Occupational Medicine Advance Access originally published online on November 21, 2007
Occupational Medicine 2008 58(1):74-76; doi:10.1093/occmed/kqm104
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Short Reports |
The prevalence and impact of voice problems in primary school teachers
1 5 Route du Bout du Monde, 1206 Geneva, Switzerland
2 Department of Banking and Finance, Smurfit School of Business, University College Dublin, Dublin, Ireland
Correspondence to: Caitriona Munier, 5 Route du Bout du Monde, 1206 Geneva, Switzerland. Tel: +41 22 3466111; e-mail: muniermchugh{at}eircom.net
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Abstract |
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Background Teachers have been identified as at increased risk of developing an occupational voice disorder. Primary school teachers are particularly at risk as they have little opportunity for voice rest during the working day.
Aim To analyse the prevalence and impact of voice problems in primary school teachers in the workplace.
Method An 85-item questionnaire was administered to 550 primary school teachers from 42 schools in the greater Dublin area.
Results A response rate of 55% was obtained. Results suggest that 27% suffered from a voice problem, 53% an ‘intermittent’ voice problem, while only 20% had no voice problem. Teachers of the junior classes were more vulnerable to developing a voice problem than those of senior classes. The most common symptoms were ‘dry throat’ and ‘vocal fatigue’.
Conclusion Voice disorders were very common in our study of primary school teachers. Those most frequently affected taught the younger classes. Further intervention is needed to identify and minimize risk factors and reduce the negative impact of voice on the individual and on work.
Keywords Risk factors; teachers; voice problems
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Introduction |
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Teachers have been identified as being at increased risk of developing an occupational voice disorder because of the demands put on their voices professionally [1–4]. Numerous studies have examined the prevalence, nature, risk factors, symptoms and causes of voice problems in teachers and their impact on work [5,6].
In the past, much attention was given to medical, individual, psychological and emotional factors and their role in the development of voice disorders [7,8]. Recent publications in this area have identified that ergonomics issues have an important role to play in the etiology of voice problems in teachers and other professional voice users [9].
Primary school teachers are particularly at risk as they have little opportunity for vocal rest during the working day. Their day is characterized by an average of 5 h of continuous teaching with a short break in the morning and a 30-min break for lunch. In contrast, secondary school teachers have more opportunities for vocal rest as their day is characterized by teaching periods of 45 min which are sometimes followed by a break before the next teaching period begins. Previous studies have not taken this important difference into account and have reported their findings on primary and secondary school teachers and sometimes university lecturers as a single group.
The aim of this study was to analyse and evaluate occupationally related voice problems in primary school teachers.
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Methods |
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The sample was taken from the teachers of the primary schools in North County Dublin. Schools in this area were visited by the author who handed over the questionnaires with explanations. Some 550 questionnaires were distributed to all teachers in 42 schools. The study was carried out in the autumn term in order to minimize the effect of winter colds on the voice.
A self-administered questionnaire consisting of 85 questions was designed to investigate the vocal use patterns, working environment and voice problems in primary school teachers. Responses were analysed quantitatively and qualitatively. The last three questions were open-ended and gave respondents an opportunity to give their opinion; these items were analysed qualitatively only. Ten questions were adapted, with permission, from a Hong Kong study [3].
A follow-up telephone call was made to 1 in 20 respondents in order to validate the responses to the questionnaires.
Two different statistical tests were used for analysis of data. First, the Welch's statistic test for the difference between the means of two different normally distributed samples. Second, chi-squared statistical tests for the proportion of dependence between two groups.
While formal ethical approval was not sought, the study was felt to meet all criteria for exemption as set down by University College Dublin's Human Research Ethical Committee. The study was anonymized, subjects were self-participating, there was no conflict of interest and there was no bias or prejudice on subjects' careers as a result of having participated. In addition, the study did not involve a vulnerable group and was non-invasive.
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Results |
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A response rate of 55% was obtained with 304 questionnaires returned out of 550 distributed questionnaires. Teachers returning were 244 females, 57 males and 3 of unknown sex. Teacher's age ranged from 22 to 65 years; average 36–45 years old. In all, 85% were teaching a class of 29 to 36 pupils.
Of the returned responses, 27% (n = 82) reported a self-diagnosed voice problem at the time of the study, 53% (n = 161) reported an ‘intermittent’ voice problem and 20% (n = 61) indicated they had no voice problem.
For the purposes of analysis, the respondents were divided into three groups: ‘voice problem group’, ‘intermittent voice problem group’ and ‘normal voice group’.
There was a negative correlation between class age and number of teachers affected with a voice problem (P < 0.01) (Figure 1).
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The most common physical symptoms of which teachers in the voice problem group complained were as follows: (i) voice fatigue (18%), (ii) dry throat (19%) and (iii) cannot sing high notes (20%). Those with a voice problem reported it to negatively affect work with 12% reporting a severe effect, 34% a moderate effect and 48% a mild effect.
The most common symptoms of the intermittent voice problem group were voice fatigue (23%), dry throat (26%) and an inability to sing high notes (29%).
The symptoms ‘voice fatigue’ and ‘dry throat’ were reported more frequently in the most junior classes as shown in Figure 2.
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A chi-squared test of the significance of dependence of variables, i.e. ‘vocal fatigue’, dry throat and ‘running out of breath’, on class age was significant at the 5% level (P < 0.05) for the voice problem group.
In all, 93% of the teachers who participated in this survey had never received any formal professional voice training. One-third of our respondents reported that ‘there was a complete lack of information available and no awareness of potential problems’ and 30% of teachers reported that ‘there was no medical assistance available’.
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Discussion |
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Our findings showed a very high prevalence of 80% of voice problems among responding teachers. A significant relationship was found between age of pupils taught and number of teachers affected with a voice problem (P < 0.01).
The similarity of our results with surveys reported in other countries [1–4] suggested that occupational characteristics put teachers at risk of developing voice problems. Early treatment and prevention must be considered.
The four most common symptoms reported by teachers were ‘weak voice’, voice fatigue, dry throat and ‘inability to sing high notes’. These findings were similar to those reported by Yiu [3] in a Hong Kong study and Smith et al. [5] in an American study.
Measures that could be considered to try and reduce the impact of voice disorder in teachers include addressing possible risk factors such as the age of pupils taught, workload and opportunities for periods of vocal rest. Consideration should be given to providing teachers with formal voice training. Furthermore, improved awareness among teachers of the symptoms of voice disorder and early referral to occupational health or a specialist voice therapist or ENT surgeon for those reporting symptoms are other measures which might help prevent or reduce the impact of voice disorder.
It was generally felt that that there is a ‘black hole’ within the profession in regard to this issue. The medical profession and departments of education need to be aware of the demands put on teachers' voices. Clear Health and Safety guidelines incorporating these suggestions should be considered. The cost incurred in providing these services needs to be offset against the hidden cost in terms of absenteeism and teachers leaving the profession because of a voice problem.
This research suggests that primary school teachers are at risk of developing a voice problem. Future research needs to address variables not previously addressed such as class size and age of pupils taught.
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Conflicts of interest |
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None declared.
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References |
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[Abstract/Free Full Text] - McHugh-Munier C, Scherer K, Lehmann W, Scherer U. Personality and coping strategies in patients with vocal cord nodules and polyps. J Voice (1997) 11:452–461.[CrossRef][Web of Science][Medline]
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