How to Strengthen Your Voice in the New Normal

Coming from a family of medical professionals, Dr. Clarissa Fortuna was driven by inspiration. During the holidays when she was in elementary school, she spent most of her time in her father’s clinic writing prescriptions and when she arrived in high school she was already observing her parents, doctors Antonio Bello Fortuna (general surgeon) and Erlinda Santos Fortuna (obstetrician-gynecologist), perform surgeries. Through early clinical exposure, Dr. Fortuna knew medicine was her career. “Looking back, I don’t regret being a member of one of the most noble and time-honoured professions,” she shares.

Dr. Fortuna is a board-certified otolaryngologist-head and neck surgeon. She obtained her doctorate in medicine at the Faculty of Medicine and Surgery of the UST. She completed her postgraduate training in laryngology and professional voice care at Vanderbilt University Medical Center in Nashville, Tennessee, and at Tokyo University Hospital. She is the former director of the Ear Nose Throat Head and Neck Institute at The Medical City and is currently a senior consultant at the Center for Voice and Swallowing.

Over the past two years, the introduction of protective measures against COVID-19 such as social distancing, face shields and masks have helped curb its transmission, but have had a profound impact on our interpersonal communication. Consequences for voice health include reduced speech intelligibility and clarity and decreased frequency.

Here are some vocal hygiene tips to optimize vocal production during the transition to post-pandemic life:

1. Hydration. Adequate hydration is essential for an optimal voice. The recommended daily intake is eight to nine glasses (one eight-ounce glass). Add more if you are active and engage in activities that can cause excessive sweating. Since coffee and caffeinated beverages draw water from your body, watch your intake and drink more water to compensate for its drying effect. Technically, our bodies need constant rehydration, so be sure to remove your mask every 45-60 minutes to stay hydrated. Find a routine that works for you.

2. Nasal sprays and mouthwashes. Studies have shown that prolonged use of face masks can increase resistance and cause nasal obstruction. Medical-grade masks like the N95 used by healthcare workers can produce postnasal drip. This in turn promotes the usual throat clearing, which is abusive to the vocal cords and can cause hoarseness. The presence of mucus in your sinuses can also affect the resonance of your voice. Over-the-counter (OTC) nasal sprays consisting of hypertonic saline solution and rinses have historically been used to relieve allergy symptoms. It can prevent this mask-induced blockage and restore moisture to the nasal passages. Use it at the start of your day and at bedtime or before wearing a mask.

3. Improve communication. Communication through a mask has been quite a challenge for all of us since the pandemic. It drowns out our voice in volume and covers the middle and lower face, which accounts for 55% of our overall communication through facial gestures. Rather than speaking louder, change your speaking rate by speaking slowly and clearly, preferably in a place with low background noise. You can increase your eye expression and use non-verbal hand gestures to help the communication process. Health professionals who deal with elderly or hearing-impaired people on a daily basis must wear transparent masks. Other visual references such as flipcharts and whiteboards can also be helpful. If your budget allows, invest in masks available with purifiers and built-in microphones or voice amplification, which allow you to breathe and reduce pressure on your voice.

4. Digital infrastructure. Digital tools or platforms such as audio conferencing and video conferencing have grown tremendously during the pandemic. The work from home (WFH) culture will likely remain even long after the pandemic. If you’re in a type of job made possible by technology and your work is done remotely, set up a private workspace at home and invest in noise-canceling “muff” headphones that block out background noise. This will allow you to speak at a comfortable volume without causing strain in your voice. Let your voicemail and ears take a break when you’re offline. You need at least 15 minutes of voice nap for every hour of continuous conversation. If you’re a teacher and your school is always in online mode, design high-yield asynchronous learning content and interact during synchronous sessions to keep your voice.

“Your voice is your signature, keep it strong. Take care of it the same way you approach your health and well-being.”

5. It’s okay to sing in the shower. Whether you’re a vocal professional or not, you need your vocal cords lubricated for better vibration. The steam from the shower creates a moist environment that moistens your vocal cords and also thins the mucus in your nose and throat. Do this before going to work with a mask.

6. For voice professionals and the elite voice artist, always warm up your voice before heavy use or performance. Warm-ups can be as simple as trilling with the lips or tongue or sliding from low to high pitched sounds over vowel sounds. Singing with a mask is doubly difficult. Although performance is now permitted outdoors and indoors (with modifications), masking is still a requirement. Surgical and cloth masks (two layers) all reduce high frequencies. Get these specially designed “singer masks” or wear a racket or stand under your regular mask to allow you to open your mouth while singing. Always find a place where you can ventilate and preferably do not do more than 30 minutes of continuous singing.

7. Listen to your vice. If your voice quality is constantly hoarse and you experience vocal fatigue while speaking, rest and let your voice recover.

8. Seek professional help. If your hoarseness is longer than two weeks, you should be evaluated by a voice specialist or otolaryngologist (otolaryngologist).

9. Vocal longevity. Your voice is your “signature”; keep it strong. Take care of it the same way you take care of your health and well-being. Certain foods weaken the lower esophageal sphincter and cause laryngopharyngeal reflux (backflow of acid into the vocal cords). These include spicy foods, caffeine, alcohol, chocolate, and peppermint.

10. World Voice Day 2022. The theme for this year’s World Voice Day is “Raise Your Voice”. It was proposed by the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS), which calls us to take back our vocal presence with good voice quality that represents us and improves communication.

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