Vocal care goes way beyond how you use your voice onstage or in the studio—your everyday speech patterns and habits have more of an impact than you may realize.
As featured in: Performing Songwriter Issue January/February 2005 Visit performingsongwriter.com to order back issues or subscribe.
By Abby White
I recently interviewed an up-and-coming singer/songwriter, and we got on the topic of losing your voice. He described a rather strict regimen that he followed to avoid this, including refraining from drinking, smoking, partying and other rock ‘n’ roll clichés, exercising regularly, eating well and dragging a humidifier to every hotel room he stays in when on tour. I started laughing, because his lifestyle more closely resembled that of my 80-year-old neighbor (sans the touring) than of, say, Keith Richards, but he remarked, “Hey, I did all that. I learned.”
Unfortunately, there are a lot of singers who don’t take the necessary precautions to avoid damaging their voices. Cases in point: High-profile acts such as Linkin Park, A Perfect Circle and Christina Aguilera canceled shows this past year due to sore throats, hoarseness and general problems from vocal abuse. It’s stressful enough on vocal cords to subject them to hours of intense singing, screaming or whatever you call it (some performances nowadays defy categorization). But vocal care goes way beyond how you use your voice onstage or in the studio—your everyday speech patterns and habits have more of an impact than you may realize.
“Pay attention not only to what you are doing when singing, but when speaking as well,” says Dr. Claudio F. Milstein, of Cleveland, Ohio. “Singers tend to forget we use the same organ for both activities. Be careful when going to parties, talking over loud noise, yelling at a ball game, singing in the car, talking for hours on the phone, etc.” Th is is especially important if you are conducting interviews pre- or post-performance, because your voice is already tired from singing, and the vocal folds need to rest.
As with any medical condition, prevention is the key to ensuring that you are keeping your voice in top form, or at least letting it recover from the abuse you inflict upon yourself. We’ll examine the many types of vocal disorders that singers suffer from, including warning signals that should motivate you to hightail it to your nearest otolaryngologist (that’s doctor-speak for ear, nose and throat specialist, also known as an ENT) or laryngologist (physician voice specialist). We’ll also talk about the precautions to help you avoid experiencing a vocal disorder, and habits to adopt—or get rid of—to improve the overall quality of your voice.
TYPES OF VOCAL DISORDERS
Before I get into the specific types of disorders, let’s briefly go over the physical process of vocal function. Many complex interactions involving numerous parts of the body are necessary for voice production to occur, specifically the abdominal and back musculature, lungs, oral cavity, pharynx (throat), larynx (voice box), nose and rib cage. Vocal folds, also referred to as vocal cords, are located within the larynx. Below the larynx is the “power source” for the voice; a respiratory muscle called the diaphragm, which runs along the bottom of the rib cage. It’s important to understand how these parts work together, because a deficiency in one area results in problems in another. For example, if there’s a problem with the muscles that provide support for breathing, vocalization is impaired, and the laryngeal muscles are oft en damaged attempting to compensate for this lack of support. If you’re looking for a more detailed anatomical description, pull out that old anatomy textbook or check out www.voiceproblem.org
[DISCLAIMER: As you’ve probably figured out, I have no certification in any kind of medical field. I barely passed biology. So if you are experiencing any of the symptoms detailed below, consult a doctor immediately, as the symptoms may be caused by a more serious condition.]
Common Signs of Serious Vocal Abuse
Common symptoms of vocal abuse include the following:
• After extensive singing or speaking, the throat is tender, breathy or hoarse.
• Even when sufficiently hydrated, the throat is very dry and has a persistent tickle, causing chronic coughing or throat clearing.
• You are unable to produce your highest note at low volume and have difficulty controlling volume in general.
• Even after one to two days of vocal rest, you are still hoarse or unable to sing with a clear voice.
• You experience breaks in the voice and/or a reduced pitch range.
• You notice an increase in vocal fatigue and tremor and an overall strained
vocal quality.
Hoarseness/Laryngitis
Defined as a rough and scratchy quality to the voice, hoarseness—also known as laryngitis—is usually a result of abnormalities such as inflammation, growths, swelling or scarring on the vibratory margin of the vocal fold. These abnormalities prevent the vocal folds from closing completely, allowing air to escape when the folds are supposed to be closed. This accounts for the breathy quality of a voice impaired by laryngitis.
In addition, laryngopharyngeal reflux (or reflux laryngitis) can occur when stomach acid refluxes up the esophagus, burning the throat and causing choking or tickling during vocalization. This is more common in the morning.
Vocal Fatigue
A trained singer should be capable of singing for several hours without experiencing vocal fatigue, the inability to vocalize for an extended period of time with no change in vocal quality. Vocal fatigue usually results from oversinging or speaking too loudly and for too long, and from abuse or misuse of the neck and abdominal musculature.
Nodules
Nearly every doctor I consulted said that nodules are the most common vocal disorder they encounter with singers. While calluses on your fingers are an inevitable side effect of guitar playing, calluses on your vocal folds can be a big problem. Some cases of these tiny bumps—which are primarily caused by vocal abuse—are asymptomatic and don’t impair voice production. However, if you’re experiencing excessive breathiness, hoarseness, vocal fatigue and loss of range, ask your doctor for a laryngoscopy, which will reveal the extent of the damage on your vocal cords. Voice therapy is oft en successful in treating and lessening the presence of nodules, although surgery is an option if therapy is not effective. In the mid-1980s, vocal powerhouse Annie Lennox was under doctor’s order not to sing as a result of her recurring problems with nodules. At the time, Lennox had just finished recording Be Yourself Tonight with Eurythmics and was unable to tour in support of the album.
Polyps
Polyps are the second most prevalent vocal disorder among singers. According to Dr. Michael Morgan of Plattsburgh, N.Y., a polyp can occur in a single event such as “singing a loud, high note that is out of the singer’s range,” which can lead to a blood vessel breaking, causing a lesion to form on the fold. Usually found on one side of the vocal folds, polyps are lesions that often have a blood vessel running along the upper surface of the fold, entering the polyp. Sometimes originating as vocal hemorrhages, polyps pose a threat as they can produce a contact injury on the opposite vocal fold if they are not treated. Voice therapy and voice rest can alleviate the presence of polyps, though some may necessitate surgical removal.
Muscle Tension
According to Nashville physicians Robert Ossoff and Thomas Cleveland of the Vanderbilt Center for Otolaryngology, “The most common problem that does not necessarily show a bump in the folds is muscle tension, which can occur when singers use too much effort when they sing. Some of the common symptoms are voice fatigue, loss of range and eventual hoarseness.”
Cysts
Sometimes misdiagnosed as nodules, cysts are lesions that cause swelling on the opposite vocal fold and differ from nodules in that they are fluid-filled and cause obstruction of a mucous gland duct.
Vocal Fold Hemorrhage
Caused by a ruptured blood vessel, vocal fold hemorrhages can be as scary as they sound. In a worst-case scenario, blood can collect under the vocal fold mucosa and form a mass or scar, which changes the vibratory action of the fold and can even trigger permanent hoarseness. If you experience a vocal fold hemorrhage, absolute vocal rest is recommended, and some cases may require drainage of the blood by way of surgery. Last year, Australian country artist Kasey Chambers had to cancel the bulk of her U.S. tour after she suffered a vocal fold hemorrhage in New York.
Vocal Fold Paralysis
Paralysis can occur on one or both vocal cords, and involves at least one nerve to the folds. Symptoms of this disorder include problems with elevating pitch, projecting the voice or having difficulty controlling sustained tones. Causes include viral infections or other trauma to the neck, and initial treatment should include vocal therapy.
If you’ve experienced any of these, you’re probably wondering how to determine if you need to consult a doctor or just take it easy on your voice. Dr. Celia R. Hooper, professor at UNC-Greensboro, advises “If patients are hoarse for more than two weeks, seek medical attention.” According to Dr. Milstein, “When you feel you are pushing too hard, those are the times you are more prone to do damage to your vocal folds.” When in doubt, see a doctor—he or she is the only one who can determine if you need to take a break, need medication or look into vocal therapy. While discomfort from vocal abuse, allergies, smoke inhalation or dehydration may be a common occurrence for any singer who performs regularly, it’s better to be safe than sorry. And in many cases the condition is a result of not using proper vocal technique. If you catch a problem in the early stages, it’s easier to learn prevention therapy and become more cognizant of habits to make or break.
(Next: Things To Avoid and Habits To Adopt)
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