Author(s)
Joseph Spellman, MD, LCDR
Christopher M. Johnson, MD, LCDR
Carole R. Roth, PhD
Michael J. Coulter, MD, LT
Affiliation(s)
Naval Medical Center San Diego
Abstract:
Introduction: Prior studies have evaluated populations at increased risk of voice overuse and dysphonia, however, little work has been done for drill instructors. The purpose of this study was to determine the prevalence of subjective and objective dysphonia in drill instructors and evaluate factors associated with dysphonia. Methods: A cross-sectional analysis of 151 active military drill instructors was undertaken investigating demographics, validated subjective measures of dysphonia, and questions related to impact on function. Acoustic and cepstral-spectral analyses were also performed. Multiple linear regression and ANOVA were used to evaluate associations of voice use with measures of dysphonia. Predictors of dysphonia were compared by univariate analysis. Results: Subjective dysphonia was present in 47.7% by the Voice Handicap Index-10 (VHI-10). 47% and 11.9% of subjects reported voice problems limiting to function for at least 1 day and at least 1 week, respectively, in the month prior to being surveyed. The mean Cepstral-Spectral Index of Dysphonia (CSID) and Rainbow Passage CSID were abnormal in 95.8% and 100%, respectively. There was no progression of dysphonia as the number of completed training cycles increased. However, there was significant improvement based on time elapsed since the last training cycle. Conclusions: There is a strikingly high prevalence of dysphonia in drill instructors. The VHI-10 may underestimate impairment in this population based on comparison to CSID. Dysphonia develops shortly after the initiation of recruit training. There was no evidence of progression of dysphonia over time, however, there was a relationship between rest and improvement.