Susana Pimentel Pinto Giannini

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.

Voz do professor: uma revisão de 15 anos de contribuição fonoaudiológica

O objetivo deste artigo foi realizar uma revisao das publicacoes brasileiras referentes a voz do professor, produzidas por fonoaudiologos, no periodo de 1994 a 2008. O estudo transversal, de natureza bibliografica, foi realizado em tres etapas. A primeira constou de levantamento em diferentes fontes; a segunda compreendeu a busca dos resumos de todos os trabalhos relacionados; na terceira, foi realizada leitura do material para classificacao em quatro categorias: avaliacao dos individuos; avaliacao dos efeitos de intervencoes; descricao de intervencoes; e estudos bibliograficos/teoricos/documentais. Foram contabilizadas 500 publicacoes, sendo 415 (83%) referentes as categorias de avaliacoes e, dentre essas, 357 (86%) com objetivo de avaliacao dos participantes e/ou das condicoes de trabalho e apenas 58 (14%) com preocupacao de avaliar os efeitos de programas/intervencoes. Quanto as dimensoes de analise das avaliacoes, que em 202 estudos (48,7%) foram mais de uma, a perspectiva dos proprios professores foi a mais utilizada (52,5% das analises), seguida por analises perceptivo-auditivas realizadas por fonoaudiologos (15,2%), e avaliacao do ambiente e da organizacao do trabalho (14,9%). Na categoria denominada descritivos de intervencao foram encontrados 31 (6,2%) trabalhos e na categoria bibliografico/teorico/documental, 54 (10,8%). A revisao realizada confirma que a perspectiva da avaliacao vocal tem sido privilegiada nos estudos brasileiros. Avaliacoes de efeito de intervencoes, mais recentes e ainda pouco representativas, indicam uma tendencia de mudanca de foco que pode auxiliar a compreensao da complexa realidade do uso da vozxa0na docencia, nortear futuras acoes fonoaudiologicas e inspirar estudos sobre intervencao fonoaudiologica com esses individuos.

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

PURPOSEnTo develop and validate a score that can serve as a screening index for voice disorders in teachers.nnnMETHODSnThe 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.nnnRESULTSnThe 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.nnnCONCLUSIONnThe 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.

Distúrbio de voz e trabalho docente

Objetivo: analisar a associacao entre disturbio de voz e capacidade para o trabalho em docentes da rede municipal de ensino de Sao Paulo. Metodos: professoras que buscaram atendimento fonoaudiologico, com queixa de alteracao vocal; e professoras selecionadas sem queixa, expostas ao mesmo ambiente de trabalho, passaram por avaliacao perceptivo-auditiva da voz; preenchimento dos protocolos Indice de Capacidade para o trabalho e Condicao de Producao Vocal do Professor; e avaliacao perceptivo-visual da laringe. Foram classificadas como Caso as que tinham alteracao na avaliacao perceptivo-auditiva e em pregas vocais (167) e Controle as sem alteracoes nas avaliacoes (105). Resultados: a capacidade para o trabalho esteve entre baixa e moderada entre os casos (67,4%) e entre boa e otima (66,6%) nas professoras do controle (escore total). Houve associacao estatistica em duas dimensoes do ICT, apontando que as docentes com disturbio de voz apresentaram quase tres vezes mais chance de perder capacidade para o trabalho e que quanto pior a perda da capacidade, mais forte e a associacao com o disturbio de voz. Conclusao: ha associacao entre o disturbio de voz e as dimensoes capacidade atual para o trabalho comparada com a melhor de toda vida, indicando que os sujeitos que apresentaram disturbio de voz estavam em sua pior capacidade para trabalhar, e perda estimada para o trabalho por causa de doencas, indicando que quanto maior a perda da capacidade para o trabalho, mais forte e a relacao com o disturbio de voz, independente da idade.

Voz e trabalho: estudo dos condicionantes das mudanças a partir do discurso de docentes

O objetivo deste estudo e analisar, a partir da manifestacao de piora ou melhora de capacidade para o trabalho, os aspectos condicionantes de mudancas na relacao entre trabalho e voz, segundo o discurso de docentes da rede municipal de ensino de Sao Paulo. Participaram as professoras que, em comparacao com pesquisa anterior, apresentaram maior diferenca tanto para piora (Grupo A) como para melhora (Grupo B) nos resultados do Indice de Capacidade para o Trabalho. Elas foram convidadas a discutir quais aspectos poderiam explicar a melhora ou piora desses resultados, em um contexto de grupo focal. Os relatos foram transcritos e analisados qualitativamente, segundo a recorrencia dos enunciados. Constatou-se que o grupo A apresentou condicao mais adoecida e maior necessidade de falar sobre as dificuldades no trabalho. O Grupo B apresentou mais forca para enfrentar os problemas referentes ao trabalho, inclusive propostas criativas. A favor do Grupo B, tambem foram registradas melhores relacoes no trabalho quanto ao apoio social e autonomia.

A campanha da voz em dois jornais brasileiros de grande circulação

Na sociedade atual, os meios de comunicacao de massa produzem, selecionam, excluem e transformam aspectos da realidade reproduzindo-a parcialmente e formando a opiniao publica. Na area da saude, os meios de comunicacao sao destacados para a educacao e promocao da saude da populacao. Isso conduz a reflexao sobre a mediacao da realidade exercida pelos meios de comunicacao e como os temas da saude sao abordados na midia. OBJETIVO: Analisar as noticias sobre a Campanha da Voz nos jornais de grande circulacao. METODO: Analise Documental das noticias sobre a Campanha da Voz publicadas nos jornais O Estado de S. Paulo e Folha de S. Paulo, entre 13 e 20/04/2002. A analise considera aspectos quantitativos e qualitativos das reportagens e leva em conta a sua contribuicao para processos educativos condizentes com a promocao da saude. RESULTADOS: Somente a Folha publicou duas reportagens sobre a campanha. Evidenciam-se recursos apelativos dramaticos e a enfase na doenca. As abordagens de carater comportamental, normatizador, tecnicista e tecnologico referenciam a prevencao e tratamento. Ha reforco de estereotipos e banalizacao da complexidade das acoes das especialidades envolvidas. Discute-se aspectos destas especialidades e das concepcoes que as fundamentam, bem como do processo de producao da noticia implicado nas problematicas evidenciadas. CONCLUSAO: Em se tratando da Campanha da Voz, as noticias publicadas pouco contribuem para a construcao de processos educativos em saude condizentes com a promocao da saude. Maiores estudos devem ser feitos acerca do papel dos meios de comunicacao junto a promocao da saude da populacao.

Questionário Condição de Produção Vocal - Professor: comparação entre respostas em escala Likert e em escala visual analógica

PURPOSEnTo compare the responses related to vocal symptoms in two versions of the Vocal Production Condition - Teacher (CPV-T) questionnaire, with responses on a Likert scale and a Visual Analog Scale (VAS), in order to evaluate which is the best measurement method.nnnMETHODSnA cross-sectional observational study was conducted with teachers with voice disorders during the period from July 2011 to July 2012. All teachers answered the CPV-T in two versions: with answers on a 4-point Likert scale and on a 50-mm VAS. The answers related to vocal symptoms dimension were analyzed.nnnRESULTSnMost of the symptoms showed good (hoarseness, high-pitched voice, unstable voice, weak voice, effort when speaking, throat clearing, burning throat, and pain when speaking) or regular concordance (loss of voice, failing voice, low-pitched voice, vocal fatigue, dry throat, lump in the throat, secretion in the throat, pain when swallowing, difficulty swallowing, and dry cough).nnnCONCLUSIONnThe CPV-T questionnaire with answers on Likert scale proved to be more suitable than the VAS owing to the ease of understanding and interpretation, in addition to facilitating the input of answers for the researcher. Therefore, the Likert scale was chosen for the CPV-T, considering it to be validated as the method to measure the answers. The dimension of vocal aspects evaluated in the present study, the Voice Disorder Screening Index (ITDV), can be used in epidemiological studies to estimate the prevalence of vocal symptoms and in the Speech-Language Pathology and Audiology clinic routine or in monitoring teachers throughout their careers.Objetivo: Comparar as respostas referentes aos sintomas vocais em duas versoes do questionario Condicao de Producao Vocal - Professor (CPV-P), com respostas em escala Likert e em escala visual analogica (EVA), para avaliar qual e a melhor forma de afericao. Metodos: Estudo observacional transversal realizado com professoras em atendimento por disturbio de voz no periodo de julho de 2011 a julho de 2012. Todas responderam ao questionario CPV-P em duas versoes: com respostas em escala Likert de quatro pontos e em escala analogico-visual em regua de 50 mm. Foram analisadas as questoes referentes a dimensao de sintomas vocais. Resultados: A maioria dos sintomas apresentou concordância boa (rouquidao, voz fina, voz variando, voz fraca, esforco ao falar, pigarro, ardor na garganta, dor ao falar) ou regular (perda de voz, falha na voz, voz grossa, cansaco ao falar, garganta seca, bola na garganta, secrecao na garganta, dor ao engolir, dificuldade engolir, tosse seca). Conclusao: O questionario CPV-P com respostas em escala Likert mostrou-se mais indicado em relacao as respostas em EVA pela facilidade de compreensao e interpretacao, bem como por facilitar o registro das respostas para o investigador. Pelo exposto, opta-se pela recomendacao de manutencao das respostas em escala Likert para o questionario CPV-P, considerando-se validado quanto a maneira de afericao das respostas. A dimensao de aspectos vocais avaliada no presente estudo, que hoje constitui o Indice de Triagem de Disturbio de Voz (ITDV), pode ser utilizada em estudos epidemiologicos para estimar a prevalencia de sintomas vocais bem na clinica fonoaudiologica ou acompanhamento de professores ao longo da carreira.

Associação entre distúrbio de voz e sintomas de disfunção temporomandibular autorreferidos por professores

Purpose : To verify the relationship between voice disorder and temporomandibular dysfunction (TMD) in elementary and middle school teachers. Methods : The participants of this study were 138 teachers - 96 women and 42 men, with a mean age of 38 years. The teachers responded to a questionnaire with five questions on voice disorder and temporomandibular dysfunction symptoms. The data were analyzed using an association test (Chi-square) to verify the association between voice disorder and temporomandibular dysfunction symptoms, as well as the relationship of the symptoms with sex and age. Results : The temporomandibular dysfunction symptoms reported by the teachers, from the most to least frequently mentioned, were as follows: headache or facial pain, pain at the end of the day, and pain when speaking excessively. The results showed a statistically significant difference for the symptom pain when speaking excessively, pain at the end of the day, and temporomandibular joint snap in teachers without voice disorder. A statistically significant difference was observed for the female sex, regarding temporomandibular dysfunction. Temporomandibular dysfunction was more frequently reported than voice disorder, with higher incidence in female than in male teachers. Conclusion : The findings showed a statistical association between voice disorder and temporomandibular dysfunction in teachers. Further studies with integrated clinical assessment on the relationship between voice symptoms and TMD in different age groups are warranted.

Voice Disorder and Burnout Syndrome in Teachers

OBJECTIVEnThe objective of this study was to assess the association between burnout syndrome and the likely presence of voice disorders among teachers from a public elementary school in the country town of Sergipe.nnnMETHODSnThis is a cross-sectional study in which 208 teachers completed the following questionnaires: the Condition of Vocal Production-Teacher (CPV-P), the Screening Index for Voice Disorder (SIVD), and the Burnout Syndrome Evaluation Questionnaire (CESQT).nnnRESULTSnOf the 208 teachers, 76.9% were women, 77.9% came from rural areas, and 64.4% were likely to have a voice disorder. Teachers with a career length of over 15 years were almost twice as likely to have a voice disorder. Of the symptoms listed in the SIVD, the following were most prevalent: dry throat (88.1%), hoarseness (84.4%), and fatigue when speaking (82.1%). Among the burnout subscales, psychic exhaustion was the most common (30.3%). Analyses revealed that probable voice disorder was associated with psychic exhaustion with an odds ratio of 1.78 (Pu2009<0.001, χ2u2009=u200984.1%). Teachers with positive scores on two to four burnout subscales had an odds ratio of 4.01 (Pu2009=u20090.013, χ2u2009=u200986.2%) for a probable voice disorder compared with those with positive scores on zero to one subscale.nnnCONCLUSIONSnThe present results confirmed that burnout syndrome was associated with the presence of a probable voice disorder.

Relação entre a presença de sinais videolaringoscópicos sugestivos de refluxo laringofaríngeo e distúrbio de voz em professoras

OBJECTIVEnTo analyze the relationship between the presence of videolaryngoscopic signs suggestive of laryngopharyngeal reflux (LPR) and voice disorder (VD) in teachers.nnnMETHODSnthis is a cross-sectional study with convenience sample and inclusion criteria as subjects 18 years or older, be a teacher female, seek care with complaint of VD and/or LPR. The exclusion criteria included smoking and presence of respiratory changes. All subjects concluded the following instruments: Vocal Production Condition - Teacher (VPC-T), including the Screening Index for Voice Disorder (SIVD); and Voice Handicap Index (VHI). Speech samples were collected for voice perceptual assessment and all of them were submitted to otorhinolaryngology review.nnnRESULTSnWe evaluated 121 teachers, with a mean age of 43 years and 7.8 class hours per day. Only 24.0% of the teachers did not have vocal cord lesions and 42.1% had videolaryngoscopic signs suggestive of LPR. In the group of teachers with presence of Signs suggestive of LPR, the most common symptoms of SIVD were dry throat, hoarseness, throat clearing; the average VHI was 17.9 points. There was no association between voice disorder and presence of videolaryngoscopic signs suggestive of LPR. The independent factors for the LPR in the multiple binary logistic regression analysis were age and VHI score (tertile: 13-20).nnnCONCLUSIONnThere was no association between VD and LPR, but between age and VHI score.