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

Association of Psychosocial Work Factors and Psychological Distress With Voice Disorders Among Secondary School Teachers

OBJECTIVES

To assess the prevalence, lifetime prevalence of voice disorders, and its association with psychosocial work factors and psychological distress among secondary school teachers.

STUDY DESIGN

Cross-sectional study.

METHODS

Secondary data from the CLUSTer study were analyzed, which included sociodemographics, psychosocial work factors (Job Content Questionnaire-22), psychological distress (Depression Anxiety and Stress Scale-21), and outcome measure of voice (Voice Handicap Index-10).

RESULTS

A total of 1216 teachers were included in this study. Majority of them were females (81.0%), of Malays ethnicity (63.9%), and were married (83.3%). Almost one-third of the participants experienced high occupational stress. Less than one-third of them were having depression (27.9%) and stress (21.8%). More than half had anxiety (53.9%). The prevalence of voice disorders was 11.2% [95% confidence interval (CI): 8.9, 14.1], and the lifetime prevalence of voice disorders was 52.4% (95% CI: 48.8, 56.0). Participants with depression (aOR = 2.50, 95% CI: 1.48, 4.22), anxiety (aOR = 2.08, 95% CI: 1.05, 4.13), and stress (aOR = 1.94, 95% CI: 1.11, 3.40) were associated with voice disorders. Psychosocial work factors such as occupational stress, supervisor support, and coworker support were not associated with voice disorders.

CONCLUSION

Psychological distress is associated with the prevalence of voice disorders among secondary school teachers. These findings can be utilized in developing, designing, and implementing interventions or programs to reduce voice disorders for school 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.

The Risk Factors of Voice Disorders in Non-University Teachers: A Systematic Review and Meta-Analysis

OBJECTIVE

Teachers are often considered to be at high risk for voice disorders. Many studies have been conducted globally. However, the risk factors included in these studies varied, and even for the same influencing factors, the results were inconsistent across studies. No uniform conclusions have yet been drawn. The aim of this study is to identify the risk factors of voice disorders in non-university teachers and to provide insights for their prevention, treatment, and mitigation of recurrence.

METHODS

In this systematic review (PROSPERO/CRD42024554265), PubMed, Scopus, Web of Science, Embase, and Wiley were searched up to January 14, 2024. A manual search was performed in gray literature through OpenGrey and ProQuest Dissertations and Theses. There was no limitations to the date of publication and language. Studies with a cross-sectional or case-control design and investigating the risk factors of voice disorders in non-university teachers were included. Two researchers performed separately to select articles, extract data, and evaluate the quality of the included studies. The 95% confidence interval and odds ratio were applied to examine the effect size. A meta-analysis was performed with a random effects model using the Stata 16.0 software.

RESULTS

A total of 23 studies were considered, with a total of 73.609 teachers. The results of this meta-analysis: sex[OR = 1.63, confidence interval (CI) (1.17, 2.28)], smoking[OR = 1.31, CI(1.00，1.72)], upper respiratory tract infections [OR = 2.88, CI(1.59，5.23)], respiratory allergies [OR = 3.02, CI(2.21, 4.10)], endocrine diseases [OR = 2.25, CI(1.52, 3.34)]; acid reflux symptoms [OR = 2.41, CI(1.32, 4.40)], stress [OR = 2.47, CI(1.45, 4.19)], lack of discipline in the classroom [OR = 1.63, CI(1.20，2.20)], physical education [OR = 1.58, CI(1.10, 2.28)], noise in the classroom [OR = 1.89, CI(1.42, 2.53)], excessive speaking [OR = 2.52, CI(1.77, 3.60)], throat clearing [OR = 2.10, CI(1.18, 3.75)], shouting [OR = 1.42, CI(1.02, 1.96)], and speaking loudly [OR = 3.06, CI(1.91, 4.91)] may contribute to the development of voice disorders. Subgroup analyses revealed that the diagnostic tool may contribute to high heterogeneity.

CONCLUSIONS

The etiopathology of voice disorders in non-university teachers is frequently complex. Multidimensional diagnosis of voice disorders plays an important role in the study of voice disorders It is imperative to undertake early vocal training and implement preventive measures to prevent the currency of voice disorders.

The effect of sound field amplification systems on vocal demand response in teachers during lessons

PURPOSE

Sound pressure level (SPL), fundamental frequency (F0), time dose (Dt), cycle dose (Dc), and distance dose (Dd) are components affecting a vocal demand response. The study aimed to investigate the impact of sound field amplification systems (SFAS) on teachers' vocal parameters and determine the user comfort of SFAS use in teachers.

METHODS

Twenty female teachers underwent long-term voice dosimetry with Vocal Holter Med (PR.O.Voice Srl) during everyday teaching activities. The SFAS PentaClassRuna (Certes) was installed in classrooms. Voice dosimetry was provided in two different acoustical conditions-without the use of SFAS (one to two days) and with SFAS (one to three days). Teachers underwent voice acoustic and laryngoscopic evaluation before voice dosimetry. Two teachers' groups were formed: teachers with and without vocal nodules. The visual analogue scale measured the user comfort of SFAS.

RESULTS

There were no significant differences in vocal parameters and vocal doses between teachers with and without vocal nodules. Voice amplification significantly decreased average F0(-4.4 Hz), Dt%(-3.1%), Dc (-0.4 kcycles), and Dd (-1.3 m) in teachers without vocal nodules and F0 (-8.9 Hz) in teachers with vocal nodules. Vocal doses (Dt%, Dc, Dd) significantly decreased in classrooms with longer reverberation time. The user comfort of the SFAS during the lessons was high in both teachers groups.

CONCLUSIONS

SFAS was a mediator between the classroom's environment and the teacher's vocal demand response; it changed teachers' voice production parameters and reduced vocal demand response to satisfy the communication requirements. In addition, voice amplification was more beneficial for teachers without vocal fold lesions.

Burden of Voice Use and Voice Disorders in Early Childhood Educators in Singapore

It is well established that teachers are prone to voice-related problems. Much of existing literature focuses on grade-school teachers, and early childhood educators are an understudied demographic. This study aims to determine the burden of voice use and prevalence of voice disorders in early childhood educators in Singapore. METHODS: A cross-sectional survey was performed in 2022. This was sent via email to all registered preschools/kindergartens in Singapore. RESULTS: There were a total of 413 responses. Mean age of respondents was 37.4years (range 28-46years) and 99.0% were female. 67.0% were Chinese, 14.8% Malay, 9.5% Indian, and 8.7% Others. Regarding burden of voice use, 81.4% of respondents reported talking for extended periods of time (>30 minutes) and 74.5% reported having to sing on >1 occasion a day. 321/413 respondents (77.9%) had to shout or raise their voice at least once a day, whereas 128 of out 413 respondents (31.1%) reported having to scream at least once a day. Point prevalence of voice disorder (defined by VHI-10 >11 was 37.5% and sVHI-10 >12) was 47.2%. Over the preceding 12months, 72.2% of respondents experienced hoarseness on at least 4-7 occasions, with 41.4% losing their voice. While 52.5% of respondents have taken at least 1 sick day off due to an issue with their voice, only 38% has consulted a GP and 13.6% consulted an ENT specialist on at least one occasion. 45.8% have considered leaving the profession on at least one occasion. Factors significantly associated with both point prevalence and year-long prevalence of voice disorders include large class size of >20 students and needing to shout and/or scream >1 time/day.

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.

Vocal health of parents of children with hearing assistive devices

Background & Objectives

VH (Vocal health) is the need of the hour. VH of parents of children with hearing assistive devices (HAD) reveals a literature gap, during the habilitation process of their children. To explore the vocal health of parents of children with hearing assistive devices.

Methods

This cross-sectional study was conducted at Riphah International University from September to December 2021. Study recruited N=384 parents of Hearing Impaired children (HIC) using HAD for at least two years, of both genders and aged 2-9 years using convenience sampling. Voice-related quality of life (V-RQOL), and vocal health Index (VHI) -10 were used for data collection. Data was analyzed on SPSS Version 25. Descriptive statistics, Anova and t-test were utilized to see difference between means of groups. P<0.05 shows significant-results.

Results

Parents of children using hearing assistive devices had excellent V-RQOL score in 350(91.14%) parents. There was no significant difference in V=RQOL as regards type of hearing assistive device use (p=0.102), laterality of device use (p=0.918) and degree of hearing loss (p=0.143). However, type of hearing loss revealed significant difference (p=0.021). Also VHI score revealed significantly (p=0.008) lower means in parents of children with cochlear implants.

Conclusion

Current study concludes that the parents raising hearing impaired children with hearing assistive devices, possess good vocal health as determined by VHI and V-RQOL scores with only a very small number of parents reporting vocal symptoms.

Effects of Occupation-Specific Vocal Stress on the Mental Health of Day Care Teachers

INTRODUCTION

Kindergarten teachers are exposed to numerous kinds of strains, such as noise, which can negatively affect their voices. This cross-sectional study investigates whether and to what extent the profession-specific high vocal demand is associated with the educators' mental health.

METHODS

One hundred and ninety-two kindergarten teachers from Magdeburg, Germany and its surrounding areas aged 43.4 ± 12.8 years, voluntarily participated in a survey. Vocal demand and vocal demand response, general strain factors, and mental health were assessed by using questionnaires (self-check on voice demands, Rudow checklist, General Health Questionnaire, and Maslach Burnout Inventory). The statistical analyses were carried out using SPSS.

RESULTS

The interviewed educators felt stressed by the excessive number of work tasks and children in each class, noisy work environment, and loud conversations. In addition, educators complained of headaches and neck pain (66%), while 28% of them experienced hoarseness and a burning throat. The mental health of 39 of the educators was impaired, and nine were at an increased risk of burnout. Self-reported voice effort correlated low with mental health (r = 0.287; p < 0.001) and burnout risk (r = 0.306; p < 0.001).

CONCLUSION

The vocal demands on educators in day care settings are very high, which is a major associated factor for the development of burnout syndrome and is also associated with headaches and neck pain. Measures for the prevention of occupational voice disorders and voice training should be a mandatory part of the educators' training and must be offered as in-service training.

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.

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.

Predictive Risk Factors and Occupational Impact of Self-Perceived Voice Problems in Preschool-Kindergarten versus First- to Sixth-Grade Teachers

AIM

The aim of this investigation was to complete a further analysis of existing data to compare risk factors of voice problems as well as create a hierarchical ranking of risk factors in preschool-kindergarten and 1st- to 6th-grade teachers in order to develop a voice hygiene program and prioritize its goals for each group of teachers.

METHODS

An online survey was completed by 148 preschool-kindergarten and 301 1st- to 6th-grade public school teachers. Participants were divided into four groups, preschool-kindergarten and 1st- to 6th-grade teachers with no self-perceived voice disorders and preschool-kindergarten and 1st- to 6th-grade teachers with self-perceived voice disorders. A χ2 test and a multivariate logistic regression model were used to examine the differences in answers between the preschool-kindergarten teachers with and without voice disorders and the 1st- to 6th-grade teachers with and without voice disorders and to identify the most important predictors.

RESULTS

The significant predictors for preschool-kindergarten teachers are frequently or sometimes continuing to talk after a breath cycle and being exposed to an excessive or a lot of noise generated in the classroom. The significant predictors for 1st- to 6th-grade teachers include having short breaks between classes and continuing to talk frequently after a breath cycle.

CONCLUSIONS

Job-related risk factors in preschool-kindergarten and in 1st- to 6th-grade teachers may vary. Therefore, a preventative vocal hygiene education program specifically tailored for each population of teachers is suggested.