Prevalence of voice symptoms and risk factors in teacher students

Teacher students seem to have low awareness of the vocal demands in their future professions, and students with vocal symptoms are at risk for developing voice disorders during their professional careers. The purpose of the present study was to determine the prevalence of voice problems in teacher students at the very beginning of their education at the university. Of 1636 students approached in the first couple of days, 1250 (76%) answered two questionnaires about voice symptoms, Screen6 and Swedish Voice Handicap Index (Sw-VHI), and one questionnaire about potential risk factors. A majority of the students were women, and their mean age was 23 years (range, 18-52 years). The results showed that 208 of 1250 students (17%) had voice problems, defined as at least two symptoms weekly or more often in Screen6. The proportion of women was larger in the group with voice problems than in the group without voice problems. Significant risk factors for voice problems were vocal fold problems in childhood and adulthood, frequent throat infections, airborne allergy, smoking, hearing problems, previous work as teacher or leader, voice demanding hobbies, and previous speech therapy or voice training. There was a clear association between the number of potential vocal risk factors and the number of voice symptoms. There was also a strong association between the scores of the two questionnaires, the Sw-VHI and the Screen6. Students with voice problems according to Screen6 scored 23.1 (mean Sw-VHI) compared with 7.8 for students without voice problems.     

Voice problems and risk factors among aerobics instructors

Fifty female and four male aerobics instructors completed a questionnairepertaining to vocal problems and variables that could indicate an increased risk for developing problems. The questions concerned teaching experience, physical data regarding instructional facilities, method of voice projection, music volume, history of illness, allergies, voice loss, hoarseness, smoking habits, and knowledge of vocal hygiene. The results showed that a significant number of instructors experienced partial or complete voice loss (44%) during and after instructing, as well as increased episodes of voice loss, hoarseness, and sore throat unrelated to illness since they began instructing. Significant variables associated with voice problems included sore throat and hoarseness following instruction, and shouting to cue the participants. It was also found that very few instructors in this study had any knowledge of vocal hygiene techniques.     

Epidemiological Study of Voice Disorders Among Teaching Professionals of La Rioja, Spain

The purpose of the present study was to calculate the prevalence and incidence of voice disorders among teaching staff and find out the associated occupational risk factors. A case-control study was performed with 905 teachers, 579 cases and 326 controls; 492 were randomly selected and 413 volunteered. All teachers were asked to fill out a standard questionnaire. Next, a complete laryngeal exam was performed including a general ear, nose, and throat evaluation and videolaryngostroboscopy. The prevalence of voice disorders among teaching staff was 57%. The most prevalent lesions were vocal overstrain (18%), nodular lesions (14%), and hyperfunctional dysphonia (8%). The incidence rate was 3.87 new cases per year per 1000 teachers. Women had organic lesions three times more than men (odds ratio [OR]: 3.52, confidence interval [CI]: 2.04-6.09). However, men had chronic laryngitis three times more than women (OR: 2.93, CI: 1.50-5.71) and functional dysphonia nearly twice more than women (OR: 1.81, CI: 1.21-2.69). We find a significant risk of suffering voice disorders in teachers who smoke daily (OR: 2.31, CI: 1.58-3.37) and who drink several cups of coffee or tea (OR: 1.87, CI: 1.36-2.56). It is advisable to carry out an annual evaluation of all teaching staff on account of the high prevalence of voice disorders among them.     

Musculoskeletal Patterns in Patients With Voice Disorders

This study correlated the ear, nose, and throat (ENT) and physiotherapy input on 26 patients who presented with voice problems and were found by the ENT surgeon to have a degree of musculoskeletal issues. It also looked for patterns of musculoskeletal findings. Although all patients referred were found by the physiotherapist to have musculoskeletal abnormalities, the correlation proved to be excellent among the subgroup of performers, but only fair-to-good among the other voice professionals. Certain patterns of musculoskeletal abnormalities were frequently encountered, including a high held larynx, a shortening or contraction of the stylohyoid and sternocleidomastoid muscles, and a weak deep flexor mechanism. In this small group, most patients seemed to improve, although it must be noted that management was not limited to physiotherapy. In summary, physiotherapy input proved helpful in the evaluation and management of this group of patients presenting with voice problems.     

Voice Care Knowledge Among Clinicians and People With Healthy Voices or Dysphonia

An important clinical component in the prevention and treatment of voice disorders is voice care and hygiene. Research in voice care knowledge has mainly focussed on specific groups of professional voice users with limited reporting on the tool and evidence base used. In this study, a questionnaire to measure voice care knowledge was developed based on "best evidence." The questionnaire was validated by measuring specialist voice clinicians' agreement. Preliminary data are then presented using the voice care knowledge questionnaire with 17 subjects with nonorganic dysphonia and 17 with healthy voices. There was high (89%) agreement among the clinicians. There was a highly significant difference between the dysphonic and the healthy group scores (P = 0.00005). Furthermore, the dysphonic subjects (63% agreement) presented with less voice care knowledge than the subjects with healthy voices (72% agreement). The questionnaire provides a useful and valid tool to investigate voice care knowledge. The findings have implications for clinical intervention, voice therapy, and health prevention.     

Psychosocial Impact of the Teacher''s Voice Throughout the Career

It is generally accepted that vocal performance decreases with age. This decrease can be expected to be more pronounced in voice loading professions, which may lead to occupational dysphonia. The aim of this study was to investigate the course of voice complaints, experienced handicap, and absenteeism of work due to voice problems throughout the teaching years. Questionnaires were distributed among teachers of primary and secondary education, and 1875 were analyzed. The questionnaire was designed in such a way that personal aspects and questions about periods with symptoms and absence from work were included. The Voice Handicap Index (VHI) developed by Jacobson et al was sent along with the questionnaire. Surprisingly, a significant decrease of voice complaints during the career of the teachers was observed. The expectation that the percentage of teachers with a history of voice problems should experience more psychosocial impact, measured with the VHI, along their professional career could not be confirmed by this study. These results indicate that serious attention has to be paid to teachers with voice complaints. The fact that teachers in the beginning of their career complain more than in the end of their career emphasizes the importance of adequate aimed prevention programs for future teachers and for starting teachers with regard to their voice.     

Voice and Physical Appearance in Female-to-Male Transsexuals

The study aims to investigate if a similar interaction between physical appearance and voice could be found in female-to-male transsexuals as had been observed in male-to-female transsexuals. A panel of judges rated “maleness” of seven female-to-male transsexuals from video-recorded speech samples using three modes of presentation: auditory-only presentation, visual-only presentation, and audiovisual presentation. For the group of transsexuals as a whole, no significant differences were found between scores given in the auditory-only mode or the visual-only mode and those given in the audiovisual mode. Analysis of individual results, however, yielded significant differences in some individuals and there was some relation with hormone treatment. There was no significant correlation between the ratings of “maleness” in the auditory-only mode and fundamental frequency. Physical appearance in female-to-male transsexuals appears not to be a strong influencing factor in general, but may interact with gender recognition based on the voice in some individuals. The absence of a correlation between fundamental frequency and rating of maleness could mean that in female-to-male transsexuals, fundamental frequency is a relatively less important factor for gender expression or perhaps also that a higher voice in males is more accepted than a lower voice in females.     

Vocal Fatigue—Do Young Speech-Language Pathologists Practice What They Preach?

PurposeSpeech-Language Pathologists can be categorized as Level II professional voice users who play the roles of voice therapist or vocal coach to treat voice problems. SLPs may be at the risk of experiencing vocal fatigue due to vocal loading and other contributing factors. The present study was undertaken to find the percentage of SLPs reporting vocal fatigue, the probable factors resulting in vocal fatigue, the measures that are taken to avoid/reduce the occurrence of vocal fatigue, its effect on their professional and personal life and the measures taken to tackle it.ResultsThe results of this study are based on data collected from 142 SLPs and 50 controls using a questionnaire. 71.13% SLPs reported that they experience vocal fatigue. Some of the contributing factors that are mainly reported are long durations of voice use, voice use for recreational purposes, speaking loudly, frequent throat clearing, lack of adequate hydration and working in noisy or air-conditioned environments. The major symptoms reported were dryness in throat, tightness in neck and shoulder, choking sensation, effortful speech and pain in the throat. 59% SLPs reported that vocal fatigue affected their professional life while 44% SLPs reported that it affects their personal life also to varying degrees. Measures taken to avoid/ reduce the occurrence of vocal fatigue included vocal warm up, break in between sessions, and play activities. Only a few SLPs took intervention measures like ENT consultation, voice therapy, and home remedies.ConclusionSLPs are inevitably at high risk of experiencing vocal fatigue which, if left untreated, will lead to organic voice problems. However, many young SLPs who experience vocal fatigue reported vocal abuse, do not follow vocal hygiene program and do not follow evidence-based preventive or intervention practices to treat vocal fatigue.     

Treatment Outcomes for Professional Voice Users

Professional voice users comprise 25% to 35% of the U.S. working population. Their voice problems may interfere with job performance and impact costs for both employers and employees. The purpose of this study was to examine treatment outcomes of two specific rehabilitation programs for a group of professional voice users. Eighteen professional voice users participated in this study; half had complaints of throat pain or vocal fatigue (Dysphonia Group), and half were found to have benign vocal fold lesions (Lesion Group). One group received 5 weeks of expiratory muscle strength training followed by six sessions of traditional voice therapy. Treatment order was reversed for the second group. The study was designed as a repeated measures study with independent variables of treatment order, laryngeal diagnosis (lesion vs non-lesion), gender, and time. Dependent variables included maximum expiratory pressure (MEP), Voice Handicap Index (VHI) score, Vocal Rating Scale (VRS) score, Voice Effort Scale score, phonetogram measures, subglottal pressures, and acoustic and perceptual measures. Results showed significant improvements in MEP, VHI scores, and VRS scores, subglottal pressure for loud intensity, phonetogram area, and dynamic range. No significant difference was found between laryngeal diagnosis groups. A significant difference was not observed for treatment order. It was concluded that the combined treatment was responsible for the improvements observed. The results indicate that a combined modality treatment may be successful in the remediation of vocal problems for professional voice users.     

Voice disorders in patients with suspected laryngo-pharyngeal reflux disease

Many symptoms have been recognized in association with laryngo-pharyngealreflux disease (LPRD), but reports of perceptual voice disorders in this condition have been lacking to date. Forty-nine patients with suspected LPRD were studied for five specific perceptual voice characteristics, and these characteristics were compared to the same characteristics in individuals who had never seen an Otolaryngologist for a voice disorder or throat problem (controls). Sixteen of the suspected LPRD patients also underwent 24-hour pH probe studies. All patients with suspected LPRD had significantly increased abnormal perceptual voice characteristics (musculoskeletal tension, hard glottal attack, glottal fry, restricted tone placement, and hoarseness) compared to the controls. Statistical objective differences between the two groups was demonstrated by the presence of increased shimmer in patients with suspected LPRD compared to controls. The differential diagnosis between functional voice disorders and LPRD may be complex, and perceptual parameters may overlap. Interdisciplinary evaluation is advocated.