This year 2020, due to the pandemic situation declared by WHO for COVID-19, has meant a great change in our way of communicating and socializing.
The use of devices such as masks or screens has changed how the voice is perceived in a conversation, for example, because there is an attenuation of the voice, and this has forced us to speak in a more forced way to increase our tone of voice. As a result, there can be consequent damage to the vocal cords, especially if you do not have the proper training and advice from specialists dedicated to the care and use of the voice.
Thus, dysphonia is an increasingly frequent pathology due to this continuous strain on the voice in these circumstances and, above all, among professionals who use the voice in an essential way in their daily activity (teachers, singers, health professionals, etc.). In addition, these sectors of the population are some of the most prone to suffer vocal problems, since they use the projected voice at a great distance as a work tool and on a daily basis, and it is a serious problem when they do so without vocal techniques that help them not to suffer from this type of problems.
On the other hand, in addition to the natural vocal wear and tear that these professionals were already suffering, there is also the ambient noise and the daily stress of their activity. All this is causing a significant increase in the risk of vocal pathology due to the greater effort they have to make at work to be heard, due to the combination of masks, screens and social distance.
What is the relationship between the use of masks and the increase in dysphonia?
There are more and more studies that support a detrimental relationship for the perception of our voice due to the use of masks in this pandemic situation.
One example is the study conducted by the Brazilian Speech Therapy Department of Dr. Veis Ribeiro and collaborators, published this year 2020 in the journal “The Voice Foundation”. This study reveals that the use of masks increases the perception of vocal effort, the difficulty in intelligibility in the conversations held, as well as the auditory feed-back and the coordination of breathing with the voice, which, in this case, is impaired.
It is also interesting to note another study published this year in the journal Hearing Review, which showed the acoustic impact of different types of masks on communication between healthcare personnel and patients. The data show that the masks attenuate the high frequencies (2000-7000 Hz) spoken by the user, with a decrease in decibels (dB) of 3 to 4 dB for a simple surgical mask, and about 12 dB for N95 masks, with the difficulty of understanding the conversations held by the doctor-patient, and especially in cases with hearing loss.
As protection against the virus is of prime importance, it is vital to be assessed by a specialist in Otolaryngology in order to carry out an exhaustive study in consultation, with a view to making a diagnosis and baseline analysis of the state of our voice and the functioning of our vocal cords.
This study is highly recommended, especially in people who use their voice as a working tool or are dedicated to singing. And then, depending on the findings of the examination and analysis of the voice, and comprehensive diagnosis made in consultation, the next step is to coordinate our work with a speech therapist / phoniatrician to care for and prevent the development of diseases in the vocal cords.
What pathologies can develop as a consequence of the use of masks?
A study recently published in the prestigious journal The Laryngoscope by Dr. Heider, from the University of Chile, reveals the increased prevalence of voice disorders in this Covid-19 era, mainly associated with the use of masks.
The use of masks has been related to pathologies such as acne and voice alterations, headaches, difficulty breathing and voice pathology (accentuating the problem in people who already suffered from dysphonia or vocal problems). In addition, vocal tension is more frequent, with the possibility of vocal nodules, edemas and polyps appearing in voice professionals, singers, teachers and health personnel who must wear masks for a minimum of 8 to 12 hours a day, for which reason it has even been proposed that the use of masks should be considered an occupational disease.
What guidelines can be followed to prevent and improve voice problems, especially in professionals who use the voice on a daily basis?
The most important recommendation would be to avoid anything that can damage the vocal cords, starting with tobacco and other irritants, such as excessive coffee or alcohol, which contribute to the dehydration of the organism.
It is highly recommended to follow other tips such as, for example, speaking slowly and articulating words well, using a natural tone of voice, and using microphones if you have to use the projected voice at a great distance. Pauses should be taken while speaking to breathe deeply and, in professionals who use their voice a lot, it is recommended to warm up vocally, in order to achieve more resistance in it to face the working day.
Self-filtering masks, due to their characteristics, require more effort to breathe than surgical or hygienic masks. Therefore, a combination of both is recommended, depending on the needs of each person or situation.
It is almost an obligation or “commandment” that, before a dysphonia and, especially, of more than a week’s duration, a thorough study and analysis is made in the voice consultation. In this way, an examination and exploration of the vocal cords can be performed with the aim of preventing and diagnosing injuries at this level, with the support and coordination of Speech Therapy/Phoniatrics, and thus optimize the health and quality of our voice in our daily activity and in the sung voice.