The Vocal Pedagogy Workshop

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

Associate Professor of Voice and Vocal Pedagogy
School of Music
University of North Texas
Vocal Health
The Vocal Pedagogy Workshop 2011
Session V Vocal Health
How do we keep the voice healthy?

Avoid known irritants
Chemicals; household, garden, workplace
Cigarette smoke even secondhand
Molds, mildews, other allergens
Reinkes Edema

Provide a humid environment
Avoid long exposures to dry air
Air travel
Heated/air conditioned bedrooms
Keep your body hydrated
Dr. Van Lawrence: Pee Pale

Avoid excessive diuretics when possible
Caffeine coffee, tea, soft drinks, chocolate!
Avoid Overuse/Misuse
Too much singing
Talking in noisy environments (cars, planes, etc.)
Cheerleading, choir directing, sports events
Hematoma
What do I do when Im really sick?

Allergies/Colds
Nose Sprays
Pediatric strength Afrin. Limit to 3-5 days.
Alternate sides.
Topical nasal steroids for seasonal symptoms:
Beconase, Vancenase, Rhinocort, Nasalide, etc.

Allergies/Colds
Antihistamines for allergy symptoms
When topical applications are not enough
Potentially drying; find one that isnt
Some sedation problems
Over-the-counter brands are the worst
Chlor-trimeton, Polaramine, Dimetate, etc.
Many prescription alternatives: Seldane, Hismanol,

Clariton, many new ones.

Allergies/Colds
Decongestants; antihistamines do not control
nasal congestion, use a decongestant too.
Sometimes both are included: potentiates drying
effects and counteracts the sedation issues:
Seldane-D, Claritin-D, etc.
May cause mild stimulatory side effects: insomnia
and tachycardia

Allergies/Colds
Mucolytic Agents
Counteract drying effect of antihistamines and
decongestants
Liquefy mucus and increase the output of thin
respiratory tract secretions
Guaifenesin is a common mucolytic expectorant:
found in Mucinex, Robitussin, Humibid, etc.
Combined with a decongestant in: Entex and others

10

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
11

Laryngitis with vocal fold injury

Usually 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
12

Laryngitis without vocal fold injury

Vocal fold edema resulting from infectious or noninfectious causes
Voice rest is not necessarily indicated
Result from overuse, misuse and many URI
Treatment includes: selective voice use, hydration,
mucolytics, corticosteroids, etc.
No whispering!
13
Acute Laryngitis
14
Medications: Many common drugs have

effects on the voice. Never take them
without consulting an in the know
physician.
15
Medications: Analgesics
Aspirin is contraindicated in professional voice
users.
Causes platelet dysfunction
Predisposes to vocal fold hemorrhage
Acetaminophen is best substitute (Tylenol)
16
Medications: Antibiotics
Widely over-prescribed and overused
No use for viral infections, only bacterial
Only upon a doctors recommendation
When prescribed the full course should be
taken
17
Medications: Antitussives
Coughing is a serious concern
Cough suppression is not necessarily the goal
Productive cough is vital for healing
Many contain antihistamines and are drying
Those that contain guaifenesin are helpful
18
The Vocal Pedagogy Workshop Session V: Vocal Health
Medications: Antihypertensive Agents

Most have some drying effect
Often prescribed with diuretic agents that also
promote dehydration
If dryness is severe alternative chemicals
should be sought
19
Hormones in the singer
Most common hormonal problem in post

pubertal males are related to ingestion of
anabolic steroids
Common amongst athletes
Many health risks; liver, brain tumors
Vocal symptoms include a lowering and coarsening of
the voice
20

Most
common hormonal problem in

post pubertal females are related to
monthly ovarian cycle.
Most in immediate pre-menstrual period
Loss of range, fatigue, slight hoarseness
Due to engorgement of the vf
21

Menopause
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.
However, ovaries continue to produce
androgens (virilization).
35-40 yo performers should have baseline
estrogen levels for later reference.
23
Hormones in the singer.

Menopause.
Replacement therapy should be guided by a
gynecologist, endocrinologist, and a
laryngologist.
Androgens should not be given to a singer
if there is a reasonable therapeutic
alternative.
Androgens are found in some European
birth control The
pills.
Vocal Pedagogy Workshop 2011
24

Hypothyroidism
Thyroid gland regulates protein
synthesis and tissue metabolism.
Thyroid disorders are common in the
population (<4%).
25

Hypothyroidism
Symptoms:
Hoarseness
Vocal fatigue
Muffling of the voice
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.
27

Hypothyroidism
Increased fluid in lamina propria.
Surgical complications are significant:
Recurrent and superior laryngeal nerves pass
through the thyroid gland
Surgery can severe the nerves; paralysis
28
Gastric Reflux (GERD)

Stomach contents spill out over the
larynx.
Gastric acid irritation of the musosa
High incidence in voice complaints
Satoloff (1991) 50% of voice patients
Koufman (1996) 78% with hoarseness
29

Symptoms:
Morning hoarseness
Prolonged warm-up time
Halitosis
Excessive phlegm
Frequent throat clearing
Dry mouth
30

Symptoms:
Coated tongue
Sensation of a lump in the throat
Throat tickle
Dysphagia
Chronic sore throat
heartburn
31

Physical exam:
Erythema (reddening) & edema
(swelling) of mucosa around the
arytenoids, false folds and posterior
portion of the true folds
32

Diagnosis:
Examination by gastroenterologist
Ph monitor (24 hours)
My
diagnosis: Assume that you have it,

treat it and save yourself $$!
33

Rx
Elevate the head of the bed 6 inches

Antacids at bedtime
No eating 3 to 4 hours before bed
Avoid coffee and alchohol
Prilosec, Privicid, Nexium, etc.
34
Vocal Nodules
Benign growths on vibrating margin of
the vocal folds.
Usually bilateral and symmetric.
Caused by chronic, forceful vf contact.
35
Vocal Nodules
Occur at point of maximum contact
force; the midpoint of membranous vf.
Increases mass and stiffness.
Always result of abuse in speaking or
singing voice.
36

Nodules
37
Vocal Nodules
Symptoms:
A change in vocal quality for new case
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 will resolve with
voice therapy (90%).
Old nodules do not respond to therapy, but
therapy should be done prior to surgery.
39
Vocal Nodules
Any surgical procedure can leave a scar,
and a scar means dysfunction.
Vocal fold stripping is absolutely
considered malpractice today.
40
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
41

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The Vocal Pedagogy Workshop

Stephen F. Austin, M.M., Ph.D.