CC BY-NC-ND 4.0 · Int Arch Otorhinolaryngol 2022; 26(02): e243-e249
DOI: 10.1055/s-0041-1733929
Original Article

Videolaryngoscopy Findings of the Vocal Health Program in Dysphonic Teachers in the Federal District, Brazil

1   Escola Superior de Ciências da Saúde, Brasília, DF, Brazil
2   Hospital de Base do Distrito Federal, Brasília, Distrito Federal, Brazil
3   Governo do Distrito Federal, Gerência de Promoção à Saúde do Servidor, Brasília, Distrito Federal, Brazil
4   Department of Otorhinolaryngology, Hospital Estadual Materno-Infantil Dr. Jurandir do Nascimento, Goiânia, GO, Brazil
3   Governo do Distrito Federal, Gerência de Promoção à Saúde do Servidor, Brasília, Distrito Federal, Brazil
3   Governo do Distrito Federal, Gerência de Promoção à Saúde do Servidor, Brasília, Distrito Federal, Brazil
3   Governo do Distrito Federal, Gerência de Promoção à Saúde do Servidor, Brasília, Distrito Federal, Brazil
› Author Affiliations


Introduction The high phonatory demand required of teachers is a direct cause of the onset of vocal symptoms and of the development of laryngeal disorders.

Objective To describe the findings of the laryngeal screening performed as part of the Vocal Health Program held in the Federal Distrcit of Brazil in 2014 and 2015.

Methods The study was performed with 361 dysphonic teachers from public schools who attended the laryngeal screening (videolaryngoscopy) part of the program. Data on anamnesis, the degree of dysphonia, the findings of the laryngeal screening, the referrals made after the laryngeal screening, and the result of the assessment of vocal aptitude for work were analyzed from the forms of each participating teacher.

Results The sample of the present study (N = 361) represents 18.23% of the 1,980 teachers that went through the vocal screening of the program in 2014 and 2015. In total, 98 (27.15%) teachers presented mild dysphonia, 221 (61.22%), moderate dysphonia, and 42, (11.63%) severe dysphonia. Regarding the laryngeal screening (videolaryngoscopy exam), 269 teachers (74.52%) presented laryngeal disorders, and the main ones found were vocal nodules (43.87%), signs of laryngopharyngeal reflux (37.17%), hourglass chink (18.22%), vascular dysgenesis (18.22%), midposterior triangular chink (9.67%), and double chink (8.55%).

Conclusion Laryngeal screening through videolaryngoscopy and auditory-perceptual screening of the voice as part of vocal health programs are essential to define the diagnosis and therapeutic conduct for teachers with dysphonia. Together with intervention activities, continuing education and adequate and accessible treatment, the periodic evaluation of vocal health can contribute to reduce absenteeism and improve the quality of life and of the voice of teachers.

Publication History

Received: 15 December 2020

Accepted: 25 March 2021

Article published online:
30 August 2021

© 2021. Fundação Otorrinolaringologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

  • References

  • 1 Sataloff RT. Professional voice: the science and art of clinical care. 3rd ed.. San Diego: Plural Publishing; 2005
  • 2 Caldas Neto S, Mello Júnior JF, Martins RHG, Costa SS. Tratado de Otorrinolaringologia. vol. IV.. São Paulo: Roca; 2011
  • 3 Simberg S, Laine A, Sala E, Rönnemaa AM. Prevalence of voice disorders among future teachers. J Voice 2000; 14 (02) 231-235
  • 4 Roy N, Merrill RM, Thibeault S, Gray SD, Smith EM. Voice disorders in teachers and the general population: effects on work performance, attendance, and future career choices. J Speech Lang Hear Res [Internet]. 2004 Jun;47(3):542–51. Accessed Sep 9, 2020 at:
  • 5 Simões M, Latorre MdoR. [Prevalence of voice alteration among educators and its relationship with self-perception]. Rev Saude Publica 2006; 40 (06) 1013-1018 Accessed Sep92020 [Internet]
  • 6 Ohlsson AC, Andersson EM, Södersten M, Simberg S, Barregård L. Prevalence of voice symptoms and risk factors in teacher students. J Voice 2012; 26 (05) 629-634
  • 7 Behlau M, Zambon F, Guerrieri AC, Roy N. Epidemiology of voice disorders in teachers and nonteachers in Brazil: prevalence and adverse effects. J Voice 2012; 26 (05) 665.e9-665.e18
  • 8 Tavares ELM, Martins RHG. Vocal evaluation in teachers with or without symptoms. J Voice 2007; 21 (04) 407-414
  • 9 Chen SH, Chiang SC, Chung YM, Hsiao LC, Hsiao TY. Risk factors and effects of voice problems for teachers. J Voice 2010; 24 (02) 183-190 , quiz 191–192 Accessed Sep92020 [Internet]
  • 10 Lima-Silva MFB, Ferreira LP, Oliveira IB, Silva MAA, Ghirardi ACAM. Voice disorders in teachers: self-report, auditory-perceptive assessment of voice and vocal fold assessment. Rev Soc Bras Fonoaudiol 2012; 17 (04) 391-397 Accessed Sep 9, 2020 [Internet] at
  • 11 Fuess VLR, Lorenz MC. Vocal problems in kindergarten and primary school teachers: prevalence and risk factors. Braz J Otorhinolaryngol 2003; 69 (06) 807-812
  • 12 Smith E, Kirchner HL, Taylor M, Hoffman H, Lemke JH. Voice problems among teachers: differences by gender and teaching characteristics. J Voice 1998; 12 (03) 328-334
  • 13 Angelillo M, Di Maio G, Costa G, Angelillo N, Barillari U. Prevalence of occupational voice disorders in teachers. J Prev Med Hyg 2009; 50 (01) 26-32
  • 14 Da Costa V, Prada E, Roberts A, Cohen S. Voice disorders in primary school teachers and barriers to care. J Voice 2012; 26 (01) 69-76 Accessed Sep92020 [Internet]
  • 15 Pereira ERBN. Avaliação clínica, videolaringoscópica e vocal perceptivo-auditiva e acústica de professores disfônicos [thesis]. Botucatu: Universidade Estadual Paulista Júlio de Mesquita Filho; 2014:95. Accessed Sep 9, 2020 at:
  • 16 Oliveira GMGF, Oliveira CF, Melo DC, Carvalho WKC, Martins LCCS, Granjeiro RC. Programa de saúde vocal: primeiro olhar para os professores das escolas públicas do Distrito Federal. In: Ferreira LP, Silva MAA, Giannini SPP. editors. Distúrbio de voz relacionado ao trabalho: práticas fonoaudiológicas. São Paulo: Roca; 2015: 47-58
  • 17 Amorim AL, Robazzi MLCC, Marziale MHP, Felippe ACN, Romano CC. Health disorders and teachers' voices: a workers' health issue. Rev Latino-Am Enfermagem [Internet]. 2009 Aug;17(4):566–72. Accessed Sep 9, 2020 at:
  • 18 Van Houtte E, Van Lierde K, D'Haeseleer E, Claeys S. The prevalence of laryngeal pathology in a treatment-seeking population with dysphonia. Laryngoscope 2010; 120 (02) 306-312
  • 19 Souza CL, Carvalho FM, Araújo TM, Reis EJFB, Lima VM, Porto LA. Factors associated with vocal fold pathologies in teachers. Rev Saude Publica 2011; 45 (05) 914-921
  • 20 Butler JE, Hammond TH, Gray SD. Gender-related differences of hyaluronic acid distribution in the human vocal fold. Laryngoscope 2001; 111 (05) 907-911
  • 21 Bassi IB, Assunção AA, Gama ACC, Gonçalves LG. Características clínicas, sociodemográficas e ocupacionais de professoras com disfonia. Distúrb Comun 2011; 23 (02) 173-180
  • 22 Sarfati J. [Vocal retraining of teachers]. Rev Laryngol Otol Rhinol (Bord) 1989; 110 (04) 393-395
  • 23 Mattiske JA, Oates JM, Greenwood KM. Vocal problems among teachers: a review of prevalence, causes, prevention, and treatment. J Voice 1998; 12 (04) 489-499
  • 24 Bovo R, Galceran M, Petruccelli J, Hatzopoulos S. Vocal problems among teachers: evaluation of a preventive voice program. J Voice 2007; 21 (06) 705-722
  • 25 Munier C, Kinsella R. The prevalence and impact of voice problems in primary school teachers. Occup Med (Lond) 2008; 58 (01) 74-76 Accessed Sep92020 [Internet]
  • 26 Dragone MLS, Ferreira LP, Giannini SPP, Simões-Zenari M, Vieira VP, Behlau M. Teachers' voice: a review of 15 years of SLP contribution. Rev Soc Bras Fonoaudiol 2010; 15 (02) 289-296
  • 27 Behlau M. Voz: o livro do especialista. vol I. São Paulo: Revinter; 2001
  • 28 Remacle M, Degols JC, Delos M. Exudative lesions of Reinke's space. An anatomopathological correlation. Acta Otorhinolaryngol Belg 1996; 50 (04) 253-264
  • 29 Martins RH, Defaveri J, Custódio Domingues MA, de Albuquerque E Silva R, Fabro A. Vocal fold nodules: morphological and immunohistochemical investigations. J Voice 2010; 24 (05) 531-539
  • 30 Martins RH, Branco A, Tavares EL, Iyomasa RM, Carvalho LR, Henry MA. Laryngeal and voice disorders in patients with gastroesophageal symptoms. Correlation with pH-monitoring. Acta Cir Bras 2012; 27 (11) 821-828
  • 31 Hawkshaw MJ, Pebdani P, Sataloff RT. Reflux laryngitis: an update, 2009-2012. J Voice 2013; 27 (04) 486-494 Accessed Sep92020 [Internet]
  • 32 Hom C, Vaezi MF. Extra-esophageal manifestations of gastroesophageal reflux disease: diagnosis and treatment. Drugs 2013; 73 (12) 1281-1295
  • 33 Pontes P, Behlau M. Sulcus mucosal slicing technique. Curr Opin Otolaryngol Head Neck Surg 2010; 18 (06) 512-520