Care of the Professional Voice

Malcolm Baxter FRACS

ACENTP Sydney 2012

Care of the Professional Voice User

Does /Should the Care vary from voice problems of the non-professional?

Does the non-professional just care about excluding cancer?

Who is the Professional Voice User?• Singers / Actors -large proportion but the concept of

“professional” is fluid- “Serious amateurs” are probably our majority

• Teachers• Fitness Instructors• Clergymen• Auctioneers• Lawyers• Politicians• Anyone with face to face/ telephone contact

– Call Centre workers!

Care of the Professional Voice

Science ,Art or B*******t?

An explosion in the scientific literature ?

Punt 1983 24pp Sataloff 2005 3 vol >1500p

The Voice Team

Where?

At your rooms

Resist the temptation to be summoned to their hotel / theatre !

How?

• Videostroboscopy is the gold standard especially for the professional

• Rigid• Distal chip flexible videoscope

• Never give an opinion on a “high grade” professional singer actor without at least recording the examination-especially if a performance hangs on it. Medico-Legal implications.

Videostroboscopy

Rigid Distal Chip Flexible Videoscope

Common Medical Conditions to Beware of

• Reflux - Lifestyle of singers/actors predisposes

• Asthma- Preventer sprays especially-do not advise them to stop without consulting their respiratory doctor!

• Allergies-and use of antihistamines

• Drugs –prescription and non-prescription

• Musculoskeletal problems• URTI

The Acute Performance Emergency-”can I go on”, “if I do will it

ruin my voice for ever”?

More Chronic problems leading to the PVU seeking consultation

• MTD

• Nodules aaaarrrrggghhhh!!!!

• Other mucosal lesions Cysts,Polyps etc

• LPR often in association with one of the above

Treatments• Rest Therapeutic and preventative (music theatre very

high load) Day of silence. “Never utter a sound unless you are paid for it” Norman Punt

• Hydration

• Voice therapy (SP)

• Physio

• Medical- where appropriate

• Surgery -not to be undertaken lightly in the performer. May need extra rest,time off

In singers and actors don’t assume anatomical perfection is desirable for them--

Steroids

When to Use When the singer absolutely can’t cancel and

there is pathology in the VFs which should be amenable to their use eg Oedema,inflammation . Acute strain and bleeding are unlikely to benefit much.

Note steroid hoarders and swappers.Beware reflux, Beware Psych states,Beware

rebound

Steroids

• What to Use – Oral Prednisolone 50mg stat preferably starting

day before or no later than morning of performance. Reduce over next week. If you need to use for along time it probably means you shouldn’t be using it at all –ie a short term solution

– IM Methylprednisolone 40 mg/ml When short interval to performance . Note the Mystique of the Needle!