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Introduction: This study investigated the relationship between personality traits and MPA in the course of a specific performance., Methods: For this purpose, symptoms of MPA, functional coping with MPA and performance-related self-efficacy of a sample of 393 musicians including 23% professional, 49% non-professional orchestra musicians and 28% singers in amateur choirs were categorized and then used to analyze differences in the personality traits. The questionnaires used were the NEO-FFI and the PQM., Results: The results showed that professional orchestra musicians had significantly higher openness and conscientiousness than non-professional orchestra musicians and amateur choir singers. Musicians who had few symptoms of MPA, positive coping with MPA and high self-efficacy across a specific performance (Type 1) have low neuroticism in their personality traits. Regarding MPA, the personality traits were correlated with all MPA scales after the performance but less with MPA scales before and during the performance., Discussion: Results could indicate that personality traits play a particularly important role in the processing of performance experiences after the performance and suggest focusing on the situation after the performance in particular with professional orchestra musicians., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Spahn, Krampe-Heni, Hohagen, Immerz and Nusseck.)

Instruction: In both subjects, music and sport, the engagement with the subject content - learning an instrument or training in a sports club - usually begins in early childhood. This makes these subjects special and similar. It is therefore of interest to examine the motivation for choosing music and sport as subjects for university study., Methods: In the present investigation, 151 students at the beginning of their university studies were examined. Among these were 110 music university students in the Bachelor of Music (B.Mus.) and music teacher education program, and 41 sport university students in the Bachelor of Science (B.Sc.) and sport teacher education program. The study contained a custom-made questionnaire on sociodemographic data, questions on study choice alternatives and biographical musical or sporting background, as well as two standardized questionnaires on motivation for enrollment (STUWA) and on aspects that are important for the profession., Results: Music and sport students were at a rather high and similar level of intrinsic motivation to study their subjects. However, materialistic goals motivated the teacher education students more than the bachelor's students with an artistic program. The difference between the study programs was also found in the context of extrinsic-social motivation, where the teacher training students answered with higher scores. With regard to socially-induced motivation, it was shown that music students and sport teacher education students were more socially induced to study the respective subject compared to the general student population. With regard to uncertainty when choosing a course, it was found that Bachelor of Music students were more certain that they wanted to study exactly their particular subject. The ages at which music and sport were started in childhood were similar, but the first-year music students were younger than the sport students were. Compared to sports students, music students decided their area of study earlier, and bachelor's students in music in particular had fewer alternative study options than sports students., Discussion: The results provide a differentiated picture of student motivation to study and thus allow a deeper insight into the subject cultures of music and sport. They also open up opportunities for follow-up studies in comparison with other study subjects and programs., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Immerz, Nusseck, Hohagen and Spahn.)

Background: Playing a musical instrument requires physical movements that are involved in sound production and movements with more expressive and communicative characteristics. Both movements co-occur during a performance; however, the interaction between the movements is still unclear., Methods: Using motion capture technology, the movement patterns of clarinetists were analyzed at certain points in a performance to investigate how instrumental and ancillary movements interplay. Movements in the arms and knees of clarinetists during a performance were recorded using this technology. The mean angular movements at specific points in the piece, where some players inhaled and others did not, were compared., Results: While the players who inhaled adopted significantly more upright body and neutral arm positions, the players who did not inhale seemed less interrupted in their performance. The results showed that the players performed rather individual ancillary movements, but at specific points, such as during melodic transitions, they performed similarly. At certain points in the melody, while some players needed to inhale, others adjusted their playing according to the inhalation moment to adopt a suitable body position., Discussion: The ancillary movement was consequently interrupted by the physiological necessity to inhale. The findings provide more insights into the interplay of instrumental and ancillary movements during a performance., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Nusseck, Immerz, Hohagen and Spahn.)

Introduction: Research on Music Performance Anxiety (MPA) among amateur musicians is of great interest due to inconsistent results in literature. In addition, amateur music represents an important part of musical culture in Germany. Accordingly, the performance experiences of young wind players represent a relevant issue for research and musical practice., Methods: In the present study, 67 young amateur musicians of a brass choir were examined. Using two different questionnaires, both the dispositional MPA (K-MPAI) and the performance-specific MPA during a joint concert (Performance-specific Questionnaire for Musicians, PQM) were assessed. The PQM measures the symptoms of MPA, functional coping with MPA and self-efficacy before, during and after a specific performance. The PQM was completed by the musicians via an app directly after the concert., Results: Results showed that about 90% of the young amateur musicians had a low dispositional MPA, but about 10% showed high values. For the concrete performance, however, musicians with high dispositional MPA also experienced a very moderate to low MPA in the concert. On average, the musicians were quite nervous before the performance. After the performance, they showed low levels of MPA. Three types of MPA found in previous studies could be confirmed among the amateur musicians, with three quarters being assigned to the positive type, showing low levels of symptoms associated with consistently high levels of self-efficacy and positive functional coping., Discussion: The results provide a differentiated picture of different expressions of MPA in young amateur musicians. They also raise further questions about the correlation between dispositional and performance-specific assessment of MPA in musicians in general., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Spahn, Tenbaum, Immerz, Hohagen and Nusseck.)

Indoor event locations are particularly affected by the SARS-CoV-2 pandemic. At large venues, only incomplete risk assessments exist, whereby no suitable measures can be derived. In this study, a physical and data-driven statistical model for a comprehensive infection risk assessment has been developed. At venues displacement ventilation concepts are often implemented. Here simplified theoretical assumptions fail for the prediction of relevant airflows for airborne transmission processes. Thus, with locally resolving trace gas measurements infection risks are computed more detailed. Coupled with epidemiological data such as incidences, vaccination rates, test sensitivities, and audience characteristics such as masks and age distribution, predictions of new infections (mean), situational R-values (mean), and individual risks on- and off-seat can be achieved for the first time. Using the Stuttgart State Opera as an example, the functioning of the model and its plausibility are tested and a sensitivity analysis is performed with regard to masks and tests. Besides a reference scenario on 2022-11-29, a maximum safety scenario with an obligation of FFP2 masks and rapid antigen tests as well as a minimum safety scenario without masks and tests are investigated. For these scenarios the new infections (mean) are 10.6, 0.25 and 13.0, respectively. The situational R-values (mean) - number of new infections caused by a single infectious person in a certain situation - are 2.75, 0.32 and 3.39, respectively. Besides these results a clustered consideration divided by age, masks and whether infections occur on-seat or off-seat are presented. In conclusion this provides an instrument that can enable policymakers and operators to take appropriate measures to control pandemics despite ongoing mass gathering events., (© 2023. The Author(s).)

Introduction: In clinical practice, sustained phonation is mostly used for acoustic voice measurements, while perceptual evaluation is based on connected speech. Since sustained phonation could be associated with the use of the singing voice, and since vocal registers are more relevant for singing rather than speech, it is unclear if vocal registers contribute to observable vocal fold contact differences between sustained phonation and speech., Material and Methods: Sustained phonation (vowel [a] on comfortable pitch and loudness) and connected speech (German text: Der Nordwind und die Sonne) were analyzed for 1216 subjects (426 with and 790 without dysphonia) using the Laryngograph system (combining electroglottography and audio recordings). From these samples, fundamental frequency (ƒ o ), contact quotient (CQ), sound pressure level (SPL) and frequency perturbation (jitter first for sustained and cFx for connected speech) were evaluated., Results: Compared to connected speech, the values of ƒ o and SPL were higher for sustained phonation. For female voices, ƒ o difference was greater than for male voices. At the same time, and only for the females, CQ was lower for the sustained phonation, indicating a register difference., Conclusion: In order to achieve a better comparability, sustained phonation should be standardized regarding the ƒ o and SPL values in correspondence to the ƒ o and SPL range of reading a text. This should also reduce the risk of using a different register for different types of phonation., (Copyright © 2023 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

For music students, the COVID-19 pandemic has had a great impact, forcing them to adapt to certain coronavirus regulations laid down by the state. In this study, the experiences of music students in three consecutive semesters under different coronavirus-related conditions are investigated. At the end of three semesters, the lockdown semester [SS (Summer Semester) 2020: April - July], a partially opened semester [WS (Winter Semester) 2020/21: October - February] and a mostly opened semester (SS 2021), a total of 152 music students at the University of Music Freiburg were asked to fill in an online survey. A mixed-methods approach was used, with results showing that the qualitative statements of the students support the quantitative data. The results of the cross-sectional study demonstrate that self-regulated learning improved during the lockdown semester, through new time management and focused practice with regular breaks. During the partially opened semester, the use of blended learning formats led to organizational problems, such as travel time and change of locations. Furthermore, music students were challenged by the social distancing, which improved during the partially opened, and mostly opened semester. New technologies regarding digital communication formats were emerged, which have evolved over the course of the three semesters. Concerning the overall experience, students stated that the partially-opened semester was most challenging, since distances and change of locations had to be combined with quickly changing public COVID-19-regulations. These findings during different stages of the COVID-19 pandemic provide constructive starting points for future teaching., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationship that could be construed as a potential conflict of interest., (Copyright © 2022 Spahn, Immerz, Hipp and Nusseck.)

(1) Objective: Teaching is a particularly voice-demanding occupation. Voice training provided during teachers' education is often insufficient and thus teachers are at risk of developing voice disorders. Vocal demands during teaching are not only characterized by speaking for long durations but also by speaking in noisy environments. This provokes the so-called Lombard effect, which intuitively leads to an increase in voice intensity, pitch and phonation time in laboratory studies. However, this effect has not been thoroughly investigated in realistic teaching scenarios. (2) Methods: This study thus examined how 13 experienced, but vocally untrained, teachers behaved when reading in a noisy compared to quiet background environment. The quiet and noisy conditions were provided by a live audience either listening quietly or making noise by talking to each other. By using a portable voice accumulator, the fundamental frequency, sound pressure level of the voice and the noise as well as the phonation time were recorded in both conditions. (3) Results: The results showed that the teachers mainly responded according to the Lombard effect. In addition, analysis of phonation time revealed that they failed to increase inhalation time and appeared to lose articulation through the shortening of voiceless consonants in the noisy condition. (4) Conclusions: The teachers demonstrated vocally demanding behavior when speaking in the noisy condition, which can lead to vocal fatigue and cause dysphonia. The findings underline the necessity for specific voice training in teachers' education, and the content of such training is discussed in light of the results.

When playing an instrument, there are two main categories of body movements: instrumental movements, which are necessary for the sound production, and ancillary movements, which are associated with individual musical intentions and expressions. In this study, the particular purpose of ancillary movements of clarinet player was investigated especially in respect to how these movements were related to the musical structure of the piece and to specific audio parameters. 3D motion capture data of 19 clarinet players performing the same piece were analyzed regarding common motion patterns during the performance and in accordance with acoustic features related to pitch, dynamics (RMS energy) and timbre (spectral centroid and flux). A focus of the body movements was on the arms and the knees. The results showed that there were certain motion patterns performed by the players depending on specific musical structures. When playing a melodic part, the players often did so by bending their knees. At musical transitions, however, the knees were mainly stretched. Similarly, arm movements were more pronounced during playing melodious parts. At transitions, the arms were put closer to the torso. Considering the connection with the acoustics, a larger range of knee motions was correlated with a larger variation of the timbre. Moreover, at specific moments during the performance, when some players strongly bent their knees or lifted the arms, the RMS energy of the signal was significantly higher. The correlations of the body movements and the acoustic features showed that some players synchronized their movements with particular audio parameters more than others did. In summary, the ancillary movements of the clarinetists pursued both musical expressive intentions and physiologically necessary movements and tended to be performed with individual differences in terms of visual and auditory expression., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Nusseck, Czedik-Eysenberg, Spahn and Reuter.)

Vaccination is a significant preventive measure to contain the coronavirus disease-2019 (COVID-19) pandemic. Vaccination rates can provide useful information on the potential spread of infection in a given population. In this study, vaccination rates and attitudes towards vaccination in cultural sectors, specifically the music sector, have been investigated. In total, 4341 persons in four different areas, including visitors to performances of classical music and musicals, as well as professional and amateur musicians, have participated in this survey. Results show rates of 86% recovered from the COVID-19 virus or vaccinated at least once, with 54.5% fully vaccinated. These vaccination rates were considerably higher compared to the general population. An attitude of hesitation towards vaccination found in 6.4% of those sampled was half that of the general population. These findings drawn from a large sample indicate that in the field of music a high vaccination rate is to be found, as well as a low rejection rate of vaccination on the part of the audience and performers. The results can be used to provide insights into the vaccination status to be found at cultural events and, importantly, to assist in consideration of whether cultural events should be permitted to continue under pandemic circumstances.

Purpose: Observational study to determine if the voice-related self-concept as measured via the Fragebogen zur Erfassung des Stimmlichen Selbstkonzepts FESS (questionnaire for the assessment of the voice self-concept) can be improved through in-patient voice therapy., Methods: 234 female and 80 male patients that underwent an intensive 3- to 4-week in-patient voice treatment due to varying types of dysphonia. After imputation of missing items but not missing questionnaires, 255 patients were eligible for FESS evaluation, 313 for VHI-12 evaluation. The German questionnaire for the assessment of the voice self-concept (FESS) and the German 12-item short-form of the Voice Handicap Index (VHI-12) were administered at the beginning and at the end of the hospital stay. Before-after comparisons are made visually and via t test., Results: The Voice Handicap was significantly reduced, demonstrating the effectiveness of the administered therapy. Of the three scales of the FESS, the relationship with one's own voice and the awareness of the use of one's own voice was increased and thus improved. The connection between voice and emotional changes decreased significantly but only slightly., Conclusion: Conservative voice rehabilitation can not only reduce the voice handicap, but also improve the voice self-concept and the results can be measured., (© 2021. The Author(s).)

Most studies exploring the relation between flow and Music Performance Anxiety (MPA) have focused on the disposition of generally experiencing flow and the occurrence of MPA. Little is known about the connection between experiencing flow and MPA as it relates to a specific performance. In this study, flow and MPA have been investigated in 363 orchestral musicians in relation to a particular live music performance. The musicians were asked to fill out a questionnaire immediately after a concert. Flow experience during the performance was measured using the Flow Short Scale. The Performance-specific Questionnaire on MPA (PQM) was used for MPA. The PQM addresses particular aspects of MPA and refers retrospectively to the time before and during the performance as well as to the moment of filling out the questionnaire after the performance. Using three scales, the functional coping, the perceived symptoms of MPA and self-efficacy were determined for each time point of the performance. The results showed that experiencing flow was on average higher among orchestral musicians compared to a sample of the general population. However, there were differences between the professional and non-professional musicians. All PQM scales showed significant correlations with the global flow scale. Regression analysis on the global flow score found that regarding the time before the performance the PQM scale symptoms of MPA were diametrically connected with the flow experience. The PQM scale functional coping was shown to be positively related to the flow during the performance. Moreover, high self-efficacy was found to be closely related with stronger flow experience. Furthermore, flow seems to have positive effects on functionally coping with MPA and the self-efficacy after the performance. These findings confirm the negative relationship between flow and symptoms of MPA, offering further approaches in understanding the relationship especially for live music performances., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Spahn, Krampe and Nusseck.)

The pandemic situation has forced students in higher education to use alternative learning routines due to reduced activities at universities and educational facilities. Especially music students needed to adapt their musical learning to this particular situation. Mostly affected by the lockdown was the musical practicing behavior, especially when practicing at the University of Music was not possible. In this study, music students in their second and third semesters were asked to provide information on their practicing situations during the coronavirus disease 2019 (COVID-19) lockdown. They were required to fill in questionnaires about the practicing time and concepts of self-efficacy and self-regulation for musical learning. The data of 18 music students were collected. For the analysis, they were compared with the answers of 15 music students who were asked the same questions half a year earlier before the pandemic situation occurred. The results showed that the music students relocated mostly to their parents' homes for practicing during the lockdown. In the amount of practicing, the bachelor of music students practiced less during lockdown compared with before the lockdown. The mean self-efficacy for musical learning did not differ between before and during the lockdown. For the self-regulated musical learning, the music students showed significantly higher values in the subscale on reflecting and creating a framework for the progress of musical learning during the lockdown. The findings indicate that the music students developed certain self-regulated learning skills during the lockdown and managed to find suitable solutions in continuing with their musical learning without reservation., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Nusseck and Spahn.)

Objectives: The voice is an important occupational tool for teachers. Voice training programs have been shown to help strengthen the voice health and endurance. However, longitudinal studies on voice trainings are sparse. In this study, long-term effects nearly 2 years after a voice training program have been investigated., Methods: The acoustic voice quality (Dysphonia Severity Index [DSI]), the voice self-concept (Fragebogen zur Erfassung des Stimmlichen Selbstkonzepts), and the health-related quality of life (SF-12) of 55 teachers who participated in a prior voice training program of ten 90 minutes sessions were compared to 33 teachers without voice training. The participants were measured at three times: in a pre- and a post-training survey and in a 2-years follow-up survey., Results: The trained teachers increased in DSI over all three surveys while the nontrained teachers decreased in DSI with a significant interaction effect. Also the trained teachers significantly increased the awareness of voice use and their mental health compared to the nontrained group., Conclusions: The positive effects of the voice training, which have been found between pre- and post-training and in comparison with the control group, clearly sustained in long-term 2 years after the end of the training. This finding emphasizes the importance of voice training for teachers as a long-term investment for a voice-related healthy working life., (Copyright © 2019 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Music performance anxiety (MPA) is a commonly present topic among musicians. Most studies on MPA investigated effects of a more general occurrence of MPA on performances. Less is known about individual variations of MPA within a performance, more specifically at the times before, during, and after the performance. This study used a questionnaire to investigate these performance times in order to find out if there occur different types in the variation of the perceived MPA across the performance. The study was performed with 532 musicians; 27% of them being professional orchestra musicians, 45% non-professional orchestra musicians, and 28% non-professional choir singers. The musicians were asked to fill in the Performance-specific Questionnaire for Musicians (PQM) immediately after a performance. The questionnaire contains three scales regarding symptoms of MPA, functional coping with MPA and performance-related self-efficacy. A cluster analysis was performed on the PQM scales to identify systematic variations. Findings indicate that there are three different types of MPA in the sample studied. Type 1 describes musicians who have few symptoms of MPA throughout the performance, show functional coping with MPA, and have a stable and well-developed self-efficacy. Type 2 describes musicians who begin their performance with rather high symptoms of MPA but can positively reduce these by the end of the performance and show high values in self-efficacy and in functional coping. Type 3 contains musicians who begin their performance with some symptoms of MPA, which increase to the end of the performance. The values of self-efficacy and functional coping in this type are rather low. Of the total sample, half of the musicians were assigned to Type 1 and approximately a quarter each to Type 2 (27%) and Type 3 (23%). In accordance with the literature, the results confirm the importance of self-efficacy and functional coping for a positive performance experience., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Spahn, Krampe and Nusseck.)

Good postural stability and balance provide a basis for optimal movement. For instrumental musicians, particular postures are demanded during long periods of playing and practicing. These postures can potentially also affect the postural control system even in situations when the musician is not playing the instrument. The goal of this exploratory study was to measure the postural stability and balance of instrument musicians in non-instrumental situations. By comparing these measures with a control group of non-musicians, postural differences were identified which can be ascribed to certain playing positions arising from playing the instrument. The measurement technique used was a pressure platform (Zebris force plate) to record static posturography. The postural sway of the center of pressure (COP) and the postural balance (body weight distribution) in a standing position were measured in 390 students including music students ( n = 346) and a control group ( n = 44). The analyses revealed significant differences for specific instrumental groups. Around 23% of the pianists, 25% of the upper strings players, and 33% of the guitar players showed a weight distribution significantly shifted more to the left compared to the control group (9%). In contrast, 23% of the lower strings players and 33% of the percussionists were found to stand more to the right side than the control group (5%). The results indicate that there are certain unbalanced postural patterns in musicians, outside of the music performance situation, which can be provoked by instrumental playing postures. As postural misalignments can lead to severe postural disorders in older age, preventive activities to improve postural stability and balance should be considered in instrumental education, not only during, but also outside of instrumental playing situations., (Copyright © 2020 Nusseck and Spahn.)

Introduction: Vocal loading capacity is an important aspect of vocal health and is measured using standardized vocal loading tests. However, it remains unclear how vocal fold oscillation patterns are influenced by a standardized vocal loading task., Methods: 21 (10 male, 11 female) vocally healthy subjects were analyzed concerning the dysphonia severity index (DSI) and high speed videolaryngoscopy (HSV) on the vowel /i/ at a comfortable pitch and loudness before and after a standardized vocal loading test (10 min standardized text reading, at a level higher than 80 dB (A) measured at 30 cm from the mouth)., Results: Changes in DSI were statistically significant, diminishing by 1.2 points after the vocal loading test, which was mainly caused by an increase of the minimum intensity. However, the pre-post comparison of HSV derived measures failed to show any statistically significant changes., Conclusion: It seems necessary to analyze the effects of a standardized vocal loading test on vocal fold oscillation patterns with respect to softest phonation and phonation threshold pressure rather than comfortable pitch and loudness. Level of evidence 2c.

Objectives: For school teachers, the voice is a mandatory occupational tool during teaching. Several studies, however, proved that teachers are at high risk of developing voice disorders. The aim of this study was to investigate the voice health, voice self-concept, and quality of life in German teachers., Methods: In a cross-sectional study 536 German school teachers had a laryngeal examination, acoustic voice measurements to determine the Dysphonia Severity Index and filled in a self-reporting questionnaire with the Voice Handicap Index-12), the voice self-concept (Fragebogen zur Erfassung des Stimmlichen Selbstkonzepts), and the general quality of life (SF-12)., Results: A total of 58.3% of the teachers reported that they had experienced a voice problem at least once in their career. Female teachers had more often experienced voice problems than male teachers. Twenty-five percent showed a current considerable voice abnormality of vocal fold oscillation pattern. Such voice abnormalities were observed more in male teachers than female teachers. The Dysphonia Severity Index also differed between gender with higher values in the female teachers and a steadily decreasing value over age. The voice self-concept showed differences between gender and age of the teachers. Teachers who experienced a voice problem had higher Voice Handicap Index and lower voice self-concept values compared to those without experienced voice problems. Teachers with voice abnormalities had lower values in the quality of life scales., Conclusions: The findings confirm the high risk of voice health problems among German teachers and illustrate the complexity of vocal health and quality of life issues in teachers associated with gender, age, and the history of experienced voice problems. This study strengthens the necessity for vocal training programs to prepare teachers for a professional and healthy voice use to maintain vocal health., Competing Interests: Conflict of interest The authors declare no conflict of interest., (Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Background: The questionnaire for the assessment of the voice selfconcept (FESS) contains three sub-scales indicating the personal relation with the own voice. The scales address the relationship with one's own voice, the awareness of the use of one's own voice, and the perception of the connection between voice and emotional changes. A comprehensive approach across the three scales supporting a simplified interpretation of the results was still missing., Material and Method: The FESS questionnaire was used in a sample of 536 German teachers. With a discrimination analysis, commonalities in the scale characteristics were investigated. For a comparative validation with voice health and psychological and physiological wellbeing, the Voice Handicap Index (VHI), the questionnaire for Work-related Behavior and Experience Patterns (AVEM), and the questionnaire for Health-related Quality of Life (SF-12) were additionally collected., Results: The analysis provided four different groups of voice self-concept: group 1 with healthy values in the voice self-concept and wellbeing scales, group 2 with a low voice self-concept and mean wellbeing values, group 3 with a high awareness of the voice use and mean wellbeing values and group 4 with low values in all scales., Conclusion: The results show that a combined approach across all scales of the questionnaire for the assessment of the voice self-concept enables a more detailed interpretation of the characteristics in the voice self-concept. The presented groups provide an applicable use supporting medical diagnoses., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Purpose: Teachers are at a considerable risk of developing vocal health problems due to intensive voice use during teaching. This study investigated factors related to the teacher's voice during a teaching situation., Methods: Overall, 113 teachers were recorded during a typical class lesson, lasting on average 48 min. A portable voice dosimeter (VoxLog System) was used to measure the sound pressure level (SPL) of the noise in the classroom, the teacher's voice SPL, the fundamental frequency (f o ) and the phonation time. General conditions of each lesson such as number of pupils, lesson subject and the educational level of the class were also collected. For the analysis, vocal loading doses and correlations between teacher's voice and noise SPL were calculated., Results: Voice and noise SPL values varied across the lesson subjects, with highest levels measured in sports lessons. The mean noise SPL changed throughout a lesson with highest values at the beginning and at the end of the lessons. The correlation analysis of voice and noise SPL identified two groups of teachers with different vocal SPL behaviours. For some teachers, the voice SPL varied with the noise SPL. For others, voice SPL was constantly high. A regression model on the teacher's voice SPL yielded a strong correlation with f o , the classroom noise SPL, and the individual vocal SPL behaviour., Conclusions: Classroom noise SPL and individual vocal SPL behaviour were significantly associated with teachers' voice SPL during teaching. Addressing these factors could be important steps in reducing the vocal load in teachers.

In the cases of uncertainty, even if the patient has no complaints about his voice quality, sometimes, benign vocal fold mass lesions are removed to exclude malignancy with the risk of resultant dysphonia. Narrow Band Imaging (NBI) enables a specific visualization of vessel structures in the superficial tissue. Benign lesions of the larynx are frequently characterized by abnormal vessel configuration or an absence of vessels in the area of the lesion. It was hypothesized that, in the primary diagnosis of patients with these benign lesions, the combination of white light and NBI endoscopy enables a better detection compared with white light endoscopy alone. Twenty-nine patients (eight patients with a cyst on a vocal fold, eight with a polyp, seven with a Reinke´s edema, two with a leukoplakia, one with a carcinoma, one with a granuloma, and two without any pathologic finding) were examined with normal white light and NBI endoscopy. 87 video sequences (29 white, 29 NBI, and 29 white/NBI) were generated and randomized and presented to 20 otolaryngologists who rated the videos in terms of the suspected diagnosis. Results were compared with the histopathologic findings of microlaryngoscopy. The probability of detecting benign lesions of the vocal folds was higher using NBI in combination with white light endoscopy compared with white light endoscopy alone. For vocal fold cysts, this difference was statistically significant. NBI endoscopy in combination with normal white light endoscopy improves the detection rate of benign lesions of the larynx, especially of vocal fold cysts.

Objectives: The effectiveness of a preventive training program on vocal health for German student teachers was investigated on specific vocal parameters., Methods: The voice quality as described by the Dysphonia Severity Index of 204 student teachers (training group: n = 123; control group: n = 81) was measured at the beginning and at the end of the student teachers training period (duration 1.5 years). Additionally, for investigating the voice-carrying capacity, a vocal loading test (VLT) was performed. Finally, participants had to provide a subjective judgment of a possible Voice Handicap Index., Results: The training program improved the voice quality of the trained group compared with that of the control group, whose voice quality declined. The trained group was also able to better sustain their voice quality across the VLT than the control group. Both groups, however, reported a similar increase in subjective vocal strain., Conclusions: The presented training program clearly showed a positive impact on the voice quality and the vocal capacity. The results maintain the importance of such a training program to be integrated in the education and occupational routine of teachers., (Copyright © 2016 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Introduction: Multidimensional voice evaluation is considered as gold standard in voice medicine. In this respect, the European Laryngological Society recommended a protocol for standardized evaluation (ELS-Protocol). However, there are only rare data analyzing changes during therapeutical follow-up., Material and Methods: Using this protocol, 276 patients (136 after phonosurgery, 81 after voice therapy and as a control group 59 patients without voice impairment) were evaluated with regard to their vocal capacity before and after voice therapy or phonosurgery, respectively., Results: The parameters of the ELS-protocol showed significant improvement under therapy with respect to DSI, VHI, and RBH-scale. It has been confirmed, that these measurements are suitable for the assessment of dysphonic patients with organic as well as functional voice disorders. However, detailed analysis of all the obtained parameters showed only weak or no correlation between all regarding parameters, which should be expected to provide comparable information, such as perturbation parameters or such parameters, that are derived from the acoustical spectrum., Discussion: Multidimensional evaluation of the voice as recommended by the ELS protocol is independent from the therapeutical approach able to document therapeutical success. The lack of sufficient correlations of values which should provide comparable information shows that an optimization or standardization of measuring instruments, computer hardware and software is necessary., (© Georg Thieme Verlag KG Stuttgart · New York.)