Every year a number of teachers and early years workers suffer from voice strain exacerbated by prolonged use of their voice. Some even leave the profession because of it. Martin Hodgson, an education and healthcare consultant, explores the issue and looks at what schools and early years providers can do to reduce the risks.
Teachers and those working in early years rely upon their voices to carry out their work. But voice strain is a common complaint. Many accept it as an inevitable part of the job and carry on despite the pain involved. Some require periods of sickness absence as their voice recovers, but some leave the profession altogether.
What is voice strain?
Voice strain can occur if the voice is worked too hard. It is characterised by hoarseness, pain and a gradual loss of voice.
In the education and early years sectors, staff use their voices for prolonged periods. Mild voice loss is common. Occasionally it is serious and can lead to permanent voice damage.
The most common cause is shouting or speaking with a loud or raised voice for a protracted time. In music it can be caused by long periods of singing.
There may be many reasons for frequently shouting or talking loudly. For instance, members of staff may develop the habit of raising or lowering the pitch of their voices in order to be authoritative. They may also need to raise their voice to overcome background noise or poor room acoustics.
Environmental factors can also contribute to voice strain. Examples include:
large class or group sizes
poor room layout and design
high background noise levels or echo (both because they can increase susceptibility to stress and ill health, including voice strain, and because they cause people to raise their voice in order to be heard)
dust, fumes and irritants
high temperatures, poor ventilation and low humidity.
Excessive throat mucus is both a cause and a symptom. Voice strain causes thick secretions of mucus. These in turn affect voice quality and voice control. Throat clearing or coughing may help temporarily, but habitual throat clearing will generate more mucus and make the vocal folds sore and inflamed.
Excessive mucus generation can also be caused by dehydration, food sensitivities, airborne irritants, inhalers, poor air quality and colds or upper respiratory infections.
What are the symptoms of voice strain?
The voice is produced in the larynx, or voice box, which has limited sensation and few pain centres. There are, therefore, limited warning signs that the voice is being over-stretched. Symptoms tend to occur suddenly and may include:
throat pain when speaking or swallowing
a sore throat in the morning, which disappears when the voice “warms up”
a hoarse, tired voice, particularly in the evening
an increase in mucus
rapidly changing pitch or loss of control of the voice.
Chest infections and laryngitis are common complications of voice strain. Laryngitis is a severe inflammation of the larynx which can make talking very painful.
Continuing to work with untreated severe voice strain or with laryngitis can cause long-term voice damage.
Is voice loss a disability?
Voice loss can be considered as a disability under the Equality Act 2010 if it has a “substantial adverse effect” on normal day-to-day activities. It is considered long term if it has lasted for at least 12 months.
Disabled employees are protected against discrimination and the employer is under a duty to make reasonable adjustments where any work arrangements or the physical features of the workplace put a disabled person at a disadvantage.
For instance, in schools and early years services, reasonable adjustments could be made to reduce the strain on the speaker’s voice.
How can the risks be assessed?
Employers in schools and early years have a duty under the Health and Safety at Work, etc Act 1974 to make appropriate health and safety arrangements for their staff, including assessing the risks of voice loss.
A voice care risk assessment should be completed as necessary, especially in situations where a member of staff complains about voice strain symptoms or where he or she experiences heavy voice use. Newly qualified teachers may have higher risk levels than established staff as they may be less used to prolonged voice work.
If a risk is identified, appropriate preventive measures must be put in place. This can include information and training for staff and changes to the physical environment or working arrangements. Records should be kept of staff training.
Failure to complete a risk assessment and to take necessary action to control risk may leave the employer vulnerable to legal action.
How can staff prevent voice strain?
There are many things teachers and early years practitioners themselves can do to prevent voice loss or to improve matters if they have identified symptoms of voice problems. In all cases, periods of heavy voice use should be balanced with periods where the voice is rested. Staff should be aware of times when they may be particularly susceptible to voice injuries, such as when they have sore throats, chest colds or infections.
Staff should be encouraged to avoid excessive throat clearing and to sip water instead as this will also deal with dehydration. They should keep a bottle of water handy and avoid things that can cause dehydration, such as excessive consumption of alcohol, caffeine and very hot foods.
Non-medicated pastilles may help, as will avoiding smoking.
There are a number of remedies for persistent nasal congestion, including nasal sprays, oral inhalers, medications and other treatments. Staff should use the best strategy for their own bodies. If in doubt, they should see their GP.
Medical help is needed if there is:
persistent hoarseness for more than two to three weeks
regular hoarseness or voice loss
significant voice quality changes
constant vocal fatigue
difficulty or pain when swallowing.
Staff suffering from these symptoms should visit their GP, who may refer them to a throat specialist. Medical checks may include a microlaryngoscopy — a vocal chord examination. Treatment may include a referral for speech therapy.
If a staff member has to take sick leave, a referral to an occupational health service may be required to advise the employer about their return to work.
How can training help?
Schools and early years providers should make staff aware of the dangers of voice loss and of the warning signs of voice damage. Those who are considered vulnerable to voice strain can be trained in voice care or supported to complete professional voice training.
Voice training will commonly address:
tension in the neck and shoulder that affects the larynx
poor breathing, which restricts the voice
limited jaw opening, or tension in the tongue or soft palate, which keeps resonance in the throat and reduces clarity of speech
lack of mobility in face muscles and lips, reducing the clarity of communication.
Training might include daily warm-up exercises, such as:
gently stretching to relax the neck and shoulders
humming a note in the middle range, followed by a note above and then below the middle range, and then repeating this series from a different starting note
blowing out through the lips, making them wobble
saying “grr” with a rolling “r”
saying a “tongue twister” out loud.
While talking to large groups, staff should be trained to:
stand tall to increase breath support and convey confidence
breathe from the diaphragm and be aware of posture when speaking
breathe deeply and easily, speaking from the belly rather than the neck or throat
avoid shouting or raising the volume or pitch.
What else can employers do to lessen risks?
Employers should ensure that drinking water is always available for staff and that the environment is well humidified. Where possible background noise should be reduced and attention paid to the acoustic properties of buildings.
In maintained schools and early years provisions, acoustic conditions must comply with the requirements of the School Premises (England) Regulations 2012.
Portable personal amplification systems might help in some cases. However, they do not tackle the foundation of voice problems and are not a substitute for prevention strategies and voice training.
The Voice Care Network (UK) is a learning and teaching organisation that brings together speech and language therapy and voice coaching. It delivers specialist voice workshops for professional occupational voice user groups and publishes guidance on its website.
Last reviewed 25 February 2016