The Impact of Voice Disorders Among Teachers: Vocal Complaints, Treatment-Seeking Behavior, Knowledge of Vocal Care, and Voice-Related Absenteeism

Objectives

Teachers are at increased risk for developing voice disorders. Occupational risk factors have been extensively examined; however, little attention has been paid to the consequences of the vocal complaints. The objective of this study was to investigate the knowledge that teachers have about vocal care, treatment-seeking behavior, and voice-related absenteeism.

Methods

The study group comprised 994 teachers and 290 controls whose jobs did not involve vocal effort. All participants completed a questionnaire inquiring about vocal complaints, treatment-seeking behavior, voice-related absenteeism, and knowledge about vocal care. Comparisons were made between teachers with and without vocal complaints and with the control group.

Results

Teachers reported significantly more voice problems than the control population (51.2% vs 27.4%) (χ² = 50.45, df = 1, P < 0.001). Female teachers reported significantly higher levels of voice disorders than their male colleagues (38% vs 13.2%, χ² = 22.34, df = 1, P < 0.001). Teachers (25.4%) sought medical care and eventually 20.6% had missed at least 1 day of work because of voice problems. Female teachers were significantly more likely to seek medical help (χ² = 7.24, df = 1, P = 0.007) and to stay at home (χ² = 7.10, df = 1, P = 0.008) in comparison with their male colleagues. Only 13.5% of all teachers received information during their education.

Conclusions

Voice disorders have an impact on teachers' personal and professional life and imply a major financial burden for society. A substantial number of teachers needed medical help and was obligated to stay at home because of voice problems. This study strongly recommends the implementation of vocal education during the training of teacher students to prepare the vocal professional user.     

Thyroplasty revisions: frequency and predictive factors

Thyroplasty is the most commonly performed type of laryngeal framework surgery, and the surgical indications are gradually being expanded. Although many reports have described thyroplasty results and rates of success, no study has attempted to determine predictors of the need for revisions or other secondary surgical procedures. METHODS: Retrospective review of 118 primary thyroplasty procedures performed on 96 patients. Secondary surgical procedures were divided into planned second-stage procedures (all fat implantation due to scarring), touchup procedures (primarily fat or collagen injections to close localized glottic gaps), and thyroplasty revisions (for implant extrusion or slippage). Statistical analysis was performed via the chi-squared technique with p < 0.05 considered significant. RESULTS: 96 patients underwent thyroplasty, 58 for vocal fold paresis or paralysis and 38 for other indications. Thirty-two (33%) patients underwent secondary surgical procedures, including 4 planned second stage procedures, and 6 patients with progression of their underlying disease. Thirty-two secondary procedures were performed in the other 22 patients. Professional singers were found to be more likely to require touchup or planned second-stage procedures (p = 0.029). Patients with abnormal preoperative noise-toharmonic ratios were more likely to undergo secondary surgeries (p = 0.039). Maximum phonation time was not associated with need for secondary surgery. Implant material did not influence revision rates. CONCLUSIONS: Professional singers and those patients with severe voice disorders (as measured by more abnormal noise-to-harmonic ratios) are more likely to undergo secondary surgical procedures. The choice of implant material does not affect need for secondary surgical procedures.     

蜗窗激励评价的有限元计算模型研究

蜗窗驱动是实现中耳听力装置与耳蜗耦合的新途径. 利用外耳道、中耳和耳蜗集成有限元模型, 分别模拟外耳道声激励经听骨链、前庭窗传入内耳的正向传递过程和蜗窗机械激励在耳中逆向传递过程, 计算获得中耳和耳蜗的传递函数. 比较蜗窗激励和外耳道激励下耳蜗基底膜的振动, 提出了以基底膜最佳反应部位位移相等为准则的蜗窗等效激励力计算方法. 理论计算获得的蜗窗等效激励力与相关文献根据实验数据预测结果一致. 计算结果还表明耳蜗窗正、逆向激励时, 基底膜上最佳反应部位无变化, 但在蜗窗逆向激励耳蜗时, 低频下驱动基底膜运动的效率比高频时低. 所获得的理论结果可为蜗窗驱动的听力装置设计和现有装置的应用提供参考.     

Qualitative and quantitative analysis of voice onset by means of a multidimensional voice analysis system (MVAS) using high-speed imaging

High-speed filming is one of the most informative methods for assessing voice physiology data. Tracing high-speed images of the glottis provides quantitative parameters such as the glottal area and the glottal width function. By way of example, a number of studies are discussed which extract quantitative data from high-speed images showing voice onsets. Furthermore, a new computer system (MVAS; multi-dimensional voice analysis system) is presented that synchronously displays a laryngoscopic high-speed film, the electroglottographical signal, and several acoustic analyses of the recorded voice sample. The automatic measurement of glottal width and glottal area from the laryngoscopic images is also provided. Looking at former studies and our analyses of voice onsets reveals a tremendous intersubject and even intrasubject variability (different prephonatory closure, different time span until full amplitude is reached, different open quotient).