A comparative study of voice complaints and risk factors for voice complaints in female student teachers and practicing teachers early in their career.

A cross-sectional questionnaire survey was performed to compare female student teachers (454 subjects; 1st to 4th year of training) and practicing teachers (82 female teachers; 1st to 4th year of teaching career) of primary education early in their career, with regard to risk factors perceived to be a negative influence on the voice, and the relative risk of the given risk factors for voice complaints. This enables the observation of whether there is a sudden increase or difference in the perceived risk factors after starting a professional teaching career. Additionally, the existence of a history of voice problems during training was questioned among the teachers. Teachers with voice complaints compared to teachers without voice complaints reported a history of voice complaints during their training (P =0.013). Teachers compared to student teachers reported more voice complaints at the moment and/or during the past year (P =0.002). The following data were obtained from student teachers and teachers reporting voice complaints. Only around a third of the subjects of both groups sought voice care (P =0.286-0.893). Risk factors were estimated in relation to voice complaints. Student teachers reported less frequently than teachers that stress (P =0.014), work pressure (P =0.003) and the composition of the class (P =0.013) have a negative influence on their voice. Student teachers reported less frequently than teachers that the number of people they communicate with (P <0.001) and the deterioration of their general physical condition (P =0.010) have a negative influence on their voice. Student teachers reported more frequently than teachers that environmental irritants (P <0.001) and humidity (P =0.020) of the classroom have a negative influence on their voice. Student teachers more than teachers were of the opinion that the attention paid to the voice during their training was sufficient (P <0.001). To test whether professional status (student teacher versus teacher) is an effect modifier for the risk factors, odds ratios (OR) were compared between the group of teachers and of student teachers (total group with and without voice complaints) to search for interactions between the risk factors and professional status. There is a significant difference in the pattern of risk factors for student teachers and teachers (P =0.010). There is an indication that vocal loading factors and environmental factors are more influential in student teachers and that there is a tendency for psycho-emotional factors to be more influential for teachers early in their career.

Utility of the Type D Scale 16 and Voice Handicap Index to assist voice care in student teachers and teachers.

An epidemiological cross-sectional survey study was performed among female student teachers and teachers for primary education, using a general questionnaire, the Type D Scale 16 (DS16) and Voice Handicap Index (VHI). Type D personality is the combination of high 'negative affectivity' and high 'social inhibition', and the DS16 has been considered to be a reliable and valid measure of these two stable personality traits. The objectives of the study were to assess the VHI of type D subjects in comparison to non-type-D subjects, to explore the utility of the DS16 and the VHI to assess whether subjects with a type D personality were more handicapped due to their voice complaints, and whether they behaved differently in seeking voice care. It was investigated whether subjects of the type D group in comparison to the non-type-D group had a voice handicap even when they did not report voice complaints. The type D group did not report more voice complaints than the non-type-D group. However, the type D group had higher VHI scores compared to the non-type-D group. Furthermore, significantly more type D subjects had a VHI score greater than the 75th percentile than the non-type-D subjects, and they sought less voice care than the non-type-D subjects. Also among subjects who reported voice complaints, the type D group sought less care than the non-type-D group. Even among the subjects who did not report voice complaints, significantly more type D than non-type-D subjects had VHI scores higher than the 75th percentile. The findings indicated that type D subjects were apparently more bothered by their voice than the non-type-D subjects (high VHI scores); however, they did not report more voice complaints, and they also sought less voice care. The DS16 used along with the VHI was useful to identify subjects of the type D trait with a voice handicap. This enables specific voice care, encompassing not only physical, but also psychosocial aspects of vocal health.

Voice complaints, risk factors for voice problems and history of voice problems in relation to puberty in female student teachers.

The aim of the study was to estimate voice complaints, risk factors for voice complaints and history of voice problems in student teachers before they embarked on their professional teaching career. A cross-sectional questionnaire survey was performed among female student teachers. The response rate was 72% and 457 questionnaires were analyzed. Voice complaints at the moment and/or during the past year were reported by 39.6% subjects. Subjects with voice complaints had significantly higher VHI scores than subjects without voice complaints. In comparison to subjects without voice complaints, overall, subjects with voice complaints reported more frequently that vocal loading factors, physical factors, environmental factors and psychological factors had a negative influence on their voice. Subjects with voice complaints reported more frequently a history of voice complaints during puberty and before puberty in comparison to subjects without voice complaints. Voice complaints in student teachers apparently had a multifactorial genesis and with roots during puberty or before puberty. Logistic regression analysis revealed that intensive voice use, emotions and history of voice complaints during puberty were the most discriminating set of risk factors for voice complaints. Subjects with voice complaints in comparison to those without voice complaints reported more frequently that they would develop a voice problem due to future teaching and that future teaching would have a negative influence on their voice. Around three quarters of subjects with and without voice complaints reported that attention paid to their voice during their training was sufficient. However, subjects with voice complaints were observed to report the need for a refresher course on voice use more frequently than those without voice complaints. The findings call for more intensive voice training for student teachers to cope with the vocal, physical and psychological demands of the teaching profession. Authorities should take responsibility to monitor and improve working conditions of student teachers and teachers.

Risk factors for voice problems in teachers.

In order to identify factors that are associated with voice problems and voice-related absenteeism in teachers, 1,878 questionnaires were analysed. The questionnaires inquired about personal data, voice complaints, voice-related absenteeism from work and conditions that may lead to voice complaints and absenteeism. Different factors play a role in the development and consolidation of voice problems. Physical and psycho-emotional factors appear to be the most important risk factors. Remarkably, voice load and environment seem to be less important as risk factors in the development and consolidation of voice complaints. Teachers who experienced voice problems during their training reported more voice problems during their career. The results of this study stress the importance of a multifactorial approach in the diagnosis and treatment of voice problems, whereby physical and psycho-emotional aspects should be considered as sensitive to the risk of developing voice problems. Moreover, this study shows the crucial importance of adequate voice training during the teacher training programme.

Epidemiology of voice problems in Dutch teachers.

In order to assess voice complaints and absence from work due to voice problems among teachers of primary and secondary education, as well as among a control group, 2,117 questionnaires were analysed. The total group consisted of 1,878 teachers and 239 controls. Female teachers more frequently reported voice complaints and absence from work due to voice problems than their male colleagues. No unequivocal relationship between age on the one hand and voice complaints and absence from work due to voice problems on the other hand was observed. Therefore, the percent of cases was corrected for gender but not for age. More than half of the teachers reported voice problems during their career and about one fifth had a history of absence from work due to voice problems. These numbers are relatively high compared to those of the controls with as well as to those without a vocally demanding profession. More than 20% of the teachers sought medical help or had been treated for a voice problem. Remarkably, more than 12% of the teachers had experienced voice problems during their training and this group reported significantly more voice complaints and absence from work due to voice problems in their career than the colleagues without voice problems during the training. The results of the Voice Handicap Index scores followed these trends. These findings point at voice problems during education as a risk factor for getting voice problems during the career. The results of this study clearly demonstrate that teaching is a high-risk profession for the development of voice problems, which is in accordance with other studies and support the contention that voice is a worldwide problem in the teaching profession. Furthermore, this study indicates the importance of voice care not only during training for the profession but also during the career.

Muscular tension and body posture in relation to voice handicap and voice quality in teachers with persistent voice complaints.

The aim of this study was to investigate the relationship between extrinsic laryngeal muscular hypertonicity and deviant body posture on the one hand and voice handicap and voice quality on the other hand in teachers with persistent voice complaints and a history of voice-related absenteeism. The study group consisted of 25 female teachers. A voice therapist assessed extrinsic laryngeal muscular tension and a physical therapist assessed body posture. The assessed parameters were clustered in categories. The parameters in the different categories represent the same function. Further a tension/posture index was created, which is the summation of the different parameters. The different parameters and the index were related to the Voice Handicap Index (VHI) and the Dysphonia Severity Index (DSI). The scores of the VHI and the individual parameters differ significantly except for the posterior weight bearing and tension of the sternocleidomastoid muscle. There was also a significant difference between the individual parameters and the DSI, except for tension of the cricothyroid muscle and posterior weight bearing. The score of the tension/posture index correlates significantly with both the VHI and the DSI. In a linear regression analysis, the combination of hypertonicity of the sternocleidomastoid, the geniohyoid muscles and posterior weight bearing is the most important predictor for a high voice handicap. The combination of hypertonicity of the geniohyoid muscle, posterior weight bearing, high position of the hyoid bone, hypertonicity of the cricothyroid muscle and anteroposition of the head is the most important predictor for a low DSI score. The results of this study show the higher the score of the index, the higher the score of the voice handicap and the worse the voice quality is. Moreover, the results are indicative for the importance of assessment of muscular tension and body posture in the diagnosis of voice disorders.

A psychological cascade model for persisting voice problems in teachers.

In 76 teachers with persisting voice problems, the maintaining factors and coping strategies were examined. Physical, functional, psychological and socioeconomic factors were assessed. A parallel was drawn to a psychological cascade model designed for patients with chronic back pain. The majority of the patients were found to be in a deadlocked situation (phase 1 of the cascade model), for which the combination of externalization and unawareness of the situation is the main risk factor. Subjective rating of the voice problem was assessed by the Voice Handicap Index (VHI) and a visual analogue scale (VAS). Patients in phase 1 of the cascade model showed higher VHI and VAS scores compared with the other patients. For a high VHI score, the combination of socioeconomic factors and being in phase 1 was the most important risk factor. Socioeconomic factors were the most important risk factors for a high VAS score. We introduce the term 'chronicity', which means that the problems are maintained, the patient finds himself in a deadlocked situation, and is sliding down into a chronic disease. 'Chronicity' is essentially different from 'chronic', which refers only to the duration of the disease. We consider maintaining factors and (inadequate) coping factors, which consist of emotional/psychological, physical and socioeconomic aspects, as indicators for chronicity.