Voice Disorders and Impact of Voice Handicap in Norwegian Student Teachers

Prospective Teacher's Voice Questionnaire (PTVQ): Development of a Questionnaire to Assess Training-Related Voice Symptoms Among Prospective Teachers

AIM

To develop and validate a self-administered population-specific survey, available in Spanish, Portuguese, and English, which investigates the prevalence of voice symptoms and perceptions of risk factors associated with training among prospective teachers.

METHODS

The present study had three stages: the first stage included a literature review and content validation by experts that supported the survey development. From this phase, we defined five aspects of the Prospective Teacher's Voice Questionnaire (PTVQ): (1) target population, (2) research objectives, (3) questions to be included, (4) scales for the answers, and (5) relevance, comprehensiveness, clarityclarity, and understandability of the questions. This process was performed in parallel for the three languages (Spanish, Portuguese, and English). The second stage included pilot testing. This involved administering the first draft of the survey to a group of 120 students to evaluate the feasibility and effectiveness of the survey instrument, identify any potential problems with the survey, and refine the instrument based on feedback from the pilot participants. The third stage includes the restructuring of the questionnaire's voice quality section to eliminate redundant questions. Through Principal Component Analysis, multicollinear variables were condensed, facilitating the removal of redundant items, and ensuring that the final questionnaire comprised only the most relevant and discriminative questions.

RESULTS AND DISCUSSION

The final version of the survey, available in Spanish, Portuguese, and English, consists of four sections with a total of 57 questions. The development of the PTVQ represents a significant step toward better understanding and addressing voice disorders among prospective teachers. Future research could further refine the questionnaire and explore its predictive validity in identifying individuals at risk of voice disorders early in their teaching careers. Additionally, interventions based on the findings from the PTVQ could be developed to support the voice health and well-being of prospective teachers, ultimately improving teaching quality and job satisfaction in educational settings.

Risk Factors for Voice Disorders in Undergraduate Speech Language Pathology Students

OBJECTIVES

The aim of this research study is to determine the risk factors for voice disorders in SLP students in order to help us develop specific goals for a vocal hygiene education program specifically for SLP students.

METHODS

An online questionnaire was completed by 121 undergraduate SLP students. Participants were divided into two groups, students with no self-perceived voice disorders (NVD group) and students with self-perceived voice disorders (VD group). The Fisher Exact test (FET) was used to explore the differences in responses for each voice risk factor and the academic and occupational consequences between students with and without self-perceived voice disorders.

RESULTS

Students in the VD group were more likely to experience vocal fold problems, hearing problems and throat clearing than in the NVD group. More students in the VD group reported to "sometimes' and "often" take medications that impact their voice, hear a "moderate" amount of noise generated from the passage of planes and the road and hear a "moderate" and "large" amount of noise generated within and outside the building than in the NVD group. Moreover, students in the VD group were more likely to limit their ability to perform certain tasks at school (eg, participating in lectures) and clinical practicum (eg, administering therapy sessions) and reduce their interactions annually due to voice problems.

CONCLUSIONS

Health, voice use, lifestyle, and environmental factors are risk factors for voice disorders that were presented more frequently in SLP students with self-perceived voice disorders.

Special Education Teachers' Self-Assessed Voice Health Regarding Voice Use Habits

OBJECTIVES

Special education teachers (SETs) work with students with disabilities. To get and keep these students' attention during the lesson, they may use their voices with high loudness and frequent pitch changes. These situations can be tiring for their voices and affect their vocal health. This study aimed to compare SETs' voice fatigue, reflux symptoms, and self-assessments according to their voice use habits in their work and social lives.

METHODS

A total of 208 SETs were included. A Teacher Voice Use Habits Questionnaire was developed by considering the literature, taking expert opinion, and conducting a pilot study. In addition, the Vocal Fatigue Index (VFI), Voice Handicap Index-30 (VHI-30), and Reflux Symptom Index (RSI) were used. One-way ANOVA, Mann-Whitney U, Kruskal Wallis-H, and Pearson correlation analyses were performed.

RESULTS

Of SETs, 37.5% reported frequent hoarseness, and 65.4% reported voice fatigue during/at the end of the day. Those who answered "yes" to the questions about talking loudly at home, having the television on at home, feeling stressed in the work environment, eating and drinking before going to bed at night, smoking, having frequent colds, talking loudly during the day, and voice fatigue during/at the end of the day had significantly higher scores in all scales. Those who used their voice for more than 6hours were found to have significantly higher scores on the VFI and RSI. In all scales, the scores of those who made very frequent long phone calls were significantly higher.

CONCLUSION

According to the SETs' reports, it was concluded that they did not comply with the rules of vocal hygiene, although they used their voices for a long time. This situation should be considered an occupational health problem in schools, and it may be helpful to screen this group's voice disorders and design preventive programs.

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.

Prevalence of voice handicap among nurses in intensive care units due to occupational noise during pandemic

Background

Healthcare workers have been identified as being at risk of occupational voice disorders. Among them, nurses working in intensive care units (ICUs) are particularly vulnerable due to the risk factors that are associated with their exposure to high levels of noise. Thus, this study aimed to determine the prevalence of voice disorders among ICU nurses.

Methods

A questionnaire was administered to 100 ICU nurses from four hospitals in China. The questionnaire assessed vocal-related symptoms, perceived voice handicap, frequently heard noise sources, and the quality of communications.

Results

Results indicate that the most frequently reported voice symptoms were 'voice tiredness' and 'voiceless'. Nurses working more than 50 h per week experienced voice symptoms more frequently than nurses working for 40-50 h per week. The median value of the perceived voice handicap score (VHI-30) was 23, indicating mild voice handicap, while 24% of the nurses reported severe voice handicap. Longer working hours and working at patient wards were significantly associated with higher VHI-30 scores. The nurses also reported that the quality of verbal communication with patients and colleagues and voice problems worsened during the COVID-19 pandemic.

Conclusion

More than 20% of nurses reported severe voice handicap, however, voice handicap among ICU nurses did not appear universally to all nurses. Further research is necessary to identify the risk factors associated with voice disorders and the mechanism behind such heterogeneity among ICU nurses.

Mapping the Landscape of Voice Complaints among Teachers: A Bibliometric Investigation

PURPOSE

With the significant and growing interest in voice disorders among teachers over the last several decades, there is value in having a comprehensive overview of the current state of the field and its related research productivity. This study aims to provide an updated and comprehensive mapping of the intellectual structure and research evolution in the field of occupational voice complaints among teachers.

METHODS

A systematic review of scientific articles on occupational voice complaints among teachers published in the last two decades was conducted using the preferred reporting items for systematic reviews and meta-analyses statements. A retrospective bibliometric analysis was then performed using the Web of Science core collection and VOSviewer to identify scientific productivity indicators, including publications per year, productivity by country, journals, and most cited articles.

RESULTS

Based on the search eligibility criteria, a total of 473 articles were initially screened, and from this selection, 157 articles were identified as meeting the inclusion criteria and therefore included in the analysis. The analysis revealed a strong trend in scientific productivity, with a 300% increase in the number of publications during the last decade. The leading countries in publications on this field were Brazil, the United States, and Finland. The Journal of Voice, CoDAS, and Folia Phoniatrica et Logopaedica were the most frequently published journals. Additionally, the literature on voice complaints among teachers primarily focused on five conceptual clusters: vocal demand response, voice disorders, vocal health promotion, individual-associated factors, and voice symptoms.

CONCLUSION

This study examines the growing literature on voice complaints among teachers over the past 20 years, identifying key countries, journals, and thematic clusters. The findings have important implications for researchers, policymakers, and practitioners, providing insights for collaboration and guiding future advancements in the field.

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.

Vocal ergonomics with sports coaches: Co-devised approaches to occupational voice

BACKGROUND: Work-system participation and factors are associated with occupational vocal health for vocally reliant workers, such as sports coaches. However, there is limited use of systems approaches and worker collaboration to address occupational voice. OBJECTIVE: The current research aimed to cooperatively consider coaches’ vocally reliant systems participation, including addressing vocal ergonomic factors that can create barriers for occupational vocal health and voice use. METHODS: Collaborative action inquiries explored vocal ergonomics with coaches (n = 24) from nine professional basketball teams. Across three basketball seasons, coaches and a subject matter expert identified what influenced coaches’ voices and trialed approaches to optimize vocally reliant coaching participation. Nine action inquiry methods were used, including search conferences, ergonomic approaches to enhance systems participation, and focus groups. Multi-level analyses were also undertaken. RESULTS: Participants cooperatively generated, implemented, and evaluated different strategies. A cumulative total of 57 strategies were explored within teams (team mean = 6.33, SD = 3, range = 4–14). Cross-case analysis identified 25 different strategy types. Overall, participants appraised 31.58% (18/57) strategies as supportive (i.e., enhanced facilitators for voice), 61.40% (35/57) strategies as somewhat supportive (i.e., some enhanced facilitators and some ongoing barriers), and 7.02% (4/57) strategies as unsupportive (i.e., pervasive ongoing barriers not mitigated by strategies). Further, factors across coaches’ work-systems continued to influence coaches’ voices in dynamic and complex ways. CONCLUSIONS: Collaboration with coaches enriched vocal ergonomic approaches by providing novel, context-anchored insights. Collaboration should form ‘part’ of broader mechanisms to support coaches’ voice use and vocal health at work.

Correlation Between a Self-Voice Assessment and Objective-Voice Evaluation Outcomes in Speech Language Pathology Students

AIM

The aims of this study is to explore the correlation between the Voice Disorder Index (VDI) score and acoustic and phonatory respiratory voice parameters in speech language pathology (SLP) students with and without self-perceived voice disorders.

METHODS

The Voice Disorder Index (VDI) and the Lingwaves 3 "Voice Protocol" were administered to each participant in order to assess his/her self-perceived severity of his/her voice problem, as well as, acoustic and phonatory respiratory measurements. The correlation coefficients were used to evaluate and quantify the degree of a linear relationship between VDI scores and acoustic and phonatory respiratory voice measures in students with and without self-perceived voice disorders.

RESULTS

Relatively strong, strong and strong positive correlations were revealed when comparing the VDI physical subscale with the Dysphonia Severity Index (r(11) = 0.56, P = 0.048), mean loudness when reading in English (r(11) = 0.70, P = 0.008) and mean loudness when reading in Greek (r(11) =0.69, P = 0.009) respectively.

CONCLUSIONS

SLP students may be more aware of the impact of their laryngeal discomfort and voice output characteristics on their daily activities that can predict certain acoustic parameters than the emotional and functional impact on their daily activities.

The German Restructured Vocal Fatigue Index and Characteristics of Dysphonic and Vocally Healthy Populations

OBJECTIVE

The Vocal Fatigue Index (VFI), a 19-item psychometric self-report questionnaire, enables individuals with vocal fatigue (VF) to be identified and their complaints to be characterized. The purpose of this study was to improve the German-language version (VFI-G) and to evaluate further vocal fatigue-related characteristics of dysphonic and control populations.

METHODS

The VFI-G was restructured by replacing the three factors that structured the original: (1) tiredness of voice and voice avoidance; (2) physical discomfort; and (3) improvement of symptoms with rest, with two clusters developed on the basis of the results of a factor analysis by Nanjundeswaran et al. (2019). The two new clusters are: (1) tiredness and avoidance plus physical discomfort; and (2) symptom improvement through rest. One hundred one (101) individuals with voice disorders and 100 vocally healthy controls from a previous study that cross-validated the VFI-G participated in this study. In order to assess the validity of our newly adjusted VFI-G, independent samples t test, receiver operating characteristic curve, likelihood ratios and the Youden Index were calculated. The association of the two VF clusters with subject characteristics such as age, sex, type of voice disorder, and level of vocal usage was also analyzed using either a Pearson correlation or a one-way ANOVA for each of the two populations.

RESULTS

Significantly higher scores were obtained in voice-disordered subjects in both clusters (all P values < 0.001) than in healthy-voice subjects. The threshold for cluster 1 of the VFI-G was determined as ≥17.5 (74.3% sensitivity and 88.0% specificity). The results of cluster 2 are identical to that of factor 3 of the previous cross-validation study of the VFI-G. Most subject characteristics show no significant association with cluster 1 of the VFI-G, but cluster 2 seems to be moderately associated with age, type of voice disorder and level of vocal usage in the dysphonic population.

CONCLUSIONS

The restructured VFI-G showed improved validity and can be recommended for use in the assessment of VF. Cluster 2 is also moderately associated with several vocal fatigue-related subject characteristics of the dysphonic population.

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.

Occupational voice is a work in progress: active risk management, habilitation and rehabilitation

The current article reviews recent literature examining occupational voice use and occupational voice disorders (January 2018–July 2019).

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.