PREVALENCE OF DYSPHONIA AMONG COLLEGE TEACHERS

IN LAHORE

SUPERVISOR NAME: DR. AZKA SHABBIR

Submitted by:
 Ayesha Rehman
 Hadia Abbas
 Saleha Shakeel
 Laiba Shahnawaz
 Fatima Amjad
 Rabeeya Afzal
 Shehzaf Fatima
 Rida Mazhar
 Nabia Nisa
 Saira Mushtaq
 ABSTRACT
Background: Any change in voice output affecting one's natural voice is called dysphonia. Dysphonia may
result from damage to the vocal cord tissues. Hoarseness, a weak voice and a sore throat, are examples of
symptoms brought on by repeated use of the voice.

Objective of the study: The main objective of this study was to find the prevalence of dysphonia among
college teachers in Lahore.

Materials & Methods: It was a cross-sectional study which was conducted among college teachers of age
ranging from 20-50 years. In this study, 264 participants both men and women were included. Data was
gathered by using Voice Handicap Index (VHI) to evaluate the prevalence of dysphonia among college teachers
in Lahore.
Results: In our study, we included 264 college teachers of age 20-50 years out of which 83 (31.4%) teachers
were male and 181 (68.6%) teachers were female. The mean age and standard deviation was 1.34 ± 0.47. By
using the Voice Handicap Index (VHI) we found that 186(70.45%) teachers had mild dysphonia, 55(20.83%)
had moderate dysphonia and 23(8.71%) had severe dysphonia. So we concluded that mild dysphonia is more
common among college teachers.
Conclusion: In conclusion, there is a high prevalence of mild dysphonia among college teachers in Lahore,
affecting more than half of the studied population in the evaluation performed through Voice Handicap Index
(VHI) scale. As voice is the main tool used among teachers so if the voice quality is not improved it can lead
to the poor academic performance, psychomotor dysfunction and dysphonia.

Keywords: Dysphonia, Hoarseness, Teachers, Voice Disorder, Voice Handicap Index (VHI)
 INTRODUCTION

 Voice plays an important role in controlling social interaction and communication. Any change in voice
output that affects one's natural voice is referred to as dysphonia (Hamid et al., 2014).

 Functional dysphonia is the major cause of chronic dysphonia. A voice change lasting longer than four weeks
is known as chronic dysphonia. A change in voice quality without anatomical or neurological problems of the
larynx is known as functional dysphonia (Tierney et al., 2021).

 Compared to other professional groups, teachers have a greater frequency of vocal alterations among those
who use their voices professionally (Rossi-Barbosa et al., 2019).

 Teachers frequently suffer from voice problems, and the effects can be serious at that times (Martins et al.,
2014).
 The signs and symptoms of dysphonia are weight loss, aspiration, and dysphagia (Neighbors and Song, 2020).

 Hoarseness, dryness of mouth, vocal tiredness, throat discomfort, roughness and dysphonia are voice
conditions that are frequently observed in teachers (Evitts et al., 2022).

 One of the research indicates that due to the increased usage of their voices, professionals, particularly
teachers, are more susceptible to vocal disorders. In addition, it has been stated that about 20% of teachers
have been forced to discontinue work due to vocal issues (Seifpanahi et al., 2016).

 Gender is considered as a potential risk factor for the development of dysphonia. It is acknowledged that
women are more susceptible to experience vocal disorders as compared to men (Marchese et al., 2022).
 Voice disorders caused by lesions are classified into four categories which are malformation, traumatic,
inflammatory/ infectious and neoplastic etiologies (Kiakojoury et al., 2014).

 The major goal should be the prevention of voice issues in teachers. The best solution is early detection,
required for taking preventive action before a problem even emerges (Martins et al., 2014).

 By switching from blackboards and chalk to whiteboards and pens, providing audio equipment and
microphones, reducing the number of students in each classroom to prevent or minimize the voice symptoms
of teachers (Martins et al., 2014).
 Objective

The objective of our study was to find the prevalence of dysphonia among college teachers in Lahore.
 Rationale

The rationale of our study was to aware teachers about voice disorders and which measures should
be taken to prevent these disorders. For example drinking adequate water daily, appropriate use of
voice without yelling and use of microphones to improve the symptoms of voice disorders.
 Literature Review
The experts discuss studies on dysphonia among teachers.

 Evitts et al in 2022 investigated how professors report different voice issues while teaching online as
compared to teaching in class, and how these issues relate to common professional risks. A restricted voice
and hoarseness were the most often reported dysphonia symptoms in both teaching methodologies.

 U.K. Menon et al in 2021 reported a higher prevalence of vocal abnormalities in secondary school teachers.
The main aim of this research was to determine the rate of specific vocal disorder among teachers. Comparing
the rate and intensity of dysphonia between primary and secondary school teachers was the secondary aim. In
the population of studied teachers, 70.1% had voice abnormalities.

 Yousef Mansouri et al in 2021 showed that one of the greatest group of professionals who utilize their voice
professionally is the teaching community. Teachers rely highly on their voice in the workplace and use it as
main professional tool.
 Rossi-Barbosa et al in 2019 suggested that this research was to evaluate the socio-demographic,
organizational, lifestyle, health-disease, and vocal features of the instructors. A recurrent voice change was
present in 39.7% of subjects.

 Usha Devadas et al in 2017 claimed that teachers were more prone to acquire voice difficulties than other
voice professionals. Based on the latest findings, teachers develop voice problems as a result of a variety of
risk variables. These elements could be biological, psychological, or ecological in nature.

 Previous studies focused on Dysphonia among Primary and Elementary School teachers in Lahore
exclusively, they didn't focus on Secondary Level Teachers. The Teachers at College and Higher Secondary
Level will be the focus of our research in the meantime.
 Materials and Methods

Study Design
A cross-sectional observational study was used.

Duration of Study

After the synopsis' approval, the study was completed within six months .

Study Setting
The data was collected from Teachers of Punjab Group of Colleges, Al-Noorian’s College and Govt. Shalimar
College.
Sample Size

 The sample size was calculated using the following formula through WHO online calculator

Where,
 Z =Standard normal distribution level corresponding to desired confidence level (Z=1.96 for 95% CL)

 P is anticipated population proportion = 0.78

 d is absolute precision = 0.05

 Confidence interval = 5%

 By putting these values the estimated sample size = 264

Sampling Technique
A non-probability-convenience sampling method was used in our study.

Data Collection Tool

Voice Handicap Index (VHI)

The VHI consists of 30 variables, equally divided between three domains: functional (F), physical (P), and
emotional (E). The VHI questionnaire is scored from 0-30 for mild symptoms, 31-60 for moderate symptoms and
60-120 for severe symptoms, yielding values that matched the questionnaire’s domains.
Sample Selection

Inclusion Criteria
 Age: 20-50 years (Albustan et al., 2018)
 Both male and female teachers
 Secondary level teachers

Exclusion Criteria
 Primary, Graduate and Post-graduate Teachers
 Teachers with History of any Respiratory Problems
 Any history of smoking
Data Collection Procedure
A cross-sectional study was conducted to determine the prevalence of dysphonia among teachers of different
colleges in Lahore. Voice Handicap Index (VHI) questionnaire was used to evaluate the prevalence of dysphonia.

Data Analysis Method

Data was gathered by using the Voice Handicap Index (VHI) after taking consent. The statistical package for
social sciences (SPSS) version 23 was used to analyze the data.
 Results

Table 1: Age of Participants

Cumulative
Age Group Frequency Percent Valid Percent Percent

20-35 173 65.5 65.5 65.5

36-50 91 34.5 34.5 100.0
Total 264 100.0 100.0
Fig 1: Age of participants

Figure 1: shows that out of 264 teachers, 173 (65.5%) teachers were between 20-35 years while
91 (34.5%) teachers were between 36-50 years. The mean age and standard deviation was 1.34 ±
Table 2: Gender of participants

Gender Frequency Percent Valid Percent Cumulative Percent

Female 181 68.6 68.6 68.6

Male 83 31.4 31.4 100.0

Total 264 100.0 100.0

Fig 2: Gender of Participants

31.4%

68.6%

Figure 2: Out of 264 teachers, 83 teachers (31.4%) were male while 181 teachers (68.6%) were female in
our study.
Table 4: prevalence of dysphonia among college teachers in Lahore

Valid Cumulative
Frequency Percent Percent Percent
mild 186 70.5 70.5 70.5
moderate 55 20.8 20.8 91.3
severe 23 8.7 8.7 100.0
Total 264 100.0 100.0
Fig 4: Prevalence of dysphonia among college teachers in Lahore

Figure 4.34: shows that out of 264 teachers, 186(70.45%) had mild dysphonia, 55(20.83%) had moderate
dysphonia and 23(8.71%) had severe dysphonia.
 Discussion

Our study included 264 teachers, 83 teachers (31.4%) were male and 181 teachers (68.6%)
were female. The age range was 20-50 years. Out of them 186(70.45%) teachers had mild
dysphonia, 55(20.83%) had moderate dysphonia and 23(8.71%) had severe dysphonia.
Another study conducted by Luise Marques da Rocha in 2015 included 575 teachers out of
which 91.3% were female and 8.7% were male who filled VHI questionnaire. The study
showed that 33.9% of teachers had dysphonia.

In our study, the age range for 264 teachers was 20-50 years. The mean age and standard
deviation was 1.34 ± 0.47 . In contrast Rossi Barbosa et al in 2019 involved 146 teachers with
the ages between 24-59, average age of 41.2 years (SD ± 6.78).

Our study included 264 teachers, 83 teachers (31.4%) were male and 181 teachers (68.6%)
were female. Out of them 186 (70.5%) teachers had mild dysphonia, 55 (20.8%) had moderate
dysphonia and 23 (8.71%) had severe dysphonia. In contrast U.K.Menon et al in 2021 gave
VHI questionnaire to 319 teachers out of which 242 teachers responded. There results showed
that 22(9.1%) had mild dysphonia, 5(2.1%) had moderate dysphonia and no one had severe
dysphonia.
 Conclusion

 Mild dysphonia affects more than half of the teachers when assessed using the VHI scale.
As voice is an important tool used by teachers, so if voice quality does not improve it leads
towards learning disabilities, low academic achievement and dysphonia.
 Limitations

 The study was conducted in specific colleges which may limit the generalizability of the
finding of dysphonia among college teachers in other regions.

 Insufficient time and funding constrained present challenges and limitations in our study.

 The population of our research was only college teachers.

 Due to small sample size, the results could not be applied to all college teachers.
 Recommendations

 The teaching hours should be reduced.

 Overuse of laryngeal muscles should be reduced by the use of microphone.

 Dryness of mouth affects the voice so it is recommended to stay hydrated.

 Prolonged use of voice should be avoided by taking small pauses or by reducing lecture
time.
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 VOICE HANDICAP INDEX
Name:_______________
Date:_______________
These are statements that many people have used to describe their voices and the effects of their
voices on their lives. Circle the response that indicates how frequently you have the same
experience.
0-never
My 1-almost
voice makes it difficult never 2-sometimes
for people to hear me. 3-almost always 4-always 0 1 2 3 4
Part I-F
People have difficulty understanding me in a noisy room. 0 1 2 3 4

My family has difficulty hearing me when I call them throughout the house. 0 1 2 3 4

I use the phone less often than I would like to. 0 1 2 3 4

I tend to avoid groups of people because of my voice. 0 1 2 3 4

I speak with friends, neighbors, or relatives less often because of my voice. 0 1 2 3 4

People ask me to repeat myself when speaking face-to-face. 0 1 2 3 4

My voice difficulties restrict my personal and social life. 0 1 2 3 4

I feel left out of conversations because of my voice. 0 1 2 3 4

My voice problem causes me to lose income. 0 1 2 3 4

Subtotal________
 Part II-P
I run out of air when I talk. 0 1 2 3 4

The sound of my voice varies throughout the day. 0 1 2 3 4

People ask, “What’s wrong with your voice?” 0 1 2 3 4

My voice sounds creaky and dry. 0 1 2 3 4

I feel as though I have to strain to produce voice. 0 1 2 3 4

The clarity of my voice is unpredictable. 0 1 2 3 4

I try to change my voice to sound different. 0 1 2 3 4

I use a great deal of effort to speak. 0 1 2 3 4

My voice is worse in the evening. 0 1 2 3 4

My voice “gives out” on me in the middle of speaking. 0 1 2 3 4

Subtotal_________
Part III-E
I am tense when talking to others because of my voice. 0 1 2 3 4

People seem irritated with my voice. 0 1 2 3 4

I find other people don’t understand my voice problem. 0 1 2 3 4

My voice problem upsets me. 0 1 2 3 4

I am less outgoing because of my voice problem. 0 1 2 3 4

My voice makes me feels handicapped. 0 1 2 3 4

I feel annoyed when people ask me to repeat. 0 1 2 3 4

I feel embarrassed when people ask me to repeat. 0 1 2 3 4

My voice makes me feel incompetent. 0 1 2 3 4

I am ashamed of my voice problem. 0 1 2 3 4

Subtotal____________
 Total______________

Score Range Severity Common Association

0-30 Mild Minimal amount of handicap
31-60 Moderate Often seen in patients with vocal nodules, polyps, or cysts

60-120 Severe Often seen in patients with vocal fold paralysis or severe vocal fold scarring.

The Voice Handicap Index (VHI): Development and Validation. Barbara H. Jacobson, Alex Johnson, Cynthia
Grywalski, Alice Silbergleit, Gary Jaconsen, Michael S. Benninger. American Journal of Speech-Language
Pathology, Vol 6(3), 66-70, 1997, The Voice Handicap Index is reprinted with permission from all authors and
ASHA. Copyright 1997-2001 American Speech-Language-Hearing Association.