Prevalence of and Risk Factors for Self-Reported Voice Problems in Tibetan Monks.

Background: It is observed that Tibetan monks pray for a long duration with inappropriate pitch and loudness. Hence, they may be prone to developing voice problems (VPs). However, the monks are not stressed and do not miss praying in the monastery (which is quite different from many other professional voice users in Western countries). Moreover, no studies have investigated the nature of VPs among Tibetan monks. Such a study may provide insight into the prevalence of and risk factors for VPs and may help enhance our knowledge of the VPs in Tibetan monks.

Study Design: Cross-sectional survey.

Method: A self-reporting questionnaire was distributed among 300 Tibetan monks residing in Namdroling Nyingmapa Monastery, Karnataka, India, from February 2023 to June 2023.

Results: 39% of Tibetan monks experienced VPs in their careers; hoarseness, momentary voice loss/sudden voice changes, and dryness were the most frequently reported symptoms. Monks reporting the presence of VPs also exhibited significantly higher frequencies of different phonotraumatic behaviors like speaking with a loud voice, constantly altering the voice, frequent throat clearing, speaking/chanting during throat infections, or VPs than those who did not report VPs. The results of bivariate regression analysis identified factors such as more than 8hours of prayer duration per day, praying in the presence of musical instruments, not sipping water in between prayers, less than three liters of water intake, and the presence of acid reflux and dry throat, as significant risk factors responsible for VPs in Tibetan monks.

Conclusions: Current results suggest that monks are at a high risk of developing VPs, and several factors (vocational, environmental, lifestyle, and health-related) contribute to the development of VPs. Further, VPs in monks also affect them in terms of missing prayers, interacting less with family/friends, and avoiding social gatherings. Overall, there is a great need to educate the monks about vocal health and preventing VPs.