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

Vocal Problems and Burnout Syndrome in Nonuniversity Teachers in Galicia, Spain

INTRODUCTION

Voice disorders and burnout syndrome are common among teachers. This study aimed to explore the relationship among vocal problems, burnout syndrome, and some personal work factors.

METHODS

This cross-sectional descriptive study enrolled 90 nonuniversity teachers who completed the Multidimensional Vocal Scale for Teachers (EVM-D) to evaluate vocal problems and an adapted Spanish version of the Maslach Burnout Inventory-Educators Survey (MBI-ES) to detect burnout syndrome.

RESULTS

Overall, 16% of teachers expressed symptoms compatible with burnout, and 60% of them were in the interval above the 75th percentile of the EVM-D, i.e., they had a high risk of vocal problems. An association between burnout and more vocal problems was established among teachers, particularly between the vocal symptoms and vocal abuse dimensions with the emotional exhaustion subscale of the MBI-ES. A history of anxiety/depression and fewer years of professional experience were associated with more vocal problems. The burnout group perceived more "loss of vocal power," "vocal fatigue," "vocal effort," and "hoarseness." Vocal abuse items received the highest scores of EVM-D. However, only "shouting" in the classroom was significantly different between the groups with and without burnout.

CONCLUSION

Emotional exhaustion of burnout syndrome, history of anxiety/depression, and a shorter professional experience were associated with vocal problems, which could limit the performance of teachers. Reducing classroom noise, establishing strategies to avoid shouting, or strengthening personal accomplishments in teachers could be useful in breaking the cycle of vocal problems and emotional exhaustion, particularly at the beginning of their professional experience.

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.

Systematic Review of Literature on Prevalence of Vocal Fatigue Among Teachers

BACKGROUND

Previous results suggest that teaching is a high-risk profession for developing voice disorders.

OBJECTIVE

This study aims to determine the prevalence of vocal fatigue among teachers and its relationship with voice acoustic parameters reported in previous studies.

METHOD

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement Guidelines, we performed a systematic literature review including five databases: Scopus, Scielo, ScienceDirect, PubMed, and Web of Science. Information on study population, definition and evaluation of vocal fatigue, and teaching characteristics were extracted from each paper. The quality of the included publications was assessed using the "Quality assessment tool for quantitative studies".

RESULTS

In total, 14 publications met the inclusion criteria. The two most common work-related factors of vocal fatigue were high levels of noise inside classrooms and loud speaking voice use. Some investigations reported voice acoustic parameters such as fundamental frequency and vocal Sound Pressure Levels as associated with vocal fatigue.

CONCLUSION

Vocal fatigue is a prevalent symptom among teachers associated with teaching vocal demands. However, studies on objective parameters that complement self-reports, to quantify vocal fatigue are needed to determine permissible values for healthy occupational voice use.

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.

ROC Analysis Cut-off Points of Hellenic Voice Handicap Index for Neurogenic Voice Disorders Patients: an Exploratory Study

OBJECTIVE

The inclusion of subjective methods for evaluating Voice Disorders is proven an essential factor for diagnosis as these methods include self-reported questionnaires (eg, Voice Handicap Index-VHI) for everyday clinical practice. In turn, by obtaining cut-off scores of self-perceived questionnaires intended for assessment procedures of different voice disorders (eg, patients with neurological problems), the clinicians might be helped toward finding their patients' needs leading to better monitoring, and treatment suggestions. Consequently, the purpose of this study was to estimate the cut-off scores for the Greek VHI relevant to patients with neurogenic voice disorders.

METHODS

Ninety subjects participated in this research. Sixty-six of them served as the control group while the remaining 24 patients exhibited Neurogenic Voice Disorders (eg, spasmodic dysphonia or vocal fold paralysis). They filled in the VHI and the Voice Evaluation Template. All participants were examined with the use of video laryngeal endoscopy and stroboscopy.

RESULTS

The analysis revealed higher medians in all domains (of the VHI) for the patients compared to the control group. The cut-off points were estimated at the values of 24.50 (Total Score-AUC 0.932, P = 0.000), 9.00 (Functional Domain-AUC 0.917, P = 0.000), 10.00 (Physical Domain-AUC 0.948, P = 0.000), and 9.00 (Emotional Domain-AUC 0.830, P = 0.000).

CONCLUSION

The estimated cut-off scores are in agreement with previous studies. These scores could probably used to enhance therapeutic monitoring of patients who suffer from neurogenic voice disorders. This study underlines the importance of considering different cutoff points for individuals with voice disorders due to diverse neurogenic etiologies.

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

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

A one-school year longitudinal study of secondary school teachers' voice parameters and the influence of classroom acoustics

Recent literature reports that a large percentage of teachers complain that teaching has an adverse effect on their voice status. Thus, more needs to be done to study their vocal behavior. The objective of this longitudinal study was twofold: to determine changes in the voice use of teachers over a school year, and to study the relationships between voice use and classroom acoustic parameters. Thirty-one teachers from two secondary schools in Turin (Italy) were involved at the beginning of the 2014-2015 school year, and 22 of them also participated at the end of the same school year. The results show that teachers adjust their voices with noise and reverberation. A minimum value of the sound pressure level of voice (SPL) was found at a mid-frequency reverberation time of 0.8 s in both periods. Moreover, the teachers who worked in the worst classroom acoustic conditions showed an increase of 2.3 dB in the mean SPL and a decrease of 10% in the voicing time percentage at the end of the school year. A predictive model that can be used to estimate the mean SPL from the background noise level and the reverberation time, based on collected data, is here proposed.