Abstract
Voice disorders have been estimated to be present in between 3 and 9% of general population. Sports children have vocal abusive behavior i.e. the extra effort which they put on their voice while playing, leading to voice disorders. It is imperative to find out the voice characteristics of children involved in sports activity. To assess voice characteristics of school aged children, who are active participants in a basket ball team. A group of twenty children (13 males and 7 females) were included in the study. He or she was member of school basket ball team and had participated in many events. The perceptual voice assessment was conducted using GRBAS scale, Buffalo III Voice Profile and Voice Handicap Index (VHI). Findings on GRBAS voice rating scale—In the first parameter i.e. grade 46.7% of the subjects reported slight hoarse component. In the second parameter i.e. Roughness 46.7% of the subjects showed slight roughness component. In another parameter i.e. the asthenia 20% % of the subjects reported slight asthenia component in their voice. In the next parameter i.e. strain in the voice, 26.7% of the subjects showed slight strain component in their voice. Finding on BUFFALO III voice screening profile—In the laryngeal tone, 46.7% of the subjects showed mild hoarse component. Findings on voice handicap index (VHI)—28% of the subjects had functional symptoms of voice problems. 43% of the subjects had some physical symptoms while 28% had affected emotional component. Present study is first of its kind to focus on voice disorders among school going children who are members of a basket ball team. During sport events players tend to scream in order to communicate among their team mates, to show their aggressiveness to their opponents and to show excitement of win or frustration of the lost match leading to various voice problems. There is a high probability of occurrence of voice disorders among children who are active participants of basket ball. Proper counselling of these children is required for preventive measures and to seek voice therapy when required.
Keywords: Hoarseness, Voice handicap index, GRBAS, BUFFALO III voice screening profile
Introduction
Voice disorder may be defined as “any time the voice does not work, perform, or sound as it normally should, so that it interferes with communication” [1]. Voice disorders have been estimated to be present in 3–9% of the general population [2]. Boone and McFarlane [3] reported that about 7% of school-aged children experience continuing voice disorders.
There are many factors which may cause voice disorders. It might occur due to genetic basis or vocal loading factors in the environment, such as loud background noise, poor room acoustics, and poor air quality. General health issues, such as poor respiratory health and poor lifestyle habits, may lead to voice problems. Demographic aspects, such as gender and psychosocial factors are associated with voice disorders.
Many sports are practiced outdoors where the background noise is often high and the distance between the players is long. Also, weather elements, such as rain and wind, affect the audibility of the voice. Such issues affect the communication and are not conducive to good voice production. Children involved in sports activities have vocal abusive behavior due to the extra effort which they put on their voice while playing. This extra effort on vocal folds leads to forceful adduction and may cause trauma to the folds or may lead to other laryngeal pathologies like nodules, polyp, hemorrhage and cyst. Roy et al. [4] identified screaming as a prevalent feature in the speech of children with vocal nodules.
Research investigating voice problems in children involved in sports activities is limited. To our knowledge no study has been conducted in India reporting voice problems in sports children. However, there are few studies reporting the voice problems among sports coach [5]. In view of the limited data available in the literature on voice problems in children involved in sports activities, it’s imperative to find out the voice characteristics among sports children.
Aim
Primary aim of the study was to assess perceptual voice characteristics of school aged children, who are active participants in a basket ball team.
Materials and Methods
Patient Selection
A group of twenty children (13 males and 7 females) were included in the study. The age range was from 11 to 16 years with mean age of 13.5 years. The subjects had a minimum of 2 years of active participation in the sport activity. He or she was member of school basket ball team and had participated in many events.
Instrument
Perceptual voice assessment was done using GRBAS scale, Buffalo Voice Profile and Voice Handicap Index (VHI).
GRBAS Scale [6]
It has five components including (1) Grade, (2) Roughness, (3) Breathiness, (4) Asthenia and (5) Strain. It has four point rating system where 0 means normal while 3 means severe.
Buffalo III Voice Profile [7]
Buffalo III voice profile has components including laryngeal tone, pitch, loudness, nasal resonance, oral resonance, breath supply, muscles, voice abuse, rate, speech anxiety, speech intelligibility and an overall voice rating.
Voice Handicap Index (VHI) [8]
The Voice Handicap Index (VHI) is a 30-item self-questionnaire that has three subscales which are functional, emotional, and physical aspects of voice disorders.
Results
In the present study, twenty children were enrolled and perceptual voice assessment was conducted using GRBAS Voice Rating Scale, BUFFALO III Voice Screening Profile and Voice Handicap Index.
Findings on GRBAS Voice Rating Scale
As shown in Fig. 1, in the first parameter i.e. grade, 53.3% of the children had normal voice quality and 46.7% were found to have slight hoarse component. In the second parameter i.e. Roughness, 46.7% of the children had normal voice quality while 46.7% had slight roughness component and 6.7% had moderate roughness component. In the third parameter i.e. breathiness, 93.3% were found to have normal voice quality and 6.7% had slight breathy component. In the fourth parameter i.e. asthenia, 80% represented normal voice quality and 20% had slight asthenic component in their voice. In the fifth parameter i.e. strain 73.3% were found to have normal voice quality and 26.7% had slight strain component in their voice.
Fig. 1.
Voice characteristics of sports children on GRBAS scale, a grade, b roughness, c breathiness, d aesthenicity, e strain
Finding on BUFFALO III Voice Screening Profile (Fig. 2)
Fig. 2.
Laryngeal tone characteristics of sports children on BUFFAL III voice screening profile
The first parameter was laryngeal tone which had further three components- breathy, harsh and hoarse quality. In the laryngeal tone parameter, 53.3% of the subjects showed normal voice quality and 46.7% had mild hoarse component while other parameters i.e. pitch, loudness and nasal resonance were found to be normal in all the subjects (100%).
Findings on Voice Handicap Index (VHI)
Using the third perceptual voice assessment VHI, following results were obtained which is represented in a Fig. 3.
Fig. 3.
Voice characteristics of sports children on voice handicap index
As shown in Fig. 3, on VHI, 71% of the subjects had never complained of any functional problem; however about 28% had functional abnormalities (21, 4 and 3% showed functional problems sometimes, almost always and always respectively). 57% of the subjects did not report any physical symptoms of voice problems; however, about 43% had some physical symptoms. Similarly, 72% of the subjects had no emotional problems related to voice disorder; however, about 28% had affected emotional component.
Discussion
There have been very few studies reporting prevalence of voice disorders among children who are active sports participants. Present study is first of its kind to focus on voice disorders among school going children who are members of a basket ball team. The results of the study reveal that there is probability of occurrence of voice disorder in children who are active participants in basket ball team. These voice abnormalities are mainly in the form of hoarseness (47%), roughness (54%), and strain (27%). Also, functional, physical and emotional components of voice are affected as revealed by VHI questionnaire.
The high incidence of voice problems in sports players could probably be due to the tendency to scream in order to communicate among their team mates, to show their aggressiveness to their opponents and excitement of win or frustration of the lost match. Sports can be stressful and emotionally demanding, especially during matches or competitions [9]. There is performance anxiety and stress related to poor performance or fear to lose. Psycho-emotional factors, stress, and emotions are related to voice problems, and these issues have also been found to have a negative impact on voice production by altering the individual’s phonation pattern [10]. Just like other multi player sports, basket ball game involves lot of screaming and yelling. There is aggression and cheering for own team throughout the game. Players often project their voice over bouncing ball to communicate with other teammates. The game is physically very demanding hence combination of both physical and voice use may add to the vocal insult. This population is likely to get voice problems including hoarseness and roughness just like in other professions such as physical education instructors and teachers [11] as well as soccer coaches [12].
School aged basket ball players need preventive measures as well as services of Speech Language Pathologists for voice therapy, if required, to maintain their vocal health. Awareness needs to be created among the basketball players and their coaches regarding the effects of vocal abuse on the voice. Future studies should be carried out on the players of other sports like football, volleyball etc. with a larger sample size. Further studies could be planned to compare the findings of non–sports and sports children.
Conclusion
There is a high probability of occurrence of voice disorders among children who are active participants of basket ball game. Appropriate counselling of these children is required for the preventive measures and to seek voice therapy when required. More data is required to generalize these findings.
Contributor Information
Sanjay Munjal, Email: sanjaymunjal1@hotmail.com.
Md. Noorain Alam, Email: noorain.aslp@gmail.com.
Naresh K. Panda, Email: npanda59@yahoo.co.in
References
- 1.Roy N, Merrill RM, Thibeault S, Gray SD, Smith EM. Voice disorders in teachers and the general population: effects on work performance, attendance and future career choices. J Speech Lang Hear Res. 2004;47:542–551. doi: 10.1044/1092-4388(2004/042). [DOI] [PubMed] [Google Scholar]
- 2.Roy N, Merrill RM, Gray SD, Smith EM. Voice disorders in the general population: prevalence, risk factors, and occupational impact. Laryngoscope. 2005;115:1988–1995. doi: 10.1097/01.mlg.0000179174.32345.41. [DOI] [PubMed] [Google Scholar]
- 3.Boone DR, McFarlane SC. The voice and voice therapy. 6. Boston: Allyn and Bacon; 2000. [Google Scholar]
- 4.Roy N, Holt KI, Redmond S, Muntz H. Behavioral characteristics of children with vocal fold nodules. J Voice. 2007;21(2):157–168. doi: 10.1016/j.jvoice.2005.11.004. [DOI] [PubMed] [Google Scholar]
- 5.Fellman D, Simberg S. Prevalence and risk factors for voice problems among soccer coaches. J Voice. 2017;31:121e.9–121e.15. doi: 10.1016/j.jvoice.2016.02.003. [DOI] [PubMed] [Google Scholar]
- 6.Hirano M. Clinical examination of voice. New York: Springer; 1981. [Google Scholar]
- 7.Wilson DK. Voice problems of children. Baltimore: Williams and Wilkins; 1987. [Google Scholar]
- 8.Jacobson BH, Johnson A, Grywalski C, Silbergleit A, Jacobson G, Genninger MS. The voice handicap index: development and validation. Am J Speech Lang Pathol. 1997;6:66–70. doi: 10.1044/1058-0360.0603.66. [DOI] [Google Scholar]
- 9.Buckley K, O’Halloran P, Oates J. Occupational vocal health of elite sports coaches: an exploratory pilot study of football coaches. J Voice. 2015;29:476–483. doi: 10.1016/j.jvoice.2014.09.017. [DOI] [PubMed] [Google Scholar]
- 10.Nerriere E, Vercambre M, Gilbert F, et al. Voice disorders and mental health in teachers: a cross-sectional nationwide study. BMC Public Health. 2009;9:370. doi: 10.1186/1471-2458-9-370. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11.Rumbach AF. Voice problems of group fitness instructors: diagnosis, treatment, perceived and experienced attitudes and expectations of the industry. J Voice. 2013;27(6):786–789. doi: 10.1016/j.jvoice.2013.03.012. [DOI] [PubMed] [Google Scholar]
- 12.Buckley K, O’Halloran P, Oates J. Voice and vocal health in elite sports coaching: considerations for elite football coaching staff. Br J Sports Med. 2011;45(4):337–338. doi: 10.1136/bjsm.2011.084038.78. [DOI] [Google Scholar]