Prevalencia de los trastornos de voz ocupacionales en los docentes de dos instituciones educativas de nivel superior en Colombia en el año 2013-2014

Abstract

Abstract: As the main work tool for teaching population, the constant and prolonged voice use constitutes the principal risk factor to cause voice disorders, considered together with other aspects that may produce such pathologies. Objective: Determine the existence of voice disorders in the teaching population of specific “Higher Educational Institutes” in Colombia, as well as identify the risk factors associated to such disorders. Methods and materials: A cross-sectional descriptive study was applied and 149 teachers of “Higher Educational Institutes”, of two cities of Colombia, participated in the study. A sample questionnaire, based on a phoniatric technique model to prevent dysphonia in High School teachers of Portugal, was applied; such study is validated by the Medicine and Health Science School, as a part of the Phonoaudiology program of Rosario University, with the essay tituled “The Voice as tool work” in Colombia. Such study explored the risk factors associated to voice use in teaching. A descriptive analysis of the qualitative variables was made, in particular, by using absolute frequencies and percentages, measures of key trends, average, median, dispersion and standard deviation measures. The information assembled was evaluated using the SPSS.PASW 18 1 software. The correlation between dependent and independent variables was calculated using the Sperman’s non-parametrical ratio and the association was obtained applying de Pearsons Ji-cuadrado or Fischer exact text (expected value < 5). It was made an evaluation of the distributions of the ordinal variables with respect of the gender, employng Mann Whitney’s exact and non-parametric test. The statistics tests were evaluated on a significance level of 5% (p<0.05). Results: Age average was 36±11.7 years, the age range was between 25 and 68 years. The most frequent gender was masculine (57,0%). The presented data is a result of the answers to three voice disorders indicative questions; however such questions were not answered by the total of the screened teachers. Taking this into account the data is presented as follows: (i) t=, as total number of people who answered the question and (ii) n=, as total number of people who answer affirmatively. The prevalence of voice alteration was of 63,4% (t=82; n=52), of decrease of voice volume was 57,3% (t=122; n=70) and laryngeal fatigue was 76,8% (t=121;n=93). The laryngeal tiredness was significantly greater in men than in women (p=0.026, Test Mann Whitney exact at one tail), with the manifestation of some voice habits such as making some neck efforts while talking (rs=0,461; p<0,001) and with some difficulty to inhale and exhale oxygen when talking (rs =0,368; p<0,001). It was also noted the presence of background noise (rs =0,361, p<0,001), while staying in contaminated humid environments with dust (rs =0,311; p=0.001), as well as of stress reflected in back and shoulders pain (rs =0,349, p<0.001) and family problems (rs =0,397; p<0.001). Analyzing the diminution of voice volume while teaching or giving lectures, correlations were significantly higher in men than in women (p=0.006, Test Mann Whitney exact at one tail), with talking cervical effort (rs =0,596, P<0.001) and with difficulties inhaling/exhaling while using the voice (rs =0,508, p<0.001), with background noise exposition (rs =0,204, p=0.030), dust and humid environments (rs =305, p<0.001), with stress (rs =0,316, p=0.001), with family problems (rs =0,560, p<0.001). Women presented voice alteration while menstruating (rs =0,751, p=0.000). Lastly it was possible to make a correlation between voice alterations during occupational exposure, in which women had a greater value than with men (p=0.001, Test Mann Whitney exact at one tail). It was revealed a direct correlation between non-pausing while talking (rs =0,337, p<0.001) and coughing to clear the voice (rs =0,349, p=0.001), as well as between the use of low voice pitches (rs =0,975; p=0.004) and the presence of background noise during class (rs =0,370, p=0.001). Furthermore there is also a correlation between remaining in humid environments with dust (rs =0,253, p=0.023), and cervical symptoms associated with stress (rs =0,323, p=0,003). Finally an inverse correlation between voice pitches and volume in women while menstruating it (rs =-0,414, p=0.017) was noted. Conclusions: Taking into consideration the research results noted herein, it is important to recognize the risk factors associated to the abovementioned pathologies. As such, it must be noted that (i) regarding demographic factors, the male gender reported a highest number of voice disorders, and (ii), as to labor issues, it was determined that long services at work may cause the abovementioned pathology. In fact, from the screened population, teachers reporting laryngeal tiredness where between 36 and 45 years of age and had been teaching, and therefore exposed, for more than 6 years and less than 15 years. In regard to environmental factors, it was noted that the following aspects may lead to voice disorders: (i) exposure to drastic temperature changes, (ii) presence of background noise while teaching and (iii) polluted environments. Finally, the analysis of voice alterations in relation with theacher’s personal aspects, shows that stress and family issues may cause these pathologies. Taking into consideration the results of this study it is recommended the establishment of an epidemiological surveillance system in the institutions of higher education, the training of teachers as to personal risk factors and voice habits. Moreover it is important to supervise and eventually adequate the environmental factors that may be related to voice alterations in order to avoid the existence of these pathologies.