Voice-Related Occupational Hazards in Military Drill Instructors, A Scoping Review

While vocal injuries are well documented in teachers and singers, drill instructors (DIs) remain an understudied group. This review mapped existing evidence on occupational hazards of DI voice use worldwide, including prevalence, etiology, risk factors, prevention, treatment, and attitudes toward care.

A literature search was conducted on July 31, 2025, using four databases: Embase, MEDLINE (PubMed), Scopus, and Web of Science. This study synthesized preexisting literature and was institutional-review-board-exempt.

A scoping review was performed on English-language studies examining military or armed forces instructors in vocally demanding roles. Two independent reviewers screened and extracted data. Exclusions included inborn disease, combat injury, environmental exposures, and non-full-text records.

Of 5137 screened records, seven studies were included, with a total of 805 unique subjects. Reported dysphonia prevalence ranged from 42% to over 95%. Videostroboscopy consistently identified structural lesions and vibratory abnormalities that acoustic measures missed, suggesting underdiagnosis. Reluctance to seek care due to cultural pressures further concealed the true scope of injury. No studies formally evaluated prevention strategies, and some untreated injuries progressed to requiring surgery.

DIs represent one of the most at-risk professional voice-user populations worldwide, with injury rates exceeding those in teachers and singers. DI avoidance of seeking medical care, the absence of prevention programs, and a reliance on insensitive diagnostic tools likely underestimate the extent of pathology. Future research must prioritize longitudinal studies, improved screenings, and intervention strategies. Protecting the voices of military instructors is essential to sustaining training quality and conserving the fighting strength.

IDENTIFIER: None.