||Volume 18, Number 2, October 2005
Occupational voice problems?
by Linda Rammage
Each September, many teachers return to their assignments after a leisurely summer only to find that their voices protest at the sudden return to a high demand for continuous speech in less-than-optimal conditions. Teachers consulting the voice-care team at the Pacific Voice Clinic in Vancouver General Hospital comment that they always assumed the "September Voice" phenomenon was normal since so many of their colleagues suffer from it.
In fact, experiencing strain, pain, fatigue, hoarseness, voice cracks, or loss of voice should not be an expected consequence of the return to teaching after extended voice breaks, nor should the tendency to feel your voice straining or weakening at the end of each teaching day or week throughout the year. These symptoms are a sign of an occupational voice problem.
Vocal hazards come in many forms, both external and internal. It is well documented in the literature that acoustical conditions in the majority of classrooms throughout the western world do not meet the recommended standards for healthy speaking and effective learning. For you, this means that speaking in classrooms that have poor reverberation times (echo) or high ambient noise forces you to speak at a louder level than is healthy, in particular, under the command of the "Lombard Effect." The Lombard Effect is a psychoacoustic phenomenon that causes us to strain our voices when we do not receive adequate feedback about our voice signal as we speak. It changes speech-breathing patterns and makes us tense our vocal mechanisms. It can sometimes be countered with good voice amplification devices, but if the room reverberation characteristics are poor, amplifying the teacher’s voice may actually make the acoustic problem worse.
Classroom size, teaching specialty, age of students, and curricular issues may contribute to vocal demand profiles and background noise conditions for you in your teaching assignment.
Your general health, lifestyle and demands, coping style, personality, and vocal technique are examples of internal factors that can affect how your voice functions. Common physical conditions such as reflux, allergies, respiratory sensitivities, and obesity can have a deleterious effect on the voice.
The most common diagnosis ascribed to teachers’ voice problems is muscle tension dysphonia (poor voice). The primary mechanism through which we cause muscle tension voice problems is the voluntary muscle system. Through motor learning, we subconsciously "train" ourselves to use the muscles of the breathing system, the larynx (voice box), the face, and the neck inappropriately. By the time we are adults, a coping style that includes holding muscles in some or all of these regions is a common sequela to a cumulation of stressors, both physical and emotional. Speaking in poor acoustic environments is a common cause of psychophysical stress. Commonly, adults encounter situations in their lives where they must act and speak in a way that is in direct contradiction to how we are feeling emotionally about an issue. (It is no longer acceptable to have temper tantrums to relieve the stress!) This leads to the tendency to repress physical and vocal expressions by tensing the parts of the body that would otherwise be involved in the overt action or statement.
We are currently conducting a complex research study to help us clearly define the nature, prevalence, and risk factors that contribute to voice problems among teachers in B.C. The BCTF, the Vancouver Elementary and Secondary School Teachers’ Associations, the Richmond Teachers’ Association, the Vancouver School District, and Richmond School District have all endorsed the project and we thank the many teachers who have already participated by completing the 20-minute questionnaire that explores the many potential issues contributing to occupational voice problems. In order to meet stringent statistical demands and provide robust results to teachers and their employers we need to have the assistance of many more teachers. To avoid design flaws intrinsic to survey research that does not elicit high return rates, we are asking that teachers come together as teams representing a minimum of 90% of the teaching population in their school. By having the entire teaching population of each participating school complete the survey, we avoid biasing results by attracting only those teachers who are currently most concerned about their voices. To facilitate the questionnaire completion, we are delivering questionnaires to teachers at participating schools during pre-arranged times, staying with teachers while they complete the task, and collecting the completed questionnaires immediately. We are also requesting that a representative sample of teachers allow us to make acoustic measurements in their classrooms to acquire specific information on acoustical risks to voice problems.
If you would like to participate in this important study and help shape the future of teachers’ vocal health, please contact us.
Linda Rammage is director of the Provincial Voice Care Resource Program, Vancouver General Hospital, and the survey’s principal investigator. Linda.Rammage@vch.ca.
For further information, contact Sandra Thomsen, 604-875-4111, Ext. 61725, Sandra.Thomsen@vch.ca. Web site: www.pvcrp.com.