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Nodules, polyps, edemas and cysts were found, among others. Variations in the methodologies used in different studies could contribute to the variation in the prevalence found. The self-reported diagnosis of vocal fold pathologies was more prevalent in female teachers than in male ones. Teaching is an activity primarily performed by women.
Despite the growing inclusion of women in the job market, their historical role in the family has not changed yet, i. The resulting multiple roles create the so-called double shift: the professional activity and the domestic tasks as mother and housewife. This double shift translates into an excessive number of working hours for women, contributing to the development of diseases, especially those related to stress.
This higher prevalence is associated with a lower level of education, compared to men; a greater proportion of high housework overload; and a lower level of participation in the decision-making process.
The hyaluronic acid, for instance, a protein that attracts water to the vocal fold lamina propria, leading to a reduction in surface trauma during sound emission, is more abundant in males.
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This could partly explain the lower frequency of vocal nodules in men. Nodular lesions were predominantly diagnosed in women who suffer from major vocal trauma, as they have a smaller larynx and higher frequency of vibration. Vocal fold pathologies were more prevalent in teachers with more than seven years of teaching experience.
This finding is similar to what was observed in another study3 with teachers in the state of Bahia, in which the self-reported diagnosis of vocal fold nodules was more frequent from the fifth year of teaching practice on.
Excessive voice use was associated with the presence of self-reported diagnosis of vocal fold pathologies. This behavior includes speaking loudly and shouting.
Teachers are required to use their voice frequently and intensely, due to the need to maintain classroom discipline. The work environment may contribute to the development of voice disorders.
Variations in temperature and humidity interfere with the pharyngeal and laryngeal mucosa hydration, causing the level of irritation to be higher. The high level of background noise forces teachers to raise their voices and increases their speech effort. Among teachers, the audiometric configuration of hearing loss induced by high levels of sound pressure prevailed.
Classrooms showed noise levels of approximately 87dBA.
The noise emission sources in the classrooms are the students themselves, when they speak or move their feet or chairs and desks. These diseases result from individual predispositions and environmental conditions. Larynx exposure to mucosa-irritating factors can change the delicate vocal mechanism.
For this reason, it is important to evaluate the environment of professionals who use their voice to prevent this situation from being aggravated, due to the presence of dust or mildew. Multiple responsibilities cause teachers to experience physical and mental fatigue, which threatens their health.
In view of the pressures existing in the work organization, teachers can feel anguish, dissatisfaction, anger, hopelessness, lack of motivation, tiredness and stress.
The presence of these feelings causes teachers to experience psychological suffering in the teaching practice. In a study conducted by Medeiros et al,16 teachers with common mental disorders showed 5. These studies suggest that stress influences the occurrence of voice disorders. However, the mechanisms that measure this association have not been clearly established.
As the studies mentioned9,16 had a cross-sectional design, the possibility of reverse causality must be considered: the presence of voice disorders could influence the occurrence of common mental disorders. One of the limitations of the present study is the way how the dependent variable was assessed, because the self-reported medical diagnosis is a subjective fact.
However, this measure must be reasonably close to the actual phenomenon studied, as this is a large-scale epidemiological survey.
In addition, there are limitations inherent in cross-sectional studies. It is not possible to determine the chronological order between exposure and effect. Data on the teachers who were on a leave of absence could not be obtained, underestimating the actual prevalence of the phenomenon studied, something known as healthy worker effect.
The possibility of occurrence of information bias should not be disregarded either, because teachers who had experienced health problems tended to associate more symptoms or characteristics studied with their work.
The relevance of selection bias cannot be fully evaluated, although the proportion of losses was relatively low More in-depth studies on factors associated with voice disorders in teachers are required, aiming to promote vocal health, especially structural changes in the work environment and its form of organization. The legislation on occupational accidents' recognition of work-related voice disorders could promote voice change prevention control, the identification of initial symptoms and early diagnosis of these changes.
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