Methodology

This literature review synthesized existing knowledge on the risk factors, prevention, and management of voice disorders. A systematic approach was used to identify, select, and analyze relevant sources.

 

Search strategy

A literature search was conducted in four major electronic databases: PubMed, Scopus, Web of Science, and Google Scholar. The literature search covered publications from 1980 to 2025. This broad timeframe was selected intentionally to include studies and documents from both the Soviet and post-Soviet periods in Georgia. Such inclusion enabled a comprehensive analysis of the evolution of healthcare policies, ethical frameworks, and professional practices across diverse historical and political contexts. Keywords and Medical Subject Headings (MeSH) terms related to voice disorders were used in various combinations, including: "voice disorders," "dysphonia," "occupational voice use," "risk factors," and "prevention." Boolean operators (AND, OR) were applied to refine the search strategy. Reference lists of relevant studies and reviews were also screened to identify additional eligible articles.

 

Eligibility criteria

Studies were included if they met the following criteria: (i) Published in peer-reviewed journals in English or Georgian; (ii) Conducted on adult populations or professional voice users (e.g., teachers, singers); (iii) Focused on prevalence, risk factors, prevention, or management of voice disorders; (iv) Used quantitative, qualitative, or mixed-method approaches, or were systematic reviews/meta-analyses.

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​Studies were excluded if they: (i) Were case reports, editorials, opinion papers, or conference abstracts; (ii) Focused exclusively on surgical/medical interventions without broader discussion of risk or prevention; (iii) Were duplicates or inaccessible in full text.

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Study selection

All identified manuscripts were imported into reference manager software and screened for duplicates. Titles and abstracts were reviewed against the inclusion criteria. Full-text articles of potentially eligible studies were retrieved and assessed for final inclusion. Any discrepancies were resolved through discussion.

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Data extraction

A standardized data extraction form was developed. Information collected included: Author(s), year of publication, and country; Study design and population characteristics; Key focus, such as risk factors or prevention; Main findings and recommendations.

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Data synthesis

Findings were synthesized thematically and organized under major domains: Occupational and environmental risk factors; Individual and lifestyle-related factors; Preventive strategies and interventions; and Management and treatment approaches.

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The results were summarized narratively, highlighting patterns, gaps, and implications for future research and practice.

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Results

Consistent with global patterns, voice disorders worldwide represent a heterogeneous group of conditions that compromise vocal endurance, intensity, and acoustic quality, thereby affecting both occupational performance and quality of life. Their etiology is multifactorial, encompassing phonotraumatic behaviors associated with chronic vocal overuse and misuse, structural laryngeal anomalies, neurogenic pathologies such as vocal fold paralysis or movement disorders, and psychogenic contributors linked to stress and anxiety. Occupational voice users - including teachers, singers, actors, call-center operators, and other professionals who rely heavily on sustained phonation - are particularly vulnerable due to the cumulative demands placed on the vocal apparatus.8,13,19-21 Epidemiological data suggest that the prevalence of such disorders may be underreported in some parts of the world, particularly in the Caucasus region, including Georgia, due to limited awareness and the absence of systematic screening programs. Advancing effective prevention and therapeutic strategies, therefore, requires a nuanced understanding of prevalence, risk factors, and underlying mechanisms. Integrating multidisciplinary approaches - spanning otolaryngology, speech-language pathology, occupational health, and psychology - is critical to reducing the burden of voice disorders and improving both clinical outcomes and public health responses.

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The most common risk factors for the development of vocal disorders are occupational, behavioral, and psychological factors. Different etiological factors may contribute to voice abnormalities across age groups. In addition to physiological factors, concomitant chronic diseases, tobacco use, patient sex, occupation, and other factors are significant contributors to dysphonia.18,22

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Teachers, singers, telemarketers, and others who use their voices professionally should maintain a healthy voice.13,15 Due to overuse or misuse of their voices, many persons who use their voices for work have been found to have a higher incidence of vocal disorders than people who do not use their voices for work.23 One occupational group identified as having a higher likelihood of voice issues is teachers.15,24 According to earlier research, between 10% and 70% of this population had a vocal issue.25,26 Vocal fatigue,1,27,28 hoarseness,29-32 and throat discomfort27 are among the many voice problems that many teachers experience.

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Over 43% of teachers may at some point in their careers encounter voice problems, and 7% may be forced to quit teaching because of persistent or irreversible vocal problems, according to the American Academy of Otolaryngology.33 This high prevalence has significant ramifications for the entire educational system, since teacher turnover and absence can affect student learning outcomes, in addition to personal health and career sustainability. Additionally, a lot of impacted educators put off getting help, frequently underestimating the intensity of their symptoms, which can worsen vocal strain and result in long-term issues. Given the demands of their jobs, functional voice problems among educators are a serious public health issue that requires institutional voice care policies, early intervention, and routine screening to protect these vital workers' vocal health.8

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In extreme situations, individuals may also develop vocal abnormalities, including vocal nodules, according to studies.34 The beginning of voice abnormalities can have detrimental effects on a person's social life in addition to their health. Voice problems cause teachers to perform worse on the job.35 They are more likely to take sick leave26 or leave of absence.36 Additionally, a higher percentage of teachers quit because of vocal problems.37 Teachers' social lives and communication skills may also be negatively impacted by voice issues.19

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To draw in pupils and hold their interest, teachers - the most researched group of voice professionals34,38,39 - require more than just a strong voice; they also need a particular kind of communication skills.40 Teachers who lecture or reprimand students in a monologue format for five to seven hours a day are subject to the highest vocal demands, which frequently become louder and more forceful as the day goes on.13 However, to effectively create classroom authority and cultivate productive working relationships with students, all teachers require a functional voice.41

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Teachers and speakers are significantly more likely to sustain voice damage than individuals in other occupations, according to De Alvear et al. (2010). Aphonia (total loss of voice),42  hoarseness, weak voice, and throat pain are some of the symptoms.42 Because professionals utilize their voice as a tool for work, the risk increases with the intensity of use. Teachers are especially susceptible; thus, it is crucial to understand the causes and examine the characteristics of their voices. Environmental factors cause voice problems, and vocal hygiene education can help avoid them.43

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As stated above, despite teachers, other occupations are also risk factors for voice disorders. For salespeople, an effective voice is essential to success because it shapes the initial impression they make on clients. Travel and ticket agents talk to customers on the phone and in person for much of the day. Public relations professionals and receptionists serve as the public faces and spokespersons for their companies and organizations. They are in charge of welcoming guests and acting as the public's and media's point of contact. Politicians and journalists are in occupations that demand lively and expressive discourse as well.44

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Sports coaches' vocal health may be affected by occupational vocal demands. Given coaches' high voice loads during coaching duties and their reported poor occupational vocal health, this is especially crucial. Coaches' vocal performance and health may also be impacted by their lack of knowledge about vocal health management and usage. Further investigation into coaches' occupational voice health is necessary, given the exploratory nature of this study. Members of musical choirs and sports coaches, particularly those without formal training in voice technique, are also impacted by voice problems.45

 

A high, thin, breathy, unsteady, or reedy voice can be caused by age-related changes in the body, such as reduced lung capacity and loss of strength and muscular tone. Vocal fatigue and reduced volume are also common. 46 Due to pathological or natural changes, vocal abnormalities are common in older persons and can affect quality of life and communication. The prevalence among those over 60 ranges from 4.8% to 29.1%.46 Presbyphonia and dysphonia are terms that describe voice changes associated with ageing, including vocal weakness, hoarseness, and pitch breaks or any voice disorder, including those caused or exacerbated by age-related changes, respectively.47

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The studies revealed that voice disorders can affect more women in adulthood compared with men. There was no gender difference in dysphonia awareness. After therapy, the women reported that their subjective perceptions and acoustic analyses of their voices had improved.20 Some studies also exposed that oral contraceptives and/or hormone replacement therapy increase the risk of developing voice disorders by five times among females compared with men.21

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Depending on a person's age or sex, vocal problems can be defined as aberrant production or absence of vocal quality, pitch, loudness, and resonance. They result from several biological processes and risky habits, such as smoking, clearing one's throat, coughing, screaming, yelling, breathing irritants, and talking too much, which strain or damage the vocal folds.9,41

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Some studies on the general population explored that the risk factors, such as tobacco or alcohol, did not independently increase the odds of reporting a chronic voice disorder.5 Other studies proved that smoking is the leading risk factor for voice health.48 Smoking also causes laryngeal disease.49

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Additionally, it was established that chronic smoking could result in vocal cord disorders like leukoplakia, Reinke's edema, and laryngitis.50 Additionally, it was discovered that smokers are more likely than non-smokers to develop some malignancies, including laryngeal, pharyngeal, and oral cancer.50,51 Meta-analysis also confirmed that smoking had significant and moderate effects on the voice fundamental frequency, Maximum Phonation Time (MPT), Voice Handicap Index (VHI), and physical functions.52

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The research conducted in the USA revealed that voice disorders among young adults were associated with the number of days of drinking.53 Other studies also explore that frequent consumption of alcohol is associated with laryngeal disease.43

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Significant psychological impacts, such as elevated rates of stress, anxiety, and depression relative to the general population, are often linked to voice issues. Depression symptoms, anxiety, and elevated stress levels are a few examples of these impacts. In addition to experiencing more challenging life situations, people with voice issues may also display a more noticeable neurotic tendency. Some people experience worsening psychological distress symptoms after developing a voice issue, which raises questions about causality.54

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Big data analysis in the United States found that the presence of depressive symptoms was linked to a nearly two-fold increase in the likelihood of voice problems and that there was a significant relationship between depressive symptoms and the effectiveness and reception of voice therapy.55 A study done in one of the Asian countries found a positive correlation between self-recognition of voice disorder and mental health status.54

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Notably, no information on risk factors for voice disorder development in Georgia was found. The publication in English or Georgian was not found.