There has been a lot of discussion about facemask requirements.
Are they useful? We know, objectively, that they are - Studies have revealed that not only are N95 types masks useful, but so are homemade masks (1,2). Subjectively, we understand this: would you undergo surgery if your surgical team was not wearing face masks?
Are laws mandating the use of masks, when out in public, Constitutionally flawed? Or is a shop owner’s requirement of wearing a mask on private property a violation of a person’s rights? I’m mostly leaving those question to lawyers, but I would guess neither. As a society, we seem to accept the custom to wear "appropriate" clothing. Even here in Hawaii where shoes are much less required than the Mainland, there are standards which reflect a consideration towards others. Private businesses, public buildings, churches, parks, and schools, all have clothing requirements for a reason.
Will the use of face masks injure a person in same way? This point is still widely 'debated' by laymen who are not associated with the medical field. Some claim that they should be excused from wearing a mask due to under lying respiratory conditions. Overall the idea of injury by the mask seems to be the important question as clusters of COVID-19 cases are erupting at gyms and bars in Hawaii. One remarkable interview of a gym owner struck me as troublesome: In describing measures taken to ensure that the disease was not spread, the gentleman mentioned that everyone wears masks except during exercise. That single statement seemed to encapsulated the idea that wearing a mask is potentially harmful.
In comparison, medical professionals, who may include doctors, nurses, as well as, therapists, technicians, medical cleaners, secretaries, and assistants don't debate the safety of face masks. These professionals often perform strenuous tasks for long periods while masked. One often-cited study (3) did find that there is more discomfort as the heart rate increased while wearing an N95 mask, the type worn by these professionals. However the conclusions seemed to emphasize that this was a discomfort issue and NOT a safety issue. I have not found a study that identifies home made face masks as problematic in the same way. In fact, there did not appear to be any reputable research which found the use of face masks dangerous for those with diagnosed respiratory problems. Indeed some medical professionals who customarily wear face masks all day, also have respiratory disorders. With this in mind one doctor on Facebook posted a ‘viral’ post about the non-existence of anyone who died from wearing a mask all day in his 40-year career.
Wearing a mask is uncomfortable to be sure; and some with genuine respiratory problems might need to contact their doctor for guidance if they experience problems wearing a mask, but I wanted to explore what happens when a person wears a mask and exercises, speaks, and sings. I thought it would be ideal to use a person who has a diagnosis of a respiratory condition, so I selected myself as the subject.
The claim, as commonly referenced, states that a 'typical' human would have trouble breathing, and subsequently intake a lower level of oxygen, by wearing a cloth face mask.
Given the above, it would follow that I, a human with moderate to severe asthma, would also have trouble breathing. As such, this lowered oxygen intake would be matched by a lower blood oxygen saturation level either during, or after, exercise. The subject should also experience clinical signs of distress which might include wheezing (whistling sound made while breathing), shortness of breath, chest tightness or pain, or coughing.
Methods & Results
Blood Saturation levels while exercising
Like the mouse in Lara Numeroff’s book, I started with one procedure and it evolved into a series of tasks. The first question was this: As a person who has moderate to severe asthma would I have significantly more difficulty breathing with a facemask while exercising. So, with an assistant and a handy pulse oximeter, I set out to measure the average blood oxygen level as measured by the ingenious tool.
A pulse oximeter uses light to measure the amount of oxygen saturation within the hemoglobin coursing through the arteries. A normal reading showing typical function are 95% and above. The error rate is plus or minus 2%, which means any reading has a likelihood of being within 2% of the true measure (e.g. 95% might actually be 93% or 97%). This 2% margin of error will be important to remember, because all of my findings fell within the margin error.
I also noted my subjective feelings which are important to observe in those with respiratory disorders. Asthmatics are well known for having great oxygen levels, but clinical signs of breathing trouble such as coughing, wheezing, chest pressure or pain, and of course a feeling of shortness of breath. Here is the intro video which shows the equipment and procedure:
Here is the time lapsed video collecting the data:
After compiling the data, we realized we could understand the implications better if we compared my masked performance to an unmasked performance. So, the next week with occasional assistance I did the procedure again.
I did feel more discomfort while wearing a mask, but not by much. In neither exercise sessions, did I feel any clinical signs of an asthma attack. The pulse oximeter measurements found that my blood saturation levels, while masked, averaged 98.6% at rest, and 96.6%, during exercise. During the highest level of exertion (around 20 minutes) the masked reading dipped below the “normal” range of 95%-100% once (93%). During the unmasked exercise session, my blood saturation levels were one percentage higher 97.6%, during exercise and the lowest reading was 96% during the same intense section of exercise. At rest my blood saturation rate was again 98.6%. Similarly to the masked portion of the experiement, I did not experience any symptoms of respiratory distress. With a margin of error of 2%, a 1% difference is probably not reliable and potentially shows no real difference between wearing mask, and not wearing a mask. The low point of blood saturation might be significant as the difference was 3% or outside of the margin of error. However, the limitations of a single case study, means we can't really make a broader generalization, With that in mind, I hope others, will follow the same procedure, or even better designed experiment, in order to be confident of the findings.
Blood saturation levels while singing and speaking
In order to standardize the measurement points, I divided the eponymous Rainbow Passage (4) into relatively even sections (40-50 syllables each). Taking a baseline first, I then recorded myself reciting the Rainbow Passage with the meter on my finger and recorded the number after reading the section. I read the whole passage first without a mask and then with a mask. After averaging I can report that the percentage of oxygen saturation for unmasked was 98.36% and masked was 97.90%. A difference of .46% is again, probably not a meaningful difference.
Interestingly, as if to emphasize the relatively stable oxygen levels in masked and non-masked vocal tasks, my blood saturation levels were higher for masked singing (97.38) when compared to unmasked singing (97.22). Singing with a mask did present a problem in the types of exercises I could perform for my singing task. Rather than using a song, an exercise was used in an attempt to keep the conditions as close to the same as possible. The first choice was a lip trill or lip buzz, which uses a stream of air to blow the lips apart in a light flopping motion forwards. The mask impeded the movement of the lips. An alternate exercise was the use of the of an octave jump followed by a quick run of a descending scale back to the starting note on the syllables ki-u-ki-u.
In a word? No. Masks do not cause oxygen deprivation.
For this singer and vocologist, there was no significant difference in my oxygen levels as measured objectively using the pulse oximeter, either in my performance of exercise or vocal tasks, while wearing a mask compared to not wearing a mask. If you are very uncomfortable wearing a mask while performing exercise or vocal tasks, you might want to consider performing these tasks in a non-public place.
Here in Hawaii, showing aloha to each other is essential no matter the conditions. Of course, if you are short of breath or experiencing any respiratory difficulties you should follow up with a doctor right away. I will be writing a more detailed account. If you are interested send me a line. Thanks for reading this post and I hope it adds to the conversation. Stay safe, and Hawaii Voice and Speech Studio is ready to help you with on-line, or in person to help you with all your voice and speech needs.
 Davies A, Thompson KA, Giri K, Kafatos G, Walker J, Bennett A. Testing the efficacy of homemade masks: would they protect in an influenza pandemic?. Disaster Med Public Health Prep. 2013;7(4):413-418. doi:10.1017/dmp.2013.43
 MacIntyre, C. R., & Chughtai, A. A. (2020). A rapid systematic review of the efficacy of face masks and respirators against coronaviruses and other respiratory transmissible viruses for the community, healthcare workers and sick patients. International journal of nursing studies, 108, 103629. https://doi.org/10.1016/j.ijnurstu.2020.103629
 Li, Y., Tokura, H., Guo, Y. P., Wong, A. S., Wong, T., Chung, J., & Newton, E. (2005). Effects of wearing N95 and surgical facemasks on heart rate, thermal stress and subjective sensations. International archives of occupational and environmental health, 78(6), 501–509. https://doi.org/10.1007/s00420-004-0584-4
During the Thirty Years War, Heinrich Schütz, the 17th Century German composer, wrote in the dedication of Small Sacred Concertos,”….Music has not only gone into a great decline, but in many places has been altogether destroyed by the still continuing course of the war….” . Four Hundred years later, I too, have concerns of the decline of not only music, but poetry, theatre, and any other genre which stands as an homage to the human voice. For practitioners of the vocal arts and professions, the isolation forced by COVID-19 has a grim consequence. However just as within Schütz’s time of challenges, perhaps we may yet reap, with joy, an unexpected treasure.
Are you a new telecommuter and a professional voice user? Raise your hand doctors, teachers, therapists, lawyers, and probably a whole host of others. Now that you are in your own home practicing social distancing how does your voice feel? Are you finding it tiring a little bit as you carry on with your tasks throughout the day? Here is a post for you!
How do we know if a child will “outgrow” a developmental speech problem? The truth is we don’t know. Speech is such a complicated miracle of life which involves the coordination of multiple areas of the brain, multiple mouth and facial muscles, as well as coordination of the respiratory system and the vocal tract. There are simply too many places where the coordination might have a “hiccup.” Other factors that affect “knowing” whether a misarticulation will resolve itself includes the diversity of human beings. There are simply too many variables to neatly determine in a laboratory how a child will perform the multitude of mental, motor, and social tasks necessary to have coherent and easy conversation.
Some of the cues that we have in available to us in assessing a child’s speech development are charts that plot the “typical” development of speech in English speaking children. However, it is important to understand these charts and what they truly mean. Often times, I find that even professionals who work with children, such as pediatricians and early education teachers, misunderstand what these charts mean.
Here in lies an explanation:
The social media universe is abuzz….Freddie Mercury had extra teeth and it contributed to his vibrato…Or Freddie Mercury had extra teeth and it made him use his false vocal folds(aka vestibular folds)to sing… Are any of these suppositions correct?
Let’s get to the bottom of this mystery. I think, after reading all the evidence, we will find that Freddie Mercury’s voice was more than a mere result of an overbite. I think the evidence shows that his achievements as a vocalist rather than a freak of nature were possible because he was a remarkable musician.
The facts as we know them are these:
Could a teacher's voice problem affect student achievement?
The purpose of this blog post is two fold: 1) to advocate for teachers 2) to provide some suggestions to ease their vocal problem. Keep in mind that any vocal problem that lasts more than a week should be evaluated by a medical professional. Voice therapy might provide some help in maintaining a healthy voice and these suggestions in no way are meant to be a substitute for a thorough evaluation by a voice team.
It is not an uncommon occurrence for me to be contacted by teachers. Often this happens after October, or just before spring break. Some of their complaints include the following:
By 9:30 am, I feel like I have so much tension in my neck/throat. I have to work so hard.
By the end of the day, I can’t talk without a lot of effort.
By the end of the day, I’m hoarse!
By lunch time, I’m hoarse and then it gets better during lunch.
By the end of the week, I’m sounding so much deeper.
I can’t sing anymore!
These problems often stem from having to project a voice in a room with less than advantageous acoustics. Eventually a toll is exacted on a teacher in the form of vocal problems which can range from changes in the voice to increased effort when using the voice and even laryngitis. Voice problems are a health hazard that teachers, all across America must deal with every day. Why? In many schools, classrooms are not designed with teacher-student communication in mind. It is a distraction at the least when a teacher cannot speak, has problems speaking, or speaks and cannot be heard. At times, if necessary the teacher might need to stay out of the classroom placing the charge of teaching into the hands of a substitute, who may or may not be a specialist in teaching youngsters. This wastes precious time and money resources in the educational system. Behavioral and Brain Sciences(Vol. 1). (n.d.). doi:10.1177/2372732214548677
Here in Hawaii the problem can be aggravated by schools that are designed to have the windows open. This causes the ambient noise level to rise with the sounds of traffic, students out at recess, lawn mowers, and yes, the ever present feral chickens. When room-cooling systems are available, they are usually fans or window air conditioning units which are selected for economic reasons, and with no consideration of competitive sound levels.
The problem is wide spread, and is being researched by the vocology community around the world. A 2015 article published in The Journal of Voice found that 33% of teachers in New Zealand reported voice problems. What is most interesting in this study is that the authors included the data from studies from as far back as 1993, collected from geographic locations including, North America, South America, Europe, and Australia. Most of the data were gathered by self administered questionnaire, and 4 out of 11 had very similar definitions of vocal problems. All but one had a definition of “voice problem.” Out of these 11 studies the average of reported vocal problems, through out a teacher’s career, ranged from 31 to 63 percent of subjects Journal of Voice (Vol. 29). (Issue 5, pp645,e1-645.e13).
While this information may be overwhelming there are some proactive techniques teachers, or any other speaker, can do to maintain vocal quality. Here are five methods to improve your ability to sustain a healthy voice throughout the day.
The vocal system can be looked at in three parts: respiration, phonation, and resonation. When we place a high demand in on the vocal system it becomes imperative that all three subsystems are used efficiently for peak performance.
What's in a name? Shakesphere once asked. Well today a name of a business not only needs to reflect what that business does and what makes it special; it also needs to be easy to find in social media! with that in mind we are announcing a name streamline. While we will always be the place in Hawaii to find comprehensive language, speech, and voice services, you can now find us on Twitter, Instagram, and soon Facebook as hispeechstudio.
Our list of services still include:
Transgender voice services
The purpose of this blog post is to simply explain in a practical way what resonance is to the voice user and how it can be used to increase the ease and efficiency of singing and speaking.
Titze and Verdolini – Abbot refers to resonance as “reinforcements of natural oscillations” (Vocology The Science and Practice of Voice Habilitation 29).
In physics resonance is a phenomenon in which a vibrating system or external force drives another system to oscillate with greater amplitude at specific frequencies — Wikipedia
Resonance is vibrations that create tone through and within your mouth, throat, and nasal passages — Pamela Phillips, Singing for Dummies
In simplest terms, the voice is constructed of a power source (the lungs), a source (vocal folds also known as vocal cords) and a resonating tube(airways or vocal tract.) Furthermore, every voice vibrates and creates a pitch which is determined largely by the size of the vocal folds (please see blog post “But Size Does Matter.”) That resonating tube has certain characteristics, which influence the sound created; however, by understanding the ABCDs of resonance we can use the information to change to conform to social requirements, or to improve it to ensure greater efficiency, ease, and a reduction of work.
In May of 2001 my family and some friends went to the Big Island for the first time. I think we stayed at Kilauea Military Camp right in the park. While Pele was evident in Volcanoes National Park by the steam vents, you couldn’t see lava. So we took a helicopter ride. From the safety of the air we saw the last three remaining houses of the Royal Gardens neighborhood-which had largely been destroyed in the lava flow of 1990. Other sights included a faint glimmer of lava in the Kilauea caldera and some lava trickling in the ocean.
That trickle had an accompanying white plume of steam. The pilot/guide assured us it was a toxic cloud of basically hydrochloric acid. As we circled around the plume, he added that it was so corrosive that even heavy duty equipment designed for brutal conditions had a very short life span if left in the area for even hours. This was our introduction into what has recently been called laze in the extensive media coverage.
Lately Hawai’i just isn’t getting a break! We have experienced an unusually active rainy season throughout the islands and now, on the Big Island, there is a significant movement of magma which is threatening to open another rift(http://www.civilbeat.org/2018/05/underground-magma-on-the-move-as-quakes-rattle-volcano/). So I’d like to take a little time to discuss the dangers to the voice from these environmental hazards and what you might be able to handle these hazards.
Theoretically Honolulu, gets an average of 270 days of sunshine a year. (https://www.bestplaces.net/climate/city/hawaii/honolulu)However, we seem to have had an abundance of rain, not sunshine, of late. Waipa Kaua’i will likely have the dubious honor of the greatest amount of rain falling in a 24 hour period, ever in recorded history (https://weather.com/news/weather/news/2018-04-26-kauai-hawaii-new-us-rainfall-record). While the rest of the eight main islands did not suffer from quite that much rain, there were flash floods, leaving home owners with as much as three feet of water and mud inside. Some of these houses will likely be declared uninhabitable due to structural damage, but especially with the rainy days still continuing there is another danger—MOLD.
As a tropical island our ambient humidity is between 65-75%. Remember what average means, 50 out of 100 days the humidity will be lower than these numbers, and 50 days out of 100 the humidity will be higher. Mold surrounds us. This isn’t so much a problem when we are outside but the Centers for Disease Control do recognize that “Exposure to mold or dampness may also lead to development of asthma in some individuals.” Which ones you ask? Just like being allergic to poison ivy, nobody really knows, if or when, a non-allergic person will start reacting to it; but we do know that there are high rates of sensitivity to mold. The best cure for sensitivity to mold, is the prevention of exposure.( https://www.cdc.gov/mold/faqs.htm)The preceding link to the CDC has some ideas of prevention and abatement. Interestingly this appears to be for all mold. In the past 15-20 years there has been controversy regarding a link between “black mold,” also known as Stachybotrys chatarum and pulmonary hemorrhage(bleeding in the lungs). However, follow up studies have failed to cporroborate this link. According to the CDC while many molds “can produce toxins…the molds themselves are not toxic, or poisonous.” Regardless, exposure should be limited especially indoors. According to the Mayo clinic (https://www.mayoclinic.org/diseases-conditions/mold-allergy/symptoms-causes/syc-20351519)symptoms of mold exposure include: sneezing, runny nose, cough and postnasal drip, itchy eyes, nose and throat, watery eyes, and dry and scaly skin. If you believe you have been exposed to mold please follow up with a healthcare worker especially if you are experiencing symptoms. If you are attempting to remove mold from a water damaged areas, check with CDC and OSHA for guidelines for protective equipment.(https://www.osha.gov/SLTC/molds/control.html)
Lava is in the news again as our Islands’ current active creator, and destroyer, known as Kilauea Volcano, has been moving a significant amount of magma around. Now magma is molten rock that lives underground. When it breaks surface it is then known as lava. This is a situation that is magnificent and such a temptation to view close up. However, your voice doesn’t want you to. I have previously posted about the dangers of vog, which is a mixture of poisonous gases and particulates(tiny particles) that can cause problems for everyone by irritating the nose and and throat. Vog is created by the exposure of magma to the surface so any increase of lava can mean an increase of vog. While vog can cause problems, especially to those with compromised immune systems or those with a history of allergies, enough vog and lava can create problems for anyone. While the volcanos of Hawai’i are relatively friendly to humans, there have been times of significant explosions which can hurl tiny particles throughout the air. No one is immune to the burning and irritation of a particle of freshly catapulted basaltic glass, known as Pele’s hair, or other debris which might be ejected. Again prevention is key here.
Tours have been shut down, and local people have been urged to leave the area or stay indoors with 14 days’ worth of supplies. Do not attempt to enter any zone that has been classified as off limits, remember, lava can reach temperatures of 2,120 degrees Fahrenheit. Even “cooled” lava is around 700-800 degrees. If you are smelling a scent of rotting eggs, you are inhaling some of the poisonous gases that are emitted by the volcano and lava. Unfortunately, not all the gases have an obvious scent to humans. Asphyxiation is the most common cause of death in a volcanic event. Few if any respirators or masks are designed to withstand temperatures and many of the gases that are present in an eruption. If you or a family member has a breathing problem, run the air conditioner. Please take this seriously. If you have been exposed or near the area and are feeling ill seek the help of a medical professional.
How does all this information pertain to the voice you ask. Well there are the upper respiratory symptoms which often negatively impact the ability to produce a voice clear of a “gurgle.” There is also the fact that your body is your instrument, any injury to the body has either a direct or indirect effect on the voice.
Be safe, enjoy Pele’s show from the comfort of your home. Try this web cam from US Geological Service.
Trissa DiBenedetto WAlter
Is a singer, voice teacher, speech language pathologist, and certified vocologist