Evolution of vocal fold nodules from childhood to adolescence

Bilateral (quasi) symmetrical lesions of the anterior third of the vocal folds, commonly called vocal fold nodules (VFNs) are the most frequent vocal fold lesions in childhood caused by vocal abuse and hyperfunction. This study evaluates their long-term genesis with or without surgery and voice therapy. A group of 91 postmutational adolescents (mean age, 16 years), in whom VFNs were diagnosed in childhood, were questioned to analyze the evolution of their complaints. Thirty four of them could be clinically reexamined by means of the European Laryngological Society-protocol, including a complete laryngological investigation and voice assessment. A total of 21% of the questioned group (n = 91) had voice complaints persisting into postpubescence with a statistically significant difference (P <= 0.001) between boys (8%) and girls (37%). VFNs were still present in 47% of the girls and 7% of the boys of the clinically evaluated group (n = 34). Analysis of the data before and after puberty shows that the variables gender, allergy, and degree of dysphonia ("G") in childhood enable a fairly correct prediction of persisting voice complaints in adolescence (sensitivity of 89% and specificity of 67%). The results of this study show a clearly different evolution for both sexes, with significant higher long-term risks for dysphonic girls with allergy

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

Item does not contain fulltextAn 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

Epidemiology of voice problems in Dutch teachers.

Item does not contain fulltextIn 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

Distúrbio de voz em professores: autorreferência, avaliação perceptiva da voz e das pregas vocais Voice disorders in teachers: self-report, auditory-perceptive assessment of voice and vocal fold assessment

OBJETIVO: Analisar a presença do distúrbio de voz em professores na concordância entre autorreferência, avaliação perceptiva da voz e das pregas vocais. MÉTODOS: Deste estudo transversal, participaram 60 professores de duas escolas públicas de ensino fundamental e médio. Após responderem questionário de autopercepção (Condição de Produção Vocal do Professor - CPV-P) para caracterização da amostra e levantamento de dados sobre autorreferência ao distúrbio de voz, foram submetidos à coleta de amostra de fala e exame nasofibrolaringoscópico. Para classificar as vozes, três juízes fonoaudiólogos utilizaram à escala GRBASI e, para pregas vocais (PPVV), um otorrinolaringologista descreveu as alterações encontradas. Os dados foram analisados descritivamente, e a seguir submetidos a testes de associação. RESULTADOS: No questionário, 63,3% dos participantes referiram ter ou ter tido distúrbio de voz. Do total, 43,3% foram diagnosticados com alteração em voz e 46,7%, em prega vocal. Não houve associação entre autorreferência e avaliação da voz, nem entre autorreferência e avaliação de PPVV, com registro de concordância baixa entre as três avaliações. Porém, houve associação entre a avaliação da voz e de PPVV, com concordância intermediária entre elas. CONCLUSÃO: Há maior autorreferência a distúrbio de voz do que o constatado pela avaliação perceptiva da voz e das pregas vocais. A concordância intermediária entre as duas avaliações prediz a necessidade da realização de pelo menos uma delas por ocasião da triagem em professores.<br>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

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

Item does not contain fulltextThe 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