Dimensões do distúrbio vocal em professores

Abstract

Introduction: Lesions of vocal folds predispose to voice disorder related to work; however, high prevalence of dysphonia is confirmed regardless of the presence or degree of this kind of lesion. Related clinical controversies have been attenuated in face of recent epidemiologic studies that indicate context elements as possible triggering and aggravating factors of voice disorder, bringing clarification to hygienistic conducts in the field of speech Therapy. Having set the object of study that regards the chronicity of vocal disease and the barriers for keeping educational function on schools, the results of the survey on Belo Horizonte‟s municipal schools brought about questions that justified addressing the social representation on voice disorder. Objectives: 1) To identify the factors associated with the search of assistance to deal with vocal problems among elementary school teachers; 2) To investigate the prevalence and factors associated with recent absenteeism due to voice disorders among teachers; 3) investigate the existence of links between the social representations of teachers on the voice disorder and deal with the problem. Materials and methods: A study of social representation on dysphonia was coordinated with an epidemiological survey that involved 1,980 teachers of the Municipal School System of Belo Horizonte. Data were collected from a self-administered, unidentified, structured questionnaire, with questions about sociodemographic aspects, health and lifestyle habits, occupational history as well as questions related to labor and voice. A multiple logistic regression was performed to analyze two events: 1) the recent search for medical and/or speech Therapy assistance to address voice issues; 2) recent absenteeism due to vocal problems. The qualitative study employed the technique of focal groups and discourse analysis for the interpretation of the results obtained from interviews with a total of 18 teachers referred by medical expertise for speech therapy. Results: Both the search for assistance (event 1) and the absenteeism due to vocal problem (event 2) were associated with upper airways problems. Perception of worsening vocal quality, report of high or unbearable levels of noise in the classroom and recent absenteeism were related to event 1. Teachers who reported exposure to violence (by students and/or parents of students) in the previous year, emotional problems, and sick leave due to voice problem in the last 6 months were more susceptible to recent absenteeism (event 2) due to voice problems when compared to those who did not report absenteeism. The underestimation of voice symptoms (event 3) also emerged from the subjects discourse. Two lines of analysis allowed to build on the results achieved: 1) despite the dominant biological paradigm, macrostructural factors indicate the social nature of the teachers‟ illness process, 2) the institutional recognition of the disease and the environmental and organizational conditions of the workplace interfered in the declaration of voice disorder by the teacher. Conclusion: It arose from the subjects‟ discourse explanatory elements around the behavior of postponing the search for vocal assistance and for the absence from work due to vocal problems. A paradox was identified between the presence of vocal symptoms and inability to work and the denial or avoidance declaration of voice disorder. Fear, guilt and frustration before the diagnosis of dysphonia are (re)produced on the subjects‟ discourse. The statement vocal symptom is not immediate to its clinical expression, or in spite of stated and assumed such symptoms are relegated to the background by the teachers themselves. Multiple factors show to be related to coping with the voice disorder: health related factors (decrease of vocal quality, emotional and upper airways problems); contextual factors (report of high or unbearable levels of noise in the classroom and the testimony of abuse by students or parents at the school) associated to the search for vocal assistance and/or recent absenteeism. There is little influence of anchoring representations of voice disorder in the biomedical model on the coping strategies of teachers, compared to the weight of the representations of the voice problem as losses. Thus, it is reasonable to conclude that the identified behaviors are grounded in logic that prioritizes the goals of education, the students and the classroom at the expense of health.