American Speech-Language-Hearing Association

Profiles of Prevention: Educating the Public on Vocal Health and Hygiene

by Susan Boswell

From cheerleaders to clergy students, ASHA members are teaching their students, peers and the public how to care for the voice and larynx. Two projects in Tennessee and Minnesota drew ASHA's attention as examples of advocacy in action.

Marilyn Dunham Wark became involved in prevention awareness when her teenaged daughter joined the cheerleading squad at White Station Middle and High School in Memphis, TN.

"I saw a lot of people in my classes who had been cheerleaders and later developed vocal fold nodules," said Dunham Wark, coordinator of speech-language pathology services at the School of Audiology and Speech-Language Pathology at the University of Memphis.

For cheerleaders and others, vocal nodules form gradually as a result of vocal chord strain or misuse, causing the person's voice quality to change and the voice to tire more easily, Dunham Wark explained. "We prefer to get rid of vocal fold nodules by behavioral changes, rather than surgery. Awareness of how to use the voice correctly can go a long way toward preventing the problem."

To help the cheerleaders, Dunham Wark offers presentations to the junior high school and high school squads as the fall sports season begins.

"I talk about ways to warm up their voices, and the need for resting their voices after games," she said. "They also learn how to get volume without straining the vocal chords." She also advocates not yelling at full force as cheerleaders form pyramids, suggesting that ground-level teammates project their voices.

"Some sensations indicate problems that need to be checked out by a doctor," she said. "The cheerleaders were very receptive to learning about the vocal chords, since many of the more experienced ones had already experienced problems with their voices after games."

Dunham Wark helped a quite different population when she addressed seminary students at the Mid-American Baptist Theological Seminary in Germantown, TN.

"Seminary students want an authoritative tone when preaching, but not all ministers were meant to speak in low-pitched tones, so I talked with them about the need to find their own voice."

She drew on her clinical experience to help the seminary students learn to minister to families with members who had suffered strokes and laryngectomies. A stroke can cause an individual to utter unintentional profanities that may cause excruciating embarrassment to the family in the presence of a minister.

Vocal hygiene is the focus of another ASHA member who lives hundreds of miles further north. Alma Krikelas, who works at Boase Elementary School in Hoyt Lakes, MN, began advocating for prevention of vocal problems after she saw how little information existed about teaching elementary school children about the voice and larynx. Krikelas developed a seminar for school choir directors, health and physical education instructors, school administrators and graduate students that sparked widespread interest in prevention and vocal hygiene. Krikelas used the "VisiPitch" to demonstrate a visual representation of the voice and invited a local otolaryngologist to speak at her workshop.

"These professionals said they had never been taught how their voice was produced and never understood about the vocal chords and larynx," Krikelas said, adding that a graduate student who attended the seminar prompted the University of Minnesota to offer its first seminar on the subject.

Krikelas also noticed that high school students were bringing chewing tobacco to school and spoke to students about oral hygiene in health classes. The larynx is small -- only 12 mm long in adults -- and often taken for granted, but critical in the production of speech.

"I talked to them from the perspective that they would be potential parents, and told them that chewing tobacco and other drugs created a life threat to a child through genetic damage," Krikelas told the students, showing them models of a healthy larynx in contrast to one that had been exposed to chewing tobacco.

At first the students joked about the pictures, but then grew serious as Krikelas described a local man, a smoker who died of laryngeal cancer.

"The students understood the importance of prevention when these stories made it real to them in the context of their own future," Krikelas said.

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