ABSTRACT

Purpose

To identify scientific evidence about (Work-Related Voice Disorder) and risk factors, as well as to point out vocal symptoms, instruments and evaluation methods in spoken voice professionals.

Research strategy

Integrative literature review carried out in LILACS, SciELO, MEDLINE/PubMed and Scopus databases.

Selection criteria

Articles with spoken voice professionals, which addressed individual, organizational and/or environmental risk factors linked to symptoms and/or voice disorders, observational studies, fully available, without restriction to language and year of publication.

Results

58 papers were included, the largest publication between the years 2014 and 2022, predominantly in Brazil, with emphasis on the teacher. The most used evaluation method was vocal assessment using self-assessment protocols, followed by auditory-perceptual assessment and laryngological examination. The mostly identified risk factors were individual ones, followed by organizational and environmental ones, in addition to sensory and auditory vocal symptoms having been reported.

Conclusion

The most often self-reported factors were noise, intense voice use, respiratory changes, being female and inappropriate vocal practices. For sensory vocal symptoms, dry throat, throat clearing and vocal fatigue stand out, and for auditory symptoms, hoarseness.

Keywords:
Voice; Voice disorders; Dysphonia; Occupational health; Risk factors

RESUMO

Objetivo

Identificar evidências científicas sobre o distúrbio de voz relacionado ao trabalho e fatores de risco, além de apontar os sintomas vocais, instrumentos e métodos de avaliação em profissionais da voz falada.

Estratégia de pesquisa

Revisão integrativa da literatura, realizada nas bases de dados LILACS, SciELO, MEDLINE/PubMed e Scopus.

Critérios de seleção

Artigos com profissionais da voz falada, que abordassem os fatores de riscos individuais, organizacionais e/ou ambientais vinculados aos sintomas e/ou distúrbios de voz, estudos observacionais, disponíveis na íntegra, sem restrição ao idioma e ano de publicação.

Resultados

Foram incluídos 58 estudos, maior publicação entre os anos de 2014 e 2022, predominantemente no Brasil, em destaque, o professor. O método de avaliação mais utilizado foi autoavaliação com o uso dos protocolos, seguido da avaliação perceptivo-auditiva e do exame laringológico. Os fatores de risco mais identificados foram os individuais, seguidos dos organizacionais e ambientais, além de terem sido relatados os sintomas vocais sensoriais e auditivos.

Conclusão

Os fatores mais autorreferidos são ruído, uso intenso da voz, alterações respiratórias, ser do gênero feminino e práticas vocais inadequadas. Quanto aos sintomas vocais sensoriais, destacam-se garganta seca, pigarro e fadiga vocal, e quanto aos auditivos, rouquidão.

Palavras-chave:
Voz; Distúrbios da voz; Disfonia; Saúde ocupacional; Fatores de risco

INTRODUCTION

Spoken voice professionals have specific characteristics and practices regarding their occupational context, which favors the risk of developing voice disorders when compared to the general population. In this population, the voice is considered the main work instrument(¹1 Nakamura HY, Souza TMT, Constantini AC, Maiorino AV. Relação entre voz e ambiente. In: Siqueira MCC, Ferreira LP, Brasolotto AG, Santos RS, editores. Fonoaudiólogo: o que fazer com a voz do professor? Curitiba: Universidade Tuiuti do Paraná; 2021. p. 135-48.), and some factors may interfere with the conditions of vocal production. The factors can be endogenous, which are related to the subjects themselves, such as the presence of respiratory allergies. Furthermore, they can be exogenous, referring to aspects external to the individual, such as noise, dust/mold, temperature, and others(²2 Smith E, Gray SD, Dove H, Kirchner L, Heras H. Frequency and effects of teachers’ voice problems. J Voice. 1997 Mar;11(1):81-7. http://dx.doi.org/10.1016/S0892-1997(97)80027-6. PMid:9075180.
http://dx.doi.org/10.1016/S0892-1997(97)... ).

Endogenous and exogenous factors (i.e., individual, organizational, and environmental risks) contribute to the occurrence of vocal complaints and symptoms(³3 Silva WJN, Lopes LW, Macedo AER, Costa DB, Almeida AAF. Reduction of risk factors in patients with behavioral dysphonia after vocal group therapy. J Voice. 2017;31(1):123.e15-9. http://dx.doi.org/10.1016/j.jvoice.2016.01.007. PMid:26897544.
http://dx.doi.org/10.1016/j.jvoice.2016.... ) that, associated with occupational activity, may help in the genesis and/or maintenance of work-related voice disorder (WRVD)(⁴4 Santos CT, Santos C, Lopes LW, Silva POC, Lima-Silva MFB. Relationship between working and voice conditions self-reported by telemarketers of an emergency call center. CoDAS. 2016;28(5):583-94. http://dx.doi.org/10.1590/2317-1782/20162015125. PMid:27849240.
http://dx.doi.org/10.1590/2317-1782/2016... ).

Studies that seek to understand the vocal condition of spoken voice professionals have highlighted the high prevalence of vocal complaints in females. In addition, they emphasized the presence of neck, shoulder, and back pain, respiratory alterations, lack of restful sleep, anxiety, and irregular general health as individual factors(⁵5 Johns-Fiedler H, van Mersbergen M. The prevalence of voice disorders in 911 emergency telecommunicators. J Voice. 2015;29(3):389.e1-10. http://dx.doi.org/10.1016/j.jvoice.2014.08.008. PMid:25659735.
http://dx.doi.org/10.1016/j.jvoice.2014....

6 Fontan L, Fraval M, Michon A, Déjean S, Welby-Gieusse M. Vocal problems in sports and fitness instructors: a study of prevalence, risk factors, and need for prevention in France. J Voice. 2017;31(2):261.e33-8. http://dx.doi.org/10.1016/j.jvoice.2016.04.014. PMid:27528368.
http://dx.doi.org/10.1016/j.jvoice.2016.... -⁷7 Murta JAN, Barbosa MS, Caldeira AP, Barbosa-Medeiros MR, Rossi-Barbosa LAR. Factors associated with voice complaints in community health agents. CoDAS. 2021;33(1):e20200017. http://dx.doi.org/10.1590/2317-1782/20202020017. PMid:33886748.
http://dx.doi.org/10.1590/2317-1782/2020... ).

The environmental risks that may predispose to dysphonia mentioned in the literature include high noise, exposure to irritating chemicals of the upper airways (solvents, metal vapors, asphyxiating gases), the presence of dust or smoke in the workplace, inadequate ventilation of the environment, low humidity, unfavorable acoustics, inadequate or insufficient furniture, and material resources, among others(⁶6 Fontan L, Fraval M, Michon A, Déjean S, Welby-Gieusse M. Vocal problems in sports and fitness instructors: a study of prevalence, risk factors, and need for prevention in France. J Voice. 2017;31(2):261.e33-8. http://dx.doi.org/10.1016/j.jvoice.2016.04.014. PMid:27528368.
http://dx.doi.org/10.1016/j.jvoice.2016.... ,⁸8 Brasil. Ministério da Saúde. Distúrbio de voz relacionado ao trabalho - DVRT [Internet]. Brasília: Ministério da Saúde; 2018 [citado em 2022 Out 10]. Disponível em: http://bvsms.saude.gov.br/bvs/publicacoes/disturbio_voz_relacionado_trabalho_dvrt.pdf
http://bvsms.saude.gov.br/bvs/publicacoe...

9 Korn GP, Pontes AALP, Abranches D, Pontes AL. Vocal tract discomfort and risk factors in university teachers. J Voice. 2016;30(4):507.e1-8. http://dx.doi.org/10.1016/j.jvoice.2015.06.001. PMid:26279322.
http://dx.doi.org/10.1016/j.jvoice.2015....

10 Hagelberg AM, Simberg S. Prevalence of voice problems in priests and some risk factors contributing to them. J Voice. 2015;29(3):389.e11-8. http://dx.doi.org/10.1016/j.jvoice.2014.08.015. PMid:25795362.
http://dx.doi.org/10.1016/j.jvoice.2014.... -¹¹11 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(3):488.e1-8. http://dx.doi.org/10.1016/j.jvoice.2018.08.021. PMid:30396701.
http://dx.doi.org/10.1016/j.jvoice.2018.... ).

Regarding organizational risks, there is intensive use of voice, work-related stress, lack of autonomy, lack of training, inadequate posture and equipment, work under strong pressure, overload of functions, deprivation of access to toilets and hydration, salary dissatisfaction, and others(⁸8 Brasil. Ministério da Saúde. Distúrbio de voz relacionado ao trabalho - DVRT [Internet]. Brasília: Ministério da Saúde; 2018 [citado em 2022 Out 10]. Disponível em: http://bvsms.saude.gov.br/bvs/publicacoes/disturbio_voz_relacionado_trabalho_dvrt.pdf
http://bvsms.saude.gov.br/bvs/publicacoe... ,¹⁰10 Hagelberg AM, Simberg S. Prevalence of voice problems in priests and some risk factors contributing to them. J Voice. 2015;29(3):389.e11-8. http://dx.doi.org/10.1016/j.jvoice.2014.08.015. PMid:25795362.
http://dx.doi.org/10.1016/j.jvoice.2014.... ,¹²12 Servilha EAM, Correia JM. Correlações entre condições do ambiente, organização do trabalho, sintomas vocais autorreferidos por professores universitários e avaliação fonoaudiológica. Disturb Comun. 2014;26(3):452-62.

13 Estes C, Sadoughi B, Coleman R, D’Angelo D, Sulica L. Phonotraumatic injury in fitness instructors: risk factors, diagnoses, and treatment methods. J Voice. 2020;34(2):272-9. http://dx.doi.org/10.1016/j.jvoice.2018.10.001. PMid:30393049.
http://dx.doi.org/10.1016/j.jvoice.2018....

14 Servilha EAM, Arbach MDP. Queixas de saúde em professores universitários e sua relação com fatores de risco presentes na organização do trabalho. Disturb Comun. 2011;23(2):181-91.-¹⁵15 Cipriano FGC, Ferreira LP, Servilha EAM, Marsiglia RMG. Relation between voice disorders and work in a group of Community Health Workers. CoDAS. 2013;25(6):548-56. PMid:24626981.).

These risk factors may contribute to the presence of vocal signs and symptoms, such as hoarseness, dry throat, effort when speaking, strained speech and neck pain, difficulty in treble, lack of vocal volume and projection, loss of vocal efficiency, poor resistance when speaking, throat clearing, and inconstancy and/or tremor in the voice. When added to psychoemotional/psychosomatic factors, these signs and symptoms can evolve to WRVD(⁷7 Murta JAN, Barbosa MS, Caldeira AP, Barbosa-Medeiros MR, Rossi-Barbosa LAR. Factors associated with voice complaints in community health agents. CoDAS. 2021;33(1):e20200017. http://dx.doi.org/10.1590/2317-1782/20202020017. PMid:33886748.
http://dx.doi.org/10.1590/2317-1782/2020... ,⁸8 Brasil. Ministério da Saúde. Distúrbio de voz relacionado ao trabalho - DVRT [Internet]. Brasília: Ministério da Saúde; 2018 [citado em 2022 Out 10]. Disponível em: http://bvsms.saude.gov.br/bvs/publicacoes/disturbio_voz_relacionado_trabalho_dvrt.pdf
http://bvsms.saude.gov.br/bvs/publicacoe... ,¹⁵15 Cipriano FGC, Ferreira LP, Servilha EAM, Marsiglia RMG. Relation between voice disorders and work in a group of Community Health Workers. CoDAS. 2013;25(6):548-56. PMid:24626981.

16 Alves LP, Araújo LTR, Xavier JA No. Prevalência de queixas vocais e estudo de fatores associados em uma amostra de professores de ensino fundamental em Maceió, Alagoas, Brasil. Rev Bras Saúde Ocup. 2010;35(121):168-75. http://dx.doi.org/10.1590/S0303-76572010000100018.
http://dx.doi.org/10.1590/S0303-76572010... -¹⁷17 Rechenberg L, Goulart BN, Roithmann R. Impacto da atividade laboral de teleatendimento em sintomas e queixas vocais: estudo analítico. J Soc Bras Fonoaudiol. 2011;23(4):301-7. http://dx.doi.org/10.1590/S2179-64912011000400003. PMid:22231049.
http://dx.doi.org/10.1590/S2179-64912011... ). The development of WRVD is multicausal and requires an in-depth assessment to analyze the professionals in all their contexts.

The speech-therapy evaluation of a voice disorder is complex, and since it is related to occupational activity, its multifactorial characteristic should be considered(¹⁸18 Andrada e Silva MA, Bittencourt MFQP, Korn GP, Borrego MCM. Diagnóstico do distúrbio de voz relacionado ao trabalho: reflexões multidisciplinares sobre o uso da voz no trabalho. In: Ferreira LP, Andrada e Silva MA, editores. Distúrbio de voz relacionado ao trabalho. São Paulo: Sintropia Traduções; 2022. p. 152-77.). The evaluation of vocal patterns can be done through vocal self-assessment, with the application of protocols, auditory-perceptual judgment, and acoustic analysis of the voice, in addition to the laryngological examination performed by an otorhinolaryngologist(¹⁹19 Patel RR, Awan SN, Barkmeier-Kraemer J, Courey M, Deliyski D, Eadie T, et al. Recommended protocols for instrumental assessment of voice: american Speech-Language-Hearing Association expert panel to develop a protocol for instrumental 170 assessment of vocal function. Am J Speech Lang Pathol. 2018;27(3):887-905. http://dx.doi.org/10.1044/2018_AJSLP-17-0009. PMid:29955816.
http://dx.doi.org/10.1044/2018_AJSLP-17-... ,²⁰20 Dejonckere PH, Bradley P, Clemente P, Cornut G, Crevier-Buchman L, Friedrich G, et al. A basic protocol for functional assessment of voice pathology, especially for investigating the efficacy of (phonosurgical) treatments and evaluating new assessment techniques. Guideline elaborated by the Committee on Phoniatrics of the European Laryngological Society (ELS). Eur Arch Otorhinolaryngol. 2001;258(2):77-82. http://dx.doi.org/10.1007/s004050000299. PMid:11307610.
http://dx.doi.org/10.1007/s004050000299... ).

Furthermore, it is important to investigate individual, organizational, and environmental risk factors and their relationships with voice disorders in the context of spoken voice since studies with this proposal help better evaluate, promote, and prevent WRVD. Moreover, they avoid damage to physical and mental health and quality of life, which involves these professionals’ social and work aspects. The specific assessment and self-assessment instruments for this population of spoken voice professionals are relevant to investigate their entire occupational and vocal health context.

GOAL

This literature review aimed to identify scientific evidence on work-related voice disorders (WRVD) and risk factors. Furthermore, it pointed out vocal symptoms, instruments, and assessment methods related to spoken voice professionals.

RESEARCH STRATEGY

This study is an integrative review of the literature. It included the following steps: elaborating the guiding question, searching the scientific literature, and quantitative and qualitative data analysis.

The following question guided this study: “What are the risk factors, vocal symptoms, instruments, and assessment methods present in studies aimed at spoken voice professionals with WRVD?”. The formulation of the question and the strategic search were based on the strategy of the acronym PVO (P stands for population, context, or problem-based situation; V stands for variables, and O stands for outcomes, such as expected or unexpected results)(²¹21 Mendes ALF, Dornelas do Carmo R, Dias de Araújo AMG, Paranhos LR, Mota CSO, Schneiberg S, et al. The effects of phonation into glass, plastic, and LaxVox tubes in singers: a systematic review. J Voice. 2019 Maio;33(3):381.e1-9. http://dx.doi.org/10.1016/j.jvoice.2017.12.005. PMid:29731378.
http://dx.doi.org/10.1016/j.jvoice.2017.... ). Thus, “P” corresponded to the speaking voice professionals, “V” to individual, organizational, and environmental risk factors and the assessment instruments and methods, and “O” represented voice disorders.

The consulted databases included: Latin American and Caribbean Health Sciences Literature (LILACS), Scientific Electronic Library Online (SciELO), Medical Literature Analysis and Retrieval System Online (MEDLINE)/Public Medicine Library (PubMed), and Scopus. The keywords were selected from a consultation of the Health Sciences Descriptors (DeCS) and the Medical Subject Headings (MeSH). The descriptors included “Voice”, “Voice Disorders”, “Dysphonia”, “Occupational health”, and “Risk factors”.

Next, a strategic search based on two combinations of descriptors was carried out. It used the Boolean operators “OR” and “AND”, respectively. It included the databases a) SciELO/Scopus/LILACS: “Dysphonia” OR “Voice Disorders” OR “Voice” AND “Occupational health” AND “Risk factors”; b) MEDLINE: (((“Phonation Disorders”) OR (“Phonation Disorder”) OR (Dysphonia [MeSH])) OR ((“Voice Disorder”) OR (“Voice Disturbance”) OR (“Disturbance, Voice”) OR (“Voice Disorders” [MeSH])) OR ((“Voices”) OR (“Voice” [MeSH])) AND ((“Health, Occupational”) OR (“Occupational Health” [MeSH])) AND ((“Factor, Risk”) OR (“Risk Factor”) OR (“Risk Factors” [MeSH]))).

SELECTION CRITERIA

Regarding the inclusion criteria, we adopted articles whose population comprised spoken voice professionals, which addressed individual, organizational, and/or environmental risk factors related to voice symptoms and/or disorders, and observational studies available in full and without restriction regarding language and year of publication.

Exclusion criteria included repetition in databases, monographs, dissertations, theses, literature reviews, books, and book chapters.

Two team members independently and blindly conducted the search between May and July 2022. The first stage of article selection comprised reading and analyzing the titles and abstracts of all detected publications. It identified the repetition of articles in different databases. Then, the selected studies were read in full. Articles that did not meet the eligibility criteria were excluded. In cases of disagreement among the members, a reasoned discussion of the pre-established criteria was foreseen with a third, more experienced researcher. However, there was no need to do so. Figure 1 shows the flowchart used to identify and select the articles.

DATA ANALYSIS

Data analysis was performed descriptively, with a quantitative-qualitative synthesis of the data. In the first phase, the data from the studies were compiled and then divided into three tables. Based on the survey, a specific database was elaborated in a Microsoft Excel spreadsheet to extract the following variables: year of publication, country of study, study design, spoken voice sample/professional, methods and techniques for voice assessment, self-assessment (validated protocol, non-validated protocol), endogenous vocal risk factors (individual), exogenous vocal risk factors (environmental and organizational), and sensory and auditory vocal symptoms.

FINDINGS

The electronic searches identified a total of 266 references. Of these, 58 were selected for this study according to the eligibility criteria. Chart 1 shows the characteristics of the selected studies.

The publication of studies was higher between 2014 and 2022 (62.1%; n=36). Studies were predominantly conducted in Brazil (46.5%; n=27), followed by Finland (12.1%; n=7) and India (10.3%; n=6). Regarding the study design, cross-sectional was the most frequent (81.0%; n=47), with teachers being the most studied category of spoken voice professionals (67.2%; n=39). Table 1 shows the results of the characteristics of the selected studies.

Table 2 shows the methods, instruments, and techniques of voice assessment used in the included articles. All studies (100%; n=58) applied self-assessment protocols, and most (39.6%; n=23) were validated; Vocal Production Condition - Teacher - VPC-T (20.6%; n= 12) and Vocal Handicap Index-VHI-10 (18.9%; n= 11). It was observed that 10.3% (n=6) used the auditory-perceptual assessment and 10.3% (n=6) the laryngological examination.

Table 3 shows the number of risk factors for dysphonia and vocal symptoms related to WRVD in the selected studies. Endogenous (individual) factors were identified in most of the articles (94.8%; n=55). Exogenous factors related to working conditions were described in 93.1% (n=54) of the studies, and exogenous environmental factors were observed in 69.0% (n=40). Most articles investigated sensory vocal symptoms (77.5%; n=45), auditory vocal symptoms were investigated by 74.1% (n=46) of the publications, and both symptoms were investigated by 48.27% (n=28).

DISCUSSION

This integrative review study sought to identify evidence in the literature of the link between work-related risk factors and voice disorders. Furthermore, it aimed to point out the symptoms, instruments, and assessment methods in spoken voice professionals.

The articles included in this review were predominantly carried out in Latin America, specifically in Brazil, with the highest number of publications between 2014 and 2022. It is believed that the interest in the study of this population of voice professionals by the scientific community in Brazil is due to the historical-political movement, debates among occupational health professionals, Reference Centers for Workers' Health (Centro de Referência em Saúde do Trabalhador - CERESTs), universities, associations, legal professions, speech therapists, and others, for the recognition of WRVD amid environmental conditions and the organization of the work process(⁸8 Brasil. Ministério da Saúde. Distúrbio de voz relacionado ao trabalho - DVRT [Internet]. Brasília: Ministério da Saúde; 2018 [citado em 2022 Out 10]. Disponível em: http://bvsms.saude.gov.br/bvs/publicacoes/disturbio_voz_relacionado_trabalho_dvrt.pdf
http://bvsms.saude.gov.br/bvs/publicacoe... ,²²22 Oliveira P, Ribeiro VV, Constantini AC, Cavalcante MEOB, Sousa MS, Silva K. Prevalence of work-related voice disorders in voice professionals: systematic review and meta-analysis. J Voice. 2022. http://dx.doi.org/10.1016/j.jvoice.2022.07.030. PMid:36057482.
http://dx.doi.org/10.1016/j.jvoice.2022.... ).

Regarding the design, there was a greater number of cross-sectional observational studies. In cross-sectional studies, the frequency with which a given event manifests itself in a specific population and the associated factors are estimated at the same historical moment without the researcher’s intervention(²³23 Bastos JLD, Duquia RP. Um dos delineamentos mais empregados em epidemiologia: estudo transversal. Sci Med. 2007;17(4):229-32.). Thus, some studies aimed to verify the prevalence, i.e., the number of cases existing at a given moment(⁹9 Korn GP, Pontes AALP, Abranches D, Pontes AL. Vocal tract discomfort and risk factors in university teachers. J Voice. 2016;30(4):507.e1-8. http://dx.doi.org/10.1016/j.jvoice.2015.06.001. PMid:26279322.
http://dx.doi.org/10.1016/j.jvoice.2015.... ,¹⁰10 Hagelberg AM, Simberg S. Prevalence of voice problems in priests and some risk factors contributing to them. J Voice. 2015;29(3):389.e11-8. http://dx.doi.org/10.1016/j.jvoice.2014.08.015. PMid:25795362.
http://dx.doi.org/10.1016/j.jvoice.2014.... ,¹⁶16 Alves LP, Araújo LTR, Xavier JA No. Prevalência de queixas vocais e estudo de fatores associados em uma amostra de professores de ensino fundamental em Maceió, Alagoas, Brasil. Rev Bras Saúde Ocup. 2010;35(121):168-75. http://dx.doi.org/10.1590/S0303-76572010000100018.
http://dx.doi.org/10.1590/S0303-76572010... ,²⁴24 Leão SHDS, Oates JM, Purdy SC, Scott D, Morton RP. Voice problems in New Zealand Teachers: a national survey. J Voice. 2015;29(5):645.e1-13. http://dx.doi.org/10.1016/j.jvoice.2014.11.004. PMid:25619465.
http://dx.doi.org/10.1016/j.jvoice.2014....

25 Devadas U, Hegde M, Maruthy S. Prevalence of and risk factors for self-reported voice problems among Hindu temple priests. J Voice. 2019;33(5):805.e1-12. http://dx.doi.org/10.1016/j.jvoice.2018.03.020. PMid:29748026.
http://dx.doi.org/10.1016/j.jvoice.2018....

26 Simões M, Latorre MRDO. Prevalência de alteração vocal em educadoras e sua relação com a auto-percepção. Rev Saude Publica. 2006;40(6):1013-8. http://dx.doi.org/10.1590/S0034-89102006000700008. PMid:17173157.
http://dx.doi.org/10.1590/S0034-89102006... -²⁷27 Dejonckere PH. Determinants of voice-related symptoms and complaints in different categories of teachers: the importance of the psycho-emotional component. In: Proceedings of the 7th International Workshop on Models and Analysis of Vocal Emissions for Biomedical Applications (MAVEBA 2011); 2011; Firenze, Italy. USA: Curran Associates; 2011. p. 161-4.). Other studies investigated the association of risk factors for voice disorders in the many categories of spoken voice professionals(¹¹11 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(3):488.e1-8. http://dx.doi.org/10.1016/j.jvoice.2018.08.021. PMid:30396701.
http://dx.doi.org/10.1016/j.jvoice.2018.... ,²⁸28 Munier C, Farrell R. Working conditions and workplace barriers to vocal health in primary school teachers. J Voice. 2016;30(1):127.e31-41. http://dx.doi.org/10.1016/j.jvoice.2015.03.004. PMid:25895844.
http://dx.doi.org/10.1016/j.jvoice.2015....

29 Gomes NR, Teixeira LC, Medeiros AM. Vocal symptoms in university professors: their association with vocal resources and with work environment. J Voice. 2020;34(3):352-7. http://dx.doi.org/10.1016/j.jvoice.2018.10.010. PMid:30473269.
http://dx.doi.org/10.1016/j.jvoice.2018.... -³⁰30 Sampaio MC, Reis EJFB, Carvalho FM, Porto LA, Araújo TM. Vocal effort and voice handicap among teachers. J Voice. 2012;26(6):820.e15-8. http://dx.doi.org/10.1016/j.jvoice.2012.06.003. PMid:23177755.
http://dx.doi.org/10.1016/j.jvoice.2012.... ).

The most investigated professional category was that of teachers(³¹31 Chen BL, Cheng YY, Lin CY, Guo HR. Incidence of voice disorders among private school teachers in Taiwan: a nationwide longitudinal study. Int J Environ Res Public Health. 2022;19(3):1130. http://dx.doi.org/10.3390/ijerph19031130. PMid:35162161.
http://dx.doi.org/10.3390/ijerph19031130...

32 Bermúdez de Alvear RM, Barón FJ, Martínez-Arquero AG. School teachers’ vocal use, risk factors, and voice disorder prevalence: guidelines to detect teachers with current voice problems. Folia Phoniatr Logop. 2011;63(4):209-15. http://dx.doi.org/10.1159/000316310. PMid:20938203.
http://dx.doi.org/10.1159/000316310... -³³33 Giannini SPP, Latorre MRDO, Ferreira LP. Distúrbio de voz e estresse no trabalho docente: um estudo caso-controle. Cad Saude Publica. 2012;28(11):2115-24. http://dx.doi.org/10.1590/S0102-311X2012001100011. PMid:23147953.
http://dx.doi.org/10.1590/S0102-311X2012... ) of kindergarten, elementary school, high school, or university level. It is the category with the highest prevalence of voice disorder when compared to other spoken voice professionals. The intensive use of the voice, in addition to the working conditions, such as environmental noise, aspects related to dust, cleanliness, lighting, room size, workload, and individual factors, such as respiratory allergies and stress, among others, generate a higher risk for the development of voice disorders(³²32 Bermúdez de Alvear RM, Barón FJ, Martínez-Arquero AG. School teachers’ vocal use, risk factors, and voice disorder prevalence: guidelines to detect teachers with current voice problems. Folia Phoniatr Logop. 2011;63(4):209-15. http://dx.doi.org/10.1159/000316310. PMid:20938203.
http://dx.doi.org/10.1159/000316310... ,³³33 Giannini SPP, Latorre MRDO, Ferreira LP. Distúrbio de voz e estresse no trabalho docente: um estudo caso-controle. Cad Saude Publica. 2012;28(11):2115-24. http://dx.doi.org/10.1590/S0102-311X2012001100011. PMid:23147953.
http://dx.doi.org/10.1590/S0102-311X2012... ).

Vocal self-assessment was used in all studies in this review, obtained through the application of protocols. It is widely used and conceptualized in clinical practice and research in the area, helps in the patient's perception, and enables self-knowledge regarding a given condition(³⁴34 Marinho ACF, Medeiros AM, Lima EP, Teixeira LC. Instrumentos de avaliação e autoavaliação da fala em público: uma revisão integrativa da literatura. Audiol Commun Res. 2022;27:e2539. http://dx.doi.org/10.1590/2317-6431-2021-2539.
http://dx.doi.org/10.1590/2317-6431-2021... ). The instrument most applied in the articles selected for this review was the Vocal Production Conditions - Teacher (VPC-T), elaborated and validated(³⁵35 Ferreira LP, Akutsu CM, Luciano P, Viviano NDAG. Condições de produção vocal de teleoperadores: correlação entre questões de saúde, hábitos e sintomas vocais. Rev Soc Bras Fonoaudiol. 2008;13(4):307-15. http://dx.doi.org/10.1590/S1516-80342008000400003.
http://dx.doi.org/10.1590/S1516-80342008... ), which investigates sociodemographic aspects, teachers' working conditions, vocal aspects/habits, and lifestyle.

Through the VPC-T, studies have verified the self-reported findings of the teachers' population, with an association between vocal symptoms, voice disorders, and working conditions(¹²12 Servilha EAM, Correia JM. Correlações entre condições do ambiente, organização do trabalho, sintomas vocais autorreferidos por professores universitários e avaliação fonoaudiológica. Disturb Comun. 2014;26(3):452-62.,¹⁴14 Servilha EAM, Arbach MDP. Queixas de saúde em professores universitários e sua relação com fatores de risco presentes na organização do trabalho. Disturb Comun. 2011;23(2):181-91.,³⁶36 Hermes EGC, Bastos PRHO. The prevalence of teachers’ vocal symptoms in municipal network of education in Campo Grande, Mato Grosso do Sul, Brazil. J Voice. 2016;30(6):756.e1-7. http://dx.doi.org/10.1016/j.jvoice.2015.09.005. PMid:26596844.
http://dx.doi.org/10.1016/j.jvoice.2015.... ,³⁷37 Pena JJ, Servilha EAM. Tipificação de sintomas relacionados à voz e sua produção em professores identificados com ausência de alteração vocal na avaliação fonoaudiológica. In: Anais do XIV Encontro de Iniciação Científica; 2009 Set 29-30; Campinas. Campinas: PUC; 2009.). Another study(³⁸38 Dornelas R, Santos TA, Oliveira DS, Irineu RA, Brito A, Silva K. Violence in schools and the voice of teachers. CoDAS. 2017;29(4):e20170053. PMid:28813075.) did not find a significant relationship between voice disorders and working conditions and pointed out the situation of violence against teachers at school. Furthermore, some studies evaluated the relationship between voice-related disorders and mental health. We highlight a study that applied the VPC-T protocols with the Job Stress Scale (JSS) and Work Ability Index (WAI), detecting the association of voice disorders with stress and loss/limitation of work ability(³³33 Giannini SPP, Latorre MRDO, Ferreira LP. Distúrbio de voz e estresse no trabalho docente: um estudo caso-controle. Cad Saude Publica. 2012;28(11):2115-24. http://dx.doi.org/10.1590/S0102-311X2012001100011. PMid:23147953.
http://dx.doi.org/10.1590/S0102-311X2012... ). Another study applied the Screening Index for Voice Disorder (SIVD) and the Burnout Syndrome Assessment Questionnaire (BSAQ) combined with the VPC-T. It identified that Burnout syndrome was associated with a probable voice disorder(³⁹39 Brito Mota AF, Giannini SPP, Oliveira IB, Paparelli R, Dornelas R, Ferreira LP. Voice disorder and burnout syndrome in teachers. J Voice. 2019;33(4):581.e7-16. http://dx.doi.org/10.1016/j.jvoice.2018.01.022. PMid:30220529.
http://dx.doi.org/10.1016/j.jvoice.2018.... ).

Moreover, the VPC-T was adapted and used in research with several voice professionals, such as in the category of health agents. They found an association between the development of voice disorders and environmental factors, such as dust, temperature, and work organization. Among those reported, intensive use of the voice, taking work home, intense physical exertion, inadequate furniture, physical and psychological violence/aggression, and complaints related to vocal and emotional symptoms and back pain stand out(⁴⁰40 Cipriano FG, Ferreira LP. Queixas de voz em agentes comunitários de saúde: correlação entre problemas gerais de saúde, hábitos de vida e aspectos vocais. Rev Soc Bras Fonoaudiol. 2011;16(2):132-9. http://dx.doi.org/10.1590/S1516-80342011000200005.
http://dx.doi.org/10.1590/S1516-80342011... ,⁴¹41 Cipriano FG, Ferreira LP, Servilha EAM, Marsiglia RMG. Relação entre distúrbio de voz e trabalho em um grupo de Agentes Comunitários de Saúde. CoDAS. 2013;25(6):548-56. PMid:24626981.).

This review included another protocol, the Vocal Handicap Index (VHI-10)(¹³13 Estes C, Sadoughi B, Coleman R, D’Angelo D, Sulica L. Phonotraumatic injury in fitness instructors: risk factors, diagnoses, and treatment methods. J Voice. 2020;34(2):272-9. http://dx.doi.org/10.1016/j.jvoice.2018.10.001. PMid:30393049.
http://dx.doi.org/10.1016/j.jvoice.2018.... ,⁴²42 Albustan SA, Marie BS, Natour YS, Darawsheh WB. Kuwaiti Teachers’ Perceptions of Voice Handicap. J Voice. 2018;32(3):319-24. http://dx.doi.org/10.1016/j.jvoice.2017.05.003. PMid:28576335.
http://dx.doi.org/10.1016/j.jvoice.2017.... ,⁴³43 Rantala LM, Hakala S, Holmqvist S, Sala E. Associations between voice ergonomic risk factors and acoustic features of the voice. Logoped Phoniatr Vocol. 2015;40(3):99-105. http://dx.doi.org/10.3109/14015439.2013.831947. PMid:24007529.
http://dx.doi.org/10.3109/14015439.2013.... ). It is a shortened version of the VHI, designed to assess the self-perception of the impact of a voice disorder, validated and originated from English and then adapted and validated in other languages, such as Brazilian Portuguese(⁴⁴44 Costa T, Oliveira G, Behlau M. Validation of the Voice Handicap Index: 10 (VHI-10) to the Brazilian Portuguese. CoDAS. 2013;25(5):482-5. http://dx.doi.org/10.1590/S2317-17822013000500013. PMid:24408554.
http://dx.doi.org/10.1590/S2317-17822013... ). It is not specifically indicated for the occupational context because it does not present domains related to working conditions. Furthermore, it is worth mentioning the Screening Index for Voice Disorders (SIVD)(⁴⁵45 Ghirardi ACAM, Ferreira LP, Giannini SPP, Latorre MRDO. Screening index for voice disorder (SIVD): development and validation. J Voice. 2013;27(2):195-200. http://dx.doi.org/10.1016/j.jvoice.2012.11.004. PMid:23280383.
http://dx.doi.org/10.1016/j.jvoice.2012.... ), validated for vocal screening for the risk of voice disorders in the presence of vocal symptoms(³⁸38 Dornelas R, Santos TA, Oliveira DS, Irineu RA, Brito A, Silva K. Violence in schools and the voice of teachers. CoDAS. 2017;29(4):e20170053. PMid:28813075.,³⁹39 Brito Mota AF, Giannini SPP, Oliveira IB, Paparelli R, Dornelas R, Ferreira LP. Voice disorder and burnout syndrome in teachers. J Voice. 2019;33(4):581.e7-16. http://dx.doi.org/10.1016/j.jvoice.2018.01.022. PMid:30220529.
http://dx.doi.org/10.1016/j.jvoice.2018.... ).

Studies that applied the VHI-10 with spoken voice professionals, teachers(⁴²42 Albustan SA, Marie BS, Natour YS, Darawsheh WB. Kuwaiti Teachers’ Perceptions of Voice Handicap. J Voice. 2018;32(3):319-24. http://dx.doi.org/10.1016/j.jvoice.2017.05.003. PMid:28576335.
http://dx.doi.org/10.1016/j.jvoice.2017.... ,⁴⁶46 Kyriakou K, Petinou K, Phinikettos I. Risk factors for voice disorders in university professors in Cyprus. J Voice. 2018;32(5):643.e1-9. http://dx.doi.org/10.1016/j.jvoice.2017.07.005. PMid:28826977.
http://dx.doi.org/10.1016/j.jvoice.2017.... ), and fitness instructors(¹³13 Estes C, Sadoughi B, Coleman R, D’Angelo D, Sulica L. Phonotraumatic injury in fitness instructors: risk factors, diagnoses, and treatment methods. J Voice. 2020;34(2):272-9. http://dx.doi.org/10.1016/j.jvoice.2018.10.001. PMid:30393049.
http://dx.doi.org/10.1016/j.jvoice.2018.... ) showed changes in individual factors. These include respiratory infections, cough, throat clearing, frequent stress, vocal abuse, and use of medications, in addition to the prevalence being female and elementary school. Regarding the data concerning environmental conditions, another elaborated protocol (not validated) developed by the authors was applied.

It is worth noting that, when investigating the validation of the evaluation protocols used in the selected studies, the authors elaborated part of the instruments to verify the individual aspects related to voice, environment, and working conditions. However, regardless of the point to be analyzed, some protocols did not go through the validation process. Thus, choosing a validated instrument with psychometric properties is important to ensure accuracy, specificity, sensitivity, reliability, and safety in clinical investigation and diagnosis. Moreover, it is important to ensure the population results with scientifically robust measures(⁴⁷47 Souza AC, Alexandre NMC, Guirardello EB. Psychometric properties in instruments evaluation of reliability and validity. Epidemiol Serv Saude. 2017;26(3):649-59. http://dx.doi.org/10.5123/S1679-49742017000300022. PMid:28977189.
http://dx.doi.org/10.5123/S1679-49742017... ).

As pointed out in the evaluation methods of the selected studies, the auditory-perceptual assessment has been the main reference standard for characterizing the parameters of voice quality, identifying and measuring the intensity of the deviation and the phonatory pattern of vocal production(¹²12 Servilha EAM, Correia JM. Correlações entre condições do ambiente, organização do trabalho, sintomas vocais autorreferidos por professores universitários e avaliação fonoaudiológica. Disturb Comun. 2014;26(3):452-62.,²⁶26 Simões M, Latorre MRDO. Prevalência de alteração vocal em educadoras e sua relação com a auto-percepção. Rev Saude Publica. 2006;40(6):1013-8. http://dx.doi.org/10.1590/S0034-89102006000700008. PMid:17173157.
http://dx.doi.org/10.1590/S0034-89102006... ,³³33 Giannini SPP, Latorre MRDO, Ferreira LP. Distúrbio de voz e estresse no trabalho docente: um estudo caso-controle. Cad Saude Publica. 2012;28(11):2115-24. http://dx.doi.org/10.1590/S0102-311X2012001100011. PMid:23147953.
http://dx.doi.org/10.1590/S0102-311X2012... ,⁴⁸48 Bassi I, Assunção A, Gama AC, Gonçalves L. Características clínicas, sociodemográficas e ocupacionais de professoras com disfonia. Disturb Comun. 2011;23(2):173-80.,⁴⁹49 Lehto L, Alku P, Bäckström T, Vilkman E. Voice symptoms of call-centre customer service advisers experienced during a work-day and effects of a short vocal training course. Logoped Phoniatr Vocol. 2005;30(1):14-27. http://dx.doi.org/10.1080/14015430510006659. PMid:16040436.
http://dx.doi.org/10.1080/14015430510006... ).

Another evaluation method observed was the laryngological examination(¹²12 Servilha EAM, Correia JM. Correlações entre condições do ambiente, organização do trabalho, sintomas vocais autorreferidos por professores universitários e avaliação fonoaudiológica. Disturb Comun. 2014;26(3):452-62.,¹³13 Estes C, Sadoughi B, Coleman R, D’Angelo D, Sulica L. Phonotraumatic injury in fitness instructors: risk factors, diagnoses, and treatment methods. J Voice. 2020;34(2):272-9. http://dx.doi.org/10.1016/j.jvoice.2018.10.001. PMid:30393049.
http://dx.doi.org/10.1016/j.jvoice.2018.... ,³³33 Giannini SPP, Latorre MRDO, Ferreira LP. Distúrbio de voz e estresse no trabalho docente: um estudo caso-controle. Cad Saude Publica. 2012;28(11):2115-24. http://dx.doi.org/10.1590/S0102-311X2012001100011. PMid:23147953.
http://dx.doi.org/10.1590/S0102-311X2012... ,⁴⁸48 Bassi I, Assunção A, Gama AC, Gonçalves L. Características clínicas, sociodemográficas e ocupacionais de professoras com disfonia. Disturb Comun. 2011;23(2):173-80.,⁴⁹49 Lehto L, Alku P, Bäckström T, Vilkman E. Voice symptoms of call-centre customer service advisers experienced during a work-day and effects of a short vocal training course. Logoped Phoniatr Vocol. 2005;30(1):14-27. http://dx.doi.org/10.1080/14015430510006659. PMid:16040436.
http://dx.doi.org/10.1080/14015430510006... ), which is performed by an otorhinolaryngologist and evaluates the anatomical and physiological aspects of the larynx, especially the vocal folds to diagnose the presence or absence of laryngeal lesions(¹⁸18 Andrada e Silva MA, Bittencourt MFQP, Korn GP, Borrego MCM. Diagnóstico do distúrbio de voz relacionado ao trabalho: reflexões multidisciplinares sobre o uso da voz no trabalho. In: Ferreira LP, Andrada e Silva MA, editores. Distúrbio de voz relacionado ao trabalho. São Paulo: Sintropia Traduções; 2022. p. 152-77.).

In this review, the results showed that, among the individual risk factors, the presence of respiratory alterations (allergies and asthma), being female, and having inadequate vocal habits(⁶6 Fontan L, Fraval M, Michon A, Déjean S, Welby-Gieusse M. Vocal problems in sports and fitness instructors: a study of prevalence, risk factors, and need for prevention in France. J Voice. 2017;31(2):261.e33-8. http://dx.doi.org/10.1016/j.jvoice.2016.04.014. PMid:27528368.
http://dx.doi.org/10.1016/j.jvoice.2016.... ,⁹9 Korn GP, Pontes AALP, Abranches D, Pontes AL. Vocal tract discomfort and risk factors in university teachers. J Voice. 2016;30(4):507.e1-8. http://dx.doi.org/10.1016/j.jvoice.2015.06.001. PMid:26279322.
http://dx.doi.org/10.1016/j.jvoice.2015.... ,¹¹11 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(3):488.e1-8. http://dx.doi.org/10.1016/j.jvoice.2018.08.021. PMid:30396701.
http://dx.doi.org/10.1016/j.jvoice.2018.... ,²⁹29 Gomes NR, Teixeira LC, Medeiros AM. Vocal symptoms in university professors: their association with vocal resources and with work environment. J Voice. 2020;34(3):352-7. http://dx.doi.org/10.1016/j.jvoice.2018.10.010. PMid:30473269.
http://dx.doi.org/10.1016/j.jvoice.2018.... ,³⁰30 Sampaio MC, Reis EJFB, Carvalho FM, Porto LA, Araújo TM. Vocal effort and voice handicap among teachers. J Voice. 2012;26(6):820.e15-8. http://dx.doi.org/10.1016/j.jvoice.2012.06.003. PMid:23177755.
http://dx.doi.org/10.1016/j.jvoice.2012.... ,⁵⁰50 Bolbol SA, Zalat MM, Hammam RAM, Elnakeb NL. Risk factors of voice disorders and impact of vocal hygiene awareness program among teachers in public schools in Egypt. J Voice. 2017;31(2):251.e9-16. http://dx.doi.org/10.1016/j.jvoice.2016.07.010. PMid:27522344.
http://dx.doi.org/10.1016/j.jvoice.2016....

51 Leão SHS, Oates JM, Purdy SC, Scott D, Morton RP. Voice problems in New Zealand teachers: a national survey. J Voice. 2015;29(5):645.e1-13. http://dx.doi.org/10.1016/j.jvoice.2014.11.004. PMid:25619465.
http://dx.doi.org/10.1016/j.jvoice.2014....

52 Joseph BE, Joseph AM, Jacob TM. Vocal fatigue: do young speech-language pathologists practice what they preach? J Voice. 2020;34(4):647.e1-5. http://dx.doi.org/10.1016/j.jvoice.2018.11.015. PMid:30616963.
http://dx.doi.org/10.1016/j.jvoice.2018....

53 Souza CL, Thomé CR. Queixas vocais em locutores de rádio da cidade do Salvador-Bahia. Rev Baiana de Saúde Pública. 2006;30(2):272-83.-⁵⁴54 Petter V, Oliveira PAB, Fisher PA. Relationship between self-reported dysphonia and potential risk factors among primary school teachers. Salud Trab. 2006;14(2):5-12.) predominated. In studies with teachers, vocal symptoms were associated with respiratory alterations since inadequate breathing causes fatigue in speech, which can have repercussions on voice projection and resonance. This effect induces an increase in overload throughout the vocal tract(³⁶36 Hermes EGC, Bastos PRHO. The prevalence of teachers’ vocal symptoms in municipal network of education in Campo Grande, Mato Grosso do Sul, Brazil. J Voice. 2016;30(6):756.e1-7. http://dx.doi.org/10.1016/j.jvoice.2015.09.005. PMid:26596844.
http://dx.doi.org/10.1016/j.jvoice.2015.... ,⁵⁵55 Vertanen-Greis H, Löyttyniemi E, Uitti J, Putus T. Work ability of teachers associated with voice disorders, stress, and the indoor environment: a questionnaire study in Finland. J Voice. 2022;36(6):879.e5-11. http://dx.doi.org/10.1016/j.jvoice.2020.09.022. PMid:33041177.
http://dx.doi.org/10.1016/j.jvoice.2020.... ).

Female spoken voice professionals are more predisposed to vocal problems when compared to male voices. It is believed that this fact is due to hormonal and anatomical issues, work requirements, and the role of women in society(⁵5 Johns-Fiedler H, van Mersbergen M. The prevalence of voice disorders in 911 emergency telecommunicators. J Voice. 2015;29(3):389.e1-10. http://dx.doi.org/10.1016/j.jvoice.2014.08.008. PMid:25659735.
http://dx.doi.org/10.1016/j.jvoice.2014.... ,⁷7 Murta JAN, Barbosa MS, Caldeira AP, Barbosa-Medeiros MR, Rossi-Barbosa LAR. Factors associated with voice complaints in community health agents. CoDAS. 2021;33(1):e20200017. http://dx.doi.org/10.1590/2317-1782/20202020017. PMid:33886748.
http://dx.doi.org/10.1590/2317-1782/2020... ,⁴⁹49 Lehto L, Alku P, Bäckström T, Vilkman E. Voice symptoms of call-centre customer service advisers experienced during a work-day and effects of a short vocal training course. Logoped Phoniatr Vocol. 2005;30(1):14-27. http://dx.doi.org/10.1080/14015430510006659. PMid:16040436.
http://dx.doi.org/10.1080/14015430510006... ,⁵⁶56 Palacios-Pérez AT, Sierra-Torres CH. Prevalencia y factores de riesgo asociados a alteraciones comunicativas en vendedores ambulantes de Popayán, Colombia. Rev Salud Publica. 2014;16(4):572-84. http://dx.doi.org/10.15446/rsap.v16n4.38086. PMid:25791308.
http://dx.doi.org/10.15446/rsap.v16n4.38... ). However, a study with community health agents with and without vocal complaints observed no significant difference(⁴⁰40 Cipriano FG, Ferreira LP. Queixas de voz em agentes comunitários de saúde: correlação entre problemas gerais de saúde, hábitos de vida e aspectos vocais. Rev Soc Bras Fonoaudiol. 2011;16(2):132-9. http://dx.doi.org/10.1590/S1516-80342011000200005.
http://dx.doi.org/10.1590/S1516-80342011... ).

Inadequate vocal habits were another very evident aspect in this population(⁵5 Johns-Fiedler H, van Mersbergen M. The prevalence of voice disorders in 911 emergency telecommunicators. J Voice. 2015;29(3):389.e1-10. http://dx.doi.org/10.1016/j.jvoice.2014.08.008. PMid:25659735.
http://dx.doi.org/10.1016/j.jvoice.2014.... ,⁶6 Fontan L, Fraval M, Michon A, Déjean S, Welby-Gieusse M. Vocal problems in sports and fitness instructors: a study of prevalence, risk factors, and need for prevention in France. J Voice. 2017;31(2):261.e33-8. http://dx.doi.org/10.1016/j.jvoice.2016.04.014. PMid:27528368.
http://dx.doi.org/10.1016/j.jvoice.2016.... ,⁹9 Korn GP, Pontes AALP, Abranches D, Pontes AL. Vocal tract discomfort and risk factors in university teachers. J Voice. 2016;30(4):507.e1-8. http://dx.doi.org/10.1016/j.jvoice.2015.06.001. PMid:26279322.
http://dx.doi.org/10.1016/j.jvoice.2015.... ,²⁹29 Gomes NR, Teixeira LC, Medeiros AM. Vocal symptoms in university professors: their association with vocal resources and with work environment. J Voice. 2020;34(3):352-7. http://dx.doi.org/10.1016/j.jvoice.2018.10.010. PMid:30473269.
http://dx.doi.org/10.1016/j.jvoice.2018.... ,³⁶36 Hermes EGC, Bastos PRHO. The prevalence of teachers’ vocal symptoms in municipal network of education in Campo Grande, Mato Grosso do Sul, Brazil. J Voice. 2016;30(6):756.e1-7. http://dx.doi.org/10.1016/j.jvoice.2015.09.005. PMid:26596844.
http://dx.doi.org/10.1016/j.jvoice.2015.... ,⁵²52 Joseph BE, Joseph AM, Jacob TM. Vocal fatigue: do young speech-language pathologists practice what they preach? J Voice. 2020;34(4):647.e1-5. http://dx.doi.org/10.1016/j.jvoice.2018.11.015. PMid:30616963.
http://dx.doi.org/10.1016/j.jvoice.2018.... ,⁵³53 Souza CL, Thomé CR. Queixas vocais em locutores de rádio da cidade do Salvador-Bahia. Rev Baiana de Saúde Pública. 2006;30(2):272-83.,⁵⁷57 Moreira CA No, Moreira ATR, Moreira LB. Relação entre acuidade visual e condições de trabalho escolar em crianças de um colégio do ensino fundamental público de Curitiba. Rev Bras Oftalmol. 2014;73(4):216-9.

58 Rossi-Barbosa LA, Gama ACC, Caldeira AP. Association between readiness for behavior change and complaints of vocal problems in teachers. CoDAS. 2015;27(2):170-7. http://dx.doi.org/10.1590/2317-1782/20152013088. PMid:26107083.
http://dx.doi.org/10.1590/2317-1782/2015... -⁵⁹59 Sathyanarayan M, Boominathan P, Nallamuthu A. Vocal health practices among school teachers: a study from Chennai, India. J Voice. 2019;33(5):812.e1-7. http://dx.doi.org/10.1016/j.jvoice.2018.04.005. PMid:30139639.
http://dx.doi.org/10.1016/j.jvoice.2018.... ). A study with Hindu priests showed a significant association between voice problems, vocal abuse, and high-intensity vocal production, in addition to the lack of vocal rest in cases of throat pain(²⁵25 Devadas U, Hegde M, Maruthy S. Prevalence of and risk factors for self-reported voice problems among Hindu temple priests. J Voice. 2019;33(5):805.e1-12. http://dx.doi.org/10.1016/j.jvoice.2018.03.020. PMid:29748026.
http://dx.doi.org/10.1016/j.jvoice.2018.... ). The complaint was also mentioned by street vendors, community health agents, and teachers(⁷7 Murta JAN, Barbosa MS, Caldeira AP, Barbosa-Medeiros MR, Rossi-Barbosa LAR. Factors associated with voice complaints in community health agents. CoDAS. 2021;33(1):e20200017. http://dx.doi.org/10.1590/2317-1782/20202020017. PMid:33886748.
http://dx.doi.org/10.1590/2317-1782/2020... ,⁴¹41 Cipriano FG, Ferreira LP, Servilha EAM, Marsiglia RMG. Relação entre distúrbio de voz e trabalho em um grupo de Agentes Comunitários de Saúde. CoDAS. 2013;25(6):548-56. PMid:24626981.,⁵⁶56 Palacios-Pérez AT, Sierra-Torres CH. Prevalencia y factores de riesgo asociados a alteraciones comunicativas en vendedores ambulantes de Popayán, Colombia. Rev Salud Publica. 2014;16(4):572-84. http://dx.doi.org/10.15446/rsap.v16n4.38086. PMid:25791308.
http://dx.doi.org/10.15446/rsap.v16n4.38... ,⁵⁷57 Moreira CA No, Moreira ATR, Moreira LB. Relação entre acuidade visual e condições de trabalho escolar em crianças de um colégio do ensino fundamental público de Curitiba. Rev Bras Oftalmol. 2014;73(4):216-9.), showing that individual characteristics may be associated with other risk factors in work activity, such as the intensive use of the voice self-reported by several categories of spoken voice professionals.

In a study with teachers(¹³13 Estes C, Sadoughi B, Coleman R, D’Angelo D, Sulica L. Phonotraumatic injury in fitness instructors: risk factors, diagnoses, and treatment methods. J Voice. 2020;34(2):272-9. http://dx.doi.org/10.1016/j.jvoice.2018.10.001. PMid:30393049.
http://dx.doi.org/10.1016/j.jvoice.2018.... ,²⁴24 Leão SHDS, Oates JM, Purdy SC, Scott D, Morton RP. Voice problems in New Zealand Teachers: a national survey. J Voice. 2015;29(5):645.e1-13. http://dx.doi.org/10.1016/j.jvoice.2014.11.004. PMid:25619465.
http://dx.doi.org/10.1016/j.jvoice.2014.... ,³⁶36 Hermes EGC, Bastos PRHO. The prevalence of teachers’ vocal symptoms in municipal network of education in Campo Grande, Mato Grosso do Sul, Brazil. J Voice. 2016;30(6):756.e1-7. http://dx.doi.org/10.1016/j.jvoice.2015.09.005. PMid:26596844.
http://dx.doi.org/10.1016/j.jvoice.2015.... ,⁴⁸48 Bassi I, Assunção A, Gama AC, Gonçalves L. Características clínicas, sociodemográficas e ocupacionais de professoras com disfonia. Disturb Comun. 2011;23(2):173-80.

49 Lehto L, Alku P, Bäckström T, Vilkman E. Voice symptoms of call-centre customer service advisers experienced during a work-day and effects of a short vocal training course. Logoped Phoniatr Vocol. 2005;30(1):14-27. http://dx.doi.org/10.1080/14015430510006659. PMid:16040436.
http://dx.doi.org/10.1080/14015430510006... -⁵⁰50 Bolbol SA, Zalat MM, Hammam RAM, Elnakeb NL. Risk factors of voice disorders and impact of vocal hygiene awareness program among teachers in public schools in Egypt. J Voice. 2017;31(2):251.e9-16. http://dx.doi.org/10.1016/j.jvoice.2016.07.010. PMid:27522344.
http://dx.doi.org/10.1016/j.jvoice.2016.... ,⁶⁰60 Araújo TM, Reis EJ, Carvalho FM, Porto LA, Reis IC, Andrade JM. Fatores associados a alterações vocais em professoras. Cad Saude Publica. 2008;24(6):1229-38. http://dx.doi.org/10.1590/S0102-311X2008000600004. PMid:18545749.
http://dx.doi.org/10.1590/S0102-311X2008... ), the authors concluded that voice disorder is triggered by the intensive and continuous use of the voice, with the possibility of the occurrence of lesions in the vocal folds(⁴⁸48 Bassi I, Assunção A, Gama AC, Gonçalves L. Características clínicas, sociodemográficas e ocupacionais de professoras com disfonia. Disturb Comun. 2011;23(2):173-80.,⁶⁰60 Araújo TM, Reis EJ, Carvalho FM, Porto LA, Reis IC, Andrade JM. Fatores associados a alterações vocais em professoras. Cad Saude Publica. 2008;24(6):1229-38. http://dx.doi.org/10.1590/S0102-311X2008000600004. PMid:18545749.
http://dx.doi.org/10.1590/S0102-311X2008... ). In addition, there is a lack of training and sound amplification resources(¹³13 Estes C, Sadoughi B, Coleman R, D’Angelo D, Sulica L. Phonotraumatic injury in fitness instructors: risk factors, diagnoses, and treatment methods. J Voice. 2020;34(2):272-9. http://dx.doi.org/10.1016/j.jvoice.2018.10.001. PMid:30393049.
http://dx.doi.org/10.1016/j.jvoice.2018.... ,²⁴24 Leão SHDS, Oates JM, Purdy SC, Scott D, Morton RP. Voice problems in New Zealand Teachers: a national survey. J Voice. 2015;29(5):645.e1-13. http://dx.doi.org/10.1016/j.jvoice.2014.11.004. PMid:25619465.
http://dx.doi.org/10.1016/j.jvoice.2014.... ,⁴⁹49 Lehto L, Alku P, Bäckström T, Vilkman E. Voice symptoms of call-centre customer service advisers experienced during a work-day and effects of a short vocal training course. Logoped Phoniatr Vocol. 2005;30(1):14-27. http://dx.doi.org/10.1080/14015430510006659. PMid:16040436.
http://dx.doi.org/10.1080/14015430510006... ,⁵⁰50 Bolbol SA, Zalat MM, Hammam RAM, Elnakeb NL. Risk factors of voice disorders and impact of vocal hygiene awareness program among teachers in public schools in Egypt. J Voice. 2017;31(2):251.e9-16. http://dx.doi.org/10.1016/j.jvoice.2016.07.010. PMid:27522344.
http://dx.doi.org/10.1016/j.jvoice.2016.... ).

Another organizational factor highlighted in this review associated with voice disorders comprised issues related to mental health, such as stress. This fact is believed to be due to unfavorable working conditions(³³33 Giannini SPP, Latorre MRDO, Ferreira LP. Distúrbio de voz e estresse no trabalho docente: um estudo caso-controle. Cad Saude Publica. 2012;28(11):2115-24. http://dx.doi.org/10.1590/S0102-311X2012001100011. PMid:23147953.
http://dx.doi.org/10.1590/S0102-311X2012... ,⁶¹61 Rantala LM, Hakala SJ, Holmqvist S, Sala E. Connections between voice ergonomic risk factors and voice symptoms, voice handicap, and respiratory tract diseases. J Voice. 2012;26(6):819.e13-20. http://dx.doi.org/10.1016/j.jvoice.2012.06.001. PMid:23044460.
http://dx.doi.org/10.1016/j.jvoice.2012.... ).

Regarding the environmental working conditions, noise was the most frequent risk factor related to complaints of voice disorders(⁶6 Fontan L, Fraval M, Michon A, Déjean S, Welby-Gieusse M. Vocal problems in sports and fitness instructors: a study of prevalence, risk factors, and need for prevention in France. J Voice. 2017;31(2):261.e33-8. http://dx.doi.org/10.1016/j.jvoice.2016.04.014. PMid:27528368.
http://dx.doi.org/10.1016/j.jvoice.2016.... ,⁹9 Korn GP, Pontes AALP, Abranches D, Pontes AL. Vocal tract discomfort and risk factors in university teachers. J Voice. 2016;30(4):507.e1-8. http://dx.doi.org/10.1016/j.jvoice.2015.06.001. PMid:26279322.
http://dx.doi.org/10.1016/j.jvoice.2015.... ,¹¹11 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(3):488.e1-8. http://dx.doi.org/10.1016/j.jvoice.2018.08.021. PMid:30396701.
http://dx.doi.org/10.1016/j.jvoice.2018.... ,¹⁷17 Rechenberg L, Goulart BN, Roithmann R. Impacto da atividade laboral de teleatendimento em sintomas e queixas vocais: estudo analítico. J Soc Bras Fonoaudiol. 2011;23(4):301-7. http://dx.doi.org/10.1590/S2179-64912011000400003. PMid:22231049.
http://dx.doi.org/10.1590/S2179-64912011... ,²⁹29 Gomes NR, Teixeira LC, Medeiros AM. Vocal symptoms in university professors: their association with vocal resources and with work environment. J Voice. 2020;34(3):352-7. http://dx.doi.org/10.1016/j.jvoice.2018.10.010. PMid:30473269.
http://dx.doi.org/10.1016/j.jvoice.2018.... ,³²32 Bermúdez de Alvear RM, Barón FJ, Martínez-Arquero AG. School teachers’ vocal use, risk factors, and voice disorder prevalence: guidelines to detect teachers with current voice problems. Folia Phoniatr Logop. 2011;63(4):209-15. http://dx.doi.org/10.1159/000316310. PMid:20938203.
http://dx.doi.org/10.1159/000316310... ,³⁶36 Hermes EGC, Bastos PRHO. The prevalence of teachers’ vocal symptoms in municipal network of education in Campo Grande, Mato Grosso do Sul, Brazil. J Voice. 2016;30(6):756.e1-7. http://dx.doi.org/10.1016/j.jvoice.2015.09.005. PMid:26596844.
http://dx.doi.org/10.1016/j.jvoice.2015.... ,⁵²52 Joseph BE, Joseph AM, Jacob TM. Vocal fatigue: do young speech-language pathologists practice what they preach? J Voice. 2020;34(4):647.e1-5. http://dx.doi.org/10.1016/j.jvoice.2018.11.015. PMid:30616963.
http://dx.doi.org/10.1016/j.jvoice.2018.... ,⁵⁹59 Sathyanarayan M, Boominathan P, Nallamuthu A. Vocal health practices among school teachers: a study from Chennai, India. J Voice. 2019;33(5):812.e1-7. http://dx.doi.org/10.1016/j.jvoice.2018.04.005. PMid:30139639.
http://dx.doi.org/10.1016/j.jvoice.2018.... ,⁶²62 Cediel MR, Neira JAR. Analysis of teacher working environment: factors that influence the voice. Audiol Commun Res. 2014;19(4):399-405. http://dx.doi.org/10.1590/S2317-64312014000400001337.
http://dx.doi.org/10.1590/S2317-64312014...

63 Gunasekaran N, Boominathan P, Seethapathy J. Voice needs and voice demands of professional newsreaders in southern India. J Voice. 2016;30(6):756.e9-20. http://dx.doi.org/10.1016/j.jvoice.2015.09.001. PMid:26452618.
http://dx.doi.org/10.1016/j.jvoice.2015.... -⁶⁴64 Gadepalli C, Fullwood C, Ascott F, Homer JJ. Voice burden in teachers and non-teachers in a UK population: a questionnaire-based survey. Clin Otolaryngol. 2019;44(6):1045-58. http://dx.doi.org/10.1111/coa.13437. PMid:31544346.
http://dx.doi.org/10.1111/coa.13437... ). A study conducted with teleservice operators revealed that most teleservice operators who work in noisy environments complain of voice disorders(⁴4 Santos CT, Santos C, Lopes LW, Silva POC, Lima-Silva MFB. Relationship between working and voice conditions self-reported by telemarketers of an emergency call center. CoDAS. 2016;28(5):583-94. http://dx.doi.org/10.1590/2317-1782/20162015125. PMid:27849240.
http://dx.doi.org/10.1590/2317-1782/2016... ) and high levels of background noise in the classroom(⁶⁵65 Devadas U, Bellur R, Maruthy S. Prevalence and risk factors of voice problems among primary school teachers in India. J Voice. 2017;31(1):117.e1-10. http://dx.doi.org/10.1016/j.jvoice.2016.03.006. PMid:27363867.
http://dx.doi.org/10.1016/j.jvoice.2016.... ). Another study did not present the same data on environmental factors for dysphonia(⁶²62 Cediel MR, Neira JAR. Analysis of teacher working environment: factors that influence the voice. Audiol Commun Res. 2014;19(4):399-405. http://dx.doi.org/10.1590/S2317-64312014000400001337.
http://dx.doi.org/10.1590/S2317-64312014... ). This result may be characteristic of implementing risk control measures since this frequent exposure damages vocal production and causes vocal illness due to increased vocal intensity and overload.

It is understood that vocal illness and dysphonia are symptoms related to voice disorders, may present insidious onset, and do not depend on the presence or absence of vocal fold lesions(¹⁸18 Andrada e Silva MA, Bittencourt MFQP, Korn GP, Borrego MCM. Diagnóstico do distúrbio de voz relacionado ao trabalho: reflexões multidisciplinares sobre o uso da voz no trabalho. In: Ferreira LP, Andrada e Silva MA, editores. Distúrbio de voz relacionado ao trabalho. São Paulo: Sintropia Traduções; 2022. p. 152-77.). This vocal symptom can be classified as sensory or auditory(²2 Smith E, Gray SD, Dove H, Kirchner L, Heras H. Frequency and effects of teachers’ voice problems. J Voice. 1997 Mar;11(1):81-7. http://dx.doi.org/10.1016/S0892-1997(97)80027-6. PMid:9075180.
http://dx.doi.org/10.1016/S0892-1997(97)... ).

Regarding the auditory vocal symptom, the most frequently reported by spoken voice professionals in this review was hoarseness(⁵5 Johns-Fiedler H, van Mersbergen M. The prevalence of voice disorders in 911 emergency telecommunicators. J Voice. 2015;29(3):389.e1-10. http://dx.doi.org/10.1016/j.jvoice.2014.08.008. PMid:25659735.
http://dx.doi.org/10.1016/j.jvoice.2014.... ,¹¹11 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(3):488.e1-8. http://dx.doi.org/10.1016/j.jvoice.2018.08.021. PMid:30396701.
http://dx.doi.org/10.1016/j.jvoice.2018.... ,²⁹29 Gomes NR, Teixeira LC, Medeiros AM. Vocal symptoms in university professors: their association with vocal resources and with work environment. J Voice. 2020;34(3):352-7. http://dx.doi.org/10.1016/j.jvoice.2018.10.010. PMid:30473269.
http://dx.doi.org/10.1016/j.jvoice.2018.... ,³⁶36 Hermes EGC, Bastos PRHO. The prevalence of teachers’ vocal symptoms in municipal network of education in Campo Grande, Mato Grosso do Sul, Brazil. J Voice. 2016;30(6):756.e1-7. http://dx.doi.org/10.1016/j.jvoice.2015.09.005. PMid:26596844.
http://dx.doi.org/10.1016/j.jvoice.2015.... ,⁴⁶46 Kyriakou K, Petinou K, Phinikettos I. Risk factors for voice disorders in university professors in Cyprus. J Voice. 2018;32(5):643.e1-9. http://dx.doi.org/10.1016/j.jvoice.2017.07.005. PMid:28826977.
http://dx.doi.org/10.1016/j.jvoice.2017.... ,⁵⁰50 Bolbol SA, Zalat MM, Hammam RAM, Elnakeb NL. Risk factors of voice disorders and impact of vocal hygiene awareness program among teachers in public schools in Egypt. J Voice. 2017;31(2):251.e9-16. http://dx.doi.org/10.1016/j.jvoice.2016.07.010. PMid:27522344.
http://dx.doi.org/10.1016/j.jvoice.2016.... ,⁵⁷57 Moreira CA No, Moreira ATR, Moreira LB. Relação entre acuidade visual e condições de trabalho escolar em crianças de um colégio do ensino fundamental público de Curitiba. Rev Bras Oftalmol. 2014;73(4):216-9.,⁵⁸58 Rossi-Barbosa LA, Gama ACC, Caldeira AP. Association between readiness for behavior change and complaints of vocal problems in teachers. CoDAS. 2015;27(2):170-7. http://dx.doi.org/10.1590/2317-1782/20152013088. PMid:26107083.
http://dx.doi.org/10.1590/2317-1782/2015... ), followed by voice loss(⁵⁸58 Rossi-Barbosa LA, Gama ACC, Caldeira AP. Association between readiness for behavior change and complaints of vocal problems in teachers. CoDAS. 2015;27(2):170-7. http://dx.doi.org/10.1590/2317-1782/20152013088. PMid:26107083.
http://dx.doi.org/10.1590/2317-1782/2015... ,⁶¹61 Rantala LM, Hakala SJ, Holmqvist S, Sala E. Connections between voice ergonomic risk factors and voice symptoms, voice handicap, and respiratory tract diseases. J Voice. 2012;26(6):819.e13-20. http://dx.doi.org/10.1016/j.jvoice.2012.06.001. PMid:23044460.
http://dx.doi.org/10.1016/j.jvoice.2012.... ). Hoarseness is characterized as the sensation of irregularity in vocal quality, and both are consequences of vocal overload, affecting the vocal tract and folds. A study also pointed to an association with inadequate vocal habits(⁵⁷57 Moreira CA No, Moreira ATR, Moreira LB. Relação entre acuidade visual e condições de trabalho escolar em crianças de um colégio do ensino fundamental público de Curitiba. Rev Bras Oftalmol. 2014;73(4):216-9.).

The most frequently reported sensory vocal symptoms included dry throat, throat clearing, and vocal fatigue(²⁶26 Simões M, Latorre MRDO. Prevalência de alteração vocal em educadoras e sua relação com a auto-percepção. Rev Saude Publica. 2006;40(6):1013-8. http://dx.doi.org/10.1590/S0034-89102006000700008. PMid:17173157.
http://dx.doi.org/10.1590/S0034-89102006... ,³⁵35 Ferreira LP, Akutsu CM, Luciano P, Viviano NDAG. Condições de produção vocal de teleoperadores: correlação entre questões de saúde, hábitos e sintomas vocais. Rev Soc Bras Fonoaudiol. 2008;13(4):307-15. http://dx.doi.org/10.1590/S1516-80342008000400003.
http://dx.doi.org/10.1590/S1516-80342008... ,³⁹39 Brito Mota AF, Giannini SPP, Oliveira IB, Paparelli R, Dornelas R, Ferreira LP. Voice disorder and burnout syndrome in teachers. J Voice. 2019;33(4):581.e7-16. http://dx.doi.org/10.1016/j.jvoice.2018.01.022. PMid:30220529.
http://dx.doi.org/10.1016/j.jvoice.2018.... ,⁴⁰40 Cipriano FG, Ferreira LP. Queixas de voz em agentes comunitários de saúde: correlação entre problemas gerais de saúde, hábitos de vida e aspectos vocais. Rev Soc Bras Fonoaudiol. 2011;16(2):132-9. http://dx.doi.org/10.1590/S1516-80342011000200005.
http://dx.doi.org/10.1590/S1516-80342011... ,⁶³63 Gunasekaran N, Boominathan P, Seethapathy J. Voice needs and voice demands of professional newsreaders in southern India. J Voice. 2016;30(6):756.e9-20. http://dx.doi.org/10.1016/j.jvoice.2015.09.001. PMid:26452618.
http://dx.doi.org/10.1016/j.jvoice.2015.... ). This result can be justified by the fact that some of the populations, such as journalists, teachers, community health agents, and teleoperators, use their voices in environmental conditions and work organization in an unfavorable way, in addition to the individual's conditions(²⁶26 Simões M, Latorre MRDO. Prevalência de alteração vocal em educadoras e sua relação com a auto-percepção. Rev Saude Publica. 2006;40(6):1013-8. http://dx.doi.org/10.1590/S0034-89102006000700008. PMid:17173157.
http://dx.doi.org/10.1590/S0034-89102006... ,³⁵35 Ferreira LP, Akutsu CM, Luciano P, Viviano NDAG. Condições de produção vocal de teleoperadores: correlação entre questões de saúde, hábitos e sintomas vocais. Rev Soc Bras Fonoaudiol. 2008;13(4):307-15. http://dx.doi.org/10.1590/S1516-80342008000400003.
http://dx.doi.org/10.1590/S1516-80342008... ,³⁹39 Brito Mota AF, Giannini SPP, Oliveira IB, Paparelli R, Dornelas R, Ferreira LP. Voice disorder and burnout syndrome in teachers. J Voice. 2019;33(4):581.e7-16. http://dx.doi.org/10.1016/j.jvoice.2018.01.022. PMid:30220529.
http://dx.doi.org/10.1016/j.jvoice.2018.... ,⁴⁰40 Cipriano FG, Ferreira LP. Queixas de voz em agentes comunitários de saúde: correlação entre problemas gerais de saúde, hábitos de vida e aspectos vocais. Rev Soc Bras Fonoaudiol. 2011;16(2):132-9. http://dx.doi.org/10.1590/S1516-80342011000200005.
http://dx.doi.org/10.1590/S1516-80342011... ,⁶³63 Gunasekaran N, Boominathan P, Seethapathy J. Voice needs and voice demands of professional newsreaders in southern India. J Voice. 2016;30(6):756.e9-20. http://dx.doi.org/10.1016/j.jvoice.2015.09.001. PMid:26452618.
http://dx.doi.org/10.1016/j.jvoice.2015.... ). In agreement with this information, the authors mention the work routine as one of the factors of vocal illness in the category of priests in India since the dry throat and vocal fatigue symptoms stem from respiratory infections due to exposure to cold temperatures and the smoke responsible for irritating the lining of the nasal mucosa and vocal tract(²⁵25 Devadas U, Hegde M, Maruthy S. Prevalence of and risk factors for self-reported voice problems among Hindu temple priests. J Voice. 2019;33(5):805.e1-12. http://dx.doi.org/10.1016/j.jvoice.2018.03.020. PMid:29748026.
http://dx.doi.org/10.1016/j.jvoice.2018.... ). Furthermore, there is the presence of gastroesophageal reflux disease (GERD)(¹⁰10 Hagelberg AM, Simberg S. Prevalence of voice problems in priests and some risk factors contributing to them. J Voice. 2015;29(3):389.e11-8. http://dx.doi.org/10.1016/j.jvoice.2014.08.015. PMid:25795362.
http://dx.doi.org/10.1016/j.jvoice.2014.... ,⁵⁶56 Palacios-Pérez AT, Sierra-Torres CH. Prevalencia y factores de riesgo asociados a alteraciones comunicativas en vendedores ambulantes de Popayán, Colombia. Rev Salud Publica. 2014;16(4):572-84. http://dx.doi.org/10.15446/rsap.v16n4.38086. PMid:25791308.
http://dx.doi.org/10.15446/rsap.v16n4.38... ,⁶⁵65 Devadas U, Bellur R, Maruthy S. Prevalence and risk factors of voice problems among primary school teachers in India. J Voice. 2017;31(1):117.e1-10. http://dx.doi.org/10.1016/j.jvoice.2016.03.006. PMid:27363867.
http://dx.doi.org/10.1016/j.jvoice.2016.... ,⁶⁶66 Devadas U, Jose N, Gunjawate D. Prevalence and influencing risk factors of voice problems in priests in Kerala. J Voice. 2016;30(6):771.e27-32. http://dx.doi.org/10.1016/j.jvoice.2015.11.008. PMid:26725550.
http://dx.doi.org/10.1016/j.jvoice.2015.... ).

In the studies included in this review, no standardized and validated self-assessment protocol encompassed the many categories of speaking voice professionals, hindering the analysis and reliability of the results for occupational voice disorder. Another limitation identified included the absence of specification of the items in the self-assessment protocols and the high heterogeneity in the application of the protocols, some of which were not validated and specific for this population group. It is worth mentioning that individual factors alone do not characterize WRVD. They must be related to organizational and environmental aspects.

Based on the results, further studies should be carried out for the development of validated, safe, and reliable instruments that allow the investigation of WRVD in the full multifactorial context for this category of voice professionals, being fundamental for the analysis and decision-making of the speech-language pathologist for this population.

CONCLUSION

The link between individual and external work conditions and the genesis and/or maintenance of vocal symptoms/disorders is perceived. The most frequent evaluation method is the application of a validated self-assessment instrument.

It is verified that the WRVD has a significant relationship with factors of the environment and work organization. Noise and intensive use of the voice are the most self-reported, in addition to individual risk factors, such as respiratory disorders, being female, and inadequate vocal habits. Hoarseness is the most frequently mentioned auditory vocal symptom. Dry throat, throat clearing, and vocal fatigue are the most frequently mentioned sensory vocal symptoms.

REFERÊNCIAS

Publication Dates

History