Vocal Tract Discomfort Scale (VTDS) and Voice Symptom Scale (VoiSS) in the Early Identification of Italian Teachers with Voice Disorders

THIEME Original Research Vocal Tract Discomfort Scale (VTDS) and Voice Symptom Scale (VoiSS) in the Early Identification of Italian Teachers with Voice Disorders Bruno Galletti1 Federico Sireci1,2 Roberta Mollica1 Elisabetta Iacona3 Francesco Freni1 4 Francesco Martines Enrique Perellò Scherdel5 Rocco Bruno1 Patrizia Longo1 Francesco Galletti1 1 Department of Adult and Development Age Human Pathology “Gaetano Barresi,” unit of otorhinolaryngology, University of Messina, Messina, Italy 2 Section of ENT, ARNAS Fatebenefratelli Hospital, Palermo Italy 3 Section of Audiology, Fondazione IRCCS Ca’Granda Ospedale Maggiore Policlinico, Milan, Italy 4 Department Bio.Ne.C., Section of ENT, University of Palermo, Palermo Italy 5 Servicio de Otorrinolaringologia, Hospital General Universitari vall D’Hebron Universitat Autonoma de Barcelona, Catalunya, Spain Address for correspondence Federico Sireci, MD, Department of Adult and Development Age Human Pathology “Gaetano Barresi,” unit of Otorhinolaryngology, University of Messina, Via Consolare Valeria 1, 98125, Messina ME, Italy (e-mail: ). Int Arch Otorhinolaryngol 2020;24(3):323–329. Abstract Keywords ► voice disorders ► VoiSS ► VTDS ► teachers received February 15, 2019 accepted September 17, 2019 published online December 13, 2019 Introduction The current Italian law does not include any guidance regarding voice education, prevention of voice disorders and screening in subjects with high vocal loading such as teachers. Objectives We aimed to check the correlation between the Vocal Tract Discomfort Scale (VTDS) with the Voice Symptom Scale (VoiSS) for the evaluation of Italian teachers. In addition, we aimed to investigate whether there are differences in the frequency and intensity of discomfort symptoms in teachers with disabilities comparing vocal tract discomfort symptoms in teachers with high risk (HRVD) and low risk (LRVD) of vocal disorders according to the VoiSS cutoff (> 15.5). Methods We analyzed 160 Italian teachers (111 women and 49 men) that completed the VTDS and VoiSS at vocal evaluation. The Spearman correlation test was applied to all variables. The Mann-Whitney U test was used to compare the average number of discomfort symptoms among HRVD and LRVD teachers. Results A moderate positive correlation was observed between the average number, frequency, and intensity of discomfort symptom and the total score, physical domain score, and limitation domain score of the VoiSS. Only the emotional domain score of the VoiSS showed a weak positive correlation (p < 0.001). Teachers considered in the HRVD group according to the VoiSS score had a higher number, frequency, and intensity of vocal tract discomfort symptoms. Conclusion There is correlation between the VTDS and VoiSS scales. Like the VoiSS, the VTDS is a questionnaire that detects HRVD teachers. Therefore, the results suggest that both questionnaires could be useful for a preventive voice program for Italian teachers DOI https://doi.org/ 10.1055/s-0039-1700586. ISSN 1809-9777. Copyright © 2020 by Thieme Revinter Publicações Ltda, Rio de Janeiro, Brazil 323 324 Vocal Tract Discomfort Scale (VTDS) and Voice Symptom Scale (VoiSS) Introduction The voice represents an instrument for professionals that conduct activities involved in communication, information, art, culture, education and politics. To achieve effectively their communicative results, vocal professionals are exposed to vocal effort, making them susceptible to the development of vocal pathologies.1 Voice disorders in vocal professionals (occupational dysphonia) are part of dysfunctional dysphonia, caused by an incorrect production of the vocal signal (Malmenage) or an excessively prolonged use of the voice (Surmenage).2 Teachers showed the highest risk to develop voice disorders: they are subject to prolonged vocal effort, often in a work environment characterized by a high background noise and unfavorable acoustic conditions.3 Furthermore they may have inadequate postures, usually do not know the vocal hygiene standards and can deal with anxiety and stress situations.1 Studies reveal that 20% of teachers are subject to prolonged vocal effort. The prevalence of dysphonia is higher in teachers (11%) than in other professional categories (6.2%),4 the prevalence for teachers at a single point in time ranged from 9 to 37%,5 the lifetime prevalence of voice disorders (teachers affected by dysphonia at some point in their lifetime) ranged from 50 to 80%.5,6 Vocal disorders can impact differently according to the profession: for vocal professionals, such as singers, actors, radio and TV hosts, teachers, lawyers, dysphonia has a higher effect on quality of life. In fact they are often the cause of social isolation and absence from work due to illness and patients underestimate the problem without wishing to undergo phonic examination with a fiber optic laryngoscope. Through self-assessment tools, it is possible to know the sensations of the patient due to the vocal disorder, the awareness of dysphonia, and the impact of dysphonia on quality of life.7,8 The Vocal Tract Discomfort Scale (VTDS) is a self-assessed questionnaire for the subjective evaluation of voice disorders, proposed by Mathieson in 1993, commonly used in Great Britain.9 It measures the perception of discomfort in the vocal tract using eight qualitative descriptors according to the frequency and intensity of symptoms on a numerical scale from 0 to 6.10 The subject attributes a score that best represents the frequency and intensity of each symptom: burning in the throat, throat tightness, dry throat, sore throat, itchy throat, sensitive throat, throat irritation and lump in the throat. Therefore, the questionnaire contains all of the symptoms that the vocal professionals underestimate and that are represented in cases of vocal disorders. The Voice Symptom Scale (VoiSS) is a multidimensional questionnaire, divided into three scales (physical symptoms, vocal impairment, emotional impact), which investigates the frequency of occurrence of communication difficulties, vocal symptoms, stress and emotional impact of the voice disorder on the life of the patients1,7. The subject indicates the frequency with which he or she is affected by vocal symptoms.7 This questionnaire is already validated and used in Italy. International Archives of Otorhinolaryngology Vol. 24 No. 3/2020 Galletti et al. So far, in Italy, the VoiSS and VTDS are questionnaires diffused among the professional categories at risk for voice disorders, but there are few data in the literature especially for teachers. Amaral et al1 divided teachers according to the cutoff value of VoiSS into two groups: Vocally Healthy Group and Vocal Risk Group. The latter presented a worse VTDS score after the teaching activity. The VTDS is a short and rapid questionnaire, which could allow the early identification of voice disorder in teachers and could improve the compliance of teachers wit (...truncated)