Understanding voice disorders among university staff: prevalence and associated factors - PMC Skip to main content An official website of the United States government Here's how you know Here's how you know Official websites use .gov A .gov website belongs to an official government organization in the United States. Secure .gov websites use HTTPS A lock ( Lock Locked padlock icon ) or https:// means you've safely connected to the .gov website. Share sensitive information only on official, secure websites. Search Log in Dashboard Publications Account settings Log out Search… Search NCBI Primary site navigation Search Logged in as: Dashboard Publications Account settings Log in Search PMC Full-Text Archive Search in PMC Journal List User Guide PERMALINK Copy As a library, NLM provides access to scientific literature. Inclusion in an NLM database does not imply endorsement of, or agreement with, the contents by NLM or the National Institutes of Health. Learn more: PMC Disclaimer | PMC Copyright Notice BMC Public Health . 2026 Apr 13;26:1243. doi: 10.1186/s12889-026-27088-8 Search in PMC Search in PubMed View in NLM Catalog Add to search Understanding voice disorders among university staff: prevalence and associated factors Faten Ezzelarab Younis Faten Ezzelarab Younis 1 Public Health and Community Medicine Department, Faculty of Medicine, Menoufia University, Menoufia governorate, Shebin El-Kom city, Egypt Find articles by Faten Ezzelarab Younis 1 , Sally Abdelwanees Sally Abdelwanees 1 Public Health and Community Medicine Department, Faculty of Medicine, Menoufia University, Menoufia governorate, Shebin El-Kom city, Egypt Find articles by Sally Abdelwanees 1 , Eman Fathi El-Domiaty Eman Fathi El-Domiaty 2 Phoniatrics Unit, Otorhinolaryngology Department, Faculty of Medicine, Menoufia University, Menoufia governorate, Shebin El-Kom city, Egypt Find articles by Eman Fathi El-Domiaty 2 , Amira Mohamed Abdel-Monaem Amira Mohamed Abdel-Monaem 1 Public Health and Community Medicine Department, Faculty of Medicine, Menoufia University, Menoufia governorate, Shebin El-Kom city, Egypt Find articles by Amira Mohamed Abdel-Monaem 1 , Norhan Moussa Norhan Moussa 3 Private International Law Department, Faculty of Law- Menoufia University, Menoufia governorate, Shebin El- Kom city, Egypt Find articles by Norhan Moussa 3 , Shaimaa Yaihya Abdel-Raouf Shaimaa Yaihya Abdel-Raouf 1 Public Health and Community Medicine Department, Faculty of Medicine, Menoufia University, Menoufia governorate, Shebin El-Kom city, Egypt Find articles by Shaimaa Yaihya Abdel-Raouf 1, ✉ Author information Article notes Copyright and License information 1 Public Health and Community Medicine Department, Faculty of Medicine, Menoufia University, Menoufia governorate, Shebin El-Kom city, Egypt 2 Phoniatrics Unit, Otorhinolaryngology Department, Faculty of Medicine, Menoufia University, Menoufia governorate, Shebin El-Kom city, Egypt 3 Private International Law Department, Faculty of Law- Menoufia University, Menoufia governorate, Shebin El- Kom city, Egypt ✉ Corresponding author. Received 2025 Dec 23; Accepted 2026 Mar 17; Collection date 2026. © The Author(s) 2026 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ . PMC Copyright notice PMCID: PMC13085562 PMID: 41975361 Abstract Background Voice disorders are a common health problem, especially among university staff members due to their excessive voice use. It might have significant consequences on their quality of life and work productivity. So, this study aimed to determine the prevalence of voice disorders among Egyptian staff members at Menoufia University and identify the contributing factors. Methods This cross-sectional study included 400 university staff members from different faculties in Egypt’s Menoufia University, recruited through convenience sampling. The participants obtained a self-administered questionnaire including sociodemographic information, occupational details of teaching, voice complaints, and the Voice Handicap Index-10 (VHI-10). A videolaryngostroboscopic examination was performed to identify the pathology. Results The main voice complaints among the university staff were dysphonia (40.3%) and throat dryness (41%). An abnormal VHI-10 was obtained in 164/400 (41.0%) of participants. The videolaryngostroboscopy revealed functional voice disorders (43.1%), minimal associated pathological lesions (30.4%), organic voice disorders (20.6%), and combined ones (5.9%). The significant associated factors for abnormal VHI were frequent teaching sessions per week (aOR: 1.25, 95% CI: 1.14–1.36), working a job ranked as teaching staff (aOR: 2.67, 95% CI: 1.19–5.96), deficient water intake of less than three cups per day (aOR: 5.09, 95% CI: 2.39–10.87), lack of use of amplifiers (aOR: 1.92, 95% CI: 1.15–3.19), and positive family history (aOR: 2.54, 95% CI: 1.09–5.91). Conclusions Voice disorders are highly prevalent among university staff members. Voice disorders were significantly associated with several personal, occupational, and behavioral factors. These emphasize the significance of implementing a health education program about voice care and putting practical preventive strategies into practice. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-026-27088-8. Keywords: Voice disorders, University staff, Associated factors, VHI-10, Videolaryngostroboscopy Introduction Voice disorders (VDs) refer to abnormalities in voice production or lack of quality, tone, volume, resonance, or continuity that are improper for the person’s age and gender [ 1 ]. Voice disorders are a common occupational health problem among professional voice users, like teachers and university staff, as their voice is the principal tool for their work, and they usually use it at a high volume [ 2 ]. These VDs can significantly impact both their quality of life and work performance, ultimately leading to a decrease in work productivity [ 2 – 4 ]. A recent systematic review and meta-analysis documented that the occupational voice complaint frequency among voice users was 43.9% [ 5 ]. Approximately 92% of Egyptian faculty members lacked adequate knowledge concerning voice care [ 6 ]. There are several kinds of risk factors for VDs, including sociodemographic traits like smoking, coffee drinking, and female gender; occupational factors like loud voice use, long teaching hours, and noisy environments; or medical conditions like trauma, allergy, or surgery [ 7 – 10 ]. There are several self-reported questionnaires to assess voice disorders, including the Voice Handicap Index (VHI) [ 11 ], the Voice-Related Quality of Life (V-RQOL) [ 12 ], the Voice Symptom Scale (VoiSS) [ 13 ], and Vocal Tract Discomfort Scale (VTDS) [ 14 ]. The Voice Handicap Index was a thirty-item tool that was created by Jacobson in 1997 to quantify the degree to which a voice problem affects three aspects of a patient’s life: functional, physical, and emotional levels [ 11 ]. In 2004, Rosen et al. created the Voice Handicap Index-10 (VHI-10) to be a more condensed form that patients can complete in a short time without sacrificing validity [ 15 ]. Arffa et al. in 2012 reported the normative scores for the VHI-10 tool [ 16 ]. The Arabic versions of V-RQOL [ 17 ] and the Vocal Tract Discomfort Scale (VTDS) [ 18 ] were used by previous studies [ 2 , 9 , 19 – 21 ]. The Voice Handicap Index-10 (VHI-10) is a validated, widely used, and reliable screening tool. In addition, it is brief and easy to administer, which makes it suitable for large population-based studies [ 15 ]. In 2012, Farahat validated an Arabic version of the VHI-10 and found excellent test-retest reliability ( r = 0.920) and great internal consistency with Cronbach’s α of 0.88 [ 22 ]. Videolaryngoscopy is a useful diagnostic instrument that assists in the management of VDs by evaluating the pathological findings among those who have them [ 23 ]. It aids visualization of the larynx and vocal folds’ structure and function. It is a distinct clinical examination to verify and assess VDs [ 24 ]. In Egypt, research on VDs among university staff, as opposed to teachers, is scarce and only evaluates subjective instruments without identifying the underlying causes using diagnostic techniques to assist the professional teaching staff in resolving their disorders. Several previous studies conducted in Egypt and other Arabic-speaking populations have relied primarily on subjective voice assessment tools [ 2 , 9 , 19 – 21 ]. Therefore, the purpose of this study was to determine the prevalence of voice disorders among university staff at Menoufia University in Egypt using VHI-10 and videolaryngostroboscopic examination and to identify associated factors including sociodemographic, occupational, behavioral, and genetic characteristics. Materials and methods Study design, timing, and setting This cross-sectional study was conducted from the beginning of July to the end of November 2025 at the Menoufia University Faculties in Egypt. Calculation of sample size Using the OpenEpi online calculator, version 3, the sample size was calculated at 80% power with a 0.05 α error. Based on a previous study in Saudi Arabia [ 7 ], which found that 38.8% of academic staff overall had an abnormal VHI, an estimated 365 individuals were included. 15% was added for the non-response rate; there were 420 in total. Participants : Menoufia University in Egypt has twenty colleges, with a 1:3 ratio of five medical and fifteen non-medicals. Simple random sampling was performed using a computer-generated randomization method to select one medical faculty and three non-medical faculties. The questionnaire was distributed to university staff members, and responses were collected until the determined sample size was reached using a convenience sampling method. The total university staff who participated was 400, with a 95.2% response rate. Inclusion and exclusion criteria Each staff member, regardless of age or gender, was engaged. A history of neck trauma or injury, a thyroidectomy or other neck surgery that impacted a person’s voice, or a general anesthesia procedure that affected the voice or neck tumor were also ineligible criteria. Tools The questionnaire was divided into two sections, and its completion took approximately 10 min per participant through personal interviews: The first part included items about sociodemographic and occupational data, habits that may affect voice, teaching-related factors, medical history, and awareness about voice care (as illustrated in the supplementary file). These questions were pilot tested on 37 university staff members at Menoufia University in Egypt to validate this section. Feedback from the pilot study was used to revise items for clarity and comprehensibility. A panel of experts in phoniatrics and epidemiology guaranteed content validity. Participants involved in the pilot testing were excluded from the final study sample. The second part comprised a previously validated instrument: the Arabic version of the Voice Handicap Index-10 (VHI-10), adopted from a prior study [ 22 ]. It consisted of ten questions, each of which had a score between 0 and 4 (0 denoting never, 1 nearly never, 2 sometimes, 3 almost always, and 4 always). The VHI-10 had a maximum score of 40; a score of more than 11 was considered abnormal [ 16 ]. All the participants who had abnormal VHI-10 (164 participants) were invited to laryngeal examination by videostroboscopy at Phoniatrics Clinic of Menoufia University Hospital; only 102 of them responded (62.2%). Videostroboscopy was performed using a 70-degree angle rigid laryngoscope (Shenda, China), Invisia’s MediCam Plus camera with a high-sensitivity charge-coupled device sensor (1280 × 960 pixels), and a fiber-optic light cable (4.8 × 1800 mm). The Inventis Daisy software system 3.6.3B3, which includes the Visia module created by the Inventis Company, is utilized. In both normal and stroboscopic light, vocal fold function was evaluated while the subject was at rest and while pronouncing the sustained/i/vowel at a comfortable pitch and loudness. Diagnosed laryngeal pathologies were classified into three main categories according to the occurrence of noticeable morphological changes [ 25 ]: (1) Organic voice disorders, which result from changes in the mechanism of voice production, including respiratory, laryngeal, or vocal tract (e.g., inflammatory, neurological, and traumatic disorders). (2) Functional (non-organic) voice disorders in which the physical character is intact while faulty use of voice leads to these disorders, e.g., hyperfunction dysphonia, hypofunction dysphonia, phonasthenia, and ventricular dysphonia. (3) Minimal Associated Pathological Lesions (MAPLs), which include small benign lesions affecting vocal folds, e.g., vocal fold nodules, polyps, Reinke’s edema, polypoid degeneration, laryngeal cysts, and contact granulomas. Statistical analysis The statistical analyses were performed using SPSS software (version 24.0, Chicago, IL, USA). The relationships between dichotomous variables were examined using the chi-square test (χ²). When comparing two quantitative data sets, the student’s t-test or Mann-Whitney was used as needed. To find independent factors for abnormal VHI, binary logistic regression was employed. A P-value of less than 0.05 was set as the significance level. Results Four hundred staff members from Menoufia University’s various faculties participated in this cross-sectional study. Their mean age was 41.42 ± 7.76, with a range of 24–81 years old; 86.8% of them were females, and 77.5% of them were urban residents. Of them, 87.3% were married, and 85.3% had children. Teaching staff made up the majority of the degree rank (86.3%), with assistant staff making up just 13.8%. Amongst the medical staff, 66.7% were teaching basic science subjects. Of them, 63.0% used speakers, and 52.0% had participated in remote learning. The number of teaching sessions each week ranged from one to twenty, and the employment years ranged from one to fifty years (Table 1 ). Table 1. Relationship between voice handicap index (VHI) and other parameters Parameter Total participants ( N = 400) Abnormal VHI ( N = 164) Normal VHI ( N = 236) P value Gender Male 53 (13.3%) 13 (7.9%) 40 (16.9%) 0.01* Female 347 (86.8%) 151 (92.1%) 196 (83.1%) Age (years) Mean ± SD 41.42 ± 7.76 41.01 ± 6.72 41.69 ± 8.41 0.37 Range 24–81 27–62 24–81 Residence Urban 310 (77.5%) 123 (75.0%) 187 (79.2%) 0.31 Rural 90 (22.5%) 41 (25.0%) 49 (20.8%) Marital status Married 349 (87.3%) 151 (92.1%) 198 (83.9%) 0.02* Unmarried 51 (12.8%) 13 (7.9%) 38 (16.1%) Have children Yes 341 (85.3%) 148 (90.2%) 193 (81.8%) 0.02* No 59 (14.8%) 16 (9.8%) 43 (18.2%) Number of children 0 59 (14.8%) 16 (9.8%) 43 (18.2%) 1–3 children 289 (72.3%) 123 (75.0%) 166 (70.3%) 0.04* ≥4 children 52 (13.0%) 25 (15.2%) 27 (11.4%) Occupation Assistant staff 55 (13.8%) 13 (7.9%) 42 (17.8%) 0.01* Teaching staff 345 (86.3%) 151 (92.1%) 194 (82.2%) Faculty Medical 234 (58.5%) 103 (62.8%) 131 (55.5%) 0.14 Non-medical 166 (41.5%) 61 (37.2%) 105 (44.5%) Medical staff N = 234 ( N = 103) ( N = 131) Basic 156 (66.7%) 75 (72.8%) 81 (61.8%) 0.07 Clinical 78 (33.3%) 28 (27.2%) 50 (38.2%) Use of amplifiers Yes 252 (63.0%) 87 (53.0%) 165 (69.9%) 0.001* No 148 (37.0%) 77 (47.0%) 71 (30.1%) Remote learning Yes 208 (52.0%) 92 (56.1%) 116 (49.2%) 0.17 No 192 (48.0%) 72 (43.9%) 120 (50.8%) Teaching session/week Median (range) 2.5 (1–20) 4 (1–20) 2 (1–20) < 0.001* Years of employment Median (range) 14 (1–50) 15 (2–35) 14 (1–50) 0.26 Smoking Yes 23 (5.8%) 11 (6.7%) 12 (5.1%) 0.47 No 377 (94.3%) 153 (93.3%) 224 (94.9%) Use loud voice Yes 258 (64.5%) 116 (70.7%) 142 (60.2%) 0.03* No 142 (35.5%) 48 (29.3%) 94 (39.8%) Excess tea (> 3cups/day) Yes 55 (13.8%) 24 (14.6%) 31 (13.1%) 0.66 No 345 (86.3%) 140 (85.4%) 205 (86.9%) Excess coffee (> 3cups/day) Yes 38 (9.5%) 10 (6.1%) 28 (11.9%) 0.05 No 362 (90.5%) 154 (93.9%) 208 (88.1%) Water/day <3 cups 82 (20.5%) 37 (22.6%) 45 (19.1%) < 0.001* 4–6 cups 211 (52.8%) 110 (67.1%) 101 (42.8%) >6 cups 107 (26.8%) 17 (10.4%) 90 (38.1%) GERD Yes 220 (55.0%) 101 (61.6%) 119 (50.4%) 0.02* No 180 (45.0%) 63 (38.4%) 117 (49.6%) Allergic diseases, especially respiratory Yes 73 (18.3%) 28 (17.1%) 45 (19.1%) 0.69 No 327 (81.8%) 136 (82.9%) 191 (80.9%) Chronic sinusitis or rhinitis Yes 192 (48.0%) 90 (54.9%) 102 (43.2%) 0.02* No 208 (52.0%) 74 (45.1%) 134 (56.8%) Chronic cough Yes 17 (4.3%) 4 (2.4%) 13 (5.5%) 0.13 No 383 (95.8%) 160 (97.6%) 223 (94.5%) Repeated respiratory tract infection Yes 45 (11.3%) 15 (9.1%) 30 (12.7%) 0.26 No 355 (88.8%) 149 (90.9%) 206 (87.3%) Family history for voice disorders Yes 36 (9.0%) 25 (15.2%) 11 (4.7%) < 0.001* No 364 (91.0%) 139 (84.8%) 225 (95.3%) Open in a new tab *Significant difference; SD , standard deviation; GERD , gastroesophageal reflux disease Abnormal VHI was present among 164 out of 400 university staff (41.0%). When sociodemographic characteristics were compared among those with abnormal VHI and those with normal VHI, female gender, being married, and having children were associated with a higher frequency of abnormal VHI ( P < 0.05). Regarding occupational history, the prevalence of abnormal VHI was higher among teaching staff than assistant staff ( P < 0.05), but there was no significant difference in work years or occupational history between medical and non-medical staff members ( P > 0.05). Additionally, abnormal VHI was more common for those who attended sessions more frequently each week and did not use amplifiers ( P < 0.05) (Table 1 ). Regarding habits, it was found that those who used a loud voice and drank deficient water had a higher frequency of abnormal VHI than others ( P < 0.05). Asking about medical history, it was found that the presence of gastroesophageal reflux disease (GERD) and chronic sinusitis or rhinitis among studied staff members was significantly associated with abnormal VHI ( P < 0.05). Also, those who had a positive family history of voice disorders showed a significantly high prevalence of abnormal VHI ( P < 0.05) (Table 1 ). Throat dryness and dysphonia were the most common voice complaints among the participants under study (41.0% and 40.3%), followed by difficulty speaking, sense of lump in the throat, sore throat, frequent cleaning of voice, and difficult swallowing (29%, 24.3%, 24%, 19.3%, and 13.3%, respectively). However, difficult breathing and sudden suffocation were the less frequent voice complaints (7.8% and 2%, respectively) (Fig. 1 a). The prevalence of abnormal VHI was greater in those who had complained than in those who had not (48% versus 35.3%, P < 0.05) (Fig. 1 b). Fig. 1. Open in a new tab The voice complaints and its voice handicap index (VHI) among the studied university staff members Among the 179 participants (44.8%) who reported having voice complaints, the consequences varied from no effects (63.7%) to absence from work (33%) and thinking about leaving work (3.3%). The participants used various methods to alleviate these complaints, the most common ones being excess intake of fluids (95.0%), avoiding shouting (95.0%), and avoiding noisy environments (88.8%). Only 31.8% of them went to a doctor for these complaints. Those who did not seek medical advice had many reasons: 33.6% of them stated they didn’t have enough time, 100% said the condition was not a serious condition, and 4.1% mentioned they did not know how and where to seek medical advice. Regarding awareness about voice care, only 28.5% of the studied group were aware of this, and their sources of information were nearly equally distributed between the internet, family & friends, doctors’ visits, and books, but training courses were a smaller number (7.0%). When asked about their intention to attend training courses about voice care whenever available, most of them (77.0%) said they would attend (Table 2 ). Table 2. Voice complaints and awareness about voice care Parameter Total participants ( N = 400) Its consequences on professional life N = 179 • No effect 114 (63.7%) • I had thought to leave work 6 (3.3%) • Take absenteeism from work 59 (33.0%) Presence of voice complaints Yes 179 (44.8%) No 221 (55.3%) Did you do any of these methods to relieve your complaint? N = 179 • Excess intake of fluids 170 (95.0%) • Avoid shouting 170 (95.0%) • Avoid noisy environment 159 (88.8%) • Use speakers 109 (60.9%) • Visit a doctor 57 (31.8%) If you didn’t visit a doctor, what was the cause? N = 122 • I do not have enough time 41 (33.6%) • It is not serious 122 (100%) • I don’t know how or where to seek medical help 5 (4.1%) Did you hear about voice care? Yes 114 (28.5%) No 286 (71.5%) Source of your information about voice care Internet 85 (21.3%) Family & friends 68 (17.0%) Doctors visited for voice disorders 55 (13.8%) Social media 67 (16.8%) Training courses 28 (7.0%) Books 68 (17.0%) If available, are you ready to attend courses about voice care Yes 308 (77.0%) No 92 (23.0%) Open in a new tab By regression analysis, the significant predictors for participants’ abnormal VHI were frequent weekly teaching sessions (aOR: 1.25 with 95% CI: 1.14–1.36, P < 0.05), being a member of the teaching staff (aOR: 2.67 with 95% CI: 1.19–5.96, P < 0.05), consuming less than three to six cups of water daily (for 3 cups/day, aOR: 5.09 with 95% CI: 2.39–10.87 and for 4–6 cups/day, aOR: 4.10 with 95% CI: 2.14–7.86, P < 0.05), not using amplifiers (aOR: 1.92 with 95% CI: 1.15–3.19, P < 0.05), and having a positive family history of voice disorders (aOR: 2.54 with 95% CI: 1.09–5.91, P < 0.05) (Table 3 ). Table 3. Binary logistic regression to detect predictors for voice disorders Parameter β aOR 95% CI P value Marital status Married Unmarried (reference) 0.91 2.49 0.44–14.01 0.30 Gender Male (reference) 0.17 1.19 0.53–2.63 0.67 Female Having children Yes 0.92 2.50 0.50–12.41 0.26 No (reference) Teaching sessions per week 0.22 1.25 1.14–1.36 < 0.001* Occupation Assistant staff (reference) 0.98 2.67 1.19–5.96 0.02* Teaching staff Use of loud voice Yes 0.33 1.39 0.83–2.32 0.21 No (reference) Water/day < 3 cups 1.62 5.09 2.39–10.87 < 0.001* 4–6 cups 1.41 4.10 2.14–7.86 < 0.001* > 6 cups (reference) Use of speakers Yes (reference) 0.65 1.92 1.15–3.19 0.01* No Family history for voice disorders Yes 0.93 2.54 1.09–5.91 0.03* No (reference) Chronic sinusitis or rhinitis Yes 0.12 1.13 0.68–1.87 0.64 No (reference) GERD Yes 0.28 1.32 0.81–2.17 0.27 No (reference) Open in a new tab *Significant difference; β, Beta; aOR, adjusted odds ratio; CI, Confidence Interval Videolaryngostroboscopic examination among those who had abnormal VHI revealed various pathologies such as reflux laryngitis, vocal fold polyp, phonasthenia, right sulcus vocalis, vocal fold nodules, hyperfunction dysphonia, and vocal fold paresis (Fig. 2 ). Based on these pathological findings, the voice disorders among those who had abnormal VHI were classified as follows: functional voice disorders (43.1%), MAPLs (30.4%), organic voice disorders (20.6%), and combined ones (5.9%) (Fig. 2 ). Videolaryngostroboscopy revealed normal laryngeal findings in 8.8% of participants who had abnormal VHI-10 scores and were diagnosed with phonasthenia. Fig. 2. Open in a new tab The pathological findings of videolaryngostroboscopy and the voice disorders among the participants who had abnormal voice handicap index (VHI) h) The voice disorders by videolaryngostroboscopy Discussion This cross-sectional study aimed to evaluate the prevalence of voice disorders among university staff across different faculties at Menoufia University using the VHI-10 questionnaire and videolaryngostroboscopic examination, and to investigate the associated factors. A sample of four hundred Menoufia University staff participated in this cross-sectional study. Approximately 40% of all staff members under study exhibited abnormal VHI-10. It agrees with a prior study conducted on academic staff workers in Saudi Arabia, which discovered that 38.8% of participants had abnormal VHI-10 [ 7 ]. Among the studied participants, 179 (44.8%) had voice complaints. It is similar to a comprehensive study and meta-analysis; 43.9% of voice users reported having vocal complaints [ 5 ]. The main complaints among the studied group were throat dryness and dysphonia. The participants who suffered from voice complaints had greater abnormal VHI than those who did not suffer. Similarly, a previous study conducted in Iran showed that the main complaints were vocal fatigue and hoarseness, with a significant difference between the complaining and non-complaining groups regarding the VHI scale [ 26 ]. This association between voice complaints and high VHI scores (abnormal VHI) could be explained by the fact that vocal complaints can interfere with daily or social activities, which raises the VHI score. More than 60% of the participants with abnormal VHI responded to examination by videolaryngostroboscopy. A variety of pathological changes, including reflux laryngitis, vocal fold polyps, nodules or paresis, phonasthenia, sulcus vocalis, and hyperfunction dysphonia, were found during this examination. These alterations were used to classify VDs into four categories: organic VDs, functional VDs, MAPLs, and mixed lesions. These results align with previous research on professional voice users [ 27 – 29 ]. Functional VDs were the most frequent laryngeal pathology; it was in line with a previous study conducted on an academic population [ 30 ]. Another study by Preciado-López et al. reported that the prevalence of voice disorders among teaching staff was 57.1%: 28.8% for functional dysphonia, 20.25% for organic dysphonia, and 8.1% for chronic laryngitis [ 31 ]. Of the participants in the study, less than one-third knew information about voice care. This was consistent with earlier studies [ 6 , 32 ]. It demonstrates how important it is to implement a health education program that helps these participants understand the healthy habits necessary to maintain their voice. This investigation reported that different sociodemographic characteristics were significantly associated with abnormal VHI, such as female gender; this was in line with prior studies [ 31 , 32 ]. It may be attributed to the vocal fold containing hormonal receptors, and female hormones can impact the laryngeal neuromuscular functions [ 33 ]. On the other hand, previous studies’ results showed no relationship between voice abnormalities and gender [ 7 , 10 ]. Therefore, additional research concerning gender variation with voice disorders is required. Also, those who married, had children, and worked a job ranked as teaching staff were significantly associated with abnormal VHI, which may be attributed to excessive voice utilization. In contrast, a previous study in Saudi Arabia [ 2 ] reported no association with marital status, having children, or the academic job rank. Nevertheless, there was no significant association found in this study between smoking and abnormal VHI, like the findings of previous research [ 2 , 10 ]. On the contrary, a prior study indicated that among Spanish teaching professionals, smoking was a significant risk associated with voice abnormalities [ 31 ]. Most of the participants in this study were female staff who did not smoke, which might be to blame for this diversity. Among habitual and medical characteristics of the studied participants, the use of a loud voice, inadequate water intake, GERD, and chronic sinusitis were significantly associated with abnormal VHI. It agrees with previous studies that found the significant association between abnormal VHI with loud voice and medical history [ 2 , 7 , 9 ]. After adjusting for all independent variables in binary logistic regression, all of these sociodemographic characteristics were not significant predictors of abnormal VHI; however, occupational, behavioral, and genetic characteristics, such as job rank as a teaching staff member, the frequency of weekly teaching sessions, the absence of amplifier use, insufficient water consumption, and positive family history, were significant predictors. This is in keeping with a previous study conducted in Saudi Arabia, which determined that all sociodemographic characteristics were not significant factors for the perception of voice abnormality [ 2 ]. Frequent intake of water was found to be associated with normal VHI; this is supported by a systematic review done by Alves et al. [ 34 ], which had found that increased water intake led to significant improvement in phonation. Also, use of speakers as microphones was a protective factor for voice abnormality. It is supported by a previous trial that approved the role of amplification system use as a preventive measure for VHI abnormality [ 35 ]. There was a strong association between voice abnormality and both the number of weekly teaching sessions and a positive family history. It was in line with a prior study [ 32 ]. It could be attributed to genetics that could result in cellular damage to the vocal folds, which would be exacerbated by occupations that demand extensive voice use [ 36 ]. Conclusion The prevalence of voice problems among the staff members under study was high, and few of them were aware of voice care. The most important contributing factors were frequent weekly teaching sessions, position as a teaching staff member, inadequate water intake, lack of speaker use, and a positive family history. These highlight the necessity of implementing a health education program for voice care to lessen this problem. Additionally, conduct routine VHI and videolaryngostroboscopy examinations for university staff who exhibit anomalies. Strengths and limitations The VHI-10, a validated instrument, was used in this study to identify voice disorders among university staff members; therefore, the results are more accurate than self-reporting the severity of voice problems. As well as the videolaryngostroboscopy examination, it was utilized to diagnose the underlying pathology and categories of VDs. It listed several associated factors. There were certain restrictions. As a cross-sectional study, it only shows associations rather than causative links. Moreover, the use of convenience sampling limits the generalizability of the findings. It was suggested that more long-term studies, such as cohorts or experiments, be conducted to detect the causal relationship and assess the implications of different preventive measures. Supplementary Information Supplementary Material 1 (548.9KB, pdf) Acknowledgements We were very grateful to the faculty members from Menoufia University for their participation in this study. Abbreviations VDs Voice Disorders VHI-10 Voice Handicap Index-10 aOR adjusted Odds Ratio CI Confidence Interval MAPLs Minimal Associated Pathological Lesions GERD Gastroesophageal Reflux Disease Author contributions Conceptualization, FEY; methodology, FEY, SA, EFE, AMA, NM, ShYA; writing—original draft preparation, FEY, SA, EFE, AMA, NM, ShYA; data curation, SA, FEY; writing—review and editing, FEY, SA, EFE, AMA, NM, ShYA. All authors gave their approval to the final article. Funding Open access funding provided by The Science, Technology & Innovation Funding Authority (STDF) in cooperation with The Egyptian Knowledge Bank (EKB). This study receives no funding or financial support. Data availability Data will be available upon a reasonable request. Declarations Ethics approval and consent to participate Approval to perform this study was granted by the Menoufia Faculty of Medicine Research Ethics Committee with IRB (7/2025 COM 14 − 1). This investigation followed the Declaration of Helsinki’s ethical guidelines and precepts. Each participant received an explanation of the study’s objectives and specifics. It was entirely voluntary to participate. Informed consent was obtained from all participants prior to participation. Personal information was kept confidential. Consent for publication Not applicable. Competing interests The authors declare no competing interests. Footnotes Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. References 1. American Speech-Language-Hearing Association. Definitions of Communication Disorders and Variations. Last accessed on 10 December 2025. Available online: https://www.asha.org/policy/RP1993-00208/ . 2. Al Awaji NN, Alghamdi KA, Alfaris AM, Alzamil RZ, Alhijji LN, Alyehya GS, et al. Measuring perceived voice disorders and quality of life among female university teaching faculty. J Pers Med. 2023;13(11):1568. 10.3390/jpm13111568. [ DOI ] [ PMC free article ] [ PubMed ] 3. Fageeh YA, Alotaibi TA, Althobaiti NSA, Alkhaldi AA, Althobaiti AA, Althobaiti HA, et al. Voice disorders among teachers in Taif City, Kingdom of Saudi Arabia. Cureus. 2024;16(2):e54561. 10.7759/cureus.54561. [ DOI ] [ PMC free article ] [ PubMed ] 4. Gomes NR, Teixeira LC, de Meiros AM. Vocal symptoms in university professors: their association with vocal re-sources and with work environment. J Voice. 2020;34:352–7. 10.1016/j.jvoice.2018.10.010. [ DOI ] [ PubMed ] 5. Oliveira P, Ribeiro VV, Constantini AC, Cavalcante MEOB, Sousa MDS, da Silva K. Prevalence of work-related voice disorders in voice professionals: systematic review and meta-analysis. J Voice. 2025;39(1):84–104. 10.1016/j.jvoice.2022.07.030. [ DOI ] [ PubMed ] 6. Mahmoud NF, Khaled DMF, Mohammed HO. Knowledge of Egyptian faculty members about voice care: a national cross‑sectional study. Egypt J Otolaryngol. 2022;38:1–9. 10.1186/s43163-022-00247-5. 7. Ahmed EE, Bukhari MA, Melibary RA. Voice disorders among academic staff at king saud university medical college (comparison between basic science and clinical staff). J Otolaryngol ENT Res. 2017;8(1):394–6. 10.15406/joentr.2017.08.00233. 8. Azari S, Aghaz A, Maarefvand M, Ghelichi L, Pashazadeh F, Shavaki YA. The prevalence of voice disorders and the related factors in university professors: a systematic review and meta-analysis. J Voice. 2024;38(5):1103–14. 10.1016/j.jvoice.2022.02.017. [ DOI ] [ PubMed ] 9. Alharbi NS, Alotaibi S, Alnughaythir AI, Abohelaibah F, Alruways AQ, Alharbi R, et al. Prevalence and risk factors of voice disorders among teachers in Saudi Arabia. Cureus. 2024;16(3):e56540. 10.7759/cureus.56540. [ DOI ] [ PMC free article ] [ PubMed ] 10. Ghayoumi-Anaraki Z, Heidarian-Miri H, Zainaee S, Rahmani S, Haresabadi F, Effati M, et al. Prevalence and risk factors of voice disorders in university teaching faculty members: a pilot study. JRSR. 2020;7(4):173–7. 11. Jacobson B, Johnson A, Grywalski C, et al. Voice Handicap Index (VHI): development and validation. Am J Speech Lang Pathol. 1997;6:66‒70. 12. Hogikyan ND, Sethuraman G. Validation of an instrument to measure voice-related quality of life (V-RQOL). J Voice. 1999;13(4):557–69. [ DOI ] [ PubMed ] 13. Deary IJ, Wilson JA, Carding PN, MacKenzie K. VoiSS: a patient-derived voice symptom scale. J Psychosom Res. 2003;54(5):483–9. [ DOI ] [ PubMed ] 14. Lopes LW, de Oliveira Florencio V, Silva POC, da Nóbrega E Ugulino AC, Almeida AA. Vocal tract discomfort scale (VTDS) and voice symptom scale (VoiSS) in the evaluation of patients with voice disorders. J Voice. 2019;33(3):381.e23-381.e32. 10.1016/j.jvoice.2017.11.018. [ DOI ] [ PubMed ] 15. Rosen CA, Lee AS, Osborne J, Zullo T, Murry T. Development and validation of the voice handicap index-10. Laryngoscope. 2004;114(9):1549–56. 10.1097/00005537-200409000-00009. [ DOI ] [ PubMed ] 16. Arffa RE, Krishna P, Gartner-Schmidt J, Rosen CA. Normative values for the voice handicap index-10. J Voice. 2012;26(4):462–5. 10.1016/j.jvoice.2011.04.006. [ DOI ] [ PubMed ] 17. Abdelhay SA, Abdelgoad A, Elawady MA, Khaled DMF. The validation of the voice-related quality of life (V-RQOL): Arabic version. Egypt J Ear Nose Throat Allied Sci. 2022;23(23):1–6. 18. Darawsheh WB, Shdaifat A, Natour YS. Validation of the Arabic version of vocal tract discomfort scale. Logoped Phoniatr Vocol. 2020;45(2):82–90. 10.1080/14015439.2019.1630481. [ DOI ] [ PubMed ] 19. EL‑Ghoneimy SM, Khalifa MA. Prevalence of voice disorders and associated factors among primary school teachers in Alexandria, Egypt. Alexandria J Med. 2017;53(4):363–70. 20. Abdel-Hamid MA, Fahmy VF, Momen MA, Elokda EE. Prevalence, risk factors and impact of voice disorders among primary school teachers in Cairo, Egypt. Egypt J Community Med. 2020;38(1):33–41. 10.21608/ejcm.2020.68618. 21. Alanazi R, Alrahim A, Bayounos S, Al-Ghuwainem A, Al-Bar MH. Association between voice handicap index and reflux symptom index: a cross-sectional study of undiagnosed general and teacher cohorts in Saudi Arabia. Sultan Qaboos Univ Med J. 2018;18(3):e350–4. [ DOI ] [ PMC free article ] [ PubMed ] 22. Farahat M. Validation and reliability of Arabic voice handicap index-10. Saudi Journal of Otorhinolaryngology Head and Neck Surgery. 2012;14(1):11–8. 10.4103/1319-8491.274765. 23. Vindrani N, Patel M, Gaur S, Singh V. Role of videolaryngoscopy in patients with hoarseness of voice. Santosh University Journal of Health Sciences. 2019;5(2):109–12. 10.18231/j.sujhs.2019.023. 24. Sulica L. Laryngoscopy, stroboscopy and other tools for the evaluation of voice disorders. Otolaryngol Clin North Am. 2013;46(1):21–30. 10.1016/j.otc.2012.09.001. [ DOI ] [ PubMed ] 25. Kotby MN. The accent method of voice therapy. San Deigo: Singular publishing group; 1995. 26. Azari S, Amiri Shavaki Y, Ghelichi L, Moossavi A, Saneii SH. Voice handicap index in Iranian rehabilitation professors with and without vocal complaints. Middle East Journal of Rehabilitation and Health Studies. 2022;9(3):e121048. 10.5812/mejrh-121048. 27. Heman-Ackah YD, Dean CM, Sataloff RT. Strobovideolaryngoscopic findings in singing teachers. Journal of voice: official journal of the Voice Foundation. 2002;16(1):81–6. 10.1016/s0892-1997(02)00075-9. [ DOI ] [ PubMed ] 28. Kwok M, Eslick GD. The impact of vocal and laryngeal pathologies among professional singers: a meta-analysis. J Voice. 2019;33:58–65. 10.1016/j.jvoice.2017.09.002. [ DOI ] [ PubMed ] 29. Muniraju M, Chaithanya M. A study on videostroboscopic changes and voice analysis in professional voice users. Int J Otorhinolaryngol Head Neck Surg. 2025;11:126–30. 10.18203/issn.2454-5929.ijohns20250790. 30. Brinca L, Nogueira P, Tavares AI, Batista AP, Gonçalves IC, Moreno ML. The prevalence of laryngeal pathologies in an academic population. J Voice. 2015;29(1):130.e1-130.e9. 10.1016/j.jvoice.2014.04.009. [ DOI ] [ PubMed ] 31. Preciado-López J, Pérez-Fernández C, Calzada-Uriondo M, Preciado-Ruiz P. Epidemiological study of voice disorders among teaching professionals of La Rioja. J Voice. 2008;22(4):489–508. 10.1016/j.jvoice.2006.11.008. [ DOI ] [ PubMed ] 32. Alshuhayb BS, Alkhars AZ, AlMaghlouth MK, Alkhars FS, Alamer ZA, Alarfaj AA, et al. Voice disorders among teachers in Al-Ahsa, Eastern Region, KSA: vocal complaints, treatment-seeking behaviors, and knowledge of vocal care. J Voice. 2025;39(1):147–57. 10.1016/j.jvoice.2022.07.001. [ DOI ] [ PubMed ] 33. Lenell C, Sandage MJ, Johnson AM. A tutorial of the effects of sex hormones on laryngeal senescence and neuromuscular response to exercise. J Speech Lang Hear Res. 2019;62(3):602–10. 10.1044/2018_JSLHR-S-18-0179. [ DOI ] [ PMC free article ] [ PubMed ] 34. Alves M, Krüger E, Pillay B, van Lierde K, van der Linde J. The effect of hydration on voice quality in adults: a systematic review. J Voice. 2019;33(1):125.e13-125.e28. 10.1016/j.jvoice.2017.10.001. [ DOI ] [ PubMed ] 35. Bovo R, Trevisi P, Emanuelli E, Martini A. Voice amplification for primary school teachers with voice disorders: a randomized clinical trial. Int J Occup Med Environ Health. 2013;26(3):363–72. 10.2478/s13382-013-0115-1. [ DOI ] [ PubMed ] 36. Zabret M, Hočevar Boltežar I, Šereg Bahar M. The Importance of the Occupational Vocal Load for The Occurence and Treatment of Organic Voice Disorders. Slov J Public Health. 2018;57(1):17–24. 10.2478/sjph-2018-0003. [ DOI ] [ PMC free article ] [ PubMed ] Associated Data This section collects any data citations, data availability statements, or supplementary materials included in this article. Supplementary Materials Supplementary Material 1 (548.9KB, pdf) Data Availability Statement Data will be available upon a reasonable request. Articles from BMC Public Health are provided here courtesy of BMC ACTIONS View on publisher site PDF (9.8 MB) Cite Collections Permalink PERMALINK Copy RESOURCES Similar articles Cited by other articles Links to NCBI Databases Cite Copy Download .nbib .nbib Format: AMA APA MLA NLM Add to Collections Create a new collection Add to an existing collection Name your collection * Choose a collection Unable to load your collection due to an error Please try again Add Cancel Follow NCBI NCBI on X (formerly known as Twitter) NCBI on Facebook NCBI on LinkedIn NCBI on GitHub NCBI RSS feed Connect with NLM NLM on X (formerly known as Twitter) NLM on Facebook NLM on YouTube National Library of Medicine 8600 Rockville Pike Bethesda, MD 20894 Web Policies FOIA HHS Vulnerability Disclosure Help Accessibility Careers NLM NIH HHS USA.gov Back to Top