Occupational groups at risk of voice disorders: a review of the literature

BACKGROUND: Occupational voice health is becoming more important as more people rely on their voices for their work. A number of studies have identified certain occupational groups at increased risk of developing occupational voice disorders, namely teachers, singers and aerobics instructors. Aim The paper aims to review the literature on occupational groups at risk of voice disorders and identify areas for future research. METHOD: A literature review of key databases using key words such as 'occupational', 'voice health', 'voice loss', 'dysphonia' and 'work related' was undertaken. RESULTS: The review identified case reports, studies of attendees at hospital voice clinics and a few cross-sectional studies of occupational groups in the workplace. There were no longitudinal studies found or intervention studies looking at reduction of risk. CONCLUSION: Further research on occupational voice disorders needs to be based in the workplace, and to look at the risk factors for the development of voice problems and for the efficacy of controls.     

Professional voice users: the evaluation of voice disorders

Substantial advances in understanding the anatomy and physiology of phonation, and the new technology that has improved voice measurement and voice surgery, have led to marked improvement in the standard-of-care for patients with voice disorders. Expert voice care is essential for all patients, but especially crucial for voice professionals. Professional voice users include not only singers and actors, but also clergy, teachers, receptionists, sales personnel, physicians, and anyone else whose ability to earn a living is impacted negatively by loss of vocal quality and endurance. Physicians should be familiar with the latest concepts in voice diagnosis and treatment, and with the management of common voice disorders.     

Voice disorders and mental health in teachers: a cross-sectional nationwide study

Background  

Teachers, as professional voice users, are at particular risk of voice disorders. Among contributing factors, stress and psychological tension could play a role but epidemiological data on this problem are scarce. The aim of this study was to evaluate prevalence and cofactors of voice disorders among teachers in the French National Education system, with particular attention paid to the association between voice complaint and psychological status.     

某市初中及小学教师嗓音病的现况调查

[目的]了解浙江省义乌市初中及小学教师嗓音疾病发病情况,指导临床做好防治工作。[方法]采用现况调查进行耳鼻咽喉科检查。[结果]调查1 194名初中及小学教师,发现541名嘶哑者,发病率为23.84%,且女性发病率明显高于男性（P﹤0.01）。喉部检查结果以声带小结22.03%和慢性喉炎11.56%最多,过度用嗓是造成初中及小学教师嗓音疾病的主要原因。[结论]对初中及小学教师嗓音疾病不应只限于治疗,更要重于早期检查以及纠正发音方法。     

Voice Disorders in Occupations with Vocal Load in Slovenia

Aim

The aim of this paper is to compare the prevalence of voice disorders and the risk factors for them in different occupations with a vocal load in Slovenia.

Methods

A meta-analysis of six different Slovenian studies involving teachers, physicians, salespeople, catholic priests, nurses and speech-and-language therapists (SLTs) was performed. In all six studies, similar questions about the prevalence of voice disorders and the causes for them were included.

Results

The comparison of the six studies showed that more than 82% of the 2347 included subjects had voice problems at some time during their career. The teachers were the most affected by voice problems. The prevalent cause of voice problems was the vocal load in teachers and salespeople and respiratory-tract infections in all the other occupational groups. When the occupational groups were compared, it was stated that the teachers had more voice problems and showed less care for their voices than the priests. The physicians had more voice problems and showed better consideration of vocal hygiene rules than the SLTs. The majority of all the included subjects did not receive instructions about voice care during education.

Conclusions

In order to decrease the prevalence of voice disorders in vocal professionals, a screening program is recommended before the beginning of their studies. Regular courses on voice care and proper vocal technique should be obligatory for all professional voice users during their career. The inclusion of dysphonia in the list of occupational diseases should be considered in Slovenia as it is in some European countries.     

An overview of occupational voice disorders in Poland

Occupational voice disorders make the most frequently certified category of occupational diseases in Poland, making up approximately 20% of all cases. This study presents the current knowledge of the etiopathogenesis of occupational voice disorders. It stresses the importance of the evaluation of vocal loading by means of objective measurements. Furthermore, this study discusses the medico-legal aspects of the procedure of certifying occupational voice disorders in Poland. The paper also describes the preventive programs addressed particularly to teachers, including multidisciplinary and holistic management of occupational dysphonia. Their role in the improvement of occupational safety and health (OSH) arrangement for vocally demanding professions is emphasized.     

Occupational voice disorders due to workplace exposure to irritants--a review of the literature

The medical literature contains relatively few examples of reports of voice disorders that could be attributed to chemical exposure at work. General medical conditions such as gastro-oesophageal reflux and the use of medication such as inhaled steroids are well-recognized causes of laryngitis, but the occupational causes are less well documented. This paper describes the results of a literature review looking at the reporting of cases of occupationally acquired voice disorders due to exposure to irritants in the workplace.     

The prevalence and impact of voice problems in primary school teachers

BACKGROUND: Teachers have been identified as at increased risk of developing an occupational voice disorder. Primary school teachers are particularly at risk as they have little opportunity for voice rest during the working day. AIM: To analyse the prevalence and impact of voice problems in primary school teachers in the workplace. METHOD: An 85-item questionnaire was administered to 550 primary school teachers from 42 schools in the greater Dublin area. RESULTS: A response rate of 55% was obtained. Results suggest that 27% suffered from a voice problem, 53% an 'intermittent' voice problem, while only 20% had no voice problem. Teachers of the junior classes were more vulnerable to developing a voice problem than those of senior classes. The most common symptoms were 'dry throat' and 'vocal fatigue'. CONCLUSION: Voice disorders were very common in our study of primary school teachers. Those most frequently affected taught the younger classes. Further intervention is needed to identify and minimize risk factors and reduce the negative impact of voice on the individual and on work.     

Rural Primary Care Providers'' Perceptions of Their Roles in the Provision of Mental Health Services: Voices From the Plains

Much has been written about the deficiencies of primary care providers in their treatment patterns, referral patterns and training for treating people with mental disorders. However, there is a growing realization that, regardless of these shortcomings, primary care providers will continue to be sought out by patients for care of mental disorders, due to patient preference, lack of alternatives or other reasons. Thus, a more recent focus has been on improving the link between primary care providers and mental health specialists. This may include integrated clinics, telecommunication links or simply enhancing the competency of primary care providers through clinical practice guidelines, utilization of screening instruments and greater contact with mental health professionals. Conspicuously absent from most of these studies, commissioned reports and policy papers is the voice of the rural primary care provider. Perhaps due to their heavy practice schedules, little has been written from their perspective. Accordingly, this paper presents the findings from a focus group held in early 1998, of a group of rural primary care providers who practice on the Western plains. It is in this forum that these providers discuss how they perceive their role, their treatment and referral patterns and their feelings and relationships with psychiatrists and the mental health system.     

Telerehabilitation for service delivery in speech-language pathology

Communication disorders in adults and children can have a significant effect on their quality of life and on that of their families. Speech-language pathologists face several challenges in providing assessment and treatment services to such people. Challenges include facilitating equitable access to services and providing appropriate management within a changing social and economic context. Telerehabilitation has the potential to deliver services in the home or local community via videoconferencing and through interactive computer-based therapy activities. This form of service delivery has the capacity to optimize functional outcomes by facilitating generalization of treatment effects within the person's everyday environment, and enable monitoring of communication and swallowing behaviours on a long-term basis. A number of image-based telerehabilitation applications have been used in the management of adult neurogenic speech and language disorders, stuttering, voice disorders, speech and language disorders in children, laryngectomy and swallowing dysfunction. Further development of such applications and other computer-based therapies, cost-benefit and cost-effectiveness analyses, and professional education are needed if telerehabilitation is to become an integral part of speech-language pathology practice.     

Otorhinolaryngeal and phonation aspects of gastroesophageal reflux disease]

Experts dealing with patients of chronic upper and lower airway disorders have drawn a lot of interest in the last decades to gastrooesophageal reflux disease (GORD). Nowadays it is obvious that 'occult GORD' may be an aetiological factor in this group of patients. GORD may has a role in lot of organic laryngeal diseases and functional voice disorders. Symptoms are triggered by gastric content refluxed into the oesophagus, which cause irritation and inflammation. At laryngeal and phoniatric examinations gastrointestinal signs might remain hidden behind chronic cough, hoarseness and globus sensation. Authors summarise the diagnostic and therapeutic possibilities of GORD and its typical laryngeal and phoniatric manifestations. Although the first step is medication of GORD, it might come to surgical intervention of the laryngeal alterations, sometimes followed by voice therapy as well. Authors draw attention to patients after laryngectomy, whose voice rehabilitation therapy is extremely hindered by medical therapy resistant GORD. These patients may benefit of anti-reflux surgery.     

Factors associated with voice disorders among women teachers

This study aimed to identify risk factors for voice disorders (hoarseness in the previous six months as an initial manifestation, and vocal cord nodules as a more severe manifestation of overt disease) among teachers. The cross-sectional study included 747 women teachers from elementary and middle schools in the public school system in Vitória da Conquista, Bahia State, Brazil. Data were collected using a self-applied, standardized questionnaire. Hoarseness in the previous six months was reported by 59.2% of teachers and vocal cord nodules by 12.9%. Logistic regression techniques showed that hoarseness was statistically associated with > 24 classroom hours per week, work in more than one school, and having to make an effort to speak. Vocal cord nodules were associated with working > 5 years as a teacher, work in more than one school, working at another job besides teaching, and having to make an effort to speak. In conclusion, voice disorders are frequent among schoolteachers and are associated with multiple occupational risk factors, besides purely biological ones.     

数字化血管减影造影手术教学系统的设计

充分利用医院现有网络资源,设计了一套数字化血管减影造影（DSA）手术教学系统,系统前端采集的信号主要包括手术视音频、心电监护信号等。通过控制分发传输系统、终端示教系统展示手术过程中的所有信息,同时还设专门语音双向传输系统。通过实际应用,DSA手术中的视频、实时透视和造影图像、声音等信号传输一切正常,该系统适用于DSA手术的教学。     

Health Promotion: Planning and Strategies

Keith Tones and Jackie Green's book provides an essential andtimely contribution to the evolving literature on health promotiontheory and practice. The book is important as it seeks to providea ‘distinctive voice for health promotion’ at atime when conceptual, policy and organizational changes in somecountries are resulting in numerous interpretations and oftenmisconceptions regarding its definition and practice. The strengths of the book lie in its comprehensive and logicalcoverage of the core issues in health promotion theory and practice,supported by careful and     

Treating voice problems in professional singers

A 33-year-old male singer presented with a vocal fold polyp, a 20-year-old female singer with vocal fold submucosal bleeding, and an 18-year-old female singer with early vocal fold nodules. The vocal fold polyp was removed surgically. In the second patient vocal fold nodules were visible after resorption of the blood; they were removed surgically. The third patient was treated conservatively. A professional singer with a voice problem should be examined by an ear, nose, and throat surgeon with a special interest in disorders of the professional voice. After surgical treatment of voice problems, enough rehabilitation time should be taken for optimal recovery. Agreement about resting and rehabilitation of the voice and careful planning of the return to the stage are essential. If the singer is famous it is important that the doctor should resist the pressure exerted by management and media.     

Surgery for voice.

Preoperative assessment in a multidisciplinary voice clinic, using stroboscopy, is essential. In the treatment of benign vocal fold mucosal disorders precise phonosurgical techniques, using high magnification which respects the multilayered structured of the vocal fold, are mandatory. A paralysed vocal fold can be assessed by electromyography and medialization thyroplasty procedures offer excellent 'fine tuning' of the voice.     

Youth,Caregiver, and Staff Perspectives on an Initiative to Promote Success of Emerging Adults with Emotional and Behavioral Disabilities

Transitioning to adulthood is more challenging for youth with emotional and behavioral disorders (EBD) as compared to youth with other disability types and typically-developing peers. Outcomes for emerging adults with EBD as a group are particularly concerning in the domains of unemployment, educational dropout rates, and interactions with the judicial system including incarceration, early parenting, homelessness, substance abuse, mental health problems, and suicide. The current study presents qualitative program evaluation data for one of seven grantee states awarded 5-year cooperative agreements by the Substance Abuse Mental Health Services Administration (SAMHSA) to build developmentally-appropriate and effective youth-guided local systems of care for transition age youth, ages 16–25 years, to promote positive transition outcomes. Findings, obtained from focus groups of 25 participating transition age youth, caregivers, staff, and supervisors, include strategies for maintaining and expanding on the strengths of program, as well as for improving specific program areas. Also, consistent with the goals of the program, this process provided an opportunity for the youth and caregivers to voice their opinions and perspectives regarding their services. Implications for research and practice on effectively serving the unique needs of young adults experiencing EBD and their families in areas such as navigating special education, providing emotional and behavioral supports, and leveraging interagency collaboration are discussed.     

Occupational risk factors associated with voice disorders among teachers

PURPOSE: This study was designed to determine the occupational risk factors associated with voice disorders among schoolteachers, a high-risk population for developing voice problems. METHODS: Telephone interviews were completed by 1243 teachers from Utah and Iowa. Response rates were 98% and 95%, respectively. Bivariate analyses were computed and assessed using chi-square test and Cochran-Mantel-Haenszel test, and logistic regression analyses were performed and resulting odds ratios assessed using 95% confidence intervals. RESULTS: Teachers of vocal music, drama, other performing arts and chemistry were at significantly greater risk of having a voice disorder (OR=2.2, 95% CI: 1.2-4.0; OR=2.1, 95% CI: 0.9-4.8; OR=1.6, 95% CI: 1.0-2.4; OR=2.0, 95% CI: 1.1-3.4), while teachers of special and vocational education had a significantly lower risk (OR=0.5, 95% CI: 0.3-0.7; OR=0.6, 95% CI: 0.4-0.9). When adjusted for the intensity of vocalization, only teachers of chemistry were significantly at risk (OR=2.0, 95% CI: 1.1-3.5) while teachers of special education continued to have less of a risk (OR=0.5, 95% CI: 0.4-0.8). Chronic voice disorders were more prevalent among teachers of vocal music (OR=4.1, 95% CI: 2.2-7.9) and less prevalent among teachers of vocational education (OR=0.29, 95% CI: 0.09-0.95). CONCLUSIONS: These findings suggest that teachers of specific courses are at greater risk of developing a voice disorder.     

The ever imminent electronic medical record

The electronic medical record (EMR) remains an elusive holy grail. The reasons include limited electronic and voice recognition capabilities, as well as established medical practice patterns. There is also some question as to the time and cost efficacy of inputs into an EMR.