Voice Lab

 

VOICE PHYSIOLOGY LAB

The Voice Physiology Lab is located at Yoakley Hall, 161 S Dossett Dr, Johnson City, TN 37614, Room 122 and is directed by Dr. Chaya Nanjundeswaran (Dr. Guntupalli). 

If you are interested in becoming a research participant or interested in gaining more research experience, please contact Dr. Nanjundeswaran at nanjundeswar@etsu.edu  or 423-439-4036. 

 

Director

Dr. Chaya Guntupalli, Ph.D., CCC-SLP

Education

2013 | Ph.D. University of Pittsburgh

2003 | M.S., Speech & Hearing Sciences, All India Institute of Speech and Hearing

2001 | B.S., Speech & Hearing Sciences, All India Institute of Speech and Hearing

Teaching

Clinical Voice Disorders

Speech and Hearing Sciences I

Anatomy and Physiology of Speech Systems

Clinical Process

Preventative Voice Care

Research Methods

Voice Lab

Clinical Interests

Treatment of Adult and Pediatric Voice Disorders

Preventative Care and Treatment of Professional Voice Users

Research Interests

Basic Voice Science

Voice Disorders and Treatment

Vocal Fatigue

Integration of Voice Disorders with Exercise Physiology

Fluency Disorders

 

 

People

  • Bailey Schneider - Graduate Research Assistant
  • Katya Konstanty - Graduate Research Assistant
  • Colloborators
    • Jessie Van Swearingen, University of Pittsburgh

    • Eric Hunter, Michigan State University

    • Miriam van Mersbergen, University of Memphis
    • Adrianna Shembel, The University of Texas at Dallas
    • Jessica Huber, Purdue University

Equipment

Phonatory Aerodynamic System (PAS), Model 6600

Computerized Speech Lab (CSL), Model 4150

COSMED Quark CPET Metabolic Testing System

Gas Exchange Analysis MedGraphics VO2000 

voice

CSL Model 4150PAS Model 6600

 

Projects

Current Projects of the Voice Physiology Lab:

  • Cardiovascular Conditioning in the Treatment of Vocal Fatigue (NIH-NIDCD Funded Research)
    • Teachers are a population at high risk for voice disorders given their occupational demands. In a teaching career, a common debilitating symptom among all vocal symptoms experienced is - vocal fatigue. The impact of the experience of vocal fatigue is three fold, as this symptom: (a) predicts and leads to chronic voice problems, (b) affects occupational performance, and (c) impacts student learning and academic performance. Thus, vocal fatigue leads to a broader burden on healthcare costs of a chronic disorder, the economy of education [and the educator], and student learning. Although investigated in the voice literature, vocal fatigue lacks clarity in the definition, underlying mechanisms, and specific treatment or prevention approaches. A lack of such clarity can be attributed to the fact that vocal fatigue reflects a constellation of mechanisms which all manifest as tiredness of voice. On the contrary, fatigue is well documented in the exercise physiology literature including potential mechanisms and treatment options. We utilized principles from the well-described exercise physiology literature pertaining to the pattern of oxygen consumption and metabolic fuel used during task performance to examine the manifestation of vocal fatigue associated with a vocal task. Our preliminary data on potential mechanisms of vocal fatigue suggest two factors associated with this vocal symptom: 1) a greater reliance on anaerobic resources for fuel for vocal performance (i.e. less or no use of aerobic [oxygen] resources), and 2) poor physiological recovery from the vocal task. Vocally healthy cardiovascularly conditioned individuals showed greater reliance on oxygen resources during a vocal task and a more rapid recovery post task. Traditionally, voice production exercises are widely used to improve vocal skill and enhance neuromuscular efficiency to alleviate vocal fatigue. On the contrary, cardiovascular conditioning is widely used to increase endurance and decrease the early onset of fatigue in neuromotor task performance, but has not been systematically applied as a potential treatment for the problem of vocal fatigue. In a preliminary test, four-weeks of submaximal cardiovascular conditioning treatment in individuals with vocal fatigue (recruited using scores on the different factors of the Vocal fatigue Index-VFI) resulted in a shift in the metabolic source of fuel for a vocal task from predominantly anaerobic to greater aerobic resources in all three participants, with improvement of self-reported fatigue symptoms in 1 of 3 participants. Voice production exercises alleviated the symptoms of self-reported vocal fatigue in 2/3 participants. The proposed study's objective is (a) to determine the influence of cardiovascular conditioning exercise on the physiology of vocal task performance, post task recovery and self-reported symptoms of vocal fatigue in comparison to voice production exercises and (b) to predict differential treatment options for vocal fatigue based on baseline scores on the VFI. We will recruit 52 female teachers with vocal fatigue, ages 21-45 years, to be randomized to one of the two study arms: submaximal continuous cardiovascular conditioning exercise regimen or voice production exercises regimen. In these individuals, pre- and post-intervention physiologic cost of speaking, pattern of oxygen uptake and recovery kinetics, and self-reported vocal fatigue will all be recorded to determine impact of cardiovascular conditioning compared to the voice production exercise group on the physiology of vocal task performance. The outcomes will be used (a) to inform the development of a cardiovascular conditioning regimen to enhance physiologic vocal task management, (b) to determine the differential impact of cardiovascular conditioning and voice production exercise on vocal task management and alleviation of vocal fatigue symptoms and (c) to predict differential treatment approaches based on baseline VFI scores.

Previous Projects of the Voice Physiology Lab:

  • Vocal Fatigue Index

    •  Nanjundeswaran, C., van Mersbergen M, Morgan K. Restructuring the Vocal Fatigue Index Using Mokken Scaling: Insights Into the Complex Nature of Vocal Fatigue. 2017 Nov 6. pii: S0892-1997 (17)30384-3

    • Nanjundeswaran C, van Mersbergen M, Banks R, Hunter E. Vocal Fatigue Index in Teachers Using Mokken Analysis. J Voice. 2021 Jan 29:S0892-1997(21)00022-9. doi: 10.1016/j.jvoice.2020.12.053. Epub ahead of print. PMID: 33526304; PMCID: PMC8319213.

    • Nanjundeswaran, C., Jacobson, B., Gartner-Schmidt, J., & Verdolini-Abbott, K. (2015). Vocal Fatigue Index: Development and Validation. Journal of Voice, 29 (4), 433-440.

    • Zambon, F., Moreti. F., Nanjundeswaran. C., Behlau. (2016) M. Cross-cultural adaptation of the Brazilian version of the Vocal Fatigue Index – VFI . CoDAS, (Accepted for publication)
      VFI index is currently being translated into
      • Brazilian, Fabiana Szambon – University of Sao Paulo
        Persian, Ehsan Naderifar – Zahedan University of Medical Sciences, Iran
        Chinese, Ha-Kyung KIM – East China Normal University, China
        Kannada, Dr. Raja Sudhakar – AIISH, India
        Turkish, Dr. Sehar Sirin – Kocaeli University ENT and HNS Department Turkey
        Spanish, Marcelo Saldias- Society of Vocology
  • Redefining and Further Explorations of Vocal Fatigue
    • Hunter, E., Cantor-Cutiva, L., van Leer, E., van Mersbergen, M., Nanjundeswaran, C., Pasquale, B., Sandage, M., & Whitling, S. (2020). Towards a Consensus Description of Vocal Effort, Vocal Load, Vocal Loading, and Vocal Fatigue: Journal of Speech, Language and Hearing Research. doi: 10.1044/2019_JSLHR-19-00057 

  • Understanding the underlying mechanisms of vocal fatigue

    • Nanjundeswaran, C., VanSwearingen, J., & Verdolini-Abbott, K. (2017). Metabolic Mechanisms of Vocal Fatigue. Journal of Voice, 31 (3), 378e1-378e11.

  • Understanding occupational demands and its relation to vocal fatigue in teachers
    • Creech, C., Jamison, B., Lacey, T., Patton, E., & Nanjundeswaran, C. (November 13, 2015). Understanding Role of Occupational Risk Factors in Voice Problems of Teachers, ASHA Annual Convention, Denver, CO.
  • Developing prevention protocols for teachers with voice problems
    • Nanjundeswaran, C., Li, N.Y.K., Chan, K., Wong, R.K.S., & Verdolini-Abbott, K. (2012). Preliminary Data on Prevention of Voice Problems in Student Teachers. Journal of Voice, 26 (6), 816.e1-12.

Awards/Honors

2022        Dean’s Distinguished Faculty Research Award, College of Clinical and Rehabilitative Health Sciences, East Tennessee State University

2018        Journal of Voice, Metabolic Mechanisms of Vocal Fatigue - 2017 Best Paper Award in Speech Pathology

2016        Journal of Voice, Vocal Fatigue Index (VFI): Development and Validation - 2015 Best Paper Award in Speech Pathology

2016        Dean’s Distinguished Faculty Teaching Award
                College of Clinical and Rehabilitative Health Sciences
                East Tennessee State University

2016        Recipient- Dean’s Research Fellowship Award

2015        Mentee, ASHA Pathways Program (funded by NIDCD)

2014        Dean’s Distinguished Faculty Research Award
                College of Clinical and Rehabilitative Health Sciences
                East Tennessee State University

Publications/Presentations

Publications

Foulks Pointer, N., van Mersbergen, M., & Nanjundeswaran, C. (2022). Listeners’ Attitudes Towards Young Women with Glottal Fry. Journal of Voice, S0892-1997(22)00281-8, doi: 10.1016/j.jvoice.2022.09.007

Shembel, A., & Nanjundeswaran, C. (2022). Potential Biophysiological Mechanisms Underlying Vocal Demands and Vocal Fatigue. Journal of Voice, S0892-1997(22)00220-X, doi: 10.1016/j.jvoice.2022.07.017

Nanjundeswaran, C. & Shembel, A. (2022). Laying the Groundwork to Study the Heterogenous Nature of Vocal Fatigue. Journal of Voice, S0892-1997(22)00210-7,
doi: 10.1016/j.jvoice.2022.07.008

Nanjundeswaran C, van Mersbergen M, Banks R, Hunter E. Vocal Fatigue Index in Teachers Using Mokken Analysis. J Voice. (2021). S0892-1997(21)00022-9. doi: 10.1016/j.jvoice.2020.12.053. Epub ahead of print. PMID: 33526304; PMCID: PMC8319213.

Zambon, F., Moreti, F., Ribeiro, V.V., Nanjundeswaran, C. , & Behlau, M. (2020). Vocal Fatigue Index: Validation and Cut-off Values of the Brazilian Version, Journal of Voice, https://doi.org/10.1016/j.jvoice.2020.06.018 

Hunter, E., Cantor-Cutiva, L., Leer, E. V., Mersbergen, M. V., Nanjundeswaran, C. D., Bottalico, P., Sandage, M. J., & Whitling, S. (2020): Towards a consensus description of Vocal Effort, Vocal Load, Vocal Loading, and Vocal Fatigue: Journal of Speech, Language and Hearing Research, 63(2), 509-532. doi:10.1044/2019_jslhr-19-00057

Naderifar, E., Moradi, N., Farzadi, F., Tahmasebi, N., Soltani, M., Latifi, S.M., & Nanjundeswaran, C. (2018). Cross-cultural adaptation and validation of the Vocal fatigue Index in to Persian, Journal of Voice, 18, 30192-30199. (epub ahead of print)

Nanjundeswaran C., & Carroll, T. (2017). Meta-analysis for medical intervention of unilateral vocal fold paralysis: Limited evidence on generalization of voice outcomes: Evidence-Based Communication Assessment and Intervention, 11(1-2):42-46.


Nanjundeswaran C., van Mersbergen M., & Morgan K (2017). Restructuring the Vocal Fatigue Index Using Mokken Scaling: Insights Into the Complex Nature of Vocal Fatigue, Journal of Voice, 6. pii: S0892-1997(17)30384-3.

Nanjundeswaran, C., VanSwearingen, J., & Verdolini-Abott, K., (2017). Metabolic Mechanisms of Vocal Fatigue. Journal of Voice, 31 (3), 378e1-378e11.

Zambon, F., Moreti. F., Nanjundeswaran. C., & Behlau. M (2017). Cross-cultural adaptation of the Brazilian version of the Vocal Fatigue Index – VFI . CoDAS. 29(2). doi:10.1590/2317-1782/20172015261

Nanjundeswaran, C., Jacobson, B., Gartner-Schmidt, J., & Verdolini-Abbott, K. (2015). Vocal Fatigue Index: Development and Validation. Journal of Voice, 29 (4), 433-40.

Nanjundeswaran, C., Li, N.Y.K., Chan, K., Wong, R.K.S., & Verdolini-Abbott, K. (2012). Preliminary Data on Prevention of Voice Problems in Student Teachers. Journal of Voice, 26 (6), 816.e1-12.

Guntupalli, V.K., Nanjundeswaran, C., Kalinowski, J., & Dayalu, V.N. (2012). Affective and Emotional Responses of Graduate Student Clinicians in Speech-Language Pathology to Stuttered Speech. International Journal of Language and Communication Disorders, 47 (5), 603-608.

Guntupalli, VK., Nanjundeswaran, C., Kalinowski, J., & Dayalu, V.N. (2011). The Effect of Static and Dynamic Speech Gestures on Speech Inhibition. Neuroscience Letters, 492 (1)., 39-42.

Guntupalli, VK., Nanjundeswaran, C., Kalinowski, J., & Dayalu, V.N. (2011). Past Speech Therapy Experiences of Individuals Exploring a New Stuttering Treatment. Perceptual Motor Skills, 112 (3)., 975-980.

Guntupalli, V. K., Everhart, D. E., Kalinowski, J., Nanjundeswaran, C., & Saltukalroglu, T. (2007). Emotional and physiological responses of fluent listeners while watching the speech of adults who stutter. International Journal of Language and Communication Disorders, 42, 113-129.

Guntupalli, V. K., Kalinowski, J., Nanjundeswaran, C., Saltuklaroglu, T., & Everhart, D. E. (2006). Psychophysiological responses of adults who do not stutter while listening to stuttering. International Journal of Psychophysiology, 62, 1-8.

Guntupalli, V. K., Kalinowski, J., Saltuklaroglu, T., & Nanjundeswaran, C. (2005). The effects of temporal modification of second speech signals on stuttering inhibition at two speech rates in adults. Neuroscience Letters, 385, 7-12.

Presentations

Nanjundeswaran, C., Dupre, M., Forren, S., Schneider, B., & Winkler, K. (June 4, 2022), Listener’s Attitudes Toward Young Men Using Glottal Fry, 51st Care of the Professional Voice, Annual Voice Symposium, Philadelphia, PA

Nanjundeswaran, C., Desai, V. (February 19, 2022- Invited Plenary Speaker), An Eclectic Physiologic Based Approach to Voice Therapy- Case Based Perspectives, 53rd Annual Convention of the Indian Speech and Hearing Association, Mysuru, India

Farnsworth, E., Nanjundeswaran, C, (November, 20, 2021), Metabolic Profiles of Different Voice Types; A Preliminary Report, ASHA Convention, Washington, DC.

Foulks, N., vanMersbergen, M., Louw, B., Gorman, C. & Nanjundeswaran, C. (June 3, 2021), Listeners’ Attitudes towards Young Women using Glottal Fry, 50th Annual Virtual Symposium: Care of Professional Voice, Philadelphia, PA

Nanjundeswaran, C, (May 29, 2020), Measuring and Monitoring the Complex Nature of Vocal Fatigue: Special Panel on Vocal Fatigue: Is it Worth the Effort?, 49th National Virtual Voice Symposium.

Nanjundeswaran, C., Ballone, H., Farris, A., Foulks, N., Richardson, S. (October 19, 2019). Listener Attitudes towards Individuals with Voice Disorders, Fall Voice Conference, Plano, TX.

Nanjundeswaran, C., van Mersbergen, M., Hunter, E., & Banks, R. (October 18, 2019). Mokken Scaling and Vocal Fatigue Index- Insights in to the Complex Nature of Vocal Fatigue, Poster Presentation, Fall Voice Conference, Plano, TX.

Nanjundeswaran, C., & VanSwearingen, J. (Sep 5, 2019): Cardiovascular Conditioning in the Treatment of Vocal Fatigue- Invited Speaker, World Phonosurgery Congress, Beunos Aires, Argentina.

Hunter, E., Cantor-Cutiva, L., van Leer, E., van Mersbergen, M., Nanjundeswaran, C., Pasquale, B., Sandage, M., & Whitling, S. (August 28, 2019): Towards a consensus description of Vocal Effort, Vocal Load, Vocal Loading, and Vocal Fatigue, Pan-European Voice Conference, Copenhagen, Denmark.

Ballone, H., Farris, A., Foulks, N., Richardson, S., & Nanjundeswaran, C. (April 11, 2019). Listener Attitudes toward Teachers with Voice Problems: Appalachian Student Research Forum, ETSU, Johnson City, TN.

Nanjundeswaran, C., & VanSwearingen, J. (July 31, 2018). Body-System Level Cardiovascular Conditioning and Vocal Fatigue: 11th International Conference on Voice Physiology and Biomechanics, Michigan State University, East Lansing.

Verdolini-Abbott, K., Nanjundeswaran, C., Tellis, C., & Apfelbach, C. (July 31, 2018). Vocal Fatigue: Potential Physiological Mechanisms and Treatment Implications: 11th International Conference on Voice Physiology and Biomechanics, Michigan State University, East Lansing.

Smith, H., Campolongo, K., Garreston, B., Marley, V, Waters, A., & Nanjundeswaran, C. (June 2, 2018). Student Attitudes towards Individuals with Voice Disorders: 47th Annual Symposium: Care of Professional Voice, Philadelphia, PA

Smith, H., Louw, B., Oh, S., & Nanjundeswaran, C. (June 2, 2018). Vocal Health: Awareness and Perceptions in Undergraduate Vocal Music and Theatre Majors: 47th Annual Symposium: Care of Professional Voice, Philadelphia, PA

Nanjundeswaran, C., & VanSwearingen, J. (June 3, 2017). Differential Effects of Cardiovascular Conditioning versus Voice Production Exercises in a Patient with Vocal Fatigue, technical Session: : 46th Annual Symposium: Care of the Professional Voice, Philadelphia, PA

Zambon, F., Moreti, F, Nanjundeswaran, C., & Behlau, M. (2017). Cross Cultural Adaptation of the Brazilian Version of the Vocal fatigue Index- VFI, Poster Session: 46th Annual Symposium: Care of the Professional Voice, Philadelphia, PA

Lucht, A., Boggs, E., Garland, E., McClain, B. & Nanjundeswaran, C. (April 7, 2016). Effects of Biofeedback on Vocal Behavior on a Child with a Unilateral Vocal Fold Lesion, Appalachian Student Research Forum, ETSU, Johnson City, TN.

Nanjundeswaran, C., VanSwearingen, J., & Verdolini Abbott, K. (November 13, 2015). Vocal Fatigue- Role of Aerobic Conditioning in Metabolic Cost and Recovery from Reading. ASHA Annual Convention, Denver, CO.

Creech, C., Jamison, B., Lacey, T., Patton, E., & Nanjundeswaran, C. (November 13, 2015). Understanding Role of Occupational Risk Factors in Voice Problems of Teachers, ASHA Annual Convention, Denver, CO.

Nanjundeswaran, C., Bassich, C., & Samlan, R. (November 22, 2014). Student Training in a University Setting Voice Clinic- How do we do it? ASHA Annual Convention, Orlando, FL.

Nanjundeswaran, C., VanSwearingen, J., & Verdolini- Abbott, K. (October 18, 2013). Aerobic Conditioning- Role of Aerobic Conditioning in Metabolic Cost and Recovery from Reading, Poster Presentation, Fall Voice Conference, Atlanta, GA.

Nanjundeswaran, C., Jacobson, B., Gartner-Schmidt, J., Rosen, C., & Verdolini- Abbott, K. (July 18, 2013). Vocal Fatigue Index- Validation and Implications, Technical Session, 2013 Phonosurgery Symposium, Salt Lake City, UT

Nanjundeswaran, C., Verdolini-Abbott, K., Jacobson, B., Gartner-Schmidt, J., & Rosen, C. (June 4, 2011). Final Validation of Vocal Fatigue Index. Technical Session. 40th Annual Symposium: Care of the Professional Voice, Philadelphia, PA

Book Contributions

Nanjundeswaran, C. (2019). An eclectic approach in the management of an individual with vocal fatigue. In Stemple & Hapner (Ed. 5), Voice Therapy: Clinical Case Studies.

Nanjundeswaran, C. (2015). An eclectic approach in the management of an individual with vocal fatigue. In Stemple & Hapner (Ed. 4), Voice Therapy: Clinical Case Studies.

Grants/Funding

 

Nanjundeswaran, C. (PI). Cardiovascular Conditioning in the Treatment of Vocal Fatigue, NIH-NIDCD R15 Funded (August 2019- July 2023: No Cost Extension), $407,686.

https://projectreporter.nih.gov/project_info_description.cfm?aid=9812009&icde=47901032&ddparam=&ddvalue=&ddsub=&cr=1&csb=default&cs=ASC&pball= 

 

Nanjundeswaran, C. (PI). CCHRS Dean’s Research Fellowship Award, $20,000 (Funded Spring 2016- Fall 2017).

 

Nanjundeswaran, C. (PI). A Preliminary Study on the Effects of Amplification in the Prevention of Voice Problems in Teachers, Small RDC Funded (Oct 2014- June 2015), $1097.00

 

Nanjundeswaran, C. (PI). Examination of Energy Efficiency of Two Types of Behavioral Voice Therapy, Major RDC Funded (July 2013- June 2014). $9034.00

 

Nanjundeswaran, C. (PI). Metabolic Mechanisms of Vocal Fatigue. SHRS Research Development Fund (Funded July 2012-June 2013).

 

Student Projects

Current Student Projects:

  • Loren Vermillion, student research, "A Systematic Investigation of Loudness as Vocal Demand Ingredient in Monitoring Vocal Cover Fatigue."
  • Zeth Collom, Doctoral Student, Texas Tech University Health Sciences Center- Lubbock, "Vocal Fatigue Index in Teachers."

Prior Student Research:

  • Sathvik Ramu, University High AP Research Project. "Generation Z's Attitudes towards Individuals with Glottal Fry". 
  • Marci Dupre, Kylee Winkler, Bailey Schneider, Savannah Forren, student research, “Attitudes Towards Young Men with Glottal Fry."
  • Evan Farnsworth, student research, “Metabolic profiles of different voice types.”
  • Tino Mupambo, student research, "Patient related outcome measures in voice, culture and linguistic adaptation and validation across languages - Is there a standard approach?"

Chair

  • Kristy Moore (2016). Interprofessional Patient Stimulation Training Compared to Online Training for Learning to use In-Line Speaking Valves.  

 

Last Updated on January 26th, 2023. 

                        

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