Auctioneers, politicians, barristers, broadcast journalists and teachers often have to live with the consequences of voice strain. Nuala Macklin outlines how it can affect work performance.
When we open our mouth to speak, we take it for granted that sound will follow. Many of us have experienced the inconvenience of temporary voice loss. Perhaps as a result of a two-hour stint of shouting, cheering and/or singing, at a sports game or concert.
However, for people who depend on their voice to fulfil their job, voice strain can have serious implications. Damaged vocal chords can even spell the end of a career in some cases.
Usually, one tends to think of singers in this context. Cast the net a little wider and you will find people such as auctioneers, politicians, barristers, clergywomen and men, teachers, call-centre workers, radio and television journalists. All of who rely heavily on their voice as a key work tool.
Fine Gael TD and spokeswoman for Transport, Olivia Mitchell, agrees her job is very dependent on having a working voice. "When I was a smoker this was a real problem. Particularly so at election time when the voice got weaker and weaker, and more and more strained from overuse. Happily, since giving up smoking I have no problems at all. Any strain, that I was aware of, even while making a single telephone call is now completely gone. I would still love a fag of course!"
In referring to the problem as Repetitive Voice Strain recently, the TUC in Britain noted about "about one-third of the workforce in modern economies relies on their voice to do their job". Figures were released last month which estimate that more than five million people could be affected from voice loss, costing the British economy £200 million a year - there are no equivalent figures for Ireland.
According to Dublin-based laryngologist and voice teacher, Tom Wilson, "We were designed to communicate for prolonged periods, but we were not designed to speak continuously, all day long. If you have to raise your voice, speak a lot, or speak against background sound, then you have to use a modified shout."
Referring to the origins of human speech, he explained how shouting is in fact a primitive survival strategy.
"We must be able to call out 'Help!' when in danger. The louder you shout, the more you have to control the breath in the larynx. There is a correct way to do this, which is what professional singers learn. Incorrectly done, the throat becomes constricted and leads to voice strain."
Wilson says: "People such as teachers or lawyers need to understand that there is an element of performance in their job. A professional performer knows that her instrument is herself, her voice, and importantly - the acoustic of her surroundings, so that they know what level to adjust their voice to."
A vibrant example of voice projection can be found in Dublin's Moore Street fruit and vegetable market. For generations, the street traders have been calling out their familiar lyrical chant of - "Foyve four feeftee - Feeftee cents four foyve", can be heard from O'Connell Street and not a microphone in sight.
Wilson includes industrial workers who lift heavy weights, as further examples of people at risk of developing voice strain. "In order to keep your ribs fixed when lifting a weighty object, you have to trap air in your lungs by closing your larynx. If you're carrying something very heavy, some air will tend to be squirted through your larynx producing that grunting 'aaagh' sound.
"This partial closure of the larynx opening prevents you from rupturing something, or causing a hernia. The same worker may also have to shout over a noisy background in the course of his day which can also contribute to the problem of damaged vocal chords," he said.
Similar to the muscles of any athlete, the tongue muscles and vocal organ can also be toned and strengthened.
Highlighting the value of voice training, Wilson says: "If you are suffering from voice difficulties on a regular basis, it's well worth seeing a speech and language professional. They can compare your lifestyle to your symptoms, suggest some adjustments in your work environment and train you in how to use your voice more efficiently."
Winter conditions, central heating and poor air quality containing dust particles in the workplace play a part in this problem.
To help combat this, Wilson says: "It is important to keep the larynx well hydrated by drinking water on a regular basis throughout the day. Try not to cough too much. If you feel the need to clear your throat, try and wait a bit and the ticklish mucus may shift itself."
The part of your voice box that carries the vibration is the lining, which covers the muscles and ligaments beneath. "If this lining becomes inflamed, you can develop a haemorrhage that can lead to all sorts of complications. It's difficult to loose your voice completely, but you can change it's quality which can in turn effect presentation."
Patricia Gillivan-Murphy, speech and language therapist at Dublin's Mater Hospital, conducted a controlled study last year. This examined the effectiveness of a voice treatment approach for teachers with self-reported voice problems. The results showed a combined approach of vocal exercises and vocal hygiene resulted in improved the voice symptoms and in the confidence that teachers had in their voices.
She says: "Voice research carried out internationally cites teachers as being more at risk than other vocally loaded professions. This is because of the challenge of being facilitators of learning, while overcoming the work-related hazards to good vocal performance. These include talking for long periods, mostly against background noise, with poor room acoustics and over a long speaking distance.
"Primary school teachers are frequently exposed to the infections, colds, and sore throats of young children. Many are required to sing for teaching purposes as part of the curriculum. "By the time a teacher attends a therapist, the problem is usually chronic, with physical changes evident in the vocal chords," she adds.
Gillivan-Murphy recommends compulsory voice training as part of the teacher-training syllabus as an ultimately cost-effective measure to reduce the risk of voice problems.
"Surgery on the vocal cords for teachers is the exception rather than the rule," she says.
"However it is necessary for certain types of voice problems. Voice therapy with a speech and language therapist is the preferred initial treatment option for voice problems which are considered to be secondary to vocal strain."
Earlier this year, concerns were expressed regarding the potential for claims against the State for damages to the voices of primary teachers as a result of teaching duties.
Noel Dempsey, then Minister for Education, responded to this saying: "There is very little information available to indicate how prevalent voice problems may be among the general teaching profession in Ireland. The issue has not been highlighted previously by any of the interests concerned.
"There have been reports recently in the media concerning a new study of voice problems among teachers in the Dublin area, carried out by Prof Ray Kinsella with Catherine Munier of the Smurfit School of Business, which I understand has yet to be published. The findings of the study will be considered when it becomes available."
The study published recently indicates some primary school teachers are at risk of developing voice problems that may undermine their effectiveness and contribute to absenteeism and even a decision to leave the profession altogether.
Voice care
If you lose your voice or have a sore throat accompanied by a rise in termperature, rest your voice and seek medical help.
If the following symtpoms persist, ask your GP to refer you to an Ears, Nose, Throat consultant:
General advice for maintaining a healthy voice:
In a classroom:
Avoid:
Useful sources of information:
[ www.voicecare.org.ukOpens in new window ]
Case study
Edel (not her real name) has been a primary school teacher for three years and has experienced significant voice loss and laryngitis repeatedly in that time. Two months ago, she underwent surgery to have nodules removed from her throat. She has recently to return to work and is optimistic that she can do her job, while simultaneouly protecting her precious voice.
I love my job which is teaching 25 lovely seven-year olds. It's what I've always wanted to do. Last May when I was told to take a month off because of my voice problems, I became rally down about it. You don't realise how important your voice is until it's gone. I thought that if I had to change careers I wouldn't know what to do. It would just be awful.
It became a problem in my second year of teaching when my voice began to go. I began to find it very difficult to project my voice across the room and voice became weaker and very hoarse. My throat became very sore and I was getting a lot of throat infections and missing time out in school. I didn't have any particular difficulties with my throat when I was growing up.
It was through being involved in the study on teachers and voice loss last year that I realised that I had a problem. Later on in speech therapy, I learned how to breath properly and to warm up my voice every morning by humming and with other exercises. The therapist, Patricia Callinan Murphy referred me to a surgeon, who recommended surgery. The prospect of the operation frightened me a bit as there's always a risk of damaging the vocal chords.
Three weeks ago I returned to work stronger and wiser. I drink water now instead of tea and coffee and I've cut down on spicy foods that I was very fond of. My method of teaching has changed. I have a whistle or I clap my hands to get the children's attention instead of using my voice. It took the children a little while to adapt to my new strategies. They thought I was trying to be like Britney Spears with the microphone at first. I bought a very basic model for €60 which makes a real difference.
I love to sing and I enjoy teaching music. I can't do that right now but I'd love to get back it. What I do now is I swap my music class with another teacher.
All through college, voice care was never an issue or discussed. There was maybe one lecture in all of my teacher training course which was very brief. I just remember something about being told to drink water. Voice training should be on the teacher training syllabus.