Advertisement

Voice Problems Among School Teachers employing the Tele-teaching Modality

  • Arwa A. Alkhunaizi
    Correspondence
    Address correspondence and reprint requests to Arwa A. Alkhunaizi, Otolaryngology Department, King Saud University, P.O Box 245, Riyadh, 11411, Saudi Arabia.
    Affiliations
    Department of Otolaryngology, Head and Neck Surgery, King Saud University Medical City, College of Medicine, King Saud University, Riyadh, Saudi Arabia

    ENT section, Surgical Department, Prince Mohammed Bin Abdulaziz Hospital, Second Health Cluster Riyadh, Kingdom of Saudi Arabia
    Search for articles by this author
  • Manal Bukhari
    Affiliations
    Department of Otolaryngology, Head and Neck Surgery, King Saud University Medical City, College of Medicine, King Saud University, Riyadh, Saudi Arabia
    Search for articles by this author
  • Mohammed Almohizea
    Affiliations
    Department of Otolaryngology, Head and Neck Surgery, King Saud University Medical City, College of Medicine, King Saud University, Riyadh, Saudi Arabia
    Search for articles by this author
  • Khalid H. Malki
    Affiliations
    Research Chair of Voice, Communication, and Swallowing Disorders, Otolaryngology Department, King Saud University, Riyadh, Saudi Arabia

    Department of Otolaryngology, Head and Neck Surgery, King Saud University Medical City, College of Medicine, King Saud University, Riyadh, Saudi Arabia
    Search for articles by this author
  • Tamer A. Mesallam
    Affiliations
    Research Chair of Voice, Communication, and Swallowing Disorders, Otolaryngology Department, King Saud University, Riyadh, Saudi Arabia

    Department of Otolaryngology, Head and Neck Surgery, King Saud University Medical City, College of Medicine, King Saud University, Riyadh, Saudi Arabia
    Search for articles by this author

      Summary

      Objectives

      To assess the prevalence of voice problems among teachers in Riyadh during tele-teaching and examine the relationship between the Voice Handicap Index 10 (VHI10) scores and a variety of risk factors believed to be related to voice problems. We also assessed awareness of voice hygiene and therapy among teachers.

      Study Design

      An observational cross-sectional study conducted using a multistage random sampling method among Riyadh school teachers who taught by tele-teaching for a minimum of one year.

      Methods

      A self-assessment questionnaire which included demographic information about teachers, factors related to their teaching backgrounds, tele-teaching settings, effects of tele-teaching on the voice, medical and social histories, reports of voice and reflux symptoms, VHI10, and general knowledge about voice hygiene. This was distributed to school teachers using an SMS link through the Ministry of Education's IT department.

      Results

      A total 495 were included in the study after exclusions. The prevalence of teachers who had significant voice problems during tele-teaching (VHI10>11) was 21.6%. Multiple risk factors significantly increased the risk of voice problems during tele-teaching. These factors included being female, teacher age, the presence of background noise from both teachers and students, loud voices, using an open camera during the teaching, stress and anxiety, allergies, respiratory disease, reflux, hearing problems, and a family history of voice problems. Only 4.6% of respondents were familiar with voice hygiene and voice therapy, but 65% believe that it is important for teachers to be knowledgeable about them.

      Conclusions

      Due to the lower prevalence of voice disorders among tele-teaching compared to traditional teaching methods, tele-teaching may be a viable option for teachers who have voice problems. There are still several factors influencing voice problems among tele-teachers. To attenuate potential risks, it is crucial that teachers are aware of the concepts of voice hygiene and voice therapy.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Voice
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Vilkman E.
        Voice problems at work: a challenge for occupational safety and health arrangement.
        Folia Phoniatr Logop. 2000; 52: 120-125https://doi.org/10.1159/000021519
        • Sataloff RT.
        Professional voice users: the evaluation of voice disorders.
        Occup Med. 2001; 16: 633-647
        • Titze IR
        • Svec JG
        • Popolo PS.
        Vocal dose measures: quantifying accumulated vibration exposure in vocal fold tissues.
        J Speech Lang Hear Res. 2003; 46: 919-932https://doi.org/10.1044/1092-4388(2003/072
        • Chong E
        • Chan A
        Subjective health complaints of teachers from primary and secondary schools in Hong Kong.
        Int J Occup Saf Ergon. 2010; 16: 23-39https://doi.org/10.1080/10803548.2010.11076825
        • Cantor Cutiva LC
        • Vogel I
        • Burdorf A
        Voice disorders in teachers and their associations with work-related factors: a systematic review.
        J Commun Disord. 2013; 46: 143-155https://doi.org/10.1016/j.jcomdis.2013.01.001
        • Roy N
        • Merrill RM
        • Thibeault S
        • et al.
        Prevalence of voice disorders in teachers and the general population.
        J Speech Lang Hear Res. 2004; 47: 281-293https://doi.org/10.1044/1092-4388(2004/023)
        • Van Houtte E
        • Claeys S
        • Wuyts F
        • et al.
        The impact of voice disorders among teachers: vocal complaints, treatment-seeking behavior, knowledge of vocal care, and voice-related absenteeism.
        J Voice. 2011; 25: 570-575https://doi.org/10.1016/j.jvoice.2010.04.008
        • Williams NR.
        Occupational groups at risk of voice disorders: a review of the literature.
        Occup Med (Lond). 2003; 53: 456-460https://doi.org/10.1093/occmed/kqg113
        • Pereira N
        • Lara E
        • Tavares M
        • et al.
        Voice Disorders in Teachers : Clinical, Videolaryngoscopical, and Vocal Aspects.
        J Voice. 29. 2015: 564-571https://doi.org/10.1016/j.jvoice.2014.09.019
        • da Rocha LM
        • de Lima Bach S
        • do Amaral PL
        • et al.
        Risk factors for the incidence of perceived voice disorders in elementary and middle school teachers.
        J Voice. 2017; 31 (.e7-258.e12): 258https://doi.org/10.1016/j.jvoice.2016.05.018
        • Menon UK
        • Raj M
        • Antony L
        • et al.
        Prevalence of voice disorders in school teachers in a district in South India.
        J Voice. 2021; 35: 1-8https://doi.org/10.1016/j.jvoice.2019.07.005
      1. Abo-hasseba A, Waaramaa T, Alku P, et al. Difference in voice problems and noise reports between teachers of public and private schools in upper egypt. J Voice. 2017;31:508.E11-508.E16. https://doi.org/10.1016/j.jvoice.2016.10.016

      2. Marques L, Behlau M, Dias L, et al. Behavioral Dysphonia and depression in elementary school teachers. J Voice. 2015;29:712-717. https://doi.org/10.1016/j.jvoice.2014.10.011

        • Rogerson J
        • Dodd B.
        Is there an effect of dysphonic teachers’ voices on children's processing of spoken language?.
        J Voice. 2005; 19: 47-60https://doi.org/10.1016/j.jvoice.2004.02.007
      3. Saatweber M. How to Help Teachers ’ Voices. Folia Phoniatr Logop. 2008;60:288–290. https://doi.org/10.1159/000170077

        • Morton V
        • Watson DR.
        The impact of impaired vocal quality on children's ability to process spoken language.
        Logoped Phoniatr Vocol. 2001; 26: 17-25
        • Alrahim A
        • Alanazi R
        • Al-Bar M
        Hoarseness among school teachers: a cross-sectional study from Dammam.
        J Family Community Med. 2018; 25: 205-210https://doi.org/10.4103/jfcm.JFCM_152_17
        • Malki K
        • Mesallam T.
        Psychosocial assessment of voice problems among Saudi teachers.
        J Otolaryngol Head Neck Surg. 2012; 41: 189-199
        • Alarouj H
        • Althekerallah JM
        • AlAli H
        • et al.
        A comparative study utilizing the voice handicap index-10 (vhi-10) in teachers and the general population of Kuwait.
        J Voice. 2022; 36: 289.e1-289.e10https://doi.org/10.1016/j.jvoice.2020.05.006
        • Martins RHG
        • Pereira ERBN
        • Hidalgo CB
        • et al.
        Voice disorders in teachers. A review.
        J Voice. 2014; 28: 716-724https://doi.org/10.1016/j.jvoice.2014.02.008
        • Korn GP
        • Augusto de Lima Pontes A
        • Abranches D
        Augusto de Lima Pontes P. Vocal tract discomfort and risk factors in university teachers.
        J Voice. 2016; 30: 507.e1-8https://doi.org/10.1016/j.jvoice.2015.06.001
        • Simberg S
        • Sala E
        • Vehmas K
        • et al.
        changes in the prevalence of vocal symptoms among teachers during a twelve-year period.
        J Voice. 2005; 19: 95-102https://doi.org/10.1016/j.jvoice.2004.02.009
        • Assad JP
        • Gama ACC
        • Santos JN
        • et al.
        The effects of amplification on vocal dose in teachers with dysphonia.
        J Voice. 2019; 33: 73-79https://doi.org/10.1016/j.jvoice.2017.09.011
        • Byeon H.
        The risk factors related to voice disorder in teachers: a systematic review and meta-analysis.
        Int J Environ Res Public Health. 2019; 16: 3675https://doi.org/10.3390/ijerph16193675
        • Grillo EU.
        Building a successful voice telepractice program.
        Perspect ASHA Spec Interes groups. 2019; 4: 100-110https://doi.org/10.1044/2018_PERS-SIG3-2018-0014
        • Alkhalaf S
        • Drew S
        • AlGhamdi R
        • et al.
        E-learning system on higher education institutions in KSA: Attitudes and perceptions of faculty members.
        Procedia - Soc Behav Sci. 2012; 47: 1199-1205https://doi.org/10.1016/j.sbspro.2012.06.800
        • Hassounah M
        • Raheel H
        • Alhefzi M.
        Digital response during the COVID-19 pandemic in Saudi Arabia.
        J Med Internet Res. 2020; 22: e19338https://doi.org/10.2196/19338
      4. AlArfaj A, Alyahya K, Alutaibi H et al.The effect of online teaching on vocal health among Saudi teachers during COVID-19 pandemic. Journal of Voice. 2022. https://doi.org/10.1016/j.jvoice.2022.04.006.

        • Dunham J.
        An exploratory comparative study of staff stress in English and German comprehensive schools.
        Educ Rev. 1980; 32: 11-20https://doi.org/10.1080/0013191800320102
        • Borg MG.
        Occupational stress in British educational settings: a review.
        Educ Psychol. 1990; 10: 103-126https://doi.org/10.1080/0144341900100201
        • Ozamiz-Etxebarria N
        • Idoiaga Mondragon N
        • Bueno-Notivol J
        Prevalence of anxiety, depression, and stress among teachers during the COVID-19 pandemic: a rapid systematic review with meta-analysis.
        Brain Sci. 2021; 11https://doi.org/10.3390/brainsci11091172
        • Pressley T
        • Ha C
        • Learn E.
        Teacher stress and anxiety during COVID-19: an empirical study.
        Sch Psychol. 2021; 36: 367-376https://doi.org/10.1037/spq0000468
        • Zollinger SA
        • Brumm H.
        The Lombard effect.
        Curr Biol. 2011; 21: R614-R615https://doi.org/10.1016/j.cub.2011.06.003
        • Rosen CA
        • Lee AS
        • Osborne J
        • et al.
        Development and validation of the voice handicap index-10.
        Laryngoscope. 2004; 114: 1549-1556https://doi.org/10.1097/00005537-200409000-00009
        • Farahat M.
        Validation and reliability of Arabic voice handicap index-10.
        Saudi J Otorhinolaryngol Head Neck Surg. 2012; 14: 11https://doi.org/10.4103/1319-8491.274765
        • Patjas M
        • Vertanen-Greis H
        • Pietarinen P
        • et al.
        Voice symptoms in teachers during distance teaching: a survey during the COVID-19 pandemic in Finland.
        Eur Arch Oto-Rhino-Laryngology. 2021; 278: 4383-4390https://doi.org/10.1007/s00405-021-06960-w
        • Nemr K
        • Simões-Zenari M
        • Almeida VC de
        • et al.
        COVID-19 and the teacher's voice: self-perception and contributions of speech therapy to voice and communication during the pandemic.
        Clinics (Sao Paulo). 2021; 76: e2641https://doi.org/10.6061/clinics/2021/e2641
        • Besser A
        • Lotem S
        • Zeigler-Hill V.
        psychological stress and vocal symptoms among university professors in Israel: Implications of the shift to online synchronous teaching during the COVID-19 pandemic.
        J Voice. 2022; 36 (e9-291.e16): 291https://doi.org/10.1016/j.jvoice.2020.05.028
        • Arffa RE
        • Krishna P
        • Gartner-Schmidt J
        • et al.
        Normative values for the Voice Handicap Index-10.
        J Voice. 2012; 26: 462-465https://doi.org/10.1016/j.jvoice.2011.04.006
        • Nerrière E
        • Vercambre M-N
        • Gilbert F
        • et al.
        Voice disorders and mental health in teachers: a cross-sectional nationwide study.
        BMC Public Health. 2009; 9: 370https://doi.org/10.1186/1471-2458-9-370
        • Korn GP
        • Augusto A
        • Pontes DL
        • et al.
        Hoarseness and risk factors in university teachers.
        J Voice. 2015; 29: 518.e21-518.e28https://doi.org/10.1016/j.jvoice.2014.09.008
        • Nusseck M
        • Spahn C
        • Echternach M
        • et al.
        Vocal health, voice self-concept and quality of life in German school teachers.
        J Voice. 2020; 34: 488.e29-488.e39https://doi.org/10.1016/j.jvoice.2018.11.008
        • van Houtte E
        • Claeys S
        • Wuyts F
        • et al.
        Voice disorders in teachers: occupational risk factors and psycho-emotional factors.
        Logoped Phoniatr Vocol. 2012; 37: 107-116https://doi.org/10.3109/14015439.2012.660499
        • Vertanen-Greis H
        • Löyttyniemi E
        • Uitti J.
        Voice disorders are associated with stress among teachers: a cross-sectional study in Finland.
        J Voice. 2020; 34: 488.e1-488.e8https://doi.org/10.1016/j.jvoice.2018.08.021
        • Hammond TH
        • Zhou R
        • Hammond EH
        • et al.
        The intermediate layer: a morphologic study of the elastin and hyaluronic acid constituents of normal human vocal folds.
        J Voice. 1997; 11: 59-66https://doi.org/10.1016/s0892-1997(97)80024-0
        • Hunter EJ
        • Tanner K
        • Smith ME
        Gender differences affecting vocal health of women in vocally demanding careers.
        Logoped Phoniatr Vocol. 2011; 36: 128-136https://doi.org/10.3109/14015439.2011.587447
        • de Souza AJ
        • Gonçalves D da S
        • Bastilha GR
        • et al.
        Acoustic measurements of the glottic source of female teachers with dysphonia.
        J Voice. 2020; 34: 838-846https://doi.org/10.1016/j.jvoice.2019.05.009
        • Thibeault SL
        • Merrill RM
        • Roy N
        • et al.
        Occupational risk factors associated with voice disorders among teachers.
        Ann Epidemiol. 2004; 14: 786-792https://doi.org/10.1016/j.annepidem.2004.03.004
        • Leão SH de S
        • Oates JM
        • Purdy SC
        • et al.
        Voice problems in New Zealand teachers: a national survey.
        J Voice. 2015; 29: 645.e1-645.e13https://doi.org/10.1016/j.jvoice.2014.11.004
        • Schneider B
        • van Trotsenburg M
        • Hanke G
        • et al.
        Voice impairment and menopause.
        Menopause. 2004; 11: 151-158https://doi.org/10.1097/01.gme.0000094192.24934.46
        • Medeiros A
        • Barreto S
        • Assuncao A.
        Voice disorders (dysphonia) in public school female teachers working in Belo Horizonte: prevalence and associated factors.
        J Voice. 2007; 22: 676-687https://doi.org/10.1016/j.jvoice.2007.03.008
        • Simberg S
        • Laine A
        • Sala E
        • et al.
        Prevalence of voice disorders among future teachers.
        J Voice. 2000; 14: 231-235https://doi.org/10.1016/s0892-1997(00)80030-2
        • Kooijman PGC
        • de Jong FICRS
        • Thomas G
        • et al.
        Risk factors for voice problems in teachers.
        Folia Phoniatr Logop Off organ Int Assoc Logop Phoniatr. 2006; 58: 159-174https://doi.org/10.1159/000091730
      5. Rossi-Barbosa LAR, Barbosa MR, Morais RM, et al. Self-reported acute and chronic voice disorders in teachers. J Voice. 2016 Nov 1;30(6):755-e25. https://doi.org/10.1016/j.jvoice.2015.08.003.

        • Ahmed A
        • Hamid A
        • Mohammed H
        • et al.
        Dysphonia in teachers : is it only a matter of voice misuse?.
        The Egyptian Journal of Otolaryngology. 2014; 30: 272-278
        • Smith E
        • Kirchner HL
        • Taylor M
        • et al.
        Voice problems among teachers: differences by gender and teaching characteristics.
        J Voice. 1998; 12: 328-334https://doi.org/10.1016/s0892-1997(98)80022-2
        • Nusseck M
        • Richter B
        • Spahn C
        • et al.
        Analysing the vocal behaviour of teachers during classroom teaching using a portable voice accumulator.
        Logoped Phoniatr Vocol. 2018; 43: 1-10https://doi.org/10.1080/14015439.2017.1295104
        • Da Costa V
        • Prada E
        • Roberts A
        • et al.
        Voice disorders in primary school teachers and barriers to care.
        J Voice. 2012; 26: 69-76https://doi.org/10.1016/j.jvoice.2010.09.001
        • Malki KH.
        Voice disorders among Saudi teachers in Riyadh city.
        Saudi Journal of Otorhinolaryngology Head and Neck Surgery. 2010; 12: 31https://doi.org/10.4103/1319-8491.274630
        • Kristiansen J
        • Lund SP
        • Persson R
        • et al.
        A study of classroom acoustics and school teachers’ noise exposure, voice load and speaking time during teaching, and the effects on vocal and mental fatigue development.
        Int Arch Occup Environ Health. 2014; 87: 851-860https://doi.org/10.1007/s00420-014-0927-8
        • Ferreira LP
        • de Oliveira Latorre M do RD
        • Pinto Giannini SP
        • et al.
        Influence of abusive vocal habits, hydration, mastication, and sleep in the occurrence of vocal symptoms in teachers.
        J Voice. 2010; 24: 86-92
        • Rantala L
        • Sala E
        Kankare E. teachers’ working postures and their effects on the voice.
        Folia Phoniatr Logop. 2018; 70: 24-36https://doi.org/10.1159/000487593
        • Roy N
        • Weinrich B
        • Gray SD
        • et al.
        Voice amplification versus vocal hygiene instruction for teachers with voice disorders: a treatment outcomes study.
        J Speech Lang Hear Res. 2002; 45: 625-638https://doi.org/10.1044/1092-4388(2002/050
        • McCormick CA
        • Roy N.
        The ChatterVox portable voice amplifier: a means to vibration dose reduction?.
        J Voice. 2002; 16: 502-508https://doi.org/10.1016/s0892-1997(02)00126-1
        • Picard M
        • Bradley JS.
        Revisiting speech interference in classrooms.
        Audiology. 2001; 40: 221-244
        • Gaskill CS
        • O'Brien SG
        • Tinter SR.
        The effect of voice amplification on occupational vocal dose in elementary school teachers.
        J Voice. 2012; 26: 667.e19-27https://doi.org/10.1016/j.jvoice.2011.10.010
        • Morrow SL
        • Connor NP.
        Voice amplification as a means of reducing vocal load for elementary music teachers.
        J Voice. 2011; 25: 441-446https://doi.org/10.1016/j.jvoice.2010.04.003
        • Bovo R
        • Trevisi P
        • Emanuelli E
        • et al.
        Voice amplification for primary school teachers with voice disorders: a randomized clinical trial.
        Int J Occup Med Environ Health. 2013; 26: 363-372https://doi.org/10.2478/s13382-013-0115-1
        • Larsen JB
        • Blair JC.
        The effect of classroom amplification on the signal-to-noise ratio in classrooms while class is in session.
        Lang Speech Hear Serv Sch. 2008; 39 (s10.1044/0161-1461(2008/07-0032)): 451-460
        • Shockley KM
        • Gabriel AS
        • Robertson D
        • et al.
        The fatiguing effects of camera use in virtual meetings: a within-person field experiment.
        J Appl Psychol. 2021; 106: 1137-1155https://doi.org/10.1037/apl0000948
        • Ratan R
        • Miller DB
        • Bailenson JN.
        Facial appearance dissatisfaction explains differences in zoom fatigue.
        Cyberpsychology, Behav Soc Netw. 2022; 25: 124-129https://doi.org/10.1089/cyber.2021.0112
        • Pekkarinen E
        • Viljanen V.
        Acoustic conditions for speech communication in classrooms.
        Scand Audiol. 1991; 20: 257-263https://doi.org/10.3109/01050399109045973
        • Sala E
        • Viljanen V.
        Improvement of acoustic conditions for speech communication in classrooms.
        Appl Acoust. 1995; 45: 81-91https://doi.org/10.1016/0003-682X(94)00035-T
        • Barrett P
        • Davies F
        • Zhang Y
        • et al.
        The impact of classroom design on pupils’ learning: final results of a holistic, multi-level analysis.
        Build Environ. 2015; 89: 118-133https://doi.org/10.1016/j.buildenv.2015.02.013
        • Redman Y
        • Vercelli C
        • Cantor-Cutiva LC
        • et al.
        Work-related communicative profile of voice teachers: effects of classroom noise on voice and hearing abilities.
        J Voice. 2022; 36: 291.e17-291.e31https://doi.org/10.1016/j.jvoice.2020.05.021
        • Laukkanen A-M
        • Ilomäki I
        • Leppänen K
        • et al.
        Acoustic measures and self-reports of vocal fatigue by female teachers.
        J Voice. 2008; 22: 283-289https://doi.org/10.1016/j.jvoice.2006.10.001
        • Giannini SPP
        • Latorre M
        • do RD de O
        • et al.
        Voice disorders related to job stress in teaching: a case-control study.
        Cad Saude Publica. 2012; 28: 2115-2124https://doi.org/10.1590/s0102-311x2012001100011new
        • Munier C
        • Farrell R.
        Working conditions and workplace barriers to vocal health in primary school teachers.
        J Voice. 2016; 30: 127.e31-41https://doi.org/10.1016/j.jvoice.2015.03.004
        • Alva A
        • Machado M
        • Bhojwani K
        • et al.
        Study of risk factors for development of voice disorders and its impact on the quality of life of school teachers in Mangalore, India.
        J Clin Diagn Res. 2017; 11: MC01-MC05https://doi.org/10.7860/JCDR/2017/17313.9234
        • Smith E
        • Gray SD
        • Dove H
        • et al.
        Frequency and effects of teachers’ voice problems.
        J Voice. 1997; 11: 81-87https://doi.org/10.1016/s0892-1997(97)80027-6
        • Lu D
        • Wen B
        • Yang H
        • et al.
        A comparative study of the VHI-10 and the V-RQOL for quality of life among Chinese teachers with and without voice disorders.
        J Voice. 2017; 31: 509.e1-509.e6https://doi.org/10.1016/j.jvoice.2016.10.025
        • Solomon NP
        • Glaze LE
        • Arnold RR
        • et al.
        Effects of a vocally fatiguing task and systemic hydration on men's voices.
        J Voice. 2003; 17: 31-46https://doi.org/10.1016/s0892-1997(03)00029-8
        • Narasimhan S V
        • Gowda B.
        Multiparametric analysis of voice following prolonged voice use and voice rest in teachers: evidence from discriminant analysis.
        Eur Arch Otorhinolaryngol. 2022; 279: 1397-1404https://doi.org/10.1007/s00405-021-07144-2
        • Gama AC
        • Santos JN
        • Pedra Ede F
        • et al.
        Vocal dose in teachers: correlation with dysphonia.
        CoDAS. 2016; 28: 190-192https://doi.org/10.1590/2317-1782/20162015156
        • Thomas G
        • Kooijman PG
        • Cremers CW
        • et al.
        A comparative study of voice complaints and risk factors for voice complaints in female student teachers and practicing teachers early in their career.
        Eur Arch Otorhinolaryngol. 2006; 263: 370-380https://doi.org/10.1007/s00405-005-1010-6
        • Koufman JA
        • Blalock PD.
        Vocal fatigue and dysphonia in the professional voice user: Bogart-Bacall syndrome.
        Laryngoscope. 1988; 98: 493-498https://doi.org/10.1288/00005537-198805000-00003
        • De Almeida SI
        • Pontes P
        Dysphonic occupational syndrome : new aspects of this nosological entity.
        Int. Arch. Otorhinolaryngol. 2010; 14: 346-350
        • De Almeida SI
        • Pontes P
        • Bussacos MA
        • Neves L
        • Zambon F
        Vocal self assessment questionnaire: epidemological control tool of the ocupational dysphonic syndrome in professors.
        Arquivos Internacionais de Otorrinolaringologia. 2010 Jul; 14: 316-321
        • Calas M
        • Verhulst J
        • Lecoq M
        • et al.
        Vocal pathology of teachers.
        Rev Laryngol Otol Rhinol (Bord). 1989; 110: 397-406
        • Simberg S
        • Sala E
        • Laine A
        Rönnemaa AM. A fast and easy screening method for voice disorders among teacher students.
        Logoped Phoniatr Vocol. 2001; 26: 10-16
        • Byeon H.
        Occupational risks for voice disorders: evidence from a Korea national cross-sectional survey.
        Logoped Phoniatr Vocol. 2017; 42: 39-43https://doi.org/10.1080/14015439.2016.1178326
        • Altwigry AM
        • Almutairi MS
        • Ahmed M.
        Gastroesophageal reflux disease prevalence among school teachers of Saudi Arabia and its impact on their daily life activities.
        Int J Health Sci (Qassim). 2017; 11: 59-64
        • Lechien JR
        • Saussez S
        • Harmegnies B
        • et al.
        Laryngopharyngeal reflux and voice disorders: a multifactorial model of etiology and pathophysiology.
        J Voice. 2017; 31: 733-752https://doi.org/10.1016/j.jvoice.2017.03.015
        • Barbosa IK
        • Behlau M
        • Lima-Silva MF
        • et al.
        Voice symptoms, perceived voice control, and common mental disorders in elementary school teachers.
        J Voice. 2021; 35: 158.e1-158.e7https://doi.org/10.1016/j.jvoice.2019.07.018
        • Almeida AA
        • Behlau M.
        Relations between self-regulation behavior and vocal symptoms.
        J Voice. 2017; 31: 455-461https://doi.org/10.1016/j.jvoice.2016.10.010
        • Misono S
        • Meredith L
        • Peterson CB
        • et al.
        New perspective on psychosocial distress in patients with dysphonia: the moderating role of perceived control.
        J Voice. 2016; 30: 172-176https://doi.org/10.1016/j.jvoice.2015.02.002
        • da Rocha LM
        • de Mattos Souza LD.
        Voice Handicap Index associated with common mental disorders in elementary school teachers.
        J Voice. 2013; 27: 595-602https://doi.org/10.1016/j.jvoice.2012.10.001
        • Byeon H
        • Cha S.
        Evaluating the effects of smoking on the voice and subjective voice problems using a meta-analysis approach.
        Sci Rep. 2020; 10: 4720https://doi.org/10.1038/s41598-020-61565-3
        • Alanazi R
        • Alrahim A
        • Bayounos S
        • et al.
        Association between voice handicap index and reflux symptom index: a cross-sectional study of undiagnosed general and teacher cohorts in Saudi Arabia.
        Sultan Qaboos Univ Med J. 2018; 18: e350-e354https://doi.org/10.18295/squmj.2018.18.03.014
        • Alves M
        • Krüger E
        • Pillay B
        • et al.
        The effect of hydration on voice quality in adults: a systematic review.
        J Voice. 2019; 33: 125.e13-125.e28https://doi.org/10.1016/j.jvoice.2017.10.001
        • Franca MC
        • Simpson KO
        • Schuette A.
        Effects of caffeine on vocal acoustic and aerodynamic measures of adult females.
        CoDAS. 2013; 25: 250-255https://doi.org/10.1590/s2317-17822013000300010
        • Erath BD
        • Zañartu M
        • Peterson SD.
        Modeling viscous dissipation during vocal fold contact: the influence of tissue viscosity and thickness with implications for hydration.
        Biomech Model Mechanobiol. 2017; 16: 947-960https://doi.org/10.1007/s10237-016-0863-5
        • Behlau M
        • Oliveira G.
        Vocal hygiene for the voice professional.
        Curr Opin Otolaryngol Head Neck Surg. 2009; 17: 149-154https://doi.org/10.1097/MOO.0b013e32832af105
        • Alves IAV
        • Paulino VCP
        • Souza ALR
        • et al.
        Voice care from the student teachers’ perspective.
        J Voice. 2021; 35: 664.e21-664.e26https://doi.org/10.1016/j.jvoice.2019.12.010
        • Faham M
        • Ahmadi A
        • Drinnan M
        • et al.
        The effects of a voice education program on VHI scores of elementary school teachers.
        J Voice. 2016; 30: 755.e1-755.e11https://doi.org/10.1016/j.jvoice.2015.09.009
        • Roy N
        • Gray SD
        • Simon M
        • et al.
        An evaluation of the effects of two treatment approaches for teachers with voice disorders: a prospective randomized clinical trial.
        J Speech Lang Hear Res. 2001; 44: 286-296https://doi.org/10.1044/1092-4388(2001/023
        • Christmann MK
        • Scapini F
        • de Moraes Lima JP
        • et al.
        Voice-related quality of life, anxiety, and depression in female teachers: finger kazoo intensive short-term vocal therapy.
        J Voice. 2020; (Published online)https://doi.org/10.1016/j.jvoice.2020.08.039
        • Nallamuthu A
        • Boominathan P
        • Arunachalam R
        • et al.
        Outcomes of vocal hygiene program in facilitating vocal health in female school teachers with voice problems.
        J Voice. 2021; https://doi.org/10.1016/j.jvoice.2020.12.041
        • Richter B
        • Nusseck M
        • Spahn C
        • et al.
        Effectiveness of a voice training program for student teachers on vocal health.
        J Voice. 2016; 30: 452-459https://doi.org/10.1016/j.jvoice.2015.05.005
        • Ruotsalainen JH
        • Sellman J
        • Lehto L
        • et al.
        Interventions for preventing voice disorders in adults.
        Cochrane Database Syst Rev. 2007; 2007CD006372https://doi.org/10.1002/14651858.CD006372.pub2
        • Nusseck M
        • Immerz A
        • Spahn C
        • et al.
        Long-term effects of a voice training program for teachers on vocal and mental health.
        J Voice. 2021; 35: 438-446https://doi.org/10.1016/j.jvoice.2019.11.016
        • Speyer R.
        Effects of voice therapy: a systematic review.
        J Voice. 2008; 22: 565-580https://doi.org/10.1016/j.jvoice.2006.10.005
        • Liu H
        • Hao G
        • Chen S
        • et al.
        Effectiveness and feasibility of telepractice on voice therapy for female teachers in elementary schools with self-reported voice disorders.
        J Voice. 2021; S0892-1997: 00255-1https://doi.org/10.1016/j.jvoice.2021.07.015
        • Johnson A
        • Jacobson B
        • Grywalski C
        • et al.
        The Voice Handicap Index (VHI): development and validation.
        Am J Speech-Language Pathol. 1997; 6: 66-70