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

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.

Impact of Dietary Intake and Habits on Subjective Voice and Laryngeal Mucosal Diseases: Analysis From Korean National Health and Nutritional Examination Survey Between 2008 and 2021

OBJECTIVES

Dysphonia negatively affects social communication, leading to reduced quality of life. Comprehensive research on dysphonia and laryngeal mucosal diseases using large-scale epidemiological data is lacking. Therefore, we investigated how dietary and habitual factors influence dysphonia and laryngeal mucosal diseases using data from the Korean National Health and Nutritional Examination Survey.

STUDY DESIGN

A population-based cross-sectional study.

METHODS

The study included individuals aged 19 years and older who both underwent laryngoscopic examinations and completed a dysphonia survey. Dietary and habitual factors and results of the laryngoscopic examinations were collected. Risk factors for dysphonia and laryngeal mucosal diseases were identified.

RESULTS

The weighted frequency of dysphonia and laryngeal mucosal diseases was 6.4% and 6.0%, respectively. In univariable analyses for dysphonia, sex, body weight change, alcohol ingestion, and various minerals and vitamins showed statistically significant associations. However, in the multivariable analysis, only age, body weight, female sex, and vitamin A intake were significantly associated with dysphonia. Age, body weight, body mass index, sex, smoking, amount of sodium intake, and alcohol intake were associated with laryngeal mucosal diseases in the univariable analyses, but in the multivariable analysis, only age, smoking, and amount of niacin intake were significant factors.

CONCLUSIONS

In this large-scale epidemiological analysis, subjective dysphonia and laryngeal mucosal diseases had different frequencies and risk factors. Age was a risk factor for both dysphonia and mucosal diseases, but smoking was only a risk factor for laryngeal mucosal diseases. Diet types, calories, and water and alcohol intake were not significant risk factors for either laryngeal mucosal diseases or dysphonia.

Occupational well-being among health and social care educators: Structural equation modelling

This study tested whether empirical data about health and social care educators' occupational well-being would fit the proposed Content Model for the Promotion of the School Community Staff's Occupational Well-being. Descriptive, cross-sectional survey was conducted with 552 health and social care educators in 2020. Results confirmed that the four-aspect Content Model for the Promotion of School Community Staff's Occupational Well-being is suitable for promoting health and social care educators' occupational well-being, with some modifications. The results strengthen the view of occupational well-being as a wide-ranging phenomenon, the development of which should take into account four aspects of promoting occupational well-being.

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

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

A General Survey of Pharynlaryngeal Diseases and Voice Disorders Among Basic Education Teachers in Tianjin

OBJECTIVE

In this study, we created a city-wide database of pharynlaryngeal diseases and voice disorders among basic education teachers to analyze the incidence, distribution, and risk factors of pharynlaryngeal diseases and voice disorders.

METHODS

A total of 47,823 teachers in primary and secondary schools and kindergartens of Tianjin were enrolled in this study and underwent questionnaires and throat examinations. In addition, the data were subjected to descriptive statistics, chi-square analysis, and univariate and multivariate logistic regression analyses.

RESULTS

Pharynlaryngeal diseases and voice disorders had an overall prevalence of 69.42% among basic education teachers in Tianjin, wherein the prevalence of chronic pharyngitis, chronic hyperplastic laryngitis, and chronic simple laryngitis were the highest at 39.45%, 19.80%, and 15.59%, respectively. The results of multivariate logistic regression analysis suggest that pharynlaryngeal diseases and voice disorders were statistically correlated with gender (P < 0.001), years of teaching (P < 0.001), school district (P < 0.001), class size (P < 0.001), subjective assessment of teachers on vocal loudness (P < 0.001), neck and shoulder discomfort (P < 0.001), smoking (P < 0.001), psychological stress (P = 0.002), and frequent habitual throat clearing (P < 0.001). Furthermore, the risk factors for pharynlaryngeal diseases and voice disorders were age (P = 0.002), school district (P < 0.001), class size (P = 0.008), neck and shoulder discomfort (P = 0.038), smoking (P < 0.001), water intake habits during class (P = 0.023), and frequent habitual throat clearing (P = 0.001) for male teachers, and for female teachers, it was age (P < 0.001), school district (P < 0.001), daily teaching hours (P = 0.005), class size (P < 0.001), subjective assessment of teachers on vocal loudness (P < 0.001), neck and shoulder discomfort (P < 0.001), smoking (P = 0.033), psychological stress (P = 0.003), and frequent habitual throat clearing (P < 0.001).

CONCLUSION

Due to the high prevalence of pharynlaryngeal diseases and voice disorders among basic education teachers, throat and voice health education-related activities should be conducted for teachers to intervene in the occurrence of pharynlaryngeal diseases and voice disorders at an early stage.

Work-Related Vocal Challenges of Online Teaching: A Study of Female College Professors

BACKGROUND

College professors are at an elevated risk of developing voice disorders due to increased vocal demands associated with their working conditions, including high background noise levels, long reverberation times, prolonged voice use duration, and large class sizes. However, the impact of online classes on vocal health among college professors remains unclear.

OBJECTIVE

This longitudinal study aimed to characterize voice changes associated with online teaching among female Colombian college professors.

METHODS

Thirteen female college professors teaching online classes completed an online survey that included questions about voice functioning, working conditions, the Spanish translation of the Vocal Fatigue Index (VFI), and the Spanish translation of the Voice-Related Quality of Life. Instrumental measurements were also performed, including environmental background noise levels, hearing screening, and voice recordings before and after a synchronous online class.

RESULTS

This study found a decreased fundamental frequency in connected speech (reading) associated with the number of students per class, the number of classes per week, and background noise levels measured with a sound level meter. L1L0 was statistically smaller among experienced teachers with higher background noise levels compared with less-experienced colleagues in quieter classes. 1558kHz was statistically associated with the average number of students, whereas HNR was slightly higher for professors with more students and more classes per week.

CONCLUSION

The findings suggest that online teaching has important implications for voice production among participating teachers. This study highlights the importance of considering working conditions during online classes when designing workplace prevention programs for college professors.

Factors Associated With the Limitation at Work Because of the Voice: Study With Teachers of Basic Education In Brazil

INTRODUCTION

The voice disorder can cause limitations at work, as it affects the communication and the performance of the teaching function.

OBJECTIVE

To analyze the limitation at work because of the voice and to examine possible associations with sociodemographic characteristics, life and health habits and work conditions among Basic Education teachers in Brazil.

METHODS

Cross-sectional epidemiological study, with a representative sample, carried out between October 2015 and March 2016, with 6,324 teachers working in Basic Education in Brazil. Data collection was carried out through the application of a questionnaire via telephone with questions regarding health and working conditions. The "limitation at work because of the voice" was considered a dependent variable, whose response options were a scale with four Likert items that varied from frequently to never. The independent variables were grouped in blocks for ordinal logistic regression analysis with hierarchical entry. The magnitude of the association was assessed by the Odds Ratio (OR) with the respective confidence intervals (95% CI).

RESULTS

One third of Brazilian teachers (32.7%) reported some frequency of limitation at work (sometimes; rarely, frequently) because of the voice at some moment in the month before the survey and, of these, 5% declared high frequency. The factors that increased the chance of a greater frequency of limitation at work because of the voice were: being female (OR = 1.32; 95% CI = 1.15-1.51); teaching for elementary school (OR = 1.35; 95% CI = 1.02-1.78); use anxiolytic or antidepressant medications (OR = 1.46; 95% CI = 1.20-1.78); losing sleep due to concerns (OR = 1.69; CI = 95% = 1.46-1.95); high noise at school (OR = 2.09; 95% CI = 1.78-2.46); agitated environment by students' indiscipline (OR = 1.37; 95% CI =1.15-1.63); high demands at work (OR = 1.18; 95% CI = 1.02-1.36); not having social support (OR = 1.19; 95% CI = 1.04-1.38); having suffered verbal violence by the students (OR = 1.43; 95% CI = 1.23-1.67). On the other hand, the practice of regular physical activity (OR = 0.86; 95% CI = 0.75-1.00) and the fact of having enough time to complete work tasks (OR = 0.71; 95% CI = 0,62-0.82) decreased the chance of a higher frequency of limitation at work due to vocal problems. The perception that the work limits the teaching performance because of the voice was more frequent among teachers in the North (OR=1.41; 95% CI = 1.17-1.71) and Northeast (OR=1.46; 95% CI = 1.22-1.76) compared to the Southeast region.

CONCLUSION

Factors associated with an increase in the chance of higher frequency of reporting work limitations due to the voice: being female, lack of physical activity, losing sleep due to concern, using anxiolytic or antidepressant medication, school location in the North and Northeast, teaching for the elementary school stage, high noise at school and psychosocial aspects of work organization. The Brazilian educational sector needs public policies that take into account regional inequalities and the health and work conditions of teachers.

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.

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.

Self-assessment of teachers with normal larynges and vocal and osteomuscular complaints

INTRODUCTION

Teachers face vocal problems related to long periods of speech and increased sound pressure, as well as environmental noise, inadequate posture and tension of the cervical muscles.

OBJECTIVE

To verify the results of self-assessment of teachers with normal larynges and vocal and musculoskeletal complaints, and compare them with the reference values.

METHODS

Fifty-seven teachers, aged between 21 and 60 years (average 40.14 years) participated in the study. Anamnesis, otorhinolaryngological examination, hearing screening and self-assessment protocols were performed.

RESULTS

In the Nordic musculoskeletal questionnaire, the majority of teachers had discomfort in most parts of the body and in the situations evaluated; on the voice-related quality of life, the total and physical subscores were lower than the normative values while the emotional subscore was higher; regarding voice symptoms scale and vocal tract discomfort scale, the scores were higher than the normative values; in the hospital anxiety and depression scale, there was alteration in the total score; in the Vocal Activity and Participation Profile, the effects on work and emotion were above the normative values; on the University of Rhode Island change assessment-voice and on the voice handicap index there were no significant differences.

CONCLUSION

Most of the teachers presented vocal, musculoskeletal, and emotional complaints on the self-assessment results, what suggests excessive voice use as well as overload on the body muscles, including the larynx and vocal tract, and that they presented emotional changes. These aspects had an impact on their quality of life, but they showed no action in coping with the condition.

Perception of Primary School Teachers Towards Voice Problems and Vocal Health-Seeking Behaviors: A qualitative study

OBJECTIVE

Teachers are the most common occupational group reporting to the voice clinics with dysphonia across the globe. However, less is known about teachers' perceptions about their voice and voice problems. Hence the present study aimed to explore teachers' perception about their teaching voice, voice problems and vocal health-seeking behaviors.

METHOD

A qualitative phenomenological research design using semi-structured interviews were conducted with fifteen female primary school teachers. Participants were asked to express their perception of teaching voice, vocal health care knowledge, and vocal hygiene practices. Using inductive analysis, the researchers converted the raw data into concepts or themes and discussed.

RESULT

The present study results showed that teachers perceive voice as the primary tool for their profession. However, teachers consider voice problems as part of their professional commitments. Despite knowing the harmful effects of voice problems, teachers' pay less attention to their voice problems and perceive them as usual, unavoidable and part of their profession. Due to their demanding work schedule and not getting enough support from the management, they hesitate to consult medical professionals unless it severely affects them.

CONCLUSIONS

The data obtained from this study can be used to improve the teachers' knowledge regarding vocal health and convince the school management to extend their support for the successful implementation of the vocal health training programs for teachers.

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.

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).

Relationship Between Sleep Quality and Stress with Voice Functioning among College Professors: A Systematic Review and Meta-analysis

BACKGROUND

Sleeping is the most critical stage in the psychological and somatic recovery process. Sleep deficiency can lead to changes in the breath pattern that might contribute to the appearance and development of voice disorders. Sleep can also compromise the individual's communicative competence. Work-related stress is a risk factor for serious health and mental issues, including voice and sleep disorders. Recovery from stress is fundamental in order to preserve health, wellbeing, and work performance. No systematic review of the literature or meta-analysis concerning this relationship has been performed yet.

OBJECTIVE

To define the association of voice disorders with sleep quality and stress among teachers.

METHODS

A systematic review of literature and meta-analysis were performed. Three computerized databases were used to characterize the relationship between voice disorders among teachers with sleep quality and stress. Information such as year of publication, study population, sample size, stress/sleep exposure, voice outcome, and prevalence were extracted from each paper. All the included articles were measured in terms of their methodological quality.

RESULTS

In total, 10 publications met the criteria for inclusion. The point prevalence of voice disorders ranged widely for both sleep quality (12% to 81%), and for stress (17% to 81%). Teachers who reported stress at work were more likely to report voice disorders. Additionally, teachers who reported having slept more than 6 hours per day were less likely to report a voice disorder.

CONCLUSION

This study provides evidence about the relationship between sleep quality and work-related stress with voice functioning. Although, included studies had low quality and the number of studies was low, our results suggest that the increased occurrence of voice disorders among teachers with high stress and work and less than 6 hours/day of sleep. Future investigation should aim to identify how sleep quality and stress interact in relation to voice functioning.

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

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

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.