Research Article| Volume 37, ISSUE 2, P295.e11-295.e22, March 2023

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Outcomes of Vocal Hygiene Program in Facilitating Vocal Health in Female School Teachers With Voice Problems

  • Aishwarya Nallamuthu
    Department of Speech Language & Hearing Sciences, Sri Ramachandra Institute of Higher Education & Research, Chennai, Tamil Nadu, India
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  • Prakash Boominathan
    Address correspondence and reprint requests to Prakash Boominathan, Department of Speech Language & Hearing Sciences, Sri Ramachandra Institute of Higher Education & Research, Chennai, Tamil Nadu, India.
    Department of Speech Language & Hearing Sciences, Sri Ramachandra Institute of Higher Education & Research, Chennai, Tamil Nadu, India
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  • Ravikumar Arunachalam
    Pro-Vice Chancellor (Medical & Health Sciences), SRM Medical College Hospital & Research Centre, Kattankulathur, Tamil Nadu, India
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  • Pushpavathi Mariswamy
    All India Institute of Speech and Hearing, (Ministry of Health & Family Welfare, Govt. of India), Manasagangothri, Mysuru, India
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Published:January 19, 2021DOI:



      Teachers suffer greater impacts of voice problems due inappropriate voice use and other contributing factors such as physiological, environmental, and individual & work related issues. Structured vocal hygiene programs (VHP) prevent/reduce the risk of vocal trauma and promote vocal health in teachers. This study aimed to estimate the outcome of instituting a sociocultural relevant vocal hygiene program in facilitating vocal health among female school teachers using a comprehensive voice assessment protocol.


      VHP was developed emphasizing adequate hydration, healthy vocal diet, posture and alignment, vocal practices while teaching, and ideal speaking environment. This was administered via a face to face session to seventeen female teachers with voice concerns. All underwent a comprehensive voice assessment (subjective, objective, and self-perceptual vocal measures) before and four weeks after the VHP. Inter-rater reliability for perceptual and visual examination was estimated using Intra-Class Coefficient. Wilcoxon signed ranks test was used to compare the pre- and post-treatment measures of continuous variables (acoustic, Maximum phonation time, s/z ratio, Vocal Fatigue Index [VFI] & Voice Disorder Outcome Profile [V-DOP]), and McNemar test was used for categorical variables (vocal health questionnaire, visual examination of larynx and perceptual evaluation of voice).


      Teachers reported reduction of unhealthy vocal & nonvocal practices after VHP. Improvements in vocal and related symptoms such as sensation of heart burn (P = 0.031), discomfort around the throat (P = 0.008), inadequate breath control while speaking (P = 0.016) were noticed. Perceptually, minimal improvement was seen in voice quality (overall grade). However, MPT & s/z ratio showed no significant difference. Improvement was observed in frequency range (P = 0.004), low I0 (P = 0.044), shimmer (P = 0.017), and DSI (P = 0.013). Changes were evident in all parameters of stroboscopic evaluation (except nonvibratory portion & ventricular fold hyper-adduction). V-DOP scores indicated positive change in the overall severity (P = 0.002), physical (P = 0.003) and functional domain (P = 0.034). VFI indicated improvement in teachers voice after a period of voice rest (P = 0.048).


      Though VHP facilitated in improving the teachers’ awareness of at risk phono-traumatic behaviors and vocal health, its efficiency was limited in producing physiological improvement in teachers’ voice. The comparison of vocal metrics before & after the treatment provides information on changes that can be expected in teachers after guiding them through a systematic VHP.

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