The Hidden Cost of Teaching: An Integrative Model of Vocal Demand, Vocal Fatigue, and Voice Handicap in Teachers

The aim of this study was to investigate the relationships among vocal demand, vocal fatigue, and perceived voice handicap in teachers within a single analytical framework. The study also aimed to clarify the clinical relevance of these relationships by identifying factors that may support the prevention and early recognition of voice problems in teachers.

A total of 1088 teachers from 434 schools across Croatia participated in this cross-sectional study. Participants completed a questionnaire assessing sociodemographic, health-related, and occupational characteristics. Perceived vocal fatigue was measured using the Croatian adaptation of the Vocal Fatigue Index, and perceived voice handicap was assessed using the Croatian Voice Handicap Index. Vocal demand was operationalized using variables describing the teaching communication context. Structural equation modeling was used to examine the hypothesized relationships among study variables.

Confirmatory factor analysis supported vocal fatigue as a latent construct represented by the three subscales of the Croatian version of the Vocal Fatigue Index. In the structural model, vocal fatigue was significantly associated with participant sex, reflux, class size, teaching experience, environmental noise exposure, and teaching position. Vocal fatigue was a strong predictor of perceived voice handicap and accounted for the associations between several risk factors and perceived voice handicap. The model demonstrated good fit and explained 73% of the variance in perceived voice handicap.

The findings indicate that higher vocal demand and individual risk factors are associated with increased vocal fatigue, which is closely linked to greater perceived voice handicap in teachers. These results highlight the importance of prevention-oriented approaches and early recognition and management of vocal fatigue in occupational voice users.