Self-reported Voice Research Articles

Self-reported voice problems and contributing factors in a Francophone population of professional and student teachers and nurses

Context: We explored the relation between work related factors, health practices, personality traits and stress-coping strategies and self-reported voice problems in a population of 354 student teachers (ST), 344 professional teachers (PT), 147 student nurses (SN) and 104 professional nurses (PN). Method: An online survey was conducted. Beside an anamnestic questionnaire to collect data about voice problems, work environment, health practices the VHI-10 was used to quantify voice symptoms, the Big Five-10 to explore personality traits, and the WCC-27 to explore stress coping strategies. Results: The prevalence of self-reported voice problems was significantly higher in ST as compared to SN (23% vs 14%, p = 0.025) and in PT versus PN (24% vs 12%, p = 0.08). VHI scores were significantly higher for subjects self-reporting a voice problem and significantly higher in the professional than the student groups, with PT with self-reported voice problems having the highest scores (Mean = 22.34 SD = 0.635) p<0.001. An ANOVA shows that 55% of the variance of the VHI scores is explained by the status of the subject (ST/PT/SN/PN), (F(3,945) = 382.156, p<0.001). A linear regression shows that 43% of the variance of the VHI scores was explained by Amount of private voice use, Conscientiousness, Extraversion and Emotion centered coping scores (F(4,830) = 159.201,p<0.001).

Voice disorder in systemic lupus erythematosus.

Systemic lupus erythematosus (SLE) is a chronic disease characterized by progressive tissue damage. In recent decades, novel treatments have greatly extended the life span of SLE patients. This creates a high demand for identifying the overarching symptoms associated with SLE and developing therapies that improve their life quality under chronic care. We hypothesized that SLE patients would present dysphonic symptoms. Given that voice disorders can reduce life quality, identifying a potential SLE-related dysphonia could be relevant for the appraisal and management of this disease. We measured objective vocal parameters and perceived vocal quality with the GRBAS (Grade, Roughness, Breathiness, Asthenia, Strain) scale in SLE patients and compared them to matched healthy controls. SLE patients also filled a questionnaire reporting perceived vocal deficits. SLE patients had significantly lower vocal intensity and harmonics to noise ratio, as well as increased jitter and shimmer. All subjective parameters of the GRBAS scale were significantly abnormal in SLE patients. Additionally, the vast majority of SLE patients (29/36) reported at least one perceived vocal deficit, with the most prevalent deficits being vocal fatigue (19/36) and hoarseness (17/36). Self-reported voice deficits were highly correlated with altered GRBAS scores. Additionally, tissue damage scores in different organ systems correlated with dysphonic symptoms, suggesting that some features of SLE-related dysphonia are due to tissue damage. Our results show that a large fraction of SLE patients suffers from perceivable dysphonia and may benefit from voice therapy in order to improve quality of life.

Prevalence of Voice Disorders in Singers: Systematic Review and Meta-Analysis

The study aimed to review the prevalence of self-reported voice disorders in singers. The study is a systematic review and meta-analysis. A systematic review of five major scientific databases was conducted. An extensive search strategy was used considering the rules of each database. Original articles were included only if they had data related to self-perception of dysphonia in the past. Furthermore, heterogeneity and its relative significance were assessed. There were 2371 articles identified; duplicates were deleted, screenings were conducted, and inclusion and exclusion criteria were applied. The final analysis was conducted on 11 studies. The most implemented instruments for the study were customized questionnaires. The findings about singing styles, voice use, and age were found to be different among subjects. The overall prevalence of self-reported dysphonia in singers was 46.09% (95% confidence interval: 38.16-54.12). The heterogeneity was considerable among the studied samples (I2 = 90.59%). Four groups were then established-students, teachers, classical, and nonclassical-and compared regarding overall prevalence (21.76% in students, and significantly higher and nondifferent in the other three groups, 55.15%, 40.53%, and 46.96%, respectively) and heterogeneity (low only for the students' studies). Although with low homogeneity, singers present a high prevalence of self-perceived dysphonia over their careers. Singing students were the group with a lower prevalence. On the other hand, traditional and popular music singers, as well as singing teachers, revealed significantly higher prevalence of self-perceived dysphonia. Overall, singers are likely to report voice disorders, no matter their singing style or skills. This highlights the need of a preventive approach to address voice disorders in traditional and untrained singers.

Laryngeal Mucosal Reaction during Bronchial Histamine Challenge Test Visualized by Videolaryngostroboscopy

To examine the changes in the larynx, as well as self-reported voice and throat symptoms, among patients undergoing a histamine challenge test. Thus, to understand the possible clinical effects of histamine on the larynx. Controlled, open prospective study. Thirty adult patients with prolonged cough and suspicion of bronchial asthma underwent a histamine challenge test. Videolaryngostroboscopy was performed immediately before and after the challenge. Voice and throat symptoms immediately before and after the challenge test were assessed using a visual analog scale. Videolaryngostroboscopy after exposure showed significant increases in edema (P < 0.001) as well as redness (P < 0.001) of the vocal folds after the exposure. Self-reported voice complaints increased significantly for 8 of 11 symptoms. A moderate positive correlation was found between the increase in edema of the vocal folds and reported heartburn/regurgitation symptoms (r = 0.42, P < 0.05). Atopy, asthma, nasal symptoms, or bronchial hyperreactivity during the histamine challenge test were not associated with laryngeal reactions. According to the results, the laryngeal mucosal reaction during a histamine challenge test can be objectively visualized. Videolaryngostroboscopy findings, together with an increase in self-reported voice and throat symptoms, show that histamine has potential effects on vocal folds. The mucosal reaction seems to be pronounced among patients with reflux symptoms, probably reflecting the permeability features of the vocal folds.

Relationship between Voice Complaints and Subjective and Objective Measures of Vocal Function in Iranian Female Teachers

Teachers are at high risk of developing voice problems because of the excessive vocal demands necessitated by their profession. Teachers' self-assessment of vocal complaints, combined with subjective and objective measures of voice, may enable better therapeutic decision-making. This investigation compared audio-perceptual assessment and acoustic variables in teachers with and without voice complaints. Ninety-nine teachers completed this cross-sectional study and were assigned to one of two groups: those "with voice complaint (VC)" and those "without voice complaint (W-VC)." Voice samples were collected during reading, counting, and vowel prolongation tasks. Teachers were also asked to document any voice symptoms they experienced. Voice samples were analyzed using Dr. Speech program (4th version; Tiger Ltd., USA), and labeled "normal" or "abnormal" according to the "grade" dimension "G" from GRBAS scale. Twenty-one teachers were assigned to the VC group based on self-assessment data. There were statistically significant differences between the two groups with regard to self-reported voice symptoms of hoarseness, breathiness, pitch breaks, and vocal fatigue (P < 0.05). Fourteen participants in the VC group and 40 from the W-VC group were determined to demonstrate "abnormal" vocal quality on perceptual assessment. Only harmonic-to-noise ratio was significantly higher for the W-VC group (ES = 0.55). Teachers with and without voice complaints differed in the incidence, but not type of voice symptoms. Teachers' voice complaints did not correspond to perceptual and acoustic measures. This suggests a potential unmet need for teachers to receive further education on voice disorders.

A Prediction Model for Benign Laryngeal Disease Using Supervised Learning Techniques

This study developed prediction model for benign laryngeal disease based on machine learning which reflects the characteristics of Korean adults. This study analyzed 8,713 adults (3,801 males and 4,912 females) over the age of 19 who completed laryngoscopic assessment of 2010-2012 Korea National Health and Nutrition Examination Survey (KNHNES). RBF artificial neural network algorithm was used for analysis. The explanatory variables were age, gender, educational level, occupation, income, smoking, binge drinking, and self-reported voice problem. As the result of construction of prediction model for benign laryngeal disease, self-reported voice problem, educational level, income and smoking were significant risk factors of benign laryngeal disease (p<0.05).Construction of prevention model is required to be constructed based on this model to minimize the risks of benign laryngeal disease in Koreans.

Four-day Follow-up Study on the Self-reported Voice Condition and Noise Condition of Teachers: Relationship Between Vocal Parameters and Classroom Acoustics

This study aimed to determine the changes in self-reported voice and noise condition over a follow-up of 4 days (equivalent to one working week), to define the relationship between the objective voice parameters and the self-reported voice condition, as well as to characterize the relationship between classroom acoustics and the self-reported noise condition. This is a cohort study. We performed voice monitoring of 27 teachers for four working days using the Voice-Care device, which provides information on the fundamental frequency, vocal sound pressure level, and phonation time percentage. The participants performed a pre-monitoring, which consisted of a brief conversation, before each monitoring session, and filled in a questionnaire after each monitored lesson, in which they indicated their opinions about their voice condition and the classroom noise conditions. The teachers who, during the pre-monitoring, showed a higher standard deviation of the vocal sound pressure level and a greater phonation time percentage difference between the entire monitoring and the pre-monitoring sessions, reported fewer voice complaints. Decay time (DT40ME), a reverberation measure from the speakers' perspective, resulted to be associated with the self-reporting of the noise condition. Voice disorders at work prevention programs should include strategies to exercise the respiratory and laryngeal components of voice production, because these elements may influence the variation in the vocal sound pressure level, which was found to be significantly associated with the self-reported voice condition. This study also highlights the importance of including reverberation measures, from the speakers' perspective, in the design of schools.

Occupational risks for voice disorders: Evidence from a Korea national cross-sectional survey

This study aims to analyze the relationship between occupation and voice disorders using a national cross-sectional survey that represents the Korean population. Subjects were 5,407 members of the non-institutionalized population aged 19–59 (2,258 men, 3,149 women) who completed the laryngeal examination of the Korea National Health and Nutrition Examination Survey 2010–2012. Voice disorders were surveyed by classifying laryngeal pathologies and self-reported voice problems. Occupations were classified into ‘managers & professionals’, ‘clerical support workers’, ‘service & sales workers’, ‘skilled agricultural & forestry & fishery workers’, ‘craft & plant and machine operators and assemblers’, and ‘unskilled laborers’, based on the sixth Korean Standard Classification of Occupations. The results of the multinomial logistic regression analysis indicated that managers & professionals were 1.4 times (OR 1.42, 95% CI 1.01–2.01) more likely to have self-reported voice problems, and service & sales workers were 1.6 times (OR 1.62, 95% CI 1.14–2.30) more likely to have self-reported voice problems than economically inactive people (P < 0.05). Still, there was no significant association between the presence of laryngeal pathology and profession. Managers & professionals and service & sales workers may have a higher risk of voice problems than the economically inactive.

Relationship Between Acoustic Measurements and Self-evaluation in Patients With Voice Disorders

The study aimed to determine whether there is a relationship between acoustic measures and self-evaluation in patients with voice disorders. This is a descriptive, transversal, and observational study. Patients (257) who answered the Voice Handicap Index protocols (VHI) and the Voice Symptoms Scale (VoiSS) and recorded the vowel /ε/ were included. Standard deviation (SD) measures of the fundamental frequency (F0), jitter, shimmer, and the glottal to noise excitation ratio (GNE) vowel /ε/ were taken. There was a weak positive correlation between all scores of VoiSS and the SD of the F0 and jitter. The overall scores, physical limitation, and VoiSS showed weak positive correlations with shimmer. The overall scores, limitation, and emotional VoiSS showed weak negative correlations with the GNE. The VHI did not correlate with any of the acoustic measurements. There was no difference in the mean of the acoustic measures of the SD of F0, jitter, and GNE because of a voice problem detected from the cutoff points of VoiSS. There was no difference in any of the acoustic measurements when patients with and without voice problems were compared from VHI cutoffs. There is a correlation between the scores of VoiSS and acoustic measurements. Patients with self-reported voice problems in VoiSS present greater deviations in acoustic measures, mainly in jitter. There is no correlation between the VHI scores and the acoustic measures and no difference in the averages of these measures between patients with and without voice problems detected from the VHI cutoffs.

Associations between self-perceived voice disorders in teachers, perceptual assessment by speech-language pathologists, and instrumental analysis

Purpose: The three aims of this study were to assess agreement between self-perceived voice disorders, perceptual and instrumental assessment; to determine factors associated with perceptual voice assessment; and to determine which associated factors would serve as an initial screening tool for ascertainment of the presence or absence of voice disorders among teachers.Method: A cross-sectional study was conducted among 574 Colombian teachers. Participants filled in a questionnaire and recorded a voice sample. The voice samples were perceptually evaluated by a speech-language pathologist with the Grade, Roughness, Breathiness, Asthenia, and Strain (GRBAS) scale and objectively with an automated voice analysis for fundamental frequency, jitter, shimmer and maximum phonation time. Agreements between GRBAS scale, self-reported voice disorders and instrumental analysis were determined by unweighted Coheńs Kappa coefficients and receiver operating characteristic curves. Multivariate logistic regression analysis was used to identify variables associated with the perceptual assessment. Diagnostic performance of these variables was assessed by the area under the curve.Result: There was no agreement between self-reported voice disorders and GRBAS assessments. Maximum phonation time showed a slight agreement with perceptual assessment of voice disorders.Conclusion: Since these three methods offer different information, it is advisable to include all methods in ascertainment of voice disorders among teachers at work.

Perceptual Detection of Subtle Dysphonic Traits in Individuals with Cervical Spinal Cord Injury Using an Audience Response Systems Approach

Reduced respiratory function following lower cervical spinal cord injuries (CSCIs) may indirectly result in vocal dysfunction. Although self-reports indicate voice change and limitations following CSCI, earlier efforts using global perceptual ratings to distinguish speakers with CSCI from noninjured speakers have not been very successful. We investigate the use of an audience response system-based approach to distinguish speakers with CSCI from noninjured speakers, and explore whether specific vocal traits can be identified as characteristic for speakers with CSCI. Fourteen speech-language pathologists participated in a web-based perceptual task, where their overt reactions to vocal dysfunction were registered during the continuous playback of recordings of 36 speakers (18 with CSCI, and 18 matched controls). Dysphonic events were identified through manual perceptual analysis, to allow the exploration of connections between dysphonic events and listener reactions. More dysphonic events, and more listener reactions, were registered for speakers with CSCI than for noninjured speakers. Strain (particularly in phrase-final position) and creak (particularly in nonphrase-final position) distinguish speakers with CSCI from noninjured speakers. For the identification of intermittent and subtle signs of vocal dysfunction, an approach where the temporal distribution of symptoms is registered offers a viable means to distinguish speakers affected by voice dysfunction from non-affected speakers. In speakers with CSCI, clinicians should listen for presence of final strain and nonfinal creak, and pay attention to self-reported voice function and voice problems, to identify individuals in need for clinical assessment and intervention.

Qualidade de vida em voz na doença pulmonar crônica

RESUMO: Objetivo: analisar a qualidade de vida relacionada à voz autorreferida por indivíduos com doença pulmonar crônica. Métodos: estudo transversal, exploratório, quantitativo, com informações obtidas a partir da aplicação de questionário de qualidade de vida em voz em usuários de um ambulatório de fisioterapia integrado em hospital universitário no interior do Rio Grande do Sul, no período de março a novembro de 2012. Resultados: participaram 19 sujeitos, 12 (63,20%) do sexo masculino e 7 (36,80%) do sexo feminino. Sobre a faixa etária, 14 (73,70%) eram adultos e cinco (26,30%) idosos, sendo essa diferença estatisticamente significante. Quanto à doença pulmonar crônica, dez (52,60%) tinham bronquiectasia, seis (31,60%) doença pulmonar obstrutiva crônica e três (15,80%) asma. A média do questionário Qualidade de Vida em Voz Total foi de 85,8 ± 5,8 pontos. Não houve diferença estatística entre os três domínios do questionário e as variáveis sexo, idade e diagnóstico médico. Conclusão: predomínio percentual do sexo masculino e faixa etária adulta-meia idade, sendo essa última estatisticamente significante e diagnóstico médico de bronquiectasia. A média do questionário total foi de 85,8 ± 5,8 pontos. Não foram encontradas significância estatística na comparação do domínios do questionário com as variáveis sexo, idade e doença pulmonar. Tal fato pode ser explicado pela elaboração de estratégias de comunicação como forma de minimizar os efeitos da doença pulmonar na produção vocal. Sugere-se a realização de outras pesquisas abordando o mesmo tema, porém com amostras maiores a fim de verificar a significância estatística das variáveis estudadas.

Swallowing Disorders in Sjögren's Syndrome: Prevalence, Risk Factors, and Effects on Quality of Life.

This epidemiological investigation examined the prevalence, risk factors, and quality-of-life effects of swallowing disorders in Sjögren's syndrome (SS). One hundred and one individuals with primary or secondary SS (94 females, 7 males; mean age 59.4, SD=14.1) were interviewed regarding the presence, nature, and impact of swallowing disorders and symptoms. Associations among swallowing disorders and symptoms, select medical and social history factors, SS disease severity, and the M.D. Anderson Dysphagia Inventory (MDADI) and Short Form 36 Health Survey (SF-36) were examined. The prevalence of a current self-reported swallowing disorder was 64.4%. SS disease severity was the strongest predictor of swallowing disorders, including significant associations with the following swallow symptoms: taking smaller bites, thick mucus in the throat, difficulty placing food in the mouth, and wheezing while eating (p<.05). Additional swallowing disorder risk factors included the presence of a self-reported voice disorder, esophageal reflux, current exposure to secondary tobacco smoke, frequent neck or throat tension, frequent throat clearing, chronic post-nasal drip, and stomach or duodenal ulcers. Swallowing disorders did not differ on the basis of primary or secondary SS. Swallowing disorders and specific swallowing symptoms were uniquely associated with reduced quality of life. Among those with swallowing disorders, 42% sought treatment, with approximately half reporting improvement. Patient-perceived swallowing disorders are relatively common in SS and increase with disease severity. Specific swallowing symptoms uniquely and significantly reduce swallow and health-related quality of life, indicating the need for increased identification and management of dysphagia in this population.

Correlation Between Acoustic Measurements and Self-Reported Voice Disorders Among Female Teachers

Many studies focused on teachers' voice problems and most of them were conducted using questionnaires, whereas little research has investigated the relationship between self-reported voice disorders and objective quantification of voice. This study intends to explore the relationship of acoustic measurements according to self-reported symptoms and its predictive value of future dysphonia. This is a case-control study. Voice samples of 80 female teachers were analyzed, including 40 self-reported voice disorders (VD) and 40 self-reported normal voice (NVD) subjects. The acoustic measurements included jitter, shimmer, and noise-to-harmonics ratio (NHR). Levene's t test and logistic regression were used to analyze the differences between VD and NVD and the relationship between self-reported voice conditions and the acoustic measurements. To examine whether acoustic measurements can be used to predict further voice disorders, we applied a receiver operating characteristic (ROC) curve to determine the cutoff values and the associated sensitivity and specificity. The results showed that jitter, shimmer, and the NHR of VD were significantly higher than those of NVD. Among the parameters, the NHR and shimmer demonstrated the highest correlation with self-reported voice disorders. By using the NHR ≥0.138 and shimmer ≥0.470dB as the cutoff values, the ROC curve displayed 72.5% of sensitivity and 75% of specificity, and the overall positive predictive value for subsequent dysphonia achieved 60%. This study demonstrated a significant correlation between acoustic measurements and self-reported dysphonic symptoms. NHR and ShdB are two acoustic parameters that are more able to reflect vocal abnormalities and, probably, to predict subsequent subjective voice disorder. Future research recruiting more subjects in other occupations and genders shall validate the preliminary results revealed in this study.

Medical Costs and Productivity Costs Related to Voice Symptoms in Colombian Teachers

To investigate the medical costs and productivity costs of voice symptoms among teachers and to assess the contribution of the characteristics of voice symptoms, sociodemographic characteristics, health conditions, and work-related factors to these costs. This is a cross-sectional study. In 2012, we conducted a longitudinal study in 12 public schools in Bogotá D.C., Colombia. This study is focused on cross-sectional results obtained in the first stage of the data collection process. Participants filled out a questionnaire on sociodemographics, voice symptoms, work-related conditions, use of health care, productivity loss at work, and sickness absence. Multiple logistic regression analysis was used to explore associations among health care use, voice-related absenteeism and productivity loss with duration and severity of voice symptoms, sociodemographic characteristics, health conditions, and work-related factors. In total, 621 Colombian teachers participated in this research, 438 of whom had self-reported voice complaints and who therefore made up the study population. Total medical costs and productivity costs due to presence of voice symptoms among teachers with voice complaints equaled around 37% of their monthly wage. Approximately, 3% of the costs were direct costs for health care use, and 97% were indirect costs for productivity losses. Severity of voice symptoms was significantly associated with health care use and absenteeism. Voice symptoms among teachers have important economic consequences because of health care use, voice-related absenteeism, and productivity loss at work.

The association between lifetime cigarette smoking and dysphonia in the Korean general population: findings from a national survey.

This study aims to investigate the relationship between current smoking and lifetime amount smoked and the incidence of dysphonia using data from a national cross-sectional survey that represents the Korean population. Subjects were 3,600 non-institutionalised civilian adults over the age of 19 (1,501 males and 2,099 females) who completed the laryngeal examination of the 2008 Korea National Health and Nutrition Examination Survey (KNHANES). For lifetime amount smoked, subjects were classified as light smokers (≤26.7 pack years), medium smokers (26.7–40.5 pack years), heavy smokers (40.5–55.5 pack years), and very heavy smokers (55.5–156 pack years) based on pack years (packs smoked per day × years as a smoker). The odds ratio (OR) for the statistical test was presented using hierarchical logistic regression. When adjusted for covariates (age, gender, level of education, income, occupation, alcohol consumption and pain/discomfort during the last two weeks), current smokers had a 1.8 times (OR = 1.77, 95% CI [1.17–2.68]) higher risk for self-reported voice problems than non-smokers. Moreover, current smokers had a 1.6 times (OR = 1.56, 95% CI [1.02–2.38]) higher risk of laryngeal disorder (p < 0.05). In terms of pack years, very heavy smokers were significantly more likely to have laryngeal disorder, while self-reported voice problems were significantly more likely for heavy smokers but not very heavy smokers. The results of this study imply that chronic smoking has a significant relationship with dysphonia. Longitudinal studies are required in future work to verify the causality between lifetime smoking amount and dysphonia.

Functional Voice Testing Detects Early Changes in Vocal Pitch in Women During Testosterone Administration.

To determine dose-dependent effects of T administration on voice changes in women with low T levels. Seventy-one women who have undergone a hysterectomy with or without oophorectomy with total T < 31 ng/dL and/or free T < 3.5 pg/mL received a standardized transdermal estradiol regimen during the 12-week run-in period and were then randomized to receive weekly im injections of placebo or 3, 6.25, 12.5, or 25 mg T enanthate for 24 weeks. Total and free T levels were measured by liquid chromatography-tandem mass spectrometry and equilibrium dialysis, respectively. Voice handicap was measured by self-report using a validated voice handicap index questionnaire at baseline and 24 weeks after intervention. Functional voice testing was performed using the Kay Elemetrics-Computer Speech Lab to determine voice frequency, volume, and harmonics. Forty-six women with evaluable voice data at baseline and after intervention were included in the analysis. The five groups were similar at baseline. Mean on-treatment nadir total T concentrations were 13, 83, 106, 122, and 250 ng/dL in the placebo, 3-, 6.25-, 12.5-, and 25-mg groups, respectively. Analyses of acoustic voice parameters revealed significant lowering of average pitch in the 12.5- and 25-mg dose groups compared to placebo (P < .05); these changes in pitch were significantly related to increases in T concentrations. No significant dose- or concentration-dependent changes in self-reported voice handicap index scores were observed. Testosterone administration in women with low T levels over 24 weeks was associated with dose- and concentration-dependent decreases in average pitch in the higher dose groups. These changes were seen despite the lack of self-reported changes in voice.

Gender differences in risk factors of benign vocal fold disease in Korea: the fifth Korea National Health and Nutritional Examination Survey

The aim of this study was to confirm the prevalence rate of benign vocal fold disease (BVFD) based on gender in the Korean adult population and investigate potential risk factors of BVFD. Subjects were 8,677 non-institutionalized civilian adults over the age of 19 (3,788 males and 4,899 females) who completed the laryngeal examination of the fifth Korea National Health and Nutrition Examination Survey. Poisson regression analyses were conducted to examine the potential risk factors of BVFD. The prevalence rates of BVFD were similar in men (2.7%) and women (2.6%). When adjusted for covariates, men with self-reported voice problems had a 6.7 times greater risk (RR 6.72, 95% CI 4.17–10.84) of BVFD (P < 0.01). In addition, women with self-reported voice problems (RR 4.71, 95% CI 3.01–7.37) and current smokers (RR 1.97, 95% CI 1.01–3.81) were more likely to have BVFD (P < 0.01). There are gender differences in the risk factors of BVFD. In order to prevent BVFD, the enactment of guidelines reflecting gender differences is required.

Voice Problems in New Zealand Teachers: A National Survey

This study determined the prevalence and nature of voice problems in New Zealand (NZ) teachers using a national self-report questionnaire. Epidemiological cross-sectional survey. Participants were 1879 primary and secondary teachers (72.5% females). Three prevalence timeframes were estimated. Severity of voice problems, recovery time, days away from work, symptoms, health assistance, and voice education were also investigated. Prevalence of self-reported vocal problems was 33.2% during their teaching career, 24.7% over the teaching year, and 13.2% on the day of the survey. Primary teachers (P<0.001; odds ratio [OR]=1.74; confidence interval [CI]=1.33-2.40), females (P=0.008; OR=1.63; CI=1.13-2.37), and those aged 51-60 years (P=0.010; OR=1.45; CI=1.11-3.00) were more likely to report problems. Among teachers reporting voice problems during the year, 47% were moderate or severe; for 30%, voice recovery took more than 1 week. Approximately 28% stayed away from work 1-3 days owing to a vocal problem and 9% for more than 3 days. Women reported longer recovery times and more days away. Symptoms associated with voice problems (P<0.001) were voice quality alteration (OR=4.35; CI=3.40-5.57), vocal effort (OR=1.15; CI=0.96-1.37), voice breaks (OR=1.55; CI=1.30-1.84), voice projection difficulty (OR=1.25; CI=1.04-1.50), and throat discomfort (OR=1.22; CI=1.02-1.47). Of the teachers reporting voice problems, only 22.5% consulted a health practitioner. Only 38% of the teachers with chronic voice problems visited an otolaryngologist. Higher hours of voice training/education were associated with fewer self-reported voice problems. Voice problems are of concern for NZ teachers, as has been reported for teachers in other countries. There is still limited awareness among teachers about vocal health, potential risks, and specialized health services for voice problems.

Relationships Among Smoking, Organic, and Functional Voice Disorders in Korean General Population

The relationship between smoking and voice disorders is still controversial. This study has investigated the relationship between voice disorders and smoking by using a nationwide representative survey of the Korean population. Cross-sectional analysis of a national health survey. The study sample 7941 Korean adults, aged 19years or older (3422 men and 4519 women), who participated in the fifth Korea National Health and Nutrition Examination Survey, a nationwide representative survey of the noninstitutionalized population of the Republic of Korea. Laryngeal disorders were classified into functional voice disorders (vocal cord nodule, vocal polyp, Reinke edema, and laryngitis) and organic voice disorders (sulcus vocalis, vocal cyst, laryngeal granuloma, laryngeal keratosis, laryngeal leukoplakia, laryngeal papilloma, and suspected malignant neoplasm of the larynx). Multinomial logistic regression analyses were conducted to examine the association between smoking and voice disorders. Adjusting for covariates (age, gender, education level, occupation, income, alcohol drinking, self-reported voice problems, and self-reported health status), past smokers (odds ratio (OR)=2.97, 95% confidence interval (CI): 1.14-9.03) and current smokers (OR=3.22, 95% CI: 1.18-10.25) compared with nonsmokers, were more likely to have organic voice disorders. However, smoking was not associated with functional voice disorders. Smoking is independently associated with organic voice disorders in the Korean general population.