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Vocal Health
Voice Science
41
Health Care
Graduate
12/08/2012

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Term
Speak well
Definition
Optimum speaking range, breath support, and resonant quality
Term
Sing well
Definition
Proper body alignment and laryngeal position, free from excess tension, effective breath support and control.
Term
Moderation
Definition
Limit hours speaking and talking.
Never overuse to the point of noticeable hoarseness.
Term
Hydration
Definition
Hydration required for normal function.
"Sing wet, pee pale" (McCoy 2012)
8-12 glasses of water per day
Avoid dehydration via caffeine, alcohol, smoking
Term
Rest
Definition
Regular sleep patterns.
Avoid overuse when fatigued.
Term
Good hygiene
Definition
Frequent hand washing can reduce the risk of viral/bacterial transfer.
Term
Avoid unnecessary drug use (Antihistamines/Decongestants, NSAIDS, Acetaminophen)
Definition
Antihistamines/Decongestants have a dehydrating effect.
Aspirin, Ibuprofen, non-steroidal inflammatories (NSAIDS) increase risk of vocal fold hemorrhage. (Thin blood by coating platelets forming the clot.
Acetaminophen (as in Tylenol) safer for singers.
Term
Unnecessary drug use (vitamins and beta blockers)
Definition
Vitamins - above normal doses of A, D, and E can thin blood and cause hemorrhage
Beta blockers - Inhibit performance anxiety, depress heart rate and muscular tremor; loss of sparkle, drive, and energy in performance.
Term
Unnecessary drug use (Alcohol, Cannabis, MDMA)
Definition
Alcohol - dehydration, decrease inhibitions/fine motor control, liver damage (thinning blood & predisposing to hemorrhage)
Cannabis - decrease inhibitions/fine motor control, alter brain function
Methylenedioxymethamphetamine (ecstasy) - permanent/irreversible alteration of brain function
Term
Stay physically fit (exercise)
Definition
Stave off illness, improve chances of winning competitions/roles, sustain energy levels for performance
Ideal body weight provides optimal stamina, hormonal balance, and health.
Term
Stay physically fit (consumption)
Definition
Foods with low glycemic index
Eating disorders - can cause health problems, malnutrition, and death. Gastric acid from vomit swells vocal chords (range, timbre, endurance loss) and removes enamel from teeth (causing bad breath)
Term
Practice "safe sex"
Definition
Herpes, gonorrhea, HPV, HIV/AIDS can infect vocal tract and larynx
Term
Seatbelt and Illness
Definition
Wearing seatbelt prevents crushing of larynx in an accident.
Don't sing if ill (cold, influenza or respiratory infection). May delay recovery or cause serious injury.
Term
Laryngitis
Definition
Laryngeal inflammation (generally of superficial/intermediate layers of lamina propria)
Caused by variety of environmental/behavioral irritants, or infectious diseases.
Term
GERD/LPR
Definition
GERD - acid from stomach flows back into esophagus through lower esophageal sphincter.
LPR - laryngopharyngeal reflux; when larynx is involved.
Symptoms: vocal fatigue, prolonged warm up, loss of range, timbre change, throat clearing, feeling of "something" in throat.
Term
Fungal laryngitis
Definition
Laryngitis from fungal/yeast infection
Overuse of antibiotics can increase risk. Asthmatics with steroid inhalers at high risk.
Term
Steroid Myesthenia (weakness)
Definition
Long term exposure of vocal folds to steroid inhalers; causes thinning of muscles in vocal folds.
Term
Muscle Tension Dysphonia (MTD)
Definition
Excessive tension occurs in the intrinsic/extrinsic muscles of the larynx.
Results: hoarseness, vocal fatigue, pain when singing or speaking.
Term
Lesions and Masses (location)
Definition
Most common affect voice in the cover and lamina propria
Term
Cause of Hemorrhage
Definition
Blood vessels rupture within vocal folds, in epithelium or lamina propria
Treatment: Total voice rest.
Term
Vascular Ectasias
Definition
Dilated vessels in the cover of the vocal fold; tiny bump protruding out of the cover.
Term
Vocal Fold Polyps
Definition
Discrete lesions, usually from trauma, generally forming in superficial layer of the lamina propria. Filled with blood or clear, gelatinous material. Can damage opposing vocal fold, causing fibrosis or swelling.
Term
Polyps versus Nodules
Definition
Polyps can occur anywhere of vocal fold. Can damage opposing vocal fold at site of impact.
Nodules usually occur bilaterally at junction of anterior third and posterior two-thirds of the vocal folds.
Term
Nodules (alt. name, commonality, description, causes)
Definition
"Singer's Nodules"
Common in women, rare in men (more for tenors than basses)
Callous-like lesions along vibrating portion of vocal folds, impairing normal phonation.
Cause by misuse (unintentional), overuse (too much), or abuse (damaging manner with conscious awareness of consequences)
Term
Nodules (symptoms)
Definition
- Loss of high notes
- Inability to quietly sing stoccato
- Newly-appearing breaks during glissandi
- Delays in phonatory offset or stoppages
Term
Nodules versus MTD
Definition
Nodules - usually no huskiness/hoarseness in lower register.
MTD - entire voice excessively breathy
Term
Nodule (treatment)
Definition
Only sure confirmation is direct laryngeal examination.
Treatment
- Previously, total vocal rest
- Currently, working with voice therapist for new voice-use patterns
Term
Vocal fold Cysts
Definition
Similar to polyps with discrete, egg-shaped mass appearance under cover (extend deeply into lamina propria).
Can be from trauma, but cause unknown.
Causes rigidity of vocal fold, inhibiting normal oscillation.
Term
Contact Ulcers
Definition
Ulcerative sores that develop at/near vocal process; unilateral or bilateral.
Causes: Infection, laryngeal irritants, vocal misuse/overuse
Prone in adults with whom immunity from childhood vaccination has worn off. Sometimes seen in "verismo" singers (esp. tenors) - approach high notes with excessive breath pressure and laryngeal tension.
Term
Contact Ulcers (Symptoms/Treatment)
Definition
Symptoms: Hoarseness, loss of vocal stamina, laryngeal discomfort/pain.
Treatment: Aggressive treatment for reflux and cough suppression
Term
Vocal process Granulomas
Definition
Benign growths of inflammatory tissue at vocal processes. Part of healing process from Contact Ulcers.
Causes/Symptoms: Same as Contact Ulcers
Only affect voice if large enough to impair glottal closure and mucosal wave.
Treatment: Voice therapy; aggressive treatment for GERD
Term
Vocal Fold Paralysis (details)
Definition
Stem from superior/recurrent laryngeal nerve problems
Paralysis can be unilateral or bilateral
Term
Vocal Fold Paralysis (symptoms)
Definition
Symptoms: Dysphonia with breathiness, hoarseness and reduced amplitude, limited pitch modulation, aperiodic oscillation, dysphagia (problems swallowing), loss of chest register, and diplophonia
Term
Vocal Fold Paralysis (Nerve Damage causes)
Definition
Stroke, viral illness/injury (blows to neck or chest), thyroid surgery, and open thoracic procedures (harming recurrent nerve)
Term
Spasmodic Dysphonia
Definition
Muscles of larynx spasm, preventing easy and sustained speech.
Symptoms: Weak, strained, and halting speech
Term
Spasmodic Dysphonia
Definition
Cause: Originally believed psychogenic
New Research - neurologic disorder based in basal ganglia, form of focal, laryngeal dystonia
Treatment: Chemical denervation - injection of botulism toxin (Botox) to temporarily paralyze affected muscles
Term
Smoking/Drinking
Definition
Smoking can result in cancer, usually seen in former users 10-30 years after quitting.
Excessive drinking can thin blood and cause vocal fold hemorrhage
Term
Sexually Transmitted Diseases
Definition
Potentially impair voice function by directly infecting the vocal tract and larynx, through oral-genital contact.
Term
Laryngeal Papilloma (Recurrent Respiratory Papillomas)
Definition
Benign, wart-like lesions caused by HPV.
No cure, only remission
Vocal Symptoms: Hoarseness progressing to severe dysphonia or complete aphonia
May be confused with chronic laryngitis prior to laryngoscopy
Term
Hormonal Issues
Definition
Women: Often voice changes occur around menopause
Medication treatment should be cautious
Men: Male menopause or low androgen states can be reversed using supplemental androgen. Rarely an adverse effect on the voice.
Term
Overview
Definition
Voice is resilient with normal use. Maintaining rest, good nutrition, and proper hydration are key.
Pathologic disorders usually from abuse, misuse, overuse, trauma, or medical illness.
Good vocal hygiene and reasonable care are key.
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