For Rebecca Nicholson, a second grade teacher at Soda Creek Elementary in Steamboat Springs, the most glaring sign that something was wrong was a series of headaches.

“It was not a ‘these kids are driving me crazy’ headache,” she said. “I love my kids…There was just a strain. My voice would start to wane by the end of the day. ”

Nicholson had always had a raspy voice, but she thought it was normal—just a consequence of her natural chattiness.

“I’ve always been a talker,” she said. “I had a rattle that said ‘mighty mouth.’”

But when she went to the doctor for a check-up soon after giving birth, the doctor said she should investigate the raspiness.

It turned out Nicholson had a cyst on one of her vocal folds—part of the “voice box” that lets us speak.

Nicholson is not alone in her struggle with her voice, or in not knowing that there was a problem in the first place.

The most well-known examples of voice problems involve superstar singers. Think about the reaction when Julie Andrews announced that her famous singing range had been diminished, or when Adele canceled tours to avoid permanently hurting her voice.

But being a classroom teacher is responsible for more vocal injuries each year than professional singing.

It should come as no surprise. Teachers spend hours talking every day, often in a loud, projected voice. A teacher’s voice is, like a singer’s, his or her instrument and tool.

The difference is that while (most) professional singers know how to tend to their vocal cords and are on the look-out for the slightest irregularity or strain, most teachers have received no training at all in how to use their voices.

And very often, teachers assume that it is normal, and certainly not something to complain about, when their voices grow hoarse or tired.

“When you look at all the most common voice disorders, teachers have more voice problems than any other profession,” said Amanda Gillespie, an assistant professor of otolaryngology at the University of Pittsburgh.

“A lot of teachers think hoarseness is part of their job,” Gillespie said. “But hoarseness is never normal.”

Consequences for students

When a teacher’s voice is hoarse or injured, students suffer too.

Things teachers can do to take care of their voices:
• Do a vocal warm-up, like buzzing your lips, before you start teaching. See video below
• Hydrate: If your classroom or house is dry, use a humidifier. Drink lots of water.
• Don’t talk over students.
• Keep in mind that hoarseness is not normal. If you are regularly hoarse by the end of the week or the end of the day, see a doctor, ideally a laryngologist or voice specialist.
• Listen to your voice. If your voice is tired, figure out a way to give it a break. Don’t try to power through.
• Get lots of sleep.
• Do your best to stay healthy. (Wash your hands!)
• Watch for any sudden changes in voice. Sudden change can be a sign that there’s something seriously wrong.

One study showed that 20 percent of teachers had missed at least one work day due to vocal problems in the previous year, while no one from any other profession had missed work because of voice issues. That researcher deemed teachers at “high risk” for voice disorders.

Other research indicates that students actually find it harder to process information presented in a hoarse or raspy voice. A yet-unpublished study from a group of researchers at Towson University shows that it takes more processing time and cognitive work to understand a hoarse or injured voice.

“You’d hope it’d make teachers and administrators sit up and say, ‘Hey, we should really pay attention,’” said Gillespie.

Potential Triggers

Teachers’ intense day-to-day schedules are part of what puts them at risk. Speech therapists recommend vocal breaks—stretches of quiet—throughout the day. But teachers often use their voices even when they’re not giving instruction—while they’re on bus duty or lunch duty, for instance. Schools are also often dry, and it’s hard for teachers to get enough water over the course of the day.

Certain specialties and situations can exacerbate the challenge, said Juliana Litts, an instructor and vocal therapist at the University of Colorado School of Medicine at the Anschutz Medical Campus.

Teachers who work in louder environments, including music, drama, chemistry, or physical education teachers, are more likely to develop vocal problems.

Being stressed also doesn’t help. “Most people who come in will say, I get so much tension in my neck and shoulders,” Litts said. “Well, all those muscles are connected to systems that control the voice.”

Neither does struggling with student behavior. “A lot of vocal health has to do with classroom management,” she said. “I understand that you teach a bunch of first graders and they’re rowdy, but you can’t talk over them.”

Female teachers are also more likely to develop problems than men, due partly to physiology. (Women’s vocal cords hit each other twice as many times per second than men’s, which means they’re more likely to develop calluses or certain other problems).

Things schools can do to help teachers’ voices:
• Consider a short training on voice use for teachers.
• Provide amplification for teachers, especially in classrooms that have a lot of ambient noise (such as a music, chemistry, or gym class).
• Create schedules that allow teachers to have down time where they do not have to use their voice, ideally spread throughout the day.

But teachers receive very little training in how to use their voice.

“Nobody tells teachers, okay so this is a really good way to use your voice in your classroom. So teachers go by how they’ve always talked,” Litts said. “And a lot of times that gets them into trouble.”

“The teachers we see are usually to the point where they literally cannot function as a teacher anymore,” she said. She said some need surgery because they have waited so long. Others leave the profession or enter administration to avoid strain.

Under the Radar

Nicholson had one surgery to address vocal problems in 2012, and then another this fall with Matthew Clary, an assistant professor in the department of otolaryngology at the University of Colorado School of Medicine at the Anschutz Medical Campus. Each surgery required time off work and a period of rehabilitation.

Now, she uses an amplification system to teach. She said technology like smart boards and online lessons helped her keep kids’ attention, especially when her voice is hurting. When she knows she has long days, like during parent-teacher conferences, she plans for classes that require less talking.

“It’s definitely challenging, especially when your voice is waning,” she said. “I have core subjects at the end of the day and I don’t have a choice but to teach them.”

Nicholson has recently embarked on a new regime of vocal therapy with Litts, in which she’ll learn to use a healthy “resonant speaking voice” when delivering lessons and tips about “vocal hygiene”—how to keeping her voice rested and well.

“All teachers want to have different ways to get their kids’ attention. It’s about being creative and not using your voice as much,” she said.

“If your voice is waning or if you’re getting fatigued in your voice, it’s worth checking out,” she said. “You might have voice issues and not know it.”

Potential Solutions

But there are signs that even a little bit of knowledge and preparation can go a long way in helping teachers take care of their voices.

Below: Litts, a vocal therapist, demonstrates some exercises teachers can do in the morning to help warm their voices up for the day. (If you’re self-conscious, she says, just do them in the car or in another space where you can be alone.)

Amplification systems like the one Nicholson is using have been shown to have a positive effect on students’ learning and on teachers’ voices. A study by Nelson Roy, a professor of communication science and disorders at the University of Utah, found that when teachers used amplification, it had a marked positive impact on their voices. Teachers often use amplification systems to aid students with hearing challenges, but they can make it easier for all students to understand, Litts said.

Early results from a five-year study of teachers and voices led by Katherine Verdolini Abbott, a professor of communication science and disorders at the University of Pittsburgh, shows that a short training seemed to help teachers who had voice troubles.

In the University of Pittsburgh study, now in its fifth year, teachers who identified as having a voice problem were given a short “voice therapy boot camp,” Gillespie said.

Those who received the training showed more improvement in their vocal health than a control group that had not.

Gillespie said having such trainings early could help catch problems before they cause teachers to miss time in school or students to struggle to understand instruction.

“It might only take a one-day voice seminar to help the voices of teachers who are already starting to experience some voice problems,” she said. “Having a voice problem doesn’t mean they have to have a lot of medical visits.”

Litts said her Denver-based practice was hoping to conduct in-service trainings for teachers about healthy voice use.

She said that in the end, having a healthy voice means more than the ability to do a job.

“Ultimately what brings people in is that they feel like they can’t be person they are because their voice is limited,” Litts said. “Voice is so much part of your identity.”