title: Teachers' voice disorders and loss of work ability: a case-control study.
abstract: BACKGROUND
  Teachers constitute a profession with a high occurrence of voice disorders due to the occupation's intense vocal demands and unfavorable work environment.
  
  
  OBJECTIVE
  To identify the association between voice disorders and work ability among teachers from public schools in São Paulo, Brazil.
  
  
  METHODS
  This is a case-control study. The case group comprised teachers with voice disorder complaints, vocal quality deviations in speech pathology evaluations, and vocal fold lesions according to an evaluation by an otorhinolaryngologist. The control group was randomly selected from the same schools as those in the case group. Both groups answered the following questionnaires: sociodemographic, lifestyles, working conditions, work organization, conditions of vocal production-teacher (CVP-T), and Work Ability Index (WAI). The analysis used the chi-square association test and univariate and multivariate regression models.
  
  
  RESULTS
  The analyses of both groups showed comparable populations with no significant differences in the demographic and control variables. The groups differed, as expected, in vocal symptoms. Analyzing associations with the WAI, there was an association between decreased work ability and voice disorder (P < 0.001). This association remained in multivariate analyses where decreased (OR = 9.5, P = 0.001) and moderate (OR = 6.7, P < 0.001) work ability were also associated with voice disorders. Analyzing the ability to work, age, and acoustics; decreased (OR = 12.2, P < 0.001) and moderate (OR = 7.7, P < 0.001) work ability, age 50-65 years (OR = 3.7, P = 0.006) and poor acoustics (OR = 2.7, P = 0.007) were factors associated with voice disorders.
  
  
  CONCLUSIONS
  The occurrence of voice disorders is significantly associated with work ability, which may eventually compromise teachers' ability to continue working.
authors.affiliation: Public Health-Epidemiology at the School of Public Health, University of São Paulo (FSP-USP), São Paulo, Brazil; City Public Health Care System, Brazil; Education and Rehabilitation Division of Communication Disorders (DERDIC-PUC-SP), São Paulo, Brazil. Electronic address: ppgiannini@uol.com.br.
authors.forename: Susana Pimentel Pinto
authors.initials: SP
authors.lastname: Giannini
authors.affiliation: Department of Environmental Health, School of Public Health, University of São Paulo (FSP-USP), São Paulo, Brazil.
authors.forename: Maria do Rosário Dias de Oliveira
authors.initials: Mdo R
authors.lastname: Latorre
authors.affiliation: School of Public Health, Department of Epidemiology, University of São Paulo (FSP-USP), São Paulo, Brazil.
authors.forename: Frida Marina
authors.initials: FM
authors.lastname: Fischer
authors.affiliation: Program in Speech-Language Pathology, Pontifical Catholic University of São Paulo, São Paulo, Brazil.
authors.forename: Ana Carolina de Assis Moura
authors.initials: AC
authors.lastname: Ghirardi
authors.affiliation: Program in Speech-Language Pathology and Audiology, Pontifical Catholic University of Sao Paulo (PUC-SP), São Paulo, Brazil.
authors.forename: Léslie Piccolotto
authors.initials: LP
authors.lastname: Ferreira
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009784:Occupational Diseases / Q000175:diagnosis* / Q000503:physiopathology; D012189:Retrospective Studies; D012574:Schools; D011795:Surveys and Questionnaires; D013663:Teaching; D014832:Voice Disorders / Q000175:diagnosis* / Q000503:physiopathology; D014833:Voice Quality; D014938:Work Capacity Evaluation; D055815:Young Adult
keywords: Occupational health; Teachers; Voice disorders; Work ability index evaluation