Hoarseness and vocal tract discomfort and associated risk factors in air traffic controllers

Korn, Gustavo Polacow; Villar, Anna Carolina; Azevedo, Renata Rangel

doi:10.1016/j.bjorl.2018.02.009

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Brazilian Journal of Otorhinolaryngology

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Original article • Braz. j. otorhinolaryngol. 85 (3) • May-Jun 2019 • https://doi.org/10.1016/j.bjorl.2018.02.009 copy

Hoarseness and vocal tract discomfort and associated risk factors in air traffic controllers^✰ ✰ Please cite this article as: Korn GP, Villar AC, Azevedo RR. Hoarseness and vocal tract discomfort and associated risk factors in air traffic controllers. Braz J Otorhinolaryngol. 2019;85:329-36.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction:

An air traffic controller is a professional who performs air traffic control functions in air traffic control units and is responsible for controlling the various stages of a flight.

Objective:

To compare hoarseness and vocal tract discomfort and their risk factors among air traffic controllers in the approach control of São Paulo.

Methods:

In a cross-sectional survey, a voice self-evaluation adapted from to self-evaluation prepared by the Brazilian Ministry of Labor for teachers was administered to 76 air traffic controllers at approach control of São Paulo, Brazil.

Results:

The percentage of hoarseness and vocal tract discomfort was 19.7% and 38.2%, respectively. In relation to air pollution, the percentages of hoarseness and vocal tract discomfort were higher among those who consider their working environment to be intolerable than among those in a comfortable or disturbing environment. The percentage of hoarseness was higher among those who seek medical advice due to vocal complaints and among those who experience difficulty using their voice at work than among those who experience mild or no difficulty. The percentage of vocal tract discomfort was higher among those in a very tense and stressful environment than among those who consider their work environment to be mild or moderately tense and stressful. The percentage of vocal tract discomfort was higher among those who describe themselves as very tense and stressed or tense and stressed than among those who describe themselves as calm. Additionally, the percentage of vocal tract discomfort was higher among those who care about their health.

Conclusion:

Among air traffic controllers, the percentage of vocal tract discomfort was almost twice that of hoarseness. Both symptoms are prevalent among air traffic controllers who considered their workplace intolerable in terms of air pollution. Vocal tract discomfort was related to a tense and stressful environment, and hoarseness was related to difficulty using the voice at work.

KEYWORDS
Risk factors; Hoarseness; Workplace; Voice

Variables	Hoarseness		p-Value	Vocal tract discomfort		p-Value
	Yes	No		Yes	No
Time of working in years as an ATC
Mean (SD)	7.3 (3)	8 (7.3)	0.708^b b Student's t test.	8.2 (5)	7.6 (7.5)	0.741^b b Student's t test.
Median (Min.-Max.)	7 (3-14)	7 (1-37)		7 (2-25)	6 (1-37)
Total	15	61		29	47
Age
Mean (SD)	28.5 (3.3)	29.4 (7.1)	0.626^b b Student's t test.	29.9 (6.5)	28.8 (6.6)	0.454^b b Student's t test.
Median (Min.-Max.)	29 (24-35)	27 (22-55)		28 (23-48)	27 (22-55)
Total	15	61		29	47
Gender (percentage of population in parentheses)
Female	9 (60)	23 (37.7)	0.202^a a Chi-square test.	13 (44.8)	19 (40.4)	0.890^a a Chi-square test.
Male	6 (40)	38 (62.3)		16 (55.2)	28 (59.6)
Total	15 (100)	61 (100)		29 (100)	47 (100)

Variables	Hoarseness		p-Value	Vocal tract discomfort		p-Value
	Yes	No		Yes	No
Professional activities other than ATC
Yes	0 (0)	9 (14.8)	0.191^a a Fisher's exact test. Percentage of population in parentheses.	2 (6.9)	7 (14.9)	0.469^a a Fisher's exact test. Percentage of population in parentheses.
No	15 (100)	52 (85.2)		27 (93.1)	40 (85.1)
Total	15 (100)	61 (100)		29 (100)	47 (100)
Professional activity that consumes the most time
ATC	0 (0)	6 (66.7)	Not calculated	2 (100)	4 (57.1)	0.500^a a Fisher's exact test. Percentage of population in parentheses.
Other	0 (0)	3 (33.3)		0 (0)	3 (42.9)
Total	0 (0)	9 (100)		2 (100)	7 (100)

Variables	Hoarseness		p-Value	Vocal tract discomfort		p-Value
	Yes	No		Yes	No
Workplace in terms of noise
1. Comfortable	0	2		0	2
2. Tolerable	8 (53.3)	40 (67.8)	0.456^a a Chi-square test. Bold indicates significant p-values. Percentage of population in parentheses.	15 (51.7)	33 (73.3)	0.099^a a Chi-square test. Bold indicates significant p-values. Percentage of population in parentheses.
3. Intolerable	7 (46.7)	19 (32.2)		14 (48.3)	12 (26.7)
Total	15 (100)	59 (100)		29 (100)	45 (100)
Workplace in terms of air conditioning
1. Comfortable	1 (6.7)	10 (16.4)	0.425 ^a a Chi-square test. Bold indicates significant p-values. Percentage of population in parentheses.	4 (13.8)	7 (14.9)	0.292 ^a a Chi-square test. Bold indicates significant p-values. Percentage of population in parentheses.
2. Tolerable	7 (46.7)	32 (52.5)		12 (41.4)	27 (57.4)
3. Intolerable	7 (46.7)	19 (31.1)		13 (44.8)	13 (27.7)
Total	15 (100)	61 (100)		29 (100)	47 (100)
Workplace in terms of air pollution
1. Comfortable	1 (6.7)	13 (21.3)	0.042 ^a a Chi-square test. Bold indicates significant p-values. Percentage of population in parentheses.	2 (6.9)	12 (25.5)	0.014 ^a a Chi-square test. Bold indicates significant p-values. Percentage of population in parentheses.
2. Tolerable	7 (46.7)	38 (62.3)		16 (55.2)	29 (61.7)
3. Intolerable	7 (46.7)	10 (16.4)		11 (37.9)	6 (12.8)
Total	15 (100)	61 (100)		29 (100)	47 (100)
Workplace in terms of stress and anxiety
Mild tense and stressful	0	1		0	1
Moderate tense and stressful	7 (46.7)	24 (40.0)	0.860^a a Chi-square test. Bold indicates significant p-values. Percentage of population in parentheses.	6 (20.7)	25 (54.3)	0.008 ^a a Chi-square test. Bold indicates significant p-values. Percentage of population in parentheses.
Very tense and stressful	8 (53.3)	36 (60.0)		23 (79.3)	21 (45.7)
Total	15 (100)	60 (100)		29 (100)	46 (100)

Variables	Hoarseness		p-Value	Vocal tract discomfort		p-Value
	Yes	No		Yes	No
Degree of difficulty in voice use during work
None	4 (26.7)	27 (44.3)	<0.001^a a Fisher's exact test. Bold indicates significant p-values. Percentage of population in parentheses.	8 (27.6)	23 (48.9)	0.115^a a Fisher's exact test. Bold indicates significant p-values. Percentage of population in parentheses.
Mild	3 (20)	30 (49.2)		14 (48.3)	19 (40.4)
Moderate	8 (53.3)	4 (6.6)		7 (24.1)	5 (10.6)
Total	15 (100)	61 (100)		29 (100)	47 (100)
Care or medication for the throat or the voice
Yes	0 (0)	9 (14.8)	0.191^a a Fisher's exact test. Bold indicates significant p-values. Percentage of population in parentheses.	4 (13.8)	5 (10.6)	0.725^a a Fisher's exact test. Bold indicates significant p-values. Percentage of population in parentheses.
No	15 (100)	52 (85.2)		25 (86.2)	42 (89.4)
Total	15 (100)	61 (100)		29 (100)	47 (100)
Seeking medical advice because of vocal symptoms
Yes	4 (26.7)	3 (4.9)	0.025 ^a a Fisher's exact test. Bold indicates significant p-values. Percentage of population in parentheses.	4 (13.8)	3 (6.4)	0.417^a a Fisher's exact test. Bold indicates significant p-values. Percentage of population in parentheses.
No	11 (73.3)	58 (95.1)		25 (86.2)	44 (93.6)
Total	15 (100)	61 (100)		29 (100)	47 (100)

Variables	Hoarseness		p-Value	Vocal tract discomfort		p-Value
	Yes	No		Yes	No
In terms of use of voice inside and/or the outside workplace, you describe yourself as a person who
1. Speaks little (introvert)	3 (20)	9 (14.8)	0.806^b b Likelihood ratio test.	5 (17.2)	7 (14.9)	0.954^a a Chi-square test.
2. Speaks moderately (communicative)	8 (53.3)	38 (62.3)		17 (58.6)	29 (61.7)
3. Speaks a lot (chattering)	4 (26.7)	14 (23)		7 (24.1)	11 (23.4)
Total	15 (100)	61 (100)		29 (100)	47 (100)
In terms of stress and anxiety, you qualify yourself as a person who is
1. Calm	4 (26.7)	31 (50.8)	0.118^a a Chi-square test.	8 (27.6)	27 (57.4)	0.032 ^a a Chi-square test.
2. Tense and anxious	7 (46.7)	24 (39.3)		15 (51.7)	16 (34)
3. Very tense and anxious	4 (26.7)	6 (9.8)		6 (20.7)	4 (8.5)
Total	15 (100)	61 (100)		29 (100)	47 (100)
In terms of drinking water/hydration, you qualify yourself as a person who
1. Drinks a few liquids (forgets or does not feel thirsty and urinates less than 3× daily)	2 (13.3)	12 (19.7)	0.448^b b Likelihood ratio test.	4 (13.8)	10 (21.3)	0.614^a a Chi-square test.
2. Drinks moderately (1 to 2 L/day)	9 (60)	41 (67.2)		21 (72.4)	29 (61.7)
3. Drinks a lot (> 2 L/day)	4 (26.7)	8 (13.1)		4 (13.8)	8 (17)
Total	15 (100)	61 (100)		29 (100)	47 (100)
In terms of diet, you qualify yourself as a person who
1. Eats a little (eats <3 meals/day)	1 (6.7)	6 (9.8)	0.451^b b Likelihood ratio test.	3 (10.3)	4 (8.5)	0.965^b b Likelihood ratio test.
2. Eats moderately (eats 3 meals a day)	9 (60)	44 (72.1)		20 (69)	33 (70.2)
3. Eats a lot (does not control gluttony and recognizes this as a problem)	5 (33.3)	11 (18)		6 (20.7)	10 (21.3)
Total	15 (100)	61 (100)		29 (100)	47 (100)
Cigarettes (tobacco)
1. Yes	0 (0)	3 (4.9)	0.197^b b Likelihood ratio test.	2 (6.9)	1 (2.1)	0.518^b b Likelihood ratio test.
2. No	15 (100)	54 (88.5)		26 (89.7)	43 (91.5)
3. Former smoker	0 (0)	4 (6.6)		1 (3.4)	3 (6.4)
Total	15 (100)	61 (100)		29 (100)	47 (100)
Alcohol
1. Yes	4 (26.7)	22 (36.1)	0.701^a a Chi-square test.	10 (34.5)	16 (34)	1.000^a a Chi-square test.
2. No	11 (73.3)	39 (63.9)		19 (65.5)	31 (66)
Total	15 (100)	61 (100)		29 (100)	47 (100)
Coffee
1. Yes	10 (66.7)	43 (70.5)	0.762^c c Fisher's exact test. Bold indicates significant p-values. Percentage of population in parentheses.	21 (72.4)	32 (68.1)	0.887^a a Chi-square test.
2. No	5 (33.3)	18 (29.5)		8 (27.6)	15 (31.9)
Total	15 (100)	61 (100)		29 (100)	47 (100)
In terms of health care, you consider yourself as being
1. Absent minded	5 (33.3)	16 (26.2)	0.298^b b Likelihood ratio test.	9 (31)	12 (25.5)	0.044 ^a a Chi-square test.
2. Controlled/cautious	6 (40)	37 (60.7)		12 (41.4)	31 (66)
3. Concerned	4 (26.7)	8 (13.1)		8 (27.6)	4 (8.5)
Total	15 (100)	61 (100)		29 (100)	47 (100)

Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Sede da Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico Facial, Av. Indianópolia, 1287, 04063-002 São Paulo/SP Brasil, Tel.: (0xx11) 5053-7500, Fax: (0xx11) 5053-7512 - São Paulo - SP - Brazil
E-mail: revista@aborlccf.org.br

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[1] * Corresponding author. E-mail: gustavokorn@uol.com.br (G.P. Korn).

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Hoarseness and vocal tract discomfort and associated risk factors in air traffic controllers✰ ✰ Please cite this article as: Korn GP, Villar AC, Azevedo RR. Hoarseness and vocal tract discomfort and associated risk factors in air traffic controllers. Braz J Otorhinolaryngol. 2019;85:329-36.

Abstract

Introduction:

Objective:

Methods:

Results:

Conclusion:

Hoarseness and vocal tract discomfort and associated risk factors in air traffic controllers^✰ ✰ Please cite this article as: Korn GP, Villar AC, Azevedo RR. Hoarseness and vocal tract discomfort and associated risk factors in air traffic controllers. Braz J Otorhinolaryngol. 2019;85:329-36.