Videolaryngostroboscopic Findings in Vocally Healthy Individuals After Vocal Loading Activity

To investigate differences between the structural aspects and laryngeal functionality before and after a vocal loading activity and their association with symptoms of vocal fatigue (VF).

Young adults without vocal complaints and who use professional or nonprofessional voices participated in the research. Videolaryngostroboscopy (VLS) exams were performed before and after a vocal loading activity to which the participants were submitted, characterized by reading texts at high vocal intensity lasting 90 minutes. The exams were recorded to be evaluated later, blinded as to the moment of performance, by two otorhinolaryngologists experienced in consensus, based on the following parameters: free border of the membranous portion of the TVF at rest, mobility of the TVF during phonation, supraglottic activity during phonation, regularity of glottic cycles, amplitude of mucosal vibration, mucosal wave, phase symmetry, vertical level between VPP, glottic closure pattern, duration of glottic closure, and inflammatory aspect (hyperemia) of VPP. Vocal self-assessment questionnaires were applied to investigate effort intensity, fatigue, and perceptions about the quality of vocal production before and after vocal load activity.

The evaluation performed by otorhinolaryngologists revealed significant differences regarding the general impression of the tests performed before and after the vocal loading activity, and in 66.7% of the cases, the postvocal loading activity test was considered worse. Among the parameters evaluated, there was a significant difference in the evaluation of the glottic closure pattern, with an increase in the proportion of glottic clefts after vocal load activity. In the self-assessment of fatigue symptoms, exertion, and quality of vocal production, worsening was observed in all self-assessment instruments: Visual Analog Scale of Vocal Fatigue (VVAS), the Borg CR10 Scale, and the Self-Perception of Vocal Production Quality Scale (EAQPV) after vocal loading activity. However, this worsening was not associated with worsening of the parameters of the visual examination of the larynx.

Most participants had worse VLS after vocal loading activity, according to the general impression of the experts. The perception of effort, fatigue, and poorer quality of vocal production was also observed in the moment after vocal load activity, but these findings were not associated with worsening in the VLS examination. The patient's perception of his or her voice after a high demand is important for the monitoring and clinical diagnosis of VF and to prevent the development of laryngeal alterations.