Hazards issue 112, October-December 2010
At 50, Joyce Walters looks young for her years. A Scot, married to former policeman Brian and with two teenage kids, she found her teaching job “immensely fulfilling and, I felt, fitted in much better with family life.”
She had taught English in Italy in the early 1980s, returning to the profession in 1998. Joyce went on to graduate from the University of London’s Institute of Education in 2004 with a Certificate in Education, underlining her commitment to teaching English to Speakers of Other Languages (ESOL).
SCHOOL’S OUT Three years after obtaining a specialist teaching qualification from the University of London's Institute of Education, occupational voice loss meant Joyce Walters would never teach again. Over 5 million workers could be routinely affected by voice loss in the UK, at an annual cost to the economy running to hundreds of millions. About one-third of the workforce in modern economies relies on their voice to do their job, from teachers to trade unionists, call centre workers to checkout staff, aerobics instructors to vicars.
More: Hazards ‘Work Hoarse’ guide.
It was a qualification, though, that was going to prove to be of little use in her teaching vocation. Her voice has been ruined and the career teacher has not set foot in a classroom since December 2007.
Her problems first started with a sore throat and hoarseness in October 2005, when she was working as an ESOL teacher for Hillingdon Adult Education, employed by Hillingdon Borough Council. The adult education centre was located in Harlington Community School, a secondary school for 11 to 18-year-olds, in Hayes, Middlesex.
She’d been based at the school just one month when she first noticed symptoms. “I had my first consultation with my GP in early November 2005 as over the counter medication had been ineffective,” she recalls. “My GP advised me that my sore throat was probably only part of a cold. She did not prescribe anything but said that I should return if the hoarseness continued.”
As the academic year progressed the severity of Joyce’s symptoms increased significantly, with her throat becoming very sore and hoarse most of the time. “Early in the academic year I found that my throat would improve at the weekends and during school holidays. However as the year progressed it became increasingly difficult to have even temporary relief,” she says.
DANGEROUS TALK A lot of different medical terms might end up on your sicknote if your voice has been worked too hard, from dysphonia - voice loss and hoarseness - to nodules, polyps and aphonia, a total inability to speak. [more]
Joyce was assigned to a classroom adjacent to a roofed courtyard used by schoolchildren during the morning and lunchtime breaks. She had too many ESOL beginners in her class and, frequently, far too many noisy schoolchildren outside it.
“As a result of the noise and disruption I often had to repeat myself and raise my voice very significantly whilst teaching,” she recalls. This was exacerbated as “clarity of pronunciation, particularly for English language students at beginner level, is extremely important and students often had to ask me to repeat myself.”
But despite suffering voice problems for several months, she completed the academic year in July 2006 without taking any sick leave.
An ENT (ear, nose and throat) specialist had during the year found Joyce’s vocal chords had “thickened”. In August 2006, the medical checks were followed-up with a microlaryngoscopy - a vocal chord examination under general anaesthetic. Diagnosed with bilateral vocal chord nodules, she missed the entire 2006/07 academic year while she received speech therapy.
SAY SORRY The legal team acting for Joyce Walters helped her win compensation, but wants one other concession from her former employer, Hillingdon Council. Joanne Jefferies of Irwin Mitchell Solicitors said: “Despite numerous attempts to raise her concerns with her employer Mrs Walters was ignored and it has resulted in this terrible, life altering injury for which she is owed a big apology.” [more]
On returning to work in September 2007, Joyce was instructed to report to the same classroom “despite the noise problems and conditions persisting.” This time she refused. By now, though, it was too late. Her voice was permanently damaged. This was to be her last ever teaching term.
Management had refused throughout to move her from the more vocally-demanding ESOL beginners’ classes. And Joyce had exhausted Hillingdon Council’s formal grievance procedure.
All noise and no action
The long road to the courts was peppered with an extraordinary sequence of missed opportunities, where management could have taken simple actions to save council funds and Joyce’s voice.
Joyce had first raised her concerns with management in early October 2005. But suggested remedies – taking coffee breaks to coincide with particularly noisy periods like the main school’s break times – were not feasible because of a fixed 2.00pm finish for the ESOL sessions. The centre manager, Jane Byrd, conceded there was “harder to avoid” disruption over the lunch period, noting “the school are aware of the problem and support staff and prefects have been asked to supervise the children.”
But you can’t gag children, says Joyce, who believes it was the location that was primarily at fault, a problem compounded by a too large and growing number of learners in the class.
By January 2006, there had been no improvement, with the centre manager noting: “I do not feel a great deal can be done about it.”
Nor were managers of the ESOL programme stepping up. Joyce asked for her class to be closed to any additional learners. This was refused, with Joyce instead made to teach a “significantly larger” group than at any previous time.
In September 2006 Joyce wrote to Tricia Collis, Hillingdon Council’s head of adult education, “formally notifying her of my vocal injury and the conditions - all of which had previously been reported to management - which I alleged had led to it. Mrs Collis replied suggesting that I should initiate a grievance in line with the London Borough of Hillingdon’s policies and procedures.”
Responding to the subsequent grievance, Mrs Collis revealed noise levels in Joyce’s classroom had been investigated in April 2006. Joyce used a Freedom of Information Act request to obtain a copy of the noise report. It stated: “Assessment not required as under Noise at Work Regulations carried out only if first action level is reached.”
But Joyce, whose grievance was dismissed by management , felt this missed the point entirely. The noise regulations “are designed to prevent hearing loss and have no relevance in preventing voice loss,” she says. “When I pointed out to the head of adult education that this type of assessment was irrelevant in assessing the impact on a teacher’s voice, she argued with me that indeed it was correct.”
NO LAUGHING MATTER While talking might not be avoidable in some jobs, voice loss is. Bad workplaces and workloads make this a workplace problem. Background noise is a key risk factor. Others include overuse, fatigue, infections and indoor air quality – problems with humidity, temperature, dust and mould. [more]
Joyce believes the response “typifies management’s ignorance of this issue.” She took her case to appeal.
Written evidence submitted by head of adult education Tricia Collis to the appeal noted: “I am at no point disputing Ms Walters medical condition however vocal chord nodules are considered an occupational hazard for all teachers.”
As part of the appeal process, Hillingdon council corporate director Jean Palmer commissioned a noise monitoring exercise from the council’s Environmental Protection Unit. The investigation found: “In this particular instance the lecturer would need to raise his/her voice significantly and this would result in an increase of vocal effort. The lecturer would need to be almost shouting, imposing an additional strain...”
The report concluded: “The results of this exercise highlight that the noise levels in room A12 [Joyce’s former classroom], and indeed all rooms that border the courtyard at Harlington School are not suitable for teaching sessions during the school break(s).”
But the director rejected the appeal, instead concluding the original synchronised coffee breaks advice was correct. She added Joyce could also try to time her tutoring so she didn’t need to speak over background noise. And like adult education head Tricia Collis, Jean Palmer noted: “Vocal chord nodules are considered an occupational hazard for all teachers...”
In Joyce’s view, the council was “implying that it went with the territory and was just something I had to put up with.”
Joyce was returned to the same classroom for that final September 2007 term, teaching the same classes. Even a reduction to just two hours teaching a week was not enough to spare her voice.
Double voice loss victory
Joyce says it was articles in Hazards that made her realise she “had a potential case against my employer for personal injury.”
She had no doubt that her former employer’s negligence led to her vocal problems and that it had failed to make genuine efforts to accommodate her disability. Her twintrack legal response involved a disability discrimination Employment Tribunal and suing her employer for a personal injury compensation settlement.
ACADEMIC SILENCE A 2006 Industrial Injuries Advisory Council (IIAC) probe, prompted by investigations by Hazards, found occupational voice loss was a big problem getting little attention from researchers. IIAC concluded: “The Council recognises that this is an emerging area of research and intends to keep the subject under review.” It has since said nothing more on the issue.
IIAC position paper on occupational voice loss, Position paper No.16, March 2006 [pdf].
“I felt that my former employer had acted totally unreasonably by refusing my request to be allowed to teach a higher level course which I felt from my wide experience of ESOL teaching would have made a significant difference to the demands on my voice at a time when I was still recovering vocally,” Joyce says.
“This ‘reasonable adjustment’ would have been at absolutely no expense and would have meant assigning me a higher level rather than a lower level class.” She says this would have been “in line with medical advice” and “would have been an effective adjustment that would have allowed me to continue in my employment.”
“The tool of a teacher’s trade is his or her voice and the consequences of this tool becoming damaged are devastating, both on the teacher’s career and life,” she asserts.
“I felt that voice loss was a foreseeable injury given the literature which exists on this and the claim of the adult education head of service, repeated by the director, that ‘vocal chord nodules are an occupational hazard for all teachers’ was no excuse to turn a blind eye.”
If Hillingdon Council felt otherwise, it was not willing to risk saying so in court. When on 26 October 2009 Joyce arrived for the first day of the disability discrimination Employment Tribunal hearing, she was offered and accepted an out-of-court settlement of £11,000.
Again armed with information from Hazards and legal guidance from Irwin Mitchell Solicitors, she obtained supporting evidence for a separate personal injury claim.
FEELING SORE What started as a sore throat turned into a major handicap that left adult education teacher Joyce Walters jobless, anxious and depressed. “I found that my throat would soon become tight and painful and my voice hoarse. The tightness of my throat often led to coughing spasms in the classroom,” she says.
“A report by an ENT expert witness confirmed that my vocal nodules and hoarseness were due to chronic vocal misuse and abuse as a direct result of my work duties,” Joyce says. “The specialist also stated that it was likely that I would have ongoing voice difficulties and that I would be very unlikely to be able to engage in any occupation requiring professional use of my voice.
“Acoustic experts also agreed that occupational dysphonia - voice loss - is known to occur in teachers and that elevated ambient noise is one of several known risk factors for the condition.”
In July 2010, following more than three years of legal wrangling, Hillingdon Council told Joyce’s legal advisers “liability is not going to be contested.” An out-of-court settlement of £145,000 was agreed.
The landmark legal victories were the result of Joyce’s dogged determination not to accept that voice loss for teachers is just part of the job.
But she acknowledges she had help. She says she “would always be extremely grateful” for the assistance provided by Hazards, which was “was brilliant”.
Lawyers Colin Ettinger and Joanne Jefferies, from Irwin Mitchell Solicitors, were “excellent” and committed and with barrister Robert Weir QC, “who demonstrated a brilliant grasp of every detail of my case and... clearly explained everything to me”, took on a case which had been turned down by other leading law firms.
Together they won what is believed to be the largest voice loss payout to date. With it there comes a recognition there is nothing inevitable about a teacher losing her voice and her job as a consequence.
Making herself heard
For Joyce, the focus now is on regaining her health. She says she now has to “manage” her voice. “For example I avoid environments in which there is a lot of background noise. I also avoid raising my voice whenever possible.”
She says she is “very fortunate” to be receiving speech therapy and laryngeal manipulation from the “hugely competent” Sally Rogers, the head speech therapist at Mount Vernon Hospital, Northwood, London.
But although her voice has “improved significantly”, Joyce says she is “aware of a definite weakness in my larynx which was never present prior to the academic year 2005/2006. If I am in a noisy environment - a pub, a party - and I have to speak loudly to make myself heard, my voice will become hoarse and my throat dry, tight and painful after a short period of time. The hoarseness will usually persist for most of the following day and my laryngeal muscles will feel tense. I try to alleviate this by inhaling steam and laryngeal massage.
“In a quiet environment my voice is initially satisfactory. However, if I talk for any length of time I will soon become aware of my throat tightening and my voice will gradually become hoarse.”
Teaching is out of the question. It’s a situation that leaves her feeling “extremely disappointed” as she “found it immensely satisfying to work with ESOL students.” She had hoped to progress further in this field, one reason she had taken the Institute of Education ESOL course in 2004.
“I now mark examination papers and assess ESOL students for a leading examination board. This role requires minimal voice use and allows me to stay within the field of ESOL teaching.” But the work is intermittent, and there are periods of the year when she has no work at all.
Since the start of her symptoms, Joyce has faced five years of trauma that has left her hurting, physically and emotionally. She says she is “angry at the stance of my former employer who refused to treat the problem of an excessively noisy working environment with any degree of seriousness. Indeed, to the best of my knowledge, there has been no remedial work carried out within the classroom in which I sustained my vocal injury and it is still being used for ESOL teaching.”
She finds it “particularly concerning” that Hillingdon Council had the opportunity to investigate the problem at the outset, but decided in April 2006 that a proper noise assessment “was not required”.
It wasn’t, of course, had Joyce been raising concerns about industrial deafness. But this was a case where responsible action could have stopped painful throat symptoms turning into a socially and physically limiting disability, something that should have been instantly apparent to anyone with even a cursory knowledge of workplace health issues.
“I found the whole experience of trying to return to work after my voice loss extremely stressful,” says Joyce. “It felt like was trying to push a double decker bus up a hill with the hand brake on.”
And it affects her home life too. “I even have to think twice about day to day things, like speaking on the phone to my dad in Scotland as my voice is not strong enough to maintain a conversation for any length of time.”
There is an alternative
Joyce is speaking out because she doesn’t want others to go through the same avoidable heartache. “Obviously teachers and all professional voice users have to recognise that their voice is the tool of their trade and if it becomes damaged the consequences for their career, and future life, can be devastating.”
CHECK IT OUT! Occupational voice loss can be disabling condition - and in workplaces like schools and call centres, it is possible a large proportion of the workforce is affected. It is management problem, not a personal problem. Check it out with our safety reps’ checklist. [more]
She adds: “If a teacher finds herself having to raise her voice to such an extent that she feels her throat becoming painful and her voice hoarse then she should report the problem immediately to management and ask for an appropriate noise risk assessment to be carried out.
“The teacher should never accept the response that ‘there is not a lot that can be done about it’. In reality there is probably a great deal that management can do about it – an alternative classroom or soundproofing of walls, for example.” She says employers “must be proactive in their approach to classroom noise and undertake adequate noise assessments to identify ‘unsafe’ noise levels so that measures may be adopted to alleviate or eradicate the problem.
“I hope that employers will read about my case and realise that adopting ‘the ostrich approach’ to occupational noise is no longer an alternative.”
She also advises anyone concerned about occupational voice loss to keep track of progress - or the lack of it. “I would strongly recommend keeping a diary of the noise – dates and times when it is particularly difficult to teach, causes of the noise, effects of the noise, action taken to try and resolve the noise, result of that action, relevant medical appointments. If there is an occupational health physician at the workplace then it is a good idea to ask management for a referral if a teacher finds that her sore throats and hoarseness are becoming frequent.”
And don’t be fobbed off. “No-one should accept voice problems as ‘an occupational hazard for all teachers’ that ‘comes with the territory’,” she says. “The result may well be the end of a fulfilling career and anguish that is not only physical but also mental as the teacher has to face the anxieties of an uncertain future.”
Everyone gets sore throats, but this is something much more distressing and much more permanent, she counsels. “Voice loss is a serious occupational disease and must be treated as one. It is not a trivial issue – the voice is a teacher’s tool of the trade and to damage it can have devastating consequences.”
A lot of different medical terms might end up on your sicknote if your voice has been worked too hard, from dysphonia, voice loss and hoarseness, right up to Aphonia, a total inability to speak.
• Aphonia - inability to speak.
• Dysphonia - voice loss, hoarseness.
• Odynophonia - pain and soreness in the throat with prolonged vocal use.
• Hyperaemia of the free edges of the vocal chords - common in singers and speakers and could become chronic.
• Vasomotor chorditis - chronic congestion, usually limited to one vocal chord. Aggravated by vocal effort. Partly reversible.
• Nodules and polyps of the vocal chords.
• Laryngeal contact ulcers.
• Hyperplasia of the vestibular folds .
• Pseudomyxomatous laryngitis.
If you think you have a problem, get it checked out. See your GP and explain fully what job you do, how much you use your voice and say if you are under pressure. Remember, you know more about your job than your doc. If the problem persists, make sure you get a referral to an ear, nose and throat (ENT) specialist or a voice clinic.
‘Big apology’ due from voice loss employer
The legal team acting for Joyce Walters believes an apology from her employer is well overdue, after Hillingdon Council admitted failing to address her complaints about noise problems.
The council has admitted it was at fault for the injuries to Joyce’s voice. Her lawyers are now asking the council to apologise to her and show it has taken steps to prevent other staff developing similar problems.
Joanne Jefferies, an expert in workplace injuries with Irwin Mitchell Solicitors, said Mrs Walters’ employer had conceded the noise from outside the classroom made the problems Mrs Walters faced even worse and that they failed to address her complaints regarding the ongoing noise problems.
Ms Jefferies added that although the council has accepted full responsibility for the injury, Mrs Walters is owed an apology and reassurance that the same thing won’t happen to anyone else. “Despite numerous attempts to raise her concerns with her employer Mrs Walters was ignored and it has resulted in this terrible, life altering injury for which she is owed a big apology. To make matters worse she is still awaiting assurances that something has been done to prevent others suffering.”
The solicitor added: “Hillingdon Council have since accepted that they failed to safeguard the health and safety of their employees and what makes this case so sad is that this could, and should have been avoided. It is now imperative that lessons are not only learnt, but shared with other schools throughout the country to ensure that further suffering is prevented.”
Joyce’s injury has had such devastating consequences that it is no longer possible for her to use her voice in a professional capacity; she will not be able to teach again.
No laughing matter - workplace risk factors
While talking might not be avoidable in some jobs, voice loss is. Bad workplaces and workloads make this a workplace problem. Key factors that can lead to occupational voice loss are:
Overuse Voices aren't designed to talk continually without breaks, and cannot cope with prolonged heavy use without breaks, for example, singing or shouting.
Noise In most of the workplaces with a high risk, there tends to be little thought given to acoustics because there is not usually an occupational deafness risk. However, we raise our voices causing vocal strain when the background noise level gets about 40dB, a fraction the occupational exposure limit, so the voice struggles even though the ears are fine.
Humidity and temperature Low humidity, particularly prevalent in winter, is bad for the vocal chords and leads to an increased risk of throat irritation and infections.
Stress Your throat is affected by stress - hence, the telltale "lump in the throat". In extreme cases, this can cause “hysterical aphonia”, stress-induced voice loss.
Fatigue As the voice gets tired, it falls off, so extra effort is needed to make yourself heard. This can be the start of a damaging cycle of overuse.
Infections Colds and flu must be taken seriously - a sore throat is a warning sign that the larynx is inflamed and needs a break.
Air quality Poor workplace air can cause irritation - mould spores in damp environments, airborne dusts like glass fibre, aluminium, wood dust, silica, lime. "Hemp workers' laryngitis" is a recognised occupational disease. For teachers, chalk dust or marker fumes can cause problems.
Chemicals Some common workplace exposures - chlorine, nitrogen oxides, aromatic nitro-compounds, organic solvents, bitumen fumes - can affect the voice.
Work methods Power dialling systems, large classrooms, long scripts for call centre workers and too few breaks are among the management causes of workplace voice loss.
Strain injuries The use of speech recognition software as a response to repetitive strain injury (RSI) problems can switch the strain to the voice, unless adequate breaks are built in to the job.
All of these factors should be considered in the employer's risk assessment of a job and reasonably practicable measures should be taken to remedy the risk.
Speak up! Checklist for safety reps
Occupational voice loss can be disabling condition - and in workplaces like schools and call centres, it is possible a large proportion of the workforce is affected. It is management problem, not a personal problem.
Investigate Find out if there is a problem in your workplace - have you undertaken bodymapping, risk mapping or a workplace survey that has indicated a problem?
Risk assessment Check that workplace risk assessments have been carried out by your employer. Remember, the law says that employers should carry out "suitable and sufficient" risk assessments on the jobs you do - and that means being aware of any voice loss risk and taking "reasonably practicable" measures to tackle them.
Accident book List cases of voice loss in the accident book - and make sure you raise any dangerous trends you spot.
Maximum hours Negotiate an agreement for set maximum hours of voice-based work per day.
Noise Ensure your employer reduces the levels of background noise so you do not have to raise your voice to be heard.
Welfare Take regular rest breaks and drink plenty of fresh water to lubricate your throat (caffeine and alcohol are drying agents). TUC warns: "If you are also not using your voice properly, so that it is already under strain, then speaking with dry vocal chords for extended periods of time is likely to cause injury. It's like not having any engine oil in your car."
Stress Negotiate working patterns which reduce stress levels - the Approved Code of Practice to the Management of Health and Safety at Work Regulations requires that employers "adapt work to the individual" including modifying working methods and designing out "monotonous work and work at a pre-determined rate."
Environment Ensure your employer provides a working environment which is at a comfortable temperature and humidity (Workplace Health, Safety and Welfare Regulations 1992).
Pollution Ensure your employer has controlled dust and chemicals properly, as they can dry and inflame the mucous membranes of the vocal tract.
Sick leave Don't be part of the working wounded - overworking a throat that is already sore, through exertion or cold or flu, can cause long-term damage. Make sure your sick leave agreement isn't allowing ill workers to be frog-marched into work.
Source: Hazards ‘Work Hoarse’ guide.
Dangerous talk more
‘Big apology’ due from voice loss employer more
No laughing matter - workplace risk factors more
Speak up! Checklist for safety reps more