Vocal Health. Rate of reported voice problems among teachers. Causes of voice loss. Infections - exposure to germs and viruses

Transcription

1 Vocal Health ABCD Convention 25th August 2012 Dr Jenevora Williams Rate of reported voice problems among teachers No 32% Have you ever experienced voice problems that you feel could have been caused by your job? Yes 68% Association of Teachers & Lecturers Survey of 490 teachers, Causes of voice loss infections the way we use our voice our lifestyle the result of anxiety levels non-abuse related vocal illness These factors may only be partly within our control, but awareness can help us lessen symptoms, shorten recovery time or avoid problems Infections - exposure to germs and viruses Young people - many more infections Solution 1: Hand washing Solution 2: Healthy immune system Staying fit Sleep Healthy diet Keeping stress at bay

2 The way we use our voice Vocal Loading Vocal loading is increased by: Amount of use: the number of hours you are speaking or singing Level of use: louder voicing requires the vocal folds to collide harder Emotional stress: Anxiety creates tension in the voice Increased vocal loading vocal fold mucosa irritation vocal fold mucosal oedema huskiness and vocal struggle increased vocal fold mucosa irritation The way we use our voice - Speaking or Shouting? Background noise at work socially Room acoustics The way we use our voice Speaking with bad posture Leaning forward/ bending Twisting Solution: upright posture before you speak Speaking during physical exertion Physical exertion = constricting the throat Solution: Save the speaking until after you have done the lifting or reaching for something

3 The way we use our voice Different vocal colours The way we use our voice - pacing Voice use while under emotional stress Voice user is more prone to fatigue or injury Solutions: Low belly breathing The stress-busting breathing cycle Always warm up your own voice Maximise ease and range of motion Reinforce good vocal habits Prevent injury Singing rehearsal - best practice for reducing vocal loading Posture Good vocal technique Varied vocal qualities Pace your own voice use (frequent rests) Don t demonstrate everything - use a keyboard or a good singer from the group Don t sing along

4 Swallowing - what happens? Larynx lifts and closes Food/liquid passes over epiglottis into oesophagus Any mucous around larynx is redistributed Nothing from the mouth goes near the larynx or vocal folds Hydration Topical distribution of mucous (preferably thin) across vocal folds Systemic internal hydration of individual cells of the body Medications: Throat pastilles and lozenges dehydrate (e.g. menthol) anaesthetic swallowing (which lubricates the vocal folds) placebo Sipping water is cheaper and can be just as effective. Drinking and eating Late-night meals Dehydration Caffeine Alcohol Dairy products Exposure to irritants House dust Pollens Fumes Smoke

5 Smoking Tar = irritant directly on vocal folds + lungs At best this causes lessening in efficiency, at worst husky voices and long-term illness. Medications: Decongestants Up to five days Dehydrating effect Medications: Cough medicines Codeine or antihistamines (drying effect) Guafanesin (thins mucous) Cough if from dust, asthma or gastric reflux cough medicine no use Other common medications Antihistamines:?dehydrating, check with the pharmacist Steriod nasal spray (rhinitis) e.g. flixonase - vocal fold irritation/ dryness Antidepressants - can be drying Contraceptive pill - significant benefits Aspirin - increase possibility of haemorrhage High-Dosage Vitamin C supplements also drying Women s issues: monthly Day 24 to 28, hormone shifts swelling in vocal folds pitch uncertainty decreased vocal efficiency huskiness reduced vocal power or flexibility

6 Women s issues: menopause drier larynx less lung power weakened laryngeal muscles stiffer laryngeal cartilages thickened vocal folds more "man-like" voice fewer elastic and collagen fibres Ageing voices Post 55/65 reduced flexibility (pitch range) Muscle ageing - bowing of vocal folds and instability How can you tell if you have a voice problem? Persistent aching in the throat Lack of stamina in the voice Voice is routinely groggy when you wake up Other people s comments are you ill? What to do when the voice goes wrong Rest Steam Sleep If these are not enough after 2-3 weeks, ask a GP to refer you to a Voice Clinic

7 What to do when the voice goes wrong: At the Voice Clinic Diagnosis with endoscopic camera Laryngologist and speech therapist Also singing teacher, osteopath, physiotherapist Voice disorders: Inflammatory Infections Symptoms : croaky or breathy voice to complete voice loss. Cause: viral, bacterial, allergy, reflux or over-use. Pharyngitis, tonsillitis, sinusitis and rhinitis will not directly affect the action of the vocal folds unless there is post-nasal drip. Voice disorders: Inflammatory Allergies are common and may need ongoing treatment. Symptoms = hoarseness, nose-blowing, sneezing Common allergens = pollen, mould spores, dust, foods or cigarette smoke. Voice disorders: Inflammatory Acid reflux sore throat and hoarseness. Treatment may include antacids to neutralise the ph, PPIs and/or to raise the bed head.

8 Voice disorders: Structural Cysts: fluid-filled dilated mucosal ducts Causes: unclear Symptoms: hoarseness or coughing Treatment: surgical removal Polyps: associated with healing after vocal trauma Voice therapy: beneficial Surgery: only a last resort Tumours: benign or cancerous, some of which require surgery Voice disorders: Structural Nodules: mass of fibrous tissue, similar to callouses More frequent in boys than girls, but in more women than men Cause: high vocal loading over a prolonged period, often exacerbated by stress or anxiety Treatment: voice therapy in the first instance Voice disorders: neuromuscular Parkinson s disease Stroke Vocal fold paralysis Voice disorders: Functional Muscle Tension Dysphonia

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