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T he prevalence and impact of voice problems in CAll center operators

Article in Journal of Laryngology and Voice · January 2013

DOI: 10.4103/2230-9748.118696

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Usha Devadas Bellur Rajashekhar

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 ORIGINAL ARTICLE

The prevalence and Usha Devadas, B. Rajashekhar

impact of voice problems Department of Speech and Hearing, MCOAHS, Manipal

University, Manipal, Karnataka, India

in call center operators

ABSTRACT

Background: Since the past 10 years, the call center industry has expanded rapidly in India. Effective and
healthy voice is a primary need for these professionals. Voice problems may threaten both the working
ability and occupational health and safety of call center operators (CCOs). Western literature reports higher
prevalence of voice problems in CCOs: Yet such investigations are not reported in India. Hence, the present
study was focused on investigating the prevalence of voice problems among CCOs and its impact on
their working performance. Materials and Methods: A cross sectional survey study was conducted using
self‑reported questionnaires. Data for the present study were obtained through convenient sampling by
distributing 2000 questionnaires in 11 voice‑based call centers in Bengaluru, Karnataka, India. The results
of the study are analyzed and discussed, based on 1093 eligible questionnaires. Results: The career Access this article online
and point prevalence of voice problems in CCOs were observed to be 59% and 27%, respectively, with Website:
no significant gender difference (P > 0.05). The impact of the voice problem in terms of missing work was www.laryngologyandvoice.org
found to be significantly greater in female CCOs as compared with their male counterparts. Conclusions: DOI: 10.4103/2230-9748.118696
This study supports the findings in the literature that CCOs are at greater risk of developing voice problems Quick Response Code:
and that voice problems affect their performance. Thus, there is a great need to identify the risk factors
associated with these voice problems and educate the CCOs and employers/organizations about the
consequences of voice problems for monitoring effective functioning of CCOs.

Key words: Call center operators, impact, prevalence, voice problems

INTRODUCTION Although occupational health and safety issues are evincing

As the service sector continues to grow, more and more
personnel depend on their voices for their livelihood. Call
center operators (CCOs) are among the workers relying
heavily on their voices to carry out their profession. In the
late 1990s, with the rise in the number of call centers across
the world, researchers began to investigate the factors specific
to their working environment that could affect the workers’
health. Studies conducted on a large group of CCOs in Europe
revealed a higher relative risk of developing health‑related
problems, namely, musculoskeletal problems and psychological
distress,[1‑3] and organic voice problems.[4‑6] Studies conducted
in different parts of the world confirmed higher prevalence and
greater impact of voice problems in CCOs.[5‑9]
Address for correspondence:
Dr. Usha Devadas, Department of Speech and Hearing, MCOAHS,
Manipal University, Manipal ‑ 576 104, Karnataka, India.
E‑mail: usha.d@manipal.edu
increasing interest in India, there is still a lack of adequate
research highlighting the prevalence of voice problems in this
sector. A recent study conducted on 21 CCOs, using Voice
Handicap Index and adapted version of vocal self‑perception
attitudinal questionnaire revealed that CCOs’ vocal demands
affected their quality of voice, with no self‑awareness of this
among most of the workers.[10] In another study, Shah and
Sanghi,[11] reported that 40% of the international CCOs and
30% of the domestic CCOs are experiencing voice problems.
However, these studies are quite preliminary due to the small
number of participants.
Aim
The present study was conducted to investigate,
prevalence of voice problems in CCOs, using self‑reported
questionnaires to highlight functional impact on CCOs
performances, thus enhancing self‑awareness both to
identify risk factors and to prevent and reduce voice
problems in these workers.

Journal of Laryngology and Voice | January-June 2013 | Vol 3 | Issue 1 3

 Devadas and Rajashekhar: Voice problems in call center operators
MATERIALS AND METHODS
Participants
This cross sectional survey research was conducted by
contacting human resource (HR) managers at 25 voice‑based
call centers in Bengaluru, a metropolis in southern India,
using a self‑reported questionnaire. The responses were
forthcoming from 11 call centers: They accepted to participate
in the survey once assured of confidentiality. Nonparticipation
by other companies is attributed mainly to non‑grant of
permission from their management, organization and their
company policies. The employees in these 11 companies
ranged from 250 to 3000.
Description of the questionnaire
The self‑reported questionnaire focused on CCOs answers
on demographic data, vocal attrition symptoms, frequency
and severity of the symptoms, and impact of these symptoms
on their emotion, social interaction, job performance and
voice‑related absenteeism, and also if experiencing voice
problems on that same day. The questionnaire data for the
present study was obtained from ‘voice survey’ questionnaire
developed by Jones et al.,[5] to study the prevalence and risk
factors for voice problems in telemarketers with permission
from the primary author. The questionnaire was accompanied
by a covering letter, explaining the broad outline of the
research topic, with assurance of confidentiality to each
participant. The participants were required to sign a consent
form included in the questionnaire for documentation and
future reference purposes. Prior to data collection, the
protocol was presented before the institutional ethical
committee. On its approval, the study was conducted in
accordance with the stipulated guidelines.
Data collection
Two thousand questionnaires were distributed across
11 (7 inbound and 4 outbound) voice‑based call centers. The
questionnaires were handed over to HR managers of these call
centers who distributed the questionnaires to the CCOs. The
number of questionnaires distributed varied according to the
number of employees. That is, the number of questionnaires
distributed was around 100 and 250, respectively, in companies
with less than and more than a thousand employees. The
questionnaires filled from the CCOs were collected by HR
managers and returned to the researcher. Follow up of
non‑responders by HR managers was restricted by their busy
work schedule and inability to contact them individually.
Statistical analysis
SPSS software version 15 (Software Package for Social
Sciences, South Asia, Bangalore) was used for the analysis.
4 Journal of Laryngology and Voice | January-June 2013 | Vol 3 | Issue 1
The prevalence (career and point) of voice problems was
analyzed in terms of percentage. Mean and SD were used to
summarize continuous variables. Pearson’s Chi‑square test
was used to compare the differences in prevalence and impact
of voice problems between two genders.
RESULTS
Response rate
A wholesome response rate of 60.95% was obtained with
returning of 1219 completed questionnaires. The data
were analyzed based on 1093 questionnaires excluding the
126 incomplete questionnaires. This was further categorized
gender‑wise as response rates of 58% (632) and 42% (461)
for males and females, respectively. As literature quotes of
significant gender differences in experiencing voice problems,
the results were discussed gender‑wise.
Demographic and vocational information
The demographic and vocational information of CCOs is
given in Table 1. The gender groups presented no significant
difference in age range and work experience. All of them
were involved exclusively in answering customer calls
(80‑100 calls/shift) during the entire working day/shift with
50% of them serving inbound call centers. The average length
of their working day/shift was 8.7 and 8.5 hours (range: 8‑10
hours.) for male and female CCOs, respectively, including one
30 minutes and two 10 minutes breaks.
Career prevalence of voice problems
For the present study, to measure the career prevalence of
voice problems, the CCOs were asked to indicate whether
they experienced any of the vocal attrition symptoms listed
in the questionnaire, since they began their profession
as a CCO. No symptoms of vocal attrition were reported
throughout their career by 446 (41%) composed of 42%
male and 40% female CCOs. Higher number (n = 647; 59%)
of the CCOs (58% male and 60% female) reported of one or
more symptoms of vocal attrition, since they began their
career as CCOs irrespective of the gender. Even though the
percentage of female CCOs experiencing voice problems was
slightly higher (60%) than their male counterparts (58%), it
was not statistically significant (χ2 = 0.406; P = 0.524). The
prevalence of individual vocal symptoms reported by the
CCOs, gender wise is shown in Table 2.
As depicted in Table 2, among the 14 vocal attrition symptoms
listed, higher percentage of CCOs (both genders) indicated
the symptoms of ‘dry throat’ and ‘frequent need to clear
throat’. Pearson’s Chi‑square test indicated no significant
gender difference in reporting vocal attrition symptoms
except significantly higher number of male CCOs experiencing
 Devadas and Rajashekhar: Voice problems in call center operators

Table 1: Demographic and vocational details of the CCOs

Factor Male (n=632) Female (n=461) Test statistic P value
Average age mean+SD (range) 24.32 SD=3.225 (18-38) 24.08 SD=3.159 (18-37) t=1.22 0.22
Education
Matriculation 4 (1) 0 χ2=18.680 <0.001
Higher Secondary 184 (29) 88 (19)
Graduation 402 (64) 330 (72)
Postgraduation 42 (7) 43 (9)
Period of work experience as CCO
Less than 6 months 154 (24) 83 (18) χ2=8.605 0.071
6 months to 1 year 142 (23) 95 (21)
1-2 years 155 (25) 129 (28)
2-5 years 168 (27) 143 (31)
5-10 years 13 (2) 11 (2)
More than 10 years 0 (0) 0 (0)
Average hours worked per shift (range) 8.67 (8-10) 8.52 (8-10) t=3.71 0.041
Type of calls
Inbound all of the time 255 (40) 189 (41) χ2=9.003 0.061
Inbound most of the times 59 (9) 45 (10)
About half inbound and half outbound 60 (9) 63 (14)
Outbound most of the time 78 (12) 37 (8)
Outbound all of the time 180 (28) 127 (28)
Data are number (percentage) of CCOs unless otherwise specified. Percentages have been calculated based on the number of respondents. Boldface values indicate statistical
significance (P<0.05)

Table 2: The prevalence of individual vocal symptoms reported by the CCOs

Vocal symptoms Prevalence χ2 P value
Male (n=632) Female (n=461)
My voice seems tired and weak when i talk or sing 17 (108) 20 (92) 1.467 0.226
It seems to require extra effort to talk 19 (119) 17 (76) 0.999 0.318
My voice is hoarse and rough 16 (99) 10 (48) 6.318 0.012
My voice breaks or cracks when i talk 16 (101) 13 (59) 2.161 0.142
My throat feels uncomfortable when i talk 12 (74) 11 (50) 0.197 0.657
I constantly feel like i need to clear my throat 31 (194) 25 (117) 3.701 0.054
My throat feels dry 40 (251) 45 (206) 2.707 0.100
My throat feels scratchy 17 (105) 18 (84) 0.482 0.488
I have a burning sensation in my throat 8 (48) 7 (30) 0.476 0.490
I have a feeling of tightness or pressure in my throat 12 (76) 12 (55) 0.002 0.962
I have a choking sensation in my throat 9 (58) 10 (46) 0.199 0.656
I tend to lose my voice at the end of a sentence 17 (108) 19 (86) 0.448 0.503
I tend to lose my voice in the mid‑sentence 8 (51) 9 (40) 0.129 0.720
I frequently lose my voice completely 3 (20) 3 (14) 0.014 0.904
Data are percentages (number) of CCOs unless otherwise specified. Percentages were calculated on the number of respondents. P values were derived from the Chi‑square test.
Boldface values indicate statistical significance (P<0.05)

hoarse voice. However, no significant relationship was found there was no significant difference between reporting the
between age, work experience, education level of the CCOs frequency of vocal attrition symptoms (χ2 = 2.311; P = 0.252)
and career or point prevalence of voice problems. or the severity rating (χ2 = 3.537, P = 0.171) and gender.

Out of the 369 male and 278 female CCOs reporting one or
more symptoms, 92% of male and 93% of female CCOs reported
frequent voice problems, indicating they had occurred for every
2‑3 months or more frequently. The remaining 8% males and
7% of females reported experiencing vocal attrition symptoms
infrequently, indicating that they had occurred once in every 6
or 9 months. Further, when the CCOs were asked to indicate
the severity of these symptoms (very mild, mild, moderate,
severe, very severe), 74% of them (76% of males and 73% of
females) rated it as very mild or mild. The remaining 22% (21%
males and 24% females) rated it as moderate and 3% (4% of
males and 3% of females) as ‘severe’ or ‘very severe’. However,
Point prevalence of the voice problems
The prevalence of the voice problems on the day of survey
was reported by 292 (27%) composed of 161 (25%) male and
131 (28%) female CCOs. The relationship between point
prevalence and gender was non‑significant by Pearson’s
Chi‑square analysis (χ2 = 1.311; P = 0.252). In response to the
question of ‘how severe is the problem with your voice’, 70%
of the CCOs rated their voice problems as of milder degree.
Impact of vocal symptoms
The CCOs were asked to describe whether the vocal attrition
symptoms caused any stress or frustration, affected their

Journal of Laryngology and Voice | January-June 2013 | Vol 3 | Issue 1 5

 Devadas and Rajashekhar: Voice problems in call center operators
productivity, interaction with family or friends, and whether
they missed work.
Feelings about the vocal symptoms
The CCOs were asked to indicate their feelings about voice
problems using the following statements: Does not affect me,
rarely frustrates, occasionally frustrates, often frustrates, major
source of stress, and frustration. It was found that 41% of male
and 37% female CCOs did not get affected by the presence of
vocal symptoms. For 51% of males and 52% of females, the vocal
symptoms affected rarely or occasionally, whereas, 8% of the
male and 12% of the female CCOs felt that the vocal symptoms
was a major source of frustration for them. However, there
was no significant gender difference (χ2 = 6.997, P = 0.136)
in reporting their feeling about the vocal symptoms.
Impact of vocal symptoms on social interaction
Presence of vocal symptoms affected social interaction in only
57 (15%) male and 38 (17%) female CCOs, with no significant
gender difference (χ2 = 0.400; P = 0.527).
Impact of vocal symptoms at work
Presence of vocal symptoms affected job performance
in 288 (45%) of the CCOs and there was a significant
relationship (χ2 = 9.466; P = 0.002) between work being
affected and gender with significantly higher percentage of
female CCOs (51%) reporting of work being affected than their
male counterparts (39%). Those CCOs whose work was affected
due to vocal symptoms, indicated the effect of vocal symptoms
on their work using five statements as shown in Table 3.
As evident from Table 3, more than 50% of the CCOs (male
and female) reported that they need to repeat information
as well as need to force their voice in order to communicate
effectively with their customers. At the same time, taking
breaks away from phone was reported by higher percentage
of male (30%) compared with female (18%) CCOs.
Missing work due to vocal symptoms
One effective way to understand the impact of voice problems
is the number of days off work. This was investigated by
Table 3: Effects of vocal symptoms on the call center work
Effect of voice problem on work
Males (n=145)
I repeat myself because customers can’t understand me
I have to force my voice to be understood
I average fewer calls each hour
I take more breaks away from the phone
I tend to be less enthusiastic about selling the product
Other
Data are number (percentage) of CCOs unless otherwise specified. Percentages were calculated with the number of respondents in each group. P values derived from the
Chi‑square test. Boldface values indicate statistical significance (P<0.05)
6 Journal of Laryngology and Voice | January-June 2013 | Vol 3 | Issue 1
asking them “during your career, how long have you missed
work because of a problem with your voice?” (none, a few
days, about a week, about 2 weeks, about 3 weeks, or
more than 3 weeks). In 45% of the CCOs, presence of vocal
attrition symptoms affected their job performance among
whom only 28% (n = 182) (25% male and 33% female CCOs)
missed work. Among the 182 employees reporting of missing
work, for 22% of males and 26% of females, it was for few
days, while for 2% of males and 6% of females it was for a
week or more. Pearson’s Chi‑square test showed a significant
association (χ2 = 12.770, P = 0.026) between missing work
due to voice problems and gender with significantly higher
percentage of females (33%) reporting of missing work than
their male (25%) counterparts.
Physician/speech language pathologist (SLP) consultation
This was investigated using two questions “since beginning
this type of work, have you ever seen a doctor for problems
with your voice?” and “since beginning this type of work,
have you ever seen a speech therapist for problems with your
voice?” If yes, “how frequently did you visit the physician
or SLP?” (once in 9 months, once in 6 months, once every
2‑3 months, monthly, fortnightly, weekly). Despite 647 CCOs
reporting of experiencing one or more vocal symptoms,
only 85 (13%) consulted the Physician (11% males and 16%
females), while only 18 (3%), visited SLP (4% males and 2%
females), with majority, 562 (87%), reporting of not consulting
either of them. Among the CCOs who visited the Physician,
60 (9%) reported that their work was affected due to the
vocal attrition symptoms and only 12 (2%) sought advice
from SLPs. There was no significant relationship observed
between consulting Physician/SLP and gender ((χ2 = 3.090,
P = 0.079). In spite of 182 CCOs (90 male and 92 female)
missing work ranging from few days to 1 or 2 weeks, very
few of them (10% male and 12% female) sought help from
physicians or SLPs for their problem.
Instructions for voice care
The CCOs who participated in the study were asked whether
they had received any instructions on the care of their voice.
Out of 1093, only 158 (14%), that is, 97 (15%) males and
No. (%) of CCOs χ2 P value
Females (n=143)
86 (59) 93 (65) 1.003 0.317
107 (74) 109 (76) 0.227 0.634
28 (19) 25 (17) 0.160 0.689
44 (30) 26 (18) 5.789 0.016
43 (30) 43 (30) 0.006 0.939
5 2 1.275 0.259
 Devadas and Rajashekhar: Voice problems in call center operators
61 (13%) females reported of receiving some instructions,
while 935 (86%) never got any. Of those who received the
instructions, only 4 (4%) male CCOs received SLPs instructions,
106 (67%) reported of having received instructions from either
the present or the previous employer, 14 (8%) got them from
singing teachers and the remaining 34 (22%) from friends and
family physician. The results indicated higher percentage
of male (15%) CCOs receiving instructions about voice care
as compared with their female counterparts (13%). Among
the 158 CCOs who received instructions about their voice
care, 47 (30%) reported that they did not experience any
vocal symptoms, while the remaining 111 (70%) reported of
one or more symptoms, with majority reporting of multiple
symptoms (n = 87; 55%). When the 935 CCOs who had not
received any instructions on their voice care were asked
whether they would like to receive instructions regarding
their voice care, 668 (71%) (374 males and 294 females)
answered they will, while 267 (29%) (161 males and
106 females) did not show any interest in receiving voice
care instructions.
DISCUSSION
The present study is probably the first to provide data on
prevalence of voice problems in Indian CCOs, based on a
large sample size. The results of the current study support
the findings in the literature that CCOs are at greater risk
of developing voice disorders, irrespective of experiencing
one or more vocal symptoms. The findings also indicate that
these voice problems have or could have adverse effects on
their job performance.
Higher career (59%) and point (27%) prevalence of voice
problems, observed in the present study with non‑significant
gender difference, is consistent with reports of other studies
in the literature.[5‑7,9,12] The consistently higher prevalence
of voice problems in CCOs from different studies proves
that vocal problems are universal among CCOs owing to the
occupational vocal demands. In CCOs, the vocal performance
is not limited to physiological aspects; rather, it includes
occupation demands, coordination of vocal, emotional, and
cognitive settings for interaction with customers. It has been
reported that continuous use of voice for 2 hours is the
maximum allowable time and exceeding that would cause
a person’s vocal tract to be strained and tensed.[6,13] Apart
from this, most of the CCOs were younger (20‑30 years)
with lack of experience and coping skills to deal with vocal
demands and more vulnerable for vocal strain.[14] Thus, in
these professionals, younger age, attending to higher number
of calls (80‑100 calls/shift) with few breaks, excessive stress
and certain ergonomic conditions could lead to permanent
damage of vocal fold mucosa not amenable for day to day
Journal of Laryngology and Voice | January-June 2013 | Vol 3 | Issue 1
recovery enhancing prevalence of voice problems threatening
the effective functioning.[13] In general, women have higher
prevalence of voice problems due to some peculiarities, such
as higher fundamental frequency.[15,16] hormonal influence on
the vocal fold,[17] and lower levels of hyaluronic acid in the
vocal folds.[18] However, this was not reflected for the CCOs in
the present study as both genders reported higher prevalence
of voice problems. Studies in the literature suggest that, the
CCOs need to speak with a voice that is symbolically feminine
with wider pitch range and intonation that are unnatural
and difficult for male CCOs; such subtle paralinguistic vocal
changes could unconsciously affect them as well as their
customer negatively.[19,20] This unnatural speaking style along
with other influencing factors (smoking) would have led to
higher prevalence of vocal symptoms in male CCOs.
The vocal symptoms such as hoarseness, tiring of voice and
extra effort to talk, throat irritation or throat pain during
speech are signs of voice abuse or overuse in inappropriate
working conditions, characterizing an occupational disease.
Generally, these symptoms develop sporadic to permanent
with the appearance of organic lesions (vocal nodules).[21]
Both genders in the present study reported experiencing
multiple symptoms [Table 2]. Among the 14 vocal symptoms,
“dryness of the throat” and the “need to clear the throat”
were the most prevalent in both genders. Higher prevalence
of these symptoms among this group has been reported and
attributed to relatively low ambient humidity in call center
offices.[5,6,22] The greater frequency of occurrence of multiple
vocal symptoms affected their work productivity, as they
needed to repeat the information and to force their voices
to be understood. This indicates that CCOs experienced
vocal fatigue related to heavy vocal loading resulting in
functional voice disturbances and are at greater risk of
developing vocal pathology.[23,24] In contrast, significantly
less percentage of female CCOs reporting of taking breaks
away from phone comparatively, could be due to the fear
to disclose their real problems for job security in spite of
anonymous questionnaires.
The impact of voice problems on an individual does not
depend merely on impairment or disability but on the
handicap degree.[25] This was evident in the present study
where CCOs of both genders reported vocal symptoms with
similar degree of severity and frequency of occurrence, with
female CCOs finding their work being affected significantly
more than males. In contrast, women in general, are more
likely to recognize bodily changes as symptoms of illness
and more concerned with their health than males.[25‑27] It
is felt that this factor among the female CCOs would have
resulted in greater impact on their work performance and
taking more time off from work. Unfortunately, neither
7
 Devadas and Rajashekhar: Voice problems in call center operators
these CCOs nor their employers recognize voice problems
as work‑related risks and CCOs with increasing difficulty in
working due to their voice problems may consider transition
to less vocally demanding jobs. This supports the literature
findings that there is both a low level of knowledge related
to occupational voice problems among professional voice
users and a lack of easily available help to reduce or eliminate
these problems.[25,28,29] This is even more relevant in the
Indian context, where SLPs are less known as voice care
professionals. However, the concern expressed by the CCOs
about their voice care shows that, if made aware of available
services, they will be most motivated to act on their voice.
Hence, the initiative to teach the CCOs that, voice as their
occupational tool and the need for occupational health
safety can be regarded as an important step toward greater
understanding of voice disorders and its prevention.
Hence, the current study projects and reiterates the need
to educate CCOs on early identification and management
of vocal symptoms, as the majority never received any
instructions on voice care. It was also evident that these
professional voice users were highly interested in receiving
voice care education, thus sending a clarion call to the
practicing SLPs on the dire need for periodical assessment
and monitoring to develop specific preventive voice care
techniques for this group to get their best output. In
addition, it is necessary to convince both employers and
organizations about the consequences of voice problems
on the performance with its impact on customer care
productivity and organizational growth.
Though this study included a large sample size, non‑willingness
of some call centers to participate and non‑availability of
exact statistics on CCOs in India restricted the researchers in
obtaining random samples. However, the absolute number of
useful responses obtained (n = 1093) could be considered as
adequate to provide information on self‑experienced voice
problems among the CCOs. It was also felt that a proportion
of these voice problems may be related to health, lifestyle,
personality, and work environment‑related factors not
considered in the present study. Further work is required to
understand the risk factors contributing to voice problems,
which are under progress by the present authors.
REFERENCES
1. Sprigg CA, Smith PR, Jackson PR. Psychological risk factors in call
centres: An evaluation of work design and well‑being. England:
HSE Books; 2003.
2. Norman KW, Toomingas A. Working conditions in a selected
sample of call centre companies in Sweden. Int J Occup Saf
Ergon (JOSE) 2008;14:177‑94.
3. Norman K, Floderus B, Hagman M, Toomingas A, Tornqvist EW.
8 Journal of Laryngology and Voice | January-June 2013 | Vol 3 | Issue 1
Musculoskeletal symptoms in relation to work exposure at call
centre companies in Sweden. Work 2008;30:201‑14.
4. Cadring P. Voice loss hits call center workers. Available from:
http://www.hazards.org/voiceloss/#repetitive/voice/injury [Last
retrieved on 2005 Mar 09].
5. Jones K, Sigmon J, Hock L, Nelson E, Sullivan M, Ogren F.
Prevalence and risk factors for voice problems among
telemarketers. Arch Otolaryngol Head Neck Surg 2002;128:571‑7.
6. Lehto L, Rantala L, Vilkman E, Alku P, Backstrom T. Experiences
of a short vocal training course for call‑centre customer service
advisors. Folia Phoniatr Logop 2003;55:163‑76.
7. Titze I, Lemke J, Montequin D. Populations in the U.S. workforce
who rely on voice as a primary tool of trade: A preliminary report.
J Voice 1997;11:254‑9.
8. Grayson Z. Call center workers at risk. 2001. Available from: http://
www.independent.co.uk [Last retrieved on 2005 Nov 15].
9. Taylor P. The prevalence and nature of voice problems in call
centre operators. Australia: Unpublished Dissertation La Trobe
University 2004.
10. Vannan M, Bharadwaj T, Ravichandran A, Atreyee A. Incidence
of vocal symptoms among call center employees. Paper presented
at the 41st Annual Convention of Indian Speech and Hearing
Association.
11. Shah H, Sanghi M. A study of voice characteristics and reflux
symptom index in professional voice users (Call Centre
Employees). J Indian Speech Hear Assoc 2010;24:39‑47.
12. Oliveira A, Behlau M, Gouveia N. Vocal symptoms in telemarketers:
A random and controlled field Trail. Folia Phoniatr Logop
2009;61:76‑82.
13. Titze I. Toward occupational safety criteria for vocalization. Logop
Phoniatr Vocol 1999;24:49‑50.
14. Tavares E, Martins R. Vocal evaluation in teachers with or without
symptoms. J Voice 2007;21:407‑14.
15. Rantala L, Vilkman E. Relationship between subjective voice
complaints and acoustic parameters in female teacher’s voices.
J Voice 1999;13:484‑95.
16. Vilkman E. Occupation risk factors and voice disorders. Logop
Phoniatr Vocol 2000;52:120‑ 5.
17. Abirol J, Abitol P, Abitol B. Sex hormones and the female voice.
J Voice 1999;13:424‑46.
18. Butler JE, Hamond TH, Gray SD. Gender related differences of
hyaluronic acid distributionin human vocal fold. Laryngoscope
2001;111:907‑11.
19. Cameron D. Styling the worker: Gender and the commodification
of language in the globalized service economy. J Sociolinguistics
2000;4:323‑47.
20. Hultgren AK. Talking like a man in a service job: Language, gender
and stereotypes. Paper presented at the Camling Conference.
University of Cambridge, 2004.
21. Sapir S, Keider A, Mathers‑Schmidt B. Vocal attrition in teachers:
Survey findings. Eur J Disord Commun 1993;28:177‑85.
22. Lehto L, Alku P, Backstrom T, Vilkman E. Voice symptoms of call
centre customer service advisers experienced during a work‑day
and effects of short vocal training course. Logop Phoniatr Vocol
2005;30:14‑27.
23. Sapir S, Attias J, Shahar A. Symptoms of vocal attrition in
women army instructors and new recruits: Results from survey.
Laryngoscope 1990;100:991‑9.
24. Casper J, Murray T. Voice therapy methods in dysphonia.
Otolaryngol Clin North Am 2000;2:983‑1002.
25. Yiu E. Impact and prevention of voice problems in the teaching
profession: Embracing the consumer's view. J Voice 2002;
16:215‑28.
26. Herrington‑Hall B, Lee L, Stemple J, Niemi K, McHone M.
 Devadas and Rajashekhar: Voice problems in call center operators

Description of laryngeal pathologies by age, sex, and occupation attitudes toward seeking health care for voice issues: Understanding
in treatment seeking sample. J Speech Hear Disord 1988;53:57‑64. the barriers. J Voice 2009;23:225‑8.
27. Chan R. Does the voice improve with vocal hygiene education?
A study of some instrumental voice measures in a group of
Cite this article as: Devadas U, Rajashekhar B. The prevalence
kindergarten teachers. J Voice 1994;8:279‑91.
and impact of voice problems in call center operators. J Laryngol
28. Zeine L, Walter K. The voice and its care: Survey findings from Voice 2013;3:3-9.
actor's perspectives. J Voice 2002;16:229‑43.
Source of Support: Nil, Conflict Interest: No.
29. Gilman M, Merati A, Klein A, Hapner E, Johns M. Performer's

Journal of Laryngology and Voice | January-June 2013 | Vol 3 | Issue 1 9

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