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7. Prevention of Voice Disorders
Keywords
Prevention7.1 Prevention of Voice Disorders
7.1.1 Constitutional Limits
Physiological voice production significantly depends on hygiene of the upper respiratory tract. First, an unobstructed nasal respiration should be ensured. Voice disturbances may be accompanied by deviations in the nasal cavity. Allergic reactions in the larynx resemble inflammation. Coughing attacks due to allergy put an additional burden on the voice organ.
Preliminary phoniatric vocal fitness assessment may prevent professionally induced voice disorders by assuring that a patient meets the basic requirements of fitness for a voice profession. There are contra-indications for choosing such a profession.
Absolute contra-indications include permanent paralysis of the vocal folds, laryngeal papillomas, advanced inflammatory lesions in the respiratory tract (dry and atrophic chronic inflammation of the laryngeal mucosa), severe allergic diseases, velo-palatine insufficiency and moderate or profound hearing loss.
Relative contra-indications are solid nodules and polyps of the vocal folds, relapsing inflammation in the respiratory tract and palatine tonsils, nasal obstruction, reflux disease and unilateral deafness. Obviously, the dysfunctions can be compensated for by appropriate treatment; nevertheless they can cause professional dysphonia at a high probability (Obrębowski and Pruszewicz 1996).
7.1.2 Behavioural Aspects
The use of nasal decongestants should be avoided or at least strictly limited, as it leads to paralysis of the ciliary apparatus in the mucosa. An appropriate humidification of the pharyngeal and laryngeal mucosa protects against desiccation. A dry mucosa significantly increases phonatory effort.
For prevention of voice disorders, a programme of observing vocal hygiene may be established. In this programme, voice users receive advice during consultations on how to integrate correct voice production into everyday professional life (Holmberg et al. 2001). They should experience that during phonation a decreased muscular tension within the neck is of a significant preventive importance.
In accepting principles of correct voice production, one should remember the unfavourable side-effects of certain drugs. Hormones lead to oedema and increase the muscular mass of the vocal folds. Thereby they change timbre, decrease the average frequency, and lead to loss of high notes. Anti-allergic preparations and anti-depressants induce dryness of the mucosa. In case of suspected side-effects of any medication, the physician has to look up the drug information.
The voice organ may also be negatively affected by gastro-oesophageal reflux, which irritates the posterior part of the larynx (posterior laryngitis).
In laryngitis, independent of its intensity and aetiology, the physician should not recommend whispering but to use the normal voice as far as possible. Strained whispering intensifies contraction and constriction of the supraglottal structures and activates the nonphysiological phonation mechanism (Böhme 2006), whereas a soft whisper in the form of articulation during relaxed expiration is not harmful. In many cases of vocal dysfunction evaluated by a general practitioner or laryngologist, additional phoniatric examination and diagnostics are indispensable to indicate an intervention that allows preservation or restoration of the full capacity of the organ of voice.
7.1.3 Developmental Aspects
Prevention of voice disorders in children involves multilayer procedures (see Sect. 5.16). First of all, the presence of organic lesions in the larynx should be excluded, such as papilloma, congenital webs or other anomalies. The diagnosis is far from easy, and the procedure requires several consultations to make the child acquainted with laryngological examination.
Repeated inflammation in the throat and larynx should be treated. In cases of a small but inflamed pharyngeal tonsil, adenotomy may in particular result in a radical improvement.
In children with chronic hoarseness, an audiogenic dysphonia should be excluded. Bilateral hearing loss above 40 dB HL may cause functional voice disorders.
In preventing functional voice disorders in the developmental period, the most difficult problem is to control overexcited children with the habit of using their voice above the natural intensity. As early as it is possible, the child should be taught to talk with a soft vocal attack with no hypertension of the neck muscles, with no excessive accentuation. In some cases, a conversation using voice produced without tension at a normal conversational intensity may make the child calm down. Medication to reduce psycho-motoric over-excitation, and psychological or psychiatric treatment, may also be indicated.
Teachers should set an example by using correct physiological voice production at school, since a child frequently imitates the teacher, with whom it may be emotionally linked.
Vocal training of children must be within the physiological limits of their vocal function. The musical literature as well as songs in kindergarten should be appropriate for the physiological range of the children’s voices. In a choir, the possibility of individual vocal overload should be taken into account. This is particularly important during the mutation period, in which vocal training should be adjusted appropriately to its course. In principle, systematic singing lessons should start after mutation (Pruszewicz 1992).
7.1.4 Environmental Aspects: Harmful Agents
Cessation of smoking is a long-term process and not always effective. Information about the carcinogenic and circulatory risks of smoking is often more successful than explaining the unfavourable effects of smoking on the voice organ (Obrębowski 2008). Within the environment of children and youths, the habit of cigarette smoking should be combatted.
In the school environment, noise reduction supports attentiveness and concentration. A large number of pupils in the classroom, as well as poor acoustic conditions, lead the children to communicate at a high frequency and volume (Pruszewicz et al. 1974).
For teachers, an appropriate schedule of lessons with suitable distribution of teaching hours within a week should be attempted. An adequate number of pupils, air-conditioning of classrooms and application of audio-visual techniques improve teaching conditions and help to maintain vocal performance.
Mental health is assured by a conflict-free atmosphere.
7.1.5 Principal Rules
Prodromal signs of voice disturbances are transient changes in voice timbre, hoarseness in particular, vocal fatigue, the sensation of pressure or pain in the throat or in the neck following an insignificant vocal effort; they should not be ignored in general laryngological practice.
Excessively loud cries or laughs
Prolonged screams
Attacks of coughing
Excessively loud singing with an infection in the respiratory tract
Uncontrolled use of electronic voice amplifiers
Avoidance of rooms with improper room acoustics
Drugs affecting the vocal tract
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