Vocal problems among teachers: a review of prevalence, causes, prevention, and treatment

Prevalence and Risk Factors of Voice Disorders Among Teachers in Saudi Arabia

Introduction Voice is a crucial tool for communication, and voice problems are more likely to occur in professionals who frequently use their voice for work. Teachers, whose profession requires sustained vocal use, are particularly susceptible to occupation-related voice disorders. This study aimed to quantify the prevalence of voice disorders among teachers in Saudi Arabia, with the general population serving as a control group, and to identify associated risk factors. Methods A cross-sectional study was conducted utilizing an online self-administered questionnaire, which was completed by both teachers and the general population in Saudi Arabia. The latter group acted as a control. The questionnaire included sections on sociodemographic data, teaching patterns, symptoms of voice issues, and the Voice Handicap Index-10 (VHI-10) for assessing voice disorders among participants. Results The study included 640 participants, with 438 (68.4%) being teachers, the majority of whom were females (N = 406; 63.4%). The most common voice-related symptoms reported by teachers were hoarseness (N = 210; 37.9%) and dry throat (N = 147; 26.9%). Voice disorders, as determined by the VHI, affected 355 (55.5%) of the teachers. A high VHI score was associated with a diagnosis of voice disorders and GERD. There was no significant difference in the VHI scores between teachers and the general population (p > 0.05). Conclusion Teachers in Saudi Arabia exhibited a higher prevalence of voice disorders compared to the general population. Risk factors, such as smoking, longer teaching experience, and more teaching hours per week, were more common among teachers with voice disorders. Further investigative studies are warranted to elucidate the causal relationships between these variables and voice disorders.

Contribution of outdoor noise-induced health risk in schools located in urbanized arid country

Ambient noise pollution is deemed as one of the major growing public health issues, especially in developing countries. Therefore, it is crucial to assess the impact of noise pollution on public health. The aim of this study is to investigate the health risk of noise exposure levels in three schools: Kaab Bin Zeyd of Basic Education (school A), Hail Al-Awamour Girls school (school B), and Al-Fikr School (school C) in Muscat, Oman. The study employed a survey of 300 students, dose-response models, and regression models to quantify health risk and to determine the relationship between noise levels and perceived noise annoyance sources. The study found average noise levels (L_Aeq) of school A (70.03±8.21 dBA), school B (69.54±7.75 dBA), and school C (55.95± 5.67 dBA) to be higher than WHO's outdoor schools environment standard of 55 dBA and European (EN16798-1) classroom's critical limits of 30-34 dBA. Most of the students from schools A (30.9%), B (33.3%), and C (63%) have reported noise produced from traffic as extremely annoyed compared to aircraft of 15.4%, 11.5%, and 27.2%, respectively. Regression analysis shows that perceived traffic noise was strongly correlated with L_Aeq in school A (R² =0.481), B (R² =0.121), and C (R² = 0.132) when compared with other subjective noise types. The health risk assessment results show that the percentage of highly annoyed (%HA) was higher in school A (15.2%) and school B (14.95%) than in school C (8.18%). The estimated highly sleep disturbed (%HSD) based on mean noise levels were almost the same in schools A (15.62%) and B (15.19%) but far higher compared to school C (6.01%). However, there was an association between the mean noise exposure levels and the risk of developing ischemic heart diseases (IHD) in school A (RR= 1.172, 95% CI: 1.020-1.334), school B (RR=1.167, 95% CI: 1.020-1.325), and school C (RR=1.051, 95% CI: 1.006-1.095). Moreover, attributable risk percentage (AR%) for school A (AR% =14.675, 95% CI: 2.028-25.037), school B (AR% =14.310, 95% CI: 1.960-24.528), and school C (AR% = 4.852, 95% CI:0.596-8.742) have shown that a substantial portion of the population could be prevented from developing IHD. It is expected that findings of the study can be applied in other arid regions with sprawl urbanized built environments.

The Effects of Collegiate Sports Coaching on the Male Voice: Pilot Data

PURPOSE

This research gathered pilot data on the effects of a typical collegiate athletic season on the male coach's voice.

MATERIALS AND METHODS

Ten male coaches and ten age- and sex-matched controls participated. Qualitative and quantitative analyses were performed to assess group differences in: 1) written self-reports obtained during one session, 2) acoustic and aerodynamic variables obtained during regular season and during off-season for the coaches and only once for the controls, and 3) auditory-perceptual data provided by three speech-language pathologists using the Consensus Auditory-Perceptual Evaluation of Voice during one listening session. Data pertaining to the coaches' regular season, to the coaches' off-season, and to the control participants were designated as in-season, off-season, and control, respectively.

RESULTS

Significant self-reported findings included more phonotraumatic behaviors in the coaches than in the controls and higher in-season than off-season and control vocal demand. The coaches' history of voice problems was unrelated and the controls' was related to respiratory illness and addressing a large audience. A significant acoustic finding was lower off-season than control low fundamental frequency. Finally, trained listeners perceived control loudness as more aberrant than off-season loudness and they noted vocal fry twice as many times in in-season and off-season than in control voices.

CONCLUSIONS

This study exposed traces of adverse voice reactions to coaching and confirmed that coaches harbor a job-based proclivity to voice overuse. Self-reported measures appeared to be the least and aerodynamic the most immune to phonatory exertion that pervades daily coaching tasks. Future studies are warranted to further delineate how athletic coaching interferes with voice production.

Prevalence of Voice Problems and Associated Risk Factors Among Tamil-Speaking Imams

PURPOSE

Voice of Professional Voice Users (PVUs) are of particular interest to practicing Speech-Language Pathologists. There is a dearth of studies concerning the prevalence of voice disorders and the associated risk factors among Tamil-speaking Imams. We address this research gap using non-experimental survey research.

METHODS

A questionnaire was framed by reviewing earlier literature. The derived questionnaire was administered to one hundred Tamil-speaking Imams actively involved in religious service in Tamil Nadu. We analyzed the obtained responses quantitatively and qualitatively. We also examined the effect of age on the prevalence of voice disorders and associated risk factors.

RESULTS

Based on survey responses, the career prevalence of voice problems among Tamil-speaking Imams was as high as 89%, and the point prevalence was 64%. The general health status of the Imams were good. However, vocal health was not satisfactory. This study identified several factors that contribute to voice problems, such as constant use of loud voice, acid reflux, unhealthy vocal habits, and insufficient hydration. A positive aspect observed during this study was the absence of smoking and consumption of alcohol among Imams. Even though the Imams presented good awareness of the voice production mechanism, they reported not seeking medical help when facing a voice problem. Current findings report a minimal impact of age-related differences on associated risk factors for voice disorders among the Imams.

CONCLUSIONS

Voice disorders are prevalent among Tamil-speaking Imams. Several risk factors leading to voice disorders among these individuals need to be addressed.

Are Occupational Voice Disorders Accurately Measured? A Systematic Review of Prevalence and Methodologies in Schoolteachers to Report Voice Disorders

PURPOSE

Different measuring instruments have been described to determine the prevalence of voice disorders in schoolteachers. However, the heterogeneity of prevalence figures has made it difficult in determining the impact of voice disorders in this group. This investigation aims to review and identify scientific evidence of methodological analysis of voice disorders in teachers, the relevance of measuring instruments, the prevalence of dysphonia, and the impact on the development of vocal health prevention programs.

METHODS

A systematic review was conducted by searching six important scientific databases. Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines were carried out. Articles were included whether they presented data related to the prevalence of dysphonia and the impact of therapy programs on teachers.

RESULTS

Twenty articles out of 8,998 were selected. The cross-sectional design type was predominant throughout the investigations. Differences were observed in the number of participants across studies, leading to heterogeneous prevalence figures - which ranged from 10.5% to 69.1%. The assessment instruments are not standardly used to effectively determine the disease burden. Despite the fact of the extensive evidence of the effectiveness of programs that address dysphonia in teachers, the scarcity of literature is yet evident on systematic programs promoted by either the government or educational institutions.

CONCLUSION

Findings suggest that future investigations should consider the consensus of a global definition for occupational dysphonia in teachers in order to develop accurately measuring instruments and to assist with voice care programs and treatment approaches in this population. This might be crucial since it could also assist with the implementation of Delphi-type studies that could support the development of further evidence-based agreements around these programs (voice care and treatment approaches) in schoolteachers.

Factors Predicting Dysphonia in Professional Voice Users

OBJECTIVE

To analyze the contribution of organizational, environmental, and personal factors in predicting dysphonia in professional voice users.

STUDY DESIGN

This was a cross-sectional documentary study.

METHODS

The study sample consisted of 128 professional voice users (104 female and 24 male), with a mean age of 39.3 years. Dysphonia (laryngeal disorder associated with vocal complaints) was defined as the dependent variable. Organizational, environmental, and personal factors were defined as independent variables. Logistic regression models were used as predictive methods for data analysis. Evaluation and interpretation of the final model were performed using the ROC curve, odds ratio, and probability estimation.

RESULTS

Professional voice users exposed to low humidity and who talked a lot on their phones were less likely to be dysphonic than individuals who were not exposed to these factors. Those exposed to excessive vocal demand and who reported talking with effort were more likely to be dysphonic than those who were not exposed to these factors. The accuracy of the prediction model was 80.8%.

CONCLUSIONS

Exposure to low humidity and talking a lot on the phone were protective factors. However, excessive vocal demand and straining were risk factors for predicting the presence of dysphonia in professional voice users with high accuracy.

LaDIVA: A neurocomputational model providing laryngeal motor control for speech acquisition and production

Many voice disorders are the result of intricate neural and/or biomechanical impairments that are poorly understood. The limited knowledge of their etiological and pathophysiological mechanisms hampers effective clinical management. Behavioral studies have been used concurrently with computational models to better understand typical and pathological laryngeal motor control. Thus far, however, a unified computational framework that quantitatively integrates physiologically relevant models of phonation with the neural control of speech has not been developed. Here, we introduce LaDIVA, a novel neurocomputational model with physiologically based laryngeal motor control. We combined the DIVA model (an established neural network model of speech motor control) with the extended body-cover model (a physics-based vocal fold model). The resulting integrated model, LaDIVA, was validated by comparing its model simulations with behavioral responses to perturbations of auditory vocal fundamental frequency (fo) feedback in adults with typical speech. LaDIVA demonstrated capability to simulate different modes of laryngeal motor control, ranging from short-term (i.e., reflexive) and long-term (i.e., adaptive) auditory feedback paradigms, to generating prosodic contours in speech. Simulations showed that LaDIVA’s laryngeal motor control displays properties of motor equivalence, i.e., LaDIVA could robustly generate compensatory responses to reflexive vocal fo perturbations with varying initial laryngeal muscle activation levels leading to the same output. The model can also generate prosodic contours for studying laryngeal motor control in running speech. LaDIVA can expand the understanding of the physiology of human phonation to enable, for the first time, the investigation of causal effects of neural motor control in the fine structure of the vocal signal.

The prevalence and risk factors for perceived voice disorders in public school teachers

Objectives

The aim of this study was to explore the prevalence and risk factors in public kindergarten and elementary school teachers in the Jimei district in Xiamen. We took particular interest in the relationship between work‐related factors and voice disorders.

Study Design

A cross‐sectional investigation; a General Investigation.

Methods

This study was conducted from September 14 to 18, 2020 at public kindergarten and elementary schools in Xiamen, China. A total of 3140 teachers were separated into a perceived voice disorder group (PVD) and no perceived voice disorder group (NPVD) according to the Voice Handicap Index. The chi‐square test was applied to explore the differences between the PVD and NPVD groups. The univariate logistic regression models were used to identify the risk factors in terms of unadjusted odds ratio and 95% confidence interval. Stepwise logistic regression was then used to ascertain independent determinants.

Results

We found that the prevalence of PVD was 47.52%. The results showed that risk factors of PVD included being female (OR = 1.574), middle‐rank technical title and higher (OR = 2.199), continuous lecturing for more than 3 classes (OR = 3.034), lectured more than 10 classes a week (OR = 1.436) and taught art or physical education (OR = 1.742).

Conclusions

Teachers' work‐related characteristics were associated with PVD. This proves that a preventive voice care program for teachers, administered by the school or education bureau, is urgent. This could include components such as the reasonable arrangement of timetables and recruitment of a sufficient number of kindergarten and elementary school teachers.

Level of evidence: Case‐series

We researched 3140 public kindergarten and elementary schools teachers through general investigation, and performed stepwise logistic regression model to identify uniquely increase risk factors for developing perceived voice disorder. Our investigation is the first study that showed teachers who continuous lecturing 3 or 4 classes had a 3.034‐fold higher risk of PVD than those who have no continuous lecturing (OR = 3.034) in Mainland China. This proves that a preventive voice care program for teachers, administered by the school or education bureau, is urgent.

Videolaryngoscopy Findings of the Vocal Health Program in Dysphonic Teachers in the Federal District, Brazil

Introduction  The high phonatory demand required of teachers is a direct cause of the onset of vocal symptoms and of the development of laryngeal disorders.

Objective  To describe the findings of the laryngeal screening performed as part of the Vocal Health Program held in the Federal Distrcit of Brazil in 2014 and 2015.

Methods  The study was performed with 361 dysphonic teachers from public schools who attended the laryngeal screening (videolaryngoscopy) part of the program. Data on anamnesis, the degree of dysphonia, the findings of the laryngeal screening, the referrals made after the laryngeal screening, and the result of the assessment of vocal aptitude for work were analyzed from the forms of each participating teacher.

Results  The sample of the present study ( N  = 361) represents 18.23% of the 1,980 teachers that went through the vocal screening of the program in 2014 and 2015. In total, 98 (27.15%) teachers presented mild dysphonia, 221 (61.22%), moderate dysphonia, and 42, (11.63%) severe dysphonia. Regarding the laryngeal screening (videolaryngoscopy exam), 269 teachers (74.52%) presented laryngeal disorders, and the main ones found were vocal nodules (43.87%), signs of laryngopharyngeal reflux (37.17%), hourglass chink (18.22%), vascular dysgenesis (18.22%), midposterior triangular chink (9.67%), and double chink (8.55%).

Conclusion  Laryngeal screening through videolaryngoscopy and auditory-perceptual screening of the voice as part of vocal health programs are essential to define the diagnosis and therapeutic conduct for teachers with dysphonia. Together with intervention activities, continuing education and adequate and accessible treatment, the periodic evaluation of vocal health can contribute to reduce absenteeism and improve the quality of life and of the voice of teachers.

Efficacy of different straw phonation doses for vocal fatigue prevention

PURPOSE

The aim of the present study was to investigate the efficacy of different straw phonation doses for vocal fatigue (VF) prevention.

METHOD

Thirteen males and 13 females participated in the study. Each participant received seven preventive treatments (i.e. voice rest with hydration for 15 minutes, straw phonation into air or water for one, three and five minutes) in separate visits. Phonatory threshold pressure (PTP) and self-perceived vocal fatigue (PVF) symptoms severity were adopted as the primary and secondary outcome measures, respectively. Measurements were taken before and after the preventive treatment, and after a 90-minute VF-inducing task.

RESULT

PTP was maintained in four of the straw phonation doses, namely; the one-minute into air, one-minute, three-minute and five-minute into water conditions; but not in the voice rest condition. Straw phonation into water of a depth of 5 cm for one minute was considered the optimal dose for VF prevention. PVF, however, was not maintained after VF-inducing task in all treatment conditions.

CONCLUSION

Straw phonation into water for one minute was capable of preventing phonatory efficiency (as measured with PTP) from deteriorating. The dose identified in the present study may be adopted for future prevention studies in population that is vulnerable to VF.

The Therapeutic Effects of Straw Phonation on Vocal Fatigue

OBJECTIVES

Straw phonation has been investigated for its vocal warm-up effects on healthy populations and therapeutic effects on voice patients. The purpose of this article was to determine whether it is beneficial for vocal fatigue.

STUDY DESIGN

Prospective cohort study METHODS: Twenty-five healthy participants were recruited into 1-hour vocal loading tasks followed by 10-minute vocal rest or straw phonation on 2 different days. Various parameters including phonation threshold pressure (PTP), mean airflow, closed quotient (CQ), current speaking effort level (EFFT), and laryngeal discomfort (DISC) were acquired at baseline, after vocal load, and after the intervention.

RESULTS

Increased PTP, EFFT, and DISC were observed after vocal load. Decreased PTP, EFFT, and DISC were then acquired after both vocal rest or straw phonation. More significant improvements were obtained in straw phonation when compared with vocal rest. Additionally, significantly increased mean flow and decreased CQ were obtained after straw phonation when compared to vocal rest.

CONCLUSIONS

Straw phonation has the potential to adjust aerodynamics within the vocal tract leading to improved vocal efficiency, optimized vibration mode, and attenuated vocal fatigue. This study provided a promising treatment for vocal fatigue that could have wide clinical relevance to voice users with high voice demands.

LEVEL OF EVIDENCE

4 Laryngoscope, 130:E674-E679, 2020.

Long-Term Effects of a Voice Training Program for Teachers on Vocal and Mental Health

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.

Vocal Dose of Preservice Music Therapists, Preservice Music Teachers, and Other Undergraduate Students

BACKGROUND

Researchers have studied various populations with high vocal doses and prevalence of related voice disorders. Teachers, singers, and university students are three such populations that have been examined extensively. No studies to date, however, have examined the voice use of music therapists and compared their voice use to these other populations.

OBJECTIVE

The purpose of this investigation was to examine voice dosimeter data including phonation duration and percentage, amplitude, frequencies, and distance dose acquired over contiguous 7 day (1 week) periods by preservice music therapists, preservice music teachers, and other university students in concert with daily voice use surveys.

STUDY DESIGN

This is a quantitative descriptive design.

METHODS

Eight female students of varied majors (music therapy, music education, vocal performance, elementary education, and "other") in their third year of university study wore a voice dosimeter during all waking hours for 7 days. The dosimeter recorded voicing time, percentage, frequency, and estimated amplitude. Participants also completed surveys related to several parameters of vocal health, the number of hours they slept, and their voice care.

RESULTS

Participants experienced relatively low vocal doses during the week. Music majors experienced more voice use than nonmusic majors. Some of the highest doses occurred during teaching demonstrations and leading of music therapy practicum sessions.

CONCLUSION

Preservice music therapists and preservice music teachers may experience extreme increases in vocal load when they enter the field. Absent training protocols, these increases could be detrimental to their vocal health and long-term viability as practitioners.

The Risk Factors Related to Voice Disorder in Teachers: A Systematic Review and Meta-Analysis

Background and Objectives: Identifying the risk factors of teachers’ voice disorders is very important for preventing voice disorders and the recurrence of them. This meta-study identified risk factors associated with teachers’ voice disorders through systematic review and meta-analysis and provided basic data for preventing them. Materials and Methods: This study collected literature on the risk factors of teachers’ voice disorders using six databases (i.e., CINAHL, EBSCO, PUBMED, SCOPUS, Web of Science, and Springer Link). Search was limited to studies published between 1 January 2000 and 15 October 2018, and a total of 16 publications were selected for the analysis of this study. The quality of selected literature was assessed using the “Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields”. The effect size was analyzed by odds ratio and 95% confidence interval. Results: The results of the quality assessment ranged from 20 to 24 points with six strong studies and ten good studies. The meta-analysis showed that gender, upper airway problems, caffeine consumption, speaking loudly, number of classes per week, and resignation experience due to voice problems were the major risk factors of teachers’ voice disorders. On the other hand, age, number of children, drinking, physical activity, smoking, water intake, singing habits, duration of teaching, perception of noise inside the school, number of classes per day, noise assessment inside the classroom, and perception of technology and instruments inside the workplace were not significantly related to voice disorders. Conclusions: Longitudinal studies should be conducted in the future to confirm causality between voice disorders and risk factors based on the results of this study.

Effects of a Voice Training Program on Acoustics, Vocal Use, and Perceptual Voice Parameters in Catalan Teachers

<b><i>Objectives:</i></b> To assess the effect of EVES (Education for a Healthy and Efficient Voice), a voice training program aimed at promoting the use of an efficient and healthy voice in teachers. <b><i>Sample and Method:</i></b> Twenty-two teachers in the city of Granollers (Catalonia, Spain) were included in this research. The effect of the EVES program was evaluated focusing on the analysis of physiologic parameters on the one side (stroboscopy analysis), and on perceptual parameters on the other (Q-EVES questionnaire, Voice Handicap Index-10 [VHI-10], and GRBAS [Grade, Roughness, Breathiness, Asthenia, Strain Scale]). <b><i>Results:</i></b> The teachers incorporated the vocal strategies in their professional life and reported that the perception of difficulty in using their voice decreased. We observed a significant improvement in VHI-10 markers, in voice management abilities in the classroom, in perceptive and subjective voice parameters, and in some functional lesions. <b><i>Conclusions:</i></b> The results suggest that the educational intervention model may have a positive effect on teachers’ vocal care.

Potential Risk Factors and Prevalence of Voice Symptoms in Students Starting Their Teacher Education

The aim of the present study was to determine prevalence of voice problems and potential risk factors in teacher students at the start of their education. A total of 1494 students from seven teacher education schools participated in the study. The students answered a questionnaire about 11 risk factors, and one with six questions about voice symptoms, Screen6, and 30 statements in the Voice Handicap Index (VHI). Students reporting at least 2 weekly voice symptoms in Screen6 were assigned to the group with voice problems. Significance level was P < 0.05. Results: prevalence of risk factors was about the same in the seven groups of teacher students except the group with highest proportion of women that also showed the highest proportion of voice problems, 38%. Prevalence of voice problems in the total group was 17%. Comparison of students with or without voice problems showed that all factors except one were more prevalent among students with voice problems and women were overrepresented. Mean total VHI score was 22 in students with voice problems and eight in students without voice problems. Multiple regression analyses showed that frequent throat infections, hearing problems, previous speech therapy, or voice training were the potential risk factors that had the strongest association with voice symptoms as well as with total score in VHI. Conclusions: results from this study show that it is common that teacher students experience voice problems already at the start of their education and potential risk factors associated with voice problems are identified. Knowing that teaching is a high-risk profession for developing voice disorders, it is crucial that teacher students should receive compulsory preprofessional voice education including voice ergonomics and voice training.

The Hellenic Voice Handicap Index of Different Laryngeal Mass Lesions: A Receiver-Operating Characteristic Analysis

BACKGROUND

Voice disorders influence the quality of people's life. When the type of disorder is determined then the clinicians are capable of finding their patients' needs and address their complaints concerning their vocal problems. One of the most used tools, for assessing the patients' quality of life (in accordance with their vocal status), is the Voice Handicap Index. In this study, we determined the cut-off scores of Voice Handicap Index for population with laryngeal mass lesions such as vocal polyps and nodules. The calculated cut-off points further guide clinicians toward applying a needed interventional method/therapy even in the cases where the condition of a person could not be easily estimated.

METHODS

The study involved 130 participants (aged 19-74). Specifically, 90 nondysphonic people served as the control group, while 40 participants had already been diagnosed with voice disorders due to laryngeal mass lesions. Participants who were diagnosed with a laryngeal inflammation or had undergone a surgery were excluded from the study. The cut-off scores were determined through a receiver-operating characteristic (ROC) analysis.

RESULTS

The calculated cut-off points were 19.50 for the total score of VHI, 7.50 for the functional domain, and 8.50 for the physical and the emotional domain.

CONCLUSIONS

The aforementioned cut-off points could be used in empowering the everyday clinical practice. Moreover, their knowledge could help the construction of an individualized therapy plan, as well as monitoring-biofeedback tool for the populations with vocal fold lesions.

Vocal Health Practices Among School Teachers: A Study From Chennai, India

INTRODUCTION

A healthy vocal system is a prerequisite to produce a serviceable voice for any vocal profession. The concept of vocal health (VH) among teachers is worth exploring considering their known risk of developing voice disorders.

AIM

To provide socioculture-specific information on VH practices and nature of voice problems in teachers.

METHOD

A VH questionnaire was developed to elicit opinions toward one's own voice health and factors that indicated and contributed to impaired/poor VH from 384 school teachers.

RESULTS AND DISCUSSION

'Flexible voice' (23%), 'enduring voice' (22%), and 'good voice' (22%) were descriptions to indicate good VH by teachers. 'Vocal fatigue' (13%), 'dry throat' (9.4%), 'throat irritation' (4.7%), and 'pain while swallowing/speaking' (3.1%) were frequently reported throat sensations to indicate poor VH. For 30.2% of the teachers, voice mattered for professional needs. However, most of them managed to cope with voice problems through several home remedies and 'intentional/self-imposed neglect' despite their vocal difficulties. Sociocultural factors influencing these findings and scope to escalate voice problems in teachers as a public health issue are discussed.

CONCLUSION AND IMPLICATION

Insight and perception of VH based on self-reports and information on voice practices among teachers pertinent to this geographical location provide scope to develop models for counseling and preventive treatment for voice problems.

Effect of teacher's working conditions on voice disorder in Korea: a nationwide survey

Background

Korean teacher’s working conditions are deteriorating. There is concern about the deterioration of teachers’ health and voice disorder is one of the most common problems. Teacher’s vocal health is important for them and their students. The aim of the present study was to investigate working conditions that may affect voice disorders.

Methods

In all, 79 primary and secondary schools were randomly selected for a nationwide school system survey (N = 3345). In 64 schools, 1617 (48.3%) teachers participated via a postal self-report questionnaire from June 2016 to August 2016. After applying inclusion and exclusion criteria, data from 1301 teachers’ were used for analysis. Multiple logistic regression was used to investigate the associations between general, work-related factors, and frequent voice disorders (fVDs) to estimate the adjusted odds ratio(aOR).

Results

Teachers who reported voice symptoms more than once a week (fVD) made up 11.6%. In a multiple logistic regression, fVD was significantly associated with female, difficulty in applying for sick leave as needed, music teachers (primary school), and less than 6 h of sleep per day (primary school). The aOR for fVD was 2.72 (0.83–8.10) in the longest working hours group (> 52 h/wk) among the primary school teachers, and 1.90 (0.80–4.73) in the longest class hour group (≥ 20 h/wk), 1.52 (0.90–2.62) in homeroom teachers among the secondary school teachers, but not statistically significant.

Conclusions

Korean teachers’ working conditions are associated with fVDs. The school health system must take steps to prevent and treat voice disorders of teachers.

Amplificación vocal en el ámbito ocupacional educativo: una revisión de la literatura

Introducción. La amplificación vocal se ha utilizado como una herramienta para prevenir desórdenes de voz en profesores.Objetivos. Conocer los cambios reportados sobre el comportamiento vocal cuando los profesores utilizan sistemas de amplificación vocal y hacer una comparación entre el antes y el después de su uso.Materiales y métodos. Se realizó una revisión de artículos en cuatro bases de datos y se seleccionaron 11 bajo criterios de inclusión y exclusión: 3 presentaron un nivel de evidencia IIb, mientras que 8, IV. Se analizó la información de los artículos para recolectar datos sobre los efectos en el comportamiento vocal a nivel perceptivo y acústico frente al uso de amplificación vocal.Resultados. Los participantes tuvieron una reducción en la intensidad y en la frecuencia fundamental con mayores efectos en la población sin desorden de voz. Hubo una disminución significativa de la dosis de distancia a diferencia de la dosis de ciclo. En los cuestionarios se infirió un descenso en síntomas, reducción de la carga vocal y mejora en la comunicación.Conclusión. Los amplificadores de voz sirven para prevenir trastornos de la voz. Investigaciones futuras deberán manejar un rigor investigativo en los niveles de evidencia y un diseño de estudio que permita obtener resultados consistentes en diferentes usuarios de la voz.

Identifying Occupations at Risk for Laryngeal Disorders Requiring Specialty Voice Care

Objective

To identify occupational groups’ use of specialty voice clinic evaluation.

Study Design

Retrospective cohort study.

Setting

Tertiary subspecialty clinic.

Subjects and Methods

We analyzed data collected on patients presenting to the Massachusetts Eye and Ear Infirmary Voice and Speech Laboratory over a 20-year period (1993-2013). The relative risk (RR) and 99% confidence interval (CI) of presentation were calculated for each occupational category in the greater Boston population using year-matched data from the Bureau of Labor Statistics (BLS).

Results

The records of 12,120 new patients were reviewed. Using year- and occupation-matched BLS data from 2005 to 2013, 2726 patients were included in the cohort analysis. Several occupations had significantly higher risk of presentation. These included arts and entertainment (RR 4.98, CI 4.18-5.95), law (RR 3.24, CI 2.48-4.23), education (RR 3.08, CI 2.70-3.52), and social services (RR 2.07, CI 1.57-2.73). In contrast, many occupations had significantly reduced risk of presentation for laryngological disorders, for example, maintenance (RR 0.25, CI 0.15-0.42), food preparation (RR 0.35, CI 0.26-0.48), and administrative support (RR 0.49, CI 0.41-0.57).

Conclusion

Certain occupations are associated with higher use of laryngological services presumably because of their vocational voice needs. In addition to confirming findings from other studies, we identified several new occupation groups with increased or decreased risk for laryngologic disorders. Understanding what factors predispose to requiring specialty voice evaluation may help in targeting preventative efforts.

Elementary School Teachers' Vocal Dose: Muscle Bioenergetics and Training Implications

PURPOSE

Translating exercise-science methodology for determination of muscle bioenergetics, we hypothesized that the temporal voice-use patterns for classroom and music teachers would indicate a reliance on the immediate energy system for laryngeal skeletal-muscle metabolism. It was hypothesized that the music-teacher group would produce longer voiced segments than the classroom teachers.

METHOD

Using a between- and within-group multivariate analysis-of-variance design (5 classroom teachers; 7 music teachers), we analyzed fundamental-frequency data-collected via an ambulatory phonation monitor-for length (seconds) of voiced and nonvoiced intervals. Data were collected for 7.5 hr during the workday, over the course of several workdays for each teacher.

RESULTS

Descriptive analyses of voiced and nonvoiced intervals indicated that over 99% of voiced segments for both groups were no longer than 3.15 s, supporting the hypothesis of reliance on the immediate energy system for muscle bioenergetics. Significant differences were identified between and within the classroom- and music-teacher groups, with the music-teacher group producing longer voiced segments overall.

CONCLUSIONS

Knowledge of probable intrinsic laryngeal skeletal-muscle bioenergetics requirements could inform new interdisciplinary considerations for voice habilitation and rehabilitation.

The Impact of Cumulative Vocal Demands on Vocal Performance of Student Clinicians in Speech-Language Pathology

Effects of cumulative vocal demands on voice performance of student clinicians majoring in speech-language pathology were observed at three distinct points over the period of an academic semester. Acoustic and aerodynamic voice parameters were monitored in controlled and natural settings; participants also provided subjective information related to their voice usage. Comparisons of voice parameters in student clinicians repeatedly measured throughout an extended period of time did not lead to statistically significant differences. Self-reported data revealed a satisfactory level of knowledge and awareness regarding voice concerns in this population. These outcomes suggested consistent voice stability in this group, over the cycle of an academic semester.

Difference in Voice Problems and Noise Reports Between Teachers of Public and Private Schools in Upper Egypt

OBJECTIVE

This study aimed to assess teachers' voice symptoms and noise in schools in Upper Egypt and to study possible differences between teachers in public and private schools.

STUDY DESIGN

A cross-sectional analysis via questionnaire was carried out.

METHODS

Four schools were chosen randomly to represent primary and preparatory schools as well as public and private ones. In these schools, a total of 140 teachers participated in the study. They answered a questionnaire on vocal and throat symptoms and their effects on working and social activities, as well as levels and effects of experienced noise.

RESULTS

Of all teachers, 47.9% reported moderate or severe dysphonia within the last 6 months, and 21.4% reported daily dysphonia. All teachers reported frequent feelings of being in noise, with 82.2% feeling it sometimes or always during the working day, resulting in a need to raise their voice. Teachers in public schools experienced more noise from nearby classes.

CONCLUSION

The working conditions and vocal health of teachers in Upper Egypt, especially in public schools, are alarming.

Four-day Follow-up Study on the Self-reported Voice Condition and Noise Condition of Teachers: Relationship Between Vocal Parameters and Classroom Acoustics

OBJECTIVES

This study aimed to determine the changes in self-reported voice and noise condition over a follow-up of 4 days (equivalent to one working week), to define the relationship between the objective voice parameters and the self-reported voice condition, as well as to characterize the relationship between classroom acoustics and the self-reported noise condition.

STUDY DESIGN

This is a cohort study.

METHODS

We performed voice monitoring of 27 teachers for four working days using the Voice-Care device, which provides information on the fundamental frequency, vocal sound pressure level, and phonation time percentage. The participants performed a pre-monitoring, which consisted of a brief conversation, before each monitoring session, and filled in a questionnaire after each monitored lesson, in which they indicated their opinions about their voice condition and the classroom noise conditions.

RESULTS

The teachers who, during the pre-monitoring, showed a higher standard deviation of the vocal sound pressure level and a greater phonation time percentage difference between the entire monitoring and the pre-monitoring sessions, reported fewer voice complaints. Decay time (DT_40ME), a reverberation measure from the speakers' perspective, resulted to be associated with the self-reporting of the noise condition.

CONCLUSION

Voice disorders at work prevention programs should include strategies to exercise the respiratory and laryngeal components of voice production, because these elements may influence the variation in the vocal sound pressure level, which was found to be significantly associated with the self-reported voice condition. This study also highlights the importance of including reverberation measures, from the speakers' perspective, in the design of schools.

A Comparative Study of Iranian Female Primary School Teachers' Quality of Life With and Without Voice Complaints

OBJECTIVES/HYPOTHESIS

As the largest group of professional voice users, teachers are more likely to face voice disorders because of their specific job conditions. This study aimed to compare the quality of life in female teachers with and without voice complaints.

STUDY DESIGN

This is a cross-sectional descriptive-analytical study.

METHODS

This was a cross-sectional study of samples of primary school female teachers with (n = 60) and without (n = 60) voice disorders. All teachers were serving in Tehran, Iran. Professional background information was obtained through interviews, and quality of life was measured using the 36-item Short Form Health Survey questionnaire. A comparison was made between the study groups to analyze the data.

RESULTS

The mean age of teachers was 44 (standard deviation = 3.95) years. There were no significant differences between the two groups regarding their professional background. However, significant differences were observed between the two groups in all subscales of the 36-item Short Form Health Survey, including physical and social functioning, role limitations because of either physical or emotional problems, bodily pain, general health, vitality, and mental health (P < 0.05).

CONCLUSION

Findings of this study point to the effect of voice complaint on quality of life and showed that teachers with voice complaints suffer from poor health-related quality of life. Therefore, both voice-specific and unspecific assessment methods are required for clinical diagnostics.

Distúrbio de voz e fatores associados em professores da rede pública

Resumo Objetivo: analisar a prevalência e os fatores associados ao distúrbio de voz em professores. Métodos: estudo transversal com 317 professores. Utilizou-se o questionário Condição de Produção Vocal do Professor. A variável dependente foi o distúrbio de voz autorreferido. Foram realizadas análises bivariada, estratificada e regressão múltipla de Poisson. Resultados: a prevalência do distúrbio de voz foi de 81%. Para o estrato dos professores do ensino fundamental, apenas a poeira (RP = 1,37; IC = 1,12-1,69) foi associada ao distúrbio de voz. Para o estrato dos demais professores, as variáveis ritmo de trabalho estressante (RP = 1,81; IC = 1,17-2,82), estresse no trabalho (RP = 2,47; IC = 1,20-5,07), trabalho repetitivo (RP = 1,18; IC = 1,01-1,38), levar trabalho para casa (RP = 1,80; IC = 1,01-3,79) e escola ruidosa (RP = 1,41; IC = 1,03-1,92) apresentaram associações com distúrbio de voz. Na análise múltipla, estresse no trabalho (RP = 1,50; IC = 1,05-2,15), poeira (RP = 1,21; IC = 1,06-1,39) e falar carregando peso (RP = 1,16; IC = 1,05-1,28) permaneceram associadas ao distúrbio de voz, exceto o tempo de profissão maior ou igual a 10 anos (RP = 0,88; IC = 0,79-0,98), que apresentou efeito protetor. Conclusão: a prevalência de distúrbio de voz entre os professores é alta e os fatores associados relacionam-se ao ambiente e à organização do trabalho.

Determinants and Effects of Voice Disorders among Secondary School Teachers in Peninsular Malaysia Using a Validated Malay Version of VHI-10

OBJECTIVES

To establish the prevalence of voice disorder using the Malay-Voice Handicap Index 10 (Malay-VHI-10) and to study the determinants, quality of life, depression, anxiety and stress associated with voice disorder among secondary school teachers in Peninsular Malaysia.

METHODS

This study was divided into two phases. Phase I tested the reliability of the Malay-VHI-10 while Phase II was a cross-sectional study with two-stage sampling. In Phase II, a self-administered questionnaire was used to collect socio-demographic and teaching characteristics, depression, anxiety and stress scale (Malay version of DASS-21); and health-related quality of life (Malay version of SF12-v2). Complex sample analysis was conducted using multivariate Poisson regression with robust variance.

RESULTS

In Phase I, the Spearman correlation coefficient and Cronbach alpha for total VHI-10 score was 0.72 (p < 0.001) and 0.77 respectively; showing good correlation and internal consistency. The ICCs ranged from 0.65 to 0.78 showing fair to good reliability and demonstrating the subscales to be reliable and stable. A total of 6039 teachers participated in Phase II. They were primarily Malays, females, married, had completed tertiary education and aged between 30 to 50 years. A total of 10.4% (95% CI 7.1, 14.9) of the teachers had voice disorder (VHI-10 score > 11). Compared to Malays, a greater proportion of ethnic Chinese teachers reported voice disorder while ethnic Indian teachers were less likely to report this problem. There was a higher prevalence ratio (PR) of voice disorder among single or divorced/widowed teachers. Teachers with voice disorder were more likely to report higher rates of absenteeism (PR: 1.70, 95% CI 1.33, 2.19), lower quality of life with lower SF12-v2 physical (0.98, 95% CI 0.96, 0.99) and mental (0.97, 95% CI 0.96, 0.98) component summary scales; and higher anxiety levels (1.04, 95% CI 1.02, 1.06).

CONCLUSIONS

The Malay-VHI-10 is valid and reliable. Voice disorder was associated with increased absenteeism, marginally associated with reduced health-related quality of life as well as increased anxiety among teachers.

The economic impact of vocal attrition in public school teachers in Miami-Dade County

OBJECTIVES/HYPOTHESIS

Teachers are a known at-risk population for voice disorders. The prevalence and risk factors for voice disorders have been well studied in this population, but little is known about the associated economic cost. The purpose of this study is to assess the economic impact of voice dysfunction in teachers and understand the difference between the cost of absenteeism and presenteeism as a direct result of voice dysfunction.

STUDY DESIGN

Cross-sectional analysis via self-administered online questionnaire.

METHODS

A total of 14,256 public school teachers from Miami-Dade County, Florida, were asked to participate. Questions were formatted based on the previously validated Work Productivity and Activity Impairment: Specific Health Problem questionnaire adapted for hoarseness and voice disorders. Additional demographic questions were included in the questionnaire.

RESULTS

A total of 961 questionnaire responses were received. The demographic characteristics of respondents closely matched known statistics for public school teachers in Miami-Dade County. Economic calculations were performed for each questionnaire respondent and summed for all respondents to avoid bias. Per week, absenteeism-related costs were $25,000, whereas presenteeism-related costs were approximately $300,000. These figures were used to extrapolate annual cost. Per year, absenteeism-related costs were $1 million, whereas presenteeism-related costs were approximately $12 million.

CONCLUSION

The economic impact of voice dysfunction on the teaching profession is enormous. With the above calculations only including lost wages and decreased productivity, the actual figures may in fact be larger (cost of substitute teachers, impact on nonwork activities, etc.). Research investigating preventative measures for voice dysfunction in teachers is necessary to reduce this costly issue.

LEVEL OF EVIDENCE

2C. Laryngoscope, 126:665-671, 2016.

Emirati Teachers' Perceptions of Voice Handicap

OBJECTIVES

The purpose of the study was to explore Emirati teachers' perceptions of voice handicap and to analyze their acoustic characteristics to determine whether acoustic measures of teachers' voice would verify their perceptions of voice handicap.

METHODS

Sixty-six Emirati school teachers (33 men and 33 women), with different years of teaching experience and age, and 100 control participants (50 men and 50 women) underwent vocal assessment that included the Voice Handicap Index (VHI-Arab) and acoustic measures (F0, jitter%, shimmer%, signal to noise ratio [SNR]).

RESULTS

Significant differences between the teachers' group scores and the control group scores on the following subscales of VHI-Arab: physical (P = 0.006), emotional (P = 0.004), and total score of the test (P = 0.002). No significant differences were found among teachers in the three VHI subscales, and the total score regarding gender (functional P = 0.307; physical P = 0.341; emotional P = 0.126; and total P = 0.184), age (functional P = 0.972; physical P = 0.525; emotional P = 0.772; and total P = 0.848), and years of teaching experience (functional P = 0.319; physical P = 0.619; emotional P = 0.926; and total P = 0.638). The significant differences between the teacher's group and the control group in three acoustic measures: F0 (P = 0.000), shimmer% (P = 0.000), and SNR (P = 0.000) were further investigated. Significant differences were found among female and male teachers in F0 (P = 0.00) and SNR (P = 0.007). As for teachers' age, significant differences were found in SNR (P = 0.028). Teachers' years of experience did not show significant differences in any of the acoustic measures.

CONCLUSIONS

Teachers have a higher perception of voice handicap. However, they were able to produce better voice quality than control participants were, as expressed in better SNRs. This might have been caused either by manipulation of vocal properties or abusive overloading the vocal system to produce a procedurally acceptable voice quality.

Evaluating the effect of risperidone on speech: A cross-sectional study

Speech subsystems are susceptible to the effects of several factors including medications. The atypical antipsychotics can also adversely affect the speech because of its action on serotonin and dopamine neurotransmitters. The present study aims to analyze the speech characteristics associated with atypical antipsychotic risperidone. Speech of 92 patients on risperidone with or without trihexyphenidyl and/or clonazepam were compared with that of 31 persons who were not on any psychotropic medicines. Compared to control group, maximum phonation duration, sequential motion rate of diadochokinesia was reduced by about 3s and 1syllable/s respectively and s/z ratio was increased by 0.16 in patients with risperidone. Performance of larynx, lips and tongue sub-system and intelligibility of speech were also significantly reduced in risperidone group. Risperidone did impact the phonation and articulation sub-systems of speech mildly, which was independent of tardive dyskinesia and extrapyramidal symptoms. Randomized controlled prospective study looking into impact on speech and related effect on drug adherence, functioning and quality of life needs to be conducted with risperidone and other atypical antipsychotics.

Voice disorders in the general Greek population and in patients with laryngopharyngeal reflux. Prevalence and risk factors

OBJECTIVES

To assess the prevalence of voice disorders in the general Greek population and in patients with laryngopharyngeal reflux (LPR) with the use of the reflux symptom index (RSI).

STUDY DESIGN

Prospective epidemiological adult participant survey.

SETTING

General Greek population.

METHOD

The validated Greek version of the RSI was used to assess the prevalence of voice disorders in the general Greek population, as well as in patients with LPR, which were diagnosed using the RSI. The RSI questionnaire was completed by 340 (183 males and 157 females) randomly selected subjects. Subjects with RSI score of >13 were considered to be LPR patients.

RESULTS

The prevalence of voice disorders, which was determined by the participants giving a positive response to the field "hoarseness or a problem with your voice," was found to be 38.5% in the general Greek population. In patients with LPR, "hoarseness or a problem with your voice" was present in 90.6%. The number of cigarettes smoked daily and the number of alcoholic drinks consumed daily, each correlated with the presence of voice disorders. No relationship was revealed between voice disorders and coexisting diseases and especially with gastroesophageal reflux disease, which was the most frequent reported disorder among peptic diseases.

CONCLUSIONS

The prevalence of voice disorders, determined by a positive response to the question "hoarseness or a problem with your voice," is high (38.5%) in the general population and very high (90.6%) in patients with LPR. The number of tobacco cigarettes smoked daily and the number of alcoholic drinks consumed daily were found to be related to voice disorders.

Epidemiological voice health map of the teaching population of Granollers (Barcelona) developed from the EVES questionnaire and the VHI

The aim of this research project was to carry out an epidemiological study on the voice health of the teaching population in Granollers (Barcelona) using the EVES questionnaire and to relate the collected data to the VHI results. The study sample consisted of 233 teachers from Granollers (Barcelona). The EVES questionnaire, which includes the VHI-10, was conducted online. A high percentage of the teachers consulted suffered voice disorders, which ranged from minor to more serious cases. In regard to the data obtained using the VHI, in 28.77% of the cases there was a moderate or a serious perception of voice problems. Out of these cases only one person, who had a moderate perception of their problem, was undergoing voice therapy with a speech therapist. There are three questions in the EVES questionnaire that can efficiently indicate the existence of a voice disorder in a straightforward manner, and the results for these were similar to those recorded for the VHI group of questions. Therefore, it may be argued that questions that refer to the perception of the degree of pleasantness of one's own voice should be included, because they would provide a useful way to indicate whether there is a voice problem at a preliminary screening stage.

Teachers' voice disorders and loss of work ability: a case-control study

BACKGROUND

Teachers constitute a profession with a high occurrence of voice disorders due to the occupation's intense vocal demands and unfavorable work environment.

PURPOSE

To identify the association between voice disorders and work ability among teachers from public schools in São Paulo, Brazil.

METHODS

This is a case-control study. The case group comprised teachers with voice disorder complaints, vocal quality deviations in speech pathology evaluations, and vocal fold lesions according to an evaluation by an otorhinolaryngologist. The control group was randomly selected from the same schools as those in the case group. Both groups answered the following questionnaires: sociodemographic, lifestyles, working conditions, work organization, conditions of vocal production-teacher (CVP-T), and Work Ability Index (WAI). The analysis used the chi-square association test and univariate and multivariate regression models.

RESULTS

The analyses of both groups showed comparable populations with no significant differences in the demographic and control variables. The groups differed, as expected, in vocal symptoms. Analyzing associations with the WAI, there was an association between decreased work ability and voice disorder (P < 0.001). This association remained in multivariate analyses where decreased (OR = 9.5, P = 0.001) and moderate (OR = 6.7, P < 0.001) work ability were also associated with voice disorders. Analyzing the ability to work, age, and acoustics; decreased (OR = 12.2, P < 0.001) and moderate (OR = 7.7, P < 0.001) work ability, age 50-65 years (OR = 3.7, P = 0.006) and poor acoustics (OR = 2.7, P = 0.007) were factors associated with voice disorders.

CONCLUSIONS

The occurrence of voice disorders is significantly associated with work ability, which may eventually compromise teachers' ability to continue working.