CENTRE OF EXPERTISE IN CLINICAL FONOAUDIOLOGIA CEFAC VOICE WORKING THE VOICE OF THE TEACHER Prevention, Guide and Educate

AMALIA POLLASTRI DE CASTRO E ALMEIDA RIO DE JANEIRO 2000 2 CENTRE OF EXPERTISE IN CLINICAL FONOAUDIOLOGIA CEFAC VOICE WORKING THE VOICE OF THE TEACHER Prevention, Guide and Educate Monograph presented as part of the requirements for completion of Specialization in Voice. Advisor: Mirian Goldenberg AMALIA POLLASTRI DE CASTRO E ALMEIDA RIO DE JANEIRO 2000 3 ACKNOWLEDGEMENTS At Pollastri Maria Candida de Castro, my aunt and friend, for having welcomed me and supported lovingly along this journey. Mirian Goldenberg, professor, for gu idance and support provided in developing this work. 4 To all my patients who, directly or indirectly, contributed greatly to the achie vement of this work. 5 SUMMARY 1. 2. INTRODUCTION ................................................. ................. ................................. ................... 8 HOW TO KEEP A GOOD VOICE ............................................ .................................. ......... 11 2.1 REVIEW OF ANATOMY AND PHYSIOLOGY .............................. ............. ......................... RESPIRATORY SYSTEM ..................... ......................... 11 2.2 ............................................ 13 2.3 IMPORTANCE OF RESPIRATORY THERAPY ......................................... ... ...... VOCAL HEALTH .............................................. 15 2.4 .. ................................................ ............ 16 3. 4. Speech, gestures and postures ............................................. .... ................................ The 21 teachers daily ......................... .................... .......................................... 24 4.1 Main COMP LAINTS .............................................. .......................... ........................ 24 4.2 DIFFICULTIES ENCOUNTERED INSIDE AND OUTSIDE THE

CLASSROOM .................. 25 x 3.4 LOAD TIME VOICE INTERFACE ................ ........................... ................................ 27 4.4 Dysphonia AS OCCUPATIONAL DISEASE ............................................ ............. ..... 28 5. 6. X VOICE STRESS RATIO .............................................. ............ .................................. 31 IMPORTANCE OF VOCAL THERAPY IN WORKING WIT H TEACHERS ................ 33 6.1 How AUXILIARY TEACHERS IN CARING FOR THE VOIC E ...................... 34 6.2 The need for broader dissemination of the audiol ogic work with teachers ..................................... .................. ................................ ..... 35 7. 8. CONCLUSION ................................................ .................... ............................. 37 REFERENCES .................................... ........... ..................................... 41 6 SUMMARY The goal of this paper to show Was The Importance of prevention and correct orie ntation in the treatment of teachers voice problems. Through Theoretical Researc hs, Was raised important information Concerning the main complaints, the more co mmon vocal abuses and Their Consequences. As well as the Difficulties Those foun d by Professionals In Their daily work. Frequent psychological factors like stre ss and Lack of pedagogical resources Were Mentioned By The authors researched th e main problems found by the teachers. These Beside, the most part of Profession als work in crowded classes, without the means to Provide an Adequate Them vocal production. Resources or roams the microphones designed with better acoustics a re not the Brazilian reality, But are fundamental to the maintenance of the voic e quality and consequently to a more pleasant and efficient education. This Pape r Has Been Contribution to the teachers to Become Aware of the Importance of pre vention and habits changes. As well as prevention Towards the correct voice prob lems, since teachers Are The Professionals That Have got the highest number of v ocal alterations. 7 SUMMARY The aim of this study was to show the importance of prevention and proper guidan ce in the treatment of voice problems of teachers. Through theoretical research, important data were gathered on the main complaints, the abuses committed more vocal and their consequences, and difficulties encountered by these professional s in their day-to-day work. Factors such as frequent psychological stress and la ck of teaching resources were mentioned by the authors surveyed as major problem s encountered by teachers. Besides these, the majority of professionals working in classrooms filled and without the means that provide an adequate voice produc tion. Features such as microphone or rooms designed with a sound proposals that are better, although not part of the Brazilian reality,€are essential for maintain ing the voice quality and hence to an education more efficient and enjoyable. Pr evention is the primary means to prevent vocal problems, though, based on experi ence of private practice, few teachers who seek speech therapy before settling a problem. This work helped teachers become aware of the importance of prevention , changing habits and proper prophylaxis with the voice, since they are the prof essionals with the highest rate of vocal. August 1. INTRODUCTION Much has been studied about the voice of professionals in various fields, includ

ing the teacher's voice. With the advancement of technology and creation of opti cal fibers has become possible to learn and study in detail the anatomy and phys iology of the human voice. The Speech - science that studies human communication in normal and pathological manifestations - comes to dedicating some time to re view voice of the teacher, due to the great importance that this work has on the social, cultural and educational subjects. Which leads us to inquire about the teacher's voice is the intense desire to succeed in developing a more dynamic an d effective, with greater security, achieving positive results with a reduced pe riod of therapy. Seeking to expand this area of knowledge and at the same time, trying to understand what they think and act as our teachers, some doubts have a risen regarding the treatment of voice that were crucial to the development of t his research. According to studies conducted among professionals working with vo ice, teaching is a profession with a higher incidence of vocal changes. These ch anges affect the personal, social and, above all, professional life, causing anx iety and distress. 9 Most teachers are unaware of the influence of voice on the performance of its function, disregarding the fact that the same be the primary means of transmitti ng knowledge. There is a great lack of information from these professionals rega rding the use and care of basic voice, perhaps for the lack of appropriate guide lines for such. Generally, only when the voice begins to fail, showing signs of fatigue, or even already established a condition that makes it impossible to wor k using the same, is that the teacher awakens to the importance of their own voi ce and care be taken with her. Being an educator solid model for his students a real trainer reviews - the concern with the voice and the negative repercussio ns that it brings, both for faculty and for students, has been cause for various work in this area. It is important that teachers hold correct habits of posture , precise gestures and a good voice quality, because its pattern of conduct, bes ides influencing the transmission of knowledge is constantly observed and often imitated by other speakers. This study therefore is to expose the main difficult ies of the teacher in maintaining a healthy voice, usually due to its use in int ense rounds of excessive work, demonstrating the reflections that this practice carries on his professional and personal life and therefore such as speech thera py may benefit them in the prevention, maintenance and correction of possible la ryngeal disorders. 10 It is believed that many professionals are constantly on doubtful and uncerta in situations in the care of teachers. This work also seeks clarification of all or part of some of these doubts and uncertainties and other suscitação. 11 2. HOW TO KEEP A GOOD VOICE 2.1 REVIEW OF ANATOMY AND PHYSIOLOGY The phonatory mechanism occurs during the expiratory phase of respiration. For t his it is necessary a balanced activity of all intrinsic muscles of the larynx, which consists of arythenoid muscles, lateral cricoarytenoid and the thyroaryten oid external beam (adductor muscles). Being the abductor mechanism of the vocal folds is the posterior cricoarytenoid muscles. The tension mechanism is achieved by the cricothyroid muscle and mainly by the action of the beam's internal thyr oarytenoid muscle. The voice is produced by vibration of the vocal folds. During exhalation the vocal folds come together throughout their length, resulting in glottic closure and consequent increase in subglottic air pressure. These two op posing forces result in vocal fold vibration. Subglottic pressure is formed when the vocal folds are approximate. The volume of exhaled air leaving the lungs is slowed to the level of the glottis, resulting in increased speed of airflow thr ough the glottis (BOONE, 1984).€Subglottic pressure increases with respect to subg lottal air pressure and the vocal folds are separated quickly, tying the two pre ssures (the opening phase of a cycle of vibration).

12 Because the mass of the vocal folds and the Bernoulli effect (suction effect) , they are united again to their previous line of approach (closing phase of the cycle of vocalization). The Bernoulli effect is the attraction sucking the voca l folds, toward each other, caused by the higher velocity air passing between th e vocal cords closer together. BOONE (1984) explains that the vibratory cycle wo rks as follows: the intrinsic adductor approximate the vocal folds when expirati on starts, under the pressure increases, the airflow passing through the glottic opening and separating the vocal cords, the static mass and the effect Bernouil li the approach again, the vibratory cycle repeats. This cycle can be repeated a bout 125 times per second in the vocalization of an adult male and 215 times per second in an adult woman (BONNE, 1984). FIGURE 1. Basic laryngeal cartilaginous structures: A) cut from the right wing o f the thyroid, B) wall of the thyroid cartilage left, C) left arytenoid cartilag e; D) posterior cricoid cartilage. Intrinsic muscles: E) posterior cricoarytenoi d; F) lateral cricoarytenoid; G) arytenoid oblícuo; H) transverse arytenoid; I) ar yepiglottic; J) thyroarytenoid (vocal), K) ventricular fold; L) epiglottis. (Boo ne & McFarlane, 1994). 13 2.2 RESPIRATORY SYSTEM Humans learned to use breathing for speech. Both talk about how to sing requires an expiratory air flow capable of activating the vibration of the vocal folds. It is common to find in professional voice - more specifically teachers - a lack of breathing and speaking. Basically, it is the c onflict between the physiological needs and demands of speech through the air th at causes the incorrect use of the vocal mechanism (BOONE, 1984: 176). The depen dence of the constant renewal of air imposes certain limitations on how many wor ds can say, how many sentences can pronounce or how much emphasis we can use on an exhale. The breathing mode corresponds to the dominance of breathing (oral, n asal or mixed) chosen and used during situations of rest (outside of phonation). Ideally, the inspirations are carried out by the nasal route since that way the re is heating, humidification and air filtration, environmental conditions favor ing the vocal work (PINE 1998). Mouth breathing, besides the injuries they cause occlusion and facial growth, yet provides a drying of the laryngeal tissues, hi ndering the vibration of the vocal folds (MARCHESAN apud PINE, 1998). The classi fication of respiratory types varies among different authors that address the to pic. Brodnitz apud Leslie (1995) points to the fact that the type of thoracic br eathing is very common in raised voices. Already 14 apud WILSON Leslie (1995) highlights the difficulty in establishing a univers al standard for normal breathing. Still quoting Leslie (1995) we can say that th e classification into types is determined by the respiratory region of the chest that is more active during the process of inspiration. For SEGRE et al. (1981) "normal" would be to introduce sufficient air to the proper functioning of the m echanism of phonation, and must be fast, deep and silent for a proper issue. He said the types vary in relation to gender, age and anatomical constitution. PINE (1998) sees as the three most common types of breathing: superior costal, diaph ragmatic, or abdominal and lower costodiaphragmatic. The standard cage is genera lly used for more physical activities because it enables greater and more rapid entry of air into the lungs with high oxygenation. The standard diaphragm or low er is used during sleep. Ideal for constant talking is standard costodiaphragmat ic abdominal featuring the opening of the ribs, anterior bone external and conse quent lowering of the diaphragm with abdominal expansion (PINE, 1998). During in halation, the most important muscles are the diaphragm and external intercostal, participating muscles of the neck, back and abdomen. The expiratory muscles are responsible for moving the diaphragm muscle, the external intercostal muscles a nd the fibers of the internal intercostal muscles. The latter are responsible fo r lowering

15 ribs and come to life after ceasing the visual exhalation phase, when the ext ernal intercostal ribs are relaxed and have returned to the starting position. I ts contraction involves the use of air reserves (PINE 1998). 2.3 IMPORTANCE OF RESPIRATORY THERAPY As previously mentioned, it is common to find teachers in a pseudo-incoordinatio n phono-breathing. This lack means that these professionals use constant air of reserve generating hyperadduct glottic with subsequent impairmen t of the vocal tract (increased vocal fatigue, for example). One must remember t hat use of start of the air reserve is allowed to be sent to the current air voc al cords, through the gradual contraction of the muscles of the abdominal belt ( PINE, 1998). The waistband is made up of several muscles that participate in the dynamic charge and support of voice. The training these muscles is essential fo r the firmness of the ribs and the phrase in strong intensities. The increase in vocal intensity depends directly on the increase in subglottic air pressure, co ntrolled by glottal adduction and expiratory airflow (PINE, 1998). 16 A key problem for many professionals with voice problems is the tendency to c ompress the closed glottis to produce the necessary force, instead of increasing the air pressure by contracting the abdominal muscles. If this method is custom ary, the strain becomes the basis for a hyperfunctioning of the voice, which can generate edema, nodules and others. The balance between support and the mechanisms responsible laryngeal allows the mai ntenance of vocal fold vibration. According PINE (1998), respiratory therapy con sists basically of the installation and automation of the respiratory pattern costodiaphragmatic in the abdominal muscle conditioning and control of breath du ring the vocal demands. The importance of the work of breathing in dysphonia has been reported by several authors, but the treatment of respiratory function has been ignored by many speech pathologists, despite increasing respiratory effort be clearly seen in teachers with voice complaints. 2.4 VOCAL HEALTH Based on studies Pletsch (1997), QUINTEIRO (1989), PINE (1997), COLTON & CASPER (1996), Aydos (2000) and own observations the author of this work, we can say th at the teacher's voice is susceptible to various interferences, such as vocal ab use, climatic conditions, addictions, nutrition, hormones, respiratory disorders , inadequate 17 hydration. To maintain good vocal health teacher on the fulfillment of some v aluable recommendations described by the authors, which we now stand out: Abuses To avoid vocal abuse vocal teacher is recommended to: 1) moving around the classroom, and thus can be heard more easily, avoid talking lo ud or when students are restless, 2) Speak with an intensity of voice appropriat e to the environment, with the speed and tone of voice that suits you best, 3) u se the correct placement of the voice with resonance balanced, 4) speak quietly, avoiding unnecessary wear, 5) replace the cries of whistles or whistles when yo u want to get public attention, 6) avoid issuing onomatopoeic sounds (engines, t hunder, noise animals, musical instruments, among others), 7) visit the doctor r egularly. To prevent climate effects of climatic effects is advised: 1) agasalharse proper ly and avoid exposure to air currents continuous, 2) maintain good hydration, al lowing the fluidity of the secretions produced by the body, 3) avoid eating food

s and beverages excessively cold or hot, because they cause thermal shock, causi ng swelling in the vocal folds, 4) do not stay talking for long periods in dry e nvironments too, under the effect of air conditioning, because it attacks the mu cous membranes of the vocal folds, allowing the formation sputum and nasal and l aryngeal irritation. 18 As addictions to vices and bad habits, it is observed that: 1) cigarette toxins irritate the lining of the airways, causing coughing, hoarseness, swelling and, in most cases, an increase of secretions. 2) heavy smoking is the predominant fa ctor in the incidence of cancer of the mouth and larynx, esophagus and lung, 3) marijuana smoke is warmer than normal cigarettes and thus act more aggressively in the larynx of users, 4) aspiration of cocaine is a severe vasoconstriction of the nasal mucosa, causing imbalances in vocal resonance as nasality of voice fo r example, 5), drinking alcohol causes irritation and at the same time, has an a nesthetic effect on pharyngeal region, which provides vocal abuse which subseque ntly will cause hoarseness and burning in the aforementioned region, 6) most dru gs act directly on the larynx, which can generate effects that compromise the ph onatory apparatus, so the abuse is contraindicated. Hydration Proper hydration is also essential for the proper vocal performance. Several authors stress that the adoption of hidratoterapia gi ves good results against the hawks, the voices loud, the accumulation of secreti on and hoarseness, and also decrease the likelihood of local edema. Therefore, i t is recommended to implement a program of vocal hydration as preventive procedu re in professional voice users. 19 Power To optimize the effects of food on the voice, it is recommended: 1) avo id chocolate, milk and dairy products before teaching, because they favor the in creased secretion of mucus in the phonatory apparatus, producing hoarseness and change the system of resonance voice, 2) prevent the consumption of fizzy drinks , responsible for the sensation of "fullness" that disturbs and interferes with voice control, 3) drinking orange juice and lemon regularly as they absorb the e xcess secretion of the vocal tract, 4) take plenty of water is essential to keep the throat wet towels, a condition essential for maintaining a healthy voice. The hormonal changes of the hormonal changes, note that: 1) all the hormones pro duced by humans act directly on the development of the larynx and therefore are occasionally responsible for various events presented by vocal individuals, 2) p remenstrual dysphonia occurs by thickening of the laryngeal mucosa due to the de crease of estrogen in the blood, 3) decreased production of female sex hormones during menopause is responsible for the thickening of the female voice (deep voi ce). In men, the vocal aggravation occurs during puberty and worsening the elder ly, 4) birth control pills and drugs virilizing can tamper with the proper funct ioning of the vocal folds, affecting the change in vocal pitch (low / high). 20 Following these recommendations, educators, and other professionals who use t heir voice excessively, they are preventing themselves from future changes and a ilments that affect the larynx area, preserving thus their vocal health. March 21. Speech, gestures and postures The speech originated in Sicily in the fifth century BC but was found in Greece that means for their development (Policy, 1996). It consists of a principle of c ommunication and appreciation of oral expression, as well as talk is essential f or the Professional Voice. It is important how we speak because the load of emot ion that pass through our words. The voice conveys the feelings and reaches the listener directly, providing them with feelings of pleasure or displeasure, inte

rest or disinterest. To this end, the speaker must pass through his gestures, hi s posture and his voice an enthusiasm that engage your listeners. We can not spe ak in voice communication without the worrying about what our body language is saying. For the teacher is essential to be a good speaker, in order to attract his listeners, in this case, their stude nts, through a good voice quality combined with body language and gestures appro priate to the content transmitted. Most scholars agree that listeners hold in me mory about 10% of what they hear. When they see or engage with the body, the wit hholding of information or up to 20% 3O%. This shows that the teacher can make u se of other resources to teach and not just use the voice as the only means to d o so. 22 We should remember that does not mean that the class should be transformed in to a spectacle of fireworks, but make it clear that, besides developing a vein o f speaker, it is interesting that the teacher resorted to body language or visua l, as this will save your voice, avoiding vocal fatigue as common to these profe ssionals. The care with posture should start when the teacher comes into the cla ssroom, especially with students of age range who are most critical. The way to sit, look, cross or uncross the legs, all that is observed by the student, and a long with it, the way he talks and uses his voice. The size and intensity of the gesture of the teacher must meet the kind of room it faces. POLITO (1996) descr ibes it as a teaching resource to save the voice, the larger the room, taking in to account the number and content, larger and larger should be the gestures, emp hasizing that teachers need to find within the given context. However, the same author stresses that the gestures should only be indicated, used to reinforce wh at the teacher wants, instead of using the voice for that. Many gestures eventua lly draw the attention of the student being taught. We've heard the same story o f many students. The teacher knows the subject well, but can not teach (POLITO, 1996: 34). It is possible that the defect of communication as a whole, but if he shouted least€gestured in a correct and consistent with the content and / or posi tion themselves 23 in the center of the room, for example, would probably teach better and get t ired less voice. It is important that teachers remember that posture, voice qual ity and attitudes before talking may predispose the minds of the students in a f avorable or unfavorable to his work. April 24. The teachers daily 4.1 Main COMPLAINTS Most teachers, by virtue of time, usually talk nonstop for hours and hours toget her, sometimes screaming and trying to keep the intensity increased, with the vo ice to overcome the ambient noise. These professionals also present, with relati ve frequency, an inappropriate posture and breathing pattern insufficient for th e proper performance of their profession. As a result, these professionals have very peculiar symptoms like fatigue and vocal fatigue, loss of intensity, devoic ing of timbre, rouquidões and voiceless and, over the years, the ENT examination, nodules, edema, hyperemia and polyps are often found. Class of teachers is one of the most affected by dysphonia, having as causes bot h the workday, which usually is extensive, but also the lack of knowledge of pro per vocal techniques. The dysphonic symptoms of vocal fatigue, physical fatigue, hoarseness, voice muffled or shrill quality, tensions in the neck and even post ural problems (Fabron & Omoto, 2000). Professionals who work using voice excessively, such as teachers, need to learn to get the most out of your vocal potential, otherwise alter or impair his delic ate vocal tract for not adopting the appropriate vocal techniques.

25 FURCK & PINTO (1997) emphasized that the practice is not well-structured voca l fatigue at all the voice, by contrast, the muscles and vocal organs are develo ped and fortified with the proper exercise with. Sometimes, in the clinics, we e ncountered statements, which are common among teachers, such as: - For some time now, i am so hoarse! - I do not know what happens to my throat seems to shave when I speak . It hurts sometimes. - Now, on vacation, my voice is excellent. You can not ima gine how it looks when I'm working. - The other day my voice did not work. I was mute. Was based on complaints similar to those that many scholars began to prop ose work to guide teachers as well as singers, announcers, telephone operators, lawyers, politicians, among others, for the correct use of the phonatory apparat us. Audiologists and otolaryngologists are also regarded as being of enormous im portance, the work of prevention, detection and treatment of voice disorders tha t affect these professionals. 4.2 DIFFICULTIES ENCOUNTERED INSIDE AND OUTSIDE THE CLASSROOM Dysphonia presented by professionals from the education area has been searched a nd considered as social and occupational disease in almost All 26 countries (Oyarzun, 1984). To avoid these voice disorders that limit the ability of the teacher, has been increasingly debated on the prophylaxis of path ologies of speech. Aiming to develop a program of prophylactic orientation with teachers, Oliveira et al. (1998) investigated a group of 75 teachers belonging t o five schools in the city of Campinas-SP, three state and two individuals. Afte r undertaking a survey where they were observed material resources, environmenta l conditions, symptoms and pathologies vocals, general care with the voice and v ocal hygiene, the author reached the following conclusions: - The habit of talki ng back to the blackboard, and hinder the propagation of sound and require an in crease in the volume of voice, greatly irritates the larynx, because it facilita tes the inspiration of chalk dust, causing dryness in the throat and hoarseness. - The lack of ventilation promotes the accumulation of dust and chalk dust into the classroom, raising the possibility that the teacher develop diseases of the respiratory and allergy symptoms such as upper airway obstruction. - Try to con trol the noise within and outside the classroom by increasing the volume of voic e can cause negative symptoms in the voice (suffocation, failures etc..) And lar ynx (ardume, tiredness etc...) - Talk nonstop for hours, and overwhelm the phona tory apparatus, reduces the moisture of the mouth and larynx, causing irritation . 27 In view of these findings, Oliveira et al. (1998) suggest, among other things : 1) by exchanging the conventional chalk marker, 2) cleaning and adequate venti lation, 3) smaller rooms and more acoustic potential, 4) eliminate or minimize e xternal noise;€5) use other means, which does not cry, to reduce noise inside the classroom, 6) make brief vocal intervals during the lesson, using other means to expose the didactic content, and increase the water consumption during the peri od in which he is teaching. By following these guidelines, teachers will be elim inated or at least reduce the possibilities of emergence of problems in the phon atory apparatus. VOICE INTERFACE x 4.3 LOAD TIME The teacher, often by economic necessity or by ignorance, took excessive working hours, without realizing that this rate may be harming you, and second time, pr eventing him from teaching. According to research conducted by SOUZA & Ferreira (1996) with teachers of the Department of Education of São Paulo, the factor "work ing time" was strongly associated with symptoms of hoarseness and voice loss, be cause the frequency of occurrence these symptoms was greater the extent they wer

e increasing the hours and years of teaching. 28 For o work hat it lowing these reasons, it is recommended that teachers and other professionals wh excessively, regularly consult a physician or audiologist specialist so t can adapt the workload to the overuse of the voice, with special care, al the perpetuation of good voice quality.

4.4 Dysphonia AS OCCUPATIONAL DISEASE A large contingent of teachers who undergoes speech therapy usually does not hav e an organic cause in voice disorders. In most cases, the origin of these distur bances is Functional - inappropriate use of voice, breath bad, bad vocal techniq ue, thermal shock, excessive smoking, alcohol consumption, improper vocal habits (Boone & McFarlane, 1996). Such disorders are characterized calls dysphonia. Wh en these professionals have some dysphonia, persisting for more than twenty days as vocal fatigue, rough or dry throat, speech effort, pressure on the throat, v oice variation during the day, inability to speak for long periods, burning in t he region of the larynx , burning throat, hoarseness, coughing, speaking, flaws in the voice, hoarseness or voice loss, it is recommended that they seek an audi ologist or an ENT specialist who works specifically with laryngeal and voice, so that 29 agents causing these changes can be immediately diagnosed. Early diagnosis ensures better results in the treatment of vocal disorders and a ny changes observed in teachers and other professionals who use their voice exce ssively, and avoid more serious problems that, over time, may appear (COLTON & C ASPER, 1996). RODRIGUES et al. (1995), in survey of 20 speech therapists working in the State of São Paulo, recorded the incidence of dysphonic professionals seeking speech the rapy, reaching Actors teachers following quantitative classification for a group of 85 patients : Political Telemarketing Broadcasters Op Presenters Reporters Lawyers Talkers S peech Voice actors Auctioneers Executive Assistant Secretarial Social Journalist s Priests Seminarians 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Singers Incidence of dysphonic professionals seeking speech therapy divided by category (professional total1de 85) Amount 30 CHART 1. Number of professionals seeking guidance dysphonic speech divided into categories (RODRIGUES et al., 1995). This chart, despite being just a regional sample, serves as parameter so we can have a notion, though imprecise, the incidence of problems r elated to the phonatory apparatus presented by class teachers. The voice needs c are like the rest of the body. Therefore the lack of knowledge about it facilita tes the emergence of undesirable dysphonia. To avoid this unpleasant occurrence, warns that teachers (as well as other professionals who are part of this risk g roup) have in mind that a healthy voice is synonymous with balance, stability, i nformation and intelligence. You can avoid most problems related to voice, since we are the same as those provoke. 1

To act in Sao Paulo, as speech therapist, you must have minimum experience of 3 years in service to professional voice and publication and / or disclosure of wo rk area in a scientific event. May 31. VOICE STRESS RATIO x Stress is the response given by our body to different environmental changes expe rienced, whether real or constructed by the imagination.€Is associated with strenu ous or difficult and threatening situations faced by humans in their daily lives . Given the stress, the human body has a series of reactions, activating and dea ctivating mechanisms as a way to "fight" or "escape" from this uncomfortable sit uation. Based on studies by Pletsch (1997), we can say that the most common reaction shown by our bodies - which reaches alm ost the entire body - is as follows: Adrenaline is released into the bloodstream The stomach contracts (causing dysfu nction) The heartbeat quickens The muscles tense up Breathing becomes shallow Digestion and intestinal slow down the process Peripheral blood vessels constrict Increases blood pressure FIGURE 2. Cycle effects of stress (Pletsch, 1997). 32 These reactions, which are involuntary, acting synergistically, form a circle detrimental to the health of humans, causing a number of ailments manifested in various parts of the body where muscles tensed retained toxins, causing discomf ort, feeling tired and localized pain. Problems such as bowel dysfunction, indig estion, gastritis, migraines, high blood pressure, flu, PMS, impotence and malfunction of the vocal cords are the most cited in the literature, but also reported more serious prob lems such as diabetes, strokes and cancers (including in the area of the mouth a nd larynx) arising from the stress the individual (BONNE & McFARLANE, 1994). To prevent all these problems caused by stress, Pletsch (1997) suggests the use of relaxation techniques and massage, can make the body "unload" the accumulated st resses and facilitate the body's natural metabolic work. Using these techniques triggers physiological reactions (activation of blood circulation, toning muscle s, etc..) And psychological (anxiety reduction, feeling of relief etc...) 33 6. IMPORTANCE OF VOCAL THERAPY IN WORKING WITH TEACHERS Voice therapy is almost always the chosen treatment modality for patients with v ocal disorders that originate from behaviors that were identified as misuse or abuse of the laryngeal mechanism. Th e main aim of voice therapy is to restore the best voice possible for these pati ents (COLTON & CASPER, 1996), a voice that will be functional for the profession al practice and communication in general. A successful voice therapy requires th e clinician to identify adverse patient's vocal behaviors and, subsequently, red uce the occurrence of such abuse / misuse. Voice therapy for the majority of voc al problems, requires continuous evaluation of the patient is able to vocally (B

oone & McFarlane, 1994). In most cases, the patient is who determines if the voi ce has achieved a satisfactory level during speech therapy, however, it is impor tant for both the patient and the clinician recognize that restoring the voice t o the way it sounded before, or to achieve some idealized goal might not be poss ible. When irreversible changes occur in the structure or physiology Iaríngea prof essional, the voice can never regain its former aspect, which inevitably will le ad to frustration and resistance to treatment audiologist. The patient, angry, t rying to form a "faster" of 34 solve your problem, just getting a therapeutic intervention early and often i nconsequential, further damaging the state of his voice. Even though some patien ts are not suitable candidates for an approach to voice therapy because of adver se problems, is within the skill of the audiologist to recognize such conditions , make appropriate recommendations or provide the appropriate referral. 6.1 How AUXILIARY TEACHERS IN CARING FOR THE VOICE Not that hard to realize that many teachers go to work that is intense and exhau sting the teaching profession without the slightest knowledge of vocal technique and risks from organic misuse of the voice, coming to present future problems c aused by this misinformation. FERNANDES (1996), to characterize 22 teachers with vocal in a group of 92 high school teachers showed that by their production con ditions, this professional is predisposed to vocal changes that could be avoided if preventive work at the time of training or admission school was conducted. F or many authors, the best way to help teachers in the health care of the vocal t ract is through "preventative information." Education is primarily responsible f or the reduction of abuse and misuse vocal (COLTON & CASPER, 1996). 35 Following€will be presented the ten preventive measures proposed by the Brazili an Society of Speech, published in 1998: 1) using the volume of voice sparingly in all situations of professional activity, 2) avoid yelling at family, pulpit o r podium, in football, classroom etc.. 3) do not sing too much if you are not us ed, 4) maintain a pace appropriate to each situation of the day, 5) do not compe te with outside noises and internal to their environment, 6) avoid talking fast, very strong and sharp, 7) practice vocal exercises, how to read aloud to improv e intonation, diction, rhythm, 8) respect the limits of his voice got tired, sto pped. 9) to speak with ease, integrating all sound, no rush, 10) seek therapeuti c support with professionals qualified to teach communication and literature. 6.2 NEED DE MORE DISCLOSURE OF WORK Speech therapy TOGETHER TEACHERS Being a relatively new profession under the laws of the country, speech patholog y have not gotten the necessary credibility and respect in the society. What has been seen in the clinics is that speech therapy 36 many teachers, who may have negative tests larynx or minimal signs of larynge

al irritation, often receive up to three months or more medical treatment before referral for evaluation of voice. It is not uncommon for patients in this categ ory are treated with antibiotics, antihistamines, decongestants, tranquilizers a nd even corticoesteiróides, or be sent home with some distinctly non-specific advice about relaxing or reducing the use of voice. The Brazilian Society of Speech warns th at, given the effects of some medications have on the laryngeal mucosa, vocal sy mptoms can worsen the individual's real in the course of treatment instead of be tter. To prevent this type of occurrence and potential damage from it, suggests a greater awareness of the work of speech therapists with educational institutio ns. As this is health and primary tool of communication for humans, is believed to be much better to prevent than cure. 37 7. FINAL The aim of this study was to research and study on the teacher's voice. As is of ten the number of professionals with vocal problems, the need to investigate fur ther this issue was crucial to choosing the theme. Many questions are common for calls to these professionals. As a teacher, who has performed a vocal problem, would be able to improve and continue to make constant use of voice? How to get them to improve without having to turn away from the office? How to reconcile wo rkload, family, voice? How to prevent recurrences? Many of these questions remai ned unanswered, while others have been clarified. There are anatomical variation s from individual to individual, the stress factor is present in most of these p rofessionals, but the way each deals with it is different, workload, motivation to work, family, musical awareness, among others, are variants interfere with tr eatment outcome. Researching the teacher's voice, there were several studies, in cluding projects that were developed for inclusion in the curriculum of training courses for these professionals. One of the main reasons that led him to resear ch the topic was precisely the misinformation that these professionals have rega rding the use 38 professional voice, which is disproportionate compared to the number of proje cts and studies already published on the same topic. Despite complaints and dise ases are common among the class and reason for temporary departure for many prof essionals, misinformation is a reality and the problem presented by the teacher is considered of little importance. Teachers who make the choice to take care of the voice are sometimes regarded by colleagues as weak and tend to omit are in speech therapy because of shame or fear of being judged as "sick." For more reso urces that may exist to assist them during class, is the voice the principal mea ns of transmission of the teachings. The teacher must teach, he has a program to follow and is charged for this, students need to learn to get your work noticed and approved. When a problem arises voice, it comes with an emotional stress an d the patient arrives at the office with a great anxiety and fear of failing to improve and render you need to be able to continue teaching. Through theoretical and clinical reports, I noticed that surpassed the initial stage of treatment a nd better control of anxiety and decreasing the "fears" related to voice,€orientat ion accompanied by systemic therapy provides the teacher and a security improvem ent that allows you to walk alone in their journey of hard work with the voice. 39 Undoubtedly, the therapy with vocal teachers need to be objective, fast and e fficient for him to continue his work and see no problem in voice something whic h makes it impossible to work. The correct and adequate support allows these pro fessionals to maintain good voice quality and prevent relapses. I believe this w ork can help teachers realize how important the voice and as a vocal professiona l and psychological harms. Besides being extremely uncomfortable for the student s hear a professor dysphonia, because it generates discomfort and hinders attent ion in class. It is important that teachers realize that voice therapy is not so mething long and tiring, if conducted safely. For both, knowledge of anatomy and

physiology of the vocal tract is of paramount importance for the therapist and the teacher who needs to understand what is happening in larynx. As mentioned ab ove, several studies and projects were created, but there is ignorance about the care of the voice. Speech pathologists are also to blame because it is for us t he role of information and guidance on issues related to voice. Develop theoreti cal work is extremely important, but applying them in practice is the best way t o reach these professionals and that we are not expecting to reach us. This rese arch has provided me better understand the reality of teachers, mainly outside t he office. It is easy for the therapist to ask 40 for them to do this or that exercise, follow this or that recommendation with out experiencing what actually happens in day-to-day lives of these professional s, without hearing their complaints and difficulties. Only through this listenin g, we can tailor therapy to the reality of each one, achieving satisfactory resu lts in each patient and developing awareness of the need of constant care of his voice. "And your body is the harp of your soul; The voice belongs to draw his melodious music or interfering noises." Gibran Khalil GilbranoS 41 8. REFERENCES Aydos, B.R.S.; MOTTA, L., TEIXEIRA, S.B. Effectiveness in reducing the hydration of vocal complaints from teachers. In: Brazilian Journal of Speech. Porto Alegr e: May, v. 1, n. February, 2000. BEAUTTENMULLER, G.; LAPORTE, N. Vocal expressio n and body language. Rio de Janeiro: Revinter, 1992. Behlau, M. Laryngology and voice today. Rio de Janeiro: Revinter, 1998. Boone, DR Her voice is cheating on you, finding your natural voice. Porto Alegre: Artes Médicas, 1996. BOONE, DR; McF ARLANE, SC The voice and voice therapy. 5.ed. Porto Alegre: Artes Médicas, 1994. C OLTON, RH; CASPER, JK Understanding voice problems: a physiological perspective for diagnosis and treatment. Porto Alegre: Artes Médicas, 1996. Fabron, E.M.G.; OM OTO, S. Vocal complaints from teachers and other professionals. In: FERREIRA, L. P.: COSTA, H.O. Active voice: talking about the professional voice. São Paulo: Roc a, 2000. FERREIRA, L.P. COSTA, H. Active voice: talking about the professional v oice. São Paulo: Roca, 2000. OLIVEIRA, I.B. et al. Voice disorders in teachers of preschool and first grade. In: FERREIRA, LP; OLIVEIRA, IB; QUINTEIRO, EA; MORATO , MS Voice Professional: The professional voice. 2.ed. Carapicuiba: Pró-Fono, 1998 . Oyarzun, R.; BRUNETTO, B.; MELLA, L., AVILA, S. Dysphonia in teachers. Rev. Ot orrinolaringol., 42 (2): 12-18, 1984. 42 PINE, S.M.R. Manual of vocal hygiene for professional voice users. Paulo: Pró-F ono, 1997. PINTO, A.M.P.; FURCK, M.A.E. Project vocal health of teachers. FERREI RA, L. P. Working voice. São Paulo: Summus, 1987. Are In: Pletsch, F. Vocal techniques, relaxation and vocal health of teachers. Dissertat ion. Curitiba: CEFAC, 1997. POLITO, R. Gestures and postures. São Paulo: Saraiva, 1996. QUINTEIRO, E. A. Aesthetics of voice. São Paulo: Summus, 1989. RODRIGUES, R. , Azevedo, S.; Behlau, M. Considerations professional voice spoken. In: MARCHESA N, I.Q.; Zorzi, J.L.; GOMES, I.C.D. Topics in Speech Pathology. Vol 3. São Paulo: Lovise, 1995. SEGRE, R.; NAIDCH, S., JACKSON, C. Principles of Student phoniatri cs y y dicción professionales corner. Buenos Aires: Panamericana, 1981.