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Prevalence and Risk Factors of Benign Laryngeal Lesions Among Teachers

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Prevalence and Risk Factors of Benign Laryngeal Lesions Among Teachers Egyptian Journal of Occupational Medicine, 2021; 44 (1) : 129 - 144 PREVALENCE AND RISK FACTORS OF BENIGN LARYNGEAL LESIONS AMONG TEACHERS By El Dalatony MM1, Gabr HM1, Hafez TA2 and Abd-Ellatif EE3 1Department of Public Health and Community Medicine, 2Department of ENT, Faculty of Medicine, Menoufia University, 3Department of Public Health and Community Medicine, Faculty of Medicine, Mansoura University, Egypt. Corresponding author: El Dalatony MM Email: [email protected] Abstract Introduction: Subjects using their voice as the main professional instrument often develop vocal disorders. Teachers present a high prevalence of vocal problems in comparison to other professional categories depending on their voice as professional tool; voice changes could be assigned to the interaction between occupational (vocal loading), behavioral and lifestyle factors. Voice disorders due to professional overuse are usually chronic and can lead to an increase in sick absenteeism. Aim of work: To determine the prevalence of abnormal laryngeal findings among public-school teachers in Menoufia Governorate, Egypt using strobovideolaryngoscopy. Materials and methods: A case-control nested into a cross-sectional study was held from March 1st to May 1st, 2019. The sample is composed of four hundred and fifty-seven (457) teachers of public schools in Menoufia Governorate, Egypt.Results: The prevalence of vocal lesions among the studied group was 22.1% with (17.79-26.41) 95% confidence interval. On stroboscopic evaluation, vocal nodules were the most common structural lesion affecting the larynx; it was present in 42 (9.1%) of teachers. Other structural abnormalities included the presence of swollen arytenoids, vocal cords paresis, vocal polyps, vocal cord cyst, and epiglottic mass in a percentage of (5.9, 3.7, 1.7, 1.1, 0.4) respectively. There was higher prevalence of vocal cord lesions among older teachers with increase duration of employment/years, number of classes /days, smokers and teachers of primary school; although it didn’t show statistically significant difference. A significant relationship was reported between laryngoscopic findings and 129 130 El Dalatony MM et al. laryngopharyngeal reflux (15.1% vs 28.7% with 0.002 p-value) and water intake/day (t = 2.41, df = 2, p =.047). Conclusion: Results of the current work highlighted the need for large-scale regular educational programs to minimize vocal cord lesions among teachers. Keywords: Teachers, Vocal cord, Voice, Laryngoscopy and Videostroboscopy Introduction and social wellbeing (Luce et al, 2014). Excessive use of voice at work may Such effects could cause lower work result in voice disorders (Williams, achievement than expected, increase 2003). The American Speech- absence and might oblige teachers Language-Hearing Association (ASHA) to stop working because of vocal outlined voice disorders as abnormal problems (Kooijman et al., 2007 and vocal quality, loudness, resonance, Luce et al., 2014). Economic impact of pitch and duration of daily voice use vocal pathology among teachers is big that exceeds 40 hours/week that might such as, lost wages, lost days of work be inappropriate for an individual’s age (sickness absenteeism), and the cost of and sex (ASHA, 1993). hiring substitute teachers. The social impact of vocal lesions among United Teachers, are at high risk for voice States’ teachers nearly about $2.5 problems. Several studies have targeted billion yearly, taking into consideration teachers and discovered that frequency the sick absence days and treatment of vocal dysfunction considerably more costs (Rosow et al., 2016) evident among teachers (11% - 81.0%) Several studies have stressed on in comparison with non-teachers group occupational risk factors to vocal cords. (1.0% - 36.1%) (Alrahim et al., 2018). Duration of work are well known Vocal loading was defined as “a risk factors due to the voice overuse combination of the duration of voice use (Thibeault et al., 2004 and Moy et al, and environmental factors”, teachers 2015). The number of students within are compelled to use loud voice without the school class conjointly showed to amplification for many hours every day be important, since teaching a larger (Luce et al, 2014). Problems of voice group needs extra vocal effort (Irwig have unfavorable effects on the teacher’s et al, 2017). Ample noise levels and performance and communication ability schoolrooms with unhealthy phonics that could impair the daily activities aide compel teachers to talk more Benign Laryngeal Lesions among Teachers 131 loudly, that raises the risk. Different vocal fold finding (Sataloff et al., 2012). unsuitable working conditions, as The current study focuses on the dry air, temperature changes, dust assorted factors that would contribute and smoke might irritate the mucous to dysphonia among teachers and membranes and influence voice detects the frequency of abnormal (Verdolini and Ramig, 2001). Psycho findings of the larynx throughout emotional related factors and stress strobovideolaryngoscopy of school are apparently associated with vocal teachers. disorders (Alrahim et al., 2018). Emotions could negatively affect voice production, in sensitive persons. High- Aim of work stress levels could change the phonation To determine the prevalence of pattern due to the increased voice load abnormal laryngeal findings among (Nerriere et al., 2009). public-school teachers in Menoufia Strobovideo-laryngoscopy and Governorate, Egypt using strobovideo- objective voice measurements are laryngoscopy. important for diagnosis and treatment Materials and methods of patients suffering from vocal problems. Strobovideo-laryngoscopy Study design: A case-control nested assorts worthy information related to within the cross-sectional study. anatomy and performance of the vocal Place and duration of the study: folds, as supraglottic and subglottic Representative public schools, components. The slow-motion analysis preparatory, intermediate, secondary of the mucosal layer of the front of and technical, in Menoufia governorate, the vocal folds assists to observe Egypt; during the duration from March asymmetrical vibration, structural 1st to May 1st, 2019. changes, tiny masses, submucosal scars and different abnormalities which can’t Study sample: be observed beneath ordinary light. A total of four hundred and fifty- Moreover, there is a need for skilled seven (457) teachers of public schools explanation of findings. Some persons within the Menoufia governorate, Egypt with no complaints have an abnormal were enrolled in the study. 132 El Dalatony MM et al. A stratified random sample technique Phase I: A self-designed well was chosen to get an appropriate sample reviewed questionnaire was written size. A frame of all schools obtained into clear Arabic language was from the board directors of Education fulfilled during personal interview. The in Menoufia Governorate. Schools were interviewer started with full explanation classified into primary, preparatory, of the aim of this study and warranted the secondary and technical. One school confidentiality of personal information was selected randomly as a presentative of the participants. The questionnaire to each section. All teachers working in included different sections: the enrolled schools were involved with sociodemographic characteristics (sex a total number of 636 teachers. and age), occupational history (duration Exclusion criteria like (work of working/years, number of classes/ experience less than one-year, previous day, teaching hours/day), and health- throat and chest surgeries, endotracheal related habits (smoking, water intake, intubation, repeated infection of the types of food taken). upper respiratory tract, allergy of the Phase II: All enrolled teachers were nasal mucosa, deviation of the nasal subjected to indirect laryngoscopy septum, hormonal disturbances and examination and videostroboscopic gastrointestinal reflux disease) were evaluation. Topical anesthesia (10mg/ applied. Inclusion criteria including dose spray, Lidocaine 10% and Astra being a teacher for a duration more than Zeneca AB) was applied before every one year, free from any of the above- procedure. Laryngeal morphology mentioned exclusion criteria and who was examined in a normal white light agreed to participate in the study. source followed by examination using Four hundred and fifty-seven 70-degree rigid laryngoscope (Shenda, participants were competent for sharing China) linked to locally-fabricated representing 71.86% of the total number video camera system (Muracam of teachers. Endoscopic Camera System, Quezon City, Philippines).Vocal function was Study methods: assessed using a stroboscope while the The study was conducted in two patient’s pronunciation of the vowel phases: (i) and the frequency was assessed in Benign Laryngeal Lesions among Teachers 133 addition to evaluating the vocal folds. were elaborated. Possible risks that The examiner reviewed the recorded would be raised from this research were videos separately from the participant discussed clearly. The required official profiles approvals were obtained before starting Consent work. A clear and informed consent form Data management was taken from the participants before Data were analyzed and processed collecting any information. To assure using SPSS (statistical package of anonymity, participant’s names weren’t social sciences version 23) (SPSS Inc., collected and merely the patient’s ID. Chicago, IL, USA). Proper statistical To maintain confidentiality,
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