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
format at the American Speech-Language-Hearing Associa-
tions convention held in New Orleans, LA, during November,
2001.
Address correspondence and reprint rquests to Cynthia A.
McCormick, Ph.D., State University of New York, Department
of Communication DisordersHUM 14, 75 South Manheim
Blvd., New Paltz, NY 12561-2499, USA.
e-mail: mccormic@newpaltz.edu
It has been estimated that 5% to 10% of the U.S.
workforce would be classified as heavy occupation-
al voice users.1 While this workforce includes
members of the clergy, counselors, telemarketers,
singers, lawyers, tour guides, and stage actors (to
mention only a few), this countrys approximately
three million elementary and secondary schoolteach-
ers represent the largest group of professionals who

502
 THE CHATTERVOX PORTABLE VOICE AMPLIFIER
use their voice as a primary tool of trade (U.S. De-
partment of Education Statistics, 1999 Projections,
Table 32, p. 93). Not surprisingly, voice disorders are
a relatively common occupational hazard of teaching
school.29 School teachers are more likely to develop
voice problems1,10,11 and report higher rates of spe-
cific voice symptoms, and symptoms of physical dis-
comfort as compared to other occupations. At least
one in three teachers complains that teaching has an
adverse effect on voice, and many of those teachers
are forced to reduce teaching activities as a result.12
Twenty percent of teachers surveyed reported miss-
ing work because of a voice problem.9 Vocal dys-
function interferes with job satisfaction, perfor-
mance, and attendance;9,12 therefore, because their
voices are essential to their occupation, severe voice
problems can cause teachers to leave the profession
permanently.13
One explanation for the increased frequency of
voice disorders within this group of occupational voice
users relates to the voice demands of teaching school.
Many teachers place a heavy burden on their voice
by speaking loudly for long periods without suffi-
cient time to rest or recover. Titze14 has suggested
that the time-averaged vocal fold impact (collision)
force (f) is proportional to the vibrational amplitude
(A) and the vibrational frequency (F0). He postulated
that vocal fold tissue injury can occur in a predis-
posed individual, if a critical vibration dose is ex-
ceeded. Because teachers are individuals who spend
more time vocalizing in a manner that maximizes (1)
vocal fold acceleration/deceleration, and (2) shear-
ing/collision forces, they are prone to vibration over-
dose. It is presumed that vibration overdose con-
tributes to cycles of vocal fold tissue injury and
repair, and subsequent voice mutation. In clinical cir-
cles, the desire to limit or reduce a patients vibration
dose (i.e., vocal load) has been a guiding principle
underlying many voice therapy approaches.
One specific treatment approach to reduce vibra-
tion dose is to provide the teacher with an electronic
voice amplification (VA) system for use in the class-
room. Amplifying the voice is believed to reduce the
vocal load imposed on the larynx and presumably in-
sulates the teacher from the demands of extended,
loud voice use. To preserve or restore the voice, am-
plification essentially targets vocal loudness as the
principal factor to be modified. By reducing loudness
503
levels and thus vibration dose, the degree of tissue in-
jury due to collision and shearing forces should be
lessened, eventually leading to improvement in qual-
ity and reduced vocal recovery times.
Currently, there are numerous voice amplification
systems available to teachers that vary considerably
in design, quality, and cost. Despite an increase in the
selection and popularity of voice amplification in the
classroom, there are few studies that have objective-
ly evaluated the effects of electronic voice amplifica-
tion on reducing the speakers vocal loudness levels,
and ostensibly vibration dose. Sound-field frequency
modulation (FM) systems (with one or more strate-
gically located speakers), and stationary or portable
personal voice amplifiers are two popular approach-
es to provide voice amplification in the classroom.
Costs for such systems vary considerably, and each
system has inherent advantages and disadvantages.
Sound-field FM systems detect the speakers voice
using an FM wireless microphone typically situated
within 3 to 4 inches of the speakers mouth. The
speakers voice is converted into an electrical signal
and transmitted by an FM carrier frequency to an FM
receiver. The signal is then amplified, transduced in-
to an acoustic waveform, and transmitted via one or
more loudspeakers to the audience. Sapienza, Cran-
dell, and Curtis8 recently examined the effectiveness
of sound-field FM amplification on reducing the
sound pressure level (SPL) of teachers voices in a
simulated classroom situation. Results indicated a
significant 2.42 dB decrease in SPL levels (as mea-
sured by a head-mounted microphone 3 inches from
the mouth) for the amplified speaking condition
when compared to the unamplified condition. The
authors concluded that such reductions in SPL could
potentially reduce vocal fold irritation and other un-
toward effects of extended loud talking.
With stationary FM systems, voice amplification
occurs only in the classroom where the loudspeakers
are located. However, teachers regularly use their
voice in situations other than during classroom in-
struction, for instance in the hallway, lunchroom,
playground, gymnasium, and during other extracur-
ricular activities. Many of these circumstances de-
mand even greater increases in vocal loudness levels.
Therefore, portability of amplification is an impor-
tant concern. One such portable device is the Chat-
terVox Portable Voice Amplification System
Journal of Voice, Vol. 16, No. 4, 2002
504 CYNTHIA A. MCCORMICK AND NELSON ROY
(Siemens Hearing Instruments, Prospect Heights,
IL). According to one distributor of the ChatterVox
(Luminaud, Inc., Mentor, OH), this compact (1lb, 2
oz) waist-pack style amplifier is designed to ele-
vate the vocal output of people with temporary or
permanent voice impairments. Its objective is to
achieve a speech loudness level that is comfortable
and effective for everyday communication while re-
ducing vocal stress and strain. The battery powered
speaker system is worn around the front of the waist,
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.
Recently Roy et al15 demonstrated that voice am-
plification using the ChatterVox can be an effec-
tive treatment for teachers with disordered voices. In
their prospective, randomized clinical trial, the inves-
tigators used patient-based treatment outcome mea-
sures combined with acoustic analysis to evaluate the
effectiveness of two treatment programs. Forty-four
voice-disordered teachers were randomly assigned to
1 of 3 groups: voice amplification using the Chatter-
Vox portable amplifier (VA, n =15), vocal hygiene
(VH, n =15), and a nontreatment control group (n
=14). Before and after a six-week treatment phase,
all teachers completed: (1) the Voice Handicap Index
(VHI),16 an instrument designed to appraise the self-
perceived psychosocial consequences of voice disor-
ders, (2) a voice severity self-rating scale, and (3) an
audiorecording for later acoustic analysis. Based on
pretreatment and posttreatment comparisons, only the
amplification group experienced significant reduc-
tions on mean VHI scores, voice severity self-ratings,
and the acoustic measures of percent jitter and shim-
mer. Results from a posttreatment questionnaire re-
garding the perceived benefits of treatment revealed
that, when compared to the VH group, the VA group
reported more clarity of their speaking and singing
voice, greater ease of voice production, and greater
compliance with the therapy program. The findings
represented the first objective evidence to support the
clinical efficacy of voice amplification as a treatment
alternative for teachers with voice problems.
The above findings indicate that both sound rea-
soning and empirical evidence exist to support the
use of voice amplification with normal and voice-dis-
ordered occupational voice users. However, there are
Journal of Voice, Vol. 16, No. 4, 2002
few data regarding the degree of vocal loudness at-
tenuation (at the microphone) offered by specific
types of amplification devices. Such information is
essential for clinicians to assist those individuals who
use their voice as a primary tool of trade, many of
whom will encounter voice difficulties. Therefore,
the purpose of this investigation was to evaluate the
effects of the ChatterVox portable voice amplifica-
tion on reducing vocal loudness levels in a simulated
lecture-type setting.
METHODS
Subjects
Ten adult volunteers (7 female, 3 male) between
the ages of 21 and 50 years, with a mean age of 30.5
years (SD = 9.42), were recruited for this study. Par-
ticipants were 8 students and 2 faculty members
within the Department of Communication Disorders
at the University of Utah. All participants were native
speakers of American English. No participant report-
ed a history of voice or articulation problems, hear-
ing loss, or upper respiratory illness at the time of the
study. In addition, none of the participants had an au-
dible voice abnormality based on the perceptual
judgment of the first author (CAM). Only the two
faculty members had any professional speaking ex-
perience (Table 1).
Recording Environment
All measurements were collected in a classroom lo-
cated at the University of Utah (38 ft 23.5 ft 10
ft). The uncarpeted classroom contained a desk with
podium, an overhead projector on a portable table,
and nine rows of desks. The room had two windows
on either side of a blackboard at the front of the room
and two wooden doors (each encompassing a small
glass window) at the back of the room. Measurements
were recorded on four separate days with approxi-
mately 15 to 20 students seated throughout the room.
This setting is a typical university classroom in which
course lectures are presented to graduate students in
the Department of Communication Disorders.
Recording Procedures
Intensity data were collected with a Larson-Davis
(model CAL250) sound level meter (SLM). Mea-
surements were recorded in dB sound pressure level
 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
THE CHATTERVOX PORTABLE VOICE AMPLIFIER
505

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

506 CYNTHIA A. MCCORMICK AND NELSON ROY
(SPL), with the A-weighting filter. The meter re-
sponse was set for automatic averaging on the inte-
grate mode, for a one-minute time period. These
recording procedures were chosen because A-weight-
ing is based on a smoothed inverse of the 40 phon
curve.17 Thus, low-frequency sound energy is attenu-
ated, thereby simulating how the human ear hears.
The Chattervox was securely fastened around
each participants waist with the speaker grill facing
outward and forward. The headband of the micro-
phone was placed over the top of the head with the
microphone offset approximately one inch to the
right side of the mouth. This position was recom-
mended by the manufacturer and helped to eliminate
the popping sound heard during high-pressure con-
sonants (e.g., /p/, /b/, /t/, /d/).
Equivalent level (Leq) measurements were record-
ed using the sound level meter in four conditions: (1)
3 inches from the speakers mouth8 without amplifi-
cation; (2) 3 inches from the speakers mouth with
amplification; (3) 5 feet from the back center of the
classroom without amplification; and (4) 5 feet from
the back center of the classroom with amplification.
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
because they are a time-weighted energy average that
represents the total sound energy experienced over a
given period of time, as if the sound were unvarying.
Conventional use of the Leq concept uses sound mea-
surements taken with the A-weighting scale.17
Participants were instructed to stand in the same
location (front of classroom) and read either My
Grandfather18 or The Rainbow Passage18 repeat-
edly during the one minute of measuring for each of
the four conditions. This setup was employed to sim-
ulate a university lecture-type format, with mature
students positioned for listening and note-taking.
These readings were selected to ensure that each par-
ticipant generated a voice sample identical in phone-
mic content during the 1-minute integrating process.
For each condition, participants were instructed to
adjust the volume of their voice so that they could be
heard from the last row of the classroom (i.e., they
were to project their voices, amplified and unampli-
fied, to the back of the room). The volume control on
the amplifier was set to the 11 oclock position for all
Journal of Voice, Vol. 16, No. 4, 2002
conditions. Because there were concerns that the am-
plified measurement obtained 3 inches from the
mouth (condition 2 described above) would be cont-
aminated by the close proximity of the ChatterVox
speaker, specific instructions had to be given to the
participants. For this condition, participants were in-
structed to begin reading the passage, while adjusting
their voices accordingly. Once the participants had
read several sentences and adjusted the loudness of
their voices to project to the back row, the investiga-
tor turned off the amplifier and began recording 3
inches from the mouth. Each participant was warned
prior to beginning this condition that the amplifier
would be turned off during the reading. To ensure
that the Lombard effect was overridden in each par-
ticipant, participants were instructed to mentally note
the level of their voices and maintain that level after
the ChatterVox had been turned off. With the am-
plifier off and the speaker maintaining that level, the
Leq was obtained. If the investigator noticed a per-
ceptible change in the intensity of a participants
voice as the amplifier was turned off, the participant
was reinstructed prior to measuring.
RESULTS
Individual Leq measures for the four conditions are
presented in Table 1. Mean SPL measures for the 10
participants, for the amplified and unamplified
speaking conditions at mouth level, were 78.63 and
84.66 dBA, respectively. As can be seen, an average
decrease of 6.03 dB was obtained from this group of
speakers. A pair-wise t-test indicated that differences
between the amplified and unamplified speaking
conditions were statistically significant [t(9) = -4.24,
p < 0.002]. Inspection of individual data revealed that
9 out of 10 participants lowered their overall SPL
when using the portable amplification device. Of the
9 participants who lowered their amplified vocal out-
put (as measured at the mouth), 2 exhibited reduc-
tions of 2.7 and 2.9 dB, 5 exhibited reductions be-
tween 4.3 and 8.6 dB, and 2 exhibited reductions of
10.2 and 15.2 dB.
Mean SPL measures for the 10 participants, for the
amplified and unamplified speaking conditions at the
rear of the classroom, were 61.64 and 59.09 dBA, re-
spectively. Therefore, an average decrease of 2.55 dB
was obtained, which a pair-wise t-test revealed to be
 THE CHATTERVOX PORTABLE VOICE AMPLIFIER
significantly different [t(9) = 2.42, p < 0.038]. In-
spection of the data for individual subjects when am-
plified indicated that the voice signal detected at the
back of the classroom was louder in 8 of 10 partici-
pants, as compared to the unamplified condition. For
those 8 participants, differences between the ampli-
fied and unamplified Leq measurements ranged from
0.4 to 7.2 dB.
DISCUSSION
The purpose of this investigation was to evaluate
the effects of the ChatterVox Portable Voice Am-
plification System on reducing vocal loudness levels
(at the mouth) in a simulated lecture-type setting. Re-
sults indicated that the group of 10 nonvoice-disor-
dered study participants who employed the Chatter-
Vox produced a mean decrease of 6.03 dB in vocal
intensity at mouth level and a mean increase of 2.55
dB at the back of the classroom. Collectively, these
results indicate that the ChatterVox amplification
device reduced the speakers vocal intensity level at
the microphone, while it augmented the voice heard
at the back of the classroom. Roy et al15 recently con-
firmed the clinical effectiveness of the ChatterVox
with a cohort of voice-disordered elementary and
secondary schoolteachers. After six weeks of using
the amplifier, the teachers reported significant reduc-
tions in their level of vocal handicap and dysphonia
severity. Significant reductions on acoustic measures
of phonatory instability following the amplifier use
confirmed these self-report data. Over a typical 6
hour working day, total phonation time for a teacher
is on the order of 2 hours.19 If one assumes that the
voice-disordered teachers in the Roy et al15 clinical
trial experienced similar levels of attenuation in vo-
cal loudness levels, then such a 6-dB reduction in
voice SPL levels would contribute to a sizable reduc-
tion in vibration dose over the course of a speaking
day. This may partly account for the benefits report-
ed by those teachers. By inference, this degree of vo-
cal SPL attenuation at mouth level should contribute
to a desirable reduction in vibration dose, thus low-
ering the occurrence of vibration overdose.
The results of this investigation suggest that a
portable amplification device can effectively reduce
an individuals overall intensity of vocal output. Fur-
thermore, the effects were observed within the con-
507
text of minimal training on the device. Indeed, the
participants were fit with the device and then asked to
perform the task. There were no lengthy practice ses-
sions and no involved learning period. It appeared
then, that the subjects were capable of making neces-
sary adjustments to their vocal loudness levels with-
out extensive training or orientation to the device.
These results are also compatible with the findings
of Sapienza, Crandell, and Curtis8 findings for a sta-
tionary sound-field FM device. However, the
portable system used here produced an average de-
crease of 6.03 dB, while the stationary sound-field
FM system produced an average decrease of 2.42 dB.
At first glance, it appears that the portable amplifier
provided superior performance to the stationary am-
plification device, with the portable device producing
3.61 dB more attenuation of vocal output. However,
direct comparison of the two systems/studies is re-
stricted, because of the significant differences in ex-
perimental design and methodology (i.e., use of non-
teachers, university classroom, different speaking
tasks, microphone placement, negligible background
noise, and so on). Differences in design and method-
ology notwithstanding, certain features of the
portable amplification device do appear to be more
desirable than some stationary devices. With FM sys-
tems, voice amplification occurs only in the class-
room where the loudspeakers are located. However,
teachers regularly use their voice in situations other
than during classroom instruction, for instance in the
hallway, lunchroom, schoolyard, gymnasium, and
during other extracurricular activities. Many of these
circumstances demand even greater increases in
loudness levels. Therefore, portability of the Chatter-
Vox seems to represent an important advantage
over stationary amplification devices. If a teachers
vibration dose can be reduced during the entire work-
day, not just during course instruction, this reduction
could mean the difference between a healthy voice
and a disordered voice.
A second potential advantage relates to the cost of
the ChatterVox as compared to other FM systems.
The cost of the ChatterVox presently ranges from
approximately $150.00 to $280.00 (depending on the
distributor). However, based on an informal survey,
FM systems such as the one described by Sapienza et
al8 are on average much more costly. Therefore, fur-
ther research is needed to directly compare the per-
formance of specific amplification devices within the
Journal of Voice, Vol. 16, No. 4, 2002
508 CYNTHIA A. MCCORMICK AND NELSON ROY
contexts of cost, portability, and intelligibility of the
amplified output, to mention only a few.
Before one is completely comfortable with these re-
sults, several limitations of this study need to be ac-
knowledged that may restrict the ability to generalize
these findings. First, 8 of 10 participants were not
teachers, therefore, not experienced lecturers. Wheth-
er the results would vary depending upon lecture or
teaching experience is unknown. Second, the materi-
al spoken by each participant was read from a pho-
netically balanced passage, which is not typically the
case in an actual lecture. Third, the classroom setting
for this study simulated a college classroom, not an
elementary or secondary school classroom. The am-
bient noise levels, reverberant conditions, as well as
signal-to-noise ratios, of this type of university class-
room would likely be different from the conditions in
elementary and secondary classrooms. Therefore,
such differences affect the ability to generalize the re-
sults obtained from these speakers and this experi-
mental environment to teachers in other classroom
settings. Future studies need to directly compare the
performance of specific amplification devices (i.e.,
the degree of vocal loudness attenuation and ostensi-
bly vibration dose reduction) within a variety of set-
tings. Such comparative information will be extreme-
ly valuable to the large portion of the U.S. workforce
who rely on their voice as a primary tool of trade, and
the voice clinicians who prescribe voice amplification
devices to moderate the risk of vibration overdose.
Acknowledgments: We would like to thank the following
people for their assistance with this project: Ron Bernau
with Larson-Davis, Samuel Burchfield, Glenda ONeal,
Jayne Fritz, and Robert Wojciak.
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