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A Q&A with Kittie Verdolini Abbott: The Special Vocal Vulnerabilities of Teachers

Kittie Verdolini Abbott, Ph.D., CCC-SLP, is a professor of communication science and disorders in the School of Health and Rehabilitation Services at the University of Pittsburgh. Her general area of interest is clinical voice science. Her current research focuses on the role of vocalization for wound healing in the larynx, motor learning principles applied to models of voice therapy, and clinical trials in voice therapy.

Kittie Verdolini Abbott

Kittie Verdolini Abbott, Ph.D., CCC-SLP

Why is it important to address voice problems in teachers, and what could happen if we don’t pay attention?

Experts estimate that anywhere between about 15 and 40 percent of all teachers experience voice problems on any given day. Across the career span, almost 60 percent of teachers will experience these problems. Most voice problems in teachers are related to heavy voice use required in the profession. These problems are not merely cosmetic. They affect a teacher’s quality of life and ability to remain in the profession.

Why do you call voice problems in teachers a woman’s issue?

Female teachers are twice as likely to have voice problems as their male peers. There are two likely reasons for this gender bias. First, women have smaller vocal folds that vibrate at about twice the rate of men's vocal folds. When a female teacher uses her voice, she has about twice the number of vocal fold collisions [collisions are when the vocal folds snap against each other] as a male teacher, for the same amount of time spent talking per day. In fact, a female teacher is estimated to have about 1.5 million vocal fold collisions during a teaching day compared to a male teacher's 750,000. Collisions, and the damage they cause to tissue, are thought to be the primary cause of voice problems in teachers.  Second, again due to anatomical differences between males and females, women's vocal folds may be angled in a way that increases pressure at the midpoint of the vocal folds, which is the most vulnerable to injury.

What is the standard of care for treating voice problems, and how does your current research address current limitations?

The treatment approach depends on the problem. Most voice problems in teachers are caused by voice use and so the first-line approach is usually behavioral (voice therapy). In some cases, when nodules or polyps are involved, microsurgery might be used in addition to voice therapy to optimize results. Our current research looks at different approaches to voice therapy to determine which ones yield the best results for teachers. Based on our data so far, it appears that simple voice education and teacher-specific recommendations may be sufficient to prevent voice problems in currently healthy teachers, but voice training may also be required to treat teachers who are already having problems. In terms of voice training, our research indicates that teachers usually benefit from a training approach that allows them to use a strong voice, but one with relatively minimal vocal fold impact. This seems to offer the most likely protection from further injury.