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Factors associated with vocal health and quality of life in teachers/professors

ABSTRACT

Purpose:

to analyze the association of self-reported vocal symptoms with personal, occupational and clinical aspects and relate them to the quality of life of teachers/professors of the federal network of vocational and technological education.

Methods:

study carried out with 157 teachers from a federal public institution of vocational and technological education, who answered the World Health Organization Quality of Life questionnaire (WHOQOL-bref), Quality of Life in the Voice (V-RQOL) questionnaire and a data form (on social information, health conditions, vocal symptoms, habits, organization and working environment). Statistical analysis was performed using the Chi-square test.

Results:

29% of the teachers presented vocal symptoms. The prevalent complaints were dry throat (38.2%), cough (37.6%) and hoarseness (30.6%). There was a higher prevalence of symptoms in females. For the WHOQOL-bref, the average was 71.3 points, which is considered regular. The domain with the highest score was the psychological one with 75.3. Regarding V-RQOL, the average score in the global domain was 92.5 points, and the physical score was the most compromised one. 90.5% of teachers showed low voice impact on quality of life.

Conclusion:

although these teachers present vocal complaints, they do not reflect in the limitation of the quality of life.

Keywords:
Voice; Quality of Life; Teachers

RESUMO

Objetivo:

analisar a associação de sintomas vocais autorreferidos com aspectos pessoais, ocupacionais, clínicos e relacionar com a qualidade de vida de professores da rede federal de ensino profissional e tecnológico.

Métodos:

estudo com 157 docentes de uma instituição pública federal de educação profissional e tecnológica, que responderam aos questionários World Health Organization Quality Of Life/bref (WHOQOL-bref), Qualidade de Vida em Voz (QVV) e o formulário de dados (sociais, condições de saúde, sintomas vocais, hábitos, organização e ambiente de trabalho). A análise estatística foi realizada por meio do teste Qui-quadrado.

Resultados:

29% dos professores apresentaram sintomas vocais. As queixas prevalentes foram garganta seca (38,2%), tosse (37,6%) e rouquidão (30,6%). Houve maior prevalência dos sintomas no sexo feminino. Para o WHOQOL-bref, a média foi 71,3 pontos, considerada regular. O domínio com maior pontuação foi o psicológico com 75,3. Quanto ao QVV, o escore médio no domínio global foi de 92,5 pontos, sendo o físico o mais comprometido. 90,5% dos docentes apresentaram baixo impacto da voz na qualidade de vida.

Conclusão:

embora os docentes apresentem queixas vocais, elas não se refletem na limitação da qualidade de vida.

Descritores:
Voz; Qualidade de Vida; Docentes

Introduction

The National Consensus on Professional Voice (CNVP) emphasizes that the voice reflects the physical and mental health of the individual. The occurrence of dysphonia is very common in professions where the voice is used as a working tool. In its final report, the CNVP established the concept of professional voice as the form of oral communication used by individuals who depend on it to perform their occupational activity11. Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial (ABORL- CCF). Câmaras Técnicas de Otorrinolaringologia, Medicina do Trabalho e Perícias Médicas do CREMERJ. In: Consenso nacional sobre voz profissional: voz e trabalho: uma questão de saúde e direito do trabalhador. Rev Vox Brasilis [Periódico da Internet]. 2004. [acesso em 2016 jun 25]: 10(10):[about 1p.]. Disponível em: http://www.aborlccf.org.br/secao.asp?s=211.
http://www.aborlccf.org.br/secao.asp?s=2...
. According to the Ministry of Health's document, the Department of Environmental Health and Worker's Health, the Work-Related Voice Disorder (DVRT) is any vocal change directly related to the use of voice, during the professional activity that diminishes, compromises or prevents the worker's performance or communication, having it organic changes in the larynx or not22. BRASIL. Ministério da Saúde. Secretaria de Vigilância em Saúde/Departamento de Saúde Ambiental e Saúde do Trabalhador. Distúrbio de Voz Relacionado ao Trabalho: Saúde do Trabalhador Protocolo de Complexidade Diferenciada 2011. [acesso em 2016 maio 19]. Disponível em: http://aborlccf.org.br/imagebank/Protocolo_DVRT.pdf.
http://aborlccf.org.br/imagebank/Protoco...
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In the teaching work, the combination of prolonged voice use, individual, environmental and work organization factors, work together to increase the prevalence of vocal complaints. The voice disorder is manifested by the presence of signs and symptoms that may arise simultaneously or not, according to the severity of the case, and may lead to situations of withdrawal from work, with financial and social consequences22. BRASIL. Ministério da Saúde. Secretaria de Vigilância em Saúde/Departamento de Saúde Ambiental e Saúde do Trabalhador. Distúrbio de Voz Relacionado ao Trabalho: Saúde do Trabalhador Protocolo de Complexidade Diferenciada 2011. [acesso em 2016 maio 19]. Disponível em: http://aborlccf.org.br/imagebank/Protocolo_DVRT.pdf.
http://aborlccf.org.br/imagebank/Protoco...
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An epidemiological study conducted with 1,651 teachers and 1,614 non-teachers in 27 Brazilian states used a standardized questionnaire and found a higher prevalence of vocal symptoms in the teachers' group. It was concluded, then, that teaching is a high-risk occupation for the development of vocal disorder33. Behlau M, Zambon F, Guerrieri AC, Roy N. Epidemiology of voice disorders in teachers and nonteachers in Brazil: prevalence and adverse effects. J Voice. [Periódico na Internet]. 2012 [acesso em 2016 jun 23];26(5):[about 10 p.]. Disponível em: http://www-sciencedirectcom.ez133.periodicos.capes.gov.br/science/article/pii/S0892199711001664.
http://www-sciencedirectcom.ez133.period...
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There was an interest in research, in the last decade, to verify the influence of voice changes on quality of life (QoL) in patients and / or subjects who use the voice professionally44. Penteado RZ, Pereira IMTB. Qualidade de vida e saúde vocal dos professores. Rev Saúde Pública [Periódico da Internet]. 2007. [acesso em 2015 jul 14];41(2):7. Disponível em: http://www.scielo.br/pdf/rsp/v41n2/5638.pdf.
http://www.scielo.br/pdf/rsp/v41n2/5638....

5. Servilha EAM, Roccon PF. Relação entre voz e qualidade de vida em professores universitários. Rev. CEFAC [Periódico da Internet]. 2009. [acesso em 2016 mar 10]; 11(3):440-8. Disponível em: http://www.scielo.br/pdf/rcefac/2009nahead/42-08.pdf DOI:10.1590/S1516-18462009005000029.
http://www.scielo.br/pdf/rcefac/2009nahe...
-66. Fabrício MZ, Kasama ST, Martinez ZE. Qualidade de vida relacionada à voz de professores universitários. Rev. CEFAC [Periódico da Internet]. 2010 [acesso em 2016 jun 02];12(2):[about 7p.]. Disponível em: http://dx.doi.org/10.1590/S1516-18462009005000062.
http://dx.doi.org/10.1590/S1516-18462009...
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Quality of life is a broad, subjective and multidimensional concept that encompasses the subject's perceptions in the physical, psychological and social aspects, considering their values, goals, experiences, needs, culture, patterns and concerns77. Whoqol Group. The World Health Organization Quality of Life Assessment (WHOQOL): position paper from the World Health Organization. Soc. Sci. Med. [Periódico da Internet]. 1995 [acesso em 2015 Jul 24]; 41(10):[about 6p.]. Disponível em: http://www.ufrgs.br/psiquiatria/psiq/whoqol1.html.
http://www.ufrgs.br/psiquiatria/psiq/who...
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Researches that study the self-perception of QoL, in the voice area, use instruments that seek to capture the individual's impression of their own voice, which provides information that contributes to the understanding of vocal awareness88. Gasparini G, Behlau M. Quality of validation of the brazilian version of the Voice-Related Quality of Life (V-RQOL) Measure. J Voice [Periódico da Internet]. 2009 [acesso em 2016 jun 23];23(1):[about 6p.]. Disponível em: http://dx.doi.org.ez133.periodicos.capes.gov.br/10.1016/j.jvoice.2007.04.005.
http://dx.doi.org.ez133.periodicos.capes...
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A systematic review of the literature found that there is a need to increase research on Quality of Life related to the voice of the teacher at different levels of education (Kindergarten, Elementary, High-school or Graduate) and types of schools (Public or Private) that contemplate aspects on the conditions and organization of teaching work99. Ribas TM, Penteado RZ, Garcia-Zapata MTA. Quality of life related with the voice of teachers: exploratory systematic review of literature. Rev. CEFAC [Periódico da Internet]. 2014 [acesso em 2015 ago 11];16(1):[about 12p.]. Disponível em: http://dx.doi.org/10.1590/1982-021620144812.
http://dx.doi.org/10.1590/1982-021620144...
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Because of the transformations that have taken place in the social and economic context of the country in the last decades1010. BRASIL. Ministério da Educação. Expansão da Rede Federal 2014. [acesso em 2015 set 12]. Disponível em: http://redefederal.mec.gov.br/expansao-da-rede-federal.
http://redefederal.mec.gov.br/expansao-d...
, the offer of technical and professional education in Brazil is expanding. In view of these facts, the importance of this research is justified, due to the lack of even greater scientific production related to voice in relation to quality of life, when it comes to technical and vocational education teachers. Thus, it is expected that this research may provoke reflections and proposals to highlight the importance of vocal health.

The aim of this study was to analyse the association of self-reported vocal symptoms with personal, occupational and clinical aspects and relate them to the quality of life of teachers from the federal network of vocational and technological education.

Methods

It is a descriptive, observational, cross-sectional, quantitative study. The Research Ethics Committee of the Center has approved it for Post-graduate Studies in Maceió, AL - CESMAC with CAAE number: 49932215.3.0000.0039 from the “Plataforma Brasil”. All the participants signed the Term of Free and Informed Consent (TCLE) based on Resolution 466/12 of the National Health Council of the Ministry of Health (CNS / MS).

The data were collected in a Federal Education Institution, whose professors occupy the positions of Professor of Basic, Technical and Technological Education and can teach in the offered teaching modalities, the integrated, the subsequent, the graduation education and also the PROEJA, acting in only one or simultaneously in more than one mode.

In the integrated education, students obtain an intermediate level training in conjunction with professional training, at a technical level in the intermediate level. The subsequent is the professional training course at a technical level, offered to students who have finished high school1111. BRASIL. Ministério da Educação. História do Instituto Federal de Alagoas 2015. [acesso em 2016 jan 03]. Disponível em: http://www2.ifal.edu.br/ifal/reitoria/historia.
http://www2.ifal.edu.br/ifal/reitoria/hi...
. The Institute also offers courses aimed at Youth and Adult Education (EJA), aimed to those who did not have access or continuity of studies in primary and secondary education in their proper age1212. BRASIL. Ministério da Educação. Um novo modelo em educação profissional e tecnológica: concepção e diretrizes 2010. [Acesso em 2015 set 17]. Disponível em: http://portal.mec.gov.br/index.php?option=com_docman&view=download&alias=6691-if-concepcaoediretrizes&category_slug=setembro-2010-pdf&Itemid=30192.
http://portal.mec.gov.br/index.php?optio...
. It also has graduate courses available at graduation, baccalaureate and technology levels1111. BRASIL. Ministério da Educação. História do Instituto Federal de Alagoas 2015. [acesso em 2016 jan 03]. Disponível em: http://www2.ifal.edu.br/ifal/reitoria/historia.
http://www2.ifal.edu.br/ifal/reitoria/hi...
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The population covered all active teachers, of both sexes, without restriction as to age, with effective bond, in full and regular activity, making 263 teachers. Teachers dismissed for any reason and those who performed only administrative activities were excluded because they presented different organizational and work environment characteristics from the others in relation to vocal demand. The sample was determined in 157 individuals, using the equation for finite populations.

All participants answered two validated questionnaires, the World Health Organization Quality of Life / bref (WHOQOL / bref)1313. Fleck MA, Louzada S, Xavier M, Chachamovich E, Vieira G, Santos L et al. Aplicação da versão em português do instrumento abreviado de avaliação de qualidade de vida "WHOQOL/breve. Rev Saúde Pública [Periódico da Internet]. 2000 [acesso em 2016 jun 23]; 34(2):[about 6p.]. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0034-89102000000200012.
http://www.scielo.br/scielo.php?script=s...
and the Quality of Life in Voice (V-RQOL) questionnaire88. Gasparini G, Behlau M. Quality of validation of the brazilian version of the Voice-Related Quality of Life (V-RQOL) Measure. J Voice [Periódico da Internet]. 2009 [acesso em 2016 jun 23];23(1):[about 6p.]. Disponível em: http://dx.doi.org.ez133.periodicos.capes.gov.br/10.1016/j.jvoice.2007.04.005.
http://dx.doi.org.ez133.periodicos.capes...
. A third party form named "Data Collection Form", based on a theoretical reference of the area of Speech-Language Therapy1414. Ferreira LP, Giannini SPP, Latorre MRDO, Zenari MS. Distúrbios da voz relacionados ao trabalho: proposta de um instrumento para avaliação em professores. Disturb. Comunic. [Periódico da Internet]. 2007 [acesso em 2016 mar 10]; 19(1):[about 10p.]. Disponível em: https://revistas.pucsp.br/index.php/dic/article/download/11884/8601.
https://revistas.pucsp.br/index.php/dic/...
, pertinent to the authors who subsidized the elaboration of the instrument used in the research (Appendix).

The WHOQOL-bref with 26 questions, validated in Brazil, comprising four domains, which aim to analyse physical capacity, psychological well-being, social relations and the environment, was used. The teachers can present their answers by means of the variable score from one to five, being score one the worst condition and five, the best one. The WHOQOL-bref domains are calculated according to the terms defined in the Portuguese validation article. The results of the domain scores show values between zero and one hundred, with the worst being the closest to zero and the best, the nearest to 100. Thus, an individual with a score equal to 50 for a particular domain can be considered median in this particular domain1313. Fleck MA, Louzada S, Xavier M, Chachamovich E, Vieira G, Santos L et al. Aplicação da versão em português do instrumento abreviado de avaliação de qualidade de vida "WHOQOL/breve. Rev Saúde Pública [Periódico da Internet]. 2000 [acesso em 2016 jun 23]; 34(2):[about 6p.]. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0034-89102000000200012.
http://www.scielo.br/scielo.php?script=s...
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The Quality of Life in Voice (V-RQOL) questionnaire evaluates the Quality of Life related to the voice, and is based on the subjectivity of the teacher, who also assigns a scale from 0 to 5 according to his perception. This is a standardized inventory - Voice Related Quality of Life (V-RQOL)1515. Hogikyan ND, Sethuraman G. Validation of an instrument to measure voice-related quality of life (V-RQOL). J Voice [Periódico em Internet].1999 [acesso em 2016 jun 23]; 13(4):[about 12p.]. Disponível em: http://link-periodicos-capes-gov-br.ez133.periodicos.capes.gov.br.
http://link-periodicos-capes-gov-br.ez13...
translated and validated into Portuguese88. Gasparini G, Behlau M. Quality of validation of the brazilian version of the Voice-Related Quality of Life (V-RQOL) Measure. J Voice [Periódico da Internet]. 2009 [acesso em 2016 jun 23];23(1):[about 6p.]. Disponível em: http://dx.doi.org.ez133.periodicos.capes.gov.br/10.1016/j.jvoice.2007.04.005.
http://dx.doi.org.ez133.periodicos.capes...
. The V-RQOL contains ten questions and examines the relationship between quality of life and voice in three domains: physical (questions 1, 2, 3, 6, 7 and 9), social emotional (questions 4, 5, 8 and 10) and global, this latter aggregated to the previous two. The protocol makes it possible to calculate the scores (sum of points), which ranges from 0 (worst) to 100 (best), with the maximum score indicating a better quality of life related to voice88. Gasparini G, Behlau M. Quality of validation of the brazilian version of the Voice-Related Quality of Life (V-RQOL) Measure. J Voice [Periódico da Internet]. 2009 [acesso em 2016 jun 23];23(1):[about 6p.]. Disponível em: http://dx.doi.org.ez133.periodicos.capes.gov.br/10.1016/j.jvoice.2007.04.005.
http://dx.doi.org.ez133.periodicos.capes...
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The "Data Collection Form" addressed social information (age, gender), the organization of the teacher's activities, characteristics of the environment and work organization, health conditions, vocal symptoms and habits related to the use of voice.

The data obtained by the questionnaires were tabulated in the Excel 2010 program (Microsoft Office®). Next, the descriptive statistical analysis (absolute and relative frequency) of the variables collected in the Data Collection Form, the WHOQOL-bref scores and the V-RQOL in each of the domains was used. Subsequently, the verification of inferential statistics was performed, using the non-parametric association test x² (Chi-square), through the BioEstat® 5.0 program, to analyse the associations between self-reference of three or more vocal symptoms and the cross-referencing between the various variables studied (social characteristics, environment and work organization, behaviours and habits related to health, diseases). A minimum significance level of 5% (p≤0.05) was considered in order to reject the equality hypothesis.

Results

The data show that 29.3% (46) of teachers suffer from three or more self-reported vocal symptoms. Among the prevalent complaints were 38.2% (60) with dry throat, 37.6% (59) with cough, 30.6% (48) with hoarseness and 27.4% (43) reported pain or burning in the throat.

Table 1 presents the description of the social characteristics and work environment collected in the Data Collection Form and their association to the presence of three or more vocal symptoms collected.

Table 1:
Relationship between social and work environment characteristics reported by teachers and complaints of vocal symptoms

Table 2 shows the professional and organizational characteristics of teachers' work and their association with the recording of three or more vocal symptoms. The average weekly workload was 14.5 (SD ± 4.72), with a minimum of 4 and a maximum of 40 hours. As for the teaching time, it was observed that 44.6% of teachers have more than 20 years of profession, with 19.4 years ± 9.246 (Average ± SD), minimum 1 and maximum 39 years.

Table 2:
Relationship between professional and work organization characteristics mentioned by teachers and record of three or more vocal symptoms

Regarding the working time of the teachers in the Institution surveyed, 46.5% of them had up to 10 years of exercise; in contrast, another 31.8% had more than 20 years of work in the institution. The average working time was 15.3 years (± 10.0).

Figure 1 shows the distribution of the teaching levels taught by teachers. The majority (29.3%) (46) of teachers teach in the "integrated and graduate" classes, 20.4% (32) only teach at the "graduate" level, while 19.7% (31) teach exclusively in the "integrated" ones. As we add the percentages, it can be seen that 49.7% of teachers teach in integrated and graduate education classes, or only in graduate education.

Figure 1:
Numerical distribution of teachers according to the teaching modalities in which they teach

Table 3 shows the behaviours and habits related to the health of teachers.

Table 3:
Relation between health-related behaviours and habits, and record of three or more vocal symptoms

Table 4 shows the data collected from the answers presented by the teachers regarding self-reported diseases.

Table 4:
Association between self-reported symptoms / sensations by teachers and record of three or more vocal symptoms

The prevalence of symptoms according to the gender is exposed in Figure 2.

Figure 2:
Prevalence of vocal symptoms with respect to sex

Table 5 shows the WHOQOL-bref results. The domains average and the quality of life score showed that the teachers presented a regular quality of life.

Table 5:
Average and standard deviation of scores according to the domains of the World Health Organization Quality of Life / bref questionnaire (WHOQOL-bref)

The domain of the environment is related to aspects of safety, health, physical environment (climate, noise and pollution), finance, access to information and leisure activities. The issues with the worst scores were related to this domain, specifically question 24 (satisfaction with health services), question 9 (how healthy is the physical environment - climate, noise, pollution, attractions) and question 14 (opportunities for leisure activities). Question 16, which concerns sleep, is part of the physical domain; presented a larger number of unfavourable answers, showing either dissatisfaction or a lot of dissatisfaction.

The overall V-RQOL score was 92.5 (± 8.4), indicating a low voice influence on teachers' quality of life. The closer to 100 the score, the better this ratio. The physical score was 89.3 (± 10.4), and the social-emotional score was 97.3 (± 7.5). It is interesting to note that although 29.3% of teachers reported three or more vocal symptoms, this had no impact on quality of life.

In percentage and quantitative terms in the V-RQOL, the "low impact" scores of voice on quality of life were presented as follows: in the physical domain 81.5% (128); in the social-emotional 96.2% (151), and in the global domain, 90.5% (142).

When analysing questions 1 to 10 of the V-RQOL separately, it is observed that the most committed question is 1, followed by questions 2 and 9. It is worth commenting that complaint 1, 2 and complaint 9 were those that presented the worse evaluations, both belonging to the physical domain, and are related to the professional use of voice. The number of teachers who considered these issues as a moderate to bad problem was 24.2% for complaint 1, 10.8% for complaint 9 and 7.6% for complaint 2.

Figure 3 shows that the V-RQOL scores were all above 80, that is, they had a low impact of voice-related quality of life, however, the domains averages portrayed that the physical domain scores were lower in both sexes, but a little worse in women, especially those who reported three or more complaints in their voices.

Figure 3:
Comparison of the average scores obtained in the voice-related quality of life (V-RQOL) protocol by gender, with or without three or more vocal symptoms per domains

When comparing the V-RQOL scores by gender, in percentage terms, it was found that 13.2% (7) among women in the sample presented scores of medium to high impact, while among men the percentage was 7.7 % (8), that is, more disadvantage for the female sex.

Table 6 shows the results of V-RQOL in relation to the average WHOQOL-bref scores. We compare the V-RQOL data with the average scores obtained in the WHOQOL-bref in each domain. We noticed that there is a correspondence between the protocols. This order is reversed in the case of the V-RQOL high impact, whose WHOQOL-bref domain scores were surprisingly better, with values between 83.3 and 95.8. These data reinforce the idea that worse outcomes of the WHOQOL-bref are paired with the worst rates of V-RQOL.

Table 6:
Association of the Voice-Related Quality of Life Protocol (V-RQOL) scores in the Global domain compared to the scores of the various domains of the WHOQOL-bref

Discussion

The associations were performed by comparing the responses of the variables with the occurrence of three or more vocal symptoms, through the application of the statistical test. The literature indicates that teachers' quality of life is related to self-perception of vocal symptoms44. Penteado RZ, Pereira IMTB. Qualidade de vida e saúde vocal dos professores. Rev Saúde Pública [Periódico da Internet]. 2007. [acesso em 2015 jul 14];41(2):7. Disponível em: http://www.scielo.br/pdf/rsp/v41n2/5638.pdf.
http://www.scielo.br/pdf/rsp/v41n2/5638....
,66. Fabrício MZ, Kasama ST, Martinez ZE. Qualidade de vida relacionada à voz de professores universitários. Rev. CEFAC [Periódico da Internet]. 2010 [acesso em 2016 jun 02];12(2):[about 7p.]. Disponível em: http://dx.doi.org/10.1590/S1516-18462009005000062.
http://dx.doi.org/10.1590/S1516-18462009...
,99. Ribas TM, Penteado RZ, Garcia-Zapata MTA. Quality of life related with the voice of teachers: exploratory systematic review of literature. Rev. CEFAC [Periódico da Internet]. 2014 [acesso em 2015 ago 11];16(1):[about 12p.]. Disponível em: http://dx.doi.org/10.1590/1982-021620144812.
http://dx.doi.org/10.1590/1982-021620144...
.

According to the data collected, it was possible to obtain an overview of the technical and vocational education teachers’ self-perception regarding the quality of life and voice, as well as the associated factors that may influence vocal health.

The sample had the highest number of men, which is expected to be for this level of education, although the literature presents most of the publications with the majority of the sample being women. According to the School Census, the profile of teachers is markedly feminine in the initial years and is reversed as they move from Early Childhood Education to High School and Professional Education1616. Ministério da Educação (Mec) Instituto Nacional de Estudos e Pesquisa (INEP). Estudo exploratório sobre o professor brasileiro: Com base nos resultados do Censo Escolar da Educação Básica 2007[Periódico da Internet]. 2009 [acesso em 2016 jun 26]. Disponível em: http://portal.mec.gov.br/dmdocuments/estudoprofessor.pdf.
http://portal.mec.gov.br/dmdocuments/est...
. Research with primary school teachers showed a higher prevalence of self-reported voice alteration in females1717. Marçal CCB, Peres MA. Alteração vocal auto-referida em professores: prevalência e fatores associados. Rev Saúde Pública [Periódico da Internet]. 2011 [acesso em 2016 jun 15];45(3):[about 8p.]. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0034-89102011000300008.
http://www.scielo.br/scielo.php?script=s...
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Likewise, in this study, female teachers also presented a higher percentage of vocal symptoms. It was found that 39.6% of the female teachers had three or more vocal symptoms, which indicates a greater disadvantage in the female gender, with a statistically significant value. There was a lower index among male teachers, with 24% of male teachers reporting complaints. Studies have shown that there are important changes in the glottis configuration of women during prolonged phonation with high loudness (subjective sensation of intensity), possibly due to constitutional, anatomical differences and double working shift1818. Ortiz E, Costa EA, Spina AL, Crespo AN. Proposta de modelo de atendimento multidisciplinar para disfonias relacionadas ao trabalho: estudo preliminar. Rev Bras Otorrinolaringol. [Periódico da Internet]. 2004 [acesso em 2016 out 17];70(5):[about 6p.]. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0034-72992004000500003&lng=en. http://dx.doi.org/10.1590/S0034-72992004000500003.
http://www.scielo.br/scielo.php?script=s...
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The average age of the teachers studied was 47.2 (SD ± 9.12). The age factor deserves special attention, since the age group between 25 and 45 is considered to have the best vocal efficiency, and as the age advances, structural changes in the larynx may occur and may compromise vocal quality1919. Behlau M, Azevedo R, Pontes P. Conceito de voz normal e classificação das disfonias. In: Behlau M (org). Voz: O Livro do Especialista. 1ª ed. Rio de Janeiro: Revinter; 2001. p.53-84.. A study with technical and vocational education teachers found 39% between the ages of 30 and 39 years, followed by 29% in the 40-to-49-age group2020. Carvalho OF de, Souza FH de. Formação do docente da educação profissional e tecnológica no Brasil: um diálogo com as faculdades de educação e o curso de Pedagogia. Educ. Soc. [Periódico da Internet], 2014 [acesso em 2016 jun 15];35(128):[about 25p.]. Disponível em: http://dx.doi.org/10.1590/ES0101-73302014124974.
https://doi.org/http://dx.doi.org/10.159...
. In this study, there were more teachers aged between 41 and 50 years (33.8%), but those most affected with vocal complaints were in the age group of 51-60 years old (10.8%).

Noise was pointed out by 77% of the teachers as tolerable and 18.5% judged the noise as unpleasant. Research carried out with higher education teachers referred to the presence of noise in the classroom, but only 48.1% mentioned voice alteration, and found no significant association2121. Servilha EAM, Justo FA. Relação entre percepção de ruído em sala de aula autorreferida por professores universitários e suas consequências sobre a voz. Distúrb. Comun. [Periódico da Internet] 2014. [acesso em: 2016 dez 13]; 26(4):[about 7p.].Disponível em: https://revistas.pucsp.br/index.php/dic/article/viewFile/18080/15966.
https://revistas.pucsp.br/index.php/dic/...
. High / unbearable noise in the classroom increases the prevalence of poorer quality of life related to teachers' voice2222. Jardim R, Barreto SM, Assunção AA. Condições de trabalho, qualidade de vida e disfonia entre docentes. Cadernos de Saúde Pública [Periódico da Internet]. 2007 [acesso em 2016 jun 08];23(10):[about 22p.]. Disponível em: http:// dx.doi.org/10.1590/S0102-311X2007001000019.
https://doi.org/http:// dx.doi.org/10.15...
.

The researches show differences as to the influence or not of the high teaching workload on the development of vocal disorders in the teacher44. Penteado RZ, Pereira IMTB. Qualidade de vida e saúde vocal dos professores. Rev Saúde Pública [Periódico da Internet]. 2007. [acesso em 2015 jul 14];41(2):7. Disponível em: http://www.scielo.br/pdf/rsp/v41n2/5638.pdf.
http://www.scielo.br/pdf/rsp/v41n2/5638....
. There are studies that did not verify significance between working two shifts or more in the classroom, which characterizes high vocal demand, and the prevalence of symptoms in the voice2323. Medeiros JSA, Santos SMM, Teixeira LC, Gama ACC, Medeiros AM. Vocal symptoms reported by teachers with dysphonia and associated factors. Audiol. Commun. Res. [Internet]. 2016 [cited on 2016 Jun 24th]; 21:e1553. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S2317-64312016000100304&lng=pt. Epub 31-May-2016. http://dx.doi.org/10.1590/2317-6431-2015-1553.
http://www.scielo.br/scielo.php?script=s...
,2424. Servilha EAM, Pereira PM. Condições de trabalho, saúde e voz em professores universitários. Rev Ciênc Méd. [Periódico na Internet]. 2008 [acesso em 2016 jun 26];17(1):[about 10p.]. Disponível em: http://periodicos.puc-campinas.edu.br/seer/index.php/cienciasmedicas/article/view/741.
http://periodicos.puc-campinas.edu.br/se...
. However, other researchers have found that working in the classroom for 24 hours a week or more in the last six months has demonstrated a significant association with hoarseness in teachers2525. Araújo TM, Reis EJFB, Carvalho FM, Porto LA, Reis IC, Andrade JM. Fatores associados a alterações vocais em professoras. Cadernos de Saúde Pública [periódico na Internet]. 2008 [acesso em 2016 jun 26];24(6):[about 10p.]. Disponível em: http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0102-311X2008000600004.
http://www.scielosp.org/scielo.php?scrip...
.

In this study, the average classroom workload of less than 20 hours per week may be the reason for not being associated with the presence of three or more symptoms. Another factor worth mentioning is the composition of the study, in which the majority of teachers are male, unlike other studies, in which there is a greater predominance of female teachers, who are more predisposed to vocal alterations1717. Marçal CCB, Peres MA. Alteração vocal auto-referida em professores: prevalência e fatores associados. Rev Saúde Pública [Periódico da Internet]. 2011 [acesso em 2016 jun 15];45(3):[about 8p.]. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0034-89102011000300008.
http://www.scielo.br/scielo.php?script=s...
,1818. Ortiz E, Costa EA, Spina AL, Crespo AN. Proposta de modelo de atendimento multidisciplinar para disfonias relacionadas ao trabalho: estudo preliminar. Rev Bras Otorrinolaringol. [Periódico da Internet]. 2004 [acesso em 2016 out 17];70(5):[about 6p.]. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0034-72992004000500003&lng=en. http://dx.doi.org/10.1590/S0034-72992004000500003.
http://www.scielo.br/scielo.php?script=s...
,2626. Araújo RP. Perfil dos beneficiários do INSS em auxílio-doença por distúrbios benignos da voz. RBMT [Periódico na Internet]. 2014 [Acesso em 2016 jun 19];1:[about 7p.]. Disponível em: http://www.anamt.org.br/site/upload_arquivos/revista_brasileira_de_medicina_do_trabalho_volume_12_n%C2%BA_1_25320141526487055475.pdf.
http://www.anamt.org.br/site/upload_arqu...
.

The literature shows divergent results regarding the association between vocal alterations and teaching time2525. Araújo TM, Reis EJFB, Carvalho FM, Porto LA, Reis IC, Andrade JM. Fatores associados a alterações vocais em professoras. Cadernos de Saúde Pública [periódico na Internet]. 2008 [acesso em 2016 jun 26];24(6):[about 10p.]. Disponível em: http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0102-311X2008000600004.
http://www.scielosp.org/scielo.php?scrip...
. Studies present opposite data. Teachers with more years of teaching did not present any more vocal alterations complaints than those with less time of work2424. Servilha EAM, Pereira PM. Condições de trabalho, saúde e voz em professores universitários. Rev Ciênc Méd. [Periódico na Internet]. 2008 [acesso em 2016 jun 26];17(1):[about 10p.]. Disponível em: http://periodicos.puc-campinas.edu.br/seer/index.php/cienciasmedicas/article/view/741.
http://periodicos.puc-campinas.edu.br/se...
. A study with teachers of professional and technological education found that 48% had less than ten years of service, and 8% had taught for more than twenty-five years2020. Carvalho OF de, Souza FH de. Formação do docente da educação profissional e tecnológica no Brasil: um diálogo com as faculdades de educação e o curso de Pedagogia. Educ. Soc. [Periódico da Internet], 2014 [acesso em 2016 jun 15];35(128):[about 25p.]. Disponível em: http://dx.doi.org/10.1590/ES0101-73302014124974.
https://doi.org/http://dx.doi.org/10.159...
. There has been an expansion in the number of schools after the creation of the Federal Network of Professional, Scientific and Technological Education and the Federal Institutes of Education are a part of it. This consequently increased the number of new servants in recent years1010. BRASIL. Ministério da Educação. Expansão da Rede Federal 2014. [acesso em 2015 set 12]. Disponível em: http://redefederal.mec.gov.br/expansao-da-rede-federal.
http://redefederal.mec.gov.br/expansao-d...
, which justifies the number of teachers with more than 20 years teaching and less than ten years of practice in the institution studied.

The majority (95.6%) of the teachers in this study taught only in the school assessed. Similar research, with teachers of this same level of education, found that 88% of the teachers worked only in the institution researched, for years2020. Carvalho OF de, Souza FH de. Formação do docente da educação profissional e tecnológica no Brasil: um diálogo com as faculdades de educação e o curso de Pedagogia. Educ. Soc. [Periódico da Internet], 2014 [acesso em 2016 jun 15];35(128):[about 25p.]. Disponível em: http://dx.doi.org/10.1590/ES0101-73302014124974.
https://doi.org/http://dx.doi.org/10.159...
.

We noted that 65.6% (103) of the educators in this research referred to preferential use of the exhibition classes. Other authors2424. Servilha EAM, Pereira PM. Condições de trabalho, saúde e voz em professores universitários. Rev Ciênc Méd. [Periódico na Internet]. 2008 [acesso em 2016 jun 26];17(1):[about 10p.]. Disponível em: http://periodicos.puc-campinas.edu.br/seer/index.php/cienciasmedicas/article/view/741.
http://periodicos.puc-campinas.edu.br/se...
refer to a preference for this method of teaching in association with audio-visual resources, however, because it requires the constant use of voice, it results in greater vocal exhaustion if the teacher does not have the necessary preparation.

In this study, 29.3% of the teachers reported activities with voice use besides teaching, and 8.3% of them reported three or more vocal symptoms. Speech professionals wear the speech device in and out of their work environment, so that they increase voice overload, with possible onset of signs or symptoms after work, generating uncertainty in the cause and effect relationship11. Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial (ABORL- CCF). Câmaras Técnicas de Otorrinolaringologia, Medicina do Trabalho e Perícias Médicas do CREMERJ. In: Consenso nacional sobre voz profissional: voz e trabalho: uma questão de saúde e direito do trabalhador. Rev Vox Brasilis [Periódico da Internet]. 2004. [acesso em 2016 jun 25]: 10(10):[about 1p.]. Disponível em: http://www.aborlccf.org.br/secao.asp?s=211.
http://www.aborlccf.org.br/secao.asp?s=2...
.

Only 10.8% (17) of the teachers who participated in this study sought guidance on the use of voice professionally. Research reports that teachers lack guidance on how to identify and deal with vocal disorders66. Fabrício MZ, Kasama ST, Martinez ZE. Qualidade de vida relacionada à voz de professores universitários. Rev. CEFAC [Periódico da Internet]. 2010 [acesso em 2016 jun 02];12(2):[about 7p.]. Disponível em: http://dx.doi.org/10.1590/S1516-18462009005000062.
http://dx.doi.org/10.1590/S1516-18462009...
. A recent study found that the minority (36.4%) of teachers received some type of vocal orientation regarding voice care2727. Silva GJ, Almeida AA, Lucena BTL, Silva MFBL. Vocal symptoms and self-reported causes in teachers. Rev. CEFAC [Periódico na Internet]. 2016 [acesso em 2016 nov 15]; 18(1):[about 8p.]. Disponível em: http://www.scielo.br/scielo.php?script=sci_issuetoc&pid=1516-184620160001&lng=en&nrm=iso.
http://www.scielo.br/scielo.php?script=s...
.

It was observed that 6.4% (10) of the teachers needed medical leave or absence from work because of vocal problems. In the State of Alagoas, voice disorders are one of the main reasons for teachers to leave work environment. The number of teachers with vocal alterations has increased since 20032828. Ferracciu CCS. Distúrbio de voz relacionado ao trabalho e estratégia de enfrentamento em professoras da rede pública estadual de Alagoas [Tese]. Rio de Janeiro (RJ): Escola Nacional de Saúde Pública Sérgio Aroucha-ENSP; 2013..

Regarding the consumption of alcoholic beverages, 52.3% of them said they only use it on special occasions and 5% stated that they always drink. Although alcoholism is a factor related to vocal changes, there was no significant association2525. Araújo TM, Reis EJFB, Carvalho FM, Porto LA, Reis IC, Andrade JM. Fatores associados a alterações vocais em professoras. Cadernos de Saúde Pública [periódico na Internet]. 2008 [acesso em 2016 jun 26];24(6):[about 10p.]. Disponível em: http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0102-311X2008000600004.
http://www.scielosp.org/scielo.php?scrip...
, and this corroborates with research.

Only 2.5% of the subjects mentioned smoking. Research conducted in 2014 by the Ministry of Health and the Brazilian Institute of Geography and Statistics (IBGE) reveals that the rate of people who smoke cigarettes and other tobacco products is 20.5% lower than that recorded five years ago. Therefore, smoking habit has less and less followers in Brazil, according to IBGE's Special Tobacco Survey (PETab)2929. Ministério da Saúde e do Instituto Brasileiro de Geografia e Estatística (IBGE) 2014, Pesquisa Especial de Tabagismo do IBGE (PETab). Ministério da Saúde [Periódico na Internet]. 2014 [acesso em 2016 out 18]. Disponível em: http://portalsaude.saude.gov.br/index.php/cidadao/principal/agencia-saude/15973-numero-de-fumantes-no-brasil-cai-20-5-em-cinco-anos.
http://portalsaude.saude.gov.br/index.ph...
.

In this sample, the most cited self-reported diseases were 37.6% rhinitis / sinusitis, 29.3% respiratory allergy, 28.7% gastritis / gastroesophageal reflux / heartburn, 28% pharyngitis/tonsillitis /laryngitis. Problems of the upper airways are an important concern for the teacher's work, since approximately 40% referred to problems such as sinusitis, rhinitis, tonsillitis, pharyngitis3030. Giannini SPP, Latorre MRDO, Ferreira LP. Voice disorders (dysphonia) in public school female teachers working in Belo Horizonte. Rev. Soc. Bras. fonoaudiol. [Periódico na Internet]. 2010 [acesso em 2016 out 02]; 15(3):[about 3p.]. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-80342010000300025&lng=pt. http://dx.doi.org/10.1590/S1516-80342010000300025.
http://www.scielo.br/scielo.php?script=s...
. Another recent study confirms that 37.2% of teachers report allergy, so demonstrating high prevalence2727. Silva GJ, Almeida AA, Lucena BTL, Silva MFBL. Vocal symptoms and self-reported causes in teachers. Rev. CEFAC [Periódico na Internet]. 2016 [acesso em 2016 nov 15]; 18(1):[about 8p.]. Disponível em: http://www.scielo.br/scielo.php?script=sci_issuetoc&pid=1516-184620160001&lng=en&nrm=iso.
http://www.scielo.br/scielo.php?script=s...
.

Studies have shown that self-evaluation or vocal self-perception has been highly valued. In this study, 29.3% mentioned three or more self-reported vocal symptoms. These results corroborate with other studies carried out with teachers66. Fabrício MZ, Kasama ST, Martinez ZE. Qualidade de vida relacionada à voz de professores universitários. Rev. CEFAC [Periódico da Internet]. 2010 [acesso em 2016 jun 02];12(2):[about 7p.]. Disponível em: http://dx.doi.org/10.1590/S1516-18462009005000062.
http://dx.doi.org/10.1590/S1516-18462009...
,2525. Araújo TM, Reis EJFB, Carvalho FM, Porto LA, Reis IC, Andrade JM. Fatores associados a alterações vocais em professoras. Cadernos de Saúde Pública [periódico na Internet]. 2008 [acesso em 2016 jun 26];24(6):[about 10p.]. Disponível em: http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0102-311X2008000600004.
http://www.scielosp.org/scielo.php?scrip...
,2828. Ferracciu CCS. Distúrbio de voz relacionado ao trabalho e estratégia de enfrentamento em professoras da rede pública estadual de Alagoas [Tese]. Rio de Janeiro (RJ): Escola Nacional de Saúde Pública Sérgio Aroucha-ENSP; 2013.,3131. Morais EPG, Azevedo RR, Chiari BM. Cross-sectional study on voice self-assessment, and quality of life in voice of female teachers. Rev. CEFAC [Internet]. 2012 [cited on 2016 jul 12th];14(5):892-900. Available from:http://www.scielo.br/pdf/rcefac/v14n5/121-11.pdf DOI: http://dx.doi.org/10.1590/S1516- 18462012005000032.
http://www.scielo.br/pdf/rcefac/v14n5/12...
.

Symptoms such as hoarseness, vocal fatigue, and throat pain in teachers are signs of vocal abuse or voice use in inappropriate work conditions that may contribute to the onset of an occupational disease3232. Lima-Silva MFB, Ferreira LP, Oliveira IB, Silva MAA, Ghirardi ACAM. Voice disorders in teachers: self-report, auditory-perceptive assessment of voice and vocal fold assessment. Rev soc bras fonoaudiol. [Internet]. 2012 Dez [cited on 2016 nov 15th];17(4):391-7. Available from: http://www.scielo.br/pdf/rcefac/v18n1/1982-0216-rcefac-18-01-00158.pdf DOI: http://dx.doi.org/10.1590/S1516-80342012000400005.
http://www.scielo.br/pdf/rcefac/v18n1/19...
. Research with teachers from the State School of Alagoas found approximate data regarding the most frequent symptoms: 54.5% with dry throat, 42.7% throat clearing and 42.7% throat burning2828. Ferracciu CCS. Distúrbio de voz relacionado ao trabalho e estratégia de enfrentamento em professoras da rede pública estadual de Alagoas [Tese]. Rio de Janeiro (RJ): Escola Nacional de Saúde Pública Sérgio Aroucha-ENSP; 2013.. Another study mentions 44.3% with hoarseness, 54.5% with fatigue when speaking and 53.4% with dry throat3333. Caporossi C, Ferreira LP. Sintomas vocais e fatores relativos ao estilo de vida em professores. Rev. CEFAC [Periódico na Internet]. 2011 [acesso em 2015 jul 15];13(1):[about 7p.]. Disponível em: http://dx.doi.org/10.1590/S1516-18462010005000099.
http://dx.doi.org/10.1590/S1516-18462010...
. Researchers found a prevalence of dry throat sensation in 66.6% and hoarseness in 40.4%3434. Anhaia TC, Klahr PS, Cassol M. Association between teaching experience and voice self-assessment among professors: a cross-sectional observational study. Rev. CEFAC [Periódico na Internet]. 2015 [acesso em 2015 jul 12];17(1):[about 5 p.]. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-18462015000100052&lng=en&nrm=iso&tlng=en.
http://www.scielo.br/scielo.php?script=s...
.

Teachers should be warned about the importance of perceiving when the first signs / symptoms of vocal changes appear and seek guidance and treatment, avoiding an aggravation with negative impact from a professional, social and emotional point of view. The teacher without vocal symptoms will be more active in their activities66. Fabrício MZ, Kasama ST, Martinez ZE. Qualidade de vida relacionada à voz de professores universitários. Rev. CEFAC [Periódico da Internet]. 2010 [acesso em 2016 jun 02];12(2):[about 7p.]. Disponível em: http://dx.doi.org/10.1590/S1516-18462009005000062.
http://dx.doi.org/10.1590/S1516-18462009...
.

In the WHOQOL-bref protocol analysis in this study, the average score obtained was 71.3 (SD ± 10.9). A similar survey conducted with this same research instrument found a score of 66 as a general average of quality of life, being it considered as a regular score, taking into account that the scale of values varies from zero to one hundred44. Penteado RZ, Pereira IMTB. Qualidade de vida e saúde vocal dos professores. Rev Saúde Pública [Periódico da Internet]. 2007. [acesso em 2015 jul 14];41(2):7. Disponível em: http://www.scielo.br/pdf/rsp/v41n2/5638.pdf.
http://www.scielo.br/pdf/rsp/v41n2/5638....
. By comparison, it can be inferred that the WHOQOL-bref results in this study can be considered as a regular quality of life. The most affected domain was that of the environment with 66.1 corroborating with other studies44. Penteado RZ, Pereira IMTB. Qualidade de vida e saúde vocal dos professores. Rev Saúde Pública [Periódico da Internet]. 2007. [acesso em 2015 jul 14];41(2):7. Disponível em: http://www.scielo.br/pdf/rsp/v41n2/5638.pdf.
http://www.scielo.br/pdf/rsp/v41n2/5638....
,3535. Andrade VCF, Andrade PCR, Leite AMP, Araújo CM. Qualidade de vida de servidores técnico-administrativos: um estudo de caso. Unincor [Periódico na Internet]. 2012 [acesso em 2016 out 23];10(1):[about 8 p.]. Disponível em: http://revistas.unincor.br/index.php/revistaunincor/article/view/382/pdf.
http://revistas.unincor.br/index.php/rev...
.

A study that used this same protocol (WHOQOL-bref) with teachers from public schools had scores similar to those of this study, 68.5 in quality of life, of which 67.6 in the physical domain, 70.1 in the psychological domain, 73.9 in the social domain and 62.4 in the environmental domain3636. Pimentel BN, Fedosse E, Rodrigues NGS, Cruz KS, Santos Filha VAV. Perception of noise, hearing health and quality of life of public school teachers. Audiol. Commun Res. [Periódico na Internet]. 2016 [acesso em 2016 dez 13]; 21:1740:[about 7p.]. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S2317-64312016000100332&lng=en&nrm=iso&tlng=en.
http://www.scielo.br/scielo.php?script=s...
. In another research with high school teachers, 68.2 in the physical, 68.2 in the psychological, 70.3 in the social relations, 56.1 in the environment, results very close to those of this research44. Penteado RZ, Pereira IMTB. Qualidade de vida e saúde vocal dos professores. Rev Saúde Pública [Periódico da Internet]. 2007. [acesso em 2015 jul 14];41(2):7. Disponível em: http://www.scielo.br/pdf/rsp/v41n2/5638.pdf.
http://www.scielo.br/pdf/rsp/v41n2/5638....
.

A systematic review of the literature, whose objective was to verify the existent researches on quality of life related to teachers' voices, concluded that V-RQOL was the most used protocol in this population99. Ribas TM, Penteado RZ, Garcia-Zapata MTA. Quality of life related with the voice of teachers: exploratory systematic review of literature. Rev. CEFAC [Periódico da Internet]. 2014 [acesso em 2015 ago 11];16(1):[about 12p.]. Disponível em: http://dx.doi.org/10.1590/1982-021620144812.
http://dx.doi.org/10.1590/1982-021620144...
.

The average V-RQOL score in the global domain was 92.4 (SD ± 8.4). It can be inferred that for teachers of the researched education institution the impact of voice on quality of life was low. Some researches using the V-RQOL found averages of the domains with scores close to those of this research. A similar average of 91.1 points with teachers and 93.0 for the group of non-teachers3737. Gampel D, Karsch UM, Ferreira LP. Percepção de voz e qualidade de vida em idosos professores e não professores. Ciênc Saúde Coletiva [Periódico na Internet]. 2010 [acesso em 2016 jun 02];15(6):[about 1p.]. Disponível em: http://dx.doi.org/10.1590/S1413-81232010000600028 .
https://doi.org/http://dx.doi.org/10.159...
. However, there are studies, with much lower scores for the global domain, with a score of 65.2 performed with elementary and high school teachers3838. Gillivan-Murphy P, Drinnan MJ, O'Dwyer TP, Ridha H, Carding P. The effectiveness of a voice treatment approach for teachers with self-reported voice problems. J Voice [Periódico na Internet]. 2006 [acesso em 2016 nov 15];20(3):[about 8p.]. Disponível em: http://link-periodicos-capes-gov-br.ez133.periodicos.capes.gov.br/sfxlcl41?url_ver=Z39.88-2004&url_ctx_fmt=fi/fmt:kev:mtx:ctx&ctx_enc=info:ofi.
http://link-periodicos-capes-gov-br.ez13...
.

It is worth highlighting in this study the fact that all domains of V-RQOL were classified within the range of low voice impact in the quality of life (with scores above 80), but the most affected domain was the physical one. Literature indicates that the physical aspects, for being related to the discomfort and complaints presented by the use of the voice, facilitate the perception of the individuals to evaluate it as the most shocking. Several studies confirm this fact44. Penteado RZ, Pereira IMTB. Qualidade de vida e saúde vocal dos professores. Rev Saúde Pública [Periódico da Internet]. 2007. [acesso em 2015 jul 14];41(2):7. Disponível em: http://www.scielo.br/pdf/rsp/v41n2/5638.pdf.
http://www.scielo.br/pdf/rsp/v41n2/5638....

5. Servilha EAM, Roccon PF. Relação entre voz e qualidade de vida em professores universitários. Rev. CEFAC [Periódico da Internet]. 2009. [acesso em 2016 mar 10]; 11(3):440-8. Disponível em: http://www.scielo.br/pdf/rcefac/2009nahead/42-08.pdf DOI:10.1590/S1516-18462009005000029.
http://www.scielo.br/pdf/rcefac/2009nahe...
-66. Fabrício MZ, Kasama ST, Martinez ZE. Qualidade de vida relacionada à voz de professores universitários. Rev. CEFAC [Periódico da Internet]. 2010 [acesso em 2016 jun 02];12(2):[about 7p.]. Disponível em: http://dx.doi.org/10.1590/S1516-18462009005000062.
http://dx.doi.org/10.1590/S1516-18462009...
,99. Ribas TM, Penteado RZ, Garcia-Zapata MTA. Quality of life related with the voice of teachers: exploratory systematic review of literature. Rev. CEFAC [Periódico da Internet]. 2014 [acesso em 2015 ago 11];16(1):[about 12p.]. Disponível em: http://dx.doi.org/10.1590/1982-021620144812.
http://dx.doi.org/10.1590/1982-021620144...
,3737. Gampel D, Karsch UM, Ferreira LP. Percepção de voz e qualidade de vida em idosos professores e não professores. Ciênc Saúde Coletiva [Periódico na Internet]. 2010 [acesso em 2016 jun 02];15(6):[about 1p.]. Disponível em: http://dx.doi.org/10.1590/S1413-81232010000600028 .
https://doi.org/http://dx.doi.org/10.159...
,3838. Gillivan-Murphy P, Drinnan MJ, O'Dwyer TP, Ridha H, Carding P. The effectiveness of a voice treatment approach for teachers with self-reported voice problems. J Voice [Periódico na Internet]. 2006 [acesso em 2016 nov 15];20(3):[about 8p.]. Disponível em: http://link-periodicos-capes-gov-br.ez133.periodicos.capes.gov.br/sfxlcl41?url_ver=Z39.88-2004&url_ctx_fmt=fi/fmt:kev:mtx:ctx&ctx_enc=info:ofi.
http://link-periodicos-capes-gov-br.ez13...
.

In this study, there was a greater impairment of V-RQOL in questions 1, 2 and 9, which refer to the difficulties in speaking loudly or being heard in noisy environments, the air ending quickly and having to breathe many times while speaking and still having to repeat what they spoke in order to be understood. Other research indicates that the number of teachers (51%) with some difficulty to be heard in noisy environments is relatively high (Question 1)66. Fabrício MZ, Kasama ST, Martinez ZE. Qualidade de vida relacionada à voz de professores universitários. Rev. CEFAC [Periódico da Internet]. 2010 [acesso em 2016 jun 02];12(2):[about 7p.]. Disponível em: http://dx.doi.org/10.1590/S1516-18462009005000062.
http://dx.doi.org/10.1590/S1516-18462009...
.

Scores remained very near between the genders, with a small disadvantage for females. Another research concluded that when comparing the V-RQOL results of 1304 subjects with varied gender, age and professional vocal usage levels, the impact on quality of life related to a vocal alteration was similarly perceived by both men and women. The total results found in that study were similar in the three domains for men (total 75.5, physical 71.3, socioemotional 82.3) and women (total 74.9, physical 70.7, socioemotional 82.1)3939. Putnoki DS, Hara F, Oliveira G, Behlau M. Qualidade de vida em voz: o impacto de uma disfonia de acordo com gênero, idade e uso vocal profissional. Rev Soc Bras Fonoaudiol. [Periódico na Internet]. 2010 [acesso em 2016 out 23];15(4):[about 5p.]. Disponível: http://www.scielo.br/pdf/rsbf/v15n4/a03v15n4.pdf.
http://www.scielo.br/pdf/rsbf/v15n4/a03v...
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Research with elementary school teachers found values of 72 points in the V-RQOL for the global domain3131. Morais EPG, Azevedo RR, Chiari BM. Cross-sectional study on voice self-assessment, and quality of life in voice of female teachers. Rev. CEFAC [Internet]. 2012 [cited on 2016 jul 12th];14(5):892-900. Available from:http://www.scielo.br/pdf/rcefac/v14n5/121-11.pdf DOI: http://dx.doi.org/10.1590/S1516- 18462012005000032.
http://www.scielo.br/pdf/rcefac/v14n5/12...
. With university professors, the impact of voice on quality of life was low, with an average global domain score of 82.6 points55. Servilha EAM, Roccon PF. Relação entre voz e qualidade de vida em professores universitários. Rev. CEFAC [Periódico da Internet]. 2009. [acesso em 2016 mar 10]; 11(3):440-8. Disponível em: http://www.scielo.br/pdf/rcefac/2009nahead/42-08.pdf DOI:10.1590/S1516-18462009005000029.
http://www.scielo.br/pdf/rcefac/2009nahe...
. Most university teachers presented a good quality of life associated with voice, according to the V-RQOL evaluation, with a median of 97.5 points for the global domain, but a high prevalence of vocal symptoms was evidenced66. Fabrício MZ, Kasama ST, Martinez ZE. Qualidade de vida relacionada à voz de professores universitários. Rev. CEFAC [Periódico da Internet]. 2010 [acesso em 2016 jun 02];12(2):[about 7p.]. Disponível em: http://dx.doi.org/10.1590/S1516-18462009005000062.
http://dx.doi.org/10.1590/S1516-18462009...
. These results with university professors showed a profile, which is closer to the reality of the professionals of this research with teachers of technical and professional education. Even in this aspect, in which the symptoms did not reflect compromising the quality of life of the teachers.

It is necessary to be alert to the multicausality of dysphonia, linked to environmental conditions and factors and to the organization of work within the school, in addition to the causes related to individual health habits and conditions of each teacher. In this study, significant associations were few, and voice-related quality of life (V-RQOL) indexes in the global domain showed that 90% of teachers had a "low impact" score. However, it is worth mentioning that out of the 157 teachers participating in this study, 29% (46) reported three or more vocal symptoms that were negative for the voice, indicating caution and vigilance. Signs and symptoms are present in phases that precede organic changes, such as laryngeal changes observed in more advanced phases of dysphonia4040. Jardim R, Barreto SM, Assunção AA. Voice disorder: case definition and prevalence in teachers. Rev. Bras Epidemiol. [Periódico da Internet]. 2007 [acesso em 2016 jun 04];10(4):[about 11p.]. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1415-790X2007000400020.
http://www.scielo.br/scielo.php?script=s...
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Conclusion

Almost 30% of the teachers presented self-reported complaints of vocal symptoms. The prevalent complaints were 38.2% with dry throat, 37.6% with cough and 30.6% with hoarseness. There was a higher prevalence of symptoms in the female gender, with a statistically significant value. The symptoms presented significance with the self-reported presence of some pathologies: respiratory allergy, upper airway diseases, gastroesophageal reflux and gastritis. As for the WHOQOL-bref, the average scores were 71.3 points, with a standard deviation of ± 10.9, therefore, considered as regular. The domain with the highest score was the psychological one, with 75.3 and the most harmed was the environment, with 66.1 points.

According to the V-RQOL assessments, the average score obtained in the global domain was 92.4 points. The domain with the most disadvantage was the physical one and the most compromising issues were difficulty in speaking loudly or being heard in noisy environments, the air ending quickly and having to breathe many times while speaking, and the need to repeat what they say in order to be understood. 90.5% of teachers had low voice impact on quality of life. Thus, it can be inferred that the impact of the voice on the quality of life for the teachers of the professional and technological teaching researched was low. It can be concluded that although the teachers had 29% of vocal symptoms, these did not reflect in the limitation of quality of life.

References

  • Research support source: PSIC - Scientific Initiation Programme CESMAC

Appendix - Data Collection Form

Publication Dates

  • Publication in this collection
    Jul-Aug 2018

History

  • Received
    16 June 2017
  • Accepted
    29 May 2018
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