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!
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Avoid air born irritants
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Avoid chemicals: household, garden, workplace, etc.
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Avoid smoke!
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Reinke’s Edema
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 Avoid long exposures to dry air
–Air travel
– Heated/air conditioned bedrooms
 Keep your body hydrated!
–Dr. Van Lawrence: “Pee Pale”
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Molds, mildews, other allergens
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Coffee
Avoid excessive diuretics
Chocolate
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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
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Hemorrhagic polyp
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Hemorrhage
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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.
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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)
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 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!
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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
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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!
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Acute Laryngitis
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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)
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Huge implications for voice
 Puberty
 Normal female cycle
 Endocrine issues: thyroid, fluctuation in sex-hormones
 Menopause/Manopause
 Induced: anabolic steroid ingestion
– Athletes
– Medical treatments
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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
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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
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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.
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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 birth control pills.
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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?
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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!
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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
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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
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Gastric Reflux (GERD)
 Symptoms:
– Morning hoarseness
– Prolonged warm-up time
– Halitosis
– Excessive phlegm
– Frequent throat clearing
– Dry mouth
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Gastric Reflux (GERD)
 Symptoms:
– Coated tongue
– Sensation of a lump in the throat
– Throat tickle
– Dysphagia
– Chronic sore throat
– Heartburn – not always!
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Gastric Reflux (GERD)
 Physical exam:
– Erythema (reddening) & edema
(swelling) of mucosa around the arytenoids, false folds and posterior portion of the true folds
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Gastric Reflux (GERD)
 Diagnosis:
– Examination by gastroenterologist
– Ph monitor (24 hours)
 My diagnosis: Assume that you have it, treat it and save yourself $$!
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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
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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
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T
Nodules
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Vocal Nodules
 Symptoms:
– A change in vocal quality
– Breathiness
– Loss of range
– Vocal fatigue
– Aphonia in certain parts of the range
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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.
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Other ‘space occupying lesions:
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Cyst
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Polyp
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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.
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Other horrifying things: fungal infection
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Dislocated arytenoid
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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
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