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| OJHAS Vol. 11, Issue 2:
(Apr-Jun 2012) |
Original Article
Risk Factors for Hyperfunctional
Voice Disorders Among Teachers
Authors
Swapna Sebastian, Associate Professor (Speech Language
Pathologist & Audiologist), Department of ENT, Christian Medical College and
Hospital, Vellore,
Benedict
Anto Suresh, Social Worker, Marthoma College of Special Education,
Kasaragod, Kerala,
Santhosh Simon, Speech Language
Pathologist & Audiologist, Marthoma College of Special Education,
Kasaragod, Kerala,
Achamma Ballraj, Professor and Head, Department of ENT, Christian Medical College and
Hospital, Vellore.
Address for Correspondence
Dr. Swapna Sebastian,
Associate Professor (Speech Language
Pathologist & Audiologist),
Department of ENT,
Christian Medical
College, Vellore,
Tamilnadu, India.
E-mail:
swapna_santhosh@yahoo.co.in
Citation
Sebastian S, Suresh BA, Simon S, Ballraj A. Risk Factors for Hyperfunctional
Voice Disorders Among Teachers. Online J Health Allied Scs.
2012;11(2):6. Available at URL:
http://www.ojhas.org/issue42/2012-2-6.htm
Open Access Archives
http://cogprints.org/view/subjects/OJHAS.html
http://openmed.nic.in/view/subjects/ojhas.html
Submitted: May 28,
2012; Accepted: Jun 29, 2012; Published: Jul 25, 2012 |
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Abstract: The aim of the study was to assess the prevalence
of voice problems among teachers, and identify risk factors for developing
voice pathology. In this study we evaluated 448 teachers (400 females
and 48 males) between the age range of 25 to 55 years, from primary
school as well as secondary school which were selected randomly. A questionnaire
was given to them to find out how many of them had a voice problem.
All the positive cases were further evaluated by an Otorhinolaryngologist,
an Audiologist and a Speech Language Pathologist. Out of the 448 teachers, 39 of them(9%)
had an indication of voice disorder based on the positive respose got
from the questionnaire. Among the 39 cases identified 11 were males
(28%) and 28 were females (71%). We tried to investigate on the factors
that would have contributed to voice problem in the identified 9% of
cases .Detailed history was taken and was examined by an otorhinolaryngologist,
an audiologist and a Speech Language Pathologist.Out of the 39 cases
identified 26% had history of recurrent allergic rhinitis and laryngitis,
18% had sinusitis and post nasal drip, 18% had asthma, 26% had gastoesophageal
reflux disorder, (8%) had minimal sensori neural hearing loss and hypothyroidism
was found in 8%. Interaction of multiple factors like hereditory,
behavioral, lifestyle, medical and environmental can contribute to voice
disorders in occupational voice users. Teachers need to be educated
regarding vocal mechanism, vocal hygiene and effective voice use , dust
free and noise free work environment, diet modification like drinking
adequate water, avoiding spicy and deep fried food, regularizing
meals and avoiding sleeping immediately after food. The underlying medical
issues like allergy, sinusitis, laryngitis, hypothyroidism, gastroesophageal
reflux, hearing loss etc also need to be addressed , since vocal hygiene
alone will not help until and unless the underlying cause is taken care
of.
Key Words:
Hyperfunctional voice disorder; Risk factors |
Introduction:
Hyperfunctional voice disorders are conditions of
abuse and/ or misuse of the vocal mechanism due to excessive and/ or
imbalanced muscular forces.(1) In some cases, these excessive and/ or
imbalanced muscular forces can produce vocal fold lesions such as nodules,
contact ulcers, hemorrhages or polyps and in some cases can lead to excessive
intrinsic and extrinsic laryngeal muscle contraction, producing a tight,
strangled sound similar to adductor spasmodic dysphonia called muscle
tension dysphonia.(2)
Hyperfunctional voice disorders are more common in
occupational voice users.The most commonly studied group among occupational
voice users are teachers.Prevalence of voice problems is more in teachers
compared to other professional categories.(3) Reports show that 16%
(4) to 18% (5) of the voice cases of Speech Pathologists are people
from teaching profession. Prevalence of voice problems among teachers
varied between 20% to 75%.(4,6,7) The variation in the prevalence
can be due to the variation in the methodology used and the operational
definition of voice disorder used.
Vocal abuse and misuse as well as poor acoustic
environments of the classroom have been frequently reported as the cause
for vocal problems among teachers.(8) Medical, individual, psychological
and emotional factors has also been reported to play a role in the development
of voice disorders.(9,10)
Methodology
In this study we evaluated 448 teachers (400 females
and 48 males) between the age range of 25 to 55 years, from primary
school as well as secondary school which were selected randomly.
All the teachers selected for the study had an average teaching duration
of 5 hrs per day. A questionnaire was given to them to find out how
many of them had a voice problem. The questionnaire consisted of the
following questions.
- Whether there is a feeling of mucus or lump in the throat
- Feeling that effort is needed for speaking.
- Tendency to lose voice frequently
- Irritation in the throat
- Needs to clear the throat frequently
- Has change in the quality of voice
- Feels tired or fatigued after speaking for some time
- Has medically confirmed voice disorder
If answer to any of the questions were positive,
they were further evaluated by an otorhinolaryngologist, an audiologist
and a Speech Language Pathologist.
Results
Out of the 448 teachers, 39 of them (9%) had an indication of voice disorder based on the positive response got from the questionnaire. Among the 39 cases identified 11 were males (28%) and 28 were females (71%). Females had a higher prevalence of voice disorders compared to men. We tried to investigate on the factors that would have contributed to voice problem in the identified 9%. Detailed history was taken and were examined by an otorhinolaryngologist, an audiologist and a Speech Language Pathologist.
| Table 1: Details of the factors associated with voice disorder |
| Factor |
No of patients |
% of total identified cases |
| Male
|
Female
|
Male |
Female |
| Recurrent allergic rhinitis and laryngitis |
4 |
6 |
10% |
15% |
| Sinusitis and post nasal drip |
3 |
4 |
8% |
10% |
| Asthma |
1 |
6 |
3% |
15% |
| Hearing loss (minimal sensorineural) |
1 |
2 |
3% |
5% |
| Hypothyroidism |
0 |
3 |
- |
8% |
| Gastro esophageal reflux disorder |
3 |
7 |
8% |
18% |
| Deviated nasal septum |
1 |
0 |
3% |
- |
Out of the 39 cases identified 26% had history
of recurrent allergic rhinitis and laryngitis, 18% had sinusitis and
post nasal drip, 18% had asthma and 26% had gastoesophageal reflux
disorder. Minimal sensori neural hearing loss was found in 3 (8%) and hypothyroidism was found in 8% of the total identified cases with
voice problem.
Based on the evaluation the positive cases were diagnosed
as follows:
| Table 2: Diagnosis of Postive Cases |
| Voice disorder |
No of patients
|
%
|
| Male |
Female |
Male |
Female |
| Muscle Tension Dysphonia |
0 |
2 |
- |
5% |
| Reinke’s edema |
1 |
2 |
3% |
5% |
| Vocal Polyp |
2 |
4 |
5% |
10% |
| Vocal nodule (soft) |
2 |
7 |
5% |
18% |
| Laryngitis
|
3 |
6 |
8% |
15% |
| Congestion of vocal cords |
3 |
7 |
8% |
18% |
Other contributing factors identified were additional
use of voice after the regular classes in 4 of the female teachers who
were giving private tuition to students after the regular school hours.
The total voice use was more than for 7 hours in them.
Discussion
Our study revealed that only 9% of the teachers showed
a voice problem. We tried to study the factors that would have contributed
to the voice problem in this 9%. The major medical factors that we found
to be associated were allergic rhinitis, laryngitis, sinusitis, gastroesophageal
reflux, minimal sensori neural hearing loss and hypothyroidism
The source of energy for voice production is the
air from the lungs. The respiratory ability to support speech can be
affected by respiratory illness especially asthma and medications as
supported by the previous studies.(11-14) Inhalation of
corticosteroids by asthma patients can also cause laryngeal irritation.(14) Respiratory illnesses, chronic allergic rhinitis and sinusitis
(11-13) and gastroesophageal reflux disorders (15) have been reported
to affect the vocal fold mucosa. However effectiveness of anti-reflux
treatment for hoarseness is inconclusive.(15) Hoarseness, voice fatigue,
or voice weakness has been reported in patients with hypothyroidism.(16,17)
Unidentified hearing loss even if to minimal degree
can cause strain on the vocal cords since they try to speak louder to
get a feedback of their own voice.
Interaction of multiple factors like hereditary,
behavioral, lifestyle, medical and environment can contribute to voice
disorders in occupational voice users. Teachers need to be educated
regarding vocal mechanism, vocal hygiene and effective voice use, dust
free and noise free work environment diet modification like drinking
adequate water, avoiding spicy and deep fried food, regularizing meals
and avoiding sleeping immediately after food. The underlying medical
issues like allergy, sinusitis, laryngitis, hypothyroidism, gastro esophageal
reflux, hearing loss etc also need to be addressed, since vocal hygiene
alone will not help until and unless the underlying cause is taken care
of.
Conclusion
Apart from the overuse of voice, medical factors
like respiratory illnesses ,hypothyroidism, gastroesophageal reflux
and hearing loss can be an associated factor for hyperfunctional voice
disorder. These medical issues also need to be addressed along with
voice hygiene counseling.
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