Vocal Abuse and Vocal Hygiene

Practices Among Different Level

Professional Voice Users
in India: A Survey

Prakash Boominathan

Anitha Rajendran

Roopa Nagarajan

Jayashree Seethapathy

Muthukumaran Gnanasekar
Department of Speech, Language and Hearing Sciences,
Sri Ramachandra University
Chennai, India

Vocal hygiene is a primary aspect of concern for professional voice us-

ers. This study aimed to describe vocal abuse and vocal hygiene practices
among different levels of professional voice users in India. A questionnaire
regarding vocal abuse and vocal hygiene practices was administered to
400 voice professionals (singers, teachers, politicians, and vendors). The
results revealed politicians and vendors had the highest point prevalence
and frequency of voice problems. Politicians had highest prevalence of
abusive non-vocal habits. About 84.3% of voice professionals considered

Asia Pacifi Journal of Speech, Language, and Hearing

Volume 11, Number 1, pp. 47–53 47
Copyright © 2008 Plural Publishing, Inc.
48 ASIA PACIFIC JOURNAL OF SPEECH, LANGUAGE, AND HEARING, VOL. 11, NO. 1 VOCAL ABUSE AND VOCAL HYGIENE PRACTICES AMONG DIFFERENT LEVEL USERS 49

that abusive (nonvocal) habits had a negative influence on voice. All sub- lawyers. They can perform their jobs with Procedure
jects indulged in throat clearing, loud speaking/singing for long durations slight or moderate voice problems; only se-
(abusive vocal habits). An equal number of subjects reported that they vere dysphonia endangers adequate job per- A questionnaire was developed to col-
would resort to home remedies or not seek any help. Both ancient tradi- formance. Level IV was the nonvocal non- lect information on the vocal hygiene prac-
tional practices (consuming milk with pepper or turmeric) and empirical- professionals which included laborers and tices in the above mentioned vocal profes-
ly proven methods are practiced among these different voice profession- clerk. The non-vocal nonprofessional is not sionals (see Appendix). It was explained to
als in India to prevent voice problems. Lack of awareness to treat the voice impeded from doing his or her work when the subjects so they would provide appro-
problems earlier was high among vendors and politicians. The findings they experience any kind of dysphonia. priate responses to the questions addressed.
from the study would enable speech and voice pathologists to plan strate- Vilkman (2000) reported that kindergarten The questionnaire consisted of a few forced
gically to prevent voice problems and reach these voice professionals. teachers and teachers who work under high choice questions (Yes/No) and open-ended
background noises are classified under lev- questions. The answers from the question-
Key Words: vocal hygiene, professional voice users, abusive vocal habits, abusive
el II as well. naire were tabulated and described. Infer-
non-vocal habits
It is imperative for these professionals ential statistics was applied to understand
to possess certain qualities in their voice associations between the practices and pro-
and lifestyle that will ensure them success fessional levels.
in their profession and prolonged usage of
their voice. To attain this, it is essential for
Introduction nathan and Shruthi (2005) profiled the vocal them to be aware of vocal hygiene and its in- Results and Discussion
and nonvocal habits in Carnatic, light mu- fluence on maintaining healthy voice. How-
sic singers and indicated several poor vocal ever, to develop a vocal hygiene program
Voice professionals are more prone to tailored to the needs of the different levels
Prevalence of Voice Problems
hygiene habits among trained Carnatic and
laryngeal pathologies than the general pop- light music singers in India. Boominathan, of vocal users, detailed description of their
ulation due to their nature of work and life- Sivapriya, and Gomathy, (2005) studied the practices are required. Hence, the present Eighty-six percent of politicians and
style (Stemple, Glaze, & Gerdeman, 1995). awareness of vocal hygiene among 32 radio study aimed to determine the vocal hygiene 74% of vendors had the highest point prev-
The remarkable incidence of voice disorders professionals in India and found that more practices among the elite vocal performers- alence of voice problems; 59% of singers
in these professionals might be associated than 50% of radio professionals in this study and 49% of teachers reported to have voice
singers (level I), the professional voice users
with inappropriate use of voice and poor showed limited awareness of vocal hygiene problems. It is likely that singers and teach-
- politicians (level II), and the non-vocal pro-
vocal hygiene. Hence, occupational voice especially concerning vocal habits. Lifetime ers have some training (sensitized regarding
fessionals- teachers and vendors (level III).
health is becoming more important as more vocal effort, incorrect technique of phona- voice use and projection through tradition-
people rely on their voices for their work. tion, and psychological predisposition seem al methods emphasizing posture and breath
Among all voice professionals, teachers are to constitute major risk factors for develop- management) to use their voices, whereas
more likely to develop voice problems and ing occupational voice disorders in many of Method the other two groups have no training (for-
report high rates of specific voice symp- these vocal professionals. mal/informal). Second, politicians and ven-
toms and symptoms of physical discomfort Vocal hygiene practices may be dif- dors tend to work/speak in more adverse
during voicing (Smith, Gray, Dove, Kirch- ferent in the various levels of professional Participants conditions and more aggressively relative to
ner, & Heras, 1997). Roy, Merrill, Thibeault, singers and teachers.
voice users. Koufmann and Isaacson (1991)
Parsa, Gray, and Smith (2004) reported the 400 subjects in the age range of 25 to 45
evolved a classification of vocal profession-
prevalence of voice problems to be greater years participated in the study. They includ-
als based on their voice use and risk. The
in teachers than in the general population. ed 100 singers (54 males and 46 females) Frequency and Duration
Sliwinska-Kowalska et al. (2006) found that elite vocal performers (level I) included so-
phisticated voice users like the singers and who were professional stage performers/ of Voice Problem
prevalence of self-reported symptoms and
actors, where even a slight vocal difficulty singing students; 100 politicians (100 males)
clinical signs of voice disorders are around
can cause serious consequences to them who were supporters and party men who Forty-eight percent of the politicians
2 to 3 times more frequent in Polish female
teachers than in non-teachers. and their careers. Level II included the pro- worked for any political party (including and 44% of the vendors reported to have fre-
Timmermans, De Bodt, Wuyts, and Van fessional voice users for whom even moder- people who spoke in public meetings, peo- quent episodes of voice problems (frequen-
de Heyning (2003) demonstrated the neces- ate vocal difficulty would prevent adequate ple who volunteered for social work that in- cy of less than a week). Singers and teachers
sity of vocal hygiene education programs in job performance; clergymen, lecturers/ volved a lot of speaking organized by the po- experienced voice problems less frequently
radio professionals as they seemed to under- teachers, politicians, public speakers and litical party); 100 teachers (24 males and 76 which could be attributed to their training.
estimate the negative implications of bad telephone operators would classify in this females) of high school and higher second- However, 37% of singers and 47% of teach-
vocal hygiene. Boominathan, Nagarajan, level of voice users. In level III, the non- ary level; and 100 vendors (72 males and 28 ers reported that they had long-lasting voice
Sharadha, and Sharanya (2004) and Boomi- vocal professionals included teachers and females) who were hawkers. problems (duration of more than a week).
50 ASIA PACIFIC JOURNAL OF SPEECH, LANGUAGE, AND HEARING, VOL. 11, NO. 1 VOCAL ABUSE AND VOCAL HYGIENE PRACTICES AMONG DIFFERENT LEVEL USERS 51

Indicators (as reported)
of a Voice Problem
The common problems indicated by dif-
ferent voice professionals are sore throat,
throat irritation, throat pain, change in voice,
complete loss of voice and vocal fatigue.
Specifically, singers reported difficulty in
singing, whereas politicians and vendors in-
dicated inability to increase the loudness of
voice. Teachers did not indicate any specif-
ic factor. This highlights the need to address
these issues in the vocal hygiene program.
Reported Reasons Attributed
to These Voice Problems
The change in weather and the common
cold were quoted by subjects as reasons for
their voice problem. Interestingly, none
thought their vocal habits and their poor hy- All Subjects Indulged in Throat within a week of onset of problem. Even
giene practices could be a reason for their Clearing, Loud Speaking/Singing a group of singers, who are assumed to be
problem. However, politicians and vendors for Long Durations trained and sensitized to recognize voice
did not seem to bother to explore cause for problems, were not particularly motivated
Duration of Wait to Consult
their voice problem. to seek early consultation. This shows a des-
Someone for Their Voice Problem
perate lack of awareness to prevent/treat
Table 2 indicates that less than 50% (sta- the problem conservatively before greater
Prevalent Abusive Nonvocal tistically significant) of subjects sought help damage occurs.
Habits and the Perception of
Their Influence on Voice
Table 2. Duration of Wait to Consult Someone for a Voice Problem
Table 1 revealed that politicians had the
Chi-
highest percentage of abusive non-vocal hab-
square
its when compared to other subjects, 84.3% Duration of wait Singer Politician Teacher Vendor value p-value
(statistically significant) of subjects consid-
ered the above habits to have a negative influ- More than a week/ 70% 57% 46% 62% 12.49 0.005
ence on voice. However, they were unaware will not consult
of the ill effects of these abusive nonvocal
Less than a week 30% 43% 54% 38% 12.49 0.005
habits on vocal mechanism and therefore
continued these habits despite their delete-
rious effects. Table 3. Common Practices to Prevent Voice Problems

Chi-
square
Item Singer Politician Teacher Vendor value p- value
Table 1. Common Abusive Non-vocal Habits Prevalent in Voice Users
Empirically
Chi-
proven
square methods:
Item Singer Politician Teacher Vendor value p-value
Drink warm 21% 20% 20% 26% 1.45 0.6928
water
Consumption of 64% 85% 44% 76% 169.057 0.000
tea and coffee Voice rest 22% 17% 30% 09% 14.84 0.0019
(more than 3–4
Speak softly 10% 08% 02% 04% 7.09 0.069
cups of 100 ml
each/day) Steam 07% 12% 01% 03% 13.06 0.0045
inhalation
Consuming 26% 75% 10% 57% 98.259 0.000
alcohol Traditional
practices:
Smoking (more 9% 59% 8% 30% 73.521 0.000
than a pack of Consume milk/ 37% 21% 16% 16% 17.03 0.000
cigarette/beedi) pepper/ginger/
turmeric
Tobacco chewing 9% 36% 8% 30% 60.058 0.000
(Beetle pan, pan Take honey, 16% 19% 19% 04% 12.34 0.006
paraag, etc.) adimathuram
(herbal
Preference for 53% 67% 22% 45% 101.49 0.000
medicine)
carbonated soft
drinks (at least one Salt water 02% 16% 15% 05% 17.33 0.000
300-ml bottle a day) gargling
52 ASIA PACIFIC JOURNAL OF SPEECH, LANGUAGE, AND HEARING, VOL. 11, NO. 1
Common Practices to
Prevent Voice Problems
The subjects across all categories in-
dulged in both empirically proven meth-
ods and ancient practices as revealed in Ta-
ble 3. This highlights the need to educate
the right practice required to prevent voice
problems.
Conclusion
These findings should enable the speech/
voice pathologists or the voice care team to
plan strategically to reach these groups to
prevent voice problems and maintain vocal
health. A voice specialist while tailoring a
program should also consider the sociocul-
tural, economic, and religious background
of people involved, so that the program be-
comes more centered to client needs.
Address Correspondence to: Prakash
Boominathan, Dept. of Speech Language
and Hearing Sciences, Sri Ramachandra
University, Chennai, India 600116.
Telephone: 91-44-24765512-14 Ext:
8980/320; Fax: 91-44-24767008;
E-mail:praxb77@yahoo.com
References
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Sharanya, K. (2004). A profile of vocal and
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ITC Sangeet Research Academy, 18, 77–88.
VOCAL ABUSE AND VOCAL HYGIENE PRACTICES AMONG DIFFERENT LEVEL USERS 53
Boominathan, P., & Shruthi, R. (2005). A profile Appendix
of vocal and non-vocal habits of Indian light
music singers. Journal of ITC Sangeet Re-
search Academy, 19, 1–12. Questionnaire
Boominathan, P., Sivapriya, S., & Gomathi, K.
(2005). Awareness of vocal hygiene in ra- The information that you provided will aid in planning strategies to prevent voice problems.
dio professionals. Presented in ISHA-CON 38, This information will be kept confidential. We appreciate your time and interest in contrib-
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population. Journal of Speech, Language and
Address: _____________________________________________________________________
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