Better Hearing & Speech Month

Week 1: Teachers & Voice Disorders

Did you know that...?

  • research in voice disorders identifies teachers as “at risk” for vocal disorders?

  • more teachers seek voice therapy than any other profession?

  • vocal abuse and misuse can lead to excessive sick leave and permanent vocal damage?

  • voice disorders can be prevented?
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Why is this important?

Take a moment to think about how often you use your voice each day. Think

about how strongly it is linked to your self-concept. Your voice coveys emotion, attitude, and how you feel physically (e.g., cold, crying). What would happen if you developed a

voice disorder? Could you afford to lose your voice?


Please take the time to read the following information on voice disorders and what you can do to prevent them.

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Vocal Cord Nodules & Polyps- Common Vocal Pathologies of Teachers

1. What are Vocal Cord Nodules & Polyps?

  • Vocal cord nodules are benign (noncancerous) growths on both vocal cords that are caused by vocal abuse. Over time, repeated abuse of the vocal cords results in soft, swollen spots on each vocal cord. These spots develop into harder, callous-like growths called nodules. The nodules will become larger and stiffer the longer the vocal abuse continues.
  • Polyps can take a number of forms. They are sometimes caused by vocal abuse or

    airborne irritants (e.g., smoking, toxic fumes) and medications. Polyps appear on either one or both of the vocal cords. They appear as a swelling or bump (like a nodule), a stalk-like growth, or a blister-like lesion. Most polyps are larger than nodules and may be called by other names, such as polypoid degeneration or Reinke's edema. The best way to think about the difference between nodules and polyps is to think of a nodule as a callous and a polyp as a blister.

2. What are the signs/symptoms? (Nodules and polyps have similar symptoms.)

  • hoarseness
  • breathiness
  • a "rough" or "raspy" voice
  • a "scratchy" voice
  • harshness
  • Aphonia - absence of voice; usually have to speak in whisper; great deal of effort required to speak
  • shooting pain from ear to ear
  • a "lump in the throat" sensation
  • neck pain
  • decreased pitch range- usually associated with singers who report difficulty producing notes that previously presented no problem; tiredness & soreness in throat
  • voice or body fatigue- feeling tired after prolonged talking and continued talking takes great efford; often co-occurs with hoarseness

3. How are nodules and polyps diagnosed?

  • If hoarseness persists for more than 3 weeks, make an appointment with an ENT (Ear, Nose and Throat Specialist)

4. How are nodules and polyps treated?

  • Nodules and polyps may be treated medically, surgically, and/or behaviorally. Surgical intervention involves removing the nodule or polyp from the vocal cord. This approach only occurs when the nodules or polyps are very large or have existed for a long time. Typically, behavioral therapy is utilized prior to and after medical or surgical interventions.
  • Medical problems may be treated to reduce their impact on the vocal cords. This includes treatment for gastroesophageal reflux disease (GERD), allergies, and thyroid problems. Medical intervention to stop smoking or to control stress is sometimes needed. (MORE INFO ON GERD NEXT WEEK!!)
  • Many people receive behavioral intervention, or voice therapy, from a speech pathologist. Voice therapy involves teaching good vocal hygiene, reducing/stopping vocal abusive behaviors, and direct voice treatment to alter pitch, loudness, or breath support for good voicing. Stress reduction techniques and relaxation exercises are often taught as well.

by taking steps to eliminate vocal abuse and increase vocal hygiene you can reduce or prevent vocal nodules or polyps!

Do you demonstrate vocal abuse?

Everyone demonstrates some form(s) of vocal abuse. Vocal abuse includes

but is not limited to screaming or yelling, prolonged talking, throat clearing

or coughing, singing in your car/shower, grunting while playing sports,

smoking or exposure to second hand smoke, consuming alcohol, and excessive

whispering.

How to reduce vocal abuse...

1. Use of a sound amplification systems while teaching/talking to large groups.

2. Use of a confidential tone rather than whispering.

3. Try to be within three feet of your listener when speaking.

4. Build periods of vocal rest into your day (e.g., no singing in the car/shower, no speaking while students are at specials, etc.)

5. Identify the vocal abuses you demonstrate throughout the day and chart

them so that you know how frequently they occur. Involve your students

by having them count the number of times you clear your throat or raise

your voice each day.

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just as we take time to care for our bodies, we should take care of our vocal folds/cords. Good vocal hygiene generally includes the following techniques:

1. Hydrate your vocal folds by increasing your fluid intake (especially water) througout the day.

2. Eliminate throat clearing/coughing (when you cough your vocal folds slam

together at 70 miles per hour!). Substitute a “sniff-swallow” instead.

3. Reduce nonessential talking.

4. Reduce talking/singing in loud background noise.

5. Eliminate (or at least reduce) alcohol intake and smoking.

6. Restrict medications that dry out the mouth, throat, and larynx (voice box).

7. Restrict aspirin use during loud talking periods.

8. Increase the amount of sleep that you get.

9. Restrict talking/vocal performance during menstruation and/or times of

throat infection.

10. Restrict use of loud voice in windy, cold, out-of-door areas.

11. Eliminate or reduce caffeine intake.

12. Don’t whisper unless necessary-It is just as abusive to vocal cords as shouting.

13. If your voice sounds hoarse or strained, drinks lots of water and get external

hydration (such as using a humidifier or a steamy shower).

14. Personal favorite for my voice patients...drink warm water with lemon juice and honey whenever you have a sore throat and before/after long days of excessive talking. You can add cinnamon sticks to the water when boiling to add anti-inflammatory agent but you cannot add tea.

I highly recommend viewing...

Excellent PowerPoint on Voice Abuse & Vocal Hygiene Recs by an ENT physician :

http://www.docstoc.com/docs/108384482/Vocal-Hygiene

Christina Rojas, M.A., CCC-SLP

Washington Elementary's own friendly Speech Therapist :)

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