“…The relationships between voice use and vocal health and stress, anxiety, psychosocial factors, personality traits, lifestyle, awareness, coping strategies and self-management have been addressed but need further attention (Dietrich et al, 2008;Holmqvist et al, 2013;McHugh-Munier, Scherer, Lehmann, & Scherer, 1997;Ng et al, 2013;Oliveira et al, 2012;Van Wijck-Warnaar et al, 2010;Yano, Ichimura, Hoshino, & Nozue, 1982). For example, extroversion, hyperactivity, impulsiveness and perceived stress are traits found in patients with vocal nodules (El Uali Abeida et al, 2013;Roy, Bless, & Heisey, 2000). The connection between stress and vocal nodules needs further investigation since chronic stress has an immunosuppressive effect, which could negatively influence wound healing in phonotraumatic lesions (Holmqvist Jämsén, 2017).…”