Jefferson Voice and Swallowing Center Sees Fall Trend of Teachers "Losing Voice"
Source Newsroom: Thomas Jefferson University
Newswise — PHILADELPHIA – Gloucester County, New Jersey school teacher Lauren Roberts is now returning back to school. She has her 4th grade classroom ready. She’s bought the extra pencils, erasers and crayons.
But there was one back-to-school item that Roberts knew she needed more than any other. And having it now, she’s especially grateful. In fact, she says it’s her most important teaching asset.
Roberts, a non-smoker who has been a school teacher for the past nine years and a part-time dance instructor, taught at a special education resource center with small class sizes for the first four years of her career. While she would get a sore throat occasionally, it was manageable. She then transferred to an elementary school to teach a large fourth grade, and has suffered, starting every fall and ever since, from “losing her voice.”
“The vocal cords are the elastic bands inside the larynx that vibrate to produce a person’s voice,” says Joseph Spiegel, M.D., co-director of the Voice and Swallowing Center at Thomas Jefferson University Hospital. “Teachers are among those professionals who make great demands on their voices, often in rooms with poor acoustics and inadequate ventilation. Unfortunately, this stress on the voice can lead to problems such vocal fold swelling, vocal fold nodules and excessive muscle strain with voice use. These conditions can severely limit voice quality and stamina which can alter quality of life but can also lead to occupational disability for a classroom teacher. If left untreated, these problems can cause permanent vocal damage.”
Dr. Spiegel says the largest patient population at the Jefferson Voice and Swallowing Center is teachers. He adds that the fall season seems to be the heaviest time frame for teacher appointments at the Center.
“When teachers return to work in the fall, their voices are at their best because the vocal cords were ‘rested’ over the summer,” says Dr. Spiegel. “By mid-fall, teachers have started using their voices for longer periods of time and are frequently raising their voices loudly enough to get the attention of about 30 students. We like to see teachers early in the school year to give them the best chance for a full year with their best voice.”
More than 7.5 million people have diseases or disorders of the voice, reports the National Institute on Deafness and Other Communication Disorders (NIDCD), which supports research into the nature, causes, diagnosis, and prevention of voice disorders. A NIDCD study found that 11 percent of teachers reported a current voice problem. Non-teachers expressing voice problems comprised only 6.2 percent.
The condition is so common among teachers that Roberts thought losing her voice was “part of the job.” But day in and day out, it wore on her. She says by Friday of each week, she had no voice left.
“After a year and a half, I was becoming raspy-sounding all the time, my voice seemed deeper, I couldn’t sing along to a song in the car or change the tone of my voice,” says Roberts. “The children in my class would ask the assistant teacher to read books aloud. I had to communicate with the kids non-verbally – either through flashing overhead lights or by clapping. It was affecting my personal and professional life.”
Relief only came to Roberts when she didn’t have to speak. “During classes such as music and art, where I didn’t have to teach, I would rest my voice. At lunch, I’d eat by myself in my classroom so I wouldn’t have to speak to anyone. I’d drink water, hot tea, and use lozenges. But the relief was only temporary. I had to take sick days from work because I had no voice. I finally sought medical help.”
Roberts came to see Dr. Spiegel at Jefferson for an examination in fall 2010. “Lauren’s throat was extremely red and raw, her vocal cords were swollen and she had developed vocal fold nodules” says Dr. Spiegel. “After initial treatment with voice therapy, we did endoscopic surgery, found a benign cyst on her vocal cord and drained it. We also discovered she had acid reflux, which can contribute to vocal problems. She was given reflux treatment including medication and continued work with a speech-language pathologist after the surgery.”
The Jefferson Voice and Swallowing Center uses a team approach with laryngologists (physicians specializing in care of the voice) and speech pathologists working together. The speech pathologist serves as a teacher and coach for patients with high vocal demand and helps the patient use their voice in a way that preserves it.
“Voice therapy can help with indirect and direct therapeutic approaches,” says Rosemary Ostrowski, MM, MS, CCC/SLP, voice therapist in the Otolaryngology department at Jefferson. Indirect therapies can include recommendations such as voice amplification during teaching. Direct approaches include re-training the speaking voice with rehabilitation, much in the same way as physical therapy. Vocal exercises are used to re-train the vocal mechanism.”
“My coach taught me exercises to relax my vocal cords,” says Roberts. “I learned to speak more from my diaphragm and starting humming to help soothe my throat. I also practice saying certain phrases.”
Roberts says she’s recovered after four months of speech therapy. She has follow-up appointments with Dr. Spiegel every six months. She’s learned to manage and prevent poor voice days. “I no longer lose my voice, and it’s much louder and stronger. I can finally sing with the radio, change my tone, but most importantly, I can communicate with my students so they have the best learning experience possible.”
Roberts will occasionally use a lightweight microphone and an amplifier-speaker system to reduce vocal strain. She also gives tips to fellow teachers who are having vocal problems.
“Teachers can be our most challenging voice patients because of the constant, daily demands on their voice that do not allow substantial periods of voice rest as part of treatment,” says Dr. Spiegel. “However, with proper care, they can have a long, vocally healthy career.”
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Dr. Spiegel says that the warning signs for teachers and others who use their voice professionally include: pain when speaking and swallowing; a sore throat in the morning which disappears as the voice warms up; a hoarse or raspy, tired voice in the evening; rapidly changing pitch, sounding deeper or loss of voice control, the need or clear your throat or use effort with talking. If symptoms last longer than two weeks, seek medical attention.
Dr. Spiegel also offers these prevention tips:
• Drink water (stay well hydrated): The vocal cords vibrate extremely fast even with the most simple sound production; remaining hydrated optimizes the throat’s mucous production, aiding vocal cord lubrication.
• Do not smoke: Primary and secondhand smoke that is breathed in passes by the vocal cords causing significant irritation and swelling of the vocal cords. This will permanently change voice quality, nature, and capabilities.
• Do not abuse or misuse your voice: If you feel like your throat is dry, tired, or your voice is becoming hoarse, try to give your voice a rest.
• Minimize throat clearing: An alternative to voice clearing is taking a small sip of water or simply swallowing to clear the secretions from the throat and alleviate the need for throat clearing or coughing.