VOCAL CLINIC

Know your vocal cords and play your voice chords

Vocal Care for all

Symptoms of voice problems can range from hoarseness to vocal fatigue, to pain in the front of the throat.

  • Vocal nodules (also called Singer's Nodes, Screamer's Nodes) - Vocal cord nodules are also known as "calluses of the vocal fold." They appear on both sides of the vocal cords, typically at midpoint, and directly face each other. Like other calluses, these lesions often diminish or disappear when overuse of the area is stopped.
  • Vocal polyps and other lesions - A vocal cord polyp usually occurs  on one side of the vocal cord and can occur in a variety of shapes and sizes. Depending upon the nature of the polyp, it can cause a wide varieties of voice disturbances.
  • Vocal fold (Cord) movement disorders - paralysis - Vocal fold  weakness and paralysis result from abnormal nerve input to the voice box muscles (laryngeal muscles). Paralysis is the total interruption of nerve impulses resulting in no movement of the muscle; Paresis(partial weakness) is the partial interruption of nerve impulse resulting in weak or abnormal motion of laryngeal muscle(s).
  • GERD....Acid Reflux
  • Chronic hoarseness - Hoarseness is a general term that describes abnormal voice changes When hoarse, the voice may sound breathy, raspy, strained, or there may be changes in volume (loudness) or pitch (how high or low the voice is). The changes in sound are usually due to disorders related to vocal c ords that are the sound producing parts of the voice box (larynx). While breathing, the vocal cords remain apart. When speaking or singing, they come together, and as air leaves the lungs, they vibrate, producing sound. Swelling or lumps on the vocal cords prevent them from coming together properly and changes the way the cords vibrate, which makes a change in the voice, altering quality, volume, and pitch.
  • Muscle Tension Dysphonia: Can be due to stress, anxiety, acid reflux, muscular disorders,Some times secondary to medications and certain infections like tetanus etc..,

Diagnostic and Therapeutic Tools:

Effective treatment of voice disorders depends on correct diagnosis. At the Voice Center, sophisticated stroboscopic light sources are used to view the vocal folds in motion. Examinations are recorded for documentation and comparison. Treatment for voice disorders varies widely, depending on diagnosis. Voice disorders may be the first sign of a general disease or illness. The Voice Center keeps up to date with the latest research, therapy approaches and surgical options. Our team reviews vocal findings and develops a plan to remediate each voice disorder.

Advice for Care of the Voice

The following are helpful hints for the care of the professional voice.

Hydration

The vocal folds need to be lubricated with a thin layer of mucus in order to vibrate efficiently. The best lubrication can be achieved by drinking plenty of water. A good rule of thumb is to drink as much water as possible. Dr. Palmer says "if (your output) is light it's right.

Caffeine and alcohol pull water out of your system and deplete the vocal folds of needed lubrication. Caffeinated drinks include coffee, tea, and soft drinks. Small amounts of these beverages are acceptable, but they must be counter balanced by drinking more water.

Another factor that can affect lubrication is a dry air environment. The cause can be from gas furnaces, air conditioners, and climate with a low amount of moisture in the air. Using a cool mist humidifier at night can compensate for the dryness.

The air in airplanes is extremely dry. It is recommended that you drink at least 8 ounces of non-alcoholic and non-caffeinated liquid per hour while flying.

Throat clearing & harsh coughing

Throat clearing and harsh coughing are traumatic to the vocal cords and should be reduced as much as possible.

One of the most frequent causes for throat clearing and coughing is when there is thick mucus (due to dryness) or too much mucus (as with a cold) on or below the vocal folds. The safest and most efficient way to clear mucus is by using a productive cough where there is high air flow with little sound. This can be achieved by using the following procedure: take in as deep a breath as possible, momentarily hold your breath, push the chest and abdomen inward with as much strength as is possible, and produce a silent "H" sound while you expel the air.

Drugs

Antihistamines
Antihistamines are sometimes prescribed to treat allergies and are present in some over-the-counter cold medications. Antihistamines should rarely be used because they tend to cause dryness. Nasal steroid sprays such as Nasacort (Phone-Poulenc-Rorer), Nasonex (Schering), Flonase (Allen & Hansburys), etc. will often relieve the symptoms of the nasal allergy without the drying side effects of antihistamines.
Analgesics
Aspirin products and non-steroidal anti-inflammatory drugs (Ibuprofen) should be used with caution as they cause platelet dysfunction and this may pre-dispose to bleeding. Tylenol (McNeil Consumer Products) is the best substitute for pain relief.
Mucolytic Agents: Mucus breaking or thinning  medications.
Mucolytic expectorants (gauifenesin) help liquefy viscous mucus and increase the output of thin respiratory tract secretions. Humibid L.A. (Adams, Liquibid (Ion), and Fenesin (Dura) are currently the most convenient preparations available. These drugs may be helpful for singers who complain of thick secretions, frequency throat clearing, or postnasal drip. Postnasal drip is often caused by secretions that are too thick rather than too plentiful. Mucolytic agents need to be used with good hydration to be effective.
Local Anesthetics: Locally numbing medications. 
Avoid the use of local anesthetic over-the-counter preparations like the plague. Singing under their influence is like trying to play the piano with gloves on.
Progesterone: A hormone which maintains pregnancy can effect female voice.
Question the use of progesterone dominant birth-control pills. They may cause virilization (more masculine type) of the female larynx and a loss in the upper vocal range. There may be no other alternative for your individual situation, however, consulting  gynecologist or endocrinologist can help resolve the problem.

Recommendations to prevent Acid Reflux

What is Acid Reflux?
When we eat something, the food reaches the stomach by traveling down a muscular tube called the esophagus. Once food reaches the stomach, the stomach adds acid and pepsin (a digestive enzyme) so that the food can be digested. The esophagus has two sphincters (bands of muscle fibers that close off the tube) that help keep the contents of the stomach where they belong. One sphincter is at the top of the esophagus (at the junction with the upper throat) and one is at the bottom of the esophagus (at the junction with the stomach). The term REFLUX means "a backward or return flow," and it usually refers to the backward flow of stomach contents up through the sphincters and into the esophagus or throat.
What is GERD and LPRD?
Some people have an abnormal amount of reflux of stomach acid up through the lower sphincter and into the esophagus. This is referred to as GERD or Gastroesophageal Reflux Disease. If the reflux makes it all the way up through the upper sphincter and into the back of the throat, it is called LPRD or Laryngopharyngeal Reflux Disease. The structures in the throat (pharynx, larynx, and lungs) are much more sensitive to stomach acid so smaller amounts of reflux into this area can result in more damage.
Why Don't I Have Heartburn or Stomach Problems?
This is a question that is often asked by patients with LPRD. The fact is that very few patients with LPRD experience significant heartburn. Heartburn occurs when the tissue in the esophagus becomes irritated. Most of the reflux events that can damage the throat happen without the patient ever knowing that they are occurring.
Common Symptoms of LPRD:

Hoarseness, chronic (ongoing) cough, frequent throat clearing, pain or sensation in throat, feeling of lump in throat, problems while swallowing, bad/bitter taste in mouth (especially in the morning), asthma-like symptoms, referred ear pain, post nasal drip, singing difficulties (especially with high notes).

Diagnosis of LPRD (Laryngopharyngeal Reflux Disease):

The following signs, seen by the physician, are strong indicators of LPRD:

  • Red irritated arytenoids (structures at the back of the vocal folds)
  • Red irritated larynx
  • Small laryngeal ulcers
  • Swelling of the vocal folds
  • Granulomas in the larynx
  • Evidence of hiatal hernia (may or may not be associated with reflux)
  • Significant laryngeal pathology of any type
Treatment for LPRD:
  • Avoid Stress : Take significant steps to reduce stress! Make time in your schedule to do activities that lower your stress level. Even moderate stress can dramatically increase the amount of reflux.
  • Watch your food : You should pay close attention to how your system reacts to various foods. Each person will discover which foods cause an increase in reflux. The following foods have been shown to cause reflux in many people. It may be necessary to avoid or minimize some of the following foods: spicy, acidic, and tomato-based foods like Mexican or Italian foods; acidic fruit juices such as orange juice, grapefruit juice, cranberry juice, etc.; fast foods and other fatty foots; caffeinated beverages (coffee, tea, soft drinks); peppermint and chocolate.
  • Eat in moderate amounts: Do not gorge yourself at mealtime, eat small (moderate amounts of food), eat meals several hours before bedtime, avoid bedtime snacks, do not exercise immediately after eating.
  • Maintain Ideal Body Weight: Try to maintain a healthy body weight. Being overweight can dramatically increase reflux.
  • Avoid Tight Clothing: Avoid tight belts and other restrictive clothing.
  • Stop Smoking: If you smoke, STOP!! This dramatically causes reflux and many other evils to your body!!!
  • Watch your medications:Such as NSAIDS (Non Steroid Anti Inflammatory Drugs) (e.g. Advil type medications), aspirin, and steroids, can aggravate reflux.

Caring your vocals

Avoid smoking cigarettes. They are bad for the heart, lungs, and vocal tract. Also, avoid other irritant inhalant substances and mind-altering drugs. Tobacco and marijuana are irritants to the vocal tract. When you sing you must be in control of all body systems: physical, spiritual, and mental. Smoking is a disaster for the speaking and singing voice.

Vocal Health

Try your best to maintain a good general health. Get adequate rest to minimize fatigue. If you do get sick, do not attempt to override a cold or laryngitis. See your physician and rest your voice.

  • Exercise regularly.
  • Eat a balanced diet including: vegetables, fruits, and whole grain foods.
  • Maintain body hydration (drink 7-9 glasses of water per day).
  • Avoid dry, artificial interior climates.
  • Avoid breathing smoggy, polluted air.

Vocal  Practice

Less is more if we think of vocal longevity. Do not speak excessively. Try reducing the amount of voice use and increasing the frequency of vocal rest periods. This is especially important when suffering from vocal or generalized fatigue.

Avoid speaking/singing in a pitch range (tessitura) that is continually near the extremes of your own vocal range.

Limit the use of the voice in high-noise environments (loud restaurants, parties, cars, planes).

Avoid shouting, screaming, loud laughter, and excessively loud speech. Also, some vocal sound effects can be very damaging to the vocal folds and should be avoided. Avoid whispering. In fact, it is more damaging to whisper than talk when you are ill. This especially includes the "stage whisper."

Reduce general voice use before a performance. Reduce your mileage. Think voice conservation.

Vocal warm-ups should always be used prior to singing. Vocal cool-downs are also essential to keep the singing voice healthy.

Suggestions for good vocal care:

  • If you need to get someone's attention, use non-vocal sounds such as clapping, bells, or whistling.
  • Move closer to those with whom you are speaking.
  • Face the person(s) with whom you are speaking.
  • Use amplification as needed if possible.
  • Be aware of noise in the environment.
  • Do not strain your voice.
  • Use good abdominal/diaphragmatic breathing and support.
  • Learn to use your voice with as little unnecessary effort and tension as possible.
  • Take frequent breaths with speaking long sentences.
  • Maintain a smooth legato speech pattern with clear articulation.
  • Allow the neck, jaw and face to be relaxed
  • "Place" or "focus" the voice appropriately.
  • Speak at a normal rate of speed.
  • Use good vocal inflection.

 

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