Vocal Abuse and Vocal Hygiene Practices Among ...

Vocal Abuse and Vocal Hygiene Practices Among Different Level Professional Voice Users in India: A Survey Prakash Boominathan Anitha Rajendran Roopa Nagarajan Jayashree Seethapathy Muthukumaran Gnanasekar Department of Speech, Language and Hearing Sciences, Sri Ramachandra University Chennai, India

Vocal hygiene is a primary aspect of concern for professional voice users. This study aimed to describe vocal abuse and vocal hygiene practices among different levels of professional voice users in India. A questionnaire regarding vocal abuse and vocal hygiene practices was administered to 400 voice professionals (singers, teachers, politicians, and vendors). The results revealed politicians and vendors had the highest point prevalence and frequency of voice problems. Politicians had highest prevalence of abusive non-vocal habits. About 84.3% of voice professionals considered

Asia Pacifi Journal of Speech, Language, and Hearing Volume 11, Number 1, pp. 47–53 Copyright © 2008 Plural Publishing, Inc.

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that abusive (nonvocal) habits had a negative influence on voice. All subjects indulged in throat clearing, loud speaking/singing for long durations (abusive vocal habits). An equal number of subjects reported that they would resort to home remedies or not seek any help. Both ancient traditional practices (consuming milk with pepper or turmeric) and empirically proven methods are practiced among these different voice professionals in India to prevent voice problems. Lack of awareness to treat the voice problems earlier was high among vendors and politicians. The findings from the study would enable speech and voice pathologists to plan strategically to prevent voice problems and reach these voice professionals. Key Words: vocal hygiene, professional voice users, abusive vocal habits, abusive non-vocal habits

Introduction Voice professionals are more prone to laryngeal pathologies than the general population due to their nature of work and lifestyle (Stemple, Glaze, & Gerdeman, 1995). The remarkable incidence of voice disorders in these professionals might be associated with inappropriate use of voice and poor vocal hygiene. Hence, occupational voice health is becoming more important as more people rely on their voices for their work. Among all voice professionals, teachers are more likely to develop voice problems and report high rates of specific voice symptoms and symptoms of physical discomfort during voicing (Smith, Gray, Dove, Kirchner, & Heras, 1997). Roy, Merrill, Thibeault, Parsa, Gray, and Smith (2004) reported the prevalence of voice problems to be greater in teachers than in the general population. Sliwinska-Kowalska et al. (2006) found that prevalence of self-reported symptoms and clinical signs of voice disorders are around 2 to 3 times more frequent in Polish female teachers than in non-teachers. Timmermans, De Bodt, Wuyts, and Van de Heyning �� (2003) demonstrated the necessity of vocal hygiene education programs in radio professionals as they seemed to underestimate the negative implications of bad vocal hygiene. Boominathan, Nagarajan, Sharadha, and Sharanya (2004) and Boomi-

nathan and Shruthi (2005) profiled the vocal and nonvocal habits in Carnatic, light music singers and indicated several poor vocal hygiene habits among trained Carnatic and light music singers in India. Boominathan, Sivapriya, and Gomathy, (2005) studied the awareness of vocal hygiene among 32 radio professionals in India and found that more than 50% of radio professionals in this study showed limited awareness of vocal hygiene especially concerning vocal habits. Lifetime vocal effort, incorrect technique of phonation, and psychological predisposition seem to constitute major risk factors for developing occupational voice disorders in many of these vocal professionals. Vocal hygiene practices may be different in the various levels of professional voice users. Koufmann and Isaacson (1991) evolved a classification of vocal professionals based on their voice use and risk. The elite vocal performers (level I) included sophisticated voice users like the singers and actors, where even a slight vocal difficulty can cause serious consequences to them and their careers. Level II included the professional voice users for whom even moderate vocal difficulty would prevent adequate job performance; clergymen, lecturers/ teachers, politicians, public speakers and telephone operators would classify in this level of voice users. In level III, the nonvocal professionals included teachers and

Vocal Abuse and Vocal Hygiene Practices Among Different LeveL Users 49

lawyers. They can perform their jobs with slight or moderate voice problems; only severe dysphonia endangers adequate job performance. Level IV was the nonvocal nonprofessionals which included laborers and clerk. The non-vocal nonprofessional is not impeded from doing his or her work when they experience any kind of dysphonia. Vilkman (2000) reported that kindergarten teachers and teachers who work under high background noises are classified under level II as well. It is imperative for these professionals to possess certain qualities in their voice and lifestyle that will ensure them success in their profession and prolonged usage of their voice. To attain this, it is essential for them to be aware of vocal hygiene and its influence on maintaining healthy voice. However, to develop a vocal hygiene program tailored to the needs of the different levels of vocal users, detailed description of their practices are required. Hence, the present study aimed to determine the vocal hygiene practices among the elite vocal performerssingers (level I), the professional voice users - politicians (level II), and the non-vocal professionals- teachers and vendors (level III).

Method Participants 400 subjects in the age range of 25 to 45 years participated in the study. They included 100 singers (54 males and 46 females) who were professional stage performers/ singing students; 100 politicians (100 males) who were supporters and party men who worked for any political party (including people who spoke in public meetings, people who volunteered for social work that involved a lot of speaking organized by the political party); 100 teachers (24 males and 76 females) of high school and higher secondary level; and 100 vendors (72 males and 28 females) who were hawkers.

Procedure A questionnaire was developed to collect information on the vocal hygiene practices in the above mentioned vocal professionals (see Appendix). It was explained to the subjects so they would provide appropriate responses to the questions addressed. The questionnaire consisted of a few forced choice questions (Yes/No) and open-ended questions. The answers from the questionnaire were tabulated and described. Inferential statistics was applied to understand associations between the practices and professional levels.

Results and Discussion Prevalence of Voice Problems Eighty-six percent of politicians and 74% of vendors had the highest point prevalence of voice problems; 59% of singers and 49% of teachers reported to have voice problems. It is likely that singers and teachers have some training (sensitized regarding voice use and projection through traditional methods emphasizing posture and breath management) to use their voices, whereas the other two groups have no training (formal/informal). Second, politicians and vendors tend to work/speak in more adverse conditions and more aggressively relative to singers and teachers.

Frequency and Duration of Voice Problem Forty-eight percent of the politicians and 44% of the vendors reported to have frequent episodes of voice problems (frequency of less than a week). Singers and teachers experienced voice problems less frequently which could be attributed to their training. However, 37% of singers and 47% of teachers reported that they had long-lasting voice problems (duration of more than a week).


Indicators (as reported) of a Voice Problem The common problems indicated by different voice professionals are sore throat, throat irritation, throat pain, change in voice, complete loss of voice and vocal fatigue. Specifically, singers reported difficulty in singing, whereas politicians and vendors indicated inability to increase the loudness of voice. Teachers did not indicate any specific factor. This highlights the need to address these issues in the vocal hygiene program.

Reported Reasons Attributed to These Voice Problems The change in weather and the common cold were quoted by subjects as reasons for their voice problem. Interestingly, none


thought their vocal habits and their poor hygiene practices could be a reason for their problem. However, politicians and vendors did not seem to bother to explore cause for their voice problem.

Prevalent Abusive Nonvocal Habits and the Perception of Their Influence on Voice

Item

Singer

Politician

Teacher

Vendor

Consumption of tea and coffee (more than 3–4 cups of 100 ml each/day)

64%

85%

44%

76%

169.057

Consuming alcohol

26%

Smoking (more than a pack of cigarette/beedi)

9%

Tobacco chewing (Beetle pan, pan paraag, etc.)

9%

Preference for carbonated soft drinks (at least one 300-ml bottle a day)

53%

59%

36%

67%

8%

8%

22%

57% 30%

30%

45%

Duration of wait

Singer

Politician

Teacher

Vendor

Chisquare value

More than a week/ will not consult

70%

57%

46%

62%

12.49

0.005

Less than a week

30%

43%

54%

38%

12.49

0.005

p- value

98.259 73.521

60.058

101.49

p-value 0.000

0.000 0.000

0.000

0.000

p-value

Table 3. Common Practices to Prevent Voice Problems

Singer

Politician

Teacher

Vendor

Chisquare value

Drink warm water

21%

20%

20%

26%

1.45

0.6928

Voice rest

22%

17%

30%

09%

14.84

0.0019

Speak softly

10%

08%

02%

04%

7.09

0.069

Steam inhalation

07%

12%

01%

03%

13.06

0.0045

Consume milk/ pepper/ginger/ turmeric

37%

21%

16%

16%

17.03

0.000

Take honey, adimathuram (herbal medicine)

16%

19%

19%

04%

12.34

0.006

Salt water gargling

02%

16%

15%

05%

17.33

0.000

Item Chisquare value

within a week of onset of problem. Even a group of singers, who are assumed to be trained and sensitized to recognize voice problems, were not particularly motivated to seek early consultation. This shows a desperate lack of awareness to prevent/treat the problem conservatively before greater damage occurs.

Table 2. Duration of Wait to Consult Someone for a Voice Problem

Table 1 revealed that politicians had the highest percentage of abusive non-vocal habits when compared to other subjects, 84.3% (statistically significant) of subjects considered the above habits to have a negative influence on voice. However, they were unaware of the ill effects of these abusive nonvocal habits on vocal mechanism and therefore continued these habits despite their deleterious effects.

10%

Duration of Wait to Consult Someone for Their Voice Problem Table 2 indicates that less than 50% (statistically significant) of subjects sought help

Table 1. Common Abusive Non-vocal Habits Prevalent in Voice Users

75%

All Subjects Indulged in Throat Clearing, Loud Speaking/Singing for Long Durations

Empirically proven methods:

Traditional practices:


Common Practices to Prevent Voice Problems The subjects across all categories indulged in both empirically proven methods and ancient practices as revealed in Table 3. This highlights the need to educate the right practice required to prevent voice problems.

Conclusion These findings should enable the speech/ voice pathologists or the voice care team to plan strategically to reach these groups to prevent voice problems and maintain vocal health. A voice specialist while tailoring a program should also consider the sociocultural, economic, and religious background of people involved, so that the program becomes more centered to client needs. Address Correspondence to: Prakash Boominathan, Dept. of Speech Language and Hearing Sciences, Sri Ramachandra University, Chennai, India 600116. Telephone: 91-44-24765512-14 Ext: 8980/320; Fax: 91-44-24767008; E-mail:[email protected]

References Boominathan, P., Nagarajan, R., Sharadha, N., & Sharanya, K. (2004). A profile of vocal and non-vocal habits of carnatic singers. Journal of ITC Sangeet Research Academy, 18, 77–88.

Boominathan, P., & Shruthi, R. (2005). A profile of vocal and non-vocal habits of Indian light music singers. Journal of ITC Sangeet Research Academy, 19, 1–12. Boominathan, P., Sivapriya, S., & Gomathi, K. (2005). Awareness of vocal hygiene in radio professionals. Presented in ISHA-CON 38, Ahmedabad. Koufmann, J., & Isaacson, G. (1991). Clinical voice pathology: Theory and management (2nd ed.) San Diego, CA: Singular Publishing Group. Roy, N., Merrill, R. M., Thibeault, S., Parsa, R. A., Gray, S. D., & Smith, F. M. (2004). Prevalence of voice disorders in teachers and the general population. Journal of Speech, Language and Hearing Research, 47(2), 281–293. Sliwinska-Kowalska, M.,Niebudek-Bogusz, E., Los-Spychalska, T., Kotylo, P., SznurowskaPrzygocka, B., & Modrzewska, M. (2006). The prevalence and risk factors for occupational voice disorders in teachers. Folia Phoniatrica et Logopaedics. 58(2), 85–101. Smith, E., Gray, S. D., Dove, H., Kirchner, L., & Heras, H. (1997). Cited in N. Roy, H. Dove, K. C. Lewis, J. C. Stemple. An evaluation of the effects of two treatment approaches for teachers with voice disorders: A prospective randomized clinical trials. Journal of Speech, Language and Hearing Research, 44, 286–296. Stemple, J. C., Glaze, L. E., & Gerdman, B. K. (1995). Clinical voice pathology: Theory and management (2nd ed.). San Diego, CA: Singular Publishing Group. Timmermans, B., De Bodt, M., Wuyts, F., & Van de Heyning, P. (2003). Vocal hygiene in future professional voice users and in professional voice users. Logopedics-PhoniatricsVocology, 28, 127–132. Vilkman, E (2000). Voice problems at work: A challenge for occupational safety and health arrangement. Folia Phoniatrica et Logopedics, 52, 120–125.


Appendix Questionnaire The information that you provided will aid in planning strategies to prevent voice problems. This information will be kept confidential. We appreciate your time and interest in contributing to this project. Name:________________________________________________________________________ Age/Sex:______________________________________________________________________ Occupation:___________________________________________________________________ Address:_ _____________________________________________________________________ 1. How many years have you been working in this field? 2. Do you have any problem with your voice? a. If yes, describe your voice problem. b. If no, how would you identify your voice problems? 3. How frequently would you encounter such voice problems? 4. Do you Yes a. Drink more than 3 cups (75 ml) of tea/coffee in a day? ❑ b. Consume alcohol? ❑ c. Chew tobacco? ❑ d. Smoke cigarette/beedi/cigar? ❑ e. Drink soda/carbonated drinks? ❑ ■ Do you think that the above have an influence on your voice? ■ Which of the above do you think affects your voice? ■ What in your opinion is good for your voice? 5. What can you do when you have voice problem? 6. How long will you wait to seek consultation for your voice problem?

No ❑ ❑ ❑ ❑ ❑