Table 5 Strategies to decrease vocal fold damage and discomfort and increase communication efficiency and personal wellbeing

A

Breathe through your nose as the nose optimizes air quality, reduces vocal fold damage, facilitates production of nitric oxide (NO) and maximizes oxygen utilization (Sivasankar & Fisher, 2003).

B

Just before putting on your mask, take five “quality” breaths. With each breath, inhale through the nose for four seconds, exhale through the mouth for six seconds, then rest for two seconds. Repeat these five breaths as soon as you put on the mask, and again after you remove it (McKeowen, 2021)

C

Keep hydrated as much as possible. The vocal folds are very sensitive to dehydration (Titze, 1988; Verdolini, Titze & Druker, 1990; Chang & Karnell 2004; Sivasankar & Leydon, 2010) and respond with cough and mucus production. When feasible, use a straw to avoid removing the mask completely. When using bottle water to drink, always remember to keep them at a safe distance from any risk potential areas, to avoid contamination of the bottle itself. Always remember to be in a safe area, far from potential risk when drinking water.

D

Relax your jaw and open your mouth more when talking to avoid muscle tension that transmits to the vocal folds by way of the neck muscles.

E

Laminate a card with common expressions, allowing the patient to point to the option and/or a card with common procedures that need to be done during the session and that may have not being scheduled.

F

Use gestures, tone of voice, and body position to augment communication.

G

Reserve lengthier communications for the end of the procedure when physical distance is possible and the PPE, such as number of masks worn or the combination masks and shield, can be reduced safely.