Voicecenter.PITT.edu Voice Center

Keep Your Voice Healthy!

How the voice works and how to keep it healthy

Clark A. Rosen MD

University of Pittsburgh Voice Center

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• How Does the Voice Work?

– Vocal Anatomy and Physiology

• What Can Go Wrong with the Voice?

– Medical Problems of the Voice

• How Can One Prevent Voice Problems?

– Voice Disorders Prevention: Vocal Hygiene Plan

Voice – Care and Treatment

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• Where the body goes so goes the singing instrument

– Airplane, Steelers game, Pitt game…

• How the body goes, so goes the voice

– Fatigue

– Nutrition

– Hydration

Body -- Voice

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Larynx Voice Production

Brain

Lungs

Larynx (vocal folds)

Pharynx

Nose/Sinuses (soft palate)

Oral cavity

– Tonsils, tongue, lips

EARS

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POWER

SOURCE

RESONATOR

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Where is the Larynx?

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Larynx Anatomy

• Paired vocal folds

– Open for breathing

– Come together for sound production

• Speaking

• Singing

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Layers of the Vocal Fold

• Edges vibrate together to produce the sounds of speaking or singing

– Fine muscle control

• Specialized covering of the vocal folds

– Lamina propria (superficial)

– Needed for vocal fold vibration

• Very sensitive to injury

• Very difficult to repair

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Vocal Fold Vibration

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Vocal Fold Vibration and Singing

• Vocal fold vibration speed = pitch

– Hertz = cycles per second (Hz)

– Speaking Voice

• Male ~ 100 Hz

• Female ~ 200 Hz

– Singing voice

• C below middle C (C3) = 136 Hz

• Middle C (C4) = 256 Hz

• A4 = 440 Hz

• High C (C6) = 1024 Hz

– Vocal folds are vibrating over 1,000 times per second !!!

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• Performed by an Ear, Nose and Throat doctor in the office

Laryngeal Examination

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• Specialized instrument to examine rapid vocal fold vibration

• Allows slow motion viewing and analysis of vocal fold vibration

Stroboscopy

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Vocal Fold Vibration • Laryngeal Muscles Approximate Vocal Folds

• Tone, Length, Bulk

• Vibration Dependent on Covering of Vocal Folds (Lamina Propria)

– Bio-MECHANICAL

– Highly Elastic

– Sensitive to Injury

– Difficult to repair or replicate

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Vocal Fold Vibration at 264 Hz

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Vocal Fold Vibration at 120 times per second !

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Outside and Inside of Singing

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“You name it… It can/will happen!!!”

• Misuse / Overuse

• Laryngo-pharyngeal reflux disease

• Nasal and sinus diseases

• Dehydration

• Singing / Speaking sick

• Lumps and bumps of the vocal folds

Common Voice Problems

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–Singing is an aerobic activity

–Avoid exposure to smoke-filled air

–Treat conditions affecting lungs, such as asthma

–Exercise

–DO NOT SMOKE!!!!!!!!!!!

Caring for Your Lungs

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Smoking

Laryngeal Cancer Irreversible changes to vocal

folds

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• Stomach acid content (acid) irritates the larynx (vocal folds) and pharynx, or referred sensation from stomach or esophagus

• Occurs in everybody to some extent

• May be associated with: – Hoarseness

– Heartburn

– Foreign-body or “lump in the throat” sensation

– Frequent throat clearing

– Excessive phlegm production

Laryngo-Pharyngeal Reflux Disease (LPR)

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Laryngo-Pharyngeal Reflux Disease

• Worsened by

– Caffeine

– Alcohol

– Chocolate

– Mint

– Spicy foods

– Fatty foods

– Tomato-based foods

– Lying down with full stomach

– Tight clothes

– Obesity

– Singing

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• Precautions:

– Avoid large meals several hours before bedtime

– Avoid substances that exacerbate reflux

– Use antacids for spicy foods, heartburn

– Seek treatment if regular problem

• Change in behavior

• Medication very successful

• Prilosec, Protonix, Prevacid, Nexium, Zegerid, Aciphex, Dexilant

Laryngo-Pharyngeal Reflux Disease

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• Nasal breathing warms, humidifies and filters the air you breath

• Allergies or Infection can block nasal breathing and thus lead to mouth breathing which dries the throat and vocal folds

• Can affect voice resonance

• Causes post-nasal drainage – Frequent throat clearing

• Increased risk for vocal fold injury

Nasal and Sinus Disease

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• Antihistamines (significant drying)

– Allergy & Cold Medications

– Benadryl, Claritin, Allegra, Zyrtec, Astelin,

– Tylenol PM, Contact, …

• Anti-Depressants

– Paxil, Zoloft, Effexor, Lexapro, …

• Anti-coagulants

– Aspirin, Ibuprofen, Coumadin, Plavix, Xarelto…

– Natural: fish oil, Echinacea, gingko biloba, ginger, …

– Tylenol = OK

• Accutane

• Advair

Medicine / Drugs Concerns

“Is this medication

going to effect my

voice?

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• The practice of “singing sick” subjects the performer to a significant risk of serious vocal injury

– Vocal fold hemorrhage (bleed)

– Can lead to vocal fold scar formation

• VERY HARD TO FIX!!!

“I Have a Cold, Can I Sing?”

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Vocal fold hemorrhage

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• Most colds are caused by viruses and do not require (or benefit) from antibiotics

• What to do: (Early detection)

Back off from vocal demands

Seek treatment early

“I Have a Cold, Can I Sing?”

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• Supportive treatment:

Increase rest and hydration

Mucous thinning medication

Guaifenesin (Mucinex)

Nasal saline rinse / Neti pot

Decongestants

Pseudoephedrine

but WILL dry you out!

Avoid antihistamines if you can

“I Have a Cold, Can I Sing?”

Mother

knows best!

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• Limit vocal use

– Talking (phone, yelling……..)

– Mark through rehearsals

– Limit singing if the speaking voice is hoarse

– If you must sing, you should have a vocal fold examination prior to performance

“I Have a Cold, Can I Sing?”

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Lumps and Bumps

• Usually arise from phonotraumatic voice use or singing sick….

– Nodules

– Polyp

– Cyst

• Maximize non-surgery treatment

– Voice rest

– Voice therapy

– Singing voice therapy

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Vocal Fold Nodules

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Vocal Fold Lesions

Vocal fold polyps Vocal fold hemorrhagic polyp

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Vocal Fold Lesions

Reactive

lesion

Vocal

fold cyst

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Hoarseness is no laughing matter!

• Hoarseness is NEVER normal

• Especially repeated episodes

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Voice Care is a Team Sport

• University of Pittsburgh Voice Center

– Physicians

– Speech Pathologists

– Singing Voice Specialists

– Related Medical Specialists

– Mental Health

• 412-232-SING

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University of Pittsburgh Voice Center –412-232-SING (7464)

–UPMC Mercy

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