Prevalence and Risk Factors for Occupational Voice Disorders in Nepalese Teachers: A Cross-Sectional Study

Pokharel, Apar; Basnet, Puspa; Sharma, Bibek; Upadhyay, Hari Prasad

doi:10.1055/s-0043-1777417

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Original Research • Int Arch Otorhinolaryngol 28 (3) • 2024 • https://doi.org/10.1055/s-0043-1777417 copy

Prevalence and Risk Factors for Occupational Voice Disorders in Nepalese Teachers: A Cross-Sectional Study

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction

Teachers are a high-risk group for the development of vocal dysfunction, as they use voice extensively in their profession.

Objective

To know the prevalence and risk factors associated with voice strain in teachers.

Methods

A cross-sectional study was conducted among schoolteachers in Chitwan, Nepal. The Voice Handicap Index questionnaire was used as a survey tool.

Result

A total of 315 teachers were enrolled in the study. The mean age of the participants was of 36.7 years. Teachers from public schools, primary grade classes, > 50 pupils in the classroom, > 24 hours of classes per week, dust in class, and recurrent tonsil problems were associated with various degrees of vocal handicap.

Conclusion

There is a high prevalence of voice disorder among teachers. A holistic approach, which includes teacher education regarding voice care during their work and management of their voice handicap by taking into consideration different risk factors, must be adopted.

Keywords
school teachers; voice disorder; voice fatigue

S.N.	Variables	Mean	Standard deviation	Minimum	Median	Maximum
1	Age (in years)	36.7	10.4	18	35	61
2	Years of service	9.2	7.4	1	7	33
3	Number of pupils in class	56.9	26.1	18	45	130
4	Weekly class hours	27.1	11.6	6	29	72
5	VHI: hunctional score	10.0	7.4	0	9	31
6	VHI: physical score	9.5	7.2	0	9	29
7	VHI: emotional score	8.5	7.5	0	7	27
8	Total VHI score	27.9	21.6	0	25	85

S. N.	Variables	Number	Percentage
1	Gender
	Female	167	53.0
	Male	148	47.0
2	Type of school
	Public	132	41.9
	Private	183	58.1
3	School grade
	Primary	109	34.6
	Lower secondary	86	27.3
	Higher secondary	120	38.1
4	Number of pupils in class
	< 50	164	52.1
	≥ 50	151	47.9
5	Years of service
	< 10	181	57.5
	10 to 20	107	33.9
	> 20	27	8.6
6	Weekly class hours
	< 24	123	39.1
	≥ 24	192	60.9
7	Subject taught
	All	27	8.6
	Computer science	11	3.5
	English	87	27.6
	Games	11	3.5
	Math	70	22.2
	Nepali	31	9.8
	Science	42	13.3
	Social studies	29	9.2
	Others (Accounting/Business/Drawing)	7	2.2
8	Class temperature > 21°C	239	75.9
9	Dust in the classroom	94	29.8
10	Air conditioning	98	31.1
11	Speaking
	Low voice	60	19.1
	Raised voice	202	64.1
	Top of one's voice	53	16.8
12	Physical exercise	243	77.1
13	Tobacco use	10	3.2
14	Allergy	56	17.8
15	Ear issues	8	2.5
16	Sinusitis	34	10.8
17	Tonsil issues	80	25.4
18	Thyroid issues	12	3.8
20	Phoniatric care
	History of pharmacotherapy for voice disorder	127	40.3
	History if voice rehabilitation	88	28
	History of sick leaves due to voice disorder	42	13.33

S.N.	Variables	Odds ratio (95% confidence interval)	p-value	Adjusted odds ratio (95% confidence interval)	p-value
1	Gender
	Female	Ref.
	Male	0.9 (0.3–2.6)	0.82
2	Type of school
	Public	Ref.		Ref.
	Private	1.9 (0.6–5.6)	0.24	3.6 (0.8–16.0)	0.09
3	School grade		0.13 (overall)
	Primary	6.9 (0.9–55.5)	0.07	18.4 (1.5–221.0)	0.02 ^* * (Relaxed p-value criteria considered in the univariate analysis.
	Lower secondary	2.1 (0.6–7.1)	0.22	2.3 (0.5–10.9)	0.28
	Higher secondary	Ref.		Ref.
4	Number of upils in class	1.1 (1.0–1.1)	0.03 ^* * (Relaxed p-value criteria considered in the univariate analysis.	1.0 (1.0–1.1)	0.32
5	Years of service	1.9 (1.3–2.9)	< 0.001 ^* * (Relaxed p-value criteria considered in the univariate analysis.	2.8 (1.5–5.1)	< 0.001 ^* * (Relaxed p-value criteria considered in the univariate analysis.
6	Weekly class hours	1.0 (0.9–1.0)	0.53
7	Subject taught		0.93 (overall)
		Ref.
	Computer science	12100000 (0–Inf.)	0.99
	English	0.4 (0.1–3.7)	0.45
	Games	12100000 (0–Inf.)	0.99
	Math	2.7 (0.2–44.0)	0.50
	Nepali	0.6 (0.1–6.5)	0.64
	Science	0.5 (0.1–5.1)	0.56
	Social studies	12100000 (0–Inf.)	0.99
	Others (Accounting/Business/Drawing)	12100000 (0–Inf.)	0.99
8	Class temperature
	≤ 21°C	1.9 (0.4–8.9)	0.39
	> 21°C	Ref.
9	Dust in class
	No	Ref.		Ref.
	Yes	0.4 (0.1–1.2)	0.10	0.7 (0.2–2.9)	0.65
10	Air conditioning
	No	Ref.
	Yes	0.6 (0.2–1.7)	0.34
11	Speaking		0.29 (overall)
	Low voice	Ref.
	Raised voice	2.5 (0.8–8.3)	0.13
	Top of one's voice	2.3 (0.4–12.5)	0.33
12	Physical exercise
	No	Ref.
	Yes	0.9 (0.3–3.4)	0.89
13	Tobacco use
	No	Ref.
	Yes	2050000 (0–Inf.)	0.99
14	Allergy
	No	Ref.
	Yes	1.3 (0.3–6.0)	0.73
15	Ear issues
	No	Ref.
	Yes	0.3 (0.0–2.7)	0.29
16	Sinusitis
	No	Ref.
	Yes	0.7 (0.2–3.3)	0.67
17	Tonsil issues
	No	Ref.
	Yes	0.4 (0.2–1.3)	0.13	0.2 (0.0–0.7)	0.02 ^* * (Relaxed p-value criteria considered in the univariate analysis.
18	Thyroid issues
	No	Ref.
	Yes	2060000 (0–Inf.)	0.99

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[1] Address for correspondence Apar Pokharel, MD Department of ENT and Head and Neck Surgery, College of Medical Sciences Chitwan district, Province Number: 3 Nepal (e-mail: aparpokharel@hotmail.com.