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Research Article - Otolaryngology Online Journal (2019) Volume 9, Issue 3

Hoarseness among Preachers in Port Harcourt Metropolis

*Corresponding Author:
Matilda U.J.U. Ibekwe
Senior Lecturer, Department of Ear, Nose and Throat surgery
College of Health Sciences University of Port Harcourt, Nigeria
Choba port harcourt, rivers 084, Nigeria
Tel: 2347039120091
E-mail: [email protected]

Received date: March 18, 2019; Accepted date: May 17, 2019; Published date: May 24, 2019

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Abstract

Background: There is an increase in the number of churches and therefore preachers in Port Harcourt metropolis. Most lack formal training while majority do not use microphone during preaching. There is paucity of local work on these preachers and their voice, hence this study.

Aim: The study is to determine the prevalence of hoarseness and knowledge of voice care/hygiene among preachers in Port Harcourt metropolis. Patients and Methods: An observational study carried out among preachers in three randomly selected churches within Port Harcourt metropolis from October 2017 to March 2018 with the aid of self-administered questionnaire Preachers who gave their consent were all included in the study. The data obtained were analyzed using SPSS version 20 and results presented in statistical tables.

Results: There were 64 respondents; males n=42 (65.6%), females n=22 (34.4%). Age ranged from 18 to 68 years. The age 40-50 comprised 31.3% and the most seen. Hoarseness was noted in n=42 (65.6%). Among the respondents only 2 (3.1%) uses microphone always. Correlating age of the preachers and hoarseness showed a statistical significance. The risk factors studied, even though gave more yes to hoarseness, was not statistical significant in correlation. Lack of knowledge of voice abuse possibly causing hoarseness in preachers was significant statistically.

Conclusion: Knowledge of the risks associated with wrong voice use or voice abuse among preachers is poor. A significant number lack knowledge of voice care.

Keywords

Hoarseness; Preachers; Voice

Introduction

Voice is important for human communication. The voice is very important in communicating emotions, transmission of messages as well as expression of different things.

There are different professions that require continual use of voice for example; teachers, preachers, singers and so forth. Voice is essential in the work life of these professionals since it is their main instrument or work tool [1]. The quality of the voice can negatively or positively influence the listeners. Loss of voice quality can affect the performance of these professionals [2]. Their effectiveness and efficiency at work depends on the integrity of their voice [3]. Koufman and Isaacson [4] evolved a classification of these vocal professionals into four levels based on the importance of voice quality to their work. The preachers, teachers, actors, receptionists all belong to level two, the professional voice users; in this group moderate vocal difficulty will impair their work greatly. In these, hoarseness can mean difficulty in carrying out their work which can lead to loss of income. It may also necessitate a need to change profession [5,6]. Chen et al. [7] in their study on teachers and voice problems found that there is limitation of work in 38% of these teachers due to voice problems and a cause of financial loss in about 1 in 3 teachers [7]. Hoarseness is often associated with abnormalities of the vibratory margins of the vocal folds [8]. There are multifactorial causes which can all interact to result in hoarseness. These factors can cause trauma to the vocal cords and result in inflammatory processes, laryngitis being the commonest [9]. The factors include behavioral, organic, hereditary, environmental and occupational. Occupational factors play a more major role as some occupations lead to excessive use of the voice which could cause trauma to the vocal cords. This continual voice use allows little time for recovery from assaults on the voice, worsening the situation. Environmental factors affect the voice either directly or indirectly for instance, exposure to chemicals, dusts, irritants, bad weather conditions, humidity etc. The life style of the professional is also relevant to their voice health [6]. Some healthy vocal habits that maintain voice hygiene are adequate hydration, sound amplification therefore avoidance of shouting [10] etc. while environmental noise, smoking, pollution, air conditioning, vocal abuse, hearing loss can all add to the risk of developing vocal impairment [11]. Water drinking is essential for the maintenance of vocal quality [12]. Prolonged talkativeness and intense vocal loudness favors the occurrence of vocal trauma. [13] Intense vocal loudness acts as an internal risk factor of vocal impairment because to produce the loud sounds, more respiratory muscles are employed [14] with increase in subglottic pressure and glottis adduction [15]. This subglottic pressure increase requires the vocal folds compression to be increased so that they can maintain their position of medialization in order for voice to be produced. The result of all this is voice trauma [16] which compromises the vocal fold vibration cycle with resultant affectation or alteration of the sound it produces [11].

The preachers are among the professionals that their ability to function is dependent on a good voice. The demand on the vocals of this group of professionals can be enormous because they must get across to their listeners. In addition, the acoustics and amplifications in their environments or churches are often poor. [17] In these individuals therefore, hoarseness can impact directly on both the profession and their social life. It can diminish the productivity and regularity in the work of the professionals hence it is taken as an occupational problem [18]. Long periods of talking coupled with environmental factors such as air pollution, high levels of background noise, poor acoustics, could all give rise to increased prevalence of voice disorders [19].

In some of the preachers, hoarseness can be episodic, relating only to the time of overuse or misuse while in others, it may be constant [17]. Preachers can also have high occurrence of voice disorders due to poor information about or lack of knowledge of voice care. The standard management in hoarseness is that once it lasts more than two weeks, it should be evaluated [20]. The aim of this study therefore is to determine the prevalence of hoarseness as well as find out the knowledge of vocal hygiene among preachers in Port Harcourt metropolis.

Methodology

It is a quantitative descriptive study with data obtained by a self-administered questionnaire that was distributed in three randomly selected worship centers within Port Harcourt metropolis; one catholic and two Pentecostal within a four month period, December 2017 to March 2018. Information sought included the age of the preachers, prevalence of and possible causes of voice disorders, social habits and any disease that can affect voice quality, awareness of voice care/hygiene among others. The preachers in these churches that gave their consent were all included in the study. Excluded from the study are any of the preachers that have had any form of surgical interventions on the throat especially on the larynx or trachea prior to the study. Ethical approval was obtained from the ethical committee of the hospital. The data was analyzed using the SPSS version 20 and results presented in statistical tables.

Results

The study involved 64 subjects with age ranging 18 to 68 years. There were 42 males and 22 females giving a male preponderance 1.9:1. The majority of the respondents were found in the age group 40-50 years (31.3%) while age 18-24 years were the least. Catholic denomination was more in the study 68.8% Table 1.

Variables (N=64) Frequency Percentage (%)
Age
18-28 years 4 6.3
29-39 years 16 25
40-50 years 20 31.3
51-61 years 14 21.9
62 and above 10 15.6
Sex
Male 42 65.6
Female 22 34.4
Denomination
Catholic 44 68.8
Pentecostal 20 31.3

Table 1: Social demographic characteristics of preachers in the study.

Prevalence of hoarseness in this study was 65.6% while 34.4% had no hoarseness. The social history of the respondents; smoking n=4 (6.3%) non- smoking n=60 (93.8%) while n=48 (75.0%) takes alcohol and n=16 (25%) does not take (Figure 1).

Figure

Figure 1:Prevalence of hoarseness.

Risk factors for hoarseness shows only 3.1% of the respondents use Public Address (PA) system always while 25.0% had never used one. 59.4% still shout despite using the PA. Among the respondents, 40.6% has been preaching for less than 5 years and 21.9% for more than 15 years (Table 2).

Variables (N=64) Frequency Percentage (%)
Frequency of use of public address system
Always 2 3.1
Occasionally 46 71.9
Never 16 25
Shout when using microphone
Yes 38 59.4
No 26 40.6
Frequency of preaching in a week
Once 34 53.1
Twice 10 15.6
Thrice 14 21.9
More than three times 6 9.4
Duration of being a preacher
<5 years 26 40.6
5-10 years 16 25
11-15 years 8 12.5
>15 years 14 21.9
Exposure to cold or dust
Yes 18 28.1
No 46 71.9

Table 2: Risk factors for hoarseness (harm caused by voice abuse) in preachers.

There were 65.7% of the respondents with symptoms suggestive of coexisting airway allergy (Figure 2).

Figure

Figure 2: Distribution of manifested symptoms.

While the duration of voice change varied from few days to a week, in 85.7% the change cleared completely but in 14.3% it did not completely clear (Table 3).

Variables (N=42) Frequency Percentage (%)
Duration of voice change (loss of voice)
Within a day 10 23.8
2-4 days 26 61.9
5-7 days 6 14.3
See doctor for voice change (loss of voice)
Yes 4 9.5
No 38 90.5
When voice cleared
Within a day 12 28.6
2-4 days 22 52.4
5-7 days 6 14.3
1-2 weeks 2 4.8
Voice cleared completely
Yes 36 85.7
No 6 14.3
Treatment given
Medication 8 19
Natural remedies 6 14.3
Both 2 4.8
None 26 61.9

Table 3: Distribution of voice change-related factors among preachers.

Looking at correlations between age and development of hoarseness, there was a statistical significance, note age range 51-61, all had hoarseness this was found to be statistically significant p-value=0.002 while the sex difference was not statistically significant (Table 4).

Variables Hoarseness
Yes N=42 n(%) No  N=22 n (%) Total  N=64 n (%)
Age category
18-28 years 2 (50.0) 2 (50.0) 4 (100.0)
29-39 years 6 (37.5) 10 (62.5) 16 (100.0)
40-50 years 12 (60.0) 8 (40.0) 20 (100.0)
51-61 years 14 (100.0) 0 (0.0) 14 (100.0)
62 and above 8 (80.0) 2 (20.0) 10 (100.0)
Fisher’s exact test=15.857; p-value=0.002*
Sex
Male 28 (66.7) 14 (33.3) 42 (100.0)
Female 14 (63.6) 8 (36.4) 22 (100.0)

Table 4: Socio-demographic characteristics vs. hoarseness in preachers.

The social history did not show any statistical significance with hoarseness. While majority of the risk factors when compared with hoarseness showed no statistical significance, studying the awareness or knowledge of voice abuse affecting voice health and causing hoarseness among both the respondents with hoarseness and those without, showed significant difference statistically, p-value=0.008 (Table 5).

Awareness of harm caused by voice abuse
Aware n (%) Not aware n (%) Total n (%)
Hoarseness
Yes 16 (38.1) 26 (61.9) 42 (100.0)
No 16 (72.7) 6 (27.3) 22 (100.0)
Total 32 (50.0) 32 (50.0) 64 (100.0)

Table 5: Hoarseness vs. awareness of harm caused by voice abuse in preachers.

There is an increased chance of developing hoarseness due to not being aware of proper voice care (Table 5). In almost all the age groups there were more people unaware of proper voice care than those that are aware with p-value=0.017 which is significant (Table 6). All the risk factors studied when correlated with development of hoarseness was found not to be significant except exposure to dust and cold, most of the respondents were not aware of the effect of these environmental factors on voice health. This was found to be significant, pvalue= 0.005 (Table 7).

Awareness of harm caused by voice abuse
Variables Aware N=32  n (%) Not aware N=32 n (%) Total n (%) N=64
Age category
18-28 years 2 (50.0) 2 (50.0) 4 (100.0)
29-39 years 6 (37.5) 10 (62.5) 16 (100.0)
40-50 years 8 (40.0) 12 (60.0) 20 (100.0)
51-61 years 6 (42.9) 8 (57.1) 14 (100.0)
62 and above 10 (100.0) 0 (0.0) 10 (100.0)
Chi-square=12.086; p-value=0.017*
Sex
Male 18 (42.9) 24 (57.1) 42 (100.0)
Female 14 (63.6) 8 (36.4) 22 (100.0)

Table 6: Socio-demographic characteristics vs. awareness of harm caused by voice abuse in preachers.

Awareness of harm caused by voice abuse
Variables Aware N=32 n (%) Not aware N=32 n (%) Total  N=64 n (%)
How often use public address system
Always 0 (0.0) 2 (100.0) 2 (100.0)
Occasionally 22 (47.8) 24 (52.2) 46 (100.0)
Never 10 (62.5) 6 (37.5) 16 (100.0)
Fisher’s exact test=2.696; p-value=0.266
Shout when using microphone
Yes 20 (52.6) 18 (47.4) 38 (100.0)
No 12 (46.2) 14 (53.8) 26 (100.0)
  Chi Square=0.259; p-value=0.611    
Number of times preaching is done in a week
Once 18 (52.9) 16 (47.1) 34 (100.0)
Twice 4 (40.0) 6 (60.0) 10 (100.0)
Thrice 8 (57.1) 6 (42.9) 14 (100.0)
More than three times 2 (33.3) 4 (66.7) 6 (100.0)
Fisher’s exact test=1.497; p-value=0.739
Duration of preaching
<5 years 12 (46.2) 14 (53.8) 26 (100.0)
5-10 years 6 (37.5) 10(62.5) 16 (100.0)
11-15 years 4 (50.0) 4 (50.0) 8 (100.0)
>15 years 10 (71.4) 4 (28.6) 14 (100.0)
Fisher’s exact test=3.702; p-value=0.281
Exposure to cold or dust
Yes 4 (22.2) 14 (77.8) 18 (100.0)
No 28 (60.9) 18 (39.1) 46 (100.0)

Table 7: Risk factors associated with hoarseness vs awareness of harm caused by voice abuse in preachers.

Discussion

This study was carried out among the Pentecostal pastors and catholic priests, it was found that though there were two Pentecostal churches involved and only one catholic church, the majority of the respondents came from the catholic church n=44 (68.8%). We looked at both Pentecostal pastors as well as catholic priests because they both have different preaching styles. While the Pentecostal pastors have more intense preaching style that tends to have greater vocal demands, the catholic priests have a different and perhaps less vocally demanding style. However, there was no significant difference between these two groups in terms of hoarseness.

The prevalence of voice change was found to be 65.6% and age 40-50 years were the most affected 31.3%. In contrast, other researchers found age 31-40 years to be more affected [21-23]. There was a male preponderance found, similar to other works [21,23].

Among these preachers there was a lack of awareness of the effect and consequence of abuse on vocal health, this lack of awareness of voice abuse causing hoarseness is significant statistically with p-value of 0.008 and odds ratio (95% confidence interval)=0.231. Some were aware yet did not modify their vocal behavior. This agrees with a work by Hagelberg on voice problem among priests, there was high prevalence of voice problems and poor knowledge of vocal care among these priests [19].

According to Koufman and Isaacson [4] classification, there are four levels of voice professionals. Level 1; these are the sophisticated voice users which includes singers, actors, they are known as the elite vocal users. The mildest impairment of voice affects their work very tremendously. Preachers come under Level 2 also known as professional voice users. In this group, moderate vocal difficulty would hamper adequate job performance. Therefore in the 14.3% that the hoarseness did not clear completely, they may likely have their work hindered to a large extent. This is also based on the finding that voice disorders such as hoarseness can affect the preachers quality of life in terms of work [24] other levels are non-vocal, iii and non-vocal/nonprofessionals level iv [4].

Although the respondents that do not use microphone either occasionally or not at all had more hoarseness, this finding was not significant agreeing with some other researchers [25]. The risk factors studied though appears to give rise to hoarseness, was not statistically significant. In another study, age and length of sermon showed a significant effect on voice change but microphone use and potential voice overuse did not correlate significantly with hoarseness [25]. In the general population, the prevalence of voice problems is 6-15%. It is known that this rate increases in occupations that require intense use of voice, [26] in this study a prevalence of 65.6% was obtained, which is similar to a study in the USA on Jewish cantors 65% [27] but lower than that obtained by Hocevar from a study on Priests in Slovenia 85.6% [28] but higher than the 21%, 57.1% and 36.8% found by Hagelberg, Neto FXP and Selman respectively in their various studies on different preachers [19,29,30].

This study showed that a good number of these preachers are ignorant of voice care and voice hygiene despite the fact that their means of livelihood is dependent on the integrity of their voice. When this was correlated with other variables studied, it was statistically significant therefore there is a need for voice training in this category of professional voice users, some of them despite the use of microphone still shouts, as found in this study 59.4%. Majority of the respondents had hoarseness lasting up to a week before clearing, most 90.5% did not consult a doctor, and it is known that such repeated vocal trauma can lead to a more serious damage to the vocal cords and the larynx in general. There was a significant correlation between age and hoarseness p-value=0.002 in this study; age group 51-61 all had hoarseness while for all the other age groups the number that had hoarseness was more than those that did not have. This agrees with other works [25] in addition there was a significant lack of awareness of dangers of voice misuse with p-value of 0.017 among all the age groups. It is known that knowledge of vocal hygiene, breathing exercises and use of correct vocal technique decreases voice fatigue therefore enhancing vocal efficiency and self-confidence [31].

Conclusion

Preachers as voice professionals are quite prone to voice disorders such as hoarseness and in our environment the prevalence is quite high and majority lack knowledge of voice care and hygiene. Most importantly, they have no training whatsoever on proper voice use.

Limitations

There was no physical ENT examination carried out on the respondents and there was also no form of laryngoscopy done so as to determine the state of the larynx. There was also no vocal analysis carried out.

Some variables were not studied such as emotional stress, neurological problems etc. which could impact on the voice.

Recommendations

The preachers like the singers need proper training on voice use. They also should be educated on the effect of voice hygiene and care as it affects their profession.

References