Vocal Fatigue in School Teachers and It’s Relation to the Acoustic analysis of Voice

Abstract

Voice disorders are thought to be one of the major occupational hazards of school teaching. There is a need to study the prevalence of vocal fatigue in school teachers as it is unknown in Indian population and its awareness is at a very basic level. We aim to investigate percentage of school teachers reporting vocal fatigue and to find if there is any relationship between vocal fatigue and acoustic voice parameters. A total of 100 subjects (50-males and 50-females) in the age range of 25–35 years participated in the study. Voice Sample was obtained from the subject using a digital tape recorder and was analyzed in Visi pitch and Dr.Speech softwares. The sample was taken twice in a day, that is, before teaching and after teaching. The mean values obtained on all the questions of the vocal fatigue questionnaire show a significant increase in mean values on all the questions at post teaching ratings. Results revealed a statistically significant difference in pre and post teaching values of F0 and shimmer in males. In females, statistical significant difference was obtained in Noise to Harmonic Ratio in /u/ production. No significant correlation between acoustic parameters and overall vocal fatigue was found except for Noise to Harmonic ratio in females for /u/.

Introduction

School teachers can be categorized as Level II professional voice users as per classification by Kouffman and Isaacson 1991, [1] for whom moderate vocal difficulty would prevent adequate job performance. As a profession, teaching has excessive vocal demands and long periods of continuous speaking [2]. In India, a normal classroom has 40 students and rooms are usually noisy because of which the teachers have to raise their voices to reach effectively to the students. It is important to consider that along with teaching, teachers undertake extra duties and many are pressured to participate in other activities like after school clubs and sporting fixtures. Responsibilities such as playground duty will mean that many teachers end up shouting to gain attention out of doors in all weather, above the noise of playing or fighting children [3].

Voice disorders are thought to be one of the major occupational hazards of school teaching. The resulting symptoms can affect teacher’s ability to function in the classroom and prevent them from developing effective working relationships with other staff and students. Teachers are the second largest occupational group reporting chronic laryngeal fatigue [4].

The voice is very precise stress indicator. It may add to the subjective perception of voice load [5]. Teaching is considered a highly stressful occupation. Vocal fatigue has been defined as a "negative vocal adaptation that occurs as a consequence of prolonged voice use" [6]. The frequently reported vocal fatigue symptoms in several studies are voice tiring, hoarseness, sensations of pain or discomfort in the throat, weak voice and lower pitch [7]. This negative adaptation may be associated with perceptual differences, such as changes in voice quality, range in pitch and amplitude, and the level of effort required to phonate. It may also cause physical changes by affecting tension and comfort of the vocal mechanism, diminishing the control thereof, or changing respiratory support.

There is a need for the present study as the prevalence of vocal fatigue in school teachers is unknown in Indian population and its awareness is at very basic levels. The knowledge of vocal fatigue among teachers will help to develop voice maintenance training programme and rescheduling of workload to gain efficient outcomes from teachers. Information on how the teaching profession is impacted by voice problems and understanding causative factors will help to minimize the voice problems in this population.

Aim

The aim of study is to investigate percentage of school teachers reporting vocal fatigue and to find out if there is any relationship between vocal fatigue and voice parameters.

Methodology

The research was approved by the Research Ethics Committee of the Maharashtra University of health Sciences (MUHS), Nasik.

Participants

A total of 100 subjects (50-males and 50-females) in the age range of 25–35 years who are secondary school teachers in the rural area of Maharashtra participated in the study. All the participants had minimum 1 year experience of teaching. Convenient sampling method was adopted. Participants were explained in detail about the purpose of the study and those who were willing to participate, signed the free informed consent form. Participants having Upper respiratory tract infection at the time of the testing, hearing deficit or vision deficit or with any speech and language problems, any systemic disorders or psychological problem were excluded from the study.

Procedure

Case history (Annexure 1) was taken which included information regarding demographic, medical, personal and environmental details. The vocal fatigue questionnaire (Annexure 2) [8] was used for perceptual assessment of vocal fatigue. Questionnaire contains questions regarding quality, pitch and loudness related acoustic features, physical discomfort and behavioral adaptations. Severity of fatigue was rated on 4 point rating scale, where 0 = none, 1 = mild, 2 = moderate and 3 = severe.

Voice Sample was obtained from the subject using Cenix VR-P2340 digital tape recorder. The sample was taken twice in a day, that is, before teaching and after teaching. The subjects were asked to sit in an area comfortably with less noise disturbance (in the science lab of school). The microphone was positioned at the distance of 15 cm, at an angle of 45 degrees. The subject was asked to perform following tasks:

1. To phonate vowels /a/, /i/ & /u/ in sustained manner at comfortable pitch & loudness followed by deep breath.

2. To phonate vowel /a/ at soft, mid & high intensity.

3. To read the first three lines of Marathi/Hindi/English reading passage out of which second line was chosen for analysis.

This was done to avoid any special effects associated with initial and final sentences and yet it provided tolerable accuracy [9].

The files were converted from MP3 format to Wave file format using wave pad converter software to make it compatible to analyze in Visipitch and Dr. Speech softwares.

Visi-Pitch IV which is the latest version of the most widely used clinical instrumentation tool for speech language pathologists was used which contains Auditory Feedback tests, Real time spectrogram, Voice games, Motor speech profile, Real Time Pitch, Waveform Editor, Sona—Match and Multi-Dimensional Voice Programme (MDVP). Dr. Speech IV (professional) was used to measure the loudness range, as loudness range could not be analyzed on MDVP Programme of Visipitch IV. A stopwatch was used for the measurement of the Maximum Phonation Duration (MPD). Parameters assessed in present study are Fundamental frequency, Speaking Fundamental Frequency (SF0) (Hz), Jitter (%), Shimmer (dB), Noise to Harmonic ratio (dB), Loudness range (dB) and MPD (seconds).

Statistical Analysis

Wilcoxon sign rank test was used to find whether significant difference exists between pre and post teaching on questionnaire. Student’s t-test was applied to know whether there is a significant difference between pre- and post-teaching values of acoustical parameters which were distributed normally and for those which were not distributed normally Wilcoxon Signed Rank test was applied. To know the relation between vocal fatigue and acoustical parameters Spearman’s correlation test was applied.

Results

Ninety seven percent teachers reported that they experience vocal fatigue after teaching for consecutive classes as answered on Q. 1 of case history.

The mean and SD values obtained on all the questions of the vocal fatigue questionnaire are shown in Table 1 which shows an increase in mean values on all the questions of vocal fatigue questionnaire at post teaching ratings. The result of Wilcoxon signed rank test on all 16 Questions of Questionnaire is shown in Table 2, which shows significant difference in pre and post teaching rating on all the questions (p < 0.05) in males except for Q9 that is tension in neck shoulder region (p > 0.05). In the case of females, result shows significant difference in pre and post teaching ratings on vocal fatigue questionnaire for all questions (p < 0.05). The overall fatigue was calculated for pre and post teaching scores and result shows that overall fatigue is statistically significant after teaching (p = 0.000). Looking in detail, the percentage of teachers reporting vocal fatigue on each question of the questionnaire post teaching is shown in Table 3, where 95% of participants reported that they experience mild fatigue after teaching, 5% reported that they experience moderate fatigue and none of the participant reported severe fatigue.

Table 1.

Mean and SD for Pre- and Post- teaching scores on vocal fatigue questionnaire

Questions		Males			Females
		Mean	N	SD	Mean	N	SD
Loudness range affected	Pre	0.02	50	0.141	0	50	0
	Post	1.12	50	0.627	1.22	50	0.648
Pitch range is affected	Pre	0.08	50	0.274	0.04	50	0.198
	Post	0.98	50	0.714	1.02	50	0.622
Harshness in your voice	Pre	0.2	50	0.452	0.02	50	0.141
	Post	0.6	50	0.7	0.44	50	0.577
Hoarseness in your voice	Pre	0.08	50	0.274	0.06	50	0.314
	Post	0.48	50	0.707	0.46	50	0.676
Difficulty in projecting your voice	Pre	0.02	50	0.141	0	50	0
	Post	0.34	50	0.519	0.32	50	0.551
Breathiness in your voice	Pre	0	50	0	0	50	0
	Post	0.2	50	0.452	0.36	50	0.631
Pitch breaks in your voice	Pre	0.02	50	0.141	0.02	50	0.141
	Post	0.22	50	0.545	0.54	50	0.676
Unsteadiness in your voice	Pre	0.06	50	0.24	0.04	50	0.198
	Post	0.52	50	0.614	0.56	50	0.644
Tension in neck/shoulder region	Pre	0.04	50	0.283	0	50	0
	Post	0.14	50	0.452	0.22	50	0.465
Pain/soreness in your throat	Pre	0.02	50	0.141	0.02	50	0.141
	Post	0.16	50	0.468	0.3	50	0.58
Weakness in your voice	Pre	0	50	0	0	50	0
	Post	0.38	50	0.635	0.56	50	0.675
Require greater vocal effort to produce voice while talking	Pre	0	50	0	0	50	0
	Post	0.2	50	0.571	0.22	50	0.418
Dryness in throat	Pre	0	50	0	0	50	0
	Post	0.92	50	0.634	0.96	50	0.57
Constriction/tightness in throat	Pre	0	50	0	0	50	0
	Post	0.18	50	0.523	0.24	50	0.431
Urge for coughing	Pre	0.04	50	0.198	0	50	0
	Post	0.26	50	0.443	0.22	50	0.465
Urge For throat clearing	Pre	0.04	50	0.198	0	50	0
	Post	0.24	50	0.431	0.26	50	0.487
Total Fatigue	Pre	0.62	50	0.987	0.2	50	0.571
	Post	6.94	50	4.795	7.9	50	4.639

Table 2.

Result of Wilcoxon signed rank test on all 16 questions on questionnaire for (a) Males (b) Females

Questions	5.2 (a) Males		5.2 (b) Females
	z	Asymp. Sig. (2-tailed)	Z	Asymp. Sig. (2-tailed)
Q1post–Q1pre	−6.006	.000*	−5.989	.000**
Q2post–Q2pre	−5.465	.000*	−5.857	.000**
Q3post–Q3pre	−3.302	.001*	−4.185	.000**
Q4post–Q4pre	−3.503	.000*	−3.172	.002**
Q5post–Q5pre	−3.578	.000*	−3.557	.000**
Q6post–Q6pre	−2.887	.004*	−3.689	.000**
Q7post–Q7pre	−2.714	.007*	−4.153	.000**
Q8post–Q8pre	−4.426	.000*	−4.564	.000**
Q9post–Q9pre	−1.179	0.238	−3.051	.002**
Q10post–Q10pre	−2.333	.020*	−2.952	.003**
Q11post–Q11pre	−3.819	.000*	−4.46	.000**
Q12post–Q12pre	−2.456	.014*	−3.317	.001**
Q13post–Q13pre	−5.89	.000*	−6.01	.000**
Q14post–Q14pre	−2.53	.011*	−3.464	.001**
Q15post–Q15pre	−3.317	.001*	−3.051	.002**
Q16post–Q16pre	−2.887	.004*	−3.357	.001**

Note- * Significance at the level of .05

**Significance at the level of .01

Table 3.

Percentage of teachers reporting vocal fatigue on each item of the questionnaire post teaching

Items	Mild	Moderate	Severe
Loudness range affected	57	30	0
Pitch range is affected	56	22	0
Harshness in your voice	36	8	0
Hoarseness in your voice	25	11	0
Difficulty in projecting your voice	27	3	0
Breathiness in your voice	21	2	1
Pitch breaks in your voice	25	5	1
Unsteadiness in your voice	40	7	0
Tension in neck/shoulder region	12	3	0
Pain/soreness in your throat	13	5	0
Weakness in your voice	32	6	1
Require greater vocal effort to produce voice while talking	16	1	1
Dryness in throat	67	12	1
Constriction/tightness in throat	18	0	1
Urge For coughing	22	1	0
Urge For throat clearing	23	1	0

In acoustic analysis, a total of seven parameters were analyzed for the voice samples before and after teaching. Table 4 shows means and standard deviations for mean fundamental frequency (F0) in pre and post-teaching performance for both males and females for /a/, /i/, and /u/. Results show that there is an increase in the mean values for F0 for both males and females post teaching. Results revealed that there is a statistically significant difference in pre and post values of F0 in males for /a/, /i/ and /u/ (p = 0.001, 0.002, 0.001 respectively). Whereas in females, no significant difference existed in F0 between pre- and post-values for /a/, /i/ and /u/ (p = 0.102, 0.725, 0.129 respectively).

Table 4.

Comparison of mean fundamental frequency (F₀) in pre-teaching and post-teaching performance for both males and females

Gender	Performance	Pre-teaching		Post-teaching		t	df	p
		Mean	SD	Mean	SD
Male	/a/	126.72	13.77	132.04	14	−3.694	49	0.001**
	/i/	129.29	14.76	133.72	14.59	−3.222	49	0.002**
	/u/	131.17	14.78	136.75	15.78	−3.447	49	0.001**
Female	/a/	215.27	20.11	220.34	21.4	−1.665	49	0.102
	/i/	210.67	24.25	212.91	36.87	−0.354	49	0.725
	/u/	216.88	22.94	221.31	28.34	−1.544	49	0.129

Note: ** = Significance at 0.01 level

Mean jitter values for males were, pre /a/ = 2.02, post /a/ = 1.93, pre /i/ = 3.85, post /i/ = 3.83, pre /u/- 2.89, post /u/ = 2.94 and for females the values were, pre /a/ = 2.14, post /a/ = 2.55, pre /i/ = 2.44 and post /i/ = 2.36, pre /u/ = 2.17 and post /u/ = 2.24. Result showed no significant difference for jitter values in pre and post teaching for both males and females for /a/, /i/ and /u/ (> 0.05).

Mean and SD for pre- and post-performance for shimmer for /a/, /i/ and /u/ for both genders are shown in Table 5. Result showed statistically significant difference for males for /i/ and /u/ 0.038 and 0.036 (p < 0.05). Whereas for females, there was no significant difference for shimmer values for all the vowels.

Table 5.

Comparison of pre- and post-teaching performance for shimmer on Wilcoxon Signed rank test

Gender	Performance	Pre-teaching		Post-teaching		z (Males	P
		Mean	SD	Mean	SD
Male	/a/	1.02	0.83	1.64	1.04	0.811	0.417
	/i/	1.14	0.2	2.03	0.6	− 2.076	0.038*
	/u/	0.83	0.54	1.04	0.13	− 2.1	0.036
Female	/a/	1.36	0.21	1.74	0.36	0.685	0.493
	/i/	1.92	0.39	2.16	0.39	− 0.357	0.721
	/u/	1.31	0.15	1.38	0.15	− 0.84	0.401

Note: * = Significance at the level of .05

In Noise to harmonic ratio (NHR), results showed no statistical significant difference between pre and post teaching in males, whereas in females, statistical significant difference was obtained in /u/ (p = 0.037) as shown in Table 6.

Table 6.

Comparison of pre- and post-teaching performance for Noise to Harmonic Ratio on Wilcoxon Signed rank test

Gender	Performance	Pre-teaching		Post-teaching		z (Males	P
		Mean	SD	Mean	SD
Male	/a/	0.27	0.12	0.28	0.17	− 0.425	0.671
	/i/	0.27	0.14	0.53	1.86	− 0.787	0.431
	/u/	0.23	0.1	0.27	0.24	− 1.617	0.106
Female	/a/	0.25	0.11	0.3	0.21	− 1.66	0.097
	/i/	0.33	0.16	0.35	0.17	− 1.033	0.302
	/u/	0.28	0.15	0.3	0.13	− 2.09	0.037*

Note: * = Significance at the level of .05

In Speaking fundamental frequency (SF0), Mean SF0 for males was 148.73 pre-teaching and 151.23 post-teaching and for females mean was 233.55 pre-teaching and 239.04 post-teaching. Result showed slight increase in mean and SD values of SF0 at post teaching but there was no statistically significant difference in both males and females. (p > 0.05).

In Loudness Range, Mean value for males pre-teaching was 34.23 dB and post-teaching was 33.75 dB. For females mean value for pre-teaching was 26.26 dB and for post was 26.42 dB. Results showed no statistically significant difference between pre and post loudness range (p = 0.825 for males and p = 0.931 for females). While analyzing Maximum Phonation Duration, result showed a decrease in the mean values after teaching but these were not statistically significant (p = 0.166 for males, p = 0.058 for females). Mean value for males pre-teaching was13.84 and post-teaching was 13.32 and for females pre was12.85 and post was 11.92.

While finding the relation between vocal fatigue and acoustic parameters: The Spearman’s correlation was applied as shown in Table 7 to find out whether any relation exists between vocal fatigue and acoustical parameters which shows that there is no significant correlation between acoustic parameters and overall vocal fatigue except for noise to harmonic ratio in females for /u/.

Table 7.

Non parametric correlation results for males and females Spearman’s Correlation

	Male	Female		Male	Female
F0 /a/ Post	Correlation Coefficient	− 0.107	0.111		Correlation Coefficient	0.22	0.157
	Sig
(1-tailed)	0.229	0.221	Shimmer /i/ Post	Sig
(1-tailed)	0.062	0.138
	N	50	50		N	50	50
F0 /i/ Post	Correlation Coefficient	0.005	− 0.076		Correlation Coefficient	0.094	0.093
	Sig
(1-tailed)	0.486	0.299	Shimmer /u/ Post	Sig
(1-tailed)	0.258	0.261
	N	50	50		N	50	50
F0 /u/ Post	Correlation Coefficient	− 0.062	− 0.04		Correlation Coefficient	0.025	− .289(*)
	Sig
(1-tailed)	0.333	0.391	NHR /a/ Post	Sig
(1-tailed)	0.43	0.021
	N	50	50		N	50	50
Jitter /a/ Post	Correlation Coefficient	− 0.195	− 0.234		Correlation Coefficient	-0.045	0.09
	Sig
(1-tailed)	0.087	0.051	NHR /i/ Post	Sig
(1-tailed)	0.377	0.268
	N	50	50		N	50	50
Jitter /i/ Post	Correlation Coefficient	− 0.051	− 0.032		Correlation Coefficient	0.107	0.05
	Sig
(1-tailed)	0.362	0.412	NHR /u/ Post	Sig
(1-tailed)	0.229	0.366
	N	50	50		N	50	50
Jitter /u/ Post	Correlation Coefficient	0.042	− 0.174		Correlation Coefficient	− 0.091	0.049
	Sig
(1-tailed)	0.386	0.113	SF0 Post	Sig
(1-tailed)	0.265	0.368
	N	50	50		N	50	50
Shimmer /a/ Post	Correlation Coefficient	− 0.142	0.088		Correlation Coefficient	0.106	− 0.065
	Sig
(1-tailed)	0.163	0.271	MPD Post	Sig
(1-tailed)	0.232	0.327
	N	50	50		N	50	50

Note: * = Significance at the level of .05

Discussion

As seen in the results that there is a significant vocal fatigue reported by teachers after taking classes, these findings are in agreement with Gotaas and Starr [10] who studied vocal fatigue among elementary and secondary school teachers and found that out of 250 teachers 80% reported vocal fatigue.

Looking at the details of the vocal fatigue questionnaire, on voice quality related questions, 36% participants reported mild symptom of harshness and 8% reported moderate harshness in voice. Mild hoarseness was reported by 25% and 11% reported moderate hoarseness, 27% reported having mild difficulty in projecting their voice whereas only 3% reported moderate difficulty. Mild breathiness was reported by 21% of them, 2% reported moderate and 1% reported severe breathiness. In present study total scores obtained for mild dryness in throat were 67%, 12% had moderate dryness and 1% reported severe dryness after continuous teaching. On other body related symptoms very few of them reported difficulty in symptom’s like tension in neck and shoulder region.

Similar finding was found in study by Vintturi, Alku, Sala, Sihvo, Vilkman [11] where 40 female and 40 male voluntary young students were examined to see the effect of vocal loading, by having them read aloud a novel for five times in 45 min. The researchers found highest scores on drying in mouth and throat, and lowest on symptoms of head neck and shoulder. Also similar findings were present in study by Roy et al. [12] on elementary and secondary school teachers (ages 20–66 years). It was found that teachers were significantly more likely to have experienced hoarseness, change in quality after short use, trouble speaking or singing softly, difficulty projecting their voice, loss of singing range, discomfort while using their voice, a monotone voice, and effort required to talk compared to non-teachers.

In the acoustic analysis of voice of teachers it was found that the F0 increased in both males and females post teaching, where in males the change was significant. The results are in agreement to the study of Mahato, Regmi, Bista & Sherpa [13], which analyzed voice of sixty teachers and found significant increase in fundamental frequency after teaching practice. In Jitter, there is no significant difference in both males and females post teaching and these results are similar to previous studies [13, 14].

There is an increase in the mean values of shimmer in teachers after teaching for both genders but in females no significant difference was obtained. This finding is similar to finding of Lukkanen et al. [15] who obtained increase in shimmer value after vocal loading in twenty two male teachers with mean age 43.5 years, in the age range 28–60 years. Also Mahato et al. [13] reported a significant increase in shimmer values. Shimmer is the amount of perturbations in voice and it may reflect poor vocal control and tissue alteration [16]. In the study by Verstraete et al. [14], they found no effect or rise in shimmer during sustained phonation on normal female subjects after 25 min of vocalization.

The results showed that there is an increase in mean values for NHR for both males and females on post condition on sustained phonation of /a/, /i/, and /u/. No significant difference was found between pre and post teaching for sustained phonation of above vowels for males and for females on /a/ and /i/. Result of this study are partly similar to results obtained by Rajdudhakar and Savithri [16] who found no significant difference in NHR post teaching in primary female school teachers. In present study significant difference was found for sustained phonation of /u / in females. This finding is similar to study by Gopal Krishna and Natraja [17] in normal group and teachers group who were prone to vocal fatigue, they found increase in NHR after vocal loading task.

The speaking fundamental frequency in the present study has shown an increase but not significantly. An increase in SF0 after vocal load for one working day in teachers have been found by previous authors [17]. More studies are required to study these parameters further. Result shows no significant difference in values of loudness range at post teaching. Contradicting to this, Kitch and Oates [18] found significant change in the loudness range in singers and actors but they are elite voice performers and are from the Level 1 in Professional Voice users. This finding could not be correlated with literature because of paucity of research. Results show that the mean values for MPD have decreased after teaching though these findings are not statistically significant. In previous studies significant decrease was noted in MPD [4, 13].

The results show that there is no significant correlation between acoustic parameters and overall vocal fatigue except for NHR in females for /u/. Negative correlation of NHR in females cannot be related to literature due to paucity of study.

These results obtained no correlation of subjective findings with acoustic parameters is in consonance with finding of Lehto et al. [19] who studied changes in objective measurements and subjective Voice complaints in 24 male and 8 female call center customer-service advisors during one working day. And found no correlation between the changes in objective and subjective parameters.

In the present study, the causative factors such as background noise, inadequate ventilation, big classrooms, excessive shouting, air pollution, stress and anxiety before teaching may not have appear to be contribute to vocal fatigue in the teachers in rural area. The rural areas in India are generally less noisy due to low population density as compared to urban area, less pollution, fewer industries, less no. of vehicles, easy transportation, more open spaces, lifestyle differences like slow lifestyle, less stress, which should be taken into consideration. Hence it can be assumed that the possible causative factors contributing to majority of participants reporting mild vocal fatigue may be prolonged use of voice and insufficient voice rest between consecutive classes.

Conclusion

Voice is one of the important part in a teacher’s life and it was found that the teachers have significant fatigue after hours of continuous teaching. Also there are significant changes in fundamental frequency, shimmer and NHR parameters after teaching. More studies with different time spans in the field of teaching are required in similar lines to find out the changes in voice more comprehensively. The teachers were enlightened about the need of vocal hygiene and proper hydration to maintain good voice in the coming years in the field of teaching.

Case History

Demographic details

Name:

Telephone No:

Age/sex: D.O.B:

Date:

Address:

Name of the school:

Classes taught:

Subjects taught:

No. of years of teaching:

No. of students per class:

Average duration of each class:

No. of classes taken per week:

No. of consecutive classes per day:

Medical History

1. Are you currently having cold, running nose or recent episode in last 1 month?

2. Do you have any other ear related complaints such as ear pain,discharge, tinnitus, and giddiness/vertigo?

3. Do you feel you have decreased hearing (hearing loss)?

4. Do you have any other significant medical problem or Allergy?

5. Are you currently on any medication? For what & since when?

6. Have you cancelled any class or taken sick leave due to voice problem?

7. Have you ever consulted psychiatrist or psychologist or taken medication for psychological problem?

For Females only

• 8. Are your menstrual cycles regular?

• 9. Are you pregnant?

• 10. Are you presently taking any medication including birth control pills or taken in the past?

Lifestyle:

1. Do you have fixed time of eating?

2. Do you take adequate amount of sleep (6–8 h)?

3. What kind of food do you mostly eat?

4. How many glasses/liters of water do you drink during on average per day?

5. How many cups of_____ in a day?

   Tea:

   Coffee:

   Cold Beverages:

6. Do you smoke, consume alcohol? If yes, Please mention quantity?

Details related to Voice usage

• 1. Do you experience vocal fatigue after class? When?

• 2. Please indicate the amount of time involved in following activities in a day (hours)?

a. Teaching:

b. Others (singing, telephone, private tuitions, conversation , choral singing, bhajans , any physical activity etc)specify hours:

• 3. Do you have any history of voice problem & consulted physician or speech therapist in the past or taken speech therapy? When?

• 4. When do you feel your voice sounds?

Best: Worst:

Tick one appropriate option for each of the question: 0-Never, 1-Sometimes, 2-Most of the times, 3-Always.

Q.no	Question	0	1	2	3
1	Do you experience anxiety prior to the teaching?
2	Do you have to shout excessively in classroom?
3	Do you have adequate ventilation in classroom?
4	Do you take voice rest between classes?
5	Do you experience exposure to- Dust: Smoke: Fumes:
6	Do you have to carry heavy load from one class to other?
7	Do you have to bend in class while teaching/explaining individual student in the class?
8	Do you practice yoga/meditation?

Annexure II

Vocal Fatigue Questionnaire

Note:

• 1. All questions are necessary to answer.

• 2. Answers to the questions will not be judged on the basis of right or wrong.

• 3. All questions need to be answered honestly and correctly based on your own perception of voice.

• 4. For each questions circle only one value that you feel most appropriate.

Name: Date:

Age/Sex:

Please rate your voice based on following parameters

	Questions	None	Mild	Moderate	Severe
1	Loudness range affected
2	Pitch range is affected
3	Harshness in your voice
4	Hoarseness in your voice
5	Difficulty in projecting your voice on stage
6	Breathiness in your voice
7	Pitch breaks in your voice
8	Unsteadiness in your voice
9	Tension in neck/shoulder region
10	Pain/soreness in your throat
11	Weakness in your voice
12	Require greater vocal effort to produce voice while talking
13	Dryness in throat
14	Constriction/tightness in throat
15	Urge for coughing
16	Urge for throat clearing

Funding

No funding received.

Compliance with Ethical Standards

Conflict of interest

No conflict of interest.

Research Involving Human Participants and/or Animals

Yes and the research was approved by the Research Ethics Committee of the Maharashtra University of health Sciences (MUHS), Nasik. The study was in compliance with the ethical standards.

Informed Consent

The participants were informed regarding the aim and procedure of the study and they signed the consent forms prior to testing.