¿Quién cuida la voz en los ambientes laborales ruidosos?

Who protects the workers’ voice in noisy occupational environments?

En la industria pesada, la exposición continua a altos niveles de ruido obliga a los trabajadores a elevar de manera constante el volumen de su voz para comunicarse, provocando fatiga vocal y disfonía. En la industria metalúrgica, donde se utiliza maquinaria que genera ruido constante y de alta intensidad, los trabajadores tienen una mayor exigencia de esfuerzo vocal porque la comunicación es fundamental para la seguridad operativa. Esto puede derivar en trastornos de la voz que afectan la salud física y, por tanto, el rendimiento profesional.

En el presente artículo se describe la experiencia vivida durante el desarrollo de un proyecto de bienestar social y comunitario enfocado en mejorar la salud vocal en un ambiente laboral ruidoso como lo es una empresa metalúrgica con el fin de reflexionar sobre la importancia de diseñar e implementar protocolos de cuidado de la voz en ambientes laborales ruidosos, reconociendo que la protección de la voz debe ser una prioridad en los programas de salud ocupacional en la industria pesada y que el abordaje integral de los factores que afectan la voz en estos entornos laborales requiere un enfoque interdisciplinario que involucre profesionales especializados en salud y seguridad del trabajo y en fonoaudiología.

In heavy industry, continuous exposure to high noise levels compels workers to repeatedly raise their voices to communicate, causing vocal fatigue and dysphonia. In the metallurgical industry, where machinery generating constant, high-intensity noise is used, workers face higher vocal effort demands because communication is fundamental for operational safety. This can lead to voice disorders that impact physical health and, consequently, occupational performance.

This article describes the experience gained during the development of a social and community wellness project focused on improving vocal health in a noisy work environment, namely a metallurgical company. The objective is to reflect on the importance of designing and implementing voice care protocols in noisy work environments, recognizing that voice protection must be a priority in heavy industry occupational health programs and that a comprehensive approach to the factors affecting the voice in these work environments requires an interdisciplinary approach involving specialists in occupational health and safety and speech-language pathology.

Reflection

Henry David Tovar-Ríos1 Yennifer Paola Albarracín-Villarreal1 Marlon Steve Gutiérrez-Parra1 Yulieth Daniela Patiño-Cano1 Laura Sofía Pérez-Fuerte1 Ela Solano-Diaz1

1 Corporación Universitaria Iberoamericana - Faculty of Health Sciences - Speech-Language Pathology - Bogotá D.C. - Colombia.

Open access

Received: 09/06/2025

Accepted: 27/04/2026

Corresponding author: Henry David Tovar Ríos. Facultad de Ciencias de la Salud, Corporación Universitaria Iberoamericana. Bogotá D.C. Colombia. E-mail: henry.tovar@docente.ibero.edu.co.

Keywords: Speech-Language Pathology; Noise, Occupational; Personal Protective Equipment (MeSH).

Palabras clave: Fonoaudiología; Ruido Ocupacional; Equipos de Protección Personal (DeCS).

How to cite: Tovar-Ríos HD, Albarracín-Villarreal YP, Gutiérrez-Parra MS, Patiño-Cano YD, Pérez-Fuerte LS, Solano-Diaz E. Who protects the workers’ voice in noisy occupational environments? Rev. Fac. Med. 2026;74:e120662. English. doi: https://doi.org/10.15446/revfacmed.v74.120662.

Cómo citar: Tovar-Ríos HD, Albarracín-Villarreal YP, Gutiérrez-Parra MS, Patiño-Cano YD, Pérez-Fuerte LS, Solano-Diaz E. [¿Quién cuida la voz en los ambientes laborales ruidosos?]. Rev. Fac. Med. 2026;74:e120662. English. doi: https://doi.org/10.15446/revfacmed.v74.120662.

Copyright: ©2026 The Author(s). This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium, as long as the original author and source are credited.

Abstract

Resumen

Introduction

In heavy industry, workers are exposed to high levels of background noise, which, among other negative effects, forces them to constantly raise their voice to communicate. This phenomenon is known as the Lombard reflex—an involuntary increase in vocal effort (speaking louder, with a higher pitch, longer syllables, and a shift of speech energy to higher bands) in the presence of noise.1

In the metallurgical industry, where machinery generating constant, high-intensity noise is used for smelting, rolling, and machining tasks, workers face higher vocal effort demands because communication is fundamental for operational safety. This sustained vocal effort can lead to voice disorders that affect physical health and, consequently, work performance.2

Distinguishing between voice production (external factors contributing to situational communicative circumstances, such as noise in a metallurgical company) and voice production response (internal factors or capacities of the speaker) is essential, as this distinction will make it possible to understand that voice alterations in heavy industry workers go beyond excessive voice use in terms of volume and pitch, representing an adaptive response of their phonatory system to an acoustically aggressive environment.3 Moreover, implementing voice health prevention and promotion programs that include vocal hygiene strategies, vocal training, and ergonomic adaptations to support healthy voice use under adverse working conditions is essential to reduce the risk of voice disorders among these workers.2 However, despite its importance, vocal health is often underestimated and neglected in occupational health programs, so occupational health policies must recognize this issue and promote effective interventions to protect workers.

It should be noted that the response to vocal demand is intensified by the absence of acoustic control measures and a lack of training on proper voice use. According to Aguilar et al.,2 regarding heavy machinery operators, prolonged noise exposure not only affects the auditory system but also directly impacts vocal function by forcing individuals to adopt strained and unhealthy speech patterns to maintain effective communication. Therefore, incorporating vocal evaluation protocols and voice health promotion strategies adapted to the environmental conditions and communication dynamics of these work settings is essential to reduce the risk of occupational voice disorders and ensure healthier, more sustainable working conditions.

Speech-language pathologists are the professionals best suited to evaluate, design, and implement these voice care strategies, as they play a major role in the prevention, evaluation, and treatment of communication disorders, particularly in high-noise work environments such as those of heavy industry. Their intervention is grounded in fundamental concepts of vocal function and encompasses identifying risk factors related to voice use, carrying out vocal hygiene programs, and providing guidance on workplace adaptation to mitigate the impact of noise.

Explaining the interaction between the environment and the response of the phonatory apparatus requires utilizing the concepts of “vocal load - vocal loading,” which later conceptually transitioned to vocal demand and response to vocal demand. These concepts, explained above, enable speech-language pathologists to optimally address occupational voice conditions.3,4 This highlights the value of speech-language pathology interventions in mitigating the risks associated with voice use in noisy work environments.

Importance of speech-language pathology interventions to mitigate risks associated with voice use in noisy work environments

A literature review on noise and health showed that studies addressing this topic focus on preventing noise-induced hearing loss4,5 and evaluating auditory perception and vocal use in non-industrial settings, such as education and healthcare.6-10 No intervention protocols integrating vocal hygiene, vocal training, or ergonomic adaptations in noisy work environments like those in heavy industry were found. However, papers on voice health promotion strategies targeted at groups with high vocal demand, such as teachers or healthcare professionals, were identified.11-13

Although numerous descriptive studies exist on noise exposure in mining and industries such as construction, aluminum, and bottling,2,14-16 and multiple epidemiological surveillance programs and vocal health audits have been implemented,17-23 there are no studies confirming the efficacy of interventions specifically designed to protect the voice of workers exposed to high noise levels in industrial plants.16 This gap remains even though countries like Colombia legally recognize various ear diseases and phonation problems as occupational diseases.24 This situation may be due to the constant presence of noisy machinery and continuous shifts in work tasks, which complicate the implementation of targeted voice care measures.

This reflects a significant issue because, due to the nature of the metallurgical industry, constant voice use generates a sustained response to vocal demand that can lead to vocal abuse and, potentially, vocal hyperfunction.25 Furthermore, while scientific literature has shown that prolonged noise exposure not only affects hearing—causing occupational hearing loss—but also increases vocal fatigue,2 this interaction between noise and vocal demand remains underestimated in many corporate occupational practices.

Vocal fatigue in industrial settings manifests primarily as peripheral fatigue (affecting vocal fold tissues due to prolonged vibration) and neuromuscular fatigue, reducing the worker’s phonatory efficiency. Consequently, designing and implementing voice care protocols that include the prevention of vocal cord disorders, the use of hearing protection, education on proper voice use, and the optimization of communication is fundamental in these work environments, recognizing that voice protection must be a priority in heavy industry occupational health programs. This approach will preserve workers’ vocal health, improve communication quality, and prevent occupational diseases associated with both voice and hearing, thereby demonstrating that vocal protection is as important as hearing protection in noisy industrial environments.

This reflection arises from the experience gained during a social and community welfare project focused on communicative well-being within the context of occupational health. The project was carried out at the Bogotá headquarters of the Compañía General de Aceros as part of a formative practicum of the speech-language pathology program at the Corporación Universitaria Iberoamericana. Compañía General de Aceros is a Colombian company with a presence in 5 cities across the country (Bogotá, Cali, Bucaramanga, Medellín, and Barranquilla) and more than 40 years of experience in the steel industry, specializing in the transformation, manufacturing, and commercialization of metal-mechanic products for various productive sectors. Processes such as cutting, machining processes, drilling, assembly, and finishing of metal parts are developed in its plant. These activities involve the constant handling of heavy materials, the use of high-precision tools, and the operation of heavy machinery, generating noise levels that range between 80 and 95 decibels (dB).

The project addressed hearing and voice health and was developed in three phases: observation, implementation, and evaluation of results.

Phase 1: Observation

During this first phase, work environment screening protocols were implemented, which included sound level metering and non-participant observation. Noise levels were found to reach 85 dB and even exceed 95 dB in specific areas, a value 10 dB above the maximum level permitted limit in Colombia.26

Subsequently, considering the structural and environmental characteristics of the company, as well as employee attitudes, a perceptual checklist was conducted to identify and characterize the population based on communication needs within their work environment. This evaluation demonstrated that the company had hearing protection and care protocols in place and that administrative staff reported no communication needs. However, these protocols were not yet consolidated but were, in fact, under development.

Although this is the third project developed by the Speech-Language Pathology program of the Corporación Universitaria Iberoamericana at Compañía General de Aceros, it is the first to address the vocal dimension by considering the vocal risk derived from environmental noise. Previous experiences prioritized the auditory dimension, resulting in a partial approach to communication needs. This situation aligns with what is reported in the literature, where only two papers addressing the effect of noise on voice in high-noise exposure occupational environments were identified.

The first paper is a literature review in which Aguilar et al.2 identified the effects of noise on the health of construction workers who operate heavy equipment daily. The second is a research carried out by Ubrig-Zancanella et al.27 that investigated whether metallurgical workers are at risk of developing vocal disorders and whether they are related to their work environment. Both studies establish that occupational noise is a relevant risk factor in the development of voice disorders.

It is worth noting that the first project developed by the Corporación Universitaria Iberoamericana at Compañía General de Aceros aimed to implement an effective communication program for employees through activities focused on hearing, vocal, and communicative care to optimize job performance. The second project aimed to strengthen self-care practices in hearing and vocal health among workers at the same company, based on promotion and prevention strategies designed to reduce the risk of hearing and vocal disorders derived from working conditions.

Phase 2: Implementation

In the second phase, strategies were designed to prevent vocal disorders in both specialized equipment and heavy machinery operators and the remaining plant personnel. The design of these strategies took into account factors such as the number of workers, the time operators handled machinery during their shifts, the spaces available for conducting voice care activities, and the operators’ motivation to improve their vocal hygiene and care habits. Accordingly, dynamic and educational activities were carried out, focusing on promoting healthy vocal hygiene habits and preventing occupational voice disorders. These activities included games and contests, as well as the distribution of informative flyers and brochures.

According to the relevant literature search, there are no studies on the design and implementation of occupational voice care protocols in heavy industry, which highlights a latent need to generate knowledge regarding speech-language pathology practices in industrial sectors with high noise exposure.

The strategies implemented in Phase 2 contributed to ensuring the effectiveness of the interventions, as they were carefully designed under health promotion and prevention principles. Their content, format, and methodology proved appropriate for the plant operators’ work context, demonstrating their relevance for projects focused on vocal care in occupational environments with high noise exposure. A key aspect for the project’s success was the adoption of the recommendations provided, which was made possible by the interdisciplinary work carried out with the company’s occupational health and safety team. Furthermore, the joint design and implementation of the interventions by occupational health and safety professionals, speech-language pathology students, and the faculty member in charge guaranteed that they were relevant and applicable to the company’s work environment. Consequently, workers not only showed a willingness to participate in the activities but also made positive changes regarding vocal and auditory self-care. This positive and receptive response from the workers validated the relevance of the implemented strategies to improve the communicative aspect of their work environment.

Finally, it should be mentioned that the favorable results obtained with the project are also a product of interdisciplinary collaboration. The integration of the speech-language pathology team with the occupational health and safety area allowed a comprehensive approach to the factors affecting the voice in a noisy work environment like the one heavy industry workers are exposed to. This synergy was reflected in the combination of skills from both disciplines to solve collective problems.28

Phase 3: Evaluation of results

In the final phase of the project, following the completion of the activities and training sessions and the distribution of informative materials, a 10-question survey was administered to both administrative staff and plant workers. This survey aimed to determine the impact that the presence of speech-language pathology students in the company had on their perception of vocal health and care within their work environment. The questionnaire was designed based on the perceived morbidity survey administered prior to the project’s inception, which inquired, among other aspects, about the acquisition of knowledge regarding vocal and auditory care in noisy occupational environments, habit changes, vocal hygiene improvement, and the relevance of implementing similar projects within the company in the future.

Based on the responses obtained, it is worth noting that the project had a positive impact, as 80.0% of the workers expressed that the implemented actions and the acquired knowledge were relevant and effective in promoting voice care habits in their work environment, thereby preventing related disorders. This demonstrates that speech-language pathologists play a fundamental role in preventing auditory and vocal risks and in creating occupational protocols for auditory and vocal health promotion within the metallurgical industry.

It is essential to recognize that when conducting interventions in these environments, speech-language pathologists are also exposed to the same adverse working conditions as the rest of the personnel (i.e., high noise levels, environments with particles or toxic substances, abrupt temperature changes, and the need for communication in noisy spaces, among others). Consequently, intervention protocols should not only focus on recommendations for the working population, but they must include protection and self-care strategies for these health professionals. Ignoring this aspect may compromise not only their short-, medium-, and long-term auditory and vocal health but also the quality and continuity of their interventions. Furthermore, the practice of speech-language pathology in these contexts demands specific preparation and safety measures that guarantee both the effectiveness of interdisciplinary work and their own well-being as an active part of the work environment. This implies considering aspects such as the use of custom hearing protectors, the implementation of vocal rest periods, ergonomic adaptations, and continuous training in occupational risk prevention.29

In short, within these work environments, the speech-language pathologist is not only a professional involved in preventing auditory and vocal disorders but also a worker exposed to the very risks they seek to mitigate. Therefore, occupational health programs and protocols must encompass their comprehensive protection as part of the risk management system in heavy industry through strategies such as the use of earplugs or hearing protectors in areas with noise levels >85 dB,5 the implementation of routine vocal rest periods, and the permanent availability of resources necessary for proper hydration during interventions or training sessions. This goes hand in hand with the use of personal protective equipment such as helmets, safety glasses, hearing protectors, and boots, in compliance with current occupational safety regulations.5

Within the context of occupational health, speech-language pathologists are also responsible for several actions necessary to safely and effectively prevent, evaluate, and intervene in risks. These include identifying auditory risks, speech intelligibility problems, and communication barriers, as well as designing and conducting vocal care workshops, audiological evaluations, and training sessions on the correct use of hearing protectors to improve communicative well-being and prevent occupational injuries and illnesses.30

Conclusions

The development of this project demonstrated that interdisciplinary work between speech-language pathology and occupational health and safety specialists is essential to comprehensively address communicative risks in noisy work environments such as those found in the heavy industry. Collaboration between professionals from both disciplines enabled the creation of contextualized strategies that effectively responded to the needs of the work environment. Nevertheless, a marked lack of scientific evidence to guide specific vocal interventions in these scenarios persists, thus limiting the scope and sustainability of the implemented actions and revealing the need to strengthen applied research in occupational vocal health for protocol development

Similarly, an imbalance was identified in occupational interventions, where auditory care has historically been prioritized over vocal care, ignoring that both aspects are equally compromised in environments with high noise levels. Designing and implementing surveillance and control protocols directed at vocal health that involve evaluation, prevention, and education measures on appropriate voice use is essential.

Voice must be considered a key functional resource in highly demanding industrial settings, such as metallurgy, and its protection, framed within occupational health and safety regulations, constitutes a right for all workers.

Conflicts of interest

None stated by the authors.

Funding

None stated by the authors.

Acknowledgments

None stated by the authors.

References

1.Nusseck M, Richter B, Spahn C, Echternach M. Analysing the vocal behaviour of teachers during classroom teaching using a portable voice accumulator. Logoped Phoniatr Vocol. 2018;43(1):1-10. doi: 10.1080/14015439.2017.1295104. PMID: 28635402.

2.Aguilar Y, Moreno T, Valdés C, Moreno R. El ruido y sus efectos en la salud de los operadores de equipo pesado. SC. 2024;1(6):195-216. doi: 10.37594/sc.v1i6.1622.

3.Calvache-Mora CA, Cantor-Cutiva LC, Hunter EJ, Guzmán M, Soláque L. Systematic Review of Literature on Vocal Demand Response: Understanding Physiology, Measurements, and Associated Factors. Folia Phoniatr Logop. 2024;76(1):1-21. doi: 10.1159/000531678. PMID: 37393892; PMCID: PMC10972624.

4.Sliwinska-Kowalska M. New trends in the prevention of occupational noise-induced hearing loss. Int J Occup Med Environ Health. 2020;33(6):841. doi: 10.13075/ijomeh.1896.01600. PMID: 32994587.

5.Organización Internacional del Trabajo (OIT). La salud y la seguridad en el trabajo. El ruido en el lugar de trabajo [Internet]. Centro Internacional de Formación de la OIT; [cited 2025 Mar 18]. Available from: https://tinyurl.com/5f5kwhkc.

6.Banh J, Singh G, Pichora-Fuller MK. Age affects responses on the Speech, Spatial, and Qualities of Hearing Scale (SSQ) by adults with minimal audiometric loss. J Am Acad Audiol. 2012;23(2):81-91. doi: 10.3766/jaaa.23.2.2. PMID: 22353676.

7.Diéguez-Corría OE, Labrada-Estrada LE, Rodríguez-Aguilar Y. La voz: una herramienta para el profesional de la educación. Dilemas Contemp Educ Polít Valores. 2021;9(1). doi: 10.46377/dilemas.v9i1.2837.

8.Lince Acosta NM, Peña Rodríguez A. Uso, conservación y valor profesional de la voz. Revista Caribeña. 2023;9(10).

9.Castellanos-Monroy NE. La Importancia de la Tradición Oral en el Fortalecimiento de Competencias Comunicativas. Ciencia Latina. 2024;8(2):7787-802. doi: 10.37811/cl_rcm.v8i2.11217.

10.Maristany AR, Abadía L, Rivoira AM. Difusión del conocimiento científico: La problemática del ruido y sus efectos sobre la salud [Internet]. Universidad Nacional de Córdoba; 2013 [cited 2025 Mar 18]. Available from: https://tinyurl.com/umjwwu3u.

11.Santos RM, Cavalcante MS, Porto VFA, Morais EPG. Speech therapy strategies to promote the vocal health of teachers: integrative literature review. Rev Cienc Saude. 2021;11(1):51-60. doi: 10.21876/rcshci.v11i1.1053.

12.Harmon TG, Dromey C, Nelson B, Chapman K. Effects of background noise on speech and language in young adults. J Speech Lang Hear Res. 2021;64(4):1104-16. doi: 10.1044/2020_JSLHR-20-00376. PMID: 33719537.

13.Song Z, Lee PJ, Jung H. Prevalence of voice handicap among nurses in intensive care units due to occupational noise during pandemic. Front Public Health. 2023;11:1250512. doi: 10.3389/fpubh.2023.1250512. PMID: 37727611; PMCID: PMC10505665.

14.Campos R. La Audiología ocupacional y su aplicabilidad a la salud y seguridad ocupacional. Ciencia Latina. 2023;7(4):3063-78. doi: 10.37811/cl_rcm.v7i4.7155.

15.Chaparro-Chavarro YA, Castaño-Monsalve LÁ, Zamora-Romero D. Efectos del ruido en la salud de los trabajadores operativos de la empresa Emtelco SAS sede Aguacatala de la ciudad de Medellín, en el primer semestre del año 2023. Sociedad Cultura y Creatividad. 2023;2(1):81-98.

16.Ordónez-Guaycha CA, Carranco-López JA, Bustos-Pulluquitin SP, Toalombo-Vargas VM. Estudio sobre la afectación del ruido en la minería, una revisión sistemática de las principales afectaciones que presenta para la salud de los trabajadores. Tesla Rev Científica. 2023;3(2):e251. doi: 10.55204/trc.v3i2.e251.

17.Unidad de Prevención de Riesgos Laborales. Ruido: Efectos sobre la salud [Internet]. Zaragoza: Universidad de Zaragoza; 2022 [cited 2025 Mar 18]. Available from: https://tinyurl.com/3ez5et27.

18.Romero-Romero L, Mariángel-Carvajal K, Baéz-Cáceres T, De la Jara JA, Ávalo-Miranda P, Ramírez-Muñoz V. La voz como herramienta profesional: técnica y autocuidado vocal para el desempeño docente. Rev Estud Exp Educ. 2023;22(48):30-47. doi: 10.21703/0718-5162.v22.n48.2023.002.

19.Rodríguez-Salazar ME, Ortega-Clavijo MR, Moreira-Macias EL, Chang-Camacho LB. Impacto del ruido ergonómico en la salud de los trabajadores de centros educativos: un metaanálisis. EASI: Engirneering and Applies Sciences in Industry. 2023;2(3):57-65. doi: 10.53591/easi.v2i3.2602.

20.Velásquez-Mendoza MJ, Galeano-Suarez K. Diseño de un programa de vigilancia epidemiológica para la prevención y mitigación del riesgo vocal en los asesores comerciales: Caso Tecnoplus [Thesis] [Internet]. Bogotá D.C.: Universidad ECCI; 2025 [cited 2026 May 5 ]. Available from: https://tinyurl.com/254e4vue.

21.da Silva VM, de Lima MLLT, Guimarães NMM. Health actions and occupational vocal conservation: how are they being implemented? Rev Bras Med Trab. 2024;22(1):e2022961. doi: 10.47626/1679-4435-2022-961. PMID: 39165525; PMCID: PMC11333052.

22.Cardona-Andrade MP, Flores-Requena FJ. Diseño del Programa de Salud “Oír o Escuchar: la importancia del cuidado y las buenas prácticas de salud auditiva” [Thesis] [Internet]. Bogotá D.C.: Universidad ECCI; 2022 [cited 2026 May 5 ]. Available from: https://tinyurl.com/53xhstjj.

23.Olavarría C, Centeno D. Día mundial de la voz 2022: 16 de abril ¿De dónde proviene y para dónde vamos? Rev Otorrinolaringol Cir Cabeza Cuello. 2022;82(1):7. doi: 10.4067/s0718-48162022000100007.

24.Colombia. Congreso de la República. Decreto 1477 de 2014 (agosto 5): Por el cual se expide la Tabla de Enfermedades Laborales [Internet]. Bogotá D.C.: Diario Oficial 49237; August 4 2014 [cited 2026 Mar 25]. Available from: https://tinyurl.com/2psd89a8.

25.Hillman RE, Stepp CE, Van Stan JH, Zañartu M, Mehta DD. An Updated Theoretical Framework for Vocal Hyperfunction. Am J Speech Lang Pathol. 2020;29(4):2254-60. doi: 10.1044/2020_AJSLP-20-00104. PMID: 33007164; PMCID: PMC8740570.

26.Colombia. Ministerio de Trabajo y Ministerio de Salud y Protección social. Resolución 1792 de 1990 (mayo 3): Por la cual se adoptan valores límites permisibles para la exposición ocupacional al ruido. Bogotá D.C.: May 5 1990.

27.Ubrig-Zancanella MT, Behlau M. Relação entre ambiente de trabalho e alteração vocal em trabalhadores metalúrgicos. Rev Soc Bras Fonoaudiol. 2010;15(1):72-9. doi: 10.1590/S1516-80342010000100013.

28.Vitiello R, Huang J, Speer S, Yankova N, Peppler K, Orta-Martinez M, et al. Studying Interdisciplinary Collaboration as a Core Skill. 16th International Conference on Computer-Supported Collaborative Learning (CSCL); 2023. doi: 10.22318/cscl2023.153494.

29.Manta-Avila GV, Jiménez-Rodríguez YL, Souza-Camacho LM. Estudio de los riesgos vocales, auditivos y mecánicos en trabajadores de salud que labora en el call center Teleperformance en la ciudad de Bogotá en el 2021 [Thesis] [Internet]. Bogotá D.C.: Corporación Universitaria Iberoamericana; 2022 [cited 2025 Mayo 5]. Available from: https://tinyurl.com/4362ufed.

30.Beauchamp TL, Childress JF. Principles of biomedical ethics. 7th ed. New York: Oxford University Press; 2013.