Discriminant Capacity of Acoustic, Perceptual,

and Vocal Self: The Effects of Vocal Demands

lio Rocha Santos, and Luiz Carlos Rusilo,
^ rtes Gama, Zuleica Camargo, Marco Aure
*Ana Cristina Co
*zBelo Horizonte, Minas Gerais and yxS~ao Paulo, Brazil

Summary: Objectives. To analyze the discrimination ability of acoustic, auditory parameters, and perception of
vocal effort during professional and social voice use, and the correlations of these parameters with the vocal demands.
Study Design. Longitudinal study.
Methods. Seventy-three subjects participated in the study: 31 females aged from 28 to 65 years (G1; professional
voice users) and 42 females aged from 31 to 59 years (G2, social voice users; ). All the subjects were subjected to acoustic voice analysis including F0 median, semiamplitude interquartile, quantile 99.5%, and skewness; first F0 derivate
mean, standard deviation (SD), and skewness; intensity skewness; spectral slope mean, SD, and skewness; long-term
average spectrumfrequency SD, perceptual parameters (GRBASI scale), and self-perception of vocal effort, before
and after 2 hours and 30 minutes of voice use. Statistical analyses were completed via multivariate discriminant analysis
and canonical correlation analysis.
Results. Discriminant analysis of acoustic, perceptual, and self-rating variables and analysis of the grouped parameters did not differentiate the samples before and after vocal use. Higher levels of canonical correlation were found for the
professional voice group after voice use, with a correlation between perceptual analysis and acoustic measures.
Conclusions. The current measures could not discriminate the differences of the type of vocal demands, professional
or social.
Key Words: VoiceSpeech acousticsDysphoniaFacultySpeechLanguage and hearing sciences.
INTRODUCTION
Teachers are often referred to as vocal athletes because of the
significant vocal demands placed on them in the workplace.1,2
The American College of Sports Medicine guidelines
established clinical protocols for physical training and
conditioning.3 The guidelines outline the fundamental tenet of
training to include progressive overload, or a gradual increase
in the physical stresses associated with physical exercise.3 The
correlation between vocal loading and vocal fatigue is not
well established. Extended periods of vocal fold vibration and
collision of vocal fold tissues during continuous speech and
more so during increased sound pressure levels in teachers,4
may lead to vocal fatigue. Titze suggests that intense voice
use leads to vocal fatigue and subsequent changes in blood circulation, tension, viscosity, and the composition of fluids, with
deleterious effect on phonatory efficiency.5
The literature defines vocal fatigue as a negative adaptation as
a consequence of prolonged vocal use,6 and this negative adaptation can be observed in auditory-perceptual, acoustic, aerodynamic, or physiological evaluation, indicating an undesirable
effect on functional phonatory physiology.7 Recent literature
suggests that after vocal loading, the most sensitive parameters
indicative of hyperfunctional voice production are acoustic
Accepted for publication June 16, 2014.
From the *Department of Speech-language Pathology, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; yIntegrated Laboratory on Acoustic Analysis
and Cognition, Postgraduate Studies Program in Applied Linguistics and Language
Studies of the Pontifical Catholic University of S~ao Paulo, S~ao Paulo, Brazil;
zOtorhinolaryngology Service of Federal University of Minas Gerais, Belo Horizonte,
Minas Gerais, Brazil; and the xDepartment of Quantitative Methods, Faculty of Economics
and Administration of the Pontifical Catholic University of S~ao Paulo, S~ao Paulo, Brazil.
Address correspondence and reprint requests to Ana Cristina C^ortes Gama, Federal University of Minas Gerais, Av. Alfredo Balena, 190/249, Belo Horizon, CEP 30130-100,
Brazil. E-mail: anacgama@medicina.ufmg.br
Journal of Voice, Vol. 29, No. 2, pp. 260.e45-260.e50
0892-1997/$36.00
2015 The Voice Foundation
http://dx.doi.org/10.1016/j.jvoice.2014.06.012

signals related to fundamental frequency (F0),810 laryngeal

tremor,11,12 glottic chink on videolaryngoscopic evaluation,13,14
fatigue signals in electromyography (EMG),12 and changes in
aerodynamic parameters.9,15 Most previous research focused
on the acoustic characteristics (F0, vocal tremor) and
aerodynamic voice analysis of sustained vowels810 in selfperception of the voice16 or in physiological and laryngeal
characteristics.1214 Less attention was directed to the study of
long-term vocal properties (perceptive and acoustic) of prolonged speech. These measures, when extracted from continuous
speech, showed results more compatible with the habitual individual vocalizations compared with perceptual and acoustic
measures extracted from sustained vowels.17 Moreover, few
studies analyzed vocal and speech modifications in specific
groups of professionals,8 such as teachers in ergonomic work situations of professional vocal use.18 The effects of professional
and social vocal use in women submitted to differentiate levels
of vocal demand evaluated by acoustic and perceptual analysis
extracted from continuous speech and self-perception of vocal
effort are still less known. The aim of this study was to analyze
the discrimination ability of acoustic, auditory parameters and
perception of vocal effort of the effects of professional and social
use of the voice during an extended period of voice use, and the
correlations of these parameters with the vocal demands.
METHODS
Voice samples
This longitudinal study was approved by the committee of
ethics in research of the institution (ETIC 0531/2011).
Seventy-three subjects participated in the study: 31 females
aged from 28 to 65 years (mode 59); all were teachers of
the municipal educational system at Belo Horizonte and were
classified as professional voice users (G1). Forty-two females
aged from 31 to 59 years (mode 42) were included as

^ rtes Gama, et al
Ana Cristina Co

Vocal Demands on Acoustic, Perceptual, and Vocal Self

nonprofessional voice users (G2). The professional activities

of G2 included government employees (11), housewives (6),
traders (7), managers (6), nurses (3), hairdressers (3), engineers
(2), a nutritionist (1), student (1), nun (1), and pedagogue (1).
Exclusion criterion in G1 was speech therapy during the
research; the onset of vocal complaints in G2 was considered
exclusion criteria. Professional voice use in G1 involved continuous voice use for 2 hours and 30 minutes. In G2, social vocal
activity or voice use at home was determined during the same
time interval.
The number of subjects was defined by a sample size calculation using the one-way ANOVA test with the power of 90%,
considering the higher standard deviation (SD) and a maximal
difference between the groups to be one SD of the acoustic measures. Minitab Release 14.1 (Minitab, Inc, State College, PA)
was used for these calculations.
Subjects were accrued from four schools within Belo Horizonte; a convenient sample of female teachers who agreed to
take part in the study was obtained. Subjects in G2 were recruited from different places according to the inclusion and
exclusion criteria.
Voice recordings of G1 subjects were performed in a quiet
room at the schools where the teachers worked in the morning
to ensure relative voice rest before data acquisition. Speech samples were obtained twice; before and after 2.5 hours of classroom teaching. G2 subjects were recorded in a quiet room
within their home in the morning before and after 2.5 hours of
social vocal use. The same equipment was used in both groups,
and the interval between the recordings was defined based on the
period of voice use during classroom teaching.
The stimulus for recordings included sentences and a semispontaneous speech protocol used to evaluate phonetic vocal
quality19 based on the principle of susceptibility of the vowel
and consonantal segments to the effects of the long-term voice
quality settings. Subjects were asked to respond to Tell about
the city where you live and read six sentences in random order,
totaling three repetitions per sentence. Subjects could read the
sentences before the recording and ask any question.
Recordings were performed with the subjects seated using an
omnidiretional condensor microphone (CO1 Samson Technologies Corp., Hauppauge, NY) positioned 20 cm from the
subject at a 45 angle, linked to a sound card (Quad Capture
Interface; Roland DG Corporation, Japan) and a notebook
(Intel Pentium Processor P6200, USA). Data were stored
and analyzed via the software SONAR LE (Roland DG Corporation, Japan) in wave files, edited and named based on acoustic
and perceptual analysis.

260.e46

Perceptual analysis
Perceptual analysis was performed by two speech language pathologists with 10 years of experience in work in a voice clinic
and the samples were randomized, and therefore, the reviewers
were blinded to the group (G1 vs G2) and also the recording
condition (pre vs post loading).
The GRBASI scale was used for perceptual analysis; Gdegree of dysphonia, R-roughness, B-breathiness, A-asthenia,
S-stiffness, and the last parameter I-instability inserted by
Dejonckere et al (1996).20 With this scale, each speech pathologist evaluated the parameters according on a 0 to 3 scale with
0 reflecting absence of disturbance, 1 for slight, 2 for moderate,
and 3 for intense. The speech language pathologists performed
the perceptual analysis with Coby CV-3000 (Coby Electronics,
Lake Success, NY) earphones and were allowed to hear the
voice recordings as many times as needed.
Acoustic analysis
Acoustic analysis of the vocal samples (read sentences and
semispontaneous speech) was done by the script Expression
Evaluator21 applied to the free software Praat22 for automatic
extraction of acoustic measures. The script generated the acoustic parameters of F0 (median, semiamplitude interquartile,
quantile 99.5%, and skewness), first F0 derivative (mean, SD,
and skewness); intensity (skewness), spectral slope (mean,
SD, and skewness) and long-term average spectrum (LTAS) frequency (SD) measures.
Vocal self-perception
The subjects in both G1 and G2 were asked to evaluate their
effort during sentence reading before and after 2.5 hours of
voice use via a 10 point visual analogue scale (VAS). Zero
represented the absence of effort and 10 maximum effort.
A visual image was provided to compliment the scale
(Figure 1).
Statistical analysis
Statistical analysis of acoustic parameters, perceptual analysis,
and vocal self-perception was done by multivariate discriminant analysis and a canonical correlation analysis to evaluate
the strength of the association and to discriminate the parameters related to vocal loading in both G1 and G2.
Discriminant analysis of the acoustic parameters, perceptual analysis, and vocal self-perception was done both separately and grouped to evaluate the possibility of prediction
and discrimination of the samples in each group and at
each moment of vocal use. Canonical correlation analysis

FIGURE 1. Visual analogue scale (VAS). See http://www.jkns.or.kr/fulltext/htm/0042011125f1.htm.

260.e47

Journal of Voice, Vol. 29, No. 2, 2015

TABLE 1.
Values of Mean, Median, and Standard Deviation (SD) of the Acoustic Measurements in Group of Social Vocal Use Before
and After the Interval of 2.5 Hours
Before

After

Acoustic Measures

Mean

Median

SD

Mean

Median

SD

Median of F0
Semiamplitude interquartile of F0
Quantile 99.5% of F0
Skewness of F0
Mean of first F0 derivate
SD of first F0 derivate
Skewness of first F0 derivate
Skewness of intensity
Mean of spectral slope
SD of spectral slope
Skewness of spectral slope
LTAS-frequency (SD)

210.30
64.33
0.61
0.04
0.11
0.20
0.16
4.50
0.30
0.28
1.30
14.40

213.00
58.80
0.49
0.05
0.17
0.02
0.20
4.40
0.30
0.28
1.30
14.30

24.34
28.96
0.43
0.10
0.62
0.01
0.01
1.90
0.05
0.05
0.10
3.90

211.90
59.64
0.59
0.50
0.11
0.02
0.20
4.20
0.20
0.28
1.30
14.25

215.40
54.00
0.41
0.05
0.17
0.02
0.15
4.20
0.30
0.28
1.28
14.30

22.01
27.89
0.44
0.10
0.66
0.11
3.80
1.80
0.06
0.05
0.10
3.85

Abbreviations: SD, standard deviation; LTAS, long-term average spectrum.

of perceptual analysis and vocal self-perception was done

separately before and after the vocal use in each group. The
software XLSTAT (Addinsoft SARL, USA) was used for
statistical analysis.

RESULTS
Tables 1 and 2 show the acoustic measures in G1 and G2, and
Tables 3 and 4 show the values of the perception of vocal
effort in G1 and G2.
Discriminant analysis of the acoustic parameters, perceptual
analysis, and vocal self-perception and the analysis of the
grouped parameters (acoustic parameters, perceptual analysis,
and vocal self-perception) before and after vocal use in G2 is
shown in Table 5.

The acoustic parameters, vocal self-perception, and the

grouped parameters did not differentiate the samples with regard to prevoice versus postvoice use. Discriminant analysis
showed that for the perceptual variables evaluation of the vocal
quality differentiated 83% of the social vocal use group before
vocal loading (Table 5). The samples were separated by the
perceptual evaluation of degree of dysphonia (G) (78.1%) and
roughness (R) (78.1%).
Table 6 shows the results of the discriminant analysis applied
to the acoustic parameters, perceptual analysis, self-perception
of vocal effort, and the three parameters adjoined in the evaluation before and after of vocal use in the group of professional
vocal use. The acoustic measures and the self-perception of
vocal use in the professional vocal use group did not differentiate before and after vocal use (Table 6).

TABLE 2.
Values of Mean, Median, and Standard Deviation (SD) of the Acoustic Measurements in the Group of Professional Voice
Use Before and After an Interval of 2.5 Hours
Before
Acoustic Measures
Median of F0
Semiamplitude interquartile of F0
Quantile 99.5% of F0
Skewness of F0
Mean of first F0 derivate
SD of first F0 derivate
Skewness of first F0 derivate
Skewness of intensity
Mean of spectral slope
SD of spectral slope
Skewness of spectral slope
LTAS-frequency (SD)

After

Mean

Median

SD

Mean

Median

SD

193.0
67.2
0.770
0.094
0.116
0.026
0.30
4.85
0.23
0.26
1.29
14.5

192.6
58.8
0.850
0.100
0.190
0.020
0.20
4.80
0.22
0.25
1.28
14.3

21.1
34.5
0.470
0.090
0.750
0.015
3.65
2.10
0.06
0.06
0.08
4.4

203.5
73.7
0.789
0.092
0.186
0.027
0.18
4.60
0.22
0.25
1.30
13.6

202.2
62.4
0.850
0.100
0.250
0.020
0.10
4.60
0.21
0.24
1.30
13.3

22.0
38.4
0.450
0.093
0.744
0.015
3.30
2.03
0.06
0.06
0.09
4.3

Abbreviations: SD, standard deviation; LTAS, long-term average spectrum.

^ rtes Gama, et al
Ana Cristina Co

TABLE 3.
Values of the Perception of Vocal Effort in Group of Social
Vocal Use Before and After the Interval of 2.5 Hours
Before

After

Values

0
1
2
3
4
5
6
7
8
9
10

23
05
04
05
03
02
0
0
0
0
0

54.8
11.9
09.5
11.9
07.1
04.8
0
0
0
0
0

24
03
05
02
02
02
02
02
0
0
0

57.1
07.1
11.9
04.8
04.8
04.8
04.8
04.8
0
0
0

TABLE 5.
Confusion Matrix for the Estimation Sample Groups
Social Voice Use Before and After a Period of 2.5 Hours
From the Acoustic Parameters, Perceptual, Selfperception of Vocal Effort and All Parameters Together
Parameters
Acoustic

Perceptual

Self-perception
of vocal effort
All parameters

Abbreviation: N, number of responses.

Discriminant analysis of the perceptual analysis parameters revealed that the perceptual analysis of vocal quality
separated the professional voice users before voice use
(Table 6). The samples were separated by breathiness (B)
(94.6%), degree of dysphonia (G) (82.1%), and roughness
(R) (82.1%).
Discriminant analysis of the three parameters grouped
(acoustic, perceptual analysis, and self-perception) differentiated 70.73% of the samples of the professional voice users group
before the vocal use and 61.10% at the after vocal use (Table 6),
demonstrating a difference between these moments. The samples were separated by the perceptual evaluation of breathiness
(B) (60.3%), degree of dysphonia (G) (60.3%) and roughness
(R) (60.3%), and acoustic parameter F0 median (59.4%).
Analysis of canonical correlation explored several levels of
correlations of the acoustic parameters, perceptual analysis,
and self-perception of vocal effort between the groups before
TABLE 4.
Values of the Perception of Vocal Effort in Group of
Professional Vocal Use Before and After the Interval of
2.5 Hours
Before

After

Values

0
1
2
3
4
5
6
7
8
9
10

12
05
05
03
01
03
01
01
0
0
0

38.7
16.1
16.1
09.7
03.2
09.7
03.2
03.2
0
0
0

04
03
05
07
08
01
02
01
0
0
0

12.9
09.7
16.1
22.6
25.8
03.2
06.4
03.2
0
0
0

Abbreviation: N, number of responses.

260.e48

Vocal Demands on Acoustic, Perceptual, and Vocal Self

Moment Before After Total

Before
After
Total
Before
After
Total
Before
After
Total
Before
After
Total

369
304
673
621
553
1174
269
265
534
441
313
754

377
446
823
125
197
322
476
486
962
307
435
742

746
750
1496
746
750
1496
745
751
1496
748
748
1496

Correct
(%)
49.46
59.47
54.48
83.24
26.27
54.68
36.11
64.71
50.47
58.96
58.16
58.56

and after vocal use. Increased correlations were found in the

professional vocal use group after vocal use, with a correlation
of 32.2% between the perceptual analysis parameter of breathiness and acoustic measure of SD of the spectral slope and
36.3% between the breathiness and the acoustic measure of
spectral slope mean.

DISCUSSION
Among professional voice users, teachers are certainly increasingly vulnerable to develop dysphonia.23,24 The development of
dysphonia in teachers is because of multiple factors including
environmental (noise, dust, and smoke), organizational
(excess and demand of work and lack of material) and
individual (age, allergy, poor hydratation, stress, and so
on.).25 Therefore, the health of teachers, including their voice,
TABLE 6.
Confusion Matrix for the Estimation Sample Group of
Professional Voice Use Before and After a Period of
2.5 Hours From the Acoustic Parameters, Perceptual,
Self-Perception of Vocal Effort and All Parameters
Together
Parameters
Acoustic

Perceptual

Self-perception
of vocal effort
All parameters

Moment Before After Total

Before
After
Total
Before
After
Total
Before
After
Total
Before
After
Total

354
207
561
408
301
709
242
246
488
377
212
589

189
328
517
123
246
369
290
300
590
156
333
489

543
535
1078
531
547
1078
532
546
1078
533
545
1078

Correct
(%)
65.19
61.31
63.27
76.84
44.97
60.67
45.49
54.95
50.28
70.73
61.10
65.86

260.e49
is highly related to their environment and characteristics of academic management.26
The literature refers to the most common signs of dysphonia:
roughness, vocal fatigue, ardor, sore throat and cervical pain,
difficulty in sustaining the voice, variations in F0, absence of
vocal capacity and vocal projection, loss of vocal efficiency,
and less vocal resistance even aphonia.27 Vocal fatigue is a
prevalent symptom among teachers1,4 yet its definition,
characteristics, and mechanisms are still uncertain.7
Many authors have attempted to indentify characteristics
of vocal fatigue via acoustic14,28,29 and aerodynamic
analyses,15,28 as well as laryngeal13,14 and EMG12 characteristics; however no study has showed a strong correlation between
these parameters and vocal loading.
This study used long-term acoustic measures in continuous
speech (Tables 1 and 2), associated with the perceptual
analysis and vocal self-perception (Tables 3 and 4), in an
attempt to analyze if these parameters could be more
sensitive to the vocal fatigue process, functioning as an index
of fatigue.
When the literature is analyzed in the context of vocal
loading task, many questions remain. For example, the time
and type of vocal use has not been characterized. Analysis of
the duration of voice use varies significantly; from 15 minutes12;
30 minutes30; 45 minutes10; 2 hours28 until 8 hours.4 All of
these studies, however, failed to demonstrated results highly
related to vocal fatigue, with vast variability of results.
Regarding the type of voice use, the literature suggests value
in performing voice analysis in real work conditions14; in
reading at high intensity,12,28 and with sustained vowels.16
However, indexes of vocal fatigue have not been characterized,
demonstrating that vocal fatigue is a multifactorial process
influenced by anatomical and physiological idiosyncrasies.7,10
This study used an interval of 2 hours and 30 minutes,
because it represents the period of continuous vocal use in Brazilian schools. The speech tasks were considered consistent
with professional voice use of teachers or social vocal use, in
real-life scenarios. Therefore, environmental factors were not
controlled, although they interfere in vocal production.26
Our results demonstrate that long-term acoustic measures
and self-perception of vocal use, when analyzed jointly did
not strongly differentiate social vocal use (Table 5) and professional vocal use (Table 6). Concerning social vocal use, the
discriminant analysis of the perceptual analysis of the vocal
quality separated 83.34% of the voice samples before vocal
use (Table 5), demonstrating that the voices differentiated
only before social vocal use, being separated by the perceptual
parameters of degree of dysphonia (G) and roughness (R). This
result was also observed in the group of professional voice
users, separating 76.84% the vocal samples before vocal use,
related to the breathiness (B), degree of dysphonia (G), and
roughness (R) parameters (Table 6).
Discriminant analysis of the three parameters associated
(acoustic, perceptual analysis, and self-perception) showed
that the results, when grouped, separated 70.73% of the vocal
samples in the group of professional voice users before vocal
use (Table 6). The samples were separated by the perceptual

Journal of Voice, Vol. 29, No. 2, 2015

analysis of vocal use of breathiness (B), degree of dysphonia

(G), roughness (R), and the F0 acoustic index (median). As
all samples were obtained in the morning, before vocal use,
this result may be explained by vocal warm-up, however,
some voices before vocal use were abnormal, and with the vocal
use and vocal warm-up, the voices became more homogeneous,
also presenting with higher fundamental frequencies in the
group of professional voice users.30 As the results were similar,
it is suggested that vocal demand, professional or social, was
not an important aspect to determine the degree of vocal modification, leading us to consider that in professional voice users
under ergonomic conditions was not sufficient to cause vocal
fatigue.
Previous studies, using these acoustic measures, revealed
that F0 has increased discriminating power, separating the
supralaryngeal adjustments of elevated larynx and tension
(laryngeal hyperfunction), and the phonatory adjustments
related to aperiodicity in the sound wave, such as air escape,
rough voice, breathy voice, and crackling voice by the guide
Voice Profile Analysis Scheme (VAPS).31,32
The analysis of canonical correlation showed there was a correlation between the perceptual analysis parameter of breathiness and the SD of the spectral slope, and between the
breathiness the acoustic measure of the spectral slope in the
group of professional voice users after the vocal use. Such correlation, despite the intermediate values, suggests that the professional voice user was able to generate alterations in the
glottic level consistent with our findings of breathiness and
the measures of spectral decline with the phonatory tension.33
It is suggested that future studies use vocal dosimetry34 to
better understand if these results are correlated to an increase
in phonation dose and subsequent vocal fatigue. These data
would ultimately assist speech pathologists to develop therapeutic programs to prevent vocal disturbances in professional
voice users.
CONCLUSION
Social and professional vocal users were differentiated before
vocal use via perceptual analysis of breathiness, degree of
dysphonia, and roughness. Auditory, acoustic, and selfperception of vocal use discriminated the group of professional
voice users before voice use with regard to breathiness, degree
of dysphonia, roughness, and median F0. The current measures
could not discriminate the differences of the type of vocal demands, professional or social.
Acknowledgments
The authors wish to thank Josiane Mendes, Juliana Oliveira Rocha, Nathalia Campos, Nayara Caroline Barbosa da Silva, Priscila Campos Martins, Priscila Freire Santos and Willian
Scanferla for their assistance in data collection.
Financial support: Conselho Nacional de Desenvolvimento
Cientfico e Tecnologico (300584/20130).
REFERENCES
1. Gotaas C, Star CD. Vocal fatigue among teachers. Folia Phoniatr. 1993;45:
120129.

^ rtes Gama, et al
Ana Cristina Co

Vocal Demands on Acoustic, Perceptual, and Vocal Self

2. Gama ACC, Bicalho VS, Valentim AF, Bassi IB, Teixeira LC,
Assunc~ao AA. Vocal self-perception of speech therapy after discharge: a
prospective study. CEFAC. 2012;14:714720.
3. Kraemer WJ, Adams K, Cafarelli E, et al. American College of Sports Medicine position stand. Progression models in resistance training for healthy
adults. Med Sci Sports Exerc. 2002;34:364380.
4. Laukkanen AM, Ilomaki I, Leppanen K, Vilkman E. Acoustic measures and
self-reports of vocal fatigue by female teachers. J Voice. 2008;22:283289.
5. Titze IR. Principles of Voice Production. 2nd ed. Englewood Cliffs, NJ:
Prentice Hall; 1994:361367.
6. Scherer RC, Titze IR, Raphael BN, Wood RP, Ramig LA, Blager RF. Vocal
fatigue in a trained and an untrained voice user. In: Baer T, Sasaki C,
Harris K, eds. Laryngeal Function in Phonation and Respiration. San
Diego, CA: Singular Publishing Group; 1991:533555.
7. Welham NV, Maclagan MA. Vocal fatigue: current knowledge and future
directions. J Voice. 2003;17:2130.
8. Gelfer MP, Andrews ML, Schmidt CP. Effects of prolonged loud reading on
selected measures of vocal function in trained and untrained singers. J
Voice. 1991;5:158167.
9. Vilkman E, Lauri E, Alku P, Sala E, Shivo M. Effects of prolonged oral
reading on F0, SPL, subglottal pressure, and amplitude characteristics of
glottal flow waveforms. J Voice. 1999;13:303315.
10. Kelchner LN, Lee L, Stemple JC. Laryngeal function and vocal fatigue after prolonged reading in individuals with unilateral vocal fold paralysis. J
Voice. 2003;17:513528.
11. Boucher VJ, Lamontagne M. Effects of speaking rate on the control of
vocal fold vibration: clinical implications of active and passive aspects of
devoicing. J Speech Lang Hear Res. 2001;44:10051014.
12. Boucher VJ, Ayad T. Physiological attributes of vocal fatigue and their
acoustic effects: a synthesis of findings for a criterion-based prevention
of acquired voice disorders. J Voice. 2010;24:324336.
13. Stemple JC, Stanley J, Lee L. Objective measures of voice production in
normal subjects following prolonged voice use. J Voice. 1995;9:127133.
14. Doellinger M, Lohscheller J, McWhorter A, Kunduk M. Variability of
normal vocal fold dynamics for different vocal loading in one healthy subject investigated by phonovibrograms. J Voice. 2009;23:175181.
15. Solomon NP, DiMattia MS. Effects of a vocally fatiguing task and systemic
hydration on phonation threshold pressure. J Voice. 2000;14:341362.
16. Chang A, Karnell MP. Perceived phonatory effort and phonation threshold
pressure across a prolonged voice loading task: a study of vocal fatigue. J
Voice. 2004;18:454466.
17. Lowell SY, Colton RH, Kelley RT, Mizia SA. Predictive value and discriminant capacity of cepstral- and spectral-based measures during continuous
speech. J Voice. 2013;27:393400.
18. Vintturi J, Alku P, Lauri ER, Sala E, Sihvo M, Vilkman E. Objective analysis of vocal warm-up with special reference to ergonomic factors. J Voice.
2001;15:3653.
19. Camargo Z, Madureira S. Voice quality analysis from a phonetic perspective: voice profile analysis scheme profile for Brazilian Portuguese

20.

21.

22.

23.
24.
25.
26.

27.

28.

29.

30.

31.

32.

33.

34.

260.e50

(BP-VPAS). In: Proceedings of the Fourth Conference on Speech Prosody.

Campinas, Brazil; 2008; 1: 5760.
Dejonckere PH, Remacle M, Fresnel-Elbaz E, Woisard V, CrevierBuchman L, Millet B. Differentiated perceptual evaluation of pathological
voice quality: reliability and correlations with acoustic measurements. Rev
Laryngol Otol Rhinol. 1996;117:219224.
Barbosa PA. Detecting changes in speech expressiveness in participants of a
radio program In: Interspeech 2009 - Speech and Intelligence, 2009, Brighton. Causal Productions, 2009;1:21552158.
Boersma P, Weenink D. Praat: doing phonetics by computer [Computer
program]. Version 5.3.53. Available at: http://www.praat.org/. Accessed
March 26, 2012.
Fuess VLR, Lorenz MC. Dysphonia in teachers of the municipal school:
prevalence and risk factors. Rev Bras Otorrinolaringol. 2003;69:807812.
Giannini SPP. Disorder related to teaching voice: a case-control [doctoral
thesis]. S~ao Paulo, Brazil: Faculdade de Saude Publica da USP; 2010.
Dragone MLS, Ferreira LP, Zenari MS, Giannini SPP. The voice of Professor. Rev Soc Bras de Fonoaudiologia. 2008;1:135.
Bauer J, Stamm A, Virnich K, Wissing K, Muller U, Wirscing M,
Schaarschmidt U. Correlation between burnout syndrome and psychological and psychosomatic symptoms among teachers. Int Arch Occup Environ
Health. 2006;79:199204.
Centro de Vigil^ancia em Saude. Voice disorders related to work. Boletim
Epidemiologico Paulista [Internet]. 2006; 3. Available at: http://www.cve.
saude.sp.gov.br/agencia/bepa26_dist.htm. Accessed August 18, 2013.
Remacle A, Morsomme D, Berru E, Finck C. Vocal impact of a prolonged
reading task in dysphonic versus normophonic female teachers. J Voice.
2012;26:820.e1820.e13.
Remacle A, Morsomme D, Berru E, Finck C. Vocal impact of a prolonged
reading task at two intensity levels: objective measurements and subjective
self-ratings. J Voice. 2012;26:e177e186.
Van Lierde KM, Dhaeseleer E, Baudonck N, Claeys S, De Bodt M,
Behlau M. The impact of vocal warm-up exercises on the objective vocal
quality in female students training to be speech language pathologists. J
Voice. 2012;26:177186.
Rusilo LC, Camargo Z, Madureira S. The validity of some acoustic measures to predict voice quality settings: trends between acoustic and perceptual correlates of voice quality. In: 4TH Isca Tutorial and Research
Workshop on Experimental Linguisitics. Paris, France; 2011;1:115118.
Camargo Z, Madureira S, Pessoa A, Rusilo LC. Voice quality and gender:
some insights on correlation between perceptual and acoustic dimensions.
In: 6th International Conference on Speech Prosody. Abstract Book Speech
Prosody. Shanghai, China: Tongji University; 2012:115118.
Pessoa A, Novaes BCAC, Pereira LCK, Camargo Z. Dynamic data and
voice quality: acoustic and perceptual correlates of speech in child with a
cochlear implant. J Speech Sci. 2011;1:1733.
Carroll T, Nix J, Hunter E, Emerich K, Titze I, Abaza M. Objective measurement of vocal fatigue in classical singers: a vocal dosimetry: pilot
study. Otolaryngol Head Neck Surg. 2006;135:595602.