Voice care in the workplace

Language is a defining feature of what makes us human. This is and is our predominant method of communicating ideas, thoughts, and feelings. Speech is our main method of articulating language and is therefore essential to almost all job roles. However, some roles such as teaching or call handling are more heavily dependent on vocal communication than others.

“Approximately 1 in 40 people experience some form of long-term voice problem during their lives.  However, incredibly, 30% of people suffer from some kind of voice problem during their lifetime” Source, The Larry Project

How do we produce speech?

Respiration: Airflow is an essential element of speech. At rest, the time taken to breathe in and out is about equal. However, during speech, our breathing pattern changes, we breathe in quickly and slowly release air in a controlled manner utilizing the diaphragm and abdominal muscles. The pitch, speed and volume of speech dictate how quickly we need to expel the air. Longer sentences require larger volumes of air. Respiratory conditions that restrict airflow can therefore affect speech, as has been recently clearly demonstrated by COVID 19.

Phonation (voicing): Exhaled air is pushed up through the glottis, the gap between the vocal cords (also known as the vocal folds) making them vibrate at speed. In turn, this causes the exhaled air to vibrate. The vocal cords are membranes stretched across the larynx which, when we are silent, are relaxed and open allowing air in and out the lungs unobstructed. Vocal cord disorders are often caused by vocal abuse or misuse, disease or surgery. Symptoms may include a raspy, hoarse, low, or breathy voice, or trouble swallowing or coughing. Ageing also causes changes in both the vocal cords and the muscles that control them, affecting the quality of the voice. Some medication can also have an impact e.g. Ramipril can induce a persistent cough and inhaled steroids, such as those used in the treatment of asthma, can cause hoarseness, although using a spacer device can help reduce the risk of this.

Resonance: The vibrating exhaled air is amplified and modified by the cavities of the throat, mouth and nasal passages. It is the nature of these cavities which create an individual’s recognisable voice.

Articulation: Is the process of manipulating the sound using our tongue, teeth and lips to produce words.

Self-care and adjustments

• Warm-up. You would not run a marathon without first doing stretches. This could include neck and shoulder rolls as well as articulation exercises (chewing an imaginary marshmallow, lip trills, tongue twisters). County Durham & Darlington NHS Speech and Language Therapy have produced a useful warm-up video. (https://www.youtube.com/watch?v=GaidlbNxDYc)

• Train the voice. IOSH has identified that vocal training in the workplace can significantly reduce the risk of physiological voice problems developing. (https://iosh.com/media/1477/iosh-working-voices-full-report-2011.pdf)
• For those who find apps helpful, the “One Minute Voice WarmUp” has been developed with speech and language specialist input to teach techniques to reduce the risk of vocal damage.
• Whispering. Rather than saving the voice, it puts additional stress on the vocal cords. If you are unable to manage anything more than a whisper, it is advised to not talk on the phone or via online platforms for prolonged periods. It is suggested to limit this to 5 minutes at a time as we tend to talk louder and more forcefully when using these methods of communication. Text or email communication could be utilized as an alternative.
• Mindful. Consider the pitch of your voice, we tend to talk louder and at a higher pitch when we are stressed and emotional. Using techniques to release muscle tension can be helpful. Highlight with management any workplace issues as they arise, as support can only be offered if they are aware there is an issue.
• Avoid dehydration– keep a water bottle with you and keep sipping. Caffeinated drinks and medicated lozenges should be avoided as these dehydrate the vocal cords. Antihistamines can also have a drying effect on the vocal cords.
• Remember to breathe. Fill the lungs. Long words and sentences take more air. Try breaking long speeches down into smalle sentences. Posture can assist with breath control so ensuring an ergonomic DSE set up for those working via phone/ digital platforms is important.
• Try to avoid coughing. Coughing slams the vocal cords together at 300 miles an hour which can cause injury and inflammation, instead try swallowing or taking a sip of water. Sucking sweets or chewing gum also encourages saliva production that lubricates the throat and reduces the need to clear the throat.
• Give your voice a rest. If your role requires prolonged periods of talking, build in periods of silence into your day. Teachers may wish to consider rotating teaching methods regularly warm-up, increasing the use of videos, handouts or self-guided activities to help facilitate this. Regular 5-10 minutes breaks may be more helpful than prolonged rest after a long period of talking.
• Quit smoking or vaping. The inhaled particles cause irritation and inflammation.
• Acid reflux. Stomach acid can irritate the vocal cords resulting in a persistent cough and vocal issues. It may therefore be appropriate to suggest a GP review if this is suspected.
• Reduce background noise levels. Trying to compete with loud ambient noise causes us to talk louder, which when prolonged can cause inflammation of the vocal cords.
• Alternatives to raising your voice. There is a whole range of technological solutions to amplify the voice from sound systems to portable voice amplifiers. The Larry Project has a web page dedicated to providing some examples, however, if the issue is long term then a referral to Access to Work may be appropriate.

Useful resources

The Larry Project – Support and advocacy for individuals with vocal issues

The British Voice Association – provide a good range of health promotion leaflets regarding the “working” Voice

Asking for silence – A “getting attention” routine

As a child I attended the brownies. When Brown Owl wanted us to be quiet, she would hold up her hand and as each child noticed her action, they too would put their hand in the air and be quiet. The silence quickly spread amongst the group, without the need to raise a voice. Behaviour management strategies to limit the need for raising voice may be helpful for teachers.

Stephanie Foster RGN, BSc OH, PGC OH

Stephanie is an Occupational Health Advisor with the PAM Group