Ana Carolina de Assis Moura Ghirardi

Influence of Abusive Vocal Habits, Hydration, Mastication, and Sleep in the Occurrence of Vocal Symptoms in Teachers

Some vocal disorders in teachers are associated with occupational factors, but there are few studies that analyze the influence of vocal habits, fluid intake, mastication, and sleep on these disorders. The objective was to analyze the occurrence of vocal fatigue, hoarseness, and dry throat in elementary and high school teachers and their association with vocal habits, fluid intake, mastication, and sleep. A sample of 422 elementary and secondary school teachers was studied using a specific questionnaire. The multiple regression analysis showed that hoarseness was associated with absence of water intake (odds ratio (OR)=1.7; P=0.047), yelling/speaking loudly (OR=1.6; P=0.058), jaw-opening limitations (OR=3.8; P=0.003), average of 6 hours of sleep/night (OR=1.7; P=0.039), and waking-up feeling replenished (OR=2.0; P=0.020). The presence of vocal fatigue was significantly associated with yelling/speaking loudly (OR=2.2; P=0.013), speaking excessively (OR=2.4; P=0.023), difficulty to open the mouth to masticate (OR=6.6; P=0.003), less than 6 hours of sleep (OR=4.0; P=0.008), and waking-up feeling replenished (sometimes OR=2.8; P=0.003; or never OR=3.3; P=0.002). The presence of dry throat was associated with being a former smoker (OR=3.3; P=0.011) and having jaw-opening limitations (OR=3.9; P=0.021). In recent years, speech and hearing interventions with teachers have focused on health-care promotion actions and prevention of vocal disorders, prioritizing issues related with hydration and healthy vocal use habits. However, the findings in the present study show the need to further focus on lifestyle habits related to sleep and eating habits.

Distúrbio de voz em professores: autorreferência, avaliação perceptiva da voz e das pregas vocais

PURPOSE: To analyze the presence of voice disorders in teachers in agreement between self-report, auditory-perceptive assessment of voice quality and vocal fold assessment. METHODS: The subjects of this cross-sectional study were 60 public elementary, middle and high-school teachers. After answering a self-awareness questionnaire (Voice Production Conditions of Teachers - CPV-P) used to characterize the sample and collect self-report data regarding voice disorders, the teachers were submitted to speech sample collection procedures and laryngoscopic examination. In order to classify the voices, three speech-language pathologist judges used the GRBASI scale, and an otorhynolaryngologist described the alterations seen in the vocal folds. Data were descriptively analyzed and then submitted to association tests. RESULTS: In the questionnaire, 63.3% of the subjects reported having or having had a voice disorder, while 43.3% were diagnosed with a vocal quality deviation and 46.7% with vocal fold alteration. There was no association between self-report and voice quality assessment, or between self-report and vocal fold evaluation, with low levels of agreement between the three assessments. However, there was association between voice quality and vocal fold assessment, with intermediate level of agreement between them. CONCLUSION: There were more self-reported voice disorders than what was found in the auditory-perceptive and vocal fold assessments. The intermediate agreement between the two assessments predicts the need for the use of at least one of these techniques when performing screening procedures in teachers.

Screening index for voice disorder (SIVD): development and validation.

PURPOSE To develop and validate a score that can serve as a screening index for voice disorders in teachers. METHODS The subjects of this study were 252 female teachers, with and without voice disorders (WVD and WOVD) from the public school system of São Paulo, Brazil. All subjects underwent medical and vocal evaluations and completed a questionnaire about experienced vocal symptoms. They were then randomly divided into samples A and B. Sample A was used to develop and sample B to validate a screening index for voice disorder (SIVD). The development was done using a factorial analysis, and a cutoff point to predict the risk of having a voice disorder was defined using a receiver operating characteristic curve. The validation was done by calculating sensitivity and specificity values for the cutoff, comparing mean scores of subjects WVD and WOVD, calculating correlation between SIVD and Voice Handicap Index (VHI), and the association between the risk and presence of voice disorder. RESULTS The SIVD comprised 12 symptoms and each accounts for 1 point on the scale. The cutoff to identify risk of voice disorder is five symptoms. Analyzing sample B, it was found that SIVD has good internal consistency (α=.82) and sensitivity (94%), a strong correlation to VHI, significant association between risk of having and actual presence of voice disorder, and people WVD had higher mean SIVD. CONCLUSION The SIVD proved to be a reliable valid tool for the identification of voice disorders in teachers, especially for use in screenings, acting as an instrument of epidemiologic vigilance.

Executives' speech expressiveness: analysis of perceptive and acoustic aspects of vocal dynamics

PURPOSE To analyze speech expressiveness in a group of executives based on perceptive and acoustic aspects of vocal dynamics. METHODS Four male subjects participated in the research study (S1, S2, S3, and S4). The assessments included the Kingdomality test to obtain the keywords of communicative attitudes; perceptive-auditory assessment to characterize vocal quality and dynamics, performed by three judges who are speech language pathologists; perceptiveauditory assessment to judge the chosen keywords; speech acoustics to assess prosodic elements (Praat software); and a statistical analysis. RESULTS According to the perceptive-auditory analysis of vocal dynamics, S1, S2, S3, and S4 did not show vocal alterations and all of them were considered with lowered habitual pitch. S1: pointed out as insecure, nonobjective, nonempathetic, and unconvincing with inappropriate use of pauses that are mainly formed by hesitations; inadequate separation of prosodic groups with breaking of syntagmatic constituents. S2: regular use of pauses for respiratory reload, organization of sentences, and emphasis, which is considered secure, little objective, empathetic, and convincing. S3: pointed out as secure, objective, empathetic, and convincing with regular use of pauses for respiratory reload and organization of sentences and hesitations. S4: the most secure, objective, empathetic, and convincing, with proper use of pauses for respiratory reload, planning, and emphasis; prosodic groups agreed with the statement, without separating the syntagmatic constituents. CONCLUSION The speech characteristics and communicative attitudes were highlighted in two subjects in a different manner, in such a way that the slow rate of speech and breaks of the prosodic groups transmitted insecurity, little objectivity, and nonpersuasion.

Relationship between vocal symptoms in college students and their possible causes

Summary Introduction: Studies to understand the vocal profile of a population are important to plan collective health measures. The prevalence of vocal symptoms can be indicative of vocal disorder and must be investigated to support measures to prevent vocal diseases. Aim: To characterize vocal symptoms in college students and their possible causes, and to analyze the association between hoarseness, vocal fatigue, phlegm, and burning in the throat with the possible causes mentioned. Method: Prospective study of 517 students who answered a questionnaire about their general heath and vocal symptoms and causes. We used the study of proportions, measures of central tendency, and a chi-square test to associate the presence of symptoms and possible causes. Results: Symptoms most often mentioned: dry mouth (21%), dry throat (18.2%), phlegm (17.9%). Causes most often cited: high respiratory disease (39%), intense voice use (24%), smoking (24%). Hoarseness was associated with heavy use of voice and high respiratory disease; vocal fatigue with intense voice use, stress, and digestive problems; burning in the throat with intensive voice use, high respiratory disease, and pollution; phlegm with smoking, and upper respiratory and digestive problems. Conclusion: Not only do aspects of health and the voice interfere with its production, the external environment and habits influence the vocal symptoms of this population as well.