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Voice Care Guidelines

Last updated: 9 August 2018

CONTENTS

Introduction................................................................................................................................................................... 2

Voice Production.........................................................................................................................................................3

Introduction..............................................................................................................................................................3

Fundamentals of voice production...........................................................................................................................3

Other physical factors influencing voice...................................................................................................................4

Symptoms And Causes Of Voice Problems................................................................................................................6

Introduction..............................................................................................................................................................6

When should you be concerned about any of these symptoms?............................................................................7

Causes and contributing factors for vocal problems................................................................................................7

Using Effective Voice Techniques...............................................................................................................................9

Introduction..............................................................................................................................................................9

A word of caution.....................................................................................................................................................9

Breathing for voice...................................................................................................................................................9

Breathing exercises.................................................................................................................................................9

Posture................................................................................................................................................................... 11

Vocal Fold Vibration...............................................................................................................................................11

Pitch....................................................................................................................................................................... 12

Relaxation of the vocal fold muscles......................................................................................................................12

Voice Projection.....................................................................................................................................................13

A note on warming up the voice.............................................................................................................................13

Minimising Harmful Voice Habits...............................................................................................................................15

Introduction............................................................................................................................................................15

What constitutes vocal misuse?.............................................................................................................................15

Strategies for minimising vocal misuse..................................................................................................................16

Reducing vocal misuse..........................................................................................................................................16

Reducing the harmful effects of vocal misuse.......................................................................................................17

Maximising Physical and Emotional Health...............................................................................................................18

Introduction............................................................................................................................................................18

Improving physical health......................................................................................................................................18

Improving emotional health....................................................................................................................................19

Maximising the physical enviroment..........................................................................................................................21

Introduction............................................................................................................................................................21

Strategies for maximising the physical environment for voice...............................................................................21

Notes......................................................................................................................................................................... 23

Voice Care Guidelines Page | 1

Introduction School teachers are one of the largest groups of professional voice users WORLDWIDE. Your voices are your primary tool of trade, your main mode of communication in the classroom and one of your most powerful assets. Teaching, however, places many demands on your voice. Talking extensively, talking loudly, speaking over background noise, and speaking and projecting your voice over large distances in the playground or on the sports field are just some of the vocal pressures you confront every day. Because of these vocal demands, teachers are at increased risk for developing voice problems. Fortunately, it is not difficult for most teachers to avoid voice problems and for you to have an effective voice for your entire teaching career and beyond.


Voice ProductionIntroduction

‘You are how you sound’! Yes, the sound of the human voice tells your listeners an enormous amount about your personality, emotions, confidence and feelings about yourselves, as well as what you are really thinking. Your voice divulges a great deal about your educational background, social status, health and mental alertness. The way in which you use your voice also has the power to make your teaching interesting or deadly dull, to make your students trust you or view you suspiciously, and to make students listen intently or nod off to sleep! Unless you have a major physical disability of the voice mechanism, everyone is capable of producing the type of voice that works well in teaching, one that helps to get your message across, is vibrant and engaging.

Fundamentals of voice production

The foundation for an effective voice is based on the coordination of three factors:

breathing phonation resonance

Breathing air out of the lungs produces the power supply for the voice. This airflow from the lungs makes the vocal folds (or vocal chords) in the larynx (or voice box) vibrate to make the basic sound of the voice; this process is called phonation. Because that sound made by the vocal folds is too weak to be heard, that basic sound is then modified into the sound we recognise as the human voice as it travels up from the larynx through the throat, mouth and nose; this transformation is known as resonance. Production of a natural, effective voice depends on how well we balance or coordinate these three fundamental components of breathing, phonation and resonance.

Breathing

Our intention to produce voice is signalled to the parts of the body involved by impulses from the brain. The first response of the body to these impulses is to breathe in so that there is enough air in the lungs to power the voice. The breath is taken in through the mouth and nose, passes down the trachea (or windpipe), and is inhaled into the lungs. For air to be inhaled into the lungs the ribcage needs to expand and the dome-like diaphragm which forms the base of the chest, needs to flatten downwards. When we breathe in effectively, we feel most of this expansion in the area of the lower ribs. Once the air has been inhaled into the lungs and they reach capacity, the elastic tissue of the lung recoils and the air is exhaled or breathed out. The exhaled air then returns up through the trachea and then through the larynx where it encounters the closing vocal folds.

Phonation

When we breathe in and out without speaking, the vocal folds in the larynx are open to allow the air to pass to and from the lungs easily. The impulses sent from the brain when we intend to speak, however, signal to the muscles of the larynx to close the vocal folds. When the air coming up from the lungs encounters the closed vocal folds, the pressure and flow of the air overcomes the resistance of the vocal folds and sets them into a pattern of rapid vibration. That is, the vocal folds open and close repeatedly, around 200 - 220 times per second for women


and 100-120 times per second for men. This rapid vibration of the vocal folds produces the sound waves in the air which are the basic tones of our voices. The vocal folds are therefore the source of the human voice.

The larynx is located on the top of the trachea and is behind the Adam’s Apple. The two vocal folds in the larynx are approximately 20 mm in length and are stretched from just behind the Adam’s Apple in the front of your neck to the back of the larynx. These vocal folds are complex structures made up of four main layers. The outer layer is the mucous membrane (or epithelium). Directly under the mucous membrane is a soft, pliable layer filled with fluid; this layer is known as Reinke’s space. The mucous membrane and Reinke’s space are together known as the ‘cover’ of the vocal folds. This cover of the vocal folds must be kept moist and pliable so that it can move freely in a wave-like motion (the ‘mucosal wave’) over the deeper layers of the folds. If the cover of the vocal folds becomes dry or stiff, the voice will become rough and the person may experience throat discomfort. Under the cover of the vocal folds is the vocal ligament. This ligament is made up of elastic tissue that allows the vocal folds to change shape easily when the deepest and least pliable layer of the vocal folds, the muscle, changes shape.

The basic tone of the voice can be varied in many different ways, depending on the way in which we use the vocal folds and other parts of the voice mechanism. The main aspects of the voice that can be varied are:

pitch loudness quality

Pitch refers to how high or low the voice sounds. It is determined mainly by the speed of vibration of the vocal folds, the thickness of the edge of the folds, and the length of the folds. The higher the voice, the faster is the rate of vibration of the vocal folds. The more elongated and thinner the edges of the vocal folds become, the higher the pitch will be. On the other hand, if the vibrating edges of the vocal folds become thicker and shorter, and the vocal folds vibrate at a slower rate, the pitch will be lowered. We use variations in pitch during speech to signal meaning and emotion and this is referred to as intonation.

Loudness refers to how loud or soft a voice is. It is dependent on the amount of air pressure from the lungs and the muscle tension in the vocal folds. The greater the air pressure and the more tense the vocal folds, the louder the sound will be. The lower the air pressure from the lungs is and the slacker the vocal folds are, the softer the voice will be. We also use variations in loudness during speech to signal meaning and emotion and this is referred to as stress. To emphasise the importance of a particular word, for example, we increase the loudness of voice on that word.

Quality refers to how clear the voice sounds. Voice quality is determined by many complex factors including how relaxed the muscles of the larynx are, how moist the cover of the vocal folds is, how smoothly the vocal folds vibrate, and whether or not the vocal folds are able to close sufficiently during phonation. If the muscles of the larynx are excessively tense, the cover is dry, the folds move in an irregular way, and/or the folds cannot close together, the voice quality will sound rough, strained and/or breathy.

Resonance

The sound waves produced by the vocal folds in the larynx are too weak to be recognised as voice and so this basic tone must be amplified or resonated as it travels up through the spaces of the throat, mouth and nose. The shape, size and muscle tension of these spaces will


determine the eventual sound of the voice we will hear. Because every person is built differently in the throat, mouth and nose, the basic voice tone is modified differently in each of us so that we will all have a recognisably unique timbre of voice. This process of resonance in our voices is similar to the way in which the shape and size of a musical instrument such as a trumpet gives the basic tone produced by the reed its unique sound. Just as the resonance process in a trumpet makes the sound of the trumpet carry throughout a concert hall, resonance in the human voice gives us the ability to control its carrying power or projection.

Other physical factors influencing voice

While breathing, phonation and resonance are the basic building blocks of the voice, the effectiveness of our voices is also affected by:

body posture relaxation of the muscles of the body and the larynx

Because the parts of the body which contribute to voice production are connected to many other parts of the body’s muscular and skeletal system, the way we align the whole body and the amount of muscle tension or relaxation in the body will influence the voice. Excess tension in the muscles of the larynx, for example, can lead to a strained, harsh voice. Similarly, standing with the knees braced and the pelvis pushed forwards can lead to difficulty in coordinating relaxed breathing with phonation.


Figure 1: Anatomy of Voice Production

Symptoms and Causes of Voice ProblemsIntroduction

Many people, particularly those who use their voices extensively in their jobs or leisure activities, suffer from voice problems. The most common symptoms are discomfort in the throat, impaired voice quality such as hoarseness, a change in the pitch of the voice, voice loss, and difficulty in projecting the voice. These symptoms can occur in association with structural changes on the vocal folds like swelling, inflammation, vocal nodules, polyps, but in many cases the vocal folds appear perfectly normal. In only a very small number of cases are voice problems caused by a serious disease.

The usual cause will be a combination of small problems related to the way the person uses his or her voice, the physical environment in which the voice is used and increased levels of stress and tension. Sometimes an unhealthy lifestyle or illnesses such as hay fever, reflux and sinus problems can also contribute to the problem. Because most voice problems are caused by a combination of factors which are not serious or difficult to eliminate, most can be easily prevented or remedied if detected early.

Symptoms of Voice Problems

There are many possible symptoms of voice problems. The earliest symptoms are felt as discomfort in the throat. Throat discomfort can take many different forms:

Throat discomfort symptoms

A feeling of fatigue Dryness Scratchiness or a tickling sensation An ache, soreness or pain A feeling of tightness or pressure A feeling that talking is an effort Shallow breathing Sensation of a lump in the throat Burning sensation Frequent need to clear the throat

Later symptoms may be impairments of breath control, pitch, loudness, voice quality, and projection or resonance:

Breath control symptoms

Audible inspiration or ‘gasping’ on inspiration Running out of breathing Shallow breathing Using the shoulders and upper chest when breathing in

Pitch impairments

Pitch is too high Pitch is too low


Monotone voice - inadequate variation in pitch

Loudness impairments

Voice is too soft Voice is too loud Mono loud voice - inadequate variation in loudness

Voice quality impairments

Strained voice - too much muscle tension in the larynx Rough voice - vocal folds do not vibrate smoothly Breathy voice - vocal folds do not close adequately and air escapes Glottal fry or creaky voice - vocal folds stay closed for too long and the pitch is too low Falsetto - immature, high pitched, breathy voice in an adult male Voice breaks or cracks Voice loss - voice disappears so that only a whisper is possible Pitch breaks - sudden, transient and dramatic rises in pitch Loudness breaks - sudden, transient and dramatic drops in loudness

Note: A voice which is both strained and breathy is sometimes known as ‘husky’ and a voice which is strained, rough and breathy is often called ‘hoarse’.

Resonance impairments

Weakness or difficulty projecting the voice Muffled or throaty voice Immature resonance

When should you be concerned about any of these symptoms?

Unfortunately, there is no simple answer to this question. Nearly everyone experiences minor throat discomfort or small changes in breath control, voice quality, pitch, loudness, or resonance from time to time.

When these changes are very slight, last for only a few minutes and do not recur every day, there is usually nothing to be concerned about. When these changes are associated with a viral infection of the throat or sinuses, as long as the voice symptoms disappear when the infection resolves, there is rarely a need to be concerned.

Causes and contributing factors for vocal problems

There are many possible causes of voice problems and many contributing factors which, although not direct causes, increase a person’s risk for developing a voice problem. Although there is now a considerable body of research which has delineated many of these causal and contributing factors, much more research needs to be conducted before we know what the main causal factors are for specific individuals.

It is also clear that individuals vary widely in their susceptibility to voice problems and that a factor which causes a voice problem in one person may have no adverse effect on another. For these reasons, we have listed below a broad range of possible factors without differentiating between those which may be direct causes and those which merely increase a person’s risk of developing voice problems.


The main categories of causal and contributing factors are:

understanding of voice production and voice care principles voice use patterns voice production techniques health and stress patterns characteristics of the physical environment

Teachers who have a limited understanding of the basic anatomy and physiology of voice production and little knowledge of the principles of voice care may be at greater risk of developing voice problems. Similarly, teachers are likely to be at risk if they misuse their voices by yelling or use inefficient voice production techniques such as upper chest breathing.

Further, teachers are likely to be at risk for voice disorders if they have health problems such as reflux, allergy, poor general health and high stress levels; or use their voices in environments which are not conducive to safe voice production like rooms with poor acoustics.

Each of these categories of causal and contributing factors is covered in further detail in the specific information sheets provided with this Guideline.


Using Effective Voice TechniquesIntroduction

Although most people begin life with good voices, the vocal demands of modern working life and the strong social, health and psychological influences on the human voice often mean that many people develop ineffective and inefficient voice production techniques. Ineffective and inefficient voice production techniques include poor breathing, body posture, vocal fold vibration and voice projection strategies. Teachers who use less than optimal voice production strategies are at increased risk of developing voice disorders, even if they do not engage in the vocal misuse habits outlined in the Minimising Harmful Vocal Habits information section. This information sheet outlines some fundamental guidelines for good voice production technique in each of the areas of breathing, posture, vocal fold vibration and voice projection.

A word of caution

The voice production guidelines outlined here are not designed to provide teachers with comprehensive voice production training. The information presented in this information sheet is at a basic level only and is not intended for use by teachers with established voice disorders. In order to learn optimal vocal technique, far more than printed guidelines are required. One-to-one practical voice training lessons with an experienced speech pathologist or voice teacher are the most effective way to ensure that a teacher uses good voice production strategies.

Breathing for voice

Efficient breathing for voice production is characterised by the following features:

silent inspiration of air quick inspiration and slow exhalation of air in a rhythmic pattern relaxation and expansion of the lower ribs and abdominal area on inspiration of air a focus on the lower part of the body for breathing during speaking little or no movement of the upper chest and shoulders on inspiration of air a focus on exhalation of air rather than on inspiration so that inspiration is automatic and

relaxed release of breath either simultaneously with or just before the onset of voice - not too

early or too late pausing as soon as there are signs that you are about to run out of breath so that

inspiration of air will occur automatically for the next phrase regulation of breath supply to coordinate with the length of phrases – take sufficient air in

for the amount you wish to say in each utterance.

Breathing exercises

1. To focus on the lower part of the body for breathing:

Lie on your back on the floor with your knees up and your neck supported by a cushion. Put your hands on your lower abdomen and breathe in deeply but easily and feel your lower ribs and abdomen move out against your hands as you breathe in. Make sure that you breathe in easily so that your abdomen relaxes to expand; do not push your stomach out! As you breathe out, let the air from your lungs out slowly and gently and feel your ribs and abdomen move back down to their resting position. Breathe in and out gently and quietly in this way for one minute.


Stay lying on your back breathing in this way, but now breathe in for a count of two and then hold as “s” sound for as long as possible as you breath out. Keep the sound steady and don’t let it die away or get louder.

Time the duration of the sound as you breathe out (just count to yourself) and aim for 15-20 seconds.

Keep your hands on your abdomen so that you can still feel the expansion and then deflation of your abdomen as you breathe in and out.

Try some different sounds in the same way – “sh”, “f”, “z”. Then repeat the same exercise but vary the loudness of the sounds in different ways – e.g. “sssssSSSSS”, “SSSSSsssss”, “sssssSSSSSsssss”, “sSsSsSsSsSsSsS”. Feel your abdomen “pumping” as you change the loudness of the sound.

Now repeat all of these exercises while you sit or stand in front of a mirror. Keep your hands on your lower abdomen throughout each exercise and make sure that you do not lift your shoulders or upper chest as you breathe.

2. To breathe in naturally and coordinate breathing with your phrasing:

Breathe out and eliminate as much air as possible from the lungs. Wait for a second or two without consciously trying to breathe in. You will feel yourself naturally inspiring air with a sudden inflow of air. It is not necessary to think of breathing in, as this will happen automatically. Repeat this exercise five to ten times. Now repeat the exercise but say the ‘oo’ sound as you breathe out. When the air from your lungs is used up, simply pause and allow the lungs to refill naturally. On this exercise, do not produce the sound to the point of creating tension in your chest; simply pause to let the air flow into your lungs before you become tense.

Read the following phrases out loud. As the phrases become longer, notice how you begin to run out of breath. Signs of running out of breath include deterioration in the quality of your voice and a feeling of tightness or discomfort in your chest and throat.


A windy day

A cold, windy day

A cold, wet, windy day in winter

It was a very cold, wet and windy day in winter

It was a very cold, wet and windy day in winter and the wind was blowing

It was a very cold, wet and windy day in winter and the wind was blowing the trees

It was a very cold, wet and windy day in winter and the wind was blowing the trees as she walked

It was a very cold, wet and windy day in winter and the wind was blowing the trees as she walked through the park

It was a very cold, wet and windy day in winter and the wind was blowing the trees as she walked through the park with her dog

It was a very cold, wet and windy day in winter and the wind was blowing the trees as she walked through the park with her dog Max and the puppies

Now read these sentences again, but this time, as soon as you notice that you are about to run out of breath, become tense in the chest or throat, or feel your voice deteriorate, pause to take a breath. Mark the sentences with a ^ in the places where it would make sense to pause to top up with air.

Now read out a passage of about twenty lines from a book or the newspaper. Notice where you begin to show signs of running out of breath and mark the passage with a ^ in the places where it would make sense to pause to top up with air. Remember to pause and let the airflow in naturally, rather than consciously breathing in.

Posture

Any imbalance in body posture can adversely affect the way in which the larynx and vocal folds function to produce voice. This is because poor posture anywhere in the body can lead to excess tension and lack of flexibility in the muscles of breathing and voice. The following are some tips for achieving effective body alignment for voice production:

Do:

Align the head with your spine (ears over shoulders) Keep posture symmetrical Balance your weight evenly when standing Keep arms relaxed Keep the shoulders level and relaxed and in a slightly forward-sloping position Keep knee joints loose and legs relaxed Keep the feet directed forward and approximately 20 cm apart where possible Keep the rib cage relaxed and lifted Keep the shoulders relaxed and lowered


Don’t:

Thrust the chin forward or up Throw the head back Clench the teeth Push the tongue against the teeth Clench the hands or toes Round the shoulders Slump the spine Lean excessively forwards or sideward Tilt the pelvis excessively Hold a rigid posture Try to keep the spine straight Lock the knees Keep thigh muscles braced Raise or hunch the shoulders Narrow the back Stand or sit with an asymmetrical posture

Vocal Fold Vibration

The keys to efficient vocal fold vibration are relaxation of the muscles inside the larynx, using a pitch level that is comfortable for your vocal folds, and effective voice projection. Voice projection guidelines will be outlined in the next section of this Information Sheet. The following guidelines will assist you to keep the laryngeal muscles relaxed and to use a comfortable pitch.

Pitch

Every voice has its own comfortable pitch range. Frequent lowering of pitch to make yourself sound more in control or authoritative, or using a weak, high pitched voice in order to sound less dominant, younger or “sexy” can lead to vocal dysfunction. Similarly, frequent use of the voice at the extremes of your pitch range or beyond your comfortable pitch range in speaking or singing can cause vocal problems. Just like a musical instrument, the voice works most efficiently within its own pitch range.

A simple way to locate your comfortable pitch for speaking is to say “hmhm” as if you are signifying agreement (i.e. humming in the same way that you would say “OK” to someone in a carefree way). This sound is likely to be around your comfortable speaking pitch. In addition, you can tell whether or not you are using a comfortable pitch range in speaking or singing by monitoring your voice quality and discomfort in the chest and throat. Any deterioration in the quality of your voice or any feelings of tightness or discomfort in the chest and throat when you use high or low pitches indicates that you have probably exceeded your comfortable range.

Relaxation of the vocal fold muscles

Relaxation of the larynx can be achieved in several different ways:

Begin to yawn purposely and notice how your throat seems to relax and open wider (but do not finish the yawn – the end of the yawn involves an unwanted increase in tension of your throat and tongue muscles). Try to capture that feeling of relaxed openness when you talk.


Use a gentle, easy onset to voicing, particularly on words beginning with vowel sounds. One way to encourage this easy onset to voicing is to contrast the feelings in the throat when you say words beginning with “h” and words beginning with vowels. Using the following list, listen and feel the contrast between these two types of words. You should notice that you begin the words starting with “h” in a more relaxed way than you do the words beginning with vowels.Hoe – oh high – eye heat – eat hill – ill his – is hat – atheel – eel had – add hail – ale heart art harm – arm handy - andyhedge – edge hear – ear

Now say the words starting with vowel sounds and try to capture the same feeling of relaxation and easy voice production as you do when saying the words beginning with “h”. You could even imagine that you are saying a tiny “h” before each vowel.

Then say the following phrases using an easy onset to each word. It can be helpful to use an image such as tiptoeing or stepping lightly onto the vowels.

Isadora is an ostrich

I am an Eskimo

Anne is an extrovert

I eat ice cream

Alf is an excellent organiser

Uncle Arthur is amusing

Over and over and over again

Only elephants eat eels

Aunt Alice is especially irritating

Practicing a “silent giggle” as you speak can also help to relax the larynx and vocal folds. Silently giggle in your throat like laughing at a young child without showing them that you are laughing at them. Alternatively, snigger like a child would to another child who is being reprimanded.

While you giggle silently, breathe in and out gently and notice how quiet your breathing is. Then giggle silently again, keep breathing in and out and say vowel sounds gently (e.g. .h”, “ee”, “oo”, “or”). In the same way, keep the posture of the giggle in your throat and say the days of the week, numbers, the months of the year.

Voice Projection

The most important key to effective voice projection is to use what is known as “head resonance focus” as you speak, especially when you want the voice to carry above noise or over large distances. To use a head resonance focus you will need to project your voice from your head


instead of your throat. As you speak or sing, imagine your voice making the bones and skin of your face and head vibrate as you speak. You can feel this happening when you hum in a singsong way on “m” or “n” sounds for a few seconds.

Place your fingers lightly on the side of your nose as you hum these sounds gently. Feel the vibrations through your fingers and try to make these vibrations stronger as you hum. Try placing the palm of your hand on the top of your head or on your cheekbones as you hum these sounds. Again, feel the vibrations produced by your voice.

Now try humming “m” or “n” in a singsong way for a few seconds without placing your hand on your head. Try to capture the same feeling of head vibration or resonance inside your head as you hum. This internal sensation of skull vibration is the sensation you should try to capture whenever you need to project your voice.

To assist your voice to project even more easily, you will also need to open your mouth widely when you speak. Think of your mouth as your megaphone! You can increase this megaphone effect even further when you need to project your voice by cupping your hands around your mouth. This simple action will transmit your voice more effectively above noise or over large distances.

A note on warming up the voice

To increase the efficiency and endurance of your voice during the teaching day, it is a good idea to warm up your voice prior to extensive speaking or singing. To warm up your speaking voice, five minutes of practicing the breathing, laryngeal relaxation and humming exercises outlined previously may allow your voice to function better for the whole day. If you sing extensively as a teacher, seek advice on warm up routines for the singing voice from a reputable singing teacher.


Minimising Harmful Voice Habits Introduction

One of the most common factors which increase a teacher’s risk of developing vocal problems is using the voice in potentially harmful ways. These potentially harmful vocal habits are commonly referred to as vocal misuse.

Vocal misuse can result in structural changes on the vocal folds causing swelling, inflammation, vocal nodules, and/or polyps. These structural changes come about because the mechanical impact of the vocal folds as they contact each other during strained or forceful voice production or coughing and throat clearing leads to damage to the mucosal cover of the vocal folds.

Vocal misuse does not always result in observable damage to the vocal folds, however. In many cases, even though the vocal folds look normal, vocal misuse will cause the vocal folds to vibrate in an abnormal manner so that the voice sounds impaired or so that the throat feels uncomfortable during speaking.

What constitutes vocal misuse?

The most common vocal misuse behaviours are:

speaking or singing with excess loudness levels speaking or singing with excessively low or high pitch levels speaking or singing with excessive muscle tension in the larynx, throat, jaw, tongue and

neck speaking with hard glottal attacks - abrupt and forceful beginnings to the first sounds in

words crying, laughing and sneezing with excessive muscle tension in the larynx, throat, jaw,

tongue and neck shouting, yelling, and screaming coughing or clearing the throat excessively speaking or singing extensively or loudly during a throat infection producing voice during effort closure of the vocal folds in non-speaking activities (e.g.

weight lifting, serving in tennis) whispering or speaking in an excessively breathy or airy voice.

Whether or not these behaviours will lead to voice problems depends on the frequency and severity of the vocal misuse. Occasional gentle throat clearing, for example, is unlikely to lead to vocal problems. Frequent throat clearing in a forceful way, however, is likely to damage the mucosal cover of the vocal folds. It is also important to keep in mind that individuals vary widely in their susceptibility to vocal misuse. A vocal behaviour that causes a voice problem in one person may have little or no adverse effect on another. We are all aware of people who appear to be able to use potentially harmful vocal habits such as yelling and shouting without developing any vocal impairment!

There are many situations faced regularly by teachers that are conducive to these vocal misuse behaviours. Some frequent examples of such situations are:

speaking or singing over background noise speaking loudly to attract student’s attention or to discipline students


speaking over large distances without effective amplification speaking to large groups without effective amplification speaking in an unnatural pitch or voice quality when reading to students or directing

plays singing in a style or vocal range which is appropriate for the student but uncomfortable

for the teacher cheering or barracking at sporting events

Strategies for minimising vocal misuse

An obvious way to minimise vocal misuse is simply to avoid using any of the vocal habits listed below:

never talk or sing loudly never clear your throat never yell or shout never teach when you have a throat infection never use character voices never start words (spoken or sung) in a tense, hard way never speak over large distances or in noisy situations without a good amplifier

Avoiding all of these potentially harmful vocal behaviours is, however, far easier said than done! For this reason, we have listed below a variety of additional strategies that will help you minimise vocal misuse behaviours and/or reduce their harmful effects.

Reducing vocal misuse

Rather than trying to make your voice louder, clearly articulate, open your mouth widely when you speak, slow your speech down a little and ensure that students can see your face easily.

Stand in a place in the classroom that makes it easiest for students to hear you Move closer to students or have them move closer to you when talking to them Arrange furniture to promote short-distance conversations Arrange the classroom so those students who are likely to be noisy or need extra

attention are at the front Use methods of behaviour management which don’t involve yelling or loud talking Turn down background noise such as radios, television, PA systems, or move away from

the source of noise when talking Close doors and windows to shut out external noise sources Focus on how your voice is feeling rather than trying to hear it above the noise (i.e.

feelings of throat fatigue, dryness, soreness, or strain are danger signals) Use nonverbal means to gain attention and convey some of your message - use hand

and arm gestures or sound signals such as clapping or a bell/ whistle/children’s party clicker

Use pauses and variations in intonation (inflection) rather than loudness to gain attention and increase the responsiveness of students

Give instructions to a small number of students who then have responsibility for informing the rest of the class

Use routines such as playing a particular piece of music to signal changes in activities


Use an amplifier or megaphone where possible and ensure that you understand good microphone technique

Whenever you feel that you need to cough or clear your throat, swallow hard, yawn, take a sip of water, suck or chew a sweet but avoid medicated throat lozenges, or push air up from your lungs in short, quiet bursts

Increase your awareness of when you clear your throat and cough - count the number of times you do these things in, say, a period of an hour and then set yourself a target of reducing the number in the next hour

Restrict the amount of speaking, avoid all forms of loud or strained speaking and don’t whisper when you have a throat infection - avoid all but essential talking and, preferably, do not teach classes

Avoid whispering or using a very breathy voice to protect your voice groups or classes mainly when students are quiet

Reducing the harmful effects of vocal misuse

Sip water frequently all day to keep your larynx and vocal tract moist (one to two litres of water sipped during the day is sufficient)

Massage under the chin to increase saliva flow and keep the larynx and vocal tract moist Have steam inhalations (no additives needed) to clear mucous and keep the vocal tract

lubricated (once or twice a day for one minute is ample) Plan balanced voice use during a day by organising activities where speaking is not

involved - listening to music, tapes, videos and DVDs in classes Include a period of at least 30 minutes during the teaching day where you can work or

relax in a quiet place without talking at all Use effective and efficient voice production techniques (refer to the Using Effective

Voice Techniques information sheet for recommended breathing, posture, vocal fold vibration, and voice projection strategies).


Maximising Physical and Emotional HealthIntroduction

Although physical health factors are rarely the sole cause of voice disorders in teachers, an unhealthy lifestyle and certain illnesses significantly increase a teacher’s susceptibility to vocal problems. Recent research has demonstrated, for example, that poor general health and vitality are associated with an increased risk for voice problems. A poor diet and inadequate amounts of sleep and exercise are the most common factors associated with reduced general health and vitality. Reduced general health and vitality, in turn, will be reflected in the health of the teacher’s voice. When a person is unwell and lacking in energy, for example, they will put less energy into their voice so that it may sound weak and monotonous.

The specific illnesses that can contribute to the development of voice problems include gastro-esophageal reflux, allergies, and viral or bacterial infections affecting the respiratory system.

Reflux may lead to voice problems when acid spills over from the esophagus and burns the linings of the larynx. Common sign of reflux include coughing at night, throat clearing and hoarseness on waking, slow voice warm-up time, and acid regurgitation.

Allergies and infections of the respiratory system such as hay fever, sinusitis, the common cold and ‘flu, laryngitis and pharyngitis may cause swelling and inflammation of the vocal folds, increased coughing and throat clearing, and the production of thick, sticky mucous which collects on the vocal folds. This swelling and inflammation of the vocal folds, coughing and throat clearing and the accumulation of thick mucus mean that the vocal folds cannot vibrate normally and that the sufferer is likely to use the voice in a strained way in an attempt to improve the voice.

Tobacco smoking and other recreational drug use (e.g. marijuana, cocaine, excess alcohol), and a high caffeine intake (e.g. coffee, tea, cola drinks) can also damage the mucous membranes of the vocal folds and larynx. These substances all have a drying effect on the mucous cover of the vocal folds. In addition to the drying effect, alcohol and cocaine use can cause inflammation (redness) of the vocal folds and smoking may also cause shortness of breath, coughing and a lowering of the pitch of the voice. Finally, many medications used in the treatment of health conditions can have an adverse effect on the larynx. Inhaled corticosteroids used in the treatment of asthma, for example, can sometimes lead to an inability of the vocal folds to close normally because of their negative effect on the vocal fold muscles. Similarly, antihistamines used in the treatment of allergies often have a drying effect on the larynx, hormonal medications used to treat endometriosis can lead to a lowering of voice pitch, and some medications used to treat hypertension cause chronic coughing which is damaging to the voice.

Many types of stress and emotional reactions such as anxiety and depression can also have a negative effect on the voice. The areas of the brain responsible for the regulation of emotion are the same as those involved in voice production so that it is not surprising that a person’s emotional state is often reflected in their voice. When a person is feeling sad or stressed their friends will often be able to detect these feelings through the sound of their voice. Further, when a person is feeling stressed; the muscles of the larynx and throat are often tensed. This excess tension in the larynx and throat leads to strained voice production, an increase in the effort required to produce voice and deterioration in voice quality.


Improving physical health

An obvious way to maximise your physical health is to simply eliminate the risk factors outlined above. That is, improve your diet, get more exercise and sleep, stop smoking, and avoid using recreational drugs and caffeine. Community resources such as the QUIT Program which is designed to assist individuals to stop smoking, may also be of value to teachers who wish to improve their health.

A series of specific strategies are outlined below to assist teachers in improving their physical health so that their resistance to voice problems is increased.

Reflux

Do not eat later than two hours prior to bed Avoid foods which promote reflux (e.g. alcohol, coffee, spicy and acidic foods) Raise the head of your bed at least 8 cm Take antacids (e.g. Mylanta) or over-the-counter anti-reflux medications (e.g. Zantac) If the reflux is severe, consult your doctor for full diagnostic investigations and

prescription of anti-reflux medications where appropriate

Allergies and infections of the respiratory system

Restrict the amount of speaking or singing you do when you have a throat infection Avoid all but essential talking, and avoid loud talking and speaking over background

noise at work and at home when you have a throat infection Increase your water intake whenever you have hay fever or any infection of the

respiratory system Avoid using medicated throat lozenges (use non-medicated lollies instead) Have steam inhalations once or twice each day to clear thick mucus and keep the vocal

tract lubricated (there is no need for additives in the water)

Caffeine

Limit your caffeine intake as much as possible Substitute water, herbal teas, lemon juice for caffeinated drinks For every cup of caffeine you have, drink an additional two glasses of water

Medications

Consult your doctor if medications for any health condition seem to affect your voice or throat (it may be possible to use an alternative medication or to reduce the dosage)

Be wary of medications which contain anesthetics to numb pain in the throat (because the effect may be to reduce your ability to detect when you are straining your voice)

Avoid frequent use of aspirin (because it can predispose you to vocal fold hemorrhage)

Other physical health strategies

Avoid foods which may make mucus secretions thick and sticky (e.g. full cream dairy products, highly spiced foods, nuts, chocolate)


Try to breathe through your nose rather than your mouth (the nose warms and filters the air more effectively)

Women may need to take extra care of their voices in the few days just before and at the beginning of the menstrual period (changes in estrogen levels at this time may lead to swelling of the vocal folds)

Avoid smoky environments (passive smoking can have similar effects on the vocal folds as smoking itself)

Improving emotional health

An obvious way to maximise your emotional health is to work on reducing the stress levels associated with work and/or your life outside of work. Again, reducing stress and negative emotions is not easy without some assistance. Reading this information sheet is, however, not an effective way for you to learn to manage your stress levels.

Department employees experiencing high stress levels should consider undertaking stress management or relaxation classes, accessing the Department’s Employee Assistance Program (EAP) on ph. 1300 361 008, and/or consulting their doctor.


Maximising the physical environment Introduction

While the physical characteristics of a person’s work environment are rarely the main cause of voice problems, an environment which is conducive to vocal misuse or one which contributes to irritation of the vocal folds and larynx can increase the teacher’s susceptibility to vocal problems. The major environmental enemies of healthy voice production are high levels of noise and poor environmental acoustics. There are many potential sources of high noise levels:

children’s activity vocal noise inside or outside of classrooms teachers’ voices inside or outside of classrooms machinery aircraft and vehicle traffic noise PA system noise loud music high winds noise generated by equipment such as computers, printers and fans.

Noise levels from these sources will have a considerable impact on a teacher’s voice use behaviours, particularly when noise cannot be adequately shut out. Open or joined classrooms, thin walls or partitions, poor fitting doors and windows and close proximity to noise sources will all make it difficult to shut out noise.

Problematic acoustic features of the environment include wall, floor and ceiling surfaces which result in sound reverberation or echo such as hard surfaces of lino, tiles, concrete and timber. Other factors which are not conducive to easy voice projection include rooms with very heavy drapes and carpets which ‘deaden’ the voice and outside at swimming pools, sports fields, playgrounds. Both high noise levels and poor acoustics contribute to vocal misuse behaviours such as loud talking, shouting and strained voice production.

Some environmental conditions may also have a direct impact on the health of the vocal folds and larynx:

very dry air (e.g. air conditioned environments) dusty environments polluted air fumes from paint, solvents, chlorine, felt-tip pens and markers smoky environments high levels of plant pollens

Any of these conditions may lead to inflammation and swelling of the vocal folds and laryngeal mucous membranes, excessive coughing and throat clearing and production of thick mucus which collects on the vocal folds. It is also possible that some of these environmental factors such as plant pollens, smoke and pollution cause allergic responses of the respiratory system that in turn may adversely affect the larynx and vocal folds.


Strategies for maximising the physical environment for voice

A clear way to maximising your physical environment for healthy voice production is to avoid speaking or singing in any of the adverse environments described above. That is, avoid dusty, smoky, polluted environments, avoid air conditioning, and avoid teaching in areas where there are poor acoustics or high noise levels. Teachers will need to develop self-management strategies that minimise the effects of sub-optimal environments and to work with the school management group to improve the physical characteristics of the school setting.

An important first step is for teachers to use the strategies for minimising vocal misuse and for developing effective voice production techniques (refer to the Information Sheets titled Minimising Harmful Vocal Habits and Using Effective Voice Production Techniques). With effective voice production techniques and good voice care, it is possible to minimise the impact of poor environmental conditions. Learning to use an effective projection technique, for example, will allow the teacher to project the voice safely, even in noisy conditions. The following additional strategies for managing the voice environment are recommended:

stand in a place in the classroom that makes it easiest for students to hear and see you move closer to students or have them move closer to you when talking to them arrange furniture to promote short-distance conversations arrange the classroom so that students who are likely to be noisy or need extra attention

are at the front turn down background noise such as radios, television, PA systems where possible, or

move away from the source of noise when talking encourage students and other teachers to speak with normal voice and not to shout, yell

or scream close doors and windows to shut out external noise sources and ensure that doors of

adjacent rooms which may be noisy are closed use a portable voice amplifier or megaphone in noisy environments or places which

make it difficult to project the voice easily sip water frequently all day to keep your larynx and vocal tract moist and reduce the

effects of dry air, dust, pollution and fumes avoid using dusty chalk keep air conditioning and central heating levels low use humidifiers or vaporisers in dry, dusty environments take fresh air breaks as often as possible if working in polluted, dusty or dry

environments or if working with paint and other fumes.

In addition, plan balanced voice use during a day. Organise to undertake activities where speaking is not involved such as listening to music, tapes, videos and DVDs in classes. Include a period of at least 30 minutes during the teaching day where you can work or relax in a quiet place without talking at all.

Work with the school leadership team to achieve environmental improvements such as:

location of the employees room in a quiet place or designation of another quiet room for voice rest for staff

location of the music room away from regular classrooms banning the use of the PA system for playing loud music implementation of sound barriers in open and joined classrooms


purchase of portable amplifiers for employees replacement of low-density walls with high-density materials creation of effective door and window seals regular vacuum treatment of carpets and cleaning of all horizontal surfaces replacement of air filters in forced-air heating/cooling systems at least once per year installation of water dispensers in convenient locations for employees installation of a watering system to reduce external dust creation of wind breaks.


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