Risk of Voice Disorders in Swedish Preschool Teachers: A Cross-Sectional Study

The objectives of this study were to examine if Swedish female preschool teachers had a higher relative risk of experiencing symptoms of a voice disorder than women from the general population and if preschool teachers who experienced noise in the working environment had a higher risk of voice disorders than preschool teachers who did not experience noise at work.

Questionnaire data from 4718 female preschool teachers with teacher degrees issued from universities in Västra Götaland County in Sweden and 4122 female controls were analyzed using three outcome questions: a) hoarseness without having a cold, b) tiredness in voice and throat when talking a lot, and c) tiredness in voice and throat when reading aloud or giving an oral presentation. Prevalence of symptoms of a voice disorder and confounder adjusted risk ratio (RR) with 95% confidence intervals was assessed in preschool teachers compared to controls using log-binomial regression. A sub-analysis was performed among the preschool teachers currently working in preschool, estimating the risk of symptoms of a voice disorder in relation to two questions on noise at work, asking how often they are exposed to such high sound levels that they have to 1) raise their voice to be able to talk to others and 2) have difficulty hearing what people are saying.

Compared to controls, the preschool teachers had a higher prevalence and significantly higher RRs for all symptoms of a voice disorder. For tiredness in voice and throat when reading aloud or giving an oral presentation, the risk was increased more than threefold for teachers compared to controls (RR: 3.7; 95% confidence interval, CI: 3.2-4.3), and the risk was increased by more than twofold for the outcomes hoarseness without having a cold (RR: 2.1; 95% CI: 1.7-2.5) and tiredness in voice and throat when talking a lot (RR: 2.5; 95% CI: 2.3-2.8). In addition, among preschool teachers, a dose-response relationship was found for all voice outcomes in relation to noise exposure at work, such that increasingly higher ratios were found among those reporting more noise exposure.

Swedish female preschool teachers have a higher risk of experiencing symptoms of a voice disorder than women who have never worked in preschool. Furthermore, being exposed to high sound levels in the preschool working environment is associated with increasingly high risks of symptoms of a voice disorder. These results indicate a need for voice ergonomic interventions to improve the preschool teachers working environment.