Work hoarse?

first_img Comments are closed. Work hoarse?On 1 Aug 2001 in Personnel Today Related posts:No related photos. More and more people use their voice at work whether in a call centre or aclassroom.  This presents a challenge theOH team which needs to help workers develop strategies to look after theirvocal health.  By Carey Gardner In modern societies about one third of the labour force works in professionsin which the voice is the primary tool. And this number is in- creasing withthe development of new employment arenas such as telephone banking and callcentres. Recent research has suggested that teachers, trainers and instructorscomprise a large proportion of the population who seek help and therapy forvoice disorders. Although voice problems are common, they are most common inprofessions where there is a heavy vocal loading, for example, prolonged voiceuse, long speaking distances and in the presence of background noise1. Smith et al2 found that schoolteachers report voice problems at a rate ofnearly three times that of a randomly selected group of individuals who workedin a variety of other occupations2. The voice is the primary instrument of communication for humans bothsocially and in the workplace. Although rarely life-threatening, voice problemscan have a tremendous impact on daily life3. According to Perkins, because the human voice is a powerful indicator of anindividual’s physical and emotional health, personality, identity and aestheticorientation as well as an acoustic signal for speech, singing, drama andemotional expression, voice disorders may exert a profound effect on affectedindividuals4. Voice disorders can result from many causes including disease processes, congenitalabnormalities, faulty use of the vocal mechanism, and psychogenic causes. Themajority of voice disorders are due to the latter two factors, that isfunctional rather than organic causes5. Koufman6 suggests that the voice in actuality is the entire person, sinceany abnormality of the psyche or soma can give rise to an abnormality of thevoice. Therefore, the voice is a measure of a person’s overall sense ofwell-being. He also claims that traditional medicine has created a dichotomousmodel of disease – organic versus functional – but many voice disorders can beboth organic and functional simultaneously. However, this dichotomy has littlerelevance to understanding the management of voice disorders. The causes of voice change Voice changes appear to be associated with vocalisations that occur overlong periods of time, at a high volume, at an unusual pitch, with excessive orinappropriate tension, in the presence of unhealthy vocal fold tissue or due toa combination of these factors7. Over the past 10 years there have been several studies that have sought toidentify the nature, frequency and risk factors that contribute to voicesymptoms experienced by teachers. However, research is important in identifyingrisk factors for any profession where there is a heavy vocal loading andenvironmental risk factors. A survey by Sapir et al8, which was designed to assess the prevalence andimpact of voice loss, suggested that it was prevalent among teachers. More thanhalf of teachers suffered more than three voice symptoms, and these symptomsadversely affected their ability to teach effectively. Teachers also felt thattheir voice was a chronic source of frustration or stress to them8. In research by Smith et al2 teachers complained that teaching had an adverseimpact on their voices, and 39 per cent had cut down on their teachingactivities as a result. Further research on teachers in comparison to individuals working in otheroccupations, suggested that teachers are at a high risk for disability fromvoice disorders and that this health problem may have significant work-relatedand economic effects: 20 per cent of teachers but only 4 per cent ofnon-teachers had missed work due to voice problems2. A group of aerobics instructors were studied by Long et al9. Results showedthat a significant number of instructors experienced partial or complete voiceloss during and after instruction, as well as increased episodes of hoarsenessand sore throats unrelated to illness. Several studies indicate teaching produces a high risk of voice symptoms,and that the problem is related to vocally abusive behaviours associated withthe occupation. This health problem may have significant work-related andeconomic effects on the affected individual. The working environment Individuals who use their speaking voice as the main instrument of theirprofession are often required to speak for prolonged periods where optimalvoice quality and projection is demanded, in environments which are notconducive, and where they are required to place exceptional and continualdemands on their voices in stressful circumstances. Noise Background noise can be significant in the development of vocal symptoms.Individuals will increase the volume of their voice in noisy situations inorder to be heard. Therefore, vocal intensity and the consequential strainincrease proportionately in order to communicate effectively in noisyenvironments10. Humidity and temperature A hot dry environment can be detrimental to the voice and humidification maybe required, especially during the winter. Dehydration should be avoided sincethis can affect the vocal process and it is important to have access todrinking water to lubricate the vocal system. Pace of work and job content Prolonged periods of using the voice can contribute to vocal fatigue. Notall vocal demands are of equal importance. Therefore a schedule of work thatleaves room for voice rest and recovery should be developed. If workers are suffering vocal problems and throat symptoms due to thenature of their work this has important implications from an occupationalhealth point of view since employers have responsibilities under legislationsuch as the Health and Safety at Work Act 1974 and the Management of Health andSafety at Work Regulations 1992. This legislation requires employers to carryout systematic health and safety inspections of their premises and practicesand to identify any risks or hazards to their workers arising from thosepremises or practices. Employers are then required to take action to eliminatethe risks and hazards to health identified, or reduce them as far as is reasonablypracticable. Remedial action could apply to environmental considerations such as roomacoustics, speaking duration, distance, humidity and noise levels. Combined with remedial environmental changes, where required, and areduction in risk factors associated with vocal abuse and overuse, thedevelopment of health education programmes focusing on the voice may help to preventthe development of voice symptoms. Education would increase awareness of the factors that affect voice health,and encourage workers to become more attentive to the risk factors that lead tovocal fatigue and discomfort. Chan has detailed a programme of vocal hygiene education. This programmeincludes: – Education on the anatomy and physiology of the vocal system – Explanation of vocal abuses, talking loudly, forced whispering, forexample – Lifestyle behaviours that can affect voice health – smoking, caffeine, andalcohol, for instance – Education on healthy vocal use including strategies to maintain order, bynon-vocal signals such as clapping, which aims to conserve the voice – Moving closer to the target audience to alleviate the need for strenuousvocal effort11. The impact of a voice disorder on an individual is considered immeasurable,and the resulting symptoms such as vocal fatigue, hoarseness, voice loss anddiscomfort of the throat, can affect a worker’s ability to function andtherefore may have significant work-related and economic effects. Voice dysfunction can lead to increased sickness absence, reduced effectivenessand may in severe circum- stances, lead to the individual leaving employment. Clear evidence is emerging from a number of recent studies for developmentof strategies and educational programmes for the maintenance of voice health. The voice is the primary instrument of one-third of the labour force and assuch every effort should be made to protect it. References1. Vilkman E (2000) Voice problems at work: a challenge for occupationalsafety and health arrangement. Folia Phoniatr Logop 52(1-3):120. 2. Smith E, Lemke J, Taylor M, Kirchner HL, Hoffman H (1998) Frequency ofvoice problems among teachers and other occupations. Journal Voice, 2(4):480-8.3. Garrett.CG, Ossoff RH (1999) Hoarseness. Medical Clinics of NorthAmerica, 83 (1):115-123. 4. Perkins WH (1971) Vocal function: a behavioural analysis. In:Travis LE,ed. Handbook of speech, pathology and audiology. New York: Appleton-CenturyCrofts. 5. Herrington-Hall BL, Lee L, Stemple JC, Niemi KR, McHone M (1988)Description of laryngeal pathologies by age, sex and occupation in a treatmentseeking sample. .Journal of Speech & Hearing Disorders, 53:57-64. 6.Koufman, James A. Medicine in the vocal arts. Center for Voice Disordersof Wake Forest University. 7. Gotaas C, Starr CD (1993) Vocal fatigue among teachers. Folia Phoniatr(Basel), 45(3):120-1. 8. Sapir S, Keidar A, Mathers-Schmidt B (1993) Vocal attrition in teachers: surveyfindings.European Journal of Disorders of Communication, 28 (2): 177. 9. Long J, Williford HN, Olson MS, Wolfe. (1998) Voice problems and riskfactors among aerobics instructors. Journal Voice, 12(2):197-207. 10. Rontal E, Rontal M, Jacob HJ, Rolnick MI (1979) Vocal cord dysfunction –an industrial health hazard. Ann Otol Rhinol Laryngol,88(pt 1):818-21. 11. Chan RW (1994) Does the voice improve with vocal hygiene education? Astudy of some instrumental voice measures in a group of kindergarten teachers.Journal Voice, 8(3):279-91. Carey Gardner RGN, BA(hons), BSc OHN (Bristol) Specialist NursePractitioner is a health adviser for Bupa Wellness (Cardiff) The manifestation of voice disordersVocal fatigue a problem that begins to occur as the speaking dayprogresses and which worsens during the dayLaryngeal fatigue affects the physical sensations and effort andperceptual quality of voice productionHoarseness a term used to describe a change in a person’s normalvoice quality or change in normal pitch, vocal abuse is one of the most commoncauses of hoarseness and can lead to other vocal pathologies such as vocalnodulesAphonia loss of voiceOdynophonia pain and soreness in the throat with prolonged vocal useVoice break or voce “crack”A loss of pitch range Previous Article Next Articlelast_img