By Rudy Arispe
As a children’s music teacher at St. Thomas Episcopal School in San Antonio, Teresa Gray relies heavily on her voice. So it was a great challenge when last year she began to suffer from hoarseness and voice fatigue. As the problem worsened, she could sing for only 10 minutes before having to stop.
Her disorder was a result of a partial paralysis of one of her vocal cords, so she unknowingly compensated by overusing the other. The condition eventually required surgery. “I couldn’t speak for three weeks,” Gray says. “I wore a sign around my neck that said, ‘Recent vocal cord surgery. I cannot talk,’ so that people wouldn’t think I was rude.”
Gray is not alone in suffering a voice box injury. According to a 1997 study by the National Center for Voice and Speech, teachers in the United States make up 4.2 percent of the workforce, but account for 19.6 percent of patients seeking medical help for voice problems.
These statistics are one reason why John Nix, UTSA associate professor of voice, voice pedagogy and research, organized an international conference at UTSA on occupational voice injuries in 2007. It brought together about 50 of the world’s leading vocal researchers to discuss their findings. Funding for the conference was provided by the National Institutes of Health.
UTSA will again provide a forum for this issue when voice researchers, including doctors, voice scientists, music teachers, choral directors and speech pathologists, convene in January 2009 to share their latest information at the 4th International Conference on the Physiology and Acoustics of Singing.
The economic impact of voice injuries in teachers is significant. Because voice-related difficulties result in lost workdays, payments to substitute teachers, voice therapy/rehabilitation fees, early retirements and job retraining expenses, the estimated cost is $2.5 billion annually, according to the study, “How Much Do Teachers Talk? Do They Ever Get a Break?”
Voice problems arise because teachers must speak frequently and often loudly, which puts them at risk, says Nix. Like Gray, some may begin to overuse one vocal cord to compensate for weakness in the other. Others develop pathologies on the vocal cords, such as cysts or polyps, which are like fluid-filled blisters. The result is fatigue, hoarseness and loss of one’s voice. Those who shout or scream can even develop vocal cord hemorrhages. Worst-case scenarios may require surgery.
“In the case of a cyst or a vocal cord polyp, there’s usually a period of being on anti-inflammatory drugs,” Nix says. “You would be on complete vocal rest for 10 days with absolutely no talking. After the rest period, you would begin regular voice therapy sessions and begin slowly building your voice back up by only adding 5 to 10 minutes of voicing per day.
“It’s not career ending, but it can be devastating to someone whose occupation requires the expressive, healthy function of his or her voice.”
While someone with polyps might require surgery, a nodule, which is like a callous on the vocal cords, can usually be resolved by changing a person’s habits, Nix says.
Actors, singers, lawyers, broadcasters, telemarketers, counselors, ministers and politicians also are at risk of voice injury, Nix says. For those who require treatment, vocal therapy is recommended.
“Many types of vocal therapy used today involve making sounds with your mouth partially or totally closed, like humming, or vocalizing into a straw,” he says. “Therapy can reduce compensatory tensions and can also modify the way your vocal cords function, creating a more efficient production.”
Bad habits need to be identified, Nix adds, to prevent voice injury in the first place or, if injury has already occurred, to prevent further harm.
“Speaking too loudly or too low is also a risk factor,” he says. “A good therapist can help a person find an appropriate pitch to speak at, or help a person who is overly aggressive with words that start with vowels to use words like ‘happy Halloween’ or ‘hello’ to get them to learn to start speaking out more easily.” Nix explains that forcefully pronouncing words that begin with vowels is the result of taking a breath of air and holding it back with the vocal cords closed too firmly, irritating them when air is expelled.
“It’s about behavior modification,” he adds. “Surgery is usually the last option, but what good is
surgery if you haven’t changed the bad habits that
got the person there in the first place?”
It is also important to identify possible risk factors, including how much and how loudly a person talks, the pitch range being used and even exposure to pollutants, such as dust and fumes. Current research involves examining the causes of voice injury and identifying at-risk populations, as well as developing devices that monitor voice use.
“There is also research looking at whether it is beneficial to give someone an amplifier like an aerobics instructor wears,” he says. “There’s evidence that suggests that people who are genetically predisposed to having problems are helped by amplification. But a person who has bad habits needs therapy in addition to giving them an amplifier.”
UTSA collaborates with the Department of Otolaryngology at the University of Texas Health Science Center at San Antonio, headed by Randy Otto and Blake Simpson. Oftentimes, Nix will refer UTSA music students with voice problems to Simpson’s office. In return, Simpson sends singers from the community to Nix if they require help relating what they are learning in speech therapy to their singing.
Although Nix is not a speech pathologist, he worked in Denver at the National Center for Voice and Speech as part of a professional voice care team made up of a laryngologist, speech pathologist and singing teacher before coming to San Antonio.
“Prior to John’s arrival, there were limited resources for the ‘sick singer’ when it came to vocal pedagogy,” Simpson says. He praises Nix’s expertise in working with singers who have vocal cord pathology.
Simpson advocates what he calls good vocal hygiene so that patients keep their voices in peak condition. For example, drinking six to eight glasses of water a day helps produce a thin mucus that coats the vocal cords, keeping them moist and less prone to irritation. Not smoking, treating acid reflux and getting proper sleep also help.
When Gray began to experience severe hoarseness, she used a harmonica to get her students’ attention so as not to raise her voice. When her condition worsened, she sought the help of Simpson, who eventually removed a polyp from her vocal cord.
After surgery, the music teacher worked with Nix, who taught her to speak in a higher pitch and to form words differently. He also assisted her in what she calls voice aerobics, which “involves doing vocal exercises to stretch your vocal cords,” she says.
Nix also instructs choral students. Because they are studying to become singing teachers, the professor prepares them to be able to assist individuals with voice problems.
“Choral directors are voice experts for the vast majority of the population. They are on the front lines, so they need to have accurate information,” he says. “We discuss what healthy voice production is, and what a voice teacher can do to help versus knowing when there is a problem beyond their expertise and to refer them to a specialist.”
To view abstracts or videos from the 2007 Occupational Voice Conference, visit http://projects.dlc.utsa.edu/OVC/Index.html. |
