphonia	Low	3	13.0	1	6.7	4	10.5	> 0.999
Risk of dysphonia	High	20	87.0	14	93.3	34	89.5	> 0.999
Professional acting	No	11	47.9	6	40.0	17	44.7	0.744
Professional acting	Yes	12	52.1	9	60.0	21	55.3	0.744
Vocal instructions	No	13	56.5	10	66.7	23	60.5	0.736
Vocal instructions	Yes	10	43.5	5	33.3	15	39.5	0.736

Instruments	Degree	n	Mean	SD	Median	Min.	Max.	p	E.S.
SPRD-G	Mild	22	37.07 [32.82. 41.36]	10.47	37.50 [31.50. 42.75]	15.00	56.00	0.828^aw	0.056d
SPRD-G	Moderate or severe	16	37.66 [34.90. 40.31]	5.98	38.50 [35.00. 40.00]	27.00	47.00	0.828^aw	0.056d
SPRD-A	Mild	22	25.82 [23.40. 28.36]	6.22	25.00 [24.50. 27.00]	15.00	41.00	0.708^a	0.140^d
SPRD-A	Moderate or severe	16	26.69 [23.06. 30.31]	8.00	25.00 [21.50. 28.00]	15.00	43.00	0.708^a	0.140^d
SPRD-Final	Mild	22	62.93 [57.52. 68.39]	13.44	64.50 [55.50. 69.00]	37.00	86.00	0.798^b	0.043r
SPRD-Final	Moderate or severe	16	64.41 [60.03. 69.06]	10.19	63.50 [57.50. 66.00]	53.50	90.00	0.798^b	0.043r
EAV	Mild	22	3.93 [3.41. 4.45]	1.32	4.00 [4.00. 4.00]	0.00	6.50	0.686^b	0.068^r
EAV	Moderate or severe	16	3.97 [3.44. 4.59]	1.24	4.00 [3.00. 4.00]	2.00	7.00	0.686^b	0.068^r

Variables	Conclusion	Degree of vocal alteration						p
		Mild		Moderate or severe		Total
		n	%	n	%	n	%
Risk of dysphonia	Low	4	18.18	0	0.00	4	10.53	0.124
Risk of dysphonia	High	18	81.82	16	100	34	89.47	0.124
Other occupation or activity using the voice	N	14	63.64	9	56.25	23	60.53	0.743
Other occupation or activity using the voice	Yes	8	36.36	7	43.75	15	39.47	0.743
Professional acting	No	6	27.27	11	68.75	17	44.74	0.020 *
Professional acting	Yes	16	72.73	5	31.25	21	55.26	0.020 *
Vocal instructions	No	12	54.55	11	68.75	23	60.53	0.506
Vocal instructions	Yes	10	45.45	5	31.25	15	39.47	0.506

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[1] The student t-test for independent samples (^a) and Mann-Whitney U Test (^b)

[TFN100] ^*
Statistically significant Value at the level of 5% (p ≤ 0.05)

[TFN200] ^d
Parametric coefficient to verify the effect size of the difference between groups

[TFN300] ^r
Non-parametric coefficient to verify the effect size of the difference between groups

[5] Caption: VAS = Visual Analog Scale; SD = Standard Deviation; Min. = Minimum; Max. = Maximum; E.S. = Effect Size