- First, reduce your vocal dose by incorporating short periods of complete silence, or vocal naps, throughout the day—about 15 minutes should suffice.
- Second, stay well hydrated. Research suggests that dehydration can negatively affect the sound and feel of your voice due to changes in the biomechanical properties of the vocal folds, causing them to vibrate less efficiently (J Voice. 2019;33:125.e13-125.e28; J Voice. 2010;24:637-643).
- Third, warm up with gentle humming or lip trills to prepare your voice for a day of increased vocal demands.
- Finally, pay attention to how loudly you speak during virtual communications. Improve your setup with technology that allows you to more accurately perceive your own loudness.
Auditory Health
Our auditory system is also at risk when we engage in telemedicine. Long-term headphone use at hazardous levels is associated with hearing loss derived from the intensity of the auditory signal and the period of time your auditory system is exposed (Ann Otol Rhinol Laryngol. 2018;127:703-709; J UOEH. 1986;8 Suppl:151-161). Distance also plays a role, as Robert Hooke’s inverse square law indicates that doubling the distance from a sound source will reduce sound pressure level by 6 decibels. It’s important to monitor the output levels given the proximity of the sound source to the ear while wearing headphones. Even when exposed to moderate sounds over an extended time period, individuals can experience temporary threshold shifts, tinnitus, and sensorineural hearing loss (Noise Health. 2012;14:274-280).
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January 2021The goal should be to send the cleanest signal possible so that our patients can take away the maximum amount of information during appointments.
Technology Considerations
The quality of the tools we use impacts how well we can communicate. Consider the communication tools that come standard with your laptop: A thin, pinhole microphone placed next to a camera and miniature speakers designed to fit in a compartment next to the thousands of components that enable the computer to operate. While these tools are fine for intermittent communication, they may not be helpful for long-term use.
Speakers/Earphones. Laptop speaker portability comes with restrictions. Internal speakers are often placed too close to the screen, resulting in reverberating sound waves. These waves can cause unwanted effects, increasing distortion and decreasing clarity. Furthermore, the speaker’s miniature scale prevents a full sound, with low frequencies underperforming. To correct for this, we tend to max out the volume to overcome environmental noise, resulting in scratchy or distorted output.
Headphones can help mitigate unwanted echoes and send a signal straight to your ears, but not all headphones are created equal. Earbuds, for example, fit more loosely compared to better-encased insert headphones or over-the-head headphones, and young adults using earbuds tend to listen to them at a louder volume compared to other headphone types (J Am Acad Audiol. 2017;28:295-313). Open access allows for more competing noise, and that prompts listeners to increase the audio source volume.
Circumaural headphones encompass the ear and are preferable for videoconferencing due to the richer frequency response offered. They also prevent the need to increase the volume beyond a reasonable level.
Microphones. Many clarity issues stem from inadequate microphone capability. A laptop’s small microphone is sensitive to environmental noise, which can mask important speech information. It’s also stationary and not sensitive to changing head positions during an appointment.