You and Your Voice


Are you a professional voice user?

At the Lions Voice Clinic, anyone who needs their voice in order to carry out their job is considered a professional voice user. Professional voice users are often also considered "athletic" voice users because their voice use is more extensive and strenuous than that of nonprofessional voice users.

Professional voice users include:

  • singers
  • actors
  • teachers
  • clergy
  • salespersons
  • coaches
  • broadcasters
  • auctioneers
  • cheerleaders
  • choreographers
  • many others

At the Lions Voice Clinic, persons who use their voices like professional voice users, but in an avocational setting, are also considered professional voice users. Therefore, an individual who derives great personal satisfaction from singing in a church choir is treated with the same care as an elite professional singer, because the emotional effects of having problems with singing can be equally as devastating for the avocational voice user.

While we’re well situated to care for the most elite of performers, we have equal regard for all voice users.

Especially for the professional voice user, voice quality can be linked to self-esteem. We recognize that voice disorders can sometimes provoke extreme anxiety for an individual, especially if one's livelihood also depends on voice quality. We ensure sensitivity to the emotional, financial, and interpersonal needs of all our patients.

We are singers. We understand you


How can you keep your voice at its best?

The goal of voice treatment at the Lions Voice Clinic is to ensure that the individual can do everything with his or her voice that he or she desires, with the desired quality. Often, because a pattern of less-than-optimal voice use has created the problem in the first place, the professional voice user is better off after therapy than before the problem was first noticed.  An important component of optimal voice use is good vocal hygeine.

Vocal Hygeine: The use and care of the human voice required to keep it healthy and functioning optimally.

Though most people can get through life without ever thinking about vocal hygiene, individuals who put extra strain on their voices must keep their vocal mechanism in better condition. This can be especially true if an injury has occurred, even if the individual previously had no extraordinary voice needs.

Components of Vocal Hygiene:


The Vocal Mechanism - Quick Review

The voice is produced at the larynx (voicebox), a framework of cartilage that houses the vocal folds.  Each vocal fold is composed of a muscle, covered by a sheath of pliable, moist mucosal covering (mucosa).  The larynx has others muscles that make the vocal folds move. This is the long version of how it works.


Maintain the vitality of the vocal fold mucosa

The analogy of the vocal athlete is appropriate: physical athletes have to think about their muscles and joints; vocal athletes have to think about their muscles too. However, they have to think even more about their mucosa.

Hydration is the most important concept.

The mucosal covering of the vocal folds must be wet and slippery in order to vibrate optimally. There are two kinds of hydration to maintain: 1) systemic hydration, i.e., the internal hydration of the entire body that keeps the skin, eyes, and all other mucosal tissue healthy; and 2) topical, or surface hydration, i.e., the moisture level that keeps the epithelial surface of the vocal folds slippery enough to vibrate up to 1700 times per second!

Systemic Hydration

Definition: the internal hydration of the entire body that keeps the skin, eyes, and all other mucosal tissue healthy

Systemic Hydration comes from the fluid we consume, both what we drink and what we eat.

How much is enough?

The conventional advice used to be: Consume 64 ounces of water every day.  In other words, 8 glasses a day of water.  New research and more careful consideration of this gives more appropriate advice: consume enough fluids so that you are never thirsty or dry feeling, and your urine is clear, or very nearly clear.


Pee pale!
Wiz white!
You get the idea...

Luckily, water is anything that isn't caffeinated or alcoholic. If you drink caffeinated or alcoholic beverages, it may be wise to increase your water to compensate. Obviously, there may be health risks with consuming too much caffeine or alcohol, but in moderate amounts they are not damaging per se. Rather, it is the dehydrating effects that can be damaging to vocal health.

Milk and sugared products should not be considered water if they create thickened secretions (make you feel phlegmy) and cause throat-clearing.  Some scientists believe that sugared products aren’t as hydrating, because it’s more difficult for the body to use the water in the product.

Carbonated beverages may increase reflux in some individuals, in which case even non-caffeinated pop or sparkling waters should be used with care (e.g., avoid late at night).

Drink more if your physical demands require more, such as athletic endeavors on hot days or prolonged singing. But be reasonable. Too much water can be unhealthy, and too much in too short a time will not help you. A well-hydrated lifestyle will ensure much better vocal health than drinking a gallon of water just before a performance.

Myth: Water must be room temperature, not too hot and not too cold.  Cold water will make your laryngeal muscles tight.

Fact: Your larynx doesn’t care.  The fluid races down the esophagus, in back of the larynx, and never touches those muscles.  By the time the H2O gets back to the cells of the larynx, it’s 98.6 degrees.

However, if cold beverages make you FEEL cold, and that makes your muscles more tense, then don’t drink cold beverages.  If you like the feeling of hot beverages, that’s fine.  (We bet you won’t burn yourself too often!)  Drink the temperature that makes you happy.

Here are two hints for ensuring that you're well hydrated:

1. Your urine should be clear or very pale. Certain medications and vitamins will cause a yellow tint to urine. Urine may be more concentrated and darker first thing in the morning. Other than that, your urine should be very pale and lacking in odor.

2. You should never have a desire to clear your throat. If you constantly feel "phlegmy", it may be because your secretions are thickened due to dehydration. Thickened secretions make it harder for vocal folds to vibrate. Throat-clearing is very abusive to vocal folds. Get more water.


Topical (surface) Hydration

Definition: the moisture level that keeps the epithelial surface of the vocal folds slippery enough to vibrate

  • Keep your salivary glands stimulated.
    • Sip on liquids all day long.
    • Chew gum, suck on hard candies.
    • Don't bother with cough drops that have "vapor action" - they're rather drying.
    • Beware of medicated cough drops with anesthetic effects that keep you from feeling the pain that tells you when to stop talking or singing. Anesthetics that help you sleep may be helpful, but anesthetics that let you talk through your pain may increase your disorder.
  • Keep your environment humid. This can be very difficult in some climates. If your environment is dry, steam can help. Personal steamers are available in drugstores, though you can get the same effect from standing over a pot of simmering water or holding a hot, wet washcloth over your mouth and nose for a few minutes. o:p>
  • Keep swallowing to slough off the accumulated secretions. Don't clear your throat!
Clearing your throat is like scratching a mosquito bite.  Don’t do it!

Maintain a nice environment for your vocal folds.

Try to eliminate sources of irritation. The two most important are reflux and sinus drainage (post nasal drip). Allergies can be a problem as well.

If you suffer from reflux, you may need medical intervention to manage it, though dietary precautions and over-the-counter medications may suffice (see LPRD in our section on Related Problems). (LPRD will be a hover-and-click box)

Often, sinus drainage may be managed with environmental humidity, avoidance of allergens and irritants, and with saline nasal irrigation. Simple over-the-counter saline nasal sprays can be very helpful. However, sinus drainage may be chronic or serious enough to warrant medical intervention. Be careful of over-the-counter antihistamines which can be very dehydrating. Antihistamine nasal sprays can cause rebound congestion as well as being dehydrating. Some of the newer prescription decongestants may be less drying. Discuss it with an otolaryngologist (Ear, Nose, Throat doctor) and let him or her know you're concerned about the hydration of your vocal fold mucosa.  The prescription steroid nasal sprays can be very helpful for some individuals with extensive nasal drainage.  The steroid is topical and localized; it won’t go into your system or affect your vocal folds.

If you suffer from allergies, find a team of an allergist and otolaryngologist who are sensitive to your special needs. Managing the effects of allergies may be a long-term or ongoing endeavor, but it can be done. Make sure you maintain optimal vocal hygiene so you don't exacerbate the effects of the allergies.


Vocal fold mucosa likes to be cool and wet and pure. Cigarettes are hot and dry and toxic. Marijuana is hotter, drier, and more toxic. Anything you snort or inhale is very toxic. We didn't really have to tell you that, did we?


Avoid trauma to the mucosa

Activities that cause high impact to the vocal folds used to be called vocal abuse.  That implies some fault to persons who developed voice problems for normal behaviors such as coughing when they got sick.  Now, many voice specialists prefer the term “phonotrauma.”  We like to say “high-impact vocal activity.”

Many things we do with our voice are perfectly normal, and not at all harmful for a healthy voice, in moderate amounts.  But too much could potentially cause harm, and they may certainly prevent a vocal injury from healing. Monitoring these behaviors is crucial for optimal vocal health.

  • throat clearing
  • coughing
  • screaming, yelling
  • hard glottal attack
  • grunting
  • extended loud talking
  • extensive singing at pitch or loudness extremes
  • extensive talking in glottal fry 

** How loud do YOU talk? **

Our patients are often unaware of some of these sources of loud talking:

  • Is the TV or stereo on at all times in your household, and do you talk above it?
  • Do you talk in the car? (Cars can be very loud, especially with the radio, etc. on)
  • At home, do you talk to each other from different rooms?
  • At work or school, is the noise level in the room increased by ventilation systems, electronic equipment, etc.?


You  ARE a Vocal Athlete!

Treat the muscles of the vocal mechanism like any athletic mechanism

The analogy of the "vocal athlete" is commonly made when referring to professional voice users. Persons who use their voices extensively or who need highly detailed or exacting sounds place demands on their voice in much the same way as athletes place demands on their bodies. Although there is no bone in the larynx, the muscles, cartilages, and ligaments act like those elsewhere in the body (read About the Voice to learn more about how these mechanisms act).

However, it is important to remember that although muscles move the vocal folds, the part that vibrates is the mucosa, and most athletes don't have to think about their mucosal tissues. So, although it's helpful to think about the vocal muscles in the ways a runner thinks about leg muscles, it's important to think about the mucosa as well. Sometimes it's hard to separate the behavior of the muscle from the behavior of the mucosa. The more you understand the properties of each, the more you'll be able to understand how your own voice works, and how to keep it healthy.

By the way, most of what is described below is substantiated by high-quality, scientific research. We're keeping things simple and direct for you here so we won't get sidetracked explaining complex physiological principles. But that information is available for you. Check our Links page for good resources.

Two kinds of fatigue in the larynx:

Fatigue: A problem for athletes, especially vocal athletes.

1. Muscle fatigue
Muscles in the larynx (intrinsic laryngeal muscles) and muscles in the neck (extrinsic laryngeal muscles) can get tired just like muscles in your legs, arms, and abs. One of the problems with voices is that vocal muscles don't always let you know they're fatigued the way legs, arms, and abs do. If muscles in the larynx fatigue, it's common to recruit the larger muscles of the neck for additional pressure and stabilization. You may or may not feel fatigue in your neck or throat until you have gotten into some bad vocal habits.

2. Tissue (mucosal) fatigue
When the vocal fold mucosa starts to swell after extensive use, that's tissue fatigue. The vocal folds are stiffer when they are swollen and don't vibrate as evenly. The change in the vocal sound can range from slight airiness to extreme roughness, or inability to reach extremes of pitch or volume. Those can also be symptoms of muscle fatigue.

So, vocal fatigue can come from (at least) two sources, which can be very hard to differentiate. Also, vocal fatigue can manifest itself differently for different individuals or circumstances.

At the Lions Voice Clinic we see many persons with vocal fatigue. Their symptoms vary widely, as do their treatment programs.

Here are some concepts our clients have found useful:


  • Vocal muscles need to be warmed up before extensive use, just like you need to warm up your legs before you go running. Warm-ups should start gentle and become more vigorous, but shouldn't bring you to the point of fatigue.
  • We differentiate between physiologic warm-up and vocalises. 
    • Physiologic warm-up brings blood to the muscles and synovial fluid to the joints, as well as helping coordinate the various components of voice (such as breathing, phonation, resonance, and thinking!).
    • Vocalises are specific exercises that help train you to be a better singer, actor, or speaker.  They require a more exacting coordination of all the components of voice.
  • Just as Olympic runners move and stretch their legs before doing a race, you should do a few minutes of sirens, glides, easy humming, etc., before doing your scales and arpeggios.  Think of doing GROSS MOTOR muscle activity before doing FINE MOTOR muscle activity.
  • In the Lions Voice Clinic, we believe that vocal warm-ups should be paired with upper-body movement: gentle head rolls and shoulder rolls, back stretches, bending over, etc. This keeps the muscles of the shoulders, neck, and jaw from becoming tense, or inappropriately recruited, while using the voice.
  • Muscles need to be trained carefully and gradually. You wouldn't start an exercise program by doing 500 sit-ups the first day. You should build up gradually to vocal use just as you work up to any physical activity.
  • Fatigued muscles need rest and gradual return to activity. Muscles that frequently become fatigued need to be better conditioned.  A regular program of voice exercises can do wonders for preventing fatigue.  Optimal technique is also important.
  • Voices that are occasionally used extensively may become fatigued in a manner similar to the "weekend warrior syndrome." This is especially common among church choir singers, or persons who lecture occasionally. If the vicious cycle of overuse-fatigue-recovery is a problem, it might be solved by doing vocal exercises every day, not just the days of voice use.
  • Cool-down can be important for many vocal athletes in the same way that continuing leg movement is important after aerobic exercise in order to avoid blood pooling in the legs. After extensive voice use, especially at high volumes or the very top/bottom of your pitch range, bring your voice back to its default with 5-10 minutes of easy voice exercises, gradually retuning to speaking pitch range.
  • Muscles need to be trained for the “event” they are in.  Figure skaters don’t train for speed skating, and vice versa.  Opera singers use their vocal mechanism very differently from a singer who leads sing-alongs at a nursing home.  It’s important to recognize the specific muscular demands for any kind of voice use you do, and train for it if it’s extensive, or causes you fatigue or discomfort.  Sometimes we need a teacher or coach to help us learn the most efficient way of doing our “event.”
  • Muscles learn best from interval training.  Personal trainers often have their clients do “circuits” or “interval training,” in which they don’t necessarily bring the targeted muscles to local fatigue, but rather do groups of fewer repetitions, multiple times, with rests (or some other activity) in between.  Research shows that learning tends to be better with sort bursts of an activity, frequently throughout the day.  While it’s not always possible to practice vocal exercises for a few minutes, many times a day, it is a more efficient way of training your voice.  There’s an old saying that more singers have practiced themselves out of a career than into one.  Practice that is too long or too hard can be more harmful than good.


  • Mucosa must be kept healthy and lubricated.
  • If swelling has occurred, impact to the mucosa must be reduced. This is not always possible in the life of a vocal athlete, which is why voice disorders may develop.
  • It's not wise to use medications to reduce mucosal swelling. Some singers will take aspirin products to reduce the potential for swelling during extensive voice use. They're forgetting that these products are also blood-thinners, making them more susceptible to vocal fold hemorrhage (bursting a blood vessel) if there is a sudden impact to the mucosa, such as a yell or sudden loud note. Adding alcohol (which dilates the blood vessels) to aspirin products is even more dangerous.  If you’re taking a blood thinning medication, try to avoid sudden loud voice use.



Use the mechanism wisely

The more you know about your voice and how it works, the safer you are.

Myth: Understanding the anatomy and physiology of your vocal mechanism will interfere with your artistry while singing.

Fact: Oh come now.  That myth has been dispelled for a generation. 

The more you understand the individual characteristics of your OWN voice, the safer you are.

Here are some fundamental concepts about voice and voice use that we find ourselves saying in the Lions Voice Clinic over and over again. These aren't meant to be preachy; they're to help you understand the nature of the voice, so you can use your voice effectively and comfortably for your whole life.

Are you cast iron or porcelain?

  • Our bodies have individual strengths and weaknesses, and voices are no exception.
  • Some vocal mechanisms could be described as "cast iron", some are more like "porcelain." That is, some voice users can withstand strenuous voice use better than others.
  • Cast iron is NOT BETTER than porcelain (In much of the scientific literature, the term "fragile larynx" is used; we prefer the term "porcelain" to remind you that a delicate vocal mechanism can be a good thing. Many very talented singers are prone to fatigue or vocal fold swelling. They can have superb, lifelong careers as long as they take care of themselves.).
  • Hardness or delicacy of the larynx has nothing to do with talent.
  • Don't compare your vocal endurance to anyone else. Their mechanism may be inherently different from yours. BUT, if you experience frequent vocal fatigue, decline in voice quality, or discomfort that is affecting your life as a professional voice user, there are probably things you can do better to keep yourself in prime condition. Come visit us at the Lions Voice Clinic, or find the voice team in your area.

Are you a lion or a lamb?
  • Louder voices aren't necessarily more talented. (We didn't really have to tell you that, did we?) BUT, if your voice isn't loud enough, it may be a technical problem. Find a good teacher or coach.
  • Working harder is not necessarily helpful for producing a louder, or better, voice.  EFFICIENCY is very important to producing the best voice possible. 

This is important! 

You can't feel very much in the larynx itself unless something is wrong. There aren't sensory receptors to tell you your vocal folds are vibrating, or your muscles are contracting, so don't try to feel it.  Singers sometimes feel gratified if they can feel the pressure “on their cords” but that can be too much pressure and effort.  In efficient singing, you’ll feel the sympathetic vibrations in your face and head, and even in your chest, but not in your larynx or the surrounding neck muscles.

Any kind of pain is a sign that something is wrong.


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Deirdre D. Michael -
To make an appointment, please call us at (612) 676-5717.