“…This finding is probably related to a tendency to expose their voices to more risk factors [5], such as long durations of voice use, loud talking, yelling over distances, suboptimal room acoustics, background noise, vocal tract irritants, stress and workload demands [3, 6, 7]. In particular, sustained vocal effort, accompanied by prolonged vocal loading, seems to play a pivotal role in increasing the risk of VPs in PVUs [8-11].…”