This is Rachel Kidd – I’m a private speech and language therapist based in Waterford. I am delighted to be sharing with you my top tips on voice care for teachers. Your voice is probably one of your most precious resources as a teacher.
In the classroom, vocal quality is one of those non-verbal signals that can be adapted to communicate:
Today’s post will be a whistle-stop tour through the most common causes of voice disorders with some red-flags for when to seek help. Please note that voice therapy with a speech and language therapist can only begin following assessment by an ENT surgeon. The information in this blog is for information purposes only. The tips shared are universal tips and do not substitute for specialist assessment and intervention.
What creates a voice?
There are 4 sub-systems that combine to create the acoustic signal we call voice
Respiration (in the lungs)
Phonation (in the vocal folds)
Articulation (actions of the tongue, throat, teeth and lips to create sounds)
Resonance (air resonates through the nose or mouth)
So as you can see, there is much more going on than just vocal fold movement. When teachers have trouble with their voice, we take a deep dive into all four sub-systems to see where the problem could be emerging from.
Do I have a voice disorder?
It depends – there are three different groups of symptoms.
- Sensory – where you “feel” like something is different in your voice it might “feel” tight, sore, gravelly or even just more effortful to talk and achieve loudness. Sensory symptoms can exist without any change to what the voice sounds.
- Auditory – this is where our voice “sounds” different to yourself and others – typically clients will say “I just don’t sound like my usual self”
- Visual – an ENT surgeon does a scope and can see symptoms of a voice disorder on the vocal folds; e.g. vocal nodules, vocal fold paralysis etc
Sensory symptoms are #1 because they generally emerge first in the progression of a voice disorder. In the early stages of a voice disorder, the muscles in the larynx will compensate and put in lots of extra effort to keep the voice sounding the same as usual. If you feel a sudden change in how your throat feels when you speak, even if the acoustic quality is the same – you must get it checked out by your GP. Your GP can then arrange a referral to an ENT surgeon.
Keeping your voice healthy
Voice starts in the lungs
Remember Deirdre in Coronation Street? Every time she spoke, you could see her neck muscles “roping” …
This “roping” where the neck muscles are visible, is a very classic sign of a shallow breathing pattern – also known as “clavicular breathing.” When breathing patterns are shallow, there is insufficient air to achieve loudness and sustain vocal quality. Classically, the muscles in the larynx will compensate by squeezing and tensing in order to achieve the volume needed to e.g. reach the students at the back of the classroom. This puts extra pressure on the larynx and vocal folds and can result in a wide range of vocal difficulties.
Signs of shallow breathing:
- Roping of the neck muscles
- Moving and squeezing the shoulders to take a deep breath
- “shallow” vocal quality – sometimes called “tinny” voice
- Difficulties achieving and maintaining loudness
- A feeling of hard tension in the neck when we need to project our voice
- Constantly feeling like people didn’t hear you the first time “sorry, what was that?” (sound familiar?)
A quick test for shallow breathing
- You’ll need a friend for this
- Get a friend to pop a hand around your diaphragm and another hand on your upper chest near the sternum
- Now, close your eyes and talk for 2-3 minutes about your commute from your front door to the school gate this morning…
- Where does your friend notice the most movement – at the chest and shoulders or at the diaphragm ?
- For someone with shallow breathing, classically the chest and shoulders will move more than the diaphragm area.
The real culprit behind chronic cough
(i) A chronic cough lasts for 6 weeks or more. I have met so many people in everyday life with “that stubborn cough”, they’ve tried every antibiotic and over the counter medication with no success (and in today’s world – they’re probably had a covid test too). A chronic cough that lasts 6 weeks or more can cause havoc on the voice. Every time the person coughs, the vocal folds bang very forcefully together resulting in inflammation. It becomes more effortful and more difficult to achieve loudness and often results in hoarseness.
Numerous studies (Lechien et al., 2017) have shown that a highly significant number of cases of chronic cough were in fact caused by silent gastro-oesophageal reflux – where stomach acid flows up the oesophagus while lying in bed and irritates the vocal folds and oral cavity.
For people with a chronic cough arising from reflux, usually they experience:
- Coughing more late at night while lying in bed
- Coughing more after a large meal
(ii) Chronic Cough – STEP AWAY FROM THE STREPSILS
Where a cough is lasting for 6 weeks or more – Strepsils and other anti-bacterial medications will not only be useless, but will in fact do harm to your voice. As an antibacterial agent, Strepsils work to dehydrate the affected area. The loss of hydration in the vocal folds then inhibits vocal function resulting in further hoarseness and difficulties achieving loudness.
Multiple studies have shown the impact of reflux on chronic cough. If you have been suffering with a cough for 6 weeks or more, contact your GP and investigate (among other things), reflux.
Hydration and the voice
Adequate hydration supports vocal fold function Sivasankar and Leydon (2011). I love my morning coffee as much as the next person but it’s important to monitor the quantity and make sure you’re rehydrating sufficiently.
As a general rule of thumb, for each 12floz coffee you drink… you need to drink three times the amount in water – so 36floz of water, in order to adequately rehydrate.
Smoking and the voice
Reinke’s Oedema is a voice disorder strongly linked with the impact of smoking . This is where the vocal folds swell, causing the voice to become deeper and quite hoarse. In short, it is advised to give up smoking and to avoid all sources of passive smoking too.
Check out the environment
Be conscious also of your classroom environment . Some of the most common environmental irritants for the voice include:
- Lack of adequate ventilation
- Central heating
The impact of masks
Masks reduce vocal volume by approximately 12dB. Strictly speaking, if respiration patterns and all other vocal sub-systems are operating correctly, masks should not have an impact on vocal quality because the voice can achieve and sustain the necessary loudness.
However, we’re only human and many of us are indeed shallow/clavicular breathers or have other health issues that can impact on the voice. It is highly likely that masks will really highlight and exacerbate those maladaptive shallow breathing patterns or other vocal behaviours, heightening the risk of voice disorders such as vocal nodules etc.
A note on technology
Considering how masks reduce vocal volume by 12dB, you may be thinking of some voice amplifying options already but please note:
It is not generally a good idea to skip straight to the technology and run with the idea of “oh I’ll just get a microphone for the classroom–that will get rid of the chronic:
- tightness I’m feeling in my throat
- gravelly quality in my voice
- vocal fatigue
Chat out any chronic vocal symptoms you’re experiencing with your GP first.
Generally speaking a “chronic symptom” is a symptom that lasts for 10-14 days or more.
Speaking is not essentially a hazardous activity. We don’t get voice disorders because we “talk so much”. Voice disorders develop because one of the vocal subsystems is not functioning adequately or because there is an underlying medical cause such as reflux, etc. Let’s assume that you have been to see your GP and have attended for an ENT scope. In voice therapy, your speech and language therapist, will then probably talk about some technology options that will help to amplify your voice while you’re on the road to recovery.
If you have any queries or questions about the information in this post, drop a message to Kidd Talk Speech and Language Therapy on Instagram or Facebook. Equally, you can email firstname.lastname@example.org
Thank you to “Irish Primary Teacher” for this opportunity.
All the best,
Speech and Language Therapist
CORU No. SL024281.