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Journal of Voice

Vol. 16, No. 4, pp. 502508

2002 The Voice Foundation

The ChatterVox Portable Voice Amplifier:

A Means to Vibration Dose Reduction?

*Cynthia A. McCormick and Nelson Roy

*Department of Communication Disorders, State University of New York, New Paltz, New York;
Department of Communication Disorders, University of Utah, Salt Lake City, Utah

Summary: By speaking loudly for extended periods, teachers are vulnerable to

laryngeal and voice changes associated with vocal fold vibration overdose.
Voice clinicians frequently recommend voice amplification ostensibly de-
signed to reduce vibration dose and improve voice. However, there are few da-
ta regarding the degree of vocal loudness attenuation achieved by specific am-
plification devices. The purpose of this investigation was to examine the
effectiveness of the ChatterVox Portable Voice Amplification System
(Siemens Hearing Instruments) for reducing the sound pressure level (SPL) of
a speakers voice during a simulated classroom lecture. Ten participants were
instructed to continuously read one of two phonetically balanced passages
while amplified and unamplified. Voice intensity measurements were obtained
at three inches from the mouth (i.e., mouth level) and at the back of a class-
room in both amplified and unamplified conditions. When amplified with the
ChatterVox, speakers experienced an average decrease in vocal intensity at
mouth-level of 6.03 dB SPL (p < 0.002). Furthermore, an average increase of
2.55 dB SPL (p < 0.038) at the back of the classroom was observed. Collec-
tively, these results indicate that the ChatterVox amplification device re-
duced the speakers vocal intensity level at the microphone, while it augment-
ed the voice heard at the back of the classroom. By inference, this degree of
vocal attenuation at mouth level should contribute to a desirable reduction in
vibration dose, thus lowering the risk of vibration overdose. Key Words:
VoiceVibration overdosePortable amplification.

Accepted for publication April 16, 2002. INTRODUCTION

Portions of this manuscript have been presented in an oral It has been estimated that 5% to 10% of the U.S.
format at the American Speech-Language-Hearing Associa- workforce would be classified as heavy occupation-
tions convention held in New Orleans, LA, during November,
al voice users.1 While this workforce includes
Address correspondence and reprint rquests to Cynthia A.
members of the clergy, counselors, telemarketers,
McCormick, Ph.D., State University of New York, Department singers, lawyers, tour guides, and stage actors (to
of Communication DisordersHUM 14, 75 South Manheim mention only a few), this countrys approximately
Blvd., New Paltz, NY 12561-2499, USA. three million elementary and secondary schoolteach-
e-mail: mccormic@newpaltz.edu ers represent the largest group of professionals who


use their voice as a primary tool of trade (U.S. De- levels and thus vibration dose, the degree of tissue in-
partment of Education Statistics, 1999 Projections, jury due to collision and shearing forces should be
Table 32, p. 93). Not surprisingly, voice disorders are lessened, eventually leading to improvement in qual-
a relatively common occupational hazard of teaching ity and reduced vocal recovery times.
school.29 School teachers are more likely to develop Currently, there are numerous voice amplification
voice problems1,10,11 and report higher rates of spe- systems available to teachers that vary considerably
cific voice symptoms, and symptoms of physical dis- in design, quality, and cost. Despite an increase in the
comfort as compared to other occupations. At least selection and popularity of voice amplification in the
one in three teachers complains that teaching has an classroom, there are few studies that have objective-
adverse effect on voice, and many of those teachers ly evaluated the effects of electronic voice amplifica-
are forced to reduce teaching activities as a result.12 tion on reducing the speakers vocal loudness levels,
Twenty percent of teachers surveyed reported miss- and ostensibly vibration dose. Sound-field frequency
ing work because of a voice problem.9 Vocal dys- modulation (FM) systems (with one or more strate-
function interferes with job satisfaction, perfor- gically located speakers), and stationary or portable
mance, and attendance;9,12 therefore, because their personal voice amplifiers are two popular approach-
voices are essential to their occupation, severe voice es to provide voice amplification in the classroom.
problems can cause teachers to leave the profession Costs for such systems vary considerably, and each
system has inherent advantages and disadvantages.
One explanation for the increased frequency of Sound-field FM systems detect the speakers voice
voice disorders within this group of occupational voice using an FM wireless microphone typically situated
users relates to the voice demands of teaching school. within 3 to 4 inches of the speakers mouth. The
Many teachers place a heavy burden on their voice speakers voice is converted into an electrical signal
by speaking loudly for long periods without suffi- and transmitted by an FM carrier frequency to an FM
cient time to rest or recover. Titze14 has suggested receiver. The signal is then amplified, transduced in-
that the time-averaged vocal fold impact (collision) to an acoustic waveform, and transmitted via one or
force (f) is proportional to the vibrational amplitude more loudspeakers to the audience. Sapienza, Cran-
(A) and the vibrational frequency (F0). He postulated dell, and Curtis8 recently examined the effectiveness
that vocal fold tissue injury can occur in a predis- of sound-field FM amplification on reducing the
posed individual, if a critical vibration dose is ex- sound pressure level (SPL) of teachers voices in a
ceeded. Because teachers are individuals who spend simulated classroom situation. Results indicated a
more time vocalizing in a manner that maximizes (1) significant 2.42 dB decrease in SPL levels (as mea-
vocal fold acceleration/deceleration, and (2) shear- sured by a head-mounted microphone 3 inches from
ing/collision forces, they are prone to vibration over- the mouth) for the amplified speaking condition
dose. It is presumed that vibration overdose con- when compared to the unamplified condition. The
tributes to cycles of vocal fold tissue injury and authors concluded that such reductions in SPL could
repair, and subsequent voice mutation. In clinical cir- potentially reduce vocal fold irritation and other un-
cles, the desire to limit or reduce a patients vibration toward effects of extended loud talking.
dose (i.e., vocal load) has been a guiding principle With stationary FM systems, voice amplification
underlying many voice therapy approaches. occurs only in the classroom where the loudspeakers
One specific treatment approach to reduce vibra- are located. However, teachers regularly use their
tion dose is to provide the teacher with an electronic voice in situations other than during classroom in-
voice amplification (VA) system for use in the class- struction, for instance in the hallway, lunchroom,
room. Amplifying the voice is believed to reduce the playground, gymnasium, and during other extracur-
vocal load imposed on the larynx and presumably in- ricular activities. Many of these circumstances de-
sulates the teacher from the demands of extended, mand even greater increases in vocal loudness levels.
loud voice use. To preserve or restore the voice, am- Therefore, portability of amplification is an impor-
plification essentially targets vocal loudness as the tant concern. One such portable device is the Chat-
principal factor to be modified. By reducing loudness terVox Portable Voice Amplification System

Journal of Voice, Vol. 16, No. 4, 2002


(Siemens Hearing Instruments, Prospect Heights, few data regarding the degree of vocal loudness at-
IL). According to one distributor of the ChatterVox tenuation (at the microphone) offered by specific
(Luminaud, Inc., Mentor, OH), this compact (1lb, 2 types of amplification devices. Such information is
oz) waist-pack style amplifier is designed to ele- essential for clinicians to assist those individuals who
vate the vocal output of people with temporary or use their voice as a primary tool of trade, many of
permanent voice impairments. Its objective is to whom will encounter voice difficulties. Therefore,
achieve a speech loudness level that is comfortable the purpose of this investigation was to evaluate the
and effective for everyday communication while re- effects of the ChatterVox portable voice amplifica-
ducing vocal stress and strain. The battery powered tion on reducing vocal loudness levels in a simulated
speaker system is worn around the front of the waist, lecture-type setting.
much like a fanny pack, and is attached to a unidi-
rectional headset microphone. With this type of
speaker-microphone configuration, the manufacturer
claims up to 15 dB nominal gain before feedback. Subjects
Recently Roy et al15 demonstrated that voice am- Ten adult volunteers (7 female, 3 male) between
plification using the ChatterVox can be an effec- the ages of 21 and 50 years, with a mean age of 30.5
tive treatment for teachers with disordered voices. In years (SD = 9.42), were recruited for this study. Par-
their prospective, randomized clinical trial, the inves- ticipants were 8 students and 2 faculty members
tigators used patient-based treatment outcome mea- within the Department of Communication Disorders
sures combined with acoustic analysis to evaluate the at the University of Utah. All participants were native
effectiveness of two treatment programs. Forty-four speakers of American English. No participant report-
voice-disordered teachers were randomly assigned to ed a history of voice or articulation problems, hear-
1 of 3 groups: voice amplification using the Chatter- ing loss, or upper respiratory illness at the time of the
Vox portable amplifier (VA, n =15), vocal hygiene study. In addition, none of the participants had an au-
(VH, n =15), and a nontreatment control group (n dible voice abnormality based on the perceptual
=14). Before and after a six-week treatment phase, judgment of the first author (CAM). Only the two
all teachers completed: (1) the Voice Handicap Index faculty members had any professional speaking ex-
(VHI),16 an instrument designed to appraise the self- perience (Table 1).
perceived psychosocial consequences of voice disor-
ders, (2) a voice severity self-rating scale, and (3) an Recording Environment
audiorecording for later acoustic analysis. Based on All measurements were collected in a classroom lo-
pretreatment and posttreatment comparisons, only the cated at the University of Utah (38 ft 23.5 ft 10
amplification group experienced significant reduc- ft). The uncarpeted classroom contained a desk with
tions on mean VHI scores, voice severity self-ratings, podium, an overhead projector on a portable table,
and the acoustic measures of percent jitter and shim- and nine rows of desks. The room had two windows
mer. Results from a posttreatment questionnaire re- on either side of a blackboard at the front of the room
garding the perceived benefits of treatment revealed and two wooden doors (each encompassing a small
that, when compared to the VH group, the VA group glass window) at the back of the room. Measurements
reported more clarity of their speaking and singing were recorded on four separate days with approxi-
voice, greater ease of voice production, and greater mately 15 to 20 students seated throughout the room.
compliance with the therapy program. The findings This setting is a typical university classroom in which
represented the first objective evidence to support the course lectures are presented to graduate students in
clinical efficacy of voice amplification as a treatment the Department of Communication Disorders.
alternative for teachers with voice problems.
The above findings indicate that both sound rea- Recording Procedures
soning and empirical evidence exist to support the Intensity data were collected with a Larson-Davis
use of voice amplification with normal and voice-dis- (model CAL250) sound level meter (SLM). Mea-
ordered occupational voice users. However, there are surements were recorded in dB sound pressure level

Journal of Voice, Vol. 16, No. 4, 2002

TABLE 1. Individual Data (1-minute Leq) for the Amplified and Unamplified Speaking Conditions
At At At Back of Back of Back of
Mouth Mouth Mouth Room Room Room
Reading Speaking Amplified Unamplified Difference Amplified Unamplified Difference
Participant Age Gender Passage Experience (dB) (dB) (dB) (dB) (dB) (dB)

AF 31 Female Grandfather Student 80.0 84.3 4.3 60.5 56.2 4.3

RT 35 Female Rainbow Student 75.1 90.3 15.2 60.4 64.4 -4.0
BL 21 Female Rainbow Student 82.4 85.3 2.9 62.9 58.4 5.4
RC 34 Female Rainbow Faculty 79.1 81.8 2.7 56.4 57.4 -1.0
LS 24 Female Grandfather Student 80.3 79.6 -0.7 60.8 53.6 7.2
DS 50 Male Rainbow Student 76.6 86.8 10.2 64.3 62.2 2.1
MW 25 Female Grandfather Student 83.1 87.8 4.7 65.5 63.1 2.4
CS 24 Male Rainbow Student 78.4 83.4 5.0 63.8 58.6 5.2
KC 21 Female Grandfather Student 72.9 80.3 7.4 57.1 56.7 0.4
SD 40 Male Grandfather Faculty 78.4 87.0 8.6 64.7 60.3 4.4

Journal of Voice, Vol. 16, No. 4, 2002


(SPL), with the A-weighting filter. The meter re- conditions. Because there were concerns that the am-
sponse was set for automatic averaging on the inte- plified measurement obtained 3 inches from the
grate mode, for a one-minute time period. These mouth (condition 2 described above) would be cont-
recording procedures were chosen because A-weight- aminated by the close proximity of the ChatterVox
ing is based on a smoothed inverse of the 40 phon speaker, specific instructions had to be given to the
curve.17 Thus, low-frequency sound energy is attenu- participants. For this condition, participants were in-
ated, thereby simulating how the human ear hears. structed to begin reading the passage, while adjusting
The Chattervox was securely fastened around their voices accordingly. Once the participants had
each participants waist with the speaker grill facing read several sentences and adjusted the loudness of
outward and forward. The headband of the micro- their voices to project to the back row, the investiga-
phone was placed over the top of the head with the tor turned off the amplifier and began recording 3
microphone offset approximately one inch to the inches from the mouth. Each participant was warned
right side of the mouth. This position was recom- prior to beginning this condition that the amplifier
mended by the manufacturer and helped to eliminate would be turned off during the reading. To ensure
the popping sound heard during high-pressure con- that the Lombard effect was overridden in each par-
sonants (e.g., /p/, /b/, /t/, /d/). ticipant, participants were instructed to mentally note
Equivalent level (Leq) measurements were record- the level of their voices and maintain that level after
ed using the sound level meter in four conditions: (1) the ChatterVox had been turned off. With the am-
3 inches from the speakers mouth8 without amplifi- plifier off and the speaker maintaining that level, the
cation; (2) 3 inches from the speakers mouth with Leq was obtained. If the investigator noticed a per-
amplification; (3) 5 feet from the back center of the ceptible change in the intensity of a participants
classroom without amplification; and (4) 5 feet from voice as the amplifier was turned off, the participant
the back center of the classroom with amplification. was reinstructed prior to measuring.
The order of these conditions was randomized to pre-
vent any order effects. The microphone of the SLM
was handheld in position by the investigator at each
of these locations. Leq measurements were selected Individual Leq measures for the four conditions are
because they are a time-weighted energy average that presented in Table 1. Mean SPL measures for the 10
represents the total sound energy experienced over a participants, for the amplified and unamplified
given period of time, as if the sound were unvarying. speaking conditions at mouth level, were 78.63 and
Conventional use of the Leq concept uses sound mea- 84.66 dBA, respectively. As can be seen, an average
surements taken with the A-weighting scale.17 decrease of 6.03 dB was obtained from this group of
Participants were instructed to stand in the same speakers. A pair-wise t-test indicated that differences
location (front of classroom) and read either My between the amplified and unamplified speaking
Grandfather18 or The Rainbow Passage18 repeat- conditions were statistically significant [t(9) = -4.24,
edly during the one minute of measuring for each of p < 0.002]. Inspection of individual data revealed that
the four conditions. This setup was employed to sim- 9 out of 10 participants lowered their overall SPL
ulate a university lecture-type format, with mature when using the portable amplification device. Of the
students positioned for listening and note-taking. 9 participants who lowered their amplified vocal out-
These readings were selected to ensure that each par- put (as measured at the mouth), 2 exhibited reduc-
ticipant generated a voice sample identical in phone- tions of 2.7 and 2.9 dB, 5 exhibited reductions be-
mic content during the 1-minute integrating process. tween 4.3 and 8.6 dB, and 2 exhibited reductions of
For each condition, participants were instructed to 10.2 and 15.2 dB.
adjust the volume of their voice so that they could be Mean SPL measures for the 10 participants, for the
heard from the last row of the classroom (i.e., they amplified and unamplified speaking conditions at the
were to project their voices, amplified and unampli- rear of the classroom, were 61.64 and 59.09 dBA, re-
fied, to the back of the room). The volume control on spectively. Therefore, an average decrease of 2.55 dB
the amplifier was set to the 11 oclock position for all was obtained, which a pair-wise t-test revealed to be

Journal of Voice, Vol. 16, No. 4, 2002


significantly different [t(9) = 2.42, p < 0.038]. In- text of minimal training on the device. Indeed, the
spection of the data for individual subjects when am- participants were fit with the device and then asked to
plified indicated that the voice signal detected at the perform the task. There were no lengthy practice ses-
back of the classroom was louder in 8 of 10 partici- sions and no involved learning period. It appeared
pants, as compared to the unamplified condition. For then, that the subjects were capable of making neces-
those 8 participants, differences between the ampli- sary adjustments to their vocal loudness levels with-
fied and unamplified Leq measurements ranged from out extensive training or orientation to the device.
0.4 to 7.2 dB. These results are also compatible with the findings
of Sapienza, Crandell, and Curtis8 findings for a sta-
DISCUSSION tionary sound-field FM device. However, the
portable system used here produced an average de-
The purpose of this investigation was to evaluate crease of 6.03 dB, while the stationary sound-field
the effects of the ChatterVox Portable Voice Am- FM system produced an average decrease of 2.42 dB.
plification System on reducing vocal loudness levels At first glance, it appears that the portable amplifier
(at the mouth) in a simulated lecture-type setting. Re- provided superior performance to the stationary am-
sults indicated that the group of 10 nonvoice-disor- plification device, with the portable device producing
dered study participants who employed the Chatter- 3.61 dB more attenuation of vocal output. However,
Vox produced a mean decrease of 6.03 dB in vocal direct comparison of the two systems/studies is re-
intensity at mouth level and a mean increase of 2.55 stricted, because of the significant differences in ex-
dB at the back of the classroom. Collectively, these perimental design and methodology (i.e., use of non-
results indicate that the ChatterVox amplification teachers, university classroom, different speaking
device reduced the speakers vocal intensity level at tasks, microphone placement, negligible background
the microphone, while it augmented the voice heard noise, and so on). Differences in design and method-
at the back of the classroom. Roy et al15 recently con- ology notwithstanding, certain features of the
firmed the clinical effectiveness of the ChatterVox portable amplification device do appear to be more
with a cohort of voice-disordered elementary and desirable than some stationary devices. With FM sys-
secondary schoolteachers. After six weeks of using tems, voice amplification occurs only in the class-
the amplifier, the teachers reported significant reduc- room where the loudspeakers are located. However,
tions in their level of vocal handicap and dysphonia teachers regularly use their voice in situations other
severity. Significant reductions on acoustic measures than during classroom instruction, for instance in the
of phonatory instability following the amplifier use hallway, lunchroom, schoolyard, gymnasium, and
during other extracurricular activities. Many of these
confirmed these self-report data. Over a typical 6
circumstances demand even greater increases in
hour working day, total phonation time for a teacher
loudness levels. Therefore, portability of the Chatter-
is on the order of 2 hours.19 If one assumes that the
Vox seems to represent an important advantage
voice-disordered teachers in the Roy et al15 clinical
over stationary amplification devices. If a teachers
trial experienced similar levels of attenuation in vo- vibration dose can be reduced during the entire work-
cal loudness levels, then such a 6-dB reduction in day, not just during course instruction, this reduction
voice SPL levels would contribute to a sizable reduc- could mean the difference between a healthy voice
tion in vibration dose over the course of a speaking and a disordered voice.
day. This may partly account for the benefits report- A second potential advantage relates to the cost of
ed by those teachers. By inference, this degree of vo- the ChatterVox as compared to other FM systems.
cal SPL attenuation at mouth level should contribute The cost of the ChatterVox presently ranges from
to a desirable reduction in vibration dose, thus low- approximately $150.00 to $280.00 (depending on the
ering the occurrence of vibration overdose. distributor). However, based on an informal survey,
The results of this investigation suggest that a FM systems such as the one described by Sapienza et
portable amplification device can effectively reduce al8 are on average much more costly. Therefore, fur-
an individuals overall intensity of vocal output. Fur- ther research is needed to directly compare the per-
thermore, the effects were observed within the con- formance of specific amplification devices within the

Journal of Voice, Vol. 16, No. 4, 2002


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Journal of Voice, Vol. 16, No. 4, 2002