title: Voice problems amongst primary school teachers in Singapore.
abstract: OBJECTIVE
  Teachers are often cited to be at high risk of vocal disturbances. Many studies were performed in the West, but none locoregionally. The aim of this study is to determine the prevalence of voice problems amongst primary school teachers in six schools in Singapore and explore the associated risk factors.
  
  
  METHODS
  A cross-sectional study was conducted across six primary schools and 214 full-time teachers were surveyed. Teachers were asked to report if they have voice problems at the day of the interview, during the past 1 year and throughout their careers. Teachers who reported having current voice problems were invited for videolaryngostroboscopy. Multivariate analyses were performed to analyze risk factors associated with voice problems.
  
  
  RESULTS
  The point prevalence was 13.1% (95% confidence intervals [CI]: 9.3-18.3%). The past year prevalence and career prevalence were 25.4% (95% CI: 20-31.6%) and 32.1% (95% CI: 26.2-38.6%), respectively. Results showed that reflux symptoms (adjusted odds ratio [adj OR]=6.1, CI: 2.5-14.6) and microphone usage (adj OR=5.6, CI: 1.8-17.6) are risk factors for current voice disorders. Allergic rhinitis symptoms (adj OR=2.1, CI: 1.1-4.3), hypothyroid-like symptoms (adj OR=2.6, CI: 1.3-5.1), and microphone use (adj OR=3.4, CI: 1.1-10.0); allergic rhinitis symptoms (adj OR=2.6, CI: 1.4-5.1), reflux symptoms (adj OR=3.1, CI: 1.5-6.5), and the teaching of arts and theater studies (adj OR=2.8, CI: 1.4-5.9) are risk factors for voice problems in past 1 year and throughout the career, respectively.
  
  
  CONCLUSIONS
  The findings confirm that teaching is a high-risk profession for acquiring voice problems. The risk factors uncovered are statistically and clinically significant and biologically plausible. There is a need for educational authorities and healthcare providers to develop effective and comprehensive prevention programs to arrest vocal attrition and its detrimental effects on the quality of teaching.
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, Khoo Teck Puat Hospital, Yishun Central, Singapore, Singapore.
authors.forename: Tze Choong
authors.initials: TC
authors.lastname: Charn
authors.forename: Paul Kan Hwei
authors.initials: PK
authors.lastname: Mok
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D059026:Diagnostic Self Evaluation; D005178:Faculty / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D012307:Risk Factors; D012846:Singapore / Q000453:epidemiology; D014832:Voice Disorders / Q000453:epidemiology*; D055815:Young Adult