NNNS 3443: VOICE DISORDER

INDIVIDUAL ASSIGNMENT TITLE:

The Role of Vocal Hygiene Education in Preventing Voice Disorders in College Students.

LECTURER’S NAME :
Dr. Shoba Sharma

PREPARED BY :
Vinitaa A/P Rajakumar (A181835)
Introduction

An individual may be deemed to be in a state of vocal health when possessing the

capability to effortlessly generate sound to satisfy their personal, social, and professional

obligations (Nallamuthu et al., 2023). A voice disorder can be explained as deviations from

normal of voice quality, pitch and loudness proved unsuitable for an individual’s chronological

age, gender, cultural background and geographical region (Aronson & Bless, 2009; Boone et al.,

2010). Based on self perception, voice disorder would then be defined as whenever the voice

deviates from the normal function and interrupts communication (Pestana et al., 2017).

Professional voice users such as teachers, politicians, vendors, actors and singers are at high risk

of voice disorders as their occupational demands are high (Greve et al., 2019; Nallamuthu et al.,

2023). An interruption in the vocal health inflicts an adverse influence on the vocation of artists

as well as on the financial gains of enterprises. To certain occupations, even the slightest

deviation of vocal quality affects their quality of life related to work as their functionality in

work is affected (Pestana et al., 2017). Teachers are more susceptible in developing voice

disorders compared to other professions given their occupational demand to project their voice

louder and a longer usage throughout the day besides any external factors they may be present

such as poor ventilation, overcrowded classrooms and chalk dusts which may predispose them to

voice disorders. Compared to other 20 different occupations, teachers were found to be the

largest group receiving intervention in voice clinics. The most common organic voice conditions

experienced by teachers were acute laryngitis, vocal nodules, polyps, and edema. The field of

education has garnered the utmost scrutiny and has been the central point of a growing body of

research examining the prevalence and root causes of vocal impairments. (Bolbol et al., 2017;

Greve et al., 2019; Nallamuthu et al., 2023). Singers are another group of professional voice
users with high vocal demand susceptible to voice disorders although there are limited studies

endorsing its prevalence (Pestana et al., 2017).

A study conducted on college students found that the most frequently reported vocal

symptoms among college students were dry mouth, dry throat, and phlegm. The most commonly

cited causes of these symptoms were high respiratory disease, intense voice use, and smoking.

The study also found that hoarseness was associated with heavy use of voice and high respiratory

disease, vocal fatigue with intense voice use, stress, and digestive problems, burning in the throat

with intensive voice use, high respiratory disease, and pollution, and phlegm with smoking, and

upper respiratory and digestive problems. (Guerra et al., 2013). In another study conducted by

Bainbridge et al. (2016), found the voice disorders in young adulthood were associated with

hypertension, tinnitus, and anxiety, indicating the need for increased awareness and evaluation

among individuals with these chronic conditions.

Given the consequences of voice disorders on the quality of life of individuals, it is

crucial to provide vocal education and intervention to prevent and reduce the risk of vocal

trauma and promote vocal health (Nallamuthu et al., 2023). Voice therapy and rehabilitation are

conducted by speech therapists who analyse voice use, teach proper voice support and techniques

to optimise use of voice in individuals. Treatment is conducted by implementing direct and/or

indirect intervention used in either isolation or combination based on the individual’s needs.

(Sataloff, 2017; Nallamuthu et al., 2023) Direct intervention focuses on modifying posture,

respiratory control, articulation, resonance and musculoskeletal function to modify vocal

behaviours and establish healthy voice production (Colton & Casper, 2011; Stemple, 2000;

Sataloff, 2017). Indirect approach on intervention involves Vocal Hygiene Education (VHE).

Vocal hygiene education (VHE) is a method of therapy and prevention that relies on modifying
behaviour to protect and preserve the vocal folds as well as the typical vibratory attributes of the

vocal folds (Vermeulen et al., 2022). An effective VHE regimen usually involves instructing

individuals on the production of their voices and pinpointing and eradicating phonotraumatic

practices. VHE given to individuals involves regarding throat clearing, noisy environment,

screaming, excessive talking, caffeine consumption and adequate rest (Sataloff, 2017; Vermeulen

et al., 2022).

Literature Review

In a study aimed to investigate the effectiveness of vocal hygiene training (VH) and vocal

function exercises (VFE) in reducing vocal symptoms and vocal misuse, and increasing

knowledge of voice care, maximum phonation time, and maximum phonational frequency range

in school teachers, the results showed that both VH and VFE were effective in improving vocal

characteristics and voice knowledge after training. However, the VH group showed greater

improvements than the VFE group suggesting that preventative voice training for teachers is

likely to be effective in reducing voice disorders (Pasa et al., 2007).

In a systematic review conducted by Vermeulen et al. (2022) the study found that vocal

hygiene education programs in combination with direct voice therapy can have positive

outcomes on vocal quality and function in professional voice users. However, the effectiveness

of vocal hygiene education alone was not conclusive. In other words, the study suggests that

vocal hygiene education programs can be beneficial for professional voice users when combined

with direct voice therapy, but more research is needed to determine the effectiveness of vocal

hygiene education alone.

 Vocal performers who attended a vocal hygiene education program showed improvement

in their knowledge about voice production and care, as well as a decrease in at-risk vocal

behaviors. They also exhibited healthier vocal practices, such as improved hydration habits and

decreased caffeine and alcohol intake suggesting vocal hygiene education programs can be

beneficial for vocal performers in improving their vocal health (Pomaville et al., 2020).

Thus far, studies have mainly focused on the voice disorders and effectiveness of VHE

programmes in the occupations that are found largely impacted such as teacher and singers.

However, vocal symptoms are present in different populations independently of age group or

occupation (Guerra et al., 2013). Thus far, studies on the voice problems in college students and

young adults and the benefits of vocal hygiene awareness on them are scarce. Therefore, this

study aims to determine the role of VHE in preventing voice disorders in college students.

Methodology

A quantitative investigation, comprising of both a survey and an experimental study, is to

be conducted. A representative sample of 50 students, hailing from various courses within the

Faculty of Health Science at Universiti Kebangsaan Malaysia (UKM), shall be selected. The

inclusion criteria on the participants are, student studying full-time in UKM, non-smoking, not

received any intervention from professionals involved in intervention of voice disorders prior to

the study. Participants are required to participate fully throughout the study without missing any

sessions. The students are equally divided into a control group and the experimental group that

receives the Vocal Hygiene Education for 4 weeks which are delivered weekly once. The

experimental group will be educated on Vocal Hygiene Education by explaining the anatomy and

physiology of voice production and the healthy and unhealthy vocal habits using visuals to aid
the delivery. Prior to the first session, the participants will be given a questionnaire adapted from

"Assessment of Actors’ Vocal Knowledge" questionnaire by Ghorbani et al. (2019). The

questionnaire will have 5 sections functioning to collect personal details and medical history;

determine students' understanding of the speech-language pathologist's involvement in relation to

the vocal mechanism; assessing students’ knowledge regarding vocal abuse, misuse and

non-abusive behaviours, gauge understanding of students of phonation mechanism and laryngeal

pathology. Participants will be given to fill in the questionnaire again after the end of the 4

weeks. Participants from the experimental group will also be asked on how the knowledge of

vocal hygiene has changed their vocal use.

Expected Outcome

Students in the experimental group have better knowledge about vocal mechanism, vocal

hygiene and role of speech therapist is voice disorders which will be gauged from the

questionnaire. It is expected that students in the experimental group report positive changes in

the vocal behaviours and vocal health after receiving VHE.

Reference:

Bainbridge, K. E., Roy, N., Losonczy, K. G., Hoffman, H. J., & Cohen, S. M. (2016). Voice

disorders and associated risk markers among young adults in the United States. The

Laryngoscope, 127(9), 2093–2099. https://doi.org/10.1002/lary.26465

Bolbol, S. A., Zalat, M. M., Hammam, R. A. M., & Elnakeb, N. L. (2017). Risk factors of

voice disorders and impact of vocal hygiene awareness program among teachers in public

schools in Egypt. Journal of Voice, 31(2). https://doi.org/10.1016/j.jvoice.2016.07.010

Greve, K., Bryn, E. K., & Simberg, S. (2019). Voice disorders and impact of Voice

Handicap in Norwegian student teachers. Journal of Voice, 33(4), 445–452.

https://doi.org/10.1016/j.jvoice.2018.01.019

Guerra, J., Loiola, C., Ghirardi, A., & Ferreira, L. (2013). Relationship between vocal

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Otorhinolaryngology, 16(03), 306–312.

https://doi.org/10.7162/s1809-97772012000300002

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https://doi.org/10.1016/j.jvoice.2017.02.010

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https://doi.org/10.1044/2022_jslhr-22-00097

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vocal hygiene education programs on voice quality in professional voice users: A

systematic review. Journal of Speech, Language, and Hearing Research, 65(12),

4700–4713. https://doi.org/10.1044/2022_jslhr-22-00097