When you have problems with your voice, sometimes folk wisdom and the advice of friends will not do. It may be time to become a detective, looking more deeply into vocal health than you ever have before.
VoiceCouncil Magazine has asked leading voice scientists, doctors, therapists and teachers to help us discover the causes behind one’s voice getting trashed — and to show the way forward to vocal health.
You aren’t hitting those high notes like you used to. Something is “off” with the tone of your voice. Perhaps there’s some pain. But you are in the middle of a busy schedule. Your manager has expectations — so does the audience — so do you. It’s damn the torpedoes, full steam ahead. But what is the cost to your voice?
Understanding some basic facts about vocal health and vocal function should be required for anyone relying upon their voice to make a living. VoiceCouncil Magazine will explore some central issues below and we invite you to go to our forums to keep the discussion alive as we continue exploring the health of your voice.
What’s Going On Down There?
In Voice Science 101 students learn that vocal folds (a.k.a. the vocal cords) are muscles in the larynx that are responsible for producing sound. You can feel them at work: just hold your fingers on your throat and make a “zzzz” sound; those vibrations you feel are the vocal folds hitting against each other.
Vocal folds slap together at high speeds and with forces which vary according one’s volume and tone. Voice problems often have something to do with these folds; there is swelling due to stress or illness and a subsequent loss of vocal abilities. A singer wants vocal folds that are not swollen and able to produce sounds naturally, without undue stress. Healthy vocal folds are perhaps the singer’s greatest ally.
But vocal folds are not the whole story. Dr. John Rubin, a leading ear, nose and throat (ENT) surgeon and clinician, observes that it takes a whole body to produce a sound. Understanding how vocal folds work is just one part of a much larger picture that involves emotional, physical, social and nutritional dimensions: “When people come to me with vocal problems I need to look at which parts of the body have gone wrong. This is why I spend a lot of time with my patients; we look at diet, patterns of sleep, the medication they are on and the environment in which the singer works and plays — the number of things than could be contributing to voice problems is almost endless. Sometimes what is going on with vocal folds is not the central issue at all.”
While there can be many causes behind one’s voice getting trashed there are only 2 main enemies of vocal health.
Vocal Enemy #1: Stress
There are many ways to put stress on one’s voice: by talking too loudly, using a technique or style that doesn’t “fit”, and by singing in environments that force the voice to push more than it can handle. Dr. Ronald Scherer, well-known voice scientist and educator, says: “The main point is that whatever is making sound in the throat should be created specifically, but with healthy technique—the more training one has, the more one should be able to control the variety, color, loudness, and degree of clarity of one’s voice, without undo fatigue; that is performance vocal health”.
Dr. Rubin underscores the fact that vocal stress can happen without people even thinking about it. “A singer may be causing chronic stress to their voice by competing against a lot of background noise; singing in the car or getting into extended conversations in noisy pubs or clubs, for example”.
Noted vocal coach Melissa Cross says that the biggest cause of vocal stress is the vocalist thinking that they have to have someone else’s voice: “A singer can sometimes have someone else’s voice in their head — it’s like driving from the passenger seat. A good vocal teacher is someone who can identify natural sensations that are essential to voice production and translate them into a language of the imagination so that it can be used in performance without thinking”.
Vocal Enemy #2: Disease
“Disease” can be perceived as a frightening term, conjuring up images of an army of microorganisms attacking the throat – forces against which the singer is powerless. However, “disease” simply means that a part of the body is not functioning well. The causes of disease can certainly include microorganisms but they can just as easily be related to nutritional, environmental and toxic factors, all of which can be treated. In the case of singers, there are common ailments and proven paths back to health.
A magazine article cannot pretend to be the place where a singer can diagnose an illness. Laryngologists (or ENT doctors who specialize in the larynx) can locate problems and prescribe cures. Whether it’s the common cold or some form of “itis”, it may be essential that singers see their doctor so that the cause can be isolated and the path to healing begun.
Dr. Scherer notes that one disease that shows up often with singers is reflux (laryngopharyngeal reflux, LPR, also known as gastroesophageal reflux disease, or GERD): “Reflux is where the gastric juices from the stomach move up the esophagus and onto the vocal folds. It is quite common in vocal performers and always suspected as part of a person’s vocal problem.”
Sometimes, Scherer notes, reflux has no consistent symptoms. That is, with disease we expect to feel pain, but reflux can occur without pain, yet cause inconsistencies in voice quality and vocal range.
For people with reflux, Dr. Scherer says there is very good news: “Both medicine and lifestyle change can often allow a person to manage this problem well. Eventually, lifestyle choices may be all that is required to maintain vocal health. The problem is definitely one for which a person should see a laryngologist and other health professionals to receive the most appropriate care”.
Lifestyle Over Medicine
Voice scientists, doctors, therapists and teachers are unanimous: while there are effective medicines that can be used to treat stress and disease, there is much a vocalist can accomplish through diet, rest and new habits.
Controlling cigarette, alcohol and caffeine consumption will have a direct effect on vocal health. “Think of the process of smoking” observes Dr. Rubin. “You are taking heated materials down into the larynx—this causes irritation. Nicotine is a drug that causes drying in the larynx, not to mention the relationship between smoking and cancer”.
The vocalist would do well to see alcohol more as a voice irritant than as a balm for nervousness: alcohol can have a drying effect on the throat and excess consumption can be a factor in reflux.
Excessive caffeine has a diuretic effect, depleting the body of needed water — water that is needed, in part, to keep the larynx lubricated, so that the quality of singing voice can be maintained. People get tired and so drink a cup of coffee or have a coke to stay awake – unaware that this puts stress on their voice.
Even the beloved latte has drawbacks for the singer, says Dr. Marcus Coneys. The diuretic effect remains the same as this is caused by the caffeine and is not mitigated by the milk. In addition to this, the milk tends to stimulate the formation of mucus on the larynx, producing a “phlegmy” sounding voice. Singers should ensure that they drink a cup of water after having any drink containing caffeine.
In the case of reflux, one can reduce the intake of foods and drink that are acidic: eat less tomato based products, hot spicy foods and drink less orange juice. Not eating 3 hours before sleep and having one’s head slightly elevated keeps acidic fluids where they should be kept—in the stomach.
Eating healthy foods, drinking adequate amounts of water (6 cups a day), getting adequate rest and not being harsh with your voice is not a moralistic message—professionals say that it’s essential to support a lifestyle that depends on the voice.
Is Devotion to Health Realistic?
Understandably, there can be a fear that in addressing medical issues the singer will fall down an endless pit of medical appointments, lost time and rigorous self-analysis leading to compulsions about diet and environmental noise. The last thing any singer wants to be is so obsessed about health that important opportunities are lost, demanding schedules are held up and performances are cancelled.
Yet, the advice that comes from professionals is straightforward: simple lifestyle choices combined with learning how to use the voice more naturally in performance is achievable. Voice and speech therapist Dr. Ruth Epstein maintains that any treatment has to be sensitive to the demands on the singer’s life. “A doctor or therapist needs to build trust with the singer — this is not accomplished by demanding immediate changes that interrupts essential work, causing even greater stress for the performing artist.”
“Sometimes we practice some ‘SOS management’, acute treatments that keep a singer on track for the short term. However, we want the singer, over time, to adopt a lifestyle that will support their vocation — that makes economic as well as medical sense”.
The Team Behind the Singer
The professionals whose voices you heard in this article see themselves as a part of a anti-voice-trashing support network for the singer. Laryngologists (or ENT docs) take the time needed to diagnose the problem; they work closely with speech therapists who examine behavior changes that can be developed to increase vocal health. Voice teachers extend the work of both doctors and therapists by helping the singer to find more natural ways to use their voice.
Sometimes the “back-up” a singer needs is not musical. Even a determined soloist may need to be in harmony with this team.
VoiceCouncil Magazine thanks the outstanding team of professionals who supported this article:
Melissa Cross is considered worldwide as an expert on rock vocal technique. Her well-known clientele attest to the fact that the traditional basics of vocal technique can be applied to even the most unorthodox of musical genres. Her unique method of vocal training has culminated in the critically acclaimed release of two vocal instructional DVDs: “The Zen of Screaming” and “Zen of Screaming 2”, available on her Website.
Ruth Epstein, PhD is Head of Speech & Language Therapy Services and Consultant Speech and Language Therapist (ENT) at the Royal National Throat, Nose & Ear Hospital, London. She is also the Director of the MSc programme in Voice Pathology at the Ear Institute, University College London.
John S. Rubin, MD, FACS, FRCS is Consultant Ear Nose and Throat Surgeon at the Royal National Throat, Nose and Ear Hospital Division of The Royal Free NHS Trust. He is also the Lead Clinician of the Voice Disorders Unit as well as its Clinical Director.
Ronald C. Scherer, PhD. is a voice scientist and educator in the Department of Communication Disorders, Bowling Green State University, Bowling Green, Ohio. He teaches courses on voice disorders and voice and speech science. His research interests include the physiology and mechanics of basic, abnormal, and performance voice production, and the methodologies involved in such research.
The editor also thanks Marcus C. D. Coneys, MD for checking on the accuracy of many aspects of this article. Dr. Coneys is an anesthesiologist and pain clinician in Red Deer, Alberta.
© 2008 Gregory A. Barker, PhD.