Purpose The purpose of this document is threefold: (a) review the uses of the terms “vocal fatigue,” “vocal effort,” “vocal load,” and “vocal loading” (as found in the literature) in order to track the occurrence and the related evolution of research; (b) present a “linguistically modeled” definition of the same from the review of literature on the terms; and (c) propose conceptualized definitions of the concepts. Method A comprehensive literature search was conducted using PubMed/MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Scientific Electronic Library Online. Four terms (“vocal fatigue,” “vocal effort,” “vocal load,” and “vocal loading”), as well as possible variants, were included in the search, and their usages were compiled into conceptual definitions. Finally, a focus group of eight experts in the field (current authors) worked together to make conceptual connections and proposed consensus definitions. Results The occurrence and frequency of “vocal load,” “vocal loading,” “vocal effort,” and “vocal fatigue” in the literature are presented, and summary definitions are developed. The results indicate that these terms appear to be often interchanged with blurred distinctions. Therefore, the focus group proposes the use of two new terms, “vocal demand” and “vocal demand response,” in place of the terms “vocal load” and “vocal loading.” We also propose standardized definitions for all four concepts. Conclusion Through a comprehensive literature search, the terms “vocal fatigue,” “vocal effort,” “vocal load,” and “vocal loading” were explored, new terms were proposed, and standardized definitions were presented. Future work should refine these proposed definitions as research continues to address vocal health concerns.

Summary Introduction Since the beginning of the new pandemic, COVID-19 health services have had to face a new scenario. Voice therapy faces a double challenge, interventions using telepractice, and delivering rehabilitation services to a growing population of patients at risk of functional impairment related to the COVID-19 disease. Moreover, as COVID-19 is transmitted through droplets, it is critical to understand how to mitigate these risks during assessment and treatment. Objective To promote safety, and effective clinical practice to voice assessment and rehabilitation in the pandemic COVID-19 context for speech-language pathologists. Methods A group of 11 experts in voice and swallowing disorders from five different countries conducted a consensus recommendation following the American Academy of Otolaryngology-Head and Neck Surgery rules building a clinical guide for speech-language pathologists during this pandemic context. Results The clinical guide provides 65 recommendations for clinicians in the management of voice disorders during the pandemic and includes advice from assessment, direct treatment, telepractice, and teamwork. The consensus was reached 95% for all topics. Conclusion This guideline should be taken only as recommendation; each clinician must attempt to mitigate the risk of infection and achieve the best therapeutic results taking into account the patient's particular reality.

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Previous studies on the influence of noise and acoustics in the classroom on voice symptoms among teachers have exclusively relied on self-reports. Since self-reported physical conditions may be biased, it is important to determine the role of objective measurements of noise and acoustics in the presence of voice symptoms. To assess the association between objectively measured and self-reported physical conditions at school with the presence of voice symptoms among teachers. In 12 public schools in Bogotá, we conducted a cross-sectional study among 682 Colombian school workers at 377 workplaces. After signed the informed consent, participants filled out a questionnaire on individual and work-related conditions and the nature and severity of voice symptoms in the past month. Short-term environmental measurements of sound levels, temperature, humidity, and reverberation time were conducted during visits at the workplaces, such as classrooms and offices. Logistic regression analysis was used to determine associations between work-related factors and voice symptoms. High noise levels outside schools (odds ratio [OR] = 1.83; 95% confidence interval [CI]: 1.12–2.99) and self-reported poor acoustics at the workplace (OR = 2.44; 95% CI: 1.88–3.53) were associated with voice symptoms. We found poor agreement between the objective measurements and self-reports of physical conditions at the workplace. This study indicates that noise and acoustics may play a role in the occurrence of voice symptoms among teachers. The poor agreement between objective measurements and self-reports of physical conditions indicate that these are different entities, which argue for inclusion of physical measurements of the working environment in studies on the influence of noise and acoustics on vocal health.

The present study has investigated the occupational voice use of 27 female primary school teachers over a four-day-follow-up. Sixty-one working-day voice samples were acquired with two contact sensor-based vocal analyzers in four schools with highly different classroom acoustics. The vocal parameters were compared with a conversational task that the teachers performed before each lesson and with the measured classroom acoustic parameters. The average equivalent sound pressure level at 1 m from the mouth, which refers to the teacher's vocal effort, and the voicing time percentage were 71.2 dB [standard error (SE) 1.0 dB] and 29%, respectively. The teachers' mean voice level and fundamental frequency were significantly higher in the occupational setting than in the conversational one, which is by 5.5 dB (SE 0.5 dB) and 50 Hz (SE 3 Hz), respectively. Higher voice levels were observed for higher background noise levels, at a rate of 0.53 dB/dB, and a tendency of the background noise to increase with increasing reverberation time was observed at a rate of 13 dB/s. An optimal reverberation time of 0.7 s was found to minimize the voice level, since teachers raised their voice at lower and higher reverberation times, the latter presumably due to higher background noise levels.

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Similar to modal phonation, fry-like phonation seems to be influenced by individual and environmental factors. Therefore, clinicians interested in including this technique as part of their intervention programs may take into account the caffeine consumption and the background noise conditions of the room where the therapy will take place in order to facilitate the production of fry-like phonation.

Since these three methods offer different information, it is advisable to include all methods in ascertainment of voice disorders among teachers at work.