AM I USING MY MASK CORRECTLY?
INFORMATION AND GUIDELINES ON VOCAL HYGIENE ASSOCIATED WITH MASK USE DURING VOCAL ACTIVITY
The unfortunate global state of events that are currently taking place has certainly and indefinitely linked us to a protective tool called mask or face covering. From the beginning of the pandemic brought upon by COVID-19, a variety of them have been designed and provided to all of us- some of them handmade, some homologated or certified by authorities and some of others that have proved not to be as safe as previously made out to be. To their reliability or lack thereof, we also need to add the proper or improper use as well as hygiene measures taken by the wearer.
The link between voice and mask use has been brought into the spotlight, potentially representing a worrisome issue for vocal health, especially for those who use their voices as their work tool and whose livelihood depends on it.
It is also a cause of concern for people who use their voices as part of a hobby or those who are undergoing treatment or vocal rehabilitation. It is commonly known that our voices use a complex set or organs and structures to flow efficiently. This is why, the most appropriate way to analyze our vocal function is to see as a “whole”, as its health is also tightly linked with our emotional state. Let us focus now on the essential ways to maintain good vocal health which may be compromised by mask or face covering usage.
Cloth face masks
Non-approved
FFP2 masks, also KN95, NP5
Approved or homologated
Surgical masks
Approved or homologated
VOCAL ARTICULATION
When it comes to talking about performing proper phono-articulatory movements which are essential for good intelligibility, resonance and vocal projection, cloth masks are the main culprit in preventing said movements to happen freely, as nose-to-chain restrain is higher during the phonatory action.
With regard to certified masks, surgical facemasks allow for a wider vertical aperture as opposed to cloth masks or PPE masks (FFP2, KN95, etc.), even though the latter allow for a better upper-lip movement thanks to their design. That is why, if our work, social or family environment allows it, surgical masks would be the better choice for articulation purposes. Some vocal care guidelines include being mindful of creating wider vocal aperture, slowing down our speech during phonatory action, and reinforcing hand and body language to compensate for other restrictions.
VOCAL HYDRATION
PPE and especially surgical masks not only provide considerable benefits in terms of protection against cloth ones, but they also offer better breathability which is key for vocal hydration.
There are two kinds of hydration: direct vocal hydration and indirect vocal hydration. The last one is achieved with gradual liquid intake of at least 2 liters per day, especially during vocal activity. This type of hydration, contrary to popular belief, does not moisten the vocal chords directly as if it were a kind of shower. What happens really, in general terms, is a beneficial blood irrigation for the mucus around vocal chords. It has been shown that an increased usage of facemasks and the fact that it may be worrisome for wearers to take them off depending on the location has impacted negatively on water consumption, which has dramatically decreased causing vocal issues and other problems. A possible solution would be sanitizing hands before mask removal for a more sustained water intake during the day.
Our professional recommendation is to not only depend on water consumption (indirect hydration) but also emphasize direct vocal hydration. This is achieved with the help of a nebulizer which should be used before and after vocal activity, at least for 10 minutes and using a saline solution. Vocal steaming, using a salt dilution is also an alternative as well as gargling with sodium bicarbonate and glycerin which is also affordable and highly effective. To finish off, and since our nasal cavities are a primary filtration system for the respiratory system and a key structure for vocal performance, we need to take special care to clean them correctly. This can be done by applying a saline solution with slight pressure directly into the nostril, cleaning both canals easily and efficiently. Another option would be doing so with water and salt, using a small syringe. Using a humidifier is necessary especially in dry environments, resting areas or rooms where the vocal activity is going to take place.
VOLUMEN OR VOICE INTENSITY
Some of the elements which could potentially influence management of vocal volume are shouting or a sudden and excessive increase of vocal intensity to compensate for environment noise as well as a lack of self-monitoring or self-perception due to the effect that each type of mask creates in the reduction of decibels produced by our vocal chords.
The most obvious hindrance is that there is a physical barrier placed right in front of our lips, between ourselves and the receptor, preventing voice production to a greater or lesser extent. The truth is that higher frequencies are often concealed when filtered through the mask’s material and the lower ones are those which can escape with higher success. This is especially important when talking about sonority and understandability, the main ingredients for effective communication. You can try to test this by talking into a glass and note how it impacts speech dramatically.
Recent studies have found a loss of up to 3 to 15 decibels, with surgical masks remaining the best options as opposed to PPE and cloth masks, which offer greater resistance to sound. However, these numbers and the need to increase voice intensity or volume have not yet been confirmed to be solidly linked by evidence. It seems that the problem has more to do with the users own auditory perception or a general or specific imbalance in vocal technique.
As a general advice, so long as self-protection is not compromised and our work, family or social environment allows it, surgical masks would be the better choice, especially for professional voices and particularly when talking about educators of all kinds. In addition, if certified FFP2 masks are required, it is recommended to take breaks or alternate with a surgical one towards the end of vocal performance. Another option, for those whose workplace allows it, is the use of wireless microphones together with a quality PA system. In the case of people who are currently working from home and making video calls as part of their job, it is advisable to use headphones which provide better auditory feedback and usually feature an integrated microphone located near our oral cavity, which facilitates speech for a more efficient communication.
PROPER USE OF THE VOICE
The prevention of vocal issues plays an undeniable role for voice disorders. Any slight discomfort which manifests as pain, itchiness, throat clearing, dryness, inflammation or a change in vocal quality needs to be explored by an ear, nose and throat specialist (ENT). After the evaluation, the physician will determine whether it is convenient to have a specific treatment or rehabilitation carried out by a speech therapist who specializes in said type of procedure. It is vital for our vocal health that none of these symptoms are ignored for more than a few days, except for when they are part of a common cold or similar conditions.
Going back to the subject of specialized speech therapists and the prevention strategy mainly insisting on the acquisition of vocal technique, we will conclude this piece by saying that all of those people who use their voice as their main work tool will likely need to gain further knowledge of their own instrument. In addition, said people will also have to expand their knowledge based on their own sensations of production ease and comfortable and healthy voice output. This, together with proper vocal hygiene and self-care, will help the larynx become a more functional and resistant organ.
DAMIÁN OSORIO
Voice and speech therapist
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