Behind the Headset: Predictive Accuracy of Patient-Reported Outcome Measures for Voice Symptoms in Call Centers

Detrás de los auriculares: precisión predictiva de las medidas de resultados informadas por el paciente para los síntomas de voz en call centers

Abstract


Objective. This study examines factors predicting self-reported voice symptoms in call center workers.


Methods. Multivariate analysis and predictive modeling assess personal, work-related, acoustic, and behavioral factors. Generalized Linear Models (GLMs) and Receiver Operating Characteristic (ROC) curves are employed.


Results. Age and sleep patterns impacted voice quality and effort, while workplace factors influenced symptom perception. Unhealthy vocal behaviors related to tense voice and increased effort, while hydration was protective. Voice acoustics showed diagnostic potential, supported by ROC data. These findings emphasize voice symptom complexity in call center professionals, necessitating comprehensive assessment.


Limitations. This study recognizes its limitations, including a moderate-sized convenience sample and reliance on PROM metrics. Future research should incorporate more objective measures in addition to self-reports and acoustic analysis.


Value. This research provides novel insights into the interplay of personal, occupational, and voice-related factors in developing voice symptoms among call center workers. Predictive modeling enhances risk assessment and understanding of individual susceptibility to voice disorders.


Conclusion. Results show associations between various factors and self-reported voice symptoms. Protective factors include sleeping more than six hours and consistent hydration, whereas risk factors include working conditions, such as location and behaviors like smoking. Diagnostic models indicate good accuracy for some voice symptom PROMs, emphasizing the need for comprehensive models considering work factors, vocal behaviors, and acoustic parameters to understand voice issues complexity.


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Authors


Adrián Castillo-Allendes Department of Communicative Sciences and Disorders; Michigan State University; East Lansing; Michigan; United States. / Department of Communication Sciences and Disorders; The University of Iowa; Iowa City; United States
Lady Catherine Cantor-Cutiva Department of Communication Sciences and Disorders; The University of Iowa; Iowa City; United Sta
Eduardo Fuentes-López Department of Health Sciences; School of Medicine; Pontificia Universidad Católica de Chile; Santiago; Chile
Eric J. Hunter Department of Communication Sciences and Disorders; The University of Iowa; Iowa City; United States

References


Fuentes-López E, Fuente A, Contreras KV. Inadequate vocal hygiene habits associated with the presence of self-reported voice symptoms in telemarketers. Logop Phoniatr Vocology [Internet]. 2019 Jul 3;44(3):105-14. doi: https://doi.org/10.1080/14015439.2017.1414302

Altundas Hatman E, Torun SD. Occupational diseases among call center operators needing vocal rehabilitation. Med Lav [Internet]. 2022;113(3):e2022026. doi: https://doi.org/10.23749/mdl.v113i3.12897

Devadas U, Rajashekhar B. The prevalence and impact of voice problems in call center operators. J Laryngol Voice [Internet]. 2013 Jan 1;3(1):3-9. doi: https://doi.org/10.4103/2230-9748.118696

Cantor-Cutiva LC. Association between occupational voice use and occurrence of voice disorders a meta-analysis. Areté [Internet]. 2018 Dec 31;18(2):1-10. doi: https://doi.org/10.33881/1657-2513.art.18201

da Silva Dantas BTSE, Enéas ELS, de Azevedo SLG, da Silva MIB, de Lima-Silva MFB. Vocal Health, Working Conditions and Their Implications on the Occupational Health of Telemarketers: An Integrative Review. J Voice [Internet]. 2021 Mar 7;37(3):468.e13-468.e21. doi: https://doi.org/10.1016/j.jvoice.2021.02.008

Girardi BB, Marchand DLP, Moreira T de C, Drummond RL, Cassol M. Relação entre condições de trabalho e sintomas vocais em operadores de um call center modelo. Audiol Commun Res [Internet]. 2017;22(0):1-7. doi: http://doi.org/10.1590/2317-6431-2016-1738

Mori MC, Francis DO, Song PC. Identifying Occupations at Risk for Laryngeal Disorders Requiring Specialty Voice Care. Otolaryngol Head Neck Surg [Internet]. 2017 Sep 12;157(4):670-75. doi: https://doi.org/10.1177/0194599817726528

Byeon H. Occupational risks for voice disorders: Evidence from a Korea national cross-sectional survey. Logoped Phoniatr Vocol [Internet]. 2017 Jan 2;42(1):39-43. doi: https://doi.org/10.1080/14015439.2016.1178326

Phyland D, Miles A. Occupational voice is a work in progress: active risk management, habilitation and rehabilitation. Curr Opin Otolaryngol Head Neck Surg [Internet]. 2019 Dec;27(6):439-47. doi: https://doi.org/10.1097/MOO.0000000000000584

Bainbridge KE, Roy N, Losonczy KG, Hoffman HJ, Cohen SM. Voice disorders and associated risk markers among young adults in the United States. Laryngoscope [Internet]. 2017 Sep;127(9):2093–99. doi: https://doi.org/10.1002/lary.26465

Morawska J, Niebudek-Bogusz E. Risk factors and prevalence of voice disorders in different occupational groups – a review of literature. Otorynolaryngologia [Internet]. 2017;16(3):94-102. Available from: https://bibliotekanauki.pl/articles/1033326.pdf

Castillo‐Allendes A, Guzmán‐Ferrada D, Hunter EJ, Fuentes‐López E. Tracking Occupational Voice State with a Visual Analog Scale: Voice Quality, Vocal Fatigue, and Effort. Laryngoscope [Internet]. 2022 Sep 22;133(7):1676-82. doi: https://doi.org/10.1002/lary.30398

Francis DO, Daniero JJ, Hovis KL, Sathe N, Jacobson B, Penson DF, et al. Voice-Related Patient-Reported Outcome Measures: A Systematic Review of Instrument Development and Validation. J Speech Lang Hear Res [Internet]. 2017 Jan 1;60(1):62-88. doi: https://doi.org/10.1044/2016_JSLHR-S-16-0022

Slavych BK, Zraick RI, Ruleman A. A Systematic Review of Voice-Related Patient-Reported Outcome Measures for Use with Adults. J Voice [Internet]. 2021 Nov 12; S0892-1997(21)00340-4. doi: https://doi.org/10.1016/j.jvoice.2021.09.032

Ranapurwala SI, Cavanaugh JE, Young T, Wu H, Peek-Asa C, Ramirez MR. Public health application of predictive modeling: an example from farm vehicle crashes. Inj Epidemiol [Internet]. 2019 Jun 17;6(1):31. doi: https://doi.org/10.1186/s40621-019-0208-9

Martínez-Cifuentes R, Torres-Bustos V, Sáez-Carrillo K. Textos utilizados en la evaluación de adultos chilenos con trastornos del habla de origen neurológico. Rev Logop Foniatría y Audiol [Internet]. 2020 Apr 1;40(2):77-82. doi: https://doi.org/10.1016/j.rlfa.2019.11.002

Celestina M, Hrovat J, Kardous CA. Smartphone-based sound level measurement apps: Evaluation of compliance with international sound level meter standards. Appl Acoust [Internet]. 2018 Oct 1;139:119-28. doi: https://doi.org/10.1016/j.apacoust.2018.04.011

Celestina M, Kardous CA, Trost A. Smartphone-based sound level measurement apps: Evaluation of directional response. Appl Acoust [Internet]. 2021 Jan 1;171:107673. doi: https://doi.org/10.1016/j.apacoust.2020.107673

Kardous CA, Shaw PB. Evaluation of smartphone sound measurement applications. J Acoust Soc Am [Internet]. 2014 Mar 21;135(4):EL186–92. doi: https://doi.org/10.1121/1.4865269

Isshiki N, Okamura H, Morimoto M. LXXXIII Maximum phonation time and air flow rate during phonation: simple clinical tests for vocal function. Ann Otol Rhinol Laryngol [Internet]. 1967 Dec;76(5):998-1007. doi: https://doi.org/10.1177/000348946707600510

Maslan J, Leng X, Rees C, Blalock D, Butler SG. Maximum Phonation Time in Healthy Older Adults. J Voice [Internet]. 2011 Nov;25(6):709-13. doi: https://doi.org/10.1016/j.jvoice.2010.10.002

Núñez-Batalla F, Corte-Santos P, Señaris-González B, Llorente-Pendás JL, Górriz-Gil C, Suárez-Nieto C. Adaptation and validation to the Spanish of the Voice Handicap Index (VHI-30) and its shortened version (VHI-10). Acta Otorrinolaringol Esp [Internet]. 2007 Nov;58(9):386-92. doi: https://doi.org/10.1016/S2173-5735(07)70376-9

Rosen CA, Lee AS, Osborne J, Zullo T, Murry T. Development and Validation of the Voice Handicap Index-10. Laryngoscope [Internet]. 2004;114(9):1549-56. doi: https://doi.org/10.1097/00005537-200409000-00009

Carter JV, Pan J, Rai SN, Galandiuk S. ROC-ing along: Evaluation and interpretation of receiver operating characteristic curves. Surgery [Internet]. 2016 Mar 5;159(6):1638-45. doi: https://doi.org/10.1016/j.surg.2015.12.029

Hajian-Tilaki K. Receiver Operating Characteristic (ROC) Curve Analysis for Medical Diagnostic Test Evaluation. Caspian J Intern Med [Internet]. 2013;4(2):627-35. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3755824/

Sato K, Hirano M, Nakashima T. Age-Related Changes of Collagenous Fibers in the Human Vocal Fold Mucosa. Ann Otol Rhinol Laryngol [Internet]. 2002 Jan;111(1):15-20. doi: https://doi.org/10.1177/000348940211100103

Taylor S, Dromey C, Nissen SL, Tanner K, Eggett D, Corbin-Lewis K. Age-Related Changes in Speech and Voice: Spectral and Cepstral Measures. J Speech Lang Hear Res [Internet]. 2020 Mar 23;63(3):647-60. doi: https://doi.org/10.1044/2019_JSLHR-19-00028

Xue SA, Hao GJ. Changes in the Human Vocal Tract Due to Aging and the Acoustic Correlates of Speech Production: a Pilot Study. J Speech Lang Hear Res [Internet]. 2003 Jun;46(3):689-701. doi: https://doi.org/10.1044/1092-4388(2003/054)

Carrillo-Gonzalez A, Camargo-Mendoza M, Cantor-Cutiva LC. Relationship Between Sleep Quality and Stress with Voice Functioning among College Professors: A Systematic Review and Meta-analysis. J Voice [Internet]. 2021 May;35(3):499.e13-499.e21. doi: https://doi.org/10.1016/j.jvoice.2019.11.001

Bagnall AD, Dorrian J, Fletcher A. Some Vocal Consequences of Sleep Deprivation and the Possibility of “Fatigue Proofing” the Voice with Voicecraft® Voice Training. J Voice [Internet]. 2011 Mar 14;25(4):447-61. doi: https://doi.org/10.1016/j.jvoice.2010.10.020

Icht M, Zukerman G, Hershkovich S, Laor T, Heled Y, Fink N, et al. The “Morning Voice”: The Effect of 24 Hours of Sleep Deprivation on Vocal Parameters of Young Adults. J Voice [Internet]. 2020 May;34(3):489.e1-489.e9. doi: https://doi.org/10.1016/j.jvoice.2018.11.010

Ishikawa K, Thibeault S. Voice Rest Versus Exercise: a Review of the Literature. J Voice [Internet]. 2010 Jul;24(4):379-87. doi: https://doi.org/10.1016/j.jvoice.2008.10.011

Vyazovskiy VV. Sleep, recovery, and metaregulation: explaining the benefits of sleep. Nat Sci Sleep [Internet]. 2015 Dec 17;7:171-84. doi: https://doi.org/10.2147/NSS.S54036

Cantor-Cutiva LC. Relationship Between Room Acoustics With Voice Symptoms and Voice-Related Quality of Life Among Colombian School and College Teachers During Online Classes in Times of COVID-19 Pandemic. J Voice [Internet]. Forthcoming 2022 Mar 13. doi: https://doi.org/10.1016/j.jvoice.2022.03.008

Bottalico P, Codino J, Cantor-Cutiva LC, Marks K, Nudelman CJ, Skeffington J, et al. Reproducibility of Voice Parameters: The Effect of Room Acoustics and Microphones. J Voice [Internet]. 2020 May;34(3):320-34. doi: https://doi.org/10.1016/j.jvoice.2018.10.016

Santos CTD, Santos C, Lopes LW, Silva POC, Lima-Silva MFB de. Relationship between working and voice conditions self-reported by telemarketers of an emergency call center. Codas. 2016 Oct 24;28(5):583-94. doi: https://doi.org/10.1590/2317-1782/20162015125

Oliveira P, Ribeiro VV, Constantini AC, Cavalcante ME de OB, Sousa MDS, da Silva K. Prevalence of Work-Related Voice Disorders in Voice Professionals: Systematic Review and Meta-Analysis. J Voice [Internet]. Forthcoming 2022 Aug 31. doi: http://doi.org/10.1016/j.jvoice.2022.07.030

Hazlett DE, Duffy OM, Moorhead SA. Occupational voice demands and their impact on the call-centre industry. BMC Public Health [Internet]. 2009 Apr 20;9:1-5. doi: https://doi.org/10.1186/1471-2458-9-108

Nair CB, Nayak S, Maruthy S, Krishnan JB, Devadas U. Prevalence of Voice Problems, Self-Reported Vocal Symptoms and Associated Risk Factors in Call Center Operators (CCOs): A Systematic Review. J Voice [Internet]. Forthcoming 2021 Aug 30. doi: https://doi.org/10.1016/j.jvoice.2021.07.022

Sampaio MC, Borges Dos Reis EJF, Carvalho FM, Porto LA, Araújo TM. Vocal Effort and Voice Handicap Among Teachers. J Voice [Internet]. 2012;26(6):820.e15-820.e18. doi: https://doi.org/10.1016/j.jvoice.2012.06.003

Porto VF de A, Bezerra TT, Zambon F, Behlau M. Fatigue, effort and vocal discomfort in teachers after teaching activity. Codas [Internet]. 2021;33(4):1-8. doi: http://doi.org/10.1590/2317-1782/20202020067

Hunter EJ, Titze IR. Quantifying vocal fatigue recovery: Dynamic vocal recovery trajectories after a vocal loading exercise. Ann Otol Rhinol Laryngol [Internet]. 2009 Jun;118(6):449-60. doi: https://doi.org/10.1177/000348940911800608

Cantor-Cutiva LC, Bottalico P, Hunter E. Factors associated with vocal fry among college students. Logoped Phoniatr Vocol [Internet]. 2018 Jul;43(2):73-9. doi: https://doi.org/10.1080/14015439.2017.1362468

Castillo A, Casanova C, Valenzuela D, Castañón S. Prevalencia de disfonía en profesores de colegios de la comuna de Santiago y factores de riesgo asociados. Cienc Trab [Internet]. 2015 Apr;17(52):15-21. doi: http://doi.org/10.4067/S0718-24492015000100004

Onen C, Golac H, Tunc Songur E, Kemaloglu YK. Acoustic and Auditory-Perceptual Analysis of Voice in the Female Smokers Who Do Not Have Self-Reported Voice Complaint. J Voice [Internet]. 2023 Mar;37(2):297.e1-297.e6. doi: https://doi.org/10.1016/j.jvoice.2020.12.050

Sivasankar M, Leydon C. The role of hydration in vocal fold physiology. Curr Opin Otolaryngol Head Neck Surg [Internet]. 2010 Jun;18(3):171-5. doi: https://doi.org/10.1097/MOO.0b013e3283393784

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 [Internet]. 2019 Jan;33(1):125.e13-125.e28. doi: https://doi.org/10.1016/j.jvoice.2017.10.001

Antonetti AE da S, Siqueira LTD, Gobbo MP de A, Brasolotto AG, Silverio KCA. Relationship of Cepstral Peak Prominence-Smoothed and Long-Term Average Spectrum with Auditory-Perceptual Analysis. Appl Sci [Internet]. 2020 Dec;10(23):1-12. doi: https://doi.org/10.3390/app10238598

Mahalingam S, Boominathan P, Arunachalam R, Venkatesh L, Srinivas S. Cepstral Measures to Analyze Vocal Fatigue in Individuals with Hyperfunctional Voice Disorder. J Voice [Internet]. 2021 Nov;35(6):815-21. doi: http://doi.org/10.1016/j.jvoice.2020.02.007

Chan MPY, Liberman M. An acoustic analysis of vocal effort and speaking style. Proc Meet Acoust [Internet]. 2022 Apr 7;45(1):1-12. doi: https://doi.org/10.1121/2.0001549

Murton O, Hillman R, Mehta D. Cepstral Peak Prominence Values for Clinical Voice Evaluation. Am J Speech Lang Pathol [Internet]. 2020;29(3):1596-607. doi: https://doi.org/10.1044/2020_AJSLP-20-00001

Hunter EJ, Cantor-Cutiva LC, van Leer E, van Mersbergen M, Nanjundeswaran CD, Bottalico P, et al. Toward a Consensus Description of Vocal Effort, Vocal Load, Vocal Loading, and Vocal Fatigue. J Speech Lang Hear Res [Internet]. 2020 Feb 26;63(2):509-32. doi: https://doi.org/10.1044/2019_JSLHR-19-00057

Maryn Y, Corthals P, Van Cauwenberge P, Roy N, De Bodt M. Toward Improved Ecological Validity in the Acoustic Measurement of Overall Voice Quality: Combining Continuous Speech and Sustained Vowels. J Voice [Internet]. 2010 Sep;24(5):540-55. doi: https://doi.org/10.1016/j.jvoice.2008.12.014

Patel RR, Awan SN, Barkmeier-Kraemer J, Courey M, Deliyski D, Eadie T, et al. Recommended Protocols for Instrumental Assessment of Voice: American Speech-Language-Hearing Association Expert Panel to Develop a Protocol for Instrumental Assessment of Vocal Function. Am J Speech Lang Pathol [Internet]. 2018 Aug 6;27(3):887-905. doi: https://doi.org/10.1044/2018_AJSLP-17-0009

Constantini AC, Ribeiro VV, Behlau M. Voice Disorder Classifications: A Scoping Review – Part A. J Voice [Internet]. Forthcoming 2022 Dec 3. doi: https://doi.org/10.1016/j.jvoice.2022.11.016

Moghtader M, Soltani M, Mehravar M, JafarShaterzadehYazdi M, Dastoorpoor M, Moradi N. The Relationship Between Vocal Fatigue Index and Voice Handicap Index in University Professors with and without Voice Complaint. J Voice [Internet]. 2020;34(5):809.e1-809.e5. doi: https://doi.org/10.1016/j.jvoice.2019.01.010

Barsties v. Latoszek B, Kim GH, Delgado Hernández J, Hosokawa K, Englert M, Neumann K, et al. The validity of the Acoustic Breathiness Index in the evaluation of breathy voice quality: A Meta-Analysis. Clin Otolaryngol [Internet]. 2021;46(1):31-40. doi: https://doi.org/10.1111/coa.13629

Castillo-Allendes A, Cantor-Cutiva LC, Hunter EJ. Acoustic Effects of Vocal Warm-Up: A 7-Week Longitudinal Case Study. J Voice [Internet]. Forthcoming 2021 Nov. doi: https://doi.org/10.1016/j.jvoice.2021.09.030

Marsano-Cornejo MJ, Roco-Videla Á. Comparison of the Acoustic Parameters Obtained with Different Smartphones and a Professional Microphone. Acta Otorrinolaringol Esp (Engl Ed) [Internet]. 2022 Jan;73(1):51-5. doi: https://doi.org/10.1016/j.otoeng.2020.08.009

Dejonckere PH, Bradley P, Clemente P, Cornut G, Crevier-Buchman L, Friedrich G, et al. A basic protocol for functional assessment of voice pathology, especially for investigating the efficacy of (phonosurgical) treatments and evaluating new assessment techniques. Eur Arch Otorhinolaryngol [Internet]. 2001 Feb;258(2):77-82. doi: https://doi.org/10.1007/s004050000299

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