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OCCUPATIONAL VOICE LOSS
Work hoarse
[Hazards 88, October-December 2004]
This winter there will be no seasonal cheer from some workers - their
voices won't be up to it. Anticipated bad weather and with it low humidity,
dry, heated rooms, colds and infections, could usher in a new silent blight,
with occupational voice loss affecting record numbers of UK workers
Something to shout about
When film star Julie Andrews announced in 2004 her vocal cords were permanently
damaged and she would never sing again, it made international headlines.
For millions of workers in the UK, their voices will not be their fortune,
but they are their bread and butter, and voice loss could also spell the
end of their careers.
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.[1]
And as the service sector continues to grow, the impact of "repetitive
voice injury" on workers and the economy could be enormous.
A quarter of the workforce experiences daily voice problems, according
to a US report.[2]
In the UK, the Health and Safety Executive (HSE) has no figures on the
extent of occupational voice loss, however an estimate based on the US
figures would suggest over 5 million workers are routinely affected by
voice loss in the UK, at an annual cost to UK plc of over £200 million.
One in five teachers had missed work due to voice problems in any one
year, five times the rate for the workforce as a whole, 1998 study found.[3]
For the non-teaching workforce, an occupational disease incidence rate
of one in every 50 workers each year would put occupational voice loss
near the top of the UK's workplace health hit list.
And we are talking large numbers of at risk workers. The Call Centre
Management Association puts the number of UK call centre workers in 2004
at 1 million. And government figures for 2004 said there were 427,800
teachers in England alone.
When questioned by Hazards, teaching, call centre, banking and
industrial unions all reported occupational voice loss was a concern for
their membership. And it is not a trivial problem - too much talking in
the wrong environment can cause permanent damage, and could cost you your
job.
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 Hoarse
for courses
College lecturer Donny Gluckstein, a
union rep with Scottish teaching union EIS, lost his voice last
year. Filling in for absent colleagues and running an intensive
course "made me hoarse to the point where even speaking gently
was painful," he said. A visit to his GP confirmed he had "aphonia"
due to work-related overuse.
Armed with a sicknote, he asked for
"reasonable adjustments" to be made at work. "Being
a union health and safety rep and health and safety lecturer and
getting advice from the EIS health and safety official was very
useful," he said. Management responded positively. However,
even with the aid of a radio mike, laptop and projector, his voice
became too weak to speak. He continued teaching, silently, with
the help of portable whiteboards and the laptop.
Donny's voice only started to improve
when he finally got to see an ear, nose and throat specialist, who
said instead of rest he needed exercise supervised by a speech therapist.
He still uses the laptop and projector, has dropped intensive classes,
and has his remaining classes spread over the week to avoid long
periods of unbroken teaching. And he wants to ensure others learn
from his painful lesson. "Our safety committee discussed voice
care and management is already liaising with other local further
education colleges," he says. "One teacher training college
even asked me for advice on how to get voice training up and running.
"So the lesson is - don't suffer
in silence. There is a duty of care and a lot that can be done for
the most valuable tool in the teacher's toolbox - their voice."
Click
here to read Donny's story
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What jobs are we talking about?
The range of workers potentially at risk of occupational voice loss is
wide and includes:
• Teachers, lecturers, childcare workers
• Salespersons - shopworkers, sales staff, demonstrators, auctioneers,
counter staff
• Barristers, preachers, politicians, trade unionists
• Drill sergeants and other NCOs
• Journalists, radio and television reporters
• Entertainers - singers, actors, performers, bingo callers, line
dance callers
• Call centre workers
• Receptionists, advice line workers, counsellors, interviewers
• Aerobics, fitness instructors, coaches
Call centre-itis
As the service sector grows, more and more workers are depending on their
voice to earn a living. Call centres are one of the UK's fast growing
areas of employment and could now employ more than one in every 50 UK
workers. And the new jobs have been accompanied by an outbreak of "call
centre-itis".
According to the Royal College of Speech and Language Therapists, increasing
numbers of call-centre workers are being referred to speech therapists
because they are losing their voices. Long hours and little opportunity
for even a drink of water are to blame. "It's a growing problem,"
said Paul Carding, a professor of voice pathology and national adviser
to the college. "There is increasing evidence of people taking time
off because if they can't use their voice they can't work. At its most
severe these people can't hold down a job. They have pushed their voice
to the absolute limit. In some cases, voices really struggle to recover."
Teachers remain the most common professional group to require speech
therapy, but call centre workers have now become the fastest growing "at
risk" sector. The call centre industry says it shouldn't be singled
out, saying other jobs can also lead to the condition.
Listen to your voice
Early signs of a problem might not seem too worrying or unusual - discomfort
speaking, a lower pitch to the voice, breaking voice, a loss of vocal
range, a tickling in the throat, or an urge to cough or clear the throat,
or a voice that becomes harsh, raspy, shrill or thin. This will normally
sort itself after a break - a night's sleep or a weekend off. But if the
symptoms persist, this could be the early signs of a long-term and potentially
irreversible problem. The onset may be gradual, so it is important to
be vigilant for signs the symptoms are becoming more frequent or more
troublesome.
In severe cases, vocal strain can produce inflammation of the larynx,
swelling of the vocal chords or the appearance of vocal nodules, tumours
or ulcers. In its guidance on call centre health and safety, [7]
HSE says: "The medical term for voice problems is dysphonia. The
condition is not just an inability to speak but also includes pain, tension,
croakiness, irritating cough, inability to modulate, poor or no vocal
power and breathing difficulties."
Dangerous talk
A lot of different medical terms might end
up on your sicknote if your voice has been worked too hard.
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 cords.
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, say if you
are under pressure. Remember you know more about your job than your doc
- they are generalists. If the problem persists, make sure you get a referral
to an ear, nose and throat specialist or a voice clinic - there is a national
network of clinics with expertise in this area.
FURTHER
DETAILS: Click
here for guidance: "Identifying when medical advice may
be needed"
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.4
Humidity and temperature Low humidity,
particularly prevalent in winter, is bad for the vocal cords 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 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 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 practical measures should have been 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? www.hazards.org/tools
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.
Max 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's Worksmart guide notes: "If you are also
not using your voice properly, so that it is already under strain, then
speaking with dry vocal cords 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. [5]
Make sure your sick leave agreement isn't allowing ill workers to be
frog-marched into work (Hazards
85).
Make them listen
HSE's only guidelines on voice loss comes in its calls centres advice
document. [7]
It says: "The introduction of any good practice for voice health
which may substantially affect the health and safety of call handlers
should be done in consultation with call handlers or their representatives."
It adds: "Call centre employees should be provided with information
on the risk of dysphonia, the various symptoms of the condition and how
this risk can be reduced."
HSE gives these good practice pointers:
• To reduce the risk of straining the throat, opening greeting
scripts should be broken into shorter segments, giving call handlers
frequent micro-breaks while callers respond to their questions.
• Allow call handlers to drink at their workstations to ensure
their throats are adequately lubricated.
• Call handlers should be encouraged to drink water or caffeine-free
soft drinks to maintain hydration rather than tea or coffee or soft
drinks containing caffeine - these which are diuretics.
• Stretching the neck and shoulders relieves tension. Exercises
can be done at the workstation as well as during breaks. A prompt which
appears on the screen from time to time may be a helpful reminder for
call handlers to do these stretches.
• The risk of voice problems is greater when suffering from a
cold. Assigning staff in these circumstances to tasks which do not involve
speaking on the telephone reduces this risk.
Unifi, the finance workers' union, says "risk assessment should
be seen as a key element in helping reduce the incidence of voice loss."
If your employer hasn't completed a "suitable and sufficient"
risk assessment on your job, then your employer is breaking the law.
Unifi suggests the following negotiating points for safety reps, particularly
those whose members work in call centres or on advice lines:
• Change work routines and introduce work variety and changes
to the pace of work.
• Provide better quality headsets if equipment is faulty.
• Provide voice care training.
• Allow regular work breaks away from the phones.
• Monitor reasons for sickness absence, to spot cases of sore throats
and coughs which are caused by work, and encourage staff to swap to
other duties until they recover.
• Make improvements to air humidity, temperature and circulation.
• Offer suitable alternative employment for employees suffering
permanent voice problems.
Compensation
Union wins
£92,000 voice loss pay out
 Peter
Hilton, a member of the rail union TSSA, worked for Regional Railways
as a training instructor. He often had to lecture inside a depot
while engines were running, so he had to compete with noise and
diesel fumes from the engines.
During 1992, Peter found his voice
was becoming hoarse. More and more often, he had to reach for
a glass of water to continue lecturing. His GP sent him to a consultant,
who diagnosed chronic laryngitis. By this stage, Peter was often
unable to work because of the state of his throat.
Peter contacted TSSA and the union
put its legal team into action. First TSSA lawyers got a consultant's
report, which confirmed that the laryngitis was caused by the
fumes in the depot combined with the volume at which Peter had
to speak.
The lawyers then obtained a consultant
chemist's report on the fumes and an engineer's report on the
level of background noise. These reports indicated that while
the fumes certainly hadn't helped Peter, straining to be heard
against the noise was the main cause of his problem.
The union started legal proceedings
in November 1995, after Peter was forced to retire through ill-health
in April 1994 at the age of 59. Peter had planned to work until
he was 65 and then take a part-time position teaching at night
school, but his throat problem put that out of the question.
The case came up for trial in January
1999. TSSA lawyers produced more medical reports showing that
Peter's condition was now permanent. Before the trial, BR's solicitors
offered to settle the case for over £70,000, but TSSA's
lawyers believed Peter was owed much more.
After negotiating with BR's lawyers,
the TSSA team got the offer increased to £93,775, which
Peter accepted. Even at that point, he wasn't out of the woods.
The Department of Social Security wanted £23,775 of the
compensation back from Peter.
TSSA's lawyers successfully appealed
and Peter has secured over £92,000 to make his retirement
closer to the one he had a right to expect. [6]
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 It's
official! Teacher gets the benefit
Teaching union NUT has represented
many members struggling with occupational voice loss. In one key
case it set a precedent, getting the condition recognised by the
government in 1995 as an occupational condition and eligible for
industrial injury benefits.
Patricia Clowry, a teacher for 19
years at a Newcastle-under-Lyme primary school, began to lose
her voice when her class size was increased to 44. She needed
three operations on her vocal cords and had to leave her job.
Mrs Clowry had kept a diary and recorded
incidents when the classroom was particularly noisy. Her voice
was always worse towards the end of the week than at the beginning.
She related her voice "injury" to a series of "accidents"
- particular days when she had to strain and suffered voice problems.
A Social Security Appeals Tribunal
agreed she was entitled to compensation. It ruled "the appellant
had suffered an accident or a series of accidents which would
have occurred on a distinct occasion or occasions."
The tribunal explained the reason
for its decision: "We are satisfied that the strain of teaching
a much larger class of children of a younger age than she had
been used to put a strain on her voice but more so it was after
particular days when the children were extra difficult or more
lively that she suffered either an accident or a series of accidents
to her voice because of the extra difficulties in raising her
voice to cope with the children on those days."
In order to get a government Industrial
Injuries Benefit payout, Mrs Clowry had to prove she had suffered
an "accident". The scheme only pays out for "accidents"
or an inclusive list of occupational diseases, which does not
include voice loss.
Patricia Clowry, Social Security Appeals
Tribunal, Ref. no. 410 95 02050, 12 April 1995.
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References
1. E Vilkman. Voice problems at work: A challenge for occupational
health and safety arrangement, Folia Phoniatrica et Logopaedica, vol.52,
pages 120-125, 2000. [Abstract]
2. K Verdolini and Lorraine O Ramig. Review: Occupational risks for
voice problems, Journal of Logopedics, Phoniatrics, and Vocology,
vol.26, pages 37-46, 2001. [Abstract]
3. E Smith and others. Frequency of voice problems among teachers and
other occupations, Journal of Voice, vol.12, no.4, pages 430-388,
1998.
4. E Rontal and others. Vocal cord dysfunction - an industrial health
hazard. Annals of Otology, Rhinology and Laryngology, vol.88, pages
818-21, 1979.
5. Voice in the teaching profession, The General Teaching Council for
Scotland [pdf]
6. TSSA
journal, April/May 1999.
7. Advice
regarding call centre working practices, Local Authority Circular
94/1 rev, Health and Safety Executive/Local Authorities Enforcement Liaison
Committee (HELA), December 2001.
Resources
Hazards voice loss webpage: includes resources and union guides.
www.hazards.org/voiceloss
Hazards tools - guides to surveys, bodymapping, risk mapping and
other workplace hazard assessment tools. www.hazards.org/tools
Hazards workplace sickness guide: Union resources on workplace
sickness absence policy www.hazards.org/sickness
Voice Care Network UK, 29 Southbank Road, Kenilworth CV8 1LA. Publishes
newsletters and runs voice care clinics. It publishes a newsletter, VoiceMatters.
A booklet, More Care for Your Voice, is available from the Voice Care
Network, tel: 01926 864000 or 01926 852933, price £4.
www.voicecare.org.uk
British Voice Association, Institute of Laryngology and Otology, 330
Gray's Inn Road, London WC1X 8EE. Expert body on voice loss and has a
national network of NHS voice clinics. Tel:020 7713 0064
www.british-voice-association.com
The Royal College of Speech and Language Therapists, 2 White Hart Yard,
London SE1 1NX, tel: 020 7378 1200. Can provide advice on voice loss clinics.
NUT health and safety briefing: Voice care [word]
TUC Worksmart
guide to occupational voice loss.
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