Voice Disorders in Teachers. A Review

Occupational health disorders among physical education teachers compared to classroom and subject specialist teachers

During the course of their work, teachers may be subjected to conditions that cause different health problems. This study examines occupational health disorders in a representative sample of 858 teachers (528 female; age 44.0 ± 9.67 years) divided into three groups of teachers with specific occupational requirements: specialist physical education teachers (specialist PETs), classroom teachers, and specialist teachers. The number of health disorders in the last 12 months was recorded using the Chronic Health Disorders Questionnaire. The differences between the different types of teachers, controlled for sex and age, were analyzed using binary logistic regression. The results showed that 89% of teachers experienced colds as the most frequently reported health problem, followed by 58% for lower back problems, 57% for headaches, 51% for hoarseness, and 43% for neck problems. A binary logistic regression showed that specialist PETs were the group with the highest health risk. They were about twice as likely to have musculoskeletal or hearing disorders than the other two groups of teachers. They were also significantly more likely to suffer from hoarseness. Understanding these different health challenges is critical to developing targeted interventions and robust support systems. These interventions should include initiatives aimed at raising awareness of health risk factors, implementing injury interventions and vocal cord hygiene programs, making ergonomic adjustments, and promoting awareness of self-care (both mental and physical). Given that the teaching profession is currently struggling with an aging workforce and a shortage of teachers, addressing these challenges is critical to the continued well-being of the teaching professionals.

Prevalence of Perceived Voice Disorders and Associated Risk Factors in Teachers and General Population in Croatia

OBJECTIVES

There is no available data on the prevalence of voice disorders in Croatia. The objective of this research was to determine the prevalence of perceived voice disorders (PVD) in teachers and general population in Croatia using the Croatian Voice Handicap Index (VHI-HR) questionnaire.

METHODS

This research was divided into two phases. In phase I, the potential of the VHI-HR questionnaire to distinguish individuals with and without voice disorders was assessed. A total of 113 participants completed the VHI-HR. Receiver operating characteristic analysis was performed. In phase II, a cross-sectional study was conducted. A total of 1898 participants, including 1088 teachers from 434 Croatian schools, and 810 nonteachers were included in the study. The questionnaire on sociodemographic factors, potential risk factors associated with voice disorders, and the VHI-HR was administered. The differences in the PVD prevalence in teachers and nonteacher adults and adverse effects of PVD were investigated. The multiple logistic regression model was used to examine the factors associated with PVD occurrence.

RESULTS

In phase I, the cut-off point of 18.32 with 93.44% sensitivity and 98.08% specificity for VHI-HR was determined. In phase II, higher lifetime PVD prevalence was found among teachers. The point prevalence of PVD was 45.68% for teachers, and 21.11% for nonteachers. This study demonstrated that being a teacher, a woman, having a family history of voice disorders, reflux, working in environment with elevated noise levels, and having more than 30years of employment are associated with PVD occurrence.

CONCLUSIONS

VHI-HR score of 19 and higher proves effective in distinguishing individuals with voice disorders from those without. The odds of having PVD for teachers are 2.83 times higher than for nonteachers. Risk factors for voice disorders, among others, include occupational use of voice and working in environments with elevated noise levels.

Does Vocal Fatigue Negatively Affect Low Vocal Range in Professional, Female Opera Singers? A Survey Study and Single-Subject Pilot Study

OBJECTIVE

1. To survey how vocal fatigue manifests itself in the vocal range of a sample of professional, female opera singers. 2. To assess laryngeal videostroboscopic changes of one professional, female opera singer before and after extended operatic singing.

METHODS

Survey study: 296 professional, female opera singers were recruited to participate in an anonymous research survey querying the temporary impact of vocal fatigue in professional, female opera singers. 46.3% of participants described themselves as singing mainstage roles at large, A-level opera houses. Singers were asked to report where in their vocal range they experienced the effects of vocal fatigue and could choose more than one response. Single-subject study: One professional, female opera singer (the author) underwent two laryngeal videostroboscopic exams pre and post vocal loading. The exams were evaluated and compared independently by two blinded laryngologists.

RESULTS

The results of the survey found that 42.9% of the total responses from professional, female opera singers indicated a temporary impact on the lower middle range (≈C4-F4) as a result of vocal fatigue. 36.5% of participants experienced a temporary impact on their lowest range (≈below C4) and 19.6% reported a temporary impact on their higher range due to vocal fatigue. The results of the single-subject study showed reduced glottal closure pattern in the postloading, lower middle range, head voice condition.

CONCLUSIONS

A large proportion (64.9%) of the professional, female opera singers surveyed reported increased difficulty navigating their lower middle range and/or lowest range after extended operatic singing. These results support the single-subject study, which found that after vocal loading, there was a decrease in glottal competence while singing in head voice in the lower middle range.

Vocal Health and Vocal Health Knowledge Among Occupational Voice Users in the Province of Quebec

Voice disorders are frequent among occupational voice users such as teachers. Although these disorders can have serious personal and professional consequences, they are not often recognized as occupational diseases and little attention is paid to their prevention. This study aimed to provide a portrait of the self-reported vocal health and vocal health knowledge of occupational voice users in Quebec, Canada, and to identify risk factors associated with voice disorder symptoms. We conducted an online survey targeting occupational voice users in the province of Quebec, Canada, with a focus on those involved in teaching or training. The final sample, after excluding incomplete surveys, included 808 respondents (665 women, M = 41.5 ± 10.4 years old). The survey responses were analyzed using descriptive and inferential statistics. Results indicated that 9.8% of the respondents had a history of a diagnosed voice disorder and 68.8% of the respondents experienced at least one voice symptom on a regular basis. Ordinal logistic regressions revealed that several personal and environmental factors are associated with an increased risk of developing voice disorders symptoms: being a woman, suffering from a breathing disorder, allergies, acid reflux and/or hearing impairment, having less work experience, working with elementary school children and/or with continuous or speech noise in the background. Most of the respondents (94.6%) had never received information regarding voice disorders during their academic training and less than half of them (47.7%) knew which professionals can treat voice disorders. These findings highlight the need for formal vocal health education among both occupational voice users and their employers to improve prevention and treatment for voice disorders in an at-risk population.

Listening effort, fatigue, and streamed voice quality during online university courses

Understanding the impact of listening effort (LE) and fatigue has become increasingly crucial in optimizing the learning experience with the growing prevalence of online classrooms as a mode of instruction. The purpose of this study was to investigate the LE, fatigue, and voice quality experienced by students during online and face-to-face class sessions. A total of 110 participants with an average age of 20.76 (range 18-28) comprising first year undergraduate students in Speech and Language Therapy and Audiology programs in Turkey, rated their LE during the 2022-2023 spring semester using the Listening Effort Screening Questionnaire (LESQ) and assessed their fatigue with the Multidimensional Fatigue Inventory (MFI-20). Voice quality of lecturers was assessed using smoothed cepstral peak prominence (CPPS) measurements. Data were collected from both online and face-to-face sessions. The results revealed that participants reported increased LE and fatigue during online sessions compared to face-to-face sessions and the differences were statistically significant. Correlation analysis showed significant relationships (p < 0.05) between audio-video streaming quality and LE-related items in the LESQ, as well as MFI sub-scales and total scores. The findings revealed a relationship between an increased preference for face-to-face classrooms and higher levels of LE and fatigue, emphasizing the significance of these factors in shaping the learning experience. CPPS measurements indicated a dysphonic voice quality during online classroom audio streaming. These findings highlight the challenges of online classes in terms of increased LE, fatigue, and voice quality issues. Understanding these factors is crucial for improving online instruction and student experience.

Voice Disorders Among Teachers in Taif City, Kingdom of Saudi Arabia

Background Voice disorders (VD) pose significant challenges for teachers as they impact their professional and personal lives. Teaching requires extensive use of the voice, making teachers particularly susceptible to vocal health issues. VD can hinder the quality of education. Objectives This study aimed to comprehensively explore the prevalence, associated factors, and impact of VD among teachers and their health-seeking behavior regarding VD. Methodology A cross-sectional observational study was conducted in Taif City, Kingdom of Saudi Arabia (KSA), between November and December 2023. The data were collected through a questionnaire covering demographic variables, occupational factors, voice-related symptoms, associated health conditions, and the impact of VD. The statistical analysis was performed using SPSS Statistics version 26 (IBM Corp. Released 2019. IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY: IBM Corp.), and chi-squared tests were used to assess associations. Results The study involved 568 teachers, 61.8% of whom had VD. The study identified significant associations between VD and demographic characteristics, habits, and teaching-related variables. Age, gender, teaching subject, class size, and weekly teaching load were associated with the prevalence of VD. Hoarseness, throat pain, and throat dryness were prevalent symptoms among teachers with VD. The impact of VD on teachers was evident, with a considerable proportion reporting work absenteeism (28.7%) and even contemplating retirement due to voice problems (6.3%). Conclusion This study offers a nuanced understanding of VD among teachers in the Taif region, emphasizing the complex interplay of demographic, symptomatic, and behavioral factors. The findings underscore the need for targeted interventions, including awareness campaigns, preventive strategies, and streamlined healthcare access, to address the unique challenges that different subgroups of teachers face. Future research should further explore longitudinal trajectories and objective measures to enhance our understanding of VD in educational settings.

Towards Automated Vocal Mode Classification in Healthy Singing Voice-An XGBoost Decision Tree-Based Machine Learning Classifier

Auditory-perceptual assessment is widely used in clinical and pedagogical practice for speech and singing voice, yet several studies have shown poor intra- and inter-rater reliability in both clinical and singing voice contexts. Recent advances in artificial intelligence and machine learning offer models for automated classification and have demonstrated discriminatory power in both pathological and healthy voice. This study develops and tests an XGBoost decision tree based machine learning classifier to develop automated vocal mode classification in healthy singing voice. Classification models trained on mel-frequency cepstrum coefficients, MFCC-Zero-Time Windowing, glottal features, voice quality features, and α-ratios demonstrated 92% average F1-score accuracy in distinguishing metallic and non-metallic singing for male singers and 87% average F1-score for female singers. The model distinguished vocal modes with 70% and 69% average F1-score for male and female samples, respectively. Model performance was compared to human auditory-perceptual assessments of 64 corresponding samples performed by 41 professional singers. The model performed with approximating or subpar performance to human assessors on task-matched problems. The XGBoost gains observed across tested features reveal that the most important attributes for the tested classification problems were MFCCs and α-ratios between high and low frequency energy, with models trained on only these features achieving performance not statistically significantly different from the best tested models. The best automated models in this study do not yet match human auditory-perceptual discrimination but improve on previously reported F1-average accuracies in automated classification in singing voice.

Reducing Vocal Fatigue With Bone Conduction Devices: Comparing Forbrain and Sidetone Amplification

PURPOSE

Altered auditory feedback research aims to identify methods to strengthen speakers' awareness of their own voicing behaviors, diminish their perception of vocal fatigue, and improve their voice production. This study aims to compare the effects of two bone conduction devices that provide altered auditory feedback.

METHOD

Twenty participants (19-33 years old, age: M [SD] = 25.5 [3.85] years) participated in a vocal loading task using a standard Forbrain device that provides filtered auditory feedback via bone conduction and a modified Forbrain device that provides only sidetone amplification, and a control condition with no device was also included. They rated their vocal fatigue on a visual analog scale every 2 min during the vocal loading task. Additionally, pre- and postloading voice samples were analyzed for acoustic voice parameters.

RESULTS

Across all participants, the use of bone conduction-altered auditory feedback devices resulted in a lower vocal fatigue when compared to the condition with no feedback. During the pre- and postvoice samples, the sound pressure level decreased significantly during feedback conditions. During feedback conditions, spectral mean and standard deviation significantly decreased, and spectral skew significantly increased.

CONCLUSION

The results promote bone conduction as a possible preventative tool that may reduce self-reported vocal fatigue and compensatory voice production for healthy individuals without voice disorders.

Characterization of Dermatoglyphic Profiles and its Relation to Acoustic Measures in Voice Professionals

INTRODUCTION

Acoustic analysis is widely used for assessing and monitoring vocal function. Dermatoglyphics is a method that analyzes genetic fingerprint markers, and uses that information for predicting physical skills related to anaerobic (explosive strength and speed) and aerobic (motor coordination and resistance) mechanisms. Therefore, it can be used as an indicator for individualized vocal training.

OBJECTIVE

To characterize the dermatoglyphic profiles and their relation to acoustic measures in voice professionals.

METHODS

A cross-sectional study involving 79 voice professionals. Acoustic analysis was performed using the PRAAT software. Mean intensity, fundamental frequency (F0), and cepstral peak prominence (CPP) value were extracted from the sustained vowel /a/. Fingerprints were collected using a Watson mini-integrated biometric scanner, and were quantified by design predominance, delta index (D10), total ridge count (TRC), and dermatoglyphic profile. The acoustic measures were analyzed descriptively and compared, considering the subjects' dermatoglyphic profiles. The confidence levels ranged from 90% to 95%.

RESULTS

Most subjects exhibited anaerobic dermatoglyphic profiles (P = 0.004) and low TRC (p < 0.001). Higher F0 (P = 0.061), intensity (P = 0.065), and CPP (P = 0.073) were found for anaerobics (P < 0.001). There was a weak and negative correlation between TRC and intensity (P = 0.026), as well as between F0 (P = 0.017) and CPP (P = 0.069).

CONCLUSION

Anaerobic profiles were predominant. The values of F0, intensity, and CPP increased for the anaerobics. There was a weak negative correlation between the TRC and intensity, F0, and CPP measures. Dermatoglyphics could have been seen as an interesting tool in the voice assessment and training direction for voice professionals.

Prevalence of Self-Reported Voice Concerns and Associated Risk Markers in a Nonclinical Sample of Military Service Members

INTRODUCTION

Difficult communication environments are common in military settings, and effective voice use can be critical to mission success. This study aimed to estimate the prevalence of self-reported voice disorders among U.S. military service members and to identify factors that contribute to their voice concerns.

METHOD

A nonclinical sample of 4,123 active-duty service members was recruited across Department of Defense hearing conservation clinics. During their required annual hearing evaluation, volunteers provided responses to voice-related questions including a slightly adapted version of the Voice Handicap Index-10 (VHI-10) as part of a larger survey about communication issues. Changepoint detection was applied to age and years of service to explore cohort effects in the reporting of voice concerns. Logistic regression analyses examined multiple available factors related to communication to identify factors associated with abnormal results on the VHI-10.

RESULTS

Among the respondents, 41% reported experiencing vocal hoarseness or fatigue at least several times per year, and 8.2% (n = 336) scored above the recommended abnormal cut-point value of 11 on the VHI-10. Factors independently associated with the greatest risk for self-reported voice concerns were sex (female), cadmium exposure, vocal demands (the need for a strong, clear voice), and auditory health measures (frequency of experiencing temporary threshold shifts; self-reported hearing difficulties).

CONCLUSIONS

Based on self-reported voice concerns and false negative rates reported in the literature, the prevalence of dysphonia in a large sample of active-duty service members is estimated to be 11.7%, which is higher than that in the general population. Certain predictors for voice concerns were expected based on previous literature, like female sex and voice use, but frequency of temporary threshold shifts and exposure to cadmium were surprising. The strong link between voice and auditory problems has particular implications regarding the need for effective communication in high-noise military and other occupational environments.

Do-It-Yourself Voice Dosimeter Device: A Tutorial and Performance Results

PURPOSE

Voice dosimeters gather voice production data in the daily lives of individuals with voice disorders. Additionally, voice dosimeters aid in understanding the pathophysiology of voice disorders. Previously, several voice dosimeters were commercially available. However, these devices have been discontinued and are not available to clinicians and researchers alike. In this tutorial, instructions for a low-cost, easy-to-assemble voice dosimeter are provided. This do-it-yourself (DIY) voice dosimeter is further validated based on performance results.

METHOD

Ten vocally healthy participants wore the DIY voice dosimeter. They produced a sustained /a/ vowel and read a text with three different vocal efforts. These tasks were recorded by the DIY voice dosimeter and a reference microphone simultaneously. The expanded uncertainty of the mean error in the estimation of four voice acoustic parameters as measured by the DIY dosimeter was performed by comparing the signals acquired through the reference microphone and the dosimeter.

RESULTS

For measures of sound pressure level, the DIY voice dosimeter had a mean error of -0.68 dB with an uncertainty of 0.56 dB. For fundamental frequency, the mean error was 1.56 Hz for female participants and 1.11 Hz for male participants, with an uncertainty of 0.62 Hz and 0.34 Hz for female and male participants, respectively. Cepstral peak prominence smoothed and L₁ minus L₂ had mean errors (uncertainty) of -0.06 dB (0.27 dB) and 2.20 dB (0.72 dB).

CONCLUSION

The mean error and uncertainties for the DIY voice dosimeter are comparable to those for the most accurate voice dosimeters that were previously on the market.

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.

Self-reported voice disorders of teachers and indoor air quality in schools: a cross-sectional study in Finland

OBJECTIVE

We aimed to study the association between self-reported voice disorders among teachers and indoor air quality in school buildings.

METHODS

We performed a questionnaire study of 538 Finnish teachers working in 67 school buildings utilizing both perceived and technical evaluations; the agreement between these two assessments was also studied. The technical assessment was provided by technical experts.

RESULTS

Teachers with voice disorders reported significantly more complaints from indoor air than those without voice disorders. The results also indicated a possible connection between the technical assessment and voice disorders. After adjustment for sex, stress and asthma, the prevalence of voice disorders was 47% higher in teachers working in renovated buildings compared to those working in the non-problem buildings (aRR1.47; CI 95% 1.11-1.95). The prevalence of voice disorders was 28% higher among teachers working in buildings with problems compared to those working in non-problem buildings (aRR 1.28; 95% CI 0.99-1.64).

DISCUSSION

In our study, poor perceived indoor air was significantly associated with self-reported voice disorders in teachers and there was an agreement between the perceived and technical assessments. Our results also indicated a possible connection between the technical assessment and voice disorders. Our results imply the need for longitudinal research with technical assessment to study the effect of renovation on voice disorders.

Comparing Vocal Health and Attitudes to Voice care in Primary Teachers and Voiceover Artists - A Survey Study Using the Health Belief Model

OBJECTIVES

A range of professions experience high demands on their voices and are potentially at risk of developing voice disorders. Teachers have been studied extensively in this respect, while voiceover artists are a growing professional group with unknown levels of voice training, voice problems and voice care attitudes. To better understand profession-specific voice care requirements, we compared voice training, voice care habits and self-reported voice problems of these two professional groups and measured attitudes to voice care, informed by the Health Belief Model (HBM).

STUDY DESIGN

The study was a cross-sectional survey study with two cohorts.

METHODS

We surveyed 264 Scottish primary school teachers and 96 UK voiceover artists . Responses were obtained with multiple-choice and free-text questions. Attitudes to voice care were assessed with Likert-type questions that addressed five dimensions of the HBM.

RESULTS

Most voiceover artists had some level of voice training, compared to a minority of teachers. Low numbers of teachers reported regular voice care, compared to over half of voiceover artists. Higher numbers of teachers reported work-related voice problems. Voiceover artists reported greater awareness for vocal health and perceived potential effects of voice problems on their work as more severe. Voiceover artists also saw voice care as more beneficial. Teachers perceived barriers to voice care as substantially higher and felt less confident about voice care. Teachers with existing voice problems showed increased perceptions of voice problem susceptibility and severity and saw more benefit in voice care. Cronbach's alpha was below 0.7 for about half of the HBM-informed survey subsets, suggesting that reliability could be improved.

CONCLUSIONS

Both groups reported substantial levels of voice problems, and different attitudes to voice care suggest that the two groups require different approaches to preventative intervention. Future studies will benefit from the inclusion of further attitude dimensions beyond the HBM.

What are the Symptoms that Characterize the Clinical Condition of Vocal Fatigue? A Scoping Review and Meta-Analysis

INTRODUCTION

Vocal fatigue is a clinical manifestation associated with a perception of negative vocal adjustment. It is related to the increase in the sensation of excessive effort when speaking and the lack of conditioning of the muscles and structures that involve vocal production. Because it has a complex and multifactorial diagnosis, there is still no consensus on the symptoms most commonly found in this clinical condition.

OBJECTIVE

To review and analyze the symptoms that characterize the clinical condition of vocal fatigue.

METHODS

This study consists of a scoping review carried out in the Cochrane Library, Embase, Lilacs, and Medline databases. Observational studies or clinical trials from the last 10 years. Studies with participants younger than 18 years of age were excluded; as well as research that did not describe symptoms of vocal fatigue or that presented vocal fatigue as a symptom; studies with patients with neurological, psychiatric, syndromic conditions, or head and neck cancer. The Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies NHLBI-NIH scale was used to assess the methodological quality of selected observational studies and the PEDro scale for the analysis of experimental studies. The steps were performed by three blinded evaluators. Subsequently, meta-analyses of global means were executed for each factor under study; a comparison of the difference in the mean score for each factor between exposed and unexposed; a comparison of the difference in the average score, among non-professional voice users, for each factor between exposed and unexposed.

RESULTS

In the searches performed, 956 articles were found and 29 articles were selected according to the eligibility criteria. Of these, 93.11% of the studies were observational and 6.89% were clinical trials. Regarding the gender and age group of the study samples, women aged between 30 and 45 years were predominant. As for the occupational use of voice, 68.97% of the samples were composed of professional voice users and 31.03% of non-professional voice users, with most professional voice users being teachers and non-professional voice users, individuals with dysphonia or vocal complaint. To assess vocal fatigue symptoms, 28 studies used the Vocal Fatigue Index (VFI) protocol, and only one study used another assessment protocol, Self-Administered Voice Rating. All studies were classified as regular, according to the scale used. As for the meta-analyses performed, the mean scores of the VFI factors were higher among professional voice users when compared to non-professional voice users and higher in dysphonic individuals compared to non-dysphonic individuals.

CONCLUSION

The vocal fatigue symptoms found in this review were common in the populations of professional voice users and non-professional voice users and dysphonic and non-dysphonic individuals. These symptoms were related to vocal recovery after rest, physical discomfort, and restricted vocal use.

Voice Disorders in Lower Primary School Teachers: An Observational Study

INTRODUCTION

Voice problems are very common among teachers, and etiology-based methods are used in the diagnosis and treatment process. Our study aims to reveal the changes in subjective voice analysis during the diagnosis and treatment process of dysphonia in lower primary school teachers.

METHODS

The nature of the study is a prospective observational one designed for lower primary school teachers in Kahramanmaraş conducted between the year 2015 and 2019 and evaluations for parameters including sociodemographic characteristics, laryngeal lesions and pre- and post-treatment scales such as Voice Handicap Index-10 (VHI-10), Reflux Symptom Index (RSI) and Hospital-Anxiety Depression Scale (HADS) for treatment subgroups were made. Statistical analysis was analyzed using SPSS.

RESULTS

Three hundred and fifty-one lower primary school teachers were included in the study. A statistically significant difference was found for the development of dysphonia in terms of sociodemographic features such as smoking, professional experience and crowdedness of classroom. Changes in RSI, VHI-10 and HADS values after treatment were clinically significant in all treatment groups. While there was a significant post-treatment improvement in terms of RSI in patients with granuloma and laryngopharyngeal reflux disorders, the VHI-10, and HADS assessments revealed a significant difference in clinical recovery compared to laryngeal lesions.

CONCLUSION

The RSI, VHI-10 and HADS values for various laryngeal pathologies were found to be high in dysphonic teachers. An improvement was observed in the scale scores upon the application of treatment modalities. This situation emphasizes the importance of questionnaire survey in the diagnosis, treatment, and follow-up process of dysphonia.

Effects of Virtual Teaching on Swedish Teachers' Voices During the COVID-19 Pandemic

PURPOSE

Since the beginning of 2020, teachers all over the world have had to switch over to virtual teaching because of the COVID-19 pandemic. This change of teaching mode has unknown consequences on the vocal health of teachers who already experience voice disorders at a rate nearly double that of the general population. Therefore, the purpose of this study is to investigate teachers' self-reported voice problems during virtual teaching compared to face-to-face teaching and how they are associated to perceived risk factors in the work environment.

METHOD

Participants included 141 teachers (49 males, 92 females) in high schools and higher education in Sweden who responded to an internet-based survey. Information was collected about participants' self-reported voice handicap using a translated version of the Voice Handicap Index-10 (VHI-10). Information about self-reported VTD (Vocal Tract Discomfort) symptoms and dysphonia was collected in regard to both modes of teaching (virtual vs face-to- face). The survey also included questions on risk factors related to vocal health.

RESULTS

Self-reported voice handicap and VTD symptoms were slightly lower during periods of virtual teaching compared to periods of face-to-face teaching. There was a lower frequency of dysphonia symptoms during virtual teaching compared to face-to- face teaching, however the difference was not statistically significant. In addition, 34% of teachers reported experiencing more voice problems when teaching face-to-face while 15% reported more voice problems when teaching virtually. The most reported VTD symptoms during both virtual and face-to-face teaching were having a dry and a tight throat. The dysphonia symptoms with the highest reported frequency were a tense voice and hoarseness in both modes of teaching. Risk factors associated with higher prevalence of voice symptoms and/or higher levels of voice handicap during virtual teaching were air quality and straining the voice while teaching face-to-face. In addition, those teachers who reported more voice problems while teaching virtually also reported feeling more stressed.

CONCLUSION

The results showed a slight decrease in voice symptoms and voice handicap during virtual teaching compared to face-to-face teaching. Although multifactorial, results suggest that a potential positive effect may be attributed to better air quality in the work environment and more favorable acoustic conditions preventing teachers from straining their voice.

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.

Listening to Video Game Voices: A Call for Action for Research into the Vocal Health of Video Game Voice Actors

Video game voice actors (VGVAs) are a professional voice user (PVU) population whose occupation relies on their ability to reliably deliver extremes in vocal performance. In their work VGVAs are required to perform solo for extended durations, producing highly complex character performances that not only include extremes of vocal parameters and qualities but also highly demanding vocal acts (ie, screaming, singing) within those voice archetypes. Based on the vocal demands of their work and current understandings of occupational voice disorder, it is reasonable to consider that VGVAs may be at increased risk of vocal fatigue, injury, and disorder, as manifestations of occupational disease. This risk is of primary concern to VGVAs who recently organized industrial action to highlight their concerns regarding vocal health within their industry. As a group that is not well represented within voice research, there is little literature currently available to inform clinical support of the population. Due to the unique nature of VGVA work and the highly specific nature of occupational voice use among PVUs, we cannot necessarily generalize research from other populations to VGVAs. As such, research utilising frameworks designed to capture the complexity of voice use, demands on the voice, and experiences of its use are required to support the concerns of the population. This paper introduces VGVAs as an emerging PVU population, describes the concerns of this population within the context of current understandings of vocal fatigue, occupational voice problems and PVU populations, and details the approaches required in the development of research into the population.

Prevalence of Work-Related Voice Disorders in Voice Professionals: Systematic Review and Meta-Analysis

OBJECTIVE

To analyze the prevalence of work-related voice disorders (WRVD) among the voice professionals.

METHODS

The study protocol was registered in PROSPERO (CRD42021250121). The search was performed in the Embase, Lilacs, Medline, SCOPUS, and Web of Sciences databases. There were no limitations to the year of publication and the search included observational studies which reported data on the prevalence of dysphonia in voice professionals measured through vocal complaints, vocal self-assessment, the auditory-perceptual judgment of the voice, and laryngoscopy examinations. The critical appraisal instrument for studies reporting prevalence data was used to analyze the risk of bias of the studies. Data analysis was performed using Jamovi and R software with a significance level of 5%.

RESULTS

The initial search identified 561 articles, 73 of which were finally included and analyzed. The total number of participants was 63,126. Dysphonia was diagnosed in 45,996 participants based on a vocal complaint, 12,843 using vocal self-assessment, 1,254 using the auditory-perceptual judgment, and 1,683 using laryngoscopies. The prevalence of total dysphonia was 44.0 (95% CI 38.47; 49.69). The prevalence of vocal complaints was 43.9% (95% CI 37.37; 50.52), 42.5% (95% CI 28.57; 57.08) for self-assessment, 53.0% (95% CI 29.87; 77.19) for auditory-perceptual judgment, and 36.9% (95% CI 18.62; 57.08) for laryngoscopic examination. In the auditory-perceptual judgment, voice professionals in class 3 (moderate quality, high demand) had a higher prevalence of dysphonia than those in class 4 (moderate quality, moderate demand) (P = 0.04). In the auditory-perceptual judgment (P = 0.04), there was a higher prevalence of dysphonia in teachers than among other voice professionals non-teachers, and in the laryngeal evaluation, no differences were found between professionals (P = 0.8).

CONCLUSION

There was a high prevalence of dysphonia in voice professionals, especially in the detection by auditory-perceptual judgment. High vocal demand and being a teacher influenced the increase in the prevalence of WRVD.

Vocal fatigue perceived in remote working by teachers of different school grades during COVID-19 pandemic

Objective

Teachers have an increased prevalence of voice disorders. The present study aimed to investigate the impact of remote teaching on perceived voice fatigue among Italian teachers of all grades during the lockdown due to the COVID-19 pandemic.

Method

s The participants were 195 female teachers (M_age=48.77; SD_age=9.61) in primary, secondary, and high schools. They completed the Vocal Fatigue Index (VFI) through an online survey. The tool includes 19 items grouped into three dimensions: tiredness of voice and avoidance of voice use (TA); physical discomfort (PD); and improvement of symptoms with rest (IS). The participants reported their perceived voice fatigue during remote teaching. They were also asked to provide data about voice fatigue as perceived in previous classroom teaching. The data were analyzed through two sets of independent one-way ANOVAs, with voice fatigue subscales as criterion variables and school grade as a between-subjects factor.

Results

The teachers involved in the study reported higher voice fatigue scores than vocally healthy adults from the general population. Primary school teachers showed higher voice fatigue during remote teaching than both secondary and high school teachers, specifically for the TA and PD dimensions, whereas no difference emerged for IS. The VFI scores of primary school teachers were similar to those of dysphonic individuals.

Conclusion

The results of the study confirm that primary school teachers are more vulnerable to developing voice disorders and suggest the need for specific vocal health interventions in case of prolonged remote work.

Voice Disorders Among Teachers in Al-Ahsa, Eastern Region, KSA: Vocal Complaints, Treatment-Seeking Behaviors, and Knowledge of Vocal Care

BACKGROUND

Voice disorders are a serious and common complaint among teachers, yet there are no published studies on these conditions in the context of Al-Ahsa city in the eastern region of the Kingdom of Saudi Arabia. This study analyzed the vocal complaints of Saudi teachers, investigated their treatment-seeking behaviors, and assessed their knowledge of vocal care.

METHODS

A cross-sectional online survey was randomly distributed to 604 Saudi teachers from December 2021 to March 2022. The data included sociodemographic characteristics, academic statuses, vocal symptoms and their effects, and attitudes toward voice problems. Statistical analysis was done using the Statistical Package for the Social Sciences (v. 23). Categorical variables were expressed as frequencies and percentages. A chi-square test was conducted to verify the association between the categorical variables.

RESULTS

Of the participants, 62.1% were female. 65.4% reported having voice-related problems, with the most frequently reported symptoms being hoarseness (68.35%), throat dryness (60.76%), and sore throat (56.46%). Out of the participants who reported voice problems, 32.15% stated being affected by absenteeism from school. Only a minority of teachers sought medical help (5.1%) or received information about the vocal care (29.5%). The factors that were found to be significantly associated with voice complaints include female gender, positive family history of vocal disorders, speaking in a loud voice, being non-smoker, and having the high number of classes per week (P < 0.05).

CONCLUSION

Voice-related complaints were highly prevalent among Saudi teachers for multiple factors, most of which were manageable. This study strongly recommends the vocal educational programs to be implemented during student teacher training.

Cambios en los parámetros vocales de los docentes durante el curso escolar

La voz es una herramienta fundamental para el docente. La alteración de sus cualidades básicas es definida como disfonía y resulta ser muy común. Nuestro objetivo es estudiar si la voz de los docentes cambia, como consecuencia del esfuerzo vocal provocado por su profesión, en los trimestres del curso escolar y tras la jornada laboral, midiendo el índice acústico de calidad de voz (AVQI). Además, estudiamos si el cambio tras la jornada laboral difiere en los distintos trimestres del curso. La muestra está compuesta de 93 docentes de los cuales 40 imparten su labor en un centro público y 53 en un centro concertado. Por sexos, el 29% son hombres y el 71% son mujeres. El 41.4% imparte en infantil y/o primaria y el 58.6% en ESO y/o Bachillerato. Para la grabación de voz se utilizó el programa de análisis acústico PRAAT. Se encuentran evidencias de que en el segundo y tercer trimestre el parámetro AVQI empeora en los docentes de forma significativa tras su jornada lectiva y de forma más acusada en los que imparten ESO y Bachillerato. Los docentes de centros públicos registran niveles AVQI significativamente superiores a los de centros concertados. La disfonía es significativamente menor en los docentes que imparten las materias de música, idioma distinto del castellano y/o educación física. No se encuentran cambios significativos de AVQI entre los distintos trimestres.

Vocal Behavior of Teachers Reading with Raised Voice in a Noisy Environment

(1) Objective: Teaching is a particularly voice-demanding occupation. Voice training provided during teachers’ education is often insufficient and thus teachers are at risk of developing voice disorders. Vocal demands during teaching are not only characterized by speaking for long durations but also by speaking in noisy environments. This provokes the so-called Lombard effect, which intuitively leads to an increase in voice intensity, pitch and phonation time in laboratory studies. However, this effect has not been thoroughly investigated in realistic teaching scenarios. (2) Methods: This study thus examined how 13 experienced, but vocally untrained, teachers behaved when reading in a noisy compared to quiet background environment. The quiet and noisy conditions were provided by a live audience either listening quietly or making noise by talking to each other. By using a portable voice accumulator, the fundamental frequency, sound pressure level of the voice and the noise as well as the phonation time were recorded in both conditions. (3) Results: The results showed that the teachers mainly responded according to the Lombard effect. In addition, analysis of phonation time revealed that they failed to increase inhalation time and appeared to lose articulation through the shortening of voiceless consonants in the noisy condition. (4) Conclusions: The teachers demonstrated vocally demanding behavior when speaking in the noisy condition, which can lead to vocal fatigue and cause dysphonia. The findings underline the necessity for specific voice training in teachers’ education, and the content of such training is discussed in light of the results.

Towards Evaluating Pitch-Related Phonation Function in Speech Communication Using High-Density Surface Electromyography

Pitch, as a sensation of the sound frequency, is a crucial attribute toward constructing a natural voice for communication. Producing intelligible sounds with normal pitches depend on substantive interdependencies among facial and neck muscles. Clarifying the interrelations between the pitches and the corresponding muscular activities would be helpful for evaluating the pitch-related phonating functions, which would play a significant role both in training pronunciation and in assessing dysphonia. In this study, the speech signals and the high-density surface electromyography (HD sEMG) signals were synchronously acquired when phonating [a:], [i:], and [ә:] vowels with increasing pitches, respectively. The HD sEMG energy maps were constructed based on the root mean square values to visualize spatiotemporal characteristics of facial and neck muscle activities. Normalized median frequency (nMF) and root-mean square (nRMS) were correspondingly extracted from the speech and sEMG recordings to quantitatively investigate the correlations between sound frequencies and myoelectric characteristics. The results showed that the frame-wise energy maps built from sEMG recordings presented that the muscle contraction strength increased monotonously across pitch-rising, with left-right symmetrical distribution for the face/neck. Furthermore, the nRMS increased at a similar rate to the nMF when there were rising pitches, and the two parameters had a significant correlation across different vowel tasks [(a:) (0.88 ± 0.04), (i:) (0.89 ± 0.04), and (ә:) (0.87 ± 0.05)]. These findings suggested the possibility of utilizing muscle contraction patterns as a reference for evaluating pitch-related phonation functions. The proposed method could open a new window for developing a clinical approach for assessing the muscular functions of dysphonia.

Voice Problems Among School Teachers employing the Tele-teaching Modality

OBJECTIVES

To assess the prevalence of voice problems among teachers in Riyadh during tele-teaching and examine the relationship between the Voice Handicap Index 10 (VHI10) scores and a variety of risk factors believed to be related to voice problems. We also assessed awareness of voice hygiene and therapy among teachers.

STUDY DESIGN

An observational cross-sectional study conducted using a multistage random sampling method among Riyadh school teachers who taught by tele-teaching for a minimum of one year.

METHODS

A self-assessment questionnaire which included demographic information about teachers, factors related to their teaching backgrounds, tele-teaching settings, effects of tele-teaching on the voice, medical and social histories, reports of voice and reflux symptoms, VHI10, and general knowledge about voice hygiene. This was distributed to school teachers using an SMS link through the Ministry of Education's IT department.

RESULTS

A total 495 were included in the study after exclusions. The prevalence of teachers who had significant voice problems during tele-teaching (VHI10>11) was 21.6%. Multiple risk factors significantly increased the risk of voice problems during tele-teaching. These factors included being female, teacher age, the presence of background noise from both teachers and students, loud voices, using an open camera during the teaching, stress and anxiety, allergies, respiratory disease, reflux, hearing problems, and a family history of voice problems. Only 4.6% of respondents were familiar with voice hygiene and voice therapy, but 65% believe that it is important for teachers to be knowledgeable about them.

CONCLUSIONS

Due to the lower prevalence of voice disorders among tele-teaching compared to traditional teaching methods, tele-teaching may be a viable option for teachers who have voice problems. There are still several factors influencing voice problems among tele-teachers. To attenuate potential risks, it is crucial that teachers are aware of the concepts of voice hygiene and voice therapy.

The Effect of Vocal Hygiene Training Via Videoconference in Teachers' Voices

PURPOSE

Voice disorders are frequently seen among teachers. Intense and inappropriate use of the voice is the most frequent reason. In the literature, studies supporting the positive effect of voice hygiene behaviors to the voice in teachers exist. In the v pandemic era that we pass through, it's being observed that teaching via videoconference is becoming widespread all around the world. The primary aim of this study is to evaluate the risk factors for self-assessed "not normal" voice in teachers, in the light of their demographic and vocational information and voice hygiene behaviors. Our second aim in this study is to evaluate the effect of voice hygiene training via videoconference on teachers' voice. We believe this will contribute in shaping today's therapy modalities in vocal training.

MATERIALS AND METHODS

One hundred nine teachers, working as primary, secondary or high school teacher actively in different cities in Turkey, between 25 and 55 years of age participated and self-assessed their voice by filling the survey including demographic, occupational, medical history and voice symptoms and vocal behaviors data as well as Voice Handicap Index (VHI)-10 ve voice self rating scale (VSRS). The teachers with VHI-10 score below 5 and VSRS score "normal" were assumed to have "Normal Voice." The teachers with VHI-10 score 5 or above and VSRS "Not Normal" (mild, moderate or severe) (N = 52) were assigned to "Voice Hygiene Group" and were invited to videoconference for a voice hygiene session. Four weeks after this session, the survey, VHI-10 and VSRS were repeated and the results were compared.

RESULTS

In the first phase of the study, risk factors for not being in "Normal Voice" group for the teachers have been assessed. "Having chronic disease" and "having experienced voice problem before" have been found to be risk factors. In the second phase of the study, 52 teachers have been invited to online "Voice Hygiene" videoconference session; only 18 teachers have attended in total of three attempts of sessions. When vocal behaviors before and after the videoconference were compared, positive changes have been observed in five vocal behaviors including "avoiding smoking," "drinking enough water daily," "eating healthy food," "avoiding excessive meals," "avoiding frequent throat clearing," however VHI-10 and VSRS scores have not showed a meaningful change. Only one teacher has progressed to "normal voice" from "Voice Hygiene Group."

CONCLUSION

We believe further controlled studies with more participants adherent to videoconference sessions will be needed in order to shape today's therapy modalities.

Schoolteachers with voice handicap are twice as likely to report depressive symptoms

This study aimed to examine the association between voice disorder and depressive symptoms in schoolteachers. A cross-sectional survey was conducted with elementary and secondary schoolteachers. Voice disorders and depressive symptoms were assessed with the Voice Handicap Index-10 and the Beck Depression Inventory-II, respectively. Logistic and linear regressions models were adjusted for confounding variables. In the 389 schoolteachers studied, the prevalence of voice handicap and depressive symptoms was 18.8 and 38.8%, respectively. Voice handicap was associated with depressive symptoms on all models tested. The logistic regression showed an odds ratio of 2.21 (95% confidence interval: 1.19, 4.08; p value < 0.05), while in the linear regression each point increase on the voice disorder scale increased the Beck Depression Inventory-II score by 0.39 points (95% confidence interval: 0.26, 0.54; p value < 0.05). This study showed that teachers of public schools with voice handicap are twice as likely to report depressive symptoms.

The Effect of Online Teaching on Vocal Health Among Saudi Teachers During COVID-19 Pandemic

PURPOSE

The goal of this study is to determine how online education affects the vocal health of schoolteachers in Saudi Arabia's Eastern Province. Teachers' phono trauma is well-known as a serious occupational hazard, and online education was the primary mode of delivering instruction to students during COVID-19.

METHODS

This is a descriptive cross-sectional study conducted among teachers in the Eastern Province area of Saudi Arabia. Teachers completed a self-administered questionnaire via an online platform, which included socio-demographic data, academic status, and the Voice Handicap Index-10 questionnaire, which assessed their vocal difficulties.

RESULTS

A total of 335 teachers responded to the survey (78.2% females vs. 21.8% males). Nearly half (48.7%) were primary school teachers. 45.7% were currently teaching distance learning. Earphones and microphones (49.3%) were the most commonly used distance learning accessories. Noise in the classroom was a very much disturbing factor in teaching implied by 44.8% of the teachers. During the COVID-19 pandemic, the vocal handicap index-10 was significantly higher among females (P = 0.007), primary school teachers (P < 0.001), moreover those currently teaching distance learning (P = 0.001) and those who perceived that there is more work in distance teaching (P < 0.001).

CONCLUSION

Compared to in-person teaching, online teaching may have a positive impact on vocal health among Saudi teachers. Of all the teachers, phono trauma tends to be more among females who were primary school teachers, currently teaching distance learning, and those who perceived distance learning to be laborious.

Voice Disorders in the Workplace: A Scoping Review

OBJECTIVE

Occupational voice users (OVU) are at risk for developing voice disorders (VD). Otolaryngologists need to advocate for workplace accommodations for these patients. The objective of this study was to assess the literature on VDs in the workplace and to describe how results may guide the Otolaryngologist.

DATA SOURCES

EBSCO, PubMed, Google Scholar, UBC libraries, and SpringerLink databases.

REVIEW METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for Scoping Reviews protocol was used to conduct a scoping review from inception to December 30, 2019. Oxford Levels of Evidence were used to assess the quality of included studies. Common themes and types of accommodations and barriers were explored. This study was registered with the Open Science Framework Open Source for Collaboration in Scientific Research (10.17605/OSF.IO/RYDVN).

RESULTS

One hundred and ninety-three abstracts were screened; 32 studies met inclusion criteria. Oxford Levels of Evidence ranged from 3 to 5. Eight overarching themes were identified: prevalence of VDs among OVUs; identifying risk factors for VDs; raising awareness of VDs medico-legally, politically; the education and treatment of VDs, the importance of diagnosing VDs; measuring the impact of VDs on work productivity; identifying perceived barriers to integration into the workplace; and calculating the economic costs of VDs. VDs affect workplace productivity and have associated absenteeism, medical, and economic costs. Increased awareness and education on the risk factors for VD development can assist with prevention, early diagnosis, and treatment. Accommodations and barriers are discussed.

CONCLUSION

There is emerging literature on VDs in the workplace. A multitude of VDs exist with varying pathologies, associated barriers, and implications for functioning within the workplace. Otolaryngologists play a unique role in diagnosing voice disorders and defining and facilitating workplace accommodations.

Effects of Noise and a Speaker's Impaired Voice Quality on Spoken Language Processing in School-Aged Children: A Systematic Review and Meta-Analysis

PURPOSE

Background noise and voice problems among teachers can degrade listening conditions in classrooms. The aim of this literature review is to understand how these acoustic degradations affect spoken language processing in 6- to 18-year-old children.

METHOD

In a narrative report and meta-analysis, we systematically review studies that examined the effects of noise and/or impaired voice on children's response accuracy and response time (RT) in listening tasks. We propose the Speech Processing under Acoustic DEgradations (SPADE) framework to classify relevant findings according to three processing dimensions-speech perception, listening comprehension, and auditory working memory-and highlight potential moderators.

RESULTS

Thirty-one studies are included in this systematic review. Our meta-analysis shows that noise can impede children's accuracy in listening tasks across all processing dimensions (Cohen's d between -0.67 and -2.65, depending on signal-to-noise ratio) and that impaired voice lowers children's accuracy in listening comprehension tasks (d = -0.35). A handful of studies assessed RT, but results are inconclusive. The impact of noise and impaired voice can be moderated by listener, task, environmental, and exposure factors. The interaction between noise and impaired voice remains underinvestigated.

CONCLUSIONS

Overall, this review suggests that children have more trouble perceiving speech, processing verbal messages, and recalling verbal information when listening to speech in noise or to a speaker with dysphonia. Impoverished speech input could impede pupils' motivation and academic performance at school.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.17139377.

Comparación de parámetros de la carga vocal mediante dosimetría en profesoras

La carga vocal es definida como la cantidad de trabajo realizado por el mecanismo laríngeo a lo largo del tiempo. No se encontraron estudios de su valoración diferenciada en la sala de clases y en el espacio de simulación clínica. Es necesario diferenciar los resultados de los parámetros: frecuencia fundamental, intensidad vocal y ruido ambiental en ambos contextos para promover una perspectiva ecológica de la salud vocal de las docentes. El objetivo de esta investigación es determinar las diferencias en la carga vocal de un grupo de profesoras de tres establecimientos educacionales de la Región Metropolitana de Chile, en espacios de simulación clínica y laboral. Estudio comparativo transversal de 26 profesoras de educación preescolar y básica sin antecedentes de patologías vocales. La evaluación de los parámetros vocales se realizó a través de un dosímetro. El ruido ambiente fue evaluado por medio de un sonómetro. Los resultados arrojaron diferencias significativas de las tres variables entre la sala de clases y el espacio clínico simulado. También hubo diferencias significativas de intensidad y ruido ambiente entre niveles de enseñanza y cantidad de alumnos por sala, siendo mayor la intensidad y ruido en las salas de nivel básico, en comparación al nivel preescolar. Como conclusión existe una carga vocal mayor en la sala de clases, definida por un aumento en la frecuencia fundamental e intensidad, en comparación al espacio clínico simulado. Lo anterior podría estar determinado por el ruido ambiente. Se sugiere realizar intervención fonoaudiológica en el contexto laboral.

Diseño y validación de una escala vocal multidimensional para la detección del riesgo vocal en docentes

En el colectivo docente es frecuente el mal uso de la voz, para preservar su salud vocal es necesario un diagnóstico precoz. El objetivo del estudio fue diseñar, según criterios de especificidad y sencillez, una escala vocal multidimensional y fiable que contribuya a detectar situaciones de riesgo vocal del docente en el contexto escolar (EVM-D). Participaron 299 docentes, de 18 centros educativos de A Coruña seleccionados aleatoriamente, se dividieron en dos submuestras, una (n =143) para la realización del análisis factorial exploratorio, tanto con Análisis Paralelo como con factorización de ejes principales y rotación oblimin, y otra (n = 156) para el análisis factorial confirmatorio utilizando el método de mínimos cuadrados no ponderados. Una vez analizados los modelos, se optó por uno de tres factores de primer orden (Síntomas vocales, Hábitos de habla y Abusos vocales) y uno de segundo orden (Riesgo vocal). Los índices de bondad de ajuste fueron GFI = ,98, AGFI = ,97, SRMR = ,05; la fiabilidad compuesta (FC) en los tres factores de ,80; ,70 y ,73 y la varianza media extraída (AVE) de ,44; ,43 y ,47 respectivamente; la FC del factor de primer orden fue de ,83 y la AVE ,63. Se obtuvieron valores de corte según el sexo para los percentiles P90, P75 y P60 de riesgo vocal: alto, medio, bajo y muy bajo. La escala EVM-D fiable y consistente podría ser útil para detectar factores etiológicos o síntomas y aplicar la higiene vocal de forma precoz y autónoma por el docente.

Voice amplifier: effects on dose and vocal intensity of teachers without dysphonia

PURPOSE

Analyze the interference of using the voice amplifier in vocal dose of non-dysphonic teachers.

METHODS

This is an experimental study comparing people from the same ambience compound for 20 teachers from municipal elementary school in Belo Horizonte/MG. After consent, the participants were requested to answer the vocal symptom scale questionnaire (ESV) and later participated in two different moments of the study, for which they randomly selected. In the first moment, the participants used only the vocal dosimeter and in the second, they used the vocal dosimeter and the voice amplifier. The measurements were recorded by the device for 1h40m, in the classroom that the teachers taught. The time between the two measurements was one week, with the same room, the same time and the same discipline being taught, at both times.

RESULTS

The intensity parameter was the only one that showed difference with the use of the voice amplifier.

CONCLUSION

Use voice amplification while non-dysphonic teachers are teaching doesn't affect the fundamental frequency and vocal dose measure in the acoustics parameters. The vocal intensity is smaller when teacher uses the vocal amplification.

Voice symptoms in teachers during distance teaching: a survey during the COVID-19 pandemic in Finland

PURPOSE

Due to the coronavirus disease of 2019 (COVID-19), teachers during the pandemic have had to adapt to online teaching at short notice. This study aims to investigate the voice symptoms and their environmental risk factors as well as the work ability associated with distance teaching and to compare these with symptoms in previous contact teaching.

METHODS

We conducted a survey of 121 primary and secondary school teachers across Finland. The survey was advertised online through social media and the replies collected from voluntarily participating teachers.

RESULTS

During distance teaching vocal symptoms appeared less often than in school with 71% teachers experiencing them in regular teaching and 44% in distance teaching, VHI result decreased from 7.88 in school teaching to 4.58 in distance teaching. Acoustic conditions were reported to be more suitable in distance teaching with 73% of teachers finding them adequate during distance teaching in comparison to 46% for those in regular teaching. Background noise was the most disturbing factor for a teacher's voice in the classroom and in distance teaching and this was even more conspicuous in the classroom. Also, subjectively experienced poor indoor air quality at school influenced the voice negatively. Further, voice problems were associated with increased subjective stress levels and reduced ability to work.

CONCLUSION

Distance teaching has affected teachers' voices in a positive way compared with regular teaching. This difference is likely to be due to better acoustics and indoor air quality in distance teaching conditions.

The Relationship Between Dysphonia Severity Index and Voice-Related Quality of Life in the Elementary School Teachers with Voice Complaint

INTRODUCTION

Teachers are one of the largest groups of professional voice users who are highly dependent on their voice in their working environment using their voice as a primary tool for their profession. Thus, they are at high risk of voice disorders. Since voice disorders are multi-causal in nature, it is necessary to evaluate them systematically and in different ways to determine the exact nature of the disorder. Therefore, in this study, the relationship between Voice-Related Quality of Life (VRQOL) and Dysphonia Severity Index (DSI) was examined from the perspective of teachers with voice complaint.

METHOD

In this study, 157 primary school teachers with voice complaint (49 males and 108 females) with an average age of 38.54 ± 9.56 years were studied using DSI and VRQOL as a self-assessment.

RESULTS

The mean of VRQOL was 74.379 ± 18.95 and the mean of DSI was 1.339 ± 1.62. The results of the study showed that there is a significant positive correlation between the overall scores of DSI and VRQOL scales (r = 0.545, P < 0.001).

CONCLUSION

This study showed that a low dysphonia severity index, reflecting poor laryngeal function, is associated with lower voice-related quality of life. Therefore, accurate and timely assessment of the DSI in teachers can prevent the occurrence and/or progression of voice disorder and, consequently, prevent reducing the voice-related quality of life in teachers.

Which teachers are most at risk for voice disorders? Individual factors predicting vocal acoustic parameters monitored in situ during a workweek

PURPOSE

To identify the factors affecting teachers' vocal acoustic parameters, with the aim of detecting individuals at risk of phonotrauma.

METHOD

The voicing time, voice sound pressure level [SPL] and fundamental frequency [f_o] of 87 teachers were measured during one workweek using a voice dosimeter. We retrospectively investigated the impact of 10 factors (gender, age, teaching experience, teaching level, tobacco, gastro-esophageal problems, nonoccupational voice activity, voice education, past voice problems, and biopsychosocial impact of voice problems measured using the Voice Handicap Index [VHI]) on each voice parameter.

RESULTS

None of the above factors affected voicing time or SPL. f_o depended significantly on gender, teaching level, nonoccupational voice activity and VHI score. Specifically, f_o was higher in women (Δ = 69 Hz), in individuals without nonoccupational voice activities (Δ = 11 Hz), and in individuals with a lower VHI score (increase of 0.7 Hz for each additional point). For females, post hoc comparisons revealed a substantial impact of teaching level on f_o: university instructors had deeper voices than kindergarten (Δ = 66 Hz), elementary (Δ = 52 Hz), or secondary teachers (Δ = 41 Hz).

CONCLUSIONS

Since higher f_o increases the mechanical stress related to vocal fold vibration, the screening and prevention of phonotrauma should focus primarily on women, particularly those who teach at lower levels, and teachers with more self-rated voice problems. The lower f_o of teachers who engage in nonprofessional voice activities may suggest acute inflammation or muscle fatigue due to voice overload.

Listening to a Dysphonic Speaker in Noise May Impede Children's Spoken Language Processing in a Realistic Classroom Setting

Purpose The aim of this study was to investigate children's processing of dysphonic speech in a realistic classroom setting, under the influence of added classroom noise. Method Typically developing 6-year-old primary school children performed two listening tasks in their regular classrooms: a phoneme discrimination task to assess speech perception and a sentence-picture matching task to assess listening comprehension. Speech stimuli were played back in either a typical or an impaired voice quality. Children performed the tasks in the presence of induced classroom noise at signal-to-noise ratios between +2 and +9 dB. Results Children's performance in the phoneme discrimination task decreased significantly when the speaker's voice was impaired. The effect of voice quality on sentence-picture matching depended on task demands: Easy sentences were processed more accurately in the impaired-voice condition than in the typical-voice condition. Signal-to-noise ratio effects are discussed in light of methodological constraints. Conclusions Listening to a dysphonic teacher in a noisy classroom may impede children's perception of speech, particularly when phonological discrimination is needed to disambiguate the speech input. Future research regarding the interaction of voice quality and task demands is necessary.

Presentation and Evaluation of the Teacher's Vocal Health Guide

OBJECTIVE

in order to contribute of the collective actions of the teacher's vocal health, the specific goal was to build a guide gathering the appliable didactic content in these actions. That being, the stages performed in the instrument elaboration of the denominated Teachers' Vocal Health Guide (TVHG) will be presented.

MATERIAL AND METHODS

The elaboration process of the guide is composed of three stages: (1) parameter selection to compose the guide based on a literature review; (2) submission to a specialist examining board, with the calculation of the Content Validity Index (CVI) and the Kappa agreement coefficient; (3) content validation - the instrument was submitted to an analysis of a judges committee, and from the results the Cronbach Alfa coefficient and the CVI were calculated.

RESULTS

The elaboration of the TVHG underwent three stages. In the first stage, called parameter selection, 20 didactic contents were found, consisting of 14 theoretical and six practices. In the second stage, an evaluation of the guide was performed by a specialist examining board and two contents were excluded since their CVI was below 8. The result of the Kappa Coefficient Calculation was 0.281. In the third stage, the TVHG underwent evaluation of a new group denominated judges committee, and the items were punctuated as very relevant and completely relevant. The result of the Cronbach Alfa coefficient for the instrument with 18 items was 0.721, and this value categorizes the instrument as valid. It is necessary to continue the process of instrument validation, possibly investigating the applicability of TVHG in the teachers' opinion.

CONCLUSION

The current study presents the TVHG from the description of the three stages performed to elaborate a systematized instrument denominated TVHG, which suggests a gathering of didactic content that are appliable in collective actions of vocal health with this professional category.

Noise and a Speaker's Impaired Voice Quality Disrupt Spoken Language Processing in School-Aged Children: Evidence From Performance and Response Time Measures

Purpose Our aim was to investigate isolated and combined effects of speech-shaped noise (SSN) and a speaker's impaired voice quality on spoken language processing in first-grade children. Method In individual examinations, 53 typically developing children aged 5-6 years performed a speech perception task (phoneme discrimination) and a listening comprehension task (sentence-picture matching). Speech stimuli were randomly presented in a 2 × 2 factorial design with the factors noise (no added noise vs. SSN at 0- dB SNR) and voice quality (normal voice vs. impaired voice). Outcome measures were task performance and response time (RT). Results SSN and impaired voice quality significantly lowered children's performance and increased RTs in the speech perception task, particularly when combined. Regarding listening comprehension, a significant interaction between noise and voice quality indicated that children's performance was hindered by SSN when the speaker's voice was impaired but not when it was normal. RTs in this task were unaffected by noise or voice quality. Conclusions Results suggest that speech signal degradations caused by a speaker's impaired voice and background noise generate more processing errors and increased listening effort in young school-aged children. This finding is vital for classroom listening and highlights the importance of ensuring teachers' vocal health and adequate room acoustics.

Work-Related Communicative Profile of Voice Teachers: Effects of Classroom Noise on Voice and Hearing Abilities

PURPOSE

Vocal instructors during their normal workday are exposed to high noise levels that can affect their voice and hearing health. The goal of this study was to evaluate the voice and hearing status of voice instructors before and after lessons and relate these evaluations with voice and noise dosimetry taken during lessons.

METHODS

Eight voice instructors volunteered to participate in the study. The protocol included (1) questionnaires, (2) pre/post assessment of voice quality and hearing status, and (3) voice and noise dosimetry during lessons. Acoustic measurements were taken of the unoccupied classrooms.

RESULTS

In six of eight classrooms, the measured noise level was higher than the safety recommendations set by National Institute for Occupational Safety and Health. The background noise level and the reverberation time in the classrooms were in compliance with the national standard recommendations. We did not find a clear pattern comparing pre- and post-measurements of voice quality consistent among genders. In all subjects, the Sound Pressure Levels mean increased, and the standard deviation of fundamental frequency decreased indicating association to vocal fatigue. Previous studies link these changes to increasing vocal fatigue. The audiometric results revealed seven out of eight instructors have sensorineural hearing loss.

CONCLUSIONS

The interaction of the acoustic space and noise levels can contribute to the development of hearing and voice disorders for voice instructors. If supported by larger sample size, the results of this pilot study could justify the need for a hearing and voice conservation program for music faculty.

A Comparative Study Utilizing the Voice Handicap Index-10 (VHI-10) in Teachers and the General Population of Kuwait

OBJECTIVES

The objective of this study was to determine the prevalence of voice handicap perception of teachers in Kuwait and compare them within the general population by using the validated Arabic version of the voice handicap index-10 (VHI-10). Moreover, we explored variations within the teaching profession itself with regards to specific characteristics.

METHODS

The study was a cross-sectional survey design, in which participants from all governates of Kuwait (1820 teachers and 755 controls) completed the validated Arabic VHI-10, health-related, and demographic questions. The questionnaires were distributed among a random sample of elementary, middle, and high school teachers of both genders, and a random sample of the control population.

RESULTS

The mean VHI-10 of teachers was significantly higher than nonteachers (mean VHI-10 of teachers = 5.7, mean VHI-10 of nonteachers = 3.7, P < 0.001). Furthermore, there was a significant difference between teachers and controls in those who scored >11 in the VHI-10 (>11 = 17.6%, 10.2% respectively, P = <0.001). Female teachers scored a higher mean VHI-10 than male teachers (B = 0.66, P < 0.001). There was no difference in the mean VHI-10 among the different teaching class levels. However, elementary school teachers were the most group to exceed the cut-off point (VHI-10 >11) (Odds Ratio = 1.38, P = 0.04). With regards to smoking, we found no difference in the mean VHI-10 and scoring >11 in the questionnaire. Art and science teachers had the highest mean VHI-10 (P = 0.005 and 0.03, respectively).

CONCLUSION

The results of the study revealed a higher perception of voice handicap in teachers than nonteachers. Therefore, emphasis should be on teachers in order to prevent voice damage.

BAGLS, a multihospital Benchmark for Automatic Glottis Segmentation

Laryngeal videoendoscopy is one of the main tools in clinical examinations for voice disorders and voice research. Using high-speed videoendoscopy, it is possible to fully capture the vocal fold oscillations, however, processing the recordings typically involves a time-consuming segmentation of the glottal area by trained experts. Even though automatic methods have been proposed and the task is particularly suited for deep learning methods, there are no public datasets and benchmarks available to compare methods and to allow training of generalizing deep learning models. In an international collaboration of researchers from seven institutions from the EU and USA, we have created BAGLS, a large, multihospital dataset of 59,250 high-speed videoendoscopy frames with individually annotated segmentation masks. The frames are based on 640 recordings of healthy and disordered subjects that were recorded with varying technical equipment by numerous clinicians. The BAGLS dataset will allow an objective comparison of glottis segmentation methods and will enable interested researchers to train their own models and compare their methods.

Relevant Work Factors Associated with Voice Disorders in Early Childhood Teachers: A Comparison between Kindergarten and Elementary School Teachers in Yancheng, China

Background: Early childhood teachers consist of kindergarten and elementary school teachers in the lower grades. Young children at school may increase the vocal load of these teachers. Therefore, the objectives of this study were to determine the prevalence of voice disorders and the associated factors in early childhood teachers, and to determine if differences exist between kindergarten and elementary school teachers. Method: A cross-sectional survey was performed in July 2019 as a network questionnaire. Through cluster sampling, teachers (n = 414) from all five public kindergartens (n = 211) in the urban area of Yancheng, China, and four public elementary schools (n = 203) in the same school district participated in this study. Multivariate logistic regression models were used to analyze the associations among the prevalence of voice disorders in the teachers, school type, and relevant factors. Results: Our results indicated, based on the Voice Handicap Index scale (VHI-10, China), that the prevalence of voice disorders in early childhood teachers was 59.7%, while that in elementary school teachers (65.5%) was significantly higher than that in kindergarten teachers (54.0%) during the previous semester. Contributing factors included daily class hours, classroom air humidity, and speaking loudly during teaching. Additionally, certain types of voice usage in teaching such as falsetto speak, speaking more than other teachers, not using vocal techniques, and habitual voice clearing, were significantly associated with voice disorders. Conclusion: Most early childhood teachers have voice disorders. Compared with the kindergarten teachers, the elementary school teachers experienced a significantly higher prevalence of voice disorders. Several factors among work organization, work environment, and types of voice usage in teaching were associated with the voice disorders in early childhood teachers. The finding suggests that voice training should be provided for early childhood teachers, classroom teaching time should be decreased, and the number of teachers in basic subjects should be increased in the lower grades of elementary schools.

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.

Danos morais por distúrbio de voz relacionado ao trabalho: levantamento de julgados do Tribunal Superior do Trabalho

Resumo Introdução: trabalhadores expostos a condições ocupacionais inadequadas podem ser acometidos por distúrbio de voz relacionado ao trabalho (DVRT). Enquanto o DVRT não é legalmente reconhecido, há uma fragilização no estabelecimento do nexo causal entre trabalho e agravo vocal. Objetivo: analisar as decisões do Tribunal Superior do Trabalho (TST) nas ações movidas por trabalhadores que alegaram DVRT na Justiça. Método: estudo quantitativo, exploratório e descritivo. Para o levantamento dos acórdãos, utilizou-se o termo de busca “disfonia” no portal do TST. Resultados: identificaram-se 87 acórdãos proferidos entre os anos de 1999 a 2016, impetrados sobretudo por mulheres (88,5%), do setor de Teleatendimento (59,8%). Em 39,1% das ações, houve reconhecimento do nexo causal entre o trabalho e a doença, ganho de causa parcial (42,5%), indenização por danos morais (50,6%), indenização por danos materiais (8,0%), e multa (5,7%). Conclusão: os acórdãos mostraram a relação entre distúrbio de voz e trabalho. O reconhecimento legal do DVRT poderá contribuir para a redução do sofrimento e do tempo de espera do trabalhador pela compensação por seu adoecimento. Também poderá auxiliar na construção de políticas públicas que visem a promoção, proteção, recuperação e, sobretudo, vigilância em saúde, de modo a garantir condições de trabalho adequadas para o uso da voz no trabalho.