Transcript The Vocal Pedagogy Workshop Stephen F. Austin, M.M., Ph.D

How to keep the voice healthy?
Mainly Practical:
– Avoid overuse
– Do not sing when you are ill - EVER
– Be aware of the effect of medications and
certain lifestyle choices!
1
Avoid air born irritants
2
Avoid chemicals: household,
garden, workplace, etc.
3
Avoid smoke!
4
Reinke’s Edema
5
Humidity
 Avoid
long exposures to dry air
–Air travel
– Heated/air conditioned
bedrooms
 Keep
your body hydrated!
–Dr. Van Lawrence: “Pee Pale”
6
Molds, mildews, other allergens
7
Avoid excessive diuretics
Coffee
Chocolate
8
Overuse/misuse

Too much singing
– EVERYONE HAS THEIR OWN LIMIT
Too much talking: especially in noisy
environments-CARS, AIRPLANES, BARS
 Cheerleading, choir directing
 CLASSROOM TEACHING

9
Hemorrhagic polyp
10
Hemorrhage
11
If you are ill and have to take
prescription medications:
http://www.ncvs.org/rx.html
Allergies/Colds

Treat the symptoms
– Nose Sprays
»Colds: Pediatric strength Afrin.
Limit to 3-5 days.
Alternate sides.
»Allergies: Topical nasal steroids for seasonal
symptoms: Beconase, Vancenase, Rhinocort,
Nasalide, etc.
13
Allergies/Colds

Treat the symptoms
– Antihistamines can be drying – find one that
isn’t!
– Decongestants too – there are lots of them, find
one that works for you
– Stimulants: can interrupt normal sleep patterns
– Mucolytics are helpful: reduce viscosity of
secretions: Humibid, etc. (Guafinisen)
14
Sinusitis
Chronic low grade infection can lead to
postnasal drip and throat clearing
 May produce nasal discharge, obstructions,
etc. that can interfere with performing
 Must be managed medically
 Chronic conditions can be addressed
surgically
 Can be associated with reflux!

15
Laryngitis with vocal fold injury

Hoarseness as a result of trauma
– Cough, sneeze, yell – a singular event!
– Vocal fold inflammation
– Mucusol disruption or hemorrhage

Voice use is contraindicated
– Often seen in premenstrual women using
aspirin
– Optimal therapeutic approach in not clear
16
Laryngitis without vocal fold injury
Vocal fold edema resulting from infectious
or non-infectious causes
 Voice rest is not necessarily indicated
 Overuse, misuse and many URI
 Treatment includes: selective voice use,
hydration, mucolytics, corticosteroids, etc.
 No whispering!

17
Acute Laryngitis
18
In case you missed it: or I didn’t
say it…

Aspirin is contraindicated in professional
voice users.
– Causes platelet dysfunction
– Predisposes to vocal fold hemorrhage
– Acetaminophen is best substitute (Tylenol)
19
Hormones in the singer
Huge implications for voice
Puberty
 Normal female cycle
 Endocrine issues: thyroid, fluctuation in
sex-hormones
 Menopause/Manopause
 Induced: anabolic steroid ingestion

– Athletes
– Medical treatments
20
Menstrual cycle
 Women
can experience moderate to
severe voice disorders related to
monthly ovarian cycle.
– Most in immediate pre-menstrual period
– Loss of range, fatigue, slight hoarseness
– Due to engorgement of the vf and
changes in the mucosal lining of the vf
21
Menopause
Changes in the voice vary widely:
 Menopause is associated with changes in
the laryngeal mucosa.
 Register transition difficulties
 Breathiness, weakness, lack of flexibility,
lack of support, loss of range, change in
vibrato, pitch inaccuracies

22
Menopause
Post-menopause pitch drop due to little or
no estrogen secretions.
 WHILE the ovaries continue to produce
androgens. This results in virilization.
 35-40 yo performers should have baseline
estrogen levels for later reference.

23
Menopause
Replacement therapy should be guided by a
gynecologist, endocrinologist, and a
laryngologist.
 Traditional methods have shown to be risky
 HOWEVER non-traditional replacement
therapies with bioidentical hormones are
worth investigating! Read Suzanne Somers
 Androgens should not be given to a singer if
there is a reasonable therapeutic alternative.
 Androgens are found in some European
24
birth control pills.

Manopause
Not just for those of us who live through it
vicariously!
 Testosterone levels begin to fall about 1%
each year after age 30
 This has not been investigated in the singing
voice
 Male pitch tends to rise with age: women’s
lowers: Is it grama or grampa on the phone?

25
Hypothyroidism
 Thyroid
gland regulates protein
synthesis and tissue metabolism.
 Thyroid disorders are common in the
population (<4%).
–
–
–
–
Unexplained hoarseness
Vocal fatigue
Muffled sound
VOCAL FATIGUE!
26
Hypothyroidism
 Symptoms:
– Loss of range
– Feeling of a lump in the throat
 Can
occur when tests are within the
low-normal range.
 Surgical complications are real:
– Severed recurrent laryngeal nerve = paralysis
27
Gastric Reflux (GERD)
 Stomach
contents spill out over the
larynx.
 Gastric acid irritates the mucosa
 High incidence in voice complaints
– Satoloff (1991) 50% of voice patients
– Koufman (1996) 78% with hoarseness
28
Gastric Reflux (GERD)
 Symptoms:
–
–
–
–
–
–
Morning hoarseness
Prolonged warm-up time
Halitosis
Excessive phlegm
Frequent throat clearing
Dry mouth
29
Gastric Reflux (GERD)
 Symptoms:
– Coated tongue
– Sensation of a lump in the throat
– Throat tickle
– Dysphagia
– Chronic sore throat
– Heartburn – not always!
30
Gastric Reflux (GERD)
 Physical
exam:
– Erythema (reddening) & edema
(swelling) of mucosa around the
arytenoids, false folds and posterior
portion of the true folds
31
32
Gastric Reflux (GERD)
 Diagnosis:
– Examination by gastroenterologist
– Ph monitor (24 hours)
 My
diagnosis: Assume that you have
it, treat it and save yourself $$!
33
Gastric Reflux (GERD)
 Rx
can include:
– Elevation of the head of the bed 6 inches
– Drug therapy: Prilosec, Privicid, Nexium,
etc.
– No eating 3 to 4 hours before bed
– Avoid coffee and alcohol other ‘hot
button foods: CARBOHYDRATES
 Surgical
interventions very common
34
Vocal Nodules
 Benign
growths on vibrating margin of
the vocal folds.
 Usually bilateral and symmetric.
 Caused by chronic, forceful vf contact.
 Always at midpoint of membranous vf
 Increases mass – makes them stiff
 Always the result of abusive behavior
35
T
Nodules
36
37
Vocal Nodules

Symptoms:
– A change in vocal quality
– Breathiness
– Loss of range
– Vocal fatigue
– Aphonia in certain parts of the range
38
Vocal Nodules
 Often
confused with cysts and other
lesions without a proper diagnosis:
 Strobovideolaryngoscopic exam
 Recent onset nodules can resolve
 Old nodules do not respond to therapy,
but therapy should be done prior to
surgery.
39
Other ‘space occupying lesions:
40
Cyst
41
Polyp
42
Vocal Nodules
Can be successfully removed with good
result.
 Any surgical procedure can leave a scar,
and a scar means dysfunction (Julie
Andrews).
 Vocal fold stripping is absolutely
considered malpractice today.

43
Other horrifying things:
fungal infection
44
Dislocated arytenoid
45
46
Vocal Health Web Sites
http://www.bgsm.edu/voice/
 http://www.hopkinsmedicine.org/voice/
 http://www.voice.meei.harvard.edu/disorder
s/
 http://www.ncvs.org/ncvs/info/vocol/rx.htm
l

47