Management of high-risk performers in clinical practice

Perfil dos profissionais da voz com queixas vocais atendidos em um centro terciário de saúde

“…3,8 In our study about 70% of patients had voice symptoms lasting up to two years (11% up to 3 months, 16% between 3 and 6 months, and 41% between 6 months and 2 years), and they still remained with no precise diagnosis. Many had left their activities or had limitations to perform professionally.…”

“…For these professionals, dysphonia can render them incapable of practicing their profession, resulting in absence from work, reduced productivity, and even the need to change profession. 3,8 Studies with telemarketers, for instance, have revealed that occupational dysphonia may lead to diminished sales and a direct impact on productivity. 2 Dysphonia may result from an interaction between hereditary, behavioral, lifestyle, and occupational factors.…”

“…Various studies have related occupational activity with dysphonia, where it is believed that the main causal factor is excessive voice use, causing vocal fold trauma, with laryngitis being the most common finding. 2,8 However, one should add a variety of environmental factors that may be indirectly related to work and that can contribute to the problem, such as exposure to chemical irritants (formaldehyde, chrome, mercury, sulfuric acid), inadequate temperature and humidity levels, background noise, and poor acoustics (these are reported mainly by teachers, actors, singers and telemarketers). 1,13 Furthermore, limited recovery time and stress are also considered risk factors for occupational laryngopathy.…”

“…7 The main cause of the lesion is excessive use of the voice and tension on the vocal folds, usually a consequence of incorrect compensation following (commonly viral) laryngitis. 8 A further factor is the lifestyle of many of these professionals (smoking, inadequate diet with an increased risk of GERD), which has an important role on the genesis of vocal changes. 9,11 In our series the main diagnosis in singers was nodules, followed by minor structural changes and Reinke's edema.…”

“…When deciding to recommend rest for these professionals, the possibility of vocal fold lesions becoming even worse with its accompanying risks should be evaluated. 8 Prevention programs are important, and should focus on helping professionals to become aware of their problems, to recognize early symptoms (voice fatigue, dry cough, and changes in voice pitch), and also to practice adequate vocal hygiene. This includes good hydration, avoidance of irritants such as active or passive smoking, avoidance of dust, an adequate diet with LPR control, and rest in cases of upper airway infection.…”