Advertisement

Respiratory and Sound Pressures, Maximum Phonation Time, Cervical Disability and Voice-Related Quality of Life of Teachers

Published:December 19, 2022DOI:https://doi.org/10.1016/j.jvoice.2022.11.013

      Abstract

      Introduction

      Many teachers report discomfort and a decrease in the quality of aerodynamic, respiratory, and cervical vocal aspects as well as of vocal self-assessment.

      Objective

      Characterize and correlate measurements of Sound Pressure Levels, Maximum Phonation Time of /a/, Maximum Respiratory Pressures, Voice-Related Quality of Life and cervical pain in teachers with vocal and musculoskeletal complaints and no organic vocal fold lesions, and compare with normative values.

      Methods

      Retrospective study with 56 teachers. Anamnesis, video laryngoscopy, hearing screening, measurements of sound pressure and maximum phonation time, and manovacuometry were performed. Self-assessment protocols for Voice-Related Quality of Life and Neck Disability Index were completed.

      Results

      there was significant higher Sound Pressure Levels; significant lower Maximum Phonation Time of /a/, Maximum Expiratory Pressure, and total and physical scores of Voice-Related Quality of Life; most participants had mild cervical disability; there was a negative correlation between Maximum Expiratory Pressure and Neck Disability Index, between Maximum Inspiratory Pressure and Maximum Sound Pressure Level, and between Neck Disability Index and Voice-Related Quality of Life.

      Conclusion

      The results showed that there are damages and inadequacies in teachers’ vocal production which affect their quality of life. Therefore, it is necessary to pay attention to the conditions of use of the voice by professionals, and to their health education.

      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

        • Banks RE
        • Bottalico P
        • Hunter EJ.
        The effect of classroom capacity on vocal fatigue as quantified by the vocal fatigue index.
        Folia Phoniatr Logop. 2017; 69: 85-93https://doi.org/10.1159/000484558
        • Abou-Rafée M
        • Zambon F
        • Badaró F
        • et al.
        Vocal fatigue in dysphonic teachers who seek treatment.
        Comm Disord Audiol Swallowing. 2019; 31https://doi.org/10.1590/2317-1782/20182018120
        • Zaky EA
        • Mamdouh H
        • Maher A
        • et al.
        Comparison between male and female teachers in Egyptian primary schools regarding the effect of teaching on their voice.
        Egypt J Otolaryngol. 2020; 36https://doi.org/10.1186/s43163-020-00033-1
        • Peretyaha L
        • Grineva V
        • Shulga I
        • et al.
        Integrated research of professional voice disorders of humanitarian departments’ teachers.
        Revista Romaneasca Pentru Educatie Multidimensionala. 2019; 11: 151https://doi.org/10.18662/rrem/102
        • Roy N
        • Merrill R;
        • 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
        • Behlau M
        • Zambon F
        • Guerrieri AC
        • et al.
        Epidemiology of voice disorders in teachers and nonteachers in brazil: prevalence and adverse effects.
        J Voice. 2012; 26: 665.e9-665.e18https://doi.org/10.1016/j.jvoice.2011.09.010
        • Ribeiro VV
        • Cielo CA.
        Vocal acoustic and auditory-perceptual measures, vocal complaints and professional characteristics of teachers from the city of Santa Maria (Rio Grande Do Sul), Brazil.
        Audiol-Comm Res. 2014; 19: 387-398https://doi.org/10.1590/S2317-64312014000400001395
        • Andriollo DB
        • Frigo LF
        • Cielo CA
        Effect of pompage on teachers self-assessment—Clinical Trial.
        J Voice. 2020; https://doi.org/10.1016/j.jvoice.2020.12.023
      1. Andriollo DB. Liberação miofascial como tratamento de distúrbios da voz, respiração e postura corporal de professoras – ensaio clínico controlado e randomizado. Doctoral dissertation. Federal University of Santa Maria; 2020. https://repositorio.ufsm.br/handle/1/22204 accessed May 20th, 2022

        • Servilha EAM;
        • Costa ATF.
        Knowledge about voice and the importance of voice as an educational resource in the perspective of university professors.
        Revista Cefac. 2015; 17: 13-26https://doi.org/10.1590/1982-0216201514813
        • 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
        • Pascotini F
        • Ribeiro VV
        • Cielo CA.
        Voice of elementary school teachers with voice complaints of different educational systems.
        Distúrbios Comun. 2015; 27: 138-150
        • Cantor Cutiva LC
        • Puglisi GE
        • Astolfi A
        • et al.
        four-day follow-up study on the self-reported voice condition and noise condition of teachers: relationship between vocal parameters and classroom acoustics.
        J Voice. 2017; 31: 120.e1-120.e8https://doi.org/10.1016/j.jvoice.2016.02.017
        • Švec JG
        • Granqvist S.
        Tutorial and guidelines on measurement of sound pressure level in voice and speech.
        J Speech Lang Hear Res. 2018; 61: 441-461https://doi.org/10.1044/2017_JSLHR-S-17-0095
        • 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
        • Rossi DC
        • Munhoz DF
        • Nogueira CR
        • et al.
        Relation of peak-flow with fonation time in asmatic patients.
        Revista Centro Especialização Fonoaudiol Clín. 2006; 8: 509-517https://doi.org/10.1590/S1516-18462006000400012
        • Mailänder E
        • Mühre L
        • Barsties B.
        Lax Vox as a voice training program for teachers: a pilot study.
        J Voice. 2017; 31: 262.e13-262.e22https://doi.org/10.1016/j.jvoice.2016.04.011
        • Andriollo DB
        • Frigo LF
        • Cielo CA.
        Effect of pompage on pain, disability and craniocervical position of female teachers - randomized clinical Trial (in press).
        Phys Ther Move. 2022; 35: e35118
        • Mahato NB
        • Bista M
        • Regmi D
        • et al.
        Acoustic analysis of voice in school teachers.
        J Nepal Med Assoc. 2018; 56: 658-661https://doi.org/10.31729/jnma.3626
        • Trinite B.
        Investigating voice differences in teachers with and without self-reported voice disorders, and healthcare workers without self-reported voice disorders.
        Logop Phoniatr Vocol. 2020; : 1-8https://doi.org/10.1080/14015439.2020.1727565
        • Desjardins M
        • Bonilha HS.
        The impact of respiratory exercises on voice outcomes: a systematic review of the literature.
        J Voice. 2020; 34: 648.e1-648.e39https://doi.org/10.1016/j.jvoice.2019.01.011
        • Pessoa I
        • Houri NM
        • Montemezzo D
        • et al.
        Predictive equations for respiratory muscle strength according to international and brazilian guidelines.
        Brazil J Phys Ther. 2014; 18: 410-418https://doi.org/10.1590/bjpt-rbf.2014.0044
        • Frigo LF
        • Braz MM
        • Marques CT
        • et al.
        Core strength and spectrographic vocal characteristics in women.
        Res Soc Dev. 2020; 9e172974050https://doi.org/10.33448/rsd-v9i7.4050
        • Herndon N
        • Sundarrajan A
        • Sivasankar P
        • et al.
        Respiratory and laryngeal function in teachers: pre- and postvocal loading challenge.
        J Voice. 2019; 33: 302-309https://doi.org/10.1016/j.jvoice.2017.11.015
        • Christmann MK
        • Scapini F
        • Lima JPM
        • et al.
        Aerodynamic vocal measurements in female teachers: Finger Kazoo intensive short-term vocal therapy.
        J Voice. 2021; 35: 259-270https://doi.org/10.1016/j.jvoice.2019.08.018
        • Marçal CCB
        • Peres MA.
        Self-reported voice problems among teacher.
        Revista de Saúde Pública. 2011; 45: 503-511https://doi.org/10.1590/S0034-89102011005000025
        • Franca MC.
        A comparison of vocal demands with vocal performance among classroom student teachers.
        J Commun Disord. 2013; 46: 111-123https://doi.org/10.1016/j.jcomdis.2012.11.001
        • Pirilä S
        • Pirilä P
        • Ansamaa T
        • et al.
        Relationship between activity noise, voice parameters, and voice symptoms among female teachers.
        Folia Phoniatr Logop. 2017; 69: 94-102https://doi.org/10.1159/000484204
        • Amantéa DV
        • Novaes AP
        • Campolongo GD
        • et al.
        The importance of the postural evaluation in patients with temporomandibular joint dysfunction.
        Acta Ortopédica Brasileira. 2004; 12: 155-159https://doi.org/10.1590/S1413-78522004000300004
        • Cook C
        • Richardson J
        • Braga L
        • et al.
        Cross-cultural adaptation and validation of the brazilian portuguese version of the neck disability index and neck pain and disability scale.
        Spine. 2006; 31: 1621-1627https://doi.org/10.1097/01.Brs.0000221989.53069.16
        • Beltran-Alacreu H
        • López-De-Uralde-Villanueva I
        • Calvo-Lobo C
        • et al.
        Clinical features of patients with chronic non-specific neck pain per disability level: a novel observational study.
        Revista da Associação Médica Brasileira. 2018; 64: 700-709https://doi.org/10.1590/1806-9282.64.08.700
        • Bernal-Utrera C
        • González-Gerez JJ
        • Saavedra-Hernandez M
        • et al.
        Manual therapy versus therapeutic exercise in non-specific chronic neck pain: study protocol for a randomized controlled trial.
        Trials. 2019; 20https://doi.org/10.1186/s13063-019-3598-7
        • Langenfeld A
        • Bohlender JE
        • Swanenburg J
        • et al.
        Cervical spine disability in correlation with subjective voice handicap in patients with voice disorders: a retrospective analysis.
        J Voice. 2020; 34: 371-379https://doi.org/10.1016/j.jvoice.2018.10.013
        • Korn G
        • Park S
        • Pontes A
        • et al.
        Vocal symptoms and associated risk factors between male and female university teachers.
        International Archives of Otorhinolaryngology. 2017; 22: 271-279https://doi.org/10.1055/s-0037-1606604
        • Johansson K
        • Seiger Å
        • Forsén M
        • et al.
        Assessment of voice, speech and communication changes associated with cervical spinal cord injury.
        Int J Lang Commun Disord. 2018; 53: 761-775https://doi.org/10.1111/1460-6984.12380
        • Cielo CA
        • Ribeiro VV
        • Bastilha GR
        • et al.
        Quality of life in voice, perceptual-auditory assessment and voice acoustic analysis of teachers with vocal complaints.
        Audiol-Comm Res. 2015; 20: 130-140https://doi.org/10.1590/S2317-64312015000200001511
        • Celenay ST
        • Akbayrak T
        • Kaya DO.
        A comparison of the effects of stabilization exercises plus manual therapy to those of stabilization exercises alone in patients with nonspecific mechanical neck pain: a randomized clinical trial.
        J Orthop Sports Phys Ther. 2016; 46: 44-55https://doi.org/10.2519/jospt.2016.5979
        • Espí-López GV
        • López-Martínez S
        • Inglés M
        • et al.
        Effect of manual therapy versus proprioceptive neuromuscular facilitation in dynamic balance, mobility and flexibility in field hockey players. a randomized controlled trial.
        Phys Ther Sport. 2018; 32: 173-179https://doi.org/10.1016/j.ptsp.2018.04.017
        • Cielo CA
        • Frigo LF
        • Christmann MK.
        Sound pressure level and maximum phonation time after finger kazoo technique.
        Revista Centro Especialização Fonoaudiologia Clínica. 2013; 15: 994-1000https://doi.org/10.1590/S1516-18462013000400029
        • Valente AMSL
        • Botelho C
        • Silva AMC.
        Voice disorder and associated factors among public schools teachers.
        Revista Brasil Saúde Ocup. 2015; 40: 183-195https://doi.org/10.1590/0303-7657000093814
        • Kojidi MM.
        • Okhovatian F
        • Rahimi A
        • et al.
        Comparison between the effects of passive and active soft tissue therapies on latent trigger points of upper trapezius muscle in women: single-blind, randomized clinical trial.
        J Chiropractic Med. 2016; 15: 235-242https://doi.org/10.1016/j.jcm.2016.08.010
        • Andrade SR
        • Cielo CA
        • Schwarz K
        • et al.
        Therapy vocal and nasal sounds: effects on hyperfunctional dysphonia.
        Revista CEFAC. 2016; https://doi.org/10.1590/1982-021620161810115
        • Beber BC
        • Cielo CA
        • Siqueira MA.
        Vocal folds edge lesions and maximum phonation times.
        Revista Centro Especial Fonoaudiologia Clín. 2009; 11: 134-141https://doi.org/10.1590/S1516-18462009000100018
      2. Asha - American Speech-Language-Hearing Association. Guidelines for audiologic screening [guidelines]. P. 1-63, Fev., 1997. Disponível Em:< www.asha.org/policy>. doi:10.1044/Policy.Gl1997-00199. accessed May 20th, 2022

        • Reyes A
        • Castillo A
        • Castillo J
        • et al.
        The effects of respiratory muscle training on phonatory measures in individuals with parkinson's disease.
        J Voice. 2020; 34: 894-902https://doi.org/10.1016/j.jvoice.2019.05.001
        • Christmann MK
        • Cielo CA
        • Scapini F
        • et al.
        Controlled and randomized clinical trial of intensive shortterm voice therapy with Finger Kazzo technique in teachers.
        Audiol Comm Res. 2017; 22: e1791https://doi.org/10.1590/2317-6431-2016-1791
      3. Behlau M, Madazio G, Feijó D, et al. Avaliação Da Voz. In: Behlau, M. (Coord.). Voz - o livro do especialista. Vol.1, Rio De Janeiro: Revinter; 2013. Cap 3. 85-245.

        • Colton RH
        • Casper JK
        • Leonard R.
        Compreendendo os problemas da voz: uma perspectiva fisiológica ao diagnóstico e ao tratamento.
        Revinter, Rio De Janeiro2010: 504
        • Andriollo DB
        • Frigo LF
        • Moraes AB
        • et al.
        Forced vital capacity and maximal respiratory pressure of popular professional singers.
        Fisioterapia Brasil. 2019; 20: 70https://doi.org/10.33233/fb.v20i1.2419
        • American Thoracic Society/European Respiratory Society
        ATS/ERS statement on respiratory muscle testing.
        Am J Respir Crit Care Med. 2002; 166 (New YorkAgo): 518-624
        • Pedro Caruso
        • Albuquerque ALP
        • Santana PV
        • et al.
        Diagnostic methods to assess inspiratory and expiratory muscle strength.
        Jornal Brasileiro de Pneumologia. 2015; 41: 110-123https://doi.org/10.1590/S1806-37132015000004474
        • Madazio G
        • Moreti F
        • Yamasaki R.
        Protocolos de autoavaliação do impacto da disfonia.
        Tratado de Especialidades em Fonoaudiologia. 1 Ed. Guanabara Koogan, São Paulo2014: 113-129 (Cap 16)
        • Soares JC
        • et al.
        Correlation between head posture, pain and disability index neck in women with complaints of neck pain.
        Fisioterapia Pesquisa. São Paulo. 2012; 19: 68-72https://doi.org/10.1590/S1809-29502012000100013
        • Eftekharsada B
        • Porjafar E
        • Eslamian F
        • et al.
        Combination of exercise and acupuncture versus acupuncture alone for treatment of myofascial pain syndrome: a randomized clinical trial.
        J Acupunct Merid Stud. 2018; 11: 315-322https://doi.org/10.1016/j.jams.2018.04.006
        • Behlau M
        • Zambon F
        • Moreti F
        • et al.
        Voice self-assessment protocols: different trends among organic and behavioral dysphonias.
        J Voice. 2017; 31: 112.e13-112.e27https://doi.org/10.1016/j.jvoice.2016.03.014
        • Sinkiewicz A
        • Garstecka A
        • Mackiewicz-Nartowicz H
        • et al.
        The effectiveness of rehabilitation of occupational voice disorders in a health resort hospital environment.
        JClin Med. 2021; 10: 2581https://doi.org/10.3390/jcm10122581
        • Morrison M
        • Rammage L.
        The management of voice disorders.
        Singular Publishing Group, San Diego, London1994
        • Behlau M.
        Voz o livro do especialista.
        Revinter, Rio de Janeiro2008
        • Mourão AM
        • Bassi IB
        • Gama ACC.
        Electroglottograpical evaluation of dysphonic women with mass lesions.
        Revista CEFAC. 2011; 13: 1073-1080https://doi.org/10.1590/s1516-18462011005000097
        • Cunha LJ
        • Pereira EC
        • Ribeiro VV
        • et al.
        Influence of the body position and emission number in the results of the maximum phonation times of adults without vocal complaints.
        J Voice. 2019; 33: 831-837https://doi.org/10.1016/j.jvoice.2018.05.010
        • Bernardi JMB
        • De Barros LN
        • Assunção LS
        • et al.
        Effect of the Finnish Tube on the voice of a deaf musician: a case report.
        J Voice. 2021; 35: 498.e23-498.e29https://doi.org/10.1016/j.jvoice.2019.09.019
        • Zheng YQ
        • Zhang BR
        • Su WY
        • et al.
        Laryngeal aerodynamic analysis in assisting with the diagnosis of muscle tension dysphonia.
        J Voice. 2012; 26: 177-181https://doi.org/10.1016/j.jvoice.2010.12.001
        • Joshi A
        • Watts CR.
        A comparison of indirect and direct methods for estimating transglottal airflow rate.
        J Voice. 2018; 32: 655-659https://doi.org/10.1016/j.jvoice.2017.09.020
        • Karlsen T
        • Sandvik L
        • Heimdal JH
        • et al.
        Acoustic voice analysis and maximum phonation time in relation to voice handicap index score and larynx disease.
        J Voice. 2020; 34: 161.e27-161.e35https://doi.org/10.1016/j.jvoice.2018.07.002
        • Lira ZS
        • Lemos ILL
        • Cardoso NSV
        • et al.
        Immediate effect of the Finger-Kazoo Technique associated with Glissandos in the voice of individuals with Parkinson's Disease.
        J Voice. 2022; 36: 585.e15-585.e25https://doi.org/10.1016/j.jvoice.2020.07.027
        • 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. 2020; https://doi.org/10.1016/j.jvoice.2020.05.021
        • Gava WJ
        • Ferreira LP
        • Andrada E Silva MA
        Support and singing voice: perspective of singing teachers and speech language pathologists.
        Revista CEFAC. 2010; 12: 551-562https://doi.org/10.1590/S1516-18462010005000047
        • Behlau M
        • Madazio G
        • Pacheco C
        • et al.
        Coaching strategies for behavioral voice therapy and training.
        J Voice. 2021; https://doi.org/10.1016/j.jvoice.2020.12.039
        • Mota AFB
        • Pellicani AD
        • Dornelas R
        • et al.
        Condição de produção vocal do professor em diferentes situações funcionais.
        Comm Disord Audiol Swallowing. 2022; 34https://doi.org/10.1590/2317-1782/20202020208
        • Silva BG
        • Chammas TV
        • Zenari MS
        • et al.
        Análise de possíveis fatores de interferência no uso da voz durante atividade docente.
        Revista Saúde Públic. 2017; 51: 124https://doi.org/10.11606/S1518-8787.2017051000092
        • 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
        • Ramos AC
        • Floro RL
        • Ribeiro VV
        • et al.
        Musculoskeletal pain and voice-related quality of life in dysphonic and non-dysphonic subjects.
        J Voice. 2018; 32: 307-313https://doi.org/10.1016/j.jvoice.2017.05.019
        • Meisingset I
        • Stensdotter AK
        • Woodhouse A
        • et al.
        Neck motion, motor control, pain and disability: a longitudinal study of associations in neck pain patients in physiotherapy treatment.
        Man Ther. 2016; 22: 94-100https://doi.org/10.1016/j.math.2015.10.013
        • Ferreira FV
        • Prado AL
        • Cielo CA
        • et al.
        A relação da postura corporal com a prosódia na doença de parkinson: estudo de caso.
        Revista CEFAC. Saõ Paulo. 2007; 9 (Jul./Set): 319-329https://doi.org/10.1590/S1516-18462007000300005
        • Kang JI
        • Jeong DK
        • Choi H.
        The effect of feedback respiratory exercise on muscle activity, craniovertebral angle, and neck disability index of the neck flexors of patients with forward head posture.
        J Phys Ther Sci. 2016; 28: 2477-2481https://doi.org/10.1589/jpts.28.2477
        • Chiu KL
        • Hsieh PC
        • Wu CW
        • et al.
        Exercise training increases respiratory muscle strength and exercise capacity in patients with chronic obstructive pulmonary disease and respiratory muscle weakness.
        Heart Lung. 2020; 49: 556-563https://doi.org/10.1016/j.hrtlng.2020.03.005
        • Machado ÉC
        • Frigo LF
        • Bresolin FA
        • et al.
        Immediate effects of cervical stimulation and diaphragmatic release on vocal production.
        Fisioterapia Movimento. 2020; 33https://doi.org/10.1590/1980-5918.033.AO37