Association between occupational voice use and occurrence of voice disorders: a meta-analysis

Abstract

Purpose: This meta-analysis has two aims: 1) to provide a quantitative assessment of the occurrence of voice disorders among different occupational voice users, 2) and to determine whether being an occupational voice user (teacher, broadcaster, call-center worker, etc.) is associated with an increased occurrence of voice disorders. Method: A random-effect meta-analysis of the available scientific literature was conducted on the occurrence of voice disorders among occupational voice users. Comprehensive literature searches were conducted using two computerized databases: PubMed/MEDLINE, and Scielo. As a measure of association, the odds ratio (OR) with corresponding 95% confidence interval (95% CI) was used. Heterogeneity was assessed by chi-square and I2 and draw in forest plots. Results: Voice disorders are related with occupational voice use independently of type of prevalence with a pool OR of 2.39 for current voice disorders, 1.88 for 12-months prevalence, and 2.43 for life-time and unspecified recall period. Heterogeneity test (I2) among these articles is 68% for current voice disorders, 0% for 12-months voice disorders, and 66% for life-time and unspecified recall period. Although around 70% of the total number of included publications assessed the occurrence of voice disorders among teachers as occupational voice users, an analysis per occupation was performed to identify possible influence of this factor in the occurrence of voice disorders. Studies that include just teachers as the group of occupational voice users (n=12) reported ORs ranging from 1.20 to 4.61. Heterogeneity test (I2) among these articles is 17%. Studies that include telemarketers, newsreaders, and sellers as the group of occupational voice users (n=6) reported ORs ranging from 0.85 when future vocal professionals were compared future non-vocal professionals to 4.58 when newsreaders were compared with non-newsreaders. Heterogeneity test (I2) among these articles is 40%. Conclusion: Occupational voice users have a higher likelihood of having voice disorders. Results of this meta-analysis show that teachers had a slightly lower likelihood (pool OR=1.95) than telemarketers, broadcasters, and sellers (pool OR=2.75) for having a voice disorder regardless the type of prevalence. Nevertheless, due the weak to moderate quality of the included studies, the results should be taken with caution.

Correlation between subjective and objective voice analysis pre- and post-shift among teleoperators in a tertiary hospital

“…In contrast, Cutiva et al reported that the prevalence of voice disorders among occupational voice users was less than 11 per cent when shorter recall period studies were included. 3 The assessment method demonstrated a significant contribution to the prevalence rates: studies based on clinical examinations such as stroboscopy and video laryngoscopy showed higher prevalence rates of voice disorders compared with studies using questionnaires to assess voice disorders. We found that the subjective voice analysis using maximum phonation time and Voice Handicap Index-10 showed significant differences pre-and post-shift among teleoperators (maximum phonation time ( p < 0.018) and Voice Handicap Index ( p < 0.011)).…”

“…A meta-analysis published by Cutiva et al found a total of 18 cross-sectional studies. 3 The authors demonstrated that most of the included studies carried out voice assessments based on questionnaires and found that the prevalence of voice disorders among occupational voice users ranged from 11 to 18 per cent. Moreover, occupational voice users showed up to four times more likelihood of having a voice disorder than nonoccupational voice users.…”

“…Moreover, occupational voice users showed up to four times more likelihood of having a voice disorder than nonoccupational voice users. 3 Teachers and singers have been extensively studied and reported to have higher frequencies of voice disorders than the general population compared with telemarketing operators. Nevertheless, the lack of 'gold standard' voice assessment results in varying results across the available data.…”

Care of the Professional Voice

“…18 It is not uncommon for professional voice users to require some degree of treatment, whether that includes voice therapy and/or medical intervention, but the patient's priority is often a quick recovery and returns to work. Source: Adapted from Cantor-Cutiva (2018) 22 per week, the environment in which they use the voice, and access to amplification or the need to project the voice. It may also be necessary to discuss voice use outside of their occupation to understand whether their home or social life might be contributing to any voice difficulty.…”