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DOI: 10.1055/s-0044-1801361
Assessing Phonatory Efficiency in Kosovar Pre-primary and Primary School Teachers: Gender and Lifestyle Factors

Abstract
Pre-primary and primary school teachers rely heavily on their voices for communication. This study investigates phonatory efficiency differences among these teachers in Kosovo, focusing on gender-based differences and the impact of lifestyle behaviors. We recruited 100 teachers from pre-primary and primary levels in four municipalities. Data collection included maximum phonation measurements for the phonemes /a/, /s/, and /z/; the s/z ratio; sociodemographic data; and a self-reported questionnaire on lifestyle behaviors. Significant differences in phonatory efficiency were found, with pre-primary teachers showing reduced efficiency. Surprisingly, the mean s/z ratio was higher for primary teachers, though the results were not significant. Among primary teachers, females exhibited lower vocal efficiency than males. Correlation analysis revealed significant associations between maximum phonation time and lifestyle behaviors, including age, smoking, and loud cheering. Multiple regression analysis indicated that smoking and age significantly affected vocal efficiency. Gender also contributed to variance in vocal function, with females generally showing lower efficiency. Alcohol consumption had a marginally negative effect on vocal efficiency. This study provides insights into phonation differences among educators, marking a pioneering effort in the Southeast Balkan region, and underscores the need for policies and interventions to enhance vocal well-being.
Data Availability Statement
The dataset used in the current study can be made available from the corresponding author upon reasonable request.
Declaration of Generative AI and AI-Assisted Technologies in the Writing Process
During the preparation of this work, the author(s) used Chat GPT-3.5 solely for the purpose of enhancing language quality. After using this tool/service, the authors reviewed and edited the content as needed and took full responsibility for the content of the publication.
Publikationsverlauf
Artikel online veröffentlicht:
06. Februar 2025
© 2025. Thieme. All rights reserved.
Thieme Medical Publishers, Inc.
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References
- Andrews, M. L. Manual de tratamento da voz: da pediatria à geriatria. São Paulo: Cengage Learning; 2009
- Angelillo, M., Di Maio, G., Costa, G., Angelillo, N., & Barillari, U. (2009). Prevalence of occupational voice disorders in teachers. Journal of Preventive Medicine and Hygiene, 50, 26–32.
- Azar, A., & Chhetri, D. K. (2022). Vocal fold dynamics and muscle coordination in voice production: Implications for vocal health. The Laryngoscope. Advanced online publication . Doi: 10.1002/lary.29944
- Bainbridge, K. E., Roy, N., Losonczy, K. G., Hoffman, H. J., & Cohen, S. M. (2017). Voice disorders and associated risk markers among young adults in the United States. The Laryngoscope, 127(9), 2093–2099
- Behlau, M. Voz: O livro do especialista. vol.1, Rio de Janeiro: Revinter; 2008
- Behlau, M., & Oliveira, G. (2009). Vocal hygiene for the voice professional. Current Opinion in Otolaryngology & Head & Neck Surgery, 17(3), 149–154.
- Boon, A. J., Harper, C. J., Ghahfarokhi, L. S., Strommen, J. A., Watson, J. C., & Sorenson, E. J. (2013). Two-dimensional ultrasound imaging of the diaphragm: quantitative values in normal subjects. Muscle & Nerve, 47(6), 884–889
- Boone, D. The Voice and Voice Therapy. 2nd ed Englewood Cliffs, NJ: Prentice-Hall; 1977
- Butler, A., Lind, V. R., & Van Weelden, K. (2001). Research on the aging voice: strategies and techniques for healthy choral singing. The Phenomenon of Singing, 3, 42–50.
- Byeon, H., & Cha, S. (2020). Evaluating the effects of smoking on the voice and subjective voice problems using a meta-analysis approach. Scientific Reports, 10(1), 4720. Advance online publication. Doi: 10.1038/s41598-020-61565-3
- Byeon, H., & Lee, Y. (2013). Laryngeal pathologies in older Korean adults and their association with smoking and alcohol consumption. The Laryngoscope, 123(2), 429–433.
- Calas, M., Verhulst, J., Lecoq, M., Dalleas, B., & Seilhean, M. (1989). La pathologie vocale chez l'enseignant. Revue de Laryngologie - Otologie - Rhinologie, 110, 397–406.
- Cantor Cutiva, L. C., Vogel, I., & Burdorf, A. (2013). Voice disorders in teachers and their associations with work-related factors: a systematic review. Journal of Communication Disorders, 46(2), 143–155
- Chen, S. H., Chiang, S. C., Chung, Y. M., Hsiao, L. C., & Hsiao, T. Y. (2010). Risk factors and effects of voice problems for teachers. Journal of Voice, 24(2), 183–190
- Christmann, M. K., Scherer, T. M., Cielo, C. A., & Hoffmann, C. F. (2013). Maximum phonation time of future professional voice users. Revista CEFAC, 15, 622–630
- Cohen, S. M., Kim, J., Roy, N., Asche, C., & Courey, M. (2012). Prevalence and causes of dysphonia in a large treatment-seeking population. The Laryngoscope, 122, 343–348
- Colton, R. H., & Casper, J. K. Compreendendo os problemas de voz: uma perspectiva fisiológica ao diagnóstico e ao tratamento. Porto Alegre: Artes Médicas; 1996
- Crandell, C. C., Smaldino, J. J., & Kreisman, B. (2004). Classroom acoustic measurements. Seminars in Hearing, 25, 189–200
- de Alvear, R. B., & Martínez-Arquero, G. (2009). Teachers' voice disorders collateral effects. Otorynolaryngologia, 8(3)
- Dejonckere, P. H. (2009). Assessment of Voice and Respiratory Function. Surgery of Larynx and Trachea, 11–26. doi: 10.1007/978-3-540-79136-2_2.
- Dragone, M. L. S., Ferreira, L. P., Giannini, S. P. P., Simões-Zenari, M., Vieira, V. P., & Behlau, M. (2010). Teachers' voice: a review of 15 years of SLP contribution. Revista da Sociedade Brasileira de Fonoaudiologia, 15, 289–296
- Dworkin, J. P., Reidy, P. M., Stachler, R. J.,& Krouse, J.H. (2009). Effects of sequential Dermatophagoides pteronyssinus antigen stimulation on anatomy and physiology of the larynx. Ear, Nose & Throat Journal 88(2), 793–799. Doi: 10.1177/014556130908800210
- Eckel, F. C., & Boone, D. R. (1981). The S/Z ratio as an indicator of laryngeal pathology. The Journal of Speech and Hearing Disorders, 46, 147–149
- Freitas, C. N. J. D., Almeida, A. A., Ferreira, D. A. D. H., Medeiros, C. M. A. D., & Silva, M. F. B. D. L. (2019). The working conditions and schools teachers voice of public and private. Audiology - Communication Research, 24, e2151
- Fritzell, B. (1996). Voice disorders and occupations. Logopedics, Phoniatrics, Vocology, 21, 7–12
- Fu, S., Theodoros, D., & Ward, E. C. (2016). Long-term effects of an intensive voice treatment for vocal fold nodules. International Journal of Speech-Language Pathology, 18, 77–88
- Fuess, V. L. R., & Lorenz, M. C. (2003a). Disfonia em professores do ensino municipal: Prevalencia e fatores de risco. Revista Brasileira de Otorrinolaringologia, 69, 807–812
- Fuess, V. L., & Lorenz, M. C. (2003b). Vocal problems in kindergarten and primary school teachers: Prevalence and risk factors. Revista Brasileira de Otorrinolaringologia, 69(6), 807–812
- Gamboa, J., Jiménez-Jiménez, F. J., Nieto, A., Cobeta, I., Vegas, A., Ortí-Pareja, M., Gasalla, T., Molina, J. A., & García-Albea, E. (1998). Acoustic voice analysis in patients with essential tremor. Journal of Voice, 12, 444–452
- Gelfer, M. P., & Pazera, J. F. (2006). Maximum duration of sustained /s/ and /z/ and the s/z ratio with controlled intensity. Journal of Voice, 20(3), 369–379
- Gilman, M. (2020). Revisiting sustained phonation time of /s/, /z/, and /a/. Journal of Voice, 34(5), 731.e1–731.e7. Doi: 10.1016/j.jvoice.2020.03.012
- Hertegård, S., Gauffin, J., & Karlsson, I. (1992). Physiological correlates of the inverse filtered flow waveform. Journal of Voice, 6, 224–234
- Hillman, R. E., Holmberg, E. B., Perkell, J. S., Walsh, M., & Vaughan, C. (1990). Phonatory function associated with hyperfunctionally related vocal fold lesions. Journal of Voice, 4, 52–63
- Hillman, R. E., Montgomery, W. M., & Seitels, S. M. (1997). Current diagnosis and office practice: use of objective measures of vocal function in the multidisciplinary management of voice disorders. Current Opinion in Otolaryngology & Head & Neck Surgery, 5, 172–175.
- Hillman, R. E., Holmberg, E. B., Perkell, J. S., Walsh, M., & Vaughan, C. (1989). Objective assessment of vocal hyperfunction: an experimental framework and initial results. Journal of Speech and Hearing Research, 32(2), 373–392
- Hirano, M. Clinical Examination of Voice. New York: Springer-Verlag; 1981
- Holmberg, E. B., Doyle, P., Perkell, J. S., Hammarberg, B., & Hillman, R. E. (2003). Aerodynamic and acoustic voice measurements of patients with vocal nodules: variation in baseline and changes across voice therapy. Journal of Voice, 17, 269–282
- Holmberg, E. B., Hillman, R. E., & Perkell, J. S. (1988). Glottal airflow and transglottal air pressure measurements for male and female speakers in soft, normal, and loud voice. The Journal of the Acoustical Society of America, 84, 511–529
- Joshi, A. (2019). A comparison of the s/z ratio to instrumental aerodynamic measures of phonation. Journal of Voice. Advance online publication . Doi: 10.1016/j.jvoice.2019.02.014
- Kaqka, M., & Poposka, A. (2019). Bazat e Logopedisë Klinike (Vol. I). Dukagjini
- Kent, R. D., Kent, J. F., & Rosenbek, J. C. (1987). Maximum performance tests of speech production. The Journal of Speech and Hearing Disorders, 52, 367–387
- Kooijman, P. G., de Jong, F. I., Thomas, G., Huinck, W., Donders, R., Graamans, K., & Schutte, H. K. (2006). Risk factors for voice problems in teachers. Folia Phoniatrica et Logopaedica, 58, 159–174
- Laver, J. D. (1968). Voice quality and indexical information. The British Journal of Disorders of Communication, 3(1), 43–54
- Leão, S. H., Oates, J. M., Purdy, S. C., Scott, D., & Morton, R. P. (2015). Voice problems in New Zealand teachers: a national survey. Journal of Voice, 29, 645.e1–645.e13
- Lenell, C., & Johnson, A. M. (2017). Sexual dimorphism in laryngeal muscle fibers and ultrasonic vocalizations in the adult rat. The Laryngoscope, 127(8), E270–E276
- Linville, S. E. Vocal Aging. San Diego, CA: Singular Thomson Learning, 2001
- Linville, S. E. (2002). Source characteristics of aged voice assessed from long-term average spectra. Journal of Voice, 16(4), 472–479
- Lortie, C. L., Thibeault, M., Guitton, M. J., & Tremblay, P. (2015). Effects of age on the amplitude, frequency and perceived quality of voice. Age (Dordrecht, Netherlands), 37, 117
- Lira Luce, F., Teggi, R., Ramella, B., Biafora, M., Girasoli, L., Calori, G., Borroni, S., Proto, E., & Bussi, M. (2014). Voice disorders in primary school teachers. Acta Otorhinolaryngologica Italica, 34(6), 412–418
- Ma, E. P. M., & Love, A. L. (2010). Electroglottographic evaluation of age and gender effects during sustained phonation and connected speech. Journal of Voice, 24(2), 146–152
- Martins, R. H., Pereira, E. R., Hidalgo, C. B., & Tavares, E. L. (2014). Voice disorders in teachers. A review. Journal of Voice, 28, 716–724
- Maslan, J., Leng, X., Rees, C., Blalock, D., & Butler, S. G. (2011). Maximum phonation time in healthy older adults. Journal of Voice, 25(6), 709–713
- Mattiske, J. A., Oates, J. M., & Greenwood, K. M. (1998). Vocal problems among teachers: a review of prevalence, causes, prevention, and treatment. Journal of Voice, 12(4), 489–499
- MEST. (2016). Kosovo Education Strategic Plan 2017–2021. Pristina. Accessed December 6, 2024 at: https://masht.rksgov.net/uploads/2017/02/20161006-kesp-2017-2021-1.pdf
- Miller, M. K., & Verdolini, K. (1995). Frequency and risk factors for voice problems in teachers of singing and control subjects. Journal of Voice, 9(4), 348–362
- Morris, M. A., Meier, S. K., Griffin, J. M., Branda, M. E., & Phelan, S. M. (2016). Prevalence and etiologies of adult communication disabilities in the United States: results from the 2012 National Health Interview Survey. Disability and Health Journal, 9, 140–144.
- Munier, C., & Kinsella, R. (2008). The prevalence and impact of voice problems in primary school teachers. Occupational Medicine (Oxford, England), 58, 74–76.
- Munier, C., & Farrell, R. (2016). Working conditions and workplace barriers to vocal health in primary school teachers. Journal of Voice, 30(1), 127.e31–127.e41.
- Munier, C., Brockmann-Bauser, M., Laukkanen, A. M., Ilomäki, I., Kankare, E., & Geneid, A. (2020). Relationship between laryngeal signs and symptoms, acoustic measures, and quality of life in Finnish primary and kindergarten school teachers. Journal of Voice, 34(2), 259–271
- Newman, S. R., Butler, J., Hammond, E. H., & Gray, S. D. (2000). Preliminary report on hormone receptors in the human vocal fold. Journal of Voice, 14(1), 72–81.
- Pavlovska, I., B. Taushanova, & Zafirova, B. (2018). Risk for occurrence of laryngeal cancer among current cigarette smokers. Journal of Global Oncology, 4(2), 13s-13s
- Pierce, J. L., Tanner, K., Merrill, R. M., Shnowske, L., & Roy, N. (2021). Acoustic variability in the healthy female voice within and across days: How much and why? Journal of Speech, Language, and Hearing Research: JSLHR, 64(8), 3015–3031.
- Pizolato, R. A., Mialhe, F. L., Cortellazzi, K. L., & Ambrosano, G. M. B, CornacchioniRehder, M. I. B., Pereira, A. C. (2013). Evaluation of risk factors for voice disorders in teachers and vocal acoustic analysis as an instrument of epidemiological assessment. Revista CEFAC, 15, 957–966
- Roy, N., Merrill, R. M., Thibeault, S., Parsa, R. A., Gray, S. D., & Smith, E. M. (2004a). Prevalence of voice disorders in teachers and the general population. Journal of Speech, Language, and Hearing Research: JSLHR, 47, 281–293.
- Roy, N., Merrill, R. M., Thibeault, S., Gray, S. D., & Smith, E. M. (2004b). Voice disorders in teachers and the general population: Effects on work performance, attendance, and future career choices. Journal of Speech, Language, and Hearing Research: JSLHR, 47(3), 542–551
- Roy, N., Weinrich, B., Gray, S. D., Tanner, K., Toledo, S. W., Dove, H., Corbin-Lewis, K., & Stemple, J. C. (2002). Voice amplification versus vocal hygiene instruction for teachers with voice disorders: a treatment outcomes study. Journal of Speech, Language, and Hearing Research: JSLHR, 45(4), 625–638
- Sala, E., Laine, A., Simberg, S., Pentti, J., & Suonpää, J. (2001). The prevalence of voice disorders among day care center teachers compared with nurses: a questionnaire and clinical study. Journal of Voice, 15(3), 413–423
- Sandur, V., Murugesh, M., Banait, V., Rathi, P. M., Bhatia, S. J., Joshi, J. M., & Kate, A. (2014). Prevalence of gastro-esophageal reflux disease in patients with difficult to control asthma and effect of proton pump inhibitor therapy on asthma symptoms, reflux symptoms, pulmonary function and requirement for asthma medications. Journal of Postgraduate Medicine, 60(3), 282–286
- Sereg-Bahar, M., Jansa, R., & Hocevar-Boltezar, I. (2005). Voice disorders and gastroesophageal reflux. Logopedics, Phoniatrics, Vocology, 30(3-4), 120–124
- Simberg, S., Sala, E., Tuomainen, J., & Rönnemaa, A. M. (2009). Vocal symptoms and allergy–a pilot study. Journal of Voice, 23, 136–139
- Simões, M., & Latorre, M. D. R. D. D. O. (2002). Alteração vocal em professores: Uma revisão. Jornal Brasileiro de Fonaudiologia, 3(11), 127–134
- Smith, E., Lemke, J., Taylor, M., Kirchner, H. L., & Hoffman, H. (1998). Frequency of voice problems among teachers and other occupations. Journal of Voice, 12, 480–488
- Soman, B. (1997). The effect of variations in method of elicitation on maximum sustained phoneme duration. Journal of Voice, 11(3), 285–294
- Speyer, R., Bogaardt, H. C., Passos, V. L., Roodenburg, N. P., Zumach, A., Heijnen, M. A., Baijens, L. W., Fleskens, S. J., & Brunings, J. W. (2010). Maximum phonation time: variability and reliability. Journal of Voice, 24(3), 281–284
- Stathopoulos, E. T., & Sapienza, C. M. (1997). Developmental changes in laryngeal and respiratory function with variations in sound pressure level. Journal of Speech, Language, and Hearing Research: JSLHR, 40(3), 595–614
- Tao, Y., Lee, C. T. C., Hu, Y. J., & Liu, Q. (2020). Relevant work factors associated with voice disorders in early childhood teachers: a comparison between kindergarten and elementary school teachers in Yancheng, China. International Journal of Environmental Research and Public Health, 17(9), 3081.
- Tavares, E. L., & Martins, R. H. (2007). Vocal evaluation in teachers with or without symptoms. Journal of Voice, 21(4), 407–414
- Trudeau, M. D., & Forrest, L. A. (1997). The contributions of phonatory volume and transglottal airflow to the s/z ratio. American Journal of Speech-Language Pathology, 6, 65–69
- Tuomi, L., Björkner, E., & Finizia, C. (2014). Voice outcome in patients treated for laryngeal cancer: efficacy of voice rehabilitation. Journal of Voice, 28, 62–68
- Vaca, M., Cobeta, I., Mora, E., & Reyes, P. (2017). Clinical assessment of glottal insufficiency in age-related dysphonia. Journal of Voice, 31, 128.e1–128.e5
- Van der Meer, G., Ferreira, Y., & Loock, J. W. (2010). The S/Z ratio: A simple and reliable clinical method of evaluating laryngeal function in patients after intubation. Journal of Critical Care, 25(3), 489–492
- van Houtte, E., Claeys, S., Wuyts, F., & van Lierde, K. (2012). Voice disorders in teachers: occupational risk factors and psycho-emotional factors. Logopedics, Phoniatrics, Vocology, 37(3), 107–116
- Van Houtte, E., Van Lierde, K., D'Haeseleer, E., & Claeys, S. (2010). The prevalence of laryngeal pathology in a treatment-seeking population with dysphonia. The Laryngoscope, 120(2), 306–312
- Villanueva-Reyes, A. (2011). Voice disorders in the Metropolitan Area of San Juan, Puerto Rico: profiles of occupational groups. Journal of Voice, 25(1), 83–87
- Williams, N. R. (2003). Occupational groups at risk of voice disorders: a review of the literature. Occupational Medicine (Oxford, England), 53, 456–460
- Yang, Y., Wang, J. Q., & Gao, X. (2008). A survey of voice diseases among primary and secondary school teachers in Nanjing City. J. Nanjing Med. Univ., 28, 269–270
- Yiu, E. M. (2002). Impact and prevention of voice problems in the teaching profession: embracing the consumers' view. Journal of voice, 16(2), 215–229
- Zhuge, P., You, H., Wang, H., Zhang, Y., & Du, H. (2016). An analysis of the effects of voice therapy on patients with early vocal fold polyps. Journal of Voice, 30, 698–704