Vocal fatigue and its relation to vocal hyperfunction

This article reviews current literature on vocal fatigue and considers its potential relationship to vocal hyperfunction. Vocal fatigue is defined by its symptoms. Specifically, the voice user perceives an increase in phonatory effort over time that may be accompanied by decreased phonatory function. Vocal fatigue can present as a pure condition, such that no specific aetiology is apparent, or as a component of other voice disorders. The underlying bases of vocal fatigue appear to include the neurophysiological and biomechanical effects of extended periods of phonation. It can also be a function of strategies used to adapt to extended periods of phonation, such as the use of excessive muscular tension and suboptimal vocal fold posturing. Studies that have attempted to identify observable responses that are reliably associated with vocal fatigue have met with limited success, but recent advances in research methodology are promising. This review addresses current approaches to the study of vocal fatigue, especially regarding subject selection, design variables, and measurement variables. Future studies should address the relationship between vocal fatigue and other voice disorders, differences in individual responses to vocal-loading tasks, and differential evaluation and management of the neuromuscular, biomechanical, and central processes involved in vocal fatigue.