Occupational voice users can be defined as individuals who rely heavily on vocal communication to conduct their jobs, for example, teachers, singers, telephone sales representatives, swimming instructors, and clergy. Recently, researchers and clinicians have become increasingly aware of large numbers of occupational voice users seeking treatment in voice clinics. Occupational risk factors that have been suspected include: heavy vocal demand, poor acoustic conditions for speech, high exposure to viruses, inadequate vocal training, increasing classroom sizes and escalating pressures from employers and care-givers.

A high prevalence of voice problems among occupational voice users could have a negative impact on society. Extensive use of sick benefits, workers' compensation claims, and employment of temporary staff in the public sector costs taxpayers. In the public school system, extensive use of substitute teachers to replace vocally "sick" teachers disrupts instructional continuity. Vocally impaired teachers present poor speech signals, and may be forced to modify their teaching styles or curricula to accommodate poor voices; thus students' learning may be compromised, and poor examples of vocal communication reinforced. In the private sector, occupational voice problems can minimize worker productivity, increase unemployment, and compromise a company's image. The quality of life of individuals with voice disorders may also be affected. Individuals with communication problems often avoid expressing their thoughts and feelings vocally, and may avoid social events.

Within the Pacific Voice Clinic, several research projects are underway to explore the nature, prevalence and risk factors of occupational voice problems. Two such studies are described briefly below.



Project 1: Occupational Representation for B.C. Voice Clinic Patients

The confidential patient database for the Pacific Voice Clinic (PVC) is being examined to determine trends in demographic, occupational, and diagnostic features that might offer directions for further research on occupational voice problems. All patient identification information is excluded from the study, so the data remain anonymous. Factors such as age, gender, occupation and diagnosis are available to help identify patterns for thousands of patients seen in the past 5 years. Preliminary analyses reveal that approximately 60% of the individuals who seek assessment and treatment in the PVC are occupational voice users. The representation of several occupational groups is proportionally higher in the PVC database than the Canadian census data of employed persons might predict for those occupational groups. For example, the proportion of teachers, singers, and actors, in the PVC database is at least 5 times greater than their respective representations in the B.C. population of employed individuals. The most common diagnoses for occupational voice users visiting the PVC are muscle misuse voice disorders



Project 2: The Prevalence, Nature and Risk Factors of Voice Problems in Teachers

The Worker's Compensation Board has granted an interdisciplinary research group $40,000 to develop and test a questionnaire that will be used to determine the prevalence, nature and risk factors of voice problems among public school teachers in British Columbia. The group, lead by Dr. Linda Rammage, consists of representatives from UBC Departments of Surgery, Audiology and Speech Sciences, Engineering, Occupational and Environmental Hygiene, and Statistics as well as researchers from the B.C. Teachers' Federation. This collaborative effort will culminate in a multi-factorial tool that will be administered to a representative sample of teachers employed in B.C. Once the personal and occupational factors that put teachers at risk for voice problems have been determined, effective preventive and treatment programs can be developed.



Project 3: The Education of Health Care Professionals on Laryngectomees, specifically regarding Tracheo-Esophageal Puncture/Prosthesis Crisis

Undergoing a laryngectomy is a life altering experience. Not only do laryngectomized individuals have to deal with the diagnosis of cancer, they also have to deal with life altering changes that result from this surgery, including loss of their laryngeal voice and physical changes to the breathing and swallowing mechanisms. Most patients who have undergone this surgery receive their immediate post-operative care in one of the few hospitals where these surgeries are performed. Once their stay in the hospital is over, they return home, often to areas quite far away from a major center. However this does not mean that they no longer require the care and expertise of health care professionals who are knowledgeable about their special needs.

The primary objective of this study was to obtain information regarding the education level of health care professionals (i.e. physicians, nurses, speech language pathologists) about laryngectomees. The study focuses on Tracheo-Esophageal Prosthesis (TEP) speech and the possibility of a crisis situation involving the prosthesis. Individuals who have undergone a laryngectomy were surveyed and asked their experiences, opinions and concerns regarding TEP crises. Based on their responses, a questionnaire was developed and sent to front-line health care professionals, province wide. The questionnaire included knowledge questions and questions about comfort level, level of preparedness and amount of related experience of health-care professionals who might deal with laryngectomized individuals in their communities. Results show that there is a definite need for education, especially in rural and remote regions. Based on results of the survey, criteria for minimum knowledge required to resolve a TEP crisis was devised. The minimum knowledge criteria form the foundation for publications that are now being developed for distribution to health care workers throughout the province to help them deliver appropriate care for laryngectomized individuals experiencing TEP crises in their communities.