www.voicecareforteachers.com

Alison Russell Cecilia Pemberton Jenni Oates

Introduction This booklet and DVD are designed to provide teachers with the information they need to look after their voices and to help prevent voice problems.

As a teacher it is important to look after your voice so that it will last throughout your entire teaching career. Poor vocal habits can result in long-term voice problems. However it is not difficult to avoid these problems with good voice care. In order to avoid voice problems you should think about how you use your voice each day and try to determine if you are using it in the most efficient and effective ways possible. You also need to be aware of the effects of fatigue, stress, ill health, the vocal demands of your job, and the physical teaching environment on your voice.

How does the voice work? It is important to understand the parts of the body that are involved in producing your voice. The three components that are essential for voice production are1. the lungs that supply the air, the source of energy for the voice2. the larynx that generates the sound 3. the oral and nasal cavities which shape the sound into speech.

Voice productionThe lungs, and the associated muscles of the abdomen and chest, provide the driving force for the voice. Without air, we cannot produce any sound at all. The lungs are made up of elastic tissue. As the diaphragm is lowered when we breathe in, the air pressure in the lungs is lower than the pressure of the air outside the body, and the air is drawn into the lungs. Once the lungs reach capacity they will recoil and thus expel the air. This is the respiratory cycle of inspiration and expiration. When you breathe out, it is possible to interrupt the air stream at the level of the larynx in order to produce a voice.

Authors: Speech Pathologists Alison Russell, Adelaide Cecilia Pemberton, Sydney Jenni Oates, Melbourne

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Once the voice has been generated in the larynx, the sound travels up into the mouth where it is shaped by the tongue, lips and jaw or into the nose where it can resonate to produce certain sounds. For example, /m/ and /n/ are made by the air flowing completely through the nose, while other sounds such as /t/ and /d/ require the sound to be produced in the mouth. Vowels such as “ah” “ee” and “oo” require a balance of sound between the oral and nasal cavities.

The larynx or voice box is located on top of the windpipe in your neck, and is behind your Adam’s Apple. The voice is produced by the vocal folds in the larynx. The windpipe or trachea and the lungs are below the vocal folds. The larynx can be examined using either a flexible fiberscope through the nose or a rigid fiberscope through the mouth.

The larynx is intricately supplied with muscles that are capable of very subtle and complex movements. The vocal folds are opened when you breathe in and closed to make a voice. When getting ready to make a voice, the vocal folds are drawn together by the muscles of the larynx. Air pressure is built up below the vocal folds until it is sufficiently strong to set the vocal folds into motion. Once the vocal folds are vibrating they generate sound and this sound travels up to be shaped and amplified in the mouth and the nose. The vocal folds are the only muscles in the body which come into contact with each other when they vibrate. This makes them susceptible to irritation unless due care is taken.

The muscles of the vocal folds are capable of changing shape.This diagram shows a cross section of the vocal folds and their distinct layered structure. The deep layer is made up of muscle and forms the bulk of the vocal folds. Covering the muscle is a layer of elastic tissue that allows the vocal folds to change shape easily when the muscle changes shape. Between this layer and the cover is a thin fluid filled layer also known as Reinke’s space. Finally, the cover of the vocal folds is made up of a moist mucous membrane like the mucous membrane lining your mouth. The Reinke’s space between the membrane and the bulk of the vocal folds themselves allows the cover to move freely over the vocal folds during voice production.

When the cover of the vocal folds vibrates, it moves in a wave like motion over the surface of the vocal folds. This is the mucosal wave and the quality of this movement is largely responsible for the clarity of your voice. The vibrations of the vocal folds are very rapid - in normal speech approximately 200 cycles of vibration per second for females and approximately 120 cycles for males. They vibrate even more quickly as you sing up a scale. In an average teaching day a female teacher’s vocal folds will vibrate at least 1 million times.

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The muscles of the larynx control the pitch of the voice by changing the thickness of the vibrating edge of the vocal folds. If the edge is elongated and becomes thinner, the vibration will be faster and the pitch will be higher. As the vibrating edge of the vocal fold becomes thicker the pitch of the voice becomes lower. When speaking or singing, the vocal folds are able to make these very fine adjustments very quickly to enable the rapid changes in pitch required for varied intonation patterns or sung notes. Changes in loudness are created by increasing the air pressure below the vocal folds. The pressure builds up below the vocal folds and when the vocal folds burst open into vibration the extent of that vibration is greater, and as a consequence, the sound generated is louder.

To produce a clear voice, all of the required components, breathing, vocal fold vibration and resonance, need to be working well, and working together in a highly co-ordinated way.

WHAT IS A VOICE PROBLEM?Voice problems are not an acceptable occupational hazard

Voice problems are common for teachers. Throughout the world research on the prevalence of voice problems has concluded that school teachers are at least three times more likely than people in the general population to develop voice problems, with up to 20% of teachers experiencing voice problems each year. Most of these problems result from the vocal demands of their occupation, with some contribution from factors such as physical health and fitness and the stresses of work and home life.

Some disorders are associated with pathological changes on the edges of the vocal folds such as swelling, inflammation and vocal nodules and polyps, but in many cases the voice problems occur even though the vocal folds look perfectly normal. In only a small number of cases will voice problems be due to a specific disease that affects the larynx and vocal folds.

There are many possible symptoms of voice problems. The earliest symptoms are felt as discomfort in the throat - a tired feeling, soreness or pain, dryness, aching, a tickling sensation, a feeling of tightness or pressure in the throat, a scratchy or burning sensation, or a sensation of a lump in the throat. These symptoms may lead to huskiness, croakiness, hoarseness, breaks in the voice, a change in pitch or a reduced pitch range, difficulty in making the voice project, a feeling that talking is an effort, running out of breath while speaking, or an inability to do anything but whisper.

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Checklist 1 can be used to evaluate your symptoms. If you notice any of these symptoms occurring on a regular basis, try some of the strategies in the DVD and see if the frequency of the symptoms diminishes. Seek help from a speech pathologist if the symptoms persist.

RISK FACTORS FOR DEVELOPING A VOICE PROBLEMTalking during a throat infection, a cold, the flu, or sinusitis; frequent coughing or throat clearing; allergies; and acid reflux as well as the use of some asthma preventers, antihistamines, anti-hypertensives and some hormonal medications can all have a detrimental effect on your voice.

In an acute throat infection, the vocal folds become swollen, inflamed and they cannot vibrate smoothly or close together. The voice can become husky or hoarse or disappear altogether. Often teachers use extra vocal effort, straining their voice so they can continue teaching. This may mean that the huskiness or hoarseness will persist long after the infection has gone because they have established a new habit of using the voice in a strained way. Teachers mistakenly think that whispering is a good alternative in these circumstances - it is NOT! Whispering puts additional strain on the voice and can just make things worse.

Try to avoid repeated respiratory infections by building up resistance and maintaining good general health otherwise your voice may suffer. When you do have a throat infection, cold or flu it is especially important to take extra care of your voice to allow it to recover. Restrict the amount of speaking and avoid all forms of strained voice use until the throat infection has completely resolved. It will be necessary to avoid all but essential talking and avoid loud talking and speaking over background noise, at work, at home and in social situations. If your voice has not returned to normal within 1-2 weeks, seek help from a speech pathologist specialising in voice.

If you persistently cough or clear your throat in the absence of an acute illness see your doctor. If there is no medical cause, then this may either be a habit developed when you had a throat infection, or a symptom of a voice problem. You may feel that you need to clear your throat to make your voice clearer or to make your throat feel more comfortable, but all this does is make the problem persist. This is very common complaint of teachers and can easily be treated by a speech pathologist specialising in voice.

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OTHER HEALTH FACTORSStressMany types of stress can have a negative effect on the voice. When you are stressed, the muscles in your neck and larynx are often tense, and as a result your voice is not produced efficiently. You might notice that your voice takes more effort to produce, or that you are using your voice in a very strained way. If you are feeling stressed, seek professional advice about managing this. While it is unlikely that we will ever be stress free, it is possible to control the negative impact of stress on the voice.

Emotions And FatigueYour voice often reflects how you feel: when you are happy, sad or tired your friends will often pick up subtle nuances in your voice that reflect these emotions. This is also true when you are unwell. You lack energy and therefore put less energy into your voice. This is a real danger time for the voice of a teacher. Your voice may tire more easily or change in quality. Other symptoms of vocal fatigue include a sensation of a lump in your throat, your voice fading after prolonged talking, and soreness or pain in the laryngeal area.

AllergiesAllergies can cause voice problems. If the allergy affects the mucous lining of the nose and throat there is often a sensation of increased mucous production and a need to clear the throat. Allergies are often treated with nasal sprays or antihistamines, which may have a drying effect, and lead to using the voice with more strain or effort. If you have allergies and you are concerned that they, or the medications, are affecting your voice discuss this with your doctor.

Acid RefluxIndigestion, heartburn or reflux may cause voice problems if acid spills over from the oesophagus and burns the mucosal linings of the larynx. This may cause inflammation, excess mucous, hoarseness, and or a dry throat. If you experience problems with reflux, consult a doctor who may suggest modifying your diet to eliminate the foods causing the irritation or, alternatively, medication may be necessary. It is important to seek treatment early, as prolonged voice use with an irritated larynx may lead to long term voice problems.

SmokingSmoking irritates the lining of the larynx and can cause swelling along the length of the vocal folds. It may also cause shortness of breath, coughing and a deepening of the pitch of the voice. Smoking is harmful for the voice and should be avoided - this includes the smoking of any substance as well as passive smoking.

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WHAT CAN YOU DO TO REDUCE THE RISK OF DEVELOPING VOICE PROBLEMS?Checklist 2 will allow you to evaluate your risk factors for developing a voice problem. If you experience any of these risk factors on a daily basis, you need to consider ways in which you can reduce the risks.

Make Sure You Drink Enough WaterIt is important to maintain adequate hydration so that the vocal folds move easily and without effort. It is best to sip water throughout the day. Two litres of water is sufficient for most professional voice users, however if your throat is dry or you are breathing in particularly dry air (for instance if you are working in an air-conditioned or heated room) you may need to sip more than this. Tea, coffee and other caffeinated drinks are not a substitute for water.

Reduce Persistent Coughing And Clearing The Throat Reduce persistent coughing and clearing the throat by using strategies such as:• sipping water frequently throughout the day especially when you feel the urge to cough or clear the throat• swallowing instead of coughing or clearing the throat• yawning to release tightness in your throat instead of clearing your throat• consciously suppressing the urge to cough or clear the throat• counting the number of times you cough or clear the throat in an hour and then setting yourself a target of reducing the number in the next hour • sucking on a sweet or chewing sugarless gum, but avoiding medicated cough lollies.

Voice RestEnsure that you build in daily periods of voice rest. Like any other muscle groups that have had a great deal of exercise, your vocal folds need regular periods of rest for recovery, both throughout the teaching day and at the end of it. In the classroom use alternatives to your voice such as a talking book rather than reading aloud, giving students written instructions for tasks, using videos and DVDs as teaching tools and when possible, rest your voice at recess and lunch times.

Use amplificationIf it is essential that you call out across distances or talk very loudly for extended periods, use appropriate amplification devices. A megaphone is a safe and effective means of projecting your voice in large outdoor spaces and smaller amplification devices can be used indoors.

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Manage noise in the classroom To reduce noise coming from outside the classroom, close doors and windows.

Obviously the students generate the most significant noise in the classroom. Manage student noise by establishing routines, so students are clear that when they are noisy you will be using a signal, not your voice, to gain attention. There are many other noise generators in a classroom that can be managed. Check the noise level of equipment such as air conditioners, computers, data projectors. If you can’t turn the equipment off, don’t stand near it when you deliver instructions to your class. Noise within the classroom is often exacerbated by the hard surfaces. Adding carpet, cushions, fabrics and other sound absorbing materials will help reduce the reverberation.

Reducing the basic noise level in a classroom also means everyone can speak with less volume - teachers and students alike, thus helping to conserve your voice.

VOICE CARE TECHNIQUES

All of the voice care techniques are explained and demonstrated on the DVD. These are simple exercises that will help you to maintain a healthy voice. If you are experiencing any problems with your voice, seek help as early as possible.

PostureGood posture is an important aspect of voice production as it supports the voice, allows for good breath capacity and control, and facilitates voice projection. Good posture promotes effortless voice.

Do this exercise every day to become aware of your posture.

Standing, legs slightly apart, knees slightly bent, lift your shoulders up and roll them back, then allow them to return to a neutral position. This opens up your chest.

With an open chest, move your head from side to side to gently stretch and allow your head to return a neutral position. Push your chin out as far as it will comfortably go and pull it back as far as it will comfortably go, and find a neutral position.

It is important to be aware of the alignment of your head in relation to the rest of your body as changes in one can have an effect on the other.

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Warm up / Cool down Warming your voice up in the shower in the morning is an effective way of getting your voice ready to undertake the daily vocal teaching marathon. The shower is a great place to do these exercises, but you can also do them as you are getting ready for work.

Gently hum up and down the scale, either on a glide or on incremental notes. Go up as high and down as low as is comfortable. Never strain or extend your voice to where it breaks. Alternatives to humming are lip or tongue trilling up and down the scale. When humming or trilling make sure you are focussing on the vibration of your lips or tongue.

Do these exercises for the length of the shower and while getting ready for school; between five and ten minutes of warm up should be sufficient. You are always aiming for the best quality voice you can achieve without straining. You should repeat this exercise at the end of the day on the way home from school or before you go to bed as a cool down exercise.

DeconstrictionFor good voice production and projection it is important to have an open and relaxed throat. If the muscles above the larynx are tight or constricted this dampens the sound making it harder to project your voice. This simple exercise can reduce constriction easily.

Open your mouth and simulate the beginning of a yawn. Feel the stretch of the muscles at the back of your tongue, soft palate and pharynx. An important component of the yawn is slowly drawing the air in silently. This takes the stretch down to your vocal folds and ensures you are not just stretching the muscles of your mouth and jaw.

You should feel the muscles in your throat widening, giving a sensation of increased space. As you breathe out allow your vocal folds to gently come together and sigh /a/. Make sure that the sound of your voice is not breathy. It should be a clear, strong voice with no effort, pain or strain.

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TrillingLip or tongue trilling is an important voice technique as it helps to move the focus of the voice forward and away from the larynx. To do this exercise successfully, ensure that you feel the vibrations of your voice in the lips, tip of the tongue or front of the mouth and not at the back of the throat or tongue. As well as being a good warm up exercise, lip and tongue trills are useful to release constriction in the throat. When you do this exercise you also engage the abdominal muscles that support the voice.

Gently trill with your lips or tongue up and down the scale and make the sound as smooth as possible. Never strain or extend your voice to where it breaks.

Abdominal Control of BreathingOne of the most common complaints of teachers is that they are not able to make themselves heard. Developing a loud voice by using safe voice projection techniques is essential for sustainable voice use for teachers.

Before you start this exercise, review the exercises of posture, warming up and deconstriction. It is essential to have mastered the deconstriction exercises before undertaking the abdominal breathing exercises.

Standing with a relaxed posture, with your hand just below your ribs in the midline on your diaphragm, take a breath in and feel the abdominal muscles expanding your belly into your hand. Gently hum a comfortable note observing the movement of your abdomen as your hand moves towards your spine as you produce a voice. Increase the loudness of the sound using the muscles of your diaphragm and abdomen. You will feel these muscles tighten or ‘kick in’ as you increase the loudness.

Do not let your throat tighten. Let your abdominal muscles do the work to make your voice louder.

Gently hum again making the sound move from soft to loud and feel the abdominal muscles tighten as the sound gets louder. As you hum making a continuous sound, push on the abdominal muscles and notice how the sound gets louder.

Expand this exercise by saying the days of the week and months of the year varying the volume on each word and always focusing on abdominal muscle control of the loudness.

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Seek help earlyIf you feel that your voice is not meeting the daily demands of teaching seek advice from a Speech Pathologist specialising in voice. Seeking help early will reduce the risk of long term voice problems.

Voice Care for Teachers DVDThe Voice Care for Teachers DVD covers all of this information in more detail and includes interviews with teachers describing strategies that they have successfully implemented in the classroom to reduce noise and look after their voices.

Additional features on the DVD: Seeking help: What to do if you have a problem Voice Care Techniques: Simple exercises to try Helpful strategies: Teachers share their tips Managing noise: Getting sound advice Voice Problems: Teachers’ own experiences Voice Production: How it all works Disorder Endoscopies: A closer look at some problems

Additional information about the DVD can be found at www.voicecareforteachers.com

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CHECKLIST 1 FREQUENCY OF SYMPTOMS OF VOICE PROBLEMS

Name Date

SYMPTOM DAILY WEEKLY MONTHLY

A feeling of discomfort in the throat

Tired feeling in throat

Soreness / pain

Dryness

Aching

A tickling sensation

A feeling of tightness / pressure in throat

A scratchy / burning sensation

A lump in throat

Huskiness

Croakiness

Hoarseness

Breaks in the voice

A change in pitch

Reduced pitch range

Difficulty projecting the voice

A feeling that talking is an effort

Running out of breath while speaking

Only able to whisper

Other

CHECKLIST 2 RISK FACTORS FOR DEVELOPING A VOICE PROBLEM

Name Date

RISK FACTORS

FREQUENCY OF RISK FACTORS OCCURRING Daily Weekly Monthly Using a tight or strained voice

Frequent coughing

Persistent throat clearing

Talking during a throat infection

Allergies / Sinusitis

Frequent cold and ‘flu

Acid reflux

Certain medications

Alcohol, tobacco

Recreational drugs

Talking over noise

Persistently talking loudly

Yelling / screaming

Straining to talk over distance

Singing / acting with an inefficient technique

Using voice in an inappropriate pitch range

Stress/tension /anxiety