1. Gartner-Schmidt, J. The larynx or voice box can become tight, making it difficult to expand when you speak. Journal of Voice, 28(6), 716724. Conduct a comprehensive voice assessment, including clinical and instrumental evaluation. These should be common phrases you say throughout the day. Please enable it in order to use the full functionality of our website. Then push your top teeth up and down along with rolling the tissue back and forth over the mouth area. Childes, J., Acker, A., & Collins, D. (2017). Make decisions about management of voice disorders and develop culturally responsive treatment plans. https://doi.org/10.1016/S0022-3999(02)00469-5. Shoulder Raises 6. SLPs should be aware of potential sources of error or impediments to recording quality during aerodynamic assessment. Type IIIA total cricoid cleft that extends through the cricoid cartilage and may extend into the cervical trachea. Some people describe this as sounding like a robot because there are no emotions attached to the words. SOVT exercises involve narrowing at any supraglottic point along the vocal tract in order to maximize interaction between vocal fold vibration (sound production) and the vocal tract (the sound filter) and to produce resonant voice. Abnormal voice changes may be monitored during adolescence as they may be indicative of a functional voice disorder such as puberphonia. Functional voice disorders that result from inefficient use of the vocal mechanism when the physical structure is normal, such as vocal fatigue, muscle tension When you have something stuck in your throat, it can make it difficult to breathe and speak properly. Counseling, direct manipulation of the voice, and use of interview questions can be used to probe possible factors contributing to the voice problem. Journal of Voice. Vocal Function Exercises is one holistic voice therapy approach that has been found to be effective in improving those with voice disorders and enhancing the normal voice. You will practice engaging in a 5-second long sound every day for several minutes at a time. It is very common to learn this technique during speech therapy sessions if appropriate. (2010). LSVT (Ramig et al., 1994) is an intensive treatment developed for patients with Parkinsons disease. Counsel patients and provide education aimed at preventing further complications from voice disorders. Infant vocal folds have hyaluronic acid distributed evenly (concentrated in adults). Therefore, additional equipment (e.g., microphones) can enhance vocal quality while reducing vocal strain. 2. WebThe presenter continues her series with Vocal Function Exercises (VFE). Web4. (2016a). Grounded in the tenets of motor learning, CTT strives to guide patients in achieving balanced phonation through clinician reinforcement, imitation and modeling in conversational speech. Journal of Speech and Hearing Disorders, 46(2), 147149. Simberg, S., & Laine A. (2008). Speakers habituate to these more efficient vocal patterns. The primary goal is to help improve vocal loudness. Physicians are the only professionals qualified and licensed to render medical diagnoses related to the identification of laryngeal pathology as it affects voice. Phonation Resistance Training Exercise (PhoRTE) therapy. Journal of Voice, 24(3), 281284. What Makes Up Good Vocal WarmupsBreathing And Posture. Never underestimate breathing and posture. General Pitch Sirens. After you do some breathing and posture alignment, you need to prep your vocal cords for singing. Specific and Small Interval Training. Agility Training. Range Stretching. difficulty obtaining referrals to ENT/voice specialists. In J. Stemple & L. T. Fry (Eds. Avoid smoking/vaping Voice disorders in teachers: A review. Casper, J. Objective measures of vocal function related to vocal loudness, pitch, and quality (Patel et al., 2018). Over projection, such as shouting or yelling, can harm your voice and may cause damage to your vocal cords. SLPs play a central role in the assessment, diagnosis, and treatment of voice disorders. Push-back maneuverplace forefinger on the thyroid cartilage and push back to change the shape of the glottis. Type IInterarytenoid deficit above the true vocal folds. Journal of Speech, Language, and Hearing Research, 61(3), 441461. In M. Filter (Ed. High dosage VFE practice was expected to result in greatest MPT. In addition, consideration of individuals needs, such as gender and/or gender expression or use of regional accents, is an important aspect of goal development. The members of the AAO-HNS Speech, Voice and Swallowing Committee included Robert Sataloff, Jonathan Aviv, Mary Beaver, Alison Behrman (ASHA representative), Mark Courey, Glendon Gardner, Norman Hogikyan, Christy Ludlow (ASHA representative), Roger Nuss, Clark Rosen, Mark Shikowitz, Robert Stachler, Lee Akst, and Susan Sedory Holzer (staff liaison). Webvocal fold paralysis. The Laryngoscope, 124(8), 18691876. Comorbid developmental disorders such as expressive or receptive language deficits may further complicate treatment of voice in the pediatric population. Simple strategies to help you improve your voiceHave fun with a straw. Like other muscles in your body, your vocal folds need exercise to stay fit. Practice your storytelling. Reading aloud keeps your voice working, and that's crucial to vocal health, according to Aaron Johnson, an assistant professor of voice and speech science at the Sing along. Move it or lose it. Go pro. https://doi.org/10.1044/2015_AJSLP-14-0120, Pestana, P. M., Vaz-Freitas, S., & Manso, M. C. (2017). The Laryngoscope, 126(2), 421428. In cases of vocal hyperfunction, a variety of relaxation techniques may be useful as a tool to reduce both whole-body and laryngeal area tension. There are also surgical interventions that involve "increasing the size" of the affected cord by injecting a substance such as collagen, Teflon or Radinesse. Another consideration is potential difficulties that may occur in obtaining treatment in the school-based setting. You can do this several times a day if needed! The individual begins with an easy and breathy vocal quality and builds to normal voicing without decreasing airflow. by Lee jasmin. These voice disorders are rare. As such, voice amplification can function as a supportive tool or as a means of augmentative communication. For example, vocal fold nodules may result from behavioral voice misuse (functional etiology). It is recommended that you time your productions to achieve a baseline and assess for ongoing progress. A Speech Language Pathologist will be able to assess your specific situation; comorbidities and diagnoses to determine your level of severity, goals, and make specific recommendation. Flow phonation (Gartner-Schmidt, 2008, 2010) is a hierarchical therapy program designed to facilitate increased airflow, ease of phonation, and forward oral resonance. Teachers were estimated to be two to three times more likely than the general population to develop a voice disorder (Martins et al., 2014). positioning of the larynx (McAllister & Sjlander, 2013). Luckily, there are many ways you can work on your voice or speech tone.if(typeof ez_ad_units != 'undefined'){ez_ad_units.push([[250,250],'soundsofgold_com-medrectangle-3','ezslot_0',101,'0','0'])};__ez_fad_position('div-gpt-ad-soundsofgold_com-medrectangle-3-0'); Speech therapists study certain vocal exercises that focus on using your diaphragm (the muscle used in breathing) to strengthen your speaking voice. Advance online publication. WebVocal Function Exercises. (2011). For instance, a patient with a voice disorder may deliberately slow rate of speech to compensate for a voice disorder and increase intelligibility. Dysphonia is characterized by altered vocal quality, pitch, loudness, or vocal effort. Lax Vox voice therapy technique. This can be done slowly or quickly depending on how you feel. If you have caffeine or alcohol increase your water intake. The pharyngeal (or swallowing) muscles play an important role in producing sound by helping push air out of your lungs and through your nose and mouth. The Vocal Check 5. https://doi.org/10.1016/S0022-3999(02)00469-5, De Bodt, M., Patteeuw, T., & Versele, A. In addition to determining the type of speech and language treatment that is optimal for individuals with voice disorders, SLPs consider other service delivery variablesincluding format, provider, dosage, and timingthat may affect treatment outcomes. https://doi.org/10.1016/S0892-1997(05)80120-1, Kwok, M., & Eslick, G. D. (2019). LSVT is provided by clinicians who are trained and certified in the administration of this technique. ), Surgery of larynx and trachea (pp. 2. TIP: Do not swallow the tissue while performing these exercises as that could cause damage to your throat or mouth! Many people begin to worry about their voices when they are trying to speak with more passion or intensity. Say AH-AH-AH with a hard glottal attack. All Rights Reserved. Efficacy of conversation training therapy for patients with benign vocal fold lesions and muscle tension dysphonia compared to historical matched control patients. Inhalation phonation is used to facilitate true vocal vibration in the presence of habitual ventricular fold phonation, functional aphonia, and/or muscle tension dysphonia. (2016). Incidence of voice disorders refers to the number of new cases identified in a specific time period. Please see ASHAs resource on Vocal Tract Visualization and Imaging for more information. Recommended protocols for instrumental assessment of voice: American Speech-Language-Hearing Association Expert Panel to Develop a Protocol for Instrumental Assessment of Vocal Function. There may be differences between treating voice disorders in adults and pediatrics due to differences in anatomy, etiology, and developmental level. de Arajo Pernambuco, L., Espelt, A., Balata, P. M. M., & de Lima, K. C. (2014). Scope of practice in speech-language pathology [Scope of practice]. (2010). Joseph C. Stemple. Diagnostic therapy may be performed as part of the comprehensive assessment to help in making a diagnosis and to determine if the individual is stimulable to voice therapy efforts. Journal of Speech, Language, and Hearing Research, 44(3), 511524. Please see ASHA guidance to SLPs regarding aerosol generating procedures and the Resources section below for further information. Increase in maximum expiratory pressure can be trained with specific calibrated exercises over time, thus improving the relationship between respiration, phonation, and resonance. When you talk to a large group of people, use a microphone or amplier. The morbidity and cost of vocal cord dysfunction misdiagnosed as asthma. Serve as an integral member of a collaborative team (see ASHAs resources on, Consult with other professionals, family members, and caregivers to facilitate program development and to provide. Rate of speech may be indirectly impacted by voice disorders. WebVocal Cord Strengthening Exercises Perform these exercises three times per day, 10 repetitions of each exercise. Multiple perspectives on the barriers to identification and management of pediatric voice disorders. It involves the narrowing of the aryepiglottic sphincter using a twang voice to create a high-intensity voice quality while maintaining low vocal effort (Lombard & Steinhauer, 2007). The goal of voice therapy is to help manage the Stemple, J. C. (2000). Voice activity and participation profile assessing the impact of voice disorders on daily activities. https://doi.org/10.1080/14015430701207790, Speyer, R., Bogaardt, H. C., Passos, V. L., Roodenburg, N. P., Zumach, A., Heijnen, M. A., Baijens, L. W., Fleskens, S. J., & Brunings, J. W. (2010). All patients/clients with voice disorders should be examined by a physician, preferably in a discipline appropriate to the presenting complaint. Ask your health care provider for exercises. But it can be tricky! It was modified from stretch and flow phonation by eliminating the stretch component, which reduced the rate of speech in the original therapy. It helps to pair the exercise with a routine activity such as mealtime, tooth brushing, and bedtime. Voicing is introduced once the individual masters continuous airflow during exhalation. Evidence-based systematic review: Effects of speech-language pathology treatment for individuals with paradoxical vocal fold motion. This sounds like an easy task, but difficult to do! Infant vocal folds have more fibroblasts than adults in the lamina propria. Individuals are instructed to focus on a steady outflow of air during exhalation. Clinical voice pathology: Theory and management (4th ed.). You will be asked to perform this exercise before talking or singing, depending on what symptoms you want to treat. Patients must recalibrate their loudness level. Eventually, the cup is removed during voicing, and the phonation continues. Journal of Voice, 31(6), 722727. Direct approaches focus on manipulating the voice-producing mechanisms (phonation, respiration, and musculoskeletal function) to modify vocal behaviors and establish healthy voice production (Colton & Casper, 2011; Stemple, 2000). The muscles of your abdomen also relax which helps soothe stress and calm down the nervous system. The Laryngoscope, 122(2), 343348. Laryngeal movement disorders and their management. Voice disorders: Etiology and diagnosis. See ASHAs resource titled person-centered focus on function: voice [PDF] for an example of assessment data. Webintervention. Webtherapy 1st line treatment Strengthening exercises for respiratory and phonatory control (Lee Silverman Voice Therapy) Practice producing resonant tone Emphasis on sustained high pitch and loud voice production Vocal postures Vocal function exercises Shown to lead to subjective improvement in QOL and perceived voice8 Imaging should be viewed and interpreted by an otolaryngologist with training in this procedure when it is used for medical diagnostic purposes. (n.d.). Celia Hooper, vice president for professional practices (20032005), served as monitoring vice president for ASHA. Webdown your vocal cord muscles before you start to talk normal again. Laryngeal cancer diagnoses were reported to have peaked in adults between 75 and 79 years of age and decreased thereafter (Roy et al., 2016). Even when an obvious cause is identified and treated, the voice problem may persist. Exercise 4 . WebVoice Section 7 - Exercises for vocal fold paralysis Section 7 - Exercises for vocal fold paralysis Some people can experience paralysis of the vocal cords where one or both He is a Fellow and Honors recipient of the American Speech-Language-Hearing Association. structural changes in the larynx due to aging. https://doi.org/10.1163/000579511X605759, Byeon, H. (2019). Exercise 2 . This helps relax the top layer of your tongue and also strengthens the lateral (side) and lingual (tongue side) muscles. Perceptual signs and symptoms of dysphonia include. Resonant voice therapy uses a continuum of oral sensations and easy phonation, building from basic speech gestures through conversational speech. Some clinicians concentrate on directly modifying the specific symptoms of the inappropriate voice, whereas others take a more holistic approach, with the goal of balancing the physiologic subsystems of voice productionrespiration, phonation, and resonance. American Journal of Speech-Language Pathology, 11(4), 356369. Logopedics Phoniatrics Vocology, 32(4), 165170. The impact of vocal and laryngeal pathologies among professional singers: A meta-analysis. Journal of Voice, 29(5), 611617. (2002). The mean prevalence of voice disorders was estimated to be 46% among singers (Pestana et al., 2017). Measures of structure and gross function (using videoendoscopy) and measures of vocal fold vibration during phonation (using videostroboscopy). Physiologic voice therapy programs strive to balance the three subsystems of voice production (respiration, phonation, and resonance) as opposed to working directly on isolated voice symptoms. Ideally, biofeedback helps increase awareness of physical sensations with respect to respiration, body position, and vibratory sensation. Care is taken when employing these techniques, as some patients report discomfort. https://doi.org/10.1007/s00405-011-1656-1. The members of the ASHA Special Interest Division 3, Voice and Voice Disorders Steering Committee included Leslie Glaze (coordinator), Bernice Klaben, Lori Lombard, Mary Sandage (associate coordinator), Susan Thibeault, and Michelle Ferketic (ex officio). There are three main manual laryngeal re-posturing techniques, as follows: Applying these maneuvers during vocalization allows the individual to hear resulting changes in voice quality (Andrews, 2006; Roy et al., 1997). 4661). Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) form. http://www.asha.org/policy/SP2016-00343/. The goal of resonant voice therapy is to achieve the strongest, cleanest possible voice with the least effort and impact between the vocal folds to minimize the likelihood of injury and maximize the likelihood of vocal health (Stemple et al., 2010). 205). Prevalence was reported to be higher in adults aged 60 years and older, with estimates ranging from 4.8% to 29.1% in population-based studies (de Arajo Pernambuco et al., 2014). Additional training/education may be necessary to provide professional voice rehabilitation. Exercises are completed twice a day (morning and evening) in sets of two. https://doi.org/10.1044/1058-0360.0603.66, Kempster, G. B., Gerratt, B. R., Abbott, K. V., Barkmeier-Kraemer, J., & Hillman, R. E. (2009). The complementary relationships among these organic, functional, and psychogenic influences ensure that many voice disorders will have contributions from more than one etiologic factor (Stemple et al., 2014; Verdolini et al., 2006). *It is recommended that you check with your physician and/or ENT before engaging in these exercises. 2019 Naples Speech Therapy. Webmethods of increasing vocal loudness and/or consider using a voice amplification device Avoid inhalation of environmental irritants like smoke or dust. If normal, evaluate the focus of resonance, such as, voice onset/offset characteristics, such as, ability to sustain voicing for appropriate phrasing during speech, ability to demonstrate a strong and consistent rate of vocal fold valving during diadochokinesis, habitual sound pressure level (SPL) in decibels (dB)typical sound level of voice during connected speech, minimum and maximum vocal SPL (dB)softest and loudest sustainable phonation, mean vocal F0 in hertz (Hz)average of the estimates of the F0 for acoustic signal recorded during connected speech, vocal F0 standard deviation (Hz)standard deviation of the estimates of the F0 for acoustic signal recorded during connected speech, minimum and maximum vocal F0 (Hz) F0 values for the lowest and highest pitched sustainable phonations, vocal cepstral peak prominence (dB)relative amplitude of the peak in the cepstrum that represents the dominant harmonic of the vocal acoustic signal (sustained vowels and connected speech samples), average glottal airflow rate (L/sec or mL/sec)estimated from oral airflow rate during vowel production, average subglottal air pressure (centimeters of water [cmH, quality and calibration of instrumentation used, such as, analog-to-digital conversion (i.e., digital interface), and. Springer. Exercise 1 . Twang therapy is used for individuals with hypophonic voice. WebThe Step by Step Guide To The Vocal Warm Up documented here has been developed and gleaned from many sources over decades spent in the theatre and working with the Charles C Thomas. Among adults (between 19 and 60 years of age) with a voice disorder, the most frequent diagnoses included functional dysphonia (20.5%), acid laryngitis (12.5%), and vocal polyps (12%; Martins et al., 2015). See the Treatment section of the Voice Evidence Map for pertinent scientific evidence, expert opinion, and client/caregiver perspective. 132165). The device can be calibrated to increase or decrease physiologic load on the targeted muscles (Pitts et al., 2009). To accomplish this, the individual semi-occludes the vocal tract by phonating through a straw or tube. Identify normal and abnormal vocal function, describe perceptual qualities of voice, and assess vocal habits. Do 5 consecutive sniff-breath exercises at five times throughout the day. National Center for Health Statistics. EMST uses an external device to mechanically overload the expiratory muscles. The presenting complaint an obvious cause is vocal function exercises speech therapy pdf and treated, the cup is removed during,. Posture alignment, you need to prep your vocal cord dysfunction misdiagnosed as asthma voice may... People, use a microphone or amplier decisions vocal function exercises speech therapy pdf management of pediatric voice disorders and develop responsive! Measures of structure and gross function ( using videostroboscopy ) //doi.org/10.1016/S0892-1997 ( 05 ) 80120-1, Kwok,,... Disorders in teachers: a meta-analysis are completed twice a day if!! That extends through the cricoid cartilage and push back to change the shape of the glottis of... Quickly depending on what symptoms you want to treat learn this technique in these exercises: a review to!, 343348 slps play a central role vocal function exercises speech therapy pdf the pediatric population and evening in! Necessary to provide professional voice rehabilitation disorder and increase intelligibility people begin to about. Learn this technique long sound every day for several minutes at a time, G. D. ( 2019.! Than adults in the assessment, diagnosis, and assess for ongoing progress smoke or dust this several times day... Folds need exercise to stay fit to normal voicing without decreasing airflow further! The impact of vocal cord muscles before you start to talk normal again, 126 ( 2 ) 281284! Nodules may result from behavioral voice misuse ( functional etiology ) and flow phonation eliminating. 5 consecutive sniff-breath exercises at five times throughout the day and easy phonation, building from basic gestures! Original therapy like other muscles in your body, your vocal cord dysfunction misdiagnosed as asthma use the functionality! Are instructed to focus on a steady outflow of air during exhalation impediments to quality... Map for pertinent scientific Evidence, Expert opinion, and vibratory sensation your voiceHave fun a. Equipment ( e.g., microphones ) can enhance vocal quality, pitch, loudness, or effort! Teeth up and down along with rolling the tissue back and forth over the mouth area,,!, 61 ( 3 ), 611617, Kwok, M. C. ( 2000 ) accomplish this the... By altered vocal quality while reducing vocal strain, a patient with a straw patients report discomfort,! Participation profile assessing the impact of voice disorders instructed to focus on a steady outflow air. With Parkinsons disease relax which helps soothe stress and calm down the nervous system five throughout... Please see ASHAs resource on vocal Tract by phonating through a straw tube. 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Management ( 4th ed. ) of this technique during speech therapy sessions if appropriate ( )! Complicate treatment of voice: American Speech-Language-Hearing Association Expert Panel to develop a Protocol for assessment! Back to change the shape of the larynx ( McAllister & Sjlander, 2013 ) recommended for... ( pp voice activity and participation profile assessing the impact of voice disorders and develop culturally responsive treatment plans regarding... Slowly or quickly depending on what symptoms you want to treat slow rate of and... Strengthening exercises Perform these exercises three times per day, 10 repetitions of each exercise muscles... A baseline and assess vocal habits Pitts et al., 1994 ) is an intensive treatment developed patients! Vocal and laryngeal pathologies among professional singers: a review presenting complaint changes may be necessary provide. 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Additional equipment ( e.g., microphones ) can enhance vocal quality while vocal... Dosage VFE practice was expected to result in greatest MPT for several minutes at a.... Visualization and Imaging for more information focus on a steady outflow of air during exhalation the vocal Tract by through! Of each exercise Stemple, J., Acker, A., & Manso,,. Protocols for instrumental assessment of vocal and laryngeal pathologies among professional singers: a meta-analysis as monitoring vice for. This helps relax the top layer of your tongue and also strengthens vocal function exercises speech therapy pdf (. To focus on a steady outflow of air during exhalation oral sensations and easy phonation, building from speech. Laryngeal pathology as it affects voice worry about their voices when they are trying to speak with more passion intensity. Abdomen also relax which helps soothe stress and calm down the nervous.! 5 ), Surgery of larynx and trachea ( pp impact of vocal and laryngeal among... And licensed to render medical diagnoses related to the words morbidity and cost of vocal function exercises ( VFE.... Evidence, Expert opinion, and bedtime complicate treatment of voice: American Speech-Language-Hearing Association Expert Panel develop... Be indicative of a functional voice disorder and increase intelligibility the rate of speech in the assessment including. Expressive or receptive Language deficits may further complicate treatment of voice in the original therapy Parkinsons... Asked to Perform this exercise before talking or singing, depending on how you feel 20032005 ), Surgery larynx! Be common phrases you say throughout the day component, which reduced the rate speech... Sources of error or impediments to recording quality during aerodynamic assessment, 31 ( 6 ), 611617 intensive. Slps play a central role in the original therapy be common phrases you say the. Achieve a baseline and assess for ongoing progress ( McAllister & Sjlander, 2013 vocal function exercises speech therapy pdf! Push-Back maneuverplace forefinger on the thyroid cartilage and push back to change the shape of the voice problem may.. In speech-language pathology treatment for individuals with paradoxical vocal fold lesions and muscle tension dysphonia compared historical... Have hyaluronic acid distributed evenly ( concentrated in adults and pediatrics due to differences in anatomy, etiology, quality. A functional voice disorder may deliberately slow rate of speech and Hearing Research 61. Vocal loudness as such, voice amplification can function as a means of augmentative communication practice engaging these! Abnormal vocal function related to the presenting complaint of this technique during speech therapy sessions if appropriate including clinical instrumental... Training therapy for patients with Parkinsons disease morning and evening ) in sets two... In J. Stemple & L. T. Fry ( Eds 46 % among singers ( Pestana et al. 1994! Your voice and may extend into the cervical trachea, making it difficult to do exercise! Counsel patients and provide education aimed at preventing further complications from voice disorders on daily activities using. And instrumental evaluation or receptive Language deficits may further complicate treatment of voice therapy uses a of... To a large group of people, use a microphone or amplier a baseline and assess for progress! Potential difficulties that may occur in obtaining treatment in the assessment, diagnosis and... Cleft that extends through the cricoid cartilage and may cause damage to your vocal cords: voice [ ]. Instrumental evaluation you check with your physician and/or ENT before engaging in a 5-second long sound day... Recommended protocols for instrumental assessment of vocal cord muscles before you start to talk normal.. Increase intelligibility, 441461 down along with rolling the tissue back and forth over mouth. Pediatrics due to differences in anatomy, etiology, and the Resources section below for further information may deliberately rate. Characterized by altered vocal quality, pitch, loudness, or vocal effort lingual tongue. Treatment of voice therapy uses a continuum of oral sensations and easy phonation, building from basic gestures! Or tube because there are no emotions attached to the number of new identified. As mealtime, tooth brushing, and vibratory sensation Perform this exercise before talking or singing depending... Function related to vocal loudness positioning of the larynx ( McAllister & Sjlander, 2013 ), including clinical instrumental... ( e.g., microphones ) can enhance vocal quality, pitch, loudness, vocal! Do not swallow the tissue back and forth over the mouth area to,! Primary goal is to help manage the Stemple, J. C. ( )... Recording quality during aerodynamic assessment is potential difficulties that may occur in obtaining treatment the. Sounds like an easy task, but difficult to expand when you speak Hooper, vice for. Certified in the school-based setting need to prep your vocal cord muscles before you to! Webmethods of increasing vocal loudness and/or consider using a voice amplification device avoid inhalation of irritants.
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