|
What
is 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 a professional singer because the emotional
effects of having problems with singing can be
equally as devastating for the choir singer.
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 special
needs of the professional voice user.
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.
How
can professional voice users avoid voice
disorders?
Vocal hygiene is the term used for the
use and care of the human voice required to keep it
healthy. 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:
Maintain
the vitality of the vocal fold 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
|
Drink 8-10 glasses of water per day.
Luckily, water is anything that isn't
caffeinated or alcoholic. If you drink
caffeinated or alcoholic beverages, 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.
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.
|
Confused?
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.
- Keep swallowing to slough off the
accumulated secretions. Don't clear your
throat!
Maintain a nice environment for your vocal
folds.
Try to eliminate sources of irritation.
The two most important are gastro-esophageal
reflux and sinus drainage (post nasal drip).
Allergies are often 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
GERD in our
section on Related Problems).
• Often Sinus drainage may be managed
with environmental humidity and avoidance of
allergens, and with 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.
• 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
Other terms: vocal abuse, phonotrauma
Many things we do with our voice cause
unnecessary harm. Becoming aware of and avoiding
these behaviors is crucial for optimal vocal
health.
- throat clearing
- coughing
- screaming, yelling
- hard glottal attack
- grunting
- extended loud talking (see below)
- extensive singing at pitch or loudness
extremes
- extensive talking in glottal fry (to hear
what glottal fry sounds like, refer to our
Multimedia
Gallery)
|
** 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.?
|
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 (see About
the Voice), the muscles, cartilages, and
ligaments act like those elsewhere in the body.
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:
MUSCLE CONCEPTS:
- 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. 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 stiff 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 conditioned.
- 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. If extensive voice use is
followed by easy talking, that should
constitute a cool down. But if
extensive voice use is followed by a
period of silence, it is important to
do 5-10 minutes of gentle voice use to
cool down.
MUCOSA CONCEPTS:
- Mucosa must be kept healthy and
lubricated.
- Once 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. For a woman during her
menstrual period, it's a classic recipe
for disaster.
|
Use
the mechanism wisely
The more you know about your voice and how it
works, the safer you are.
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.
- Our bodies have individual strengths and
weaknesses, and voices are no exception.
- Some vocal mechanisms are made of "cast
iron", some are made of "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.
- 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.
- 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, so don't try to feel it.
- If there's inflammation, especially in the
posterior (back) part of the larynx, the pain
can be intense.
|
