Pablo Sigal
08/20/2021 17:36
Clarín.com
Society
Updated 08/20/2021 5:36 PM
For more than a year, the chinstrap has been imposed as an essential accessory to cope with the pandemic.
After initial doubts from the World Health Organization, it was imposed as a tool to prevent infections.
What happened to the communication, chinstrap through?
And with the voice?
How did that extra effort that must be made to make the other understand what we say without the visual context of lip reading and a volume attenuated by the fabric affect you?
Clarín
interviewed Iris Rodríguez, otolaryngologist and founder of the Asociación Argentina de la Voz.
- What is happening with this extra effort that is wearing the chinstrap all the time?
- We all suffer from it.
They have muzzled us somehow.
They have put up a barrier and told us to breathe as you can and get ready.
Here you have to take care of yourself.
Every day I discuss this with patients: there is not a single one who does not say that they have no problems communicating with the mask.
It doesn't matter what activity you do.
Teachers, journalists, announcers and we, doctors, have to communicate and explain things to patients.
We are the daily affected by this.
- Doctors have even greater barriers.
- Yes, I do endoscopies of the entire airway and I have to set an astronaut plan.
Not just a chinstrap, but a special chinstrap which is the N95 and above a surgical one, the masks and all an impressive protective equipment for me and for the patient.
So it is practically impossible to communicate.
- Almost speaking from inside a safe.
- Exactly, it's quite an effort, you don't know what it means.
Every two patients I take everything out, rest for a while, drink water, breathe, get dressed again and continue, It is really a great effort, imagine a teacher who has to face the classroom, now with face-to-face classes.
None of us were prepared for that.
The otorhinolaryngologist Iris Rodríguez.
- Is there an accelerated deterioration of the vocal cords due to forcing them? Is it reversible? Are there techniques that improve speech with a mask?
- At this moment we are talking in our service, at the Italian Hospital, of measuring these impacts, because to the common pathology that one received previously, two major pathologies of the vocal cords have been added to us.
On the one hand, what we are talking about for the use of the chinstrap.
And on the other hand, everything that is post Covid.
Anyone who has suffered the infection and that you know affects the airway, from the nose to the last alveolus of the lung.
In that we are in diapers.
As for the chinstrap, we didn't have time to prepare beforehand, but speaking with a chinstrap means learning a technique for it.
- How would it be?
- Our speech therapists are precisely prepared for it.
They have developed, they have expanded the technique that they already used, they are about to start and we must insist on the proper management of breathing.
In the management of respiratory phono coordination, that is, how you breathe and how you sound.
Also think about both the one who is going to emit the voice and the one who is going to hear is disabled by that chinstrap.
So we have to overcome that barrier and first shore up that breath.
Second, to support the phono-respiratory coordination, third, to manage a good articulation and fourth, the speed with which we speak.
- Should we speak slower?
- We have to slow down, emphasize the articulation.
If we took off our chinstrap and looked at ourselves in a mirror we would look ridiculous talking like that, but with the chinstrap you don't notice.
So we have to articulate exaggeratedly so that the other can understand what we are saying.
- What does respiratory phono coordination mean?
- It's how you're going to breathe, like taking air.
If we think about it, the fuel in our voice is air.
Like gasoline for a car, air is for the voice.
So our fuel has to arrive well.
We have to have the nostrils well uncovered, the entire air cavity comfortable so that the air enters and then comes out as a word, as a voice.
That coordination, that the air enters and then comes out as we speak is called coordination because it has to be coordinated with the intercostal muscles and the diaphragm muscle.
- That needs an apprenticeship.
- Sure, most people do not know, they did not learn to coordinate this because we are not born knowing these things.
Most of the people speak as they can, making force in the throat, in the muscles of the neck, that's why they end up so exhausted.
We promote and teach that the air must enter well towards the base of the lung, work on muscular support, that the muscles of the rib cage and the diaphragm hold that air and dose it and emit it, let's say, that the air comes out along with the words gradually, in dosed form.
- As if it were a balloon that is deflating.
- Exactly like birthday balloons.
If you open it a little bit and squeeze it slowly, it will deflate.
It is something like that, dosed.
Then, coordinate the input with the dosage of the output: that is the respiratory phono coordination.
The entry of the air and the exit would be made voice, made word, because it passes through the vocal cords, it is transformed into sound.
And made a word at the end on the lips because we articulate what we are going to say that our brain told us to say.
- What happens to the volume of the voice when speaking with a chinstrap?
- The volume does not need to be increased, we all tend to increase the volume when we have the chinstrap.
Unfortunately, you have to increase it a bit, but the emphasis must be put on the dosage of the air and on the articulation of the word, not necessarily increasing the volume.
Of course, you have to try to speak in environments where there is no noise.
- What happens with that capacity of the teachers that they had when detecting when the boys had a bad pronunciation?
- That is the other pandemic that is coming, we are going to have a significant number of different pandemics in quotation marks, because there are a lot of things that we are missing.
It is very difficult for the teacher to detect what he previously detected because the boy also has a chinstrap, and he cannot see.
The teacher has to be focused on how he is going to emit his voice and his knowledge and attend to the children who speak.
It is a titanic job what they are doing.
- What is the first symptom of voice exhaustion in a patient?
- "Doctor, I don't want to talk anymore, I don't know what's wrong with me, I'm exhausted, my neck hurts, I get up more or less well but when I arrive at noon I don't give any more, I don't want anyone to talk to me anymore and I don't want to talk plus".
Everyone complains about that.
They end up exhausted.
And in addition to articulating the word and the breath as well as possible, one of the central things is to drink a lot of water, because it evaporates while we speak and the fabric of the chinstrap absorbs.
Water is the best remedy for voice.
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