THE VOICE Teacher, Conductor, Singer, Student ! Rebecca Miles Risser, M.M.,M.A., CCC-SLP Clinical Speech Pathologist, Voice Specialist Performance Voice

THE VOICETHE VOICETeacher, Conductor, Teacher, Conductor,

Singer, Student !Singer, Student !

Rebecca Miles Risser, M.M.,M.A., CCC-Rebecca Miles Risser, M.M.,M.A., CCC-SLPSLP

Clinical Speech Pathologist, Voice Clinical Speech Pathologist, Voice SpecialistSpecialist

Performance Voice SolutionsPerformance Voice Solutions12065 Old Meridian, Suite 25512065 Old Meridian, Suite 255

Carmel, IN 46032Carmel, IN 46032317.705.2732317.705.2732

[email protected]@performancevoicesolutions.comm

The Voice Care TeamThe Voice Care Team

The Primary Care Physician (PCP)The Primary Care Physician (PCP) Family Practitioner, Pediatrician, InternistFamily Practitioner, Pediatrician, Internist

The Otolaryngologist (ENT) or The Otolaryngologist (ENT) or LaryngologistLaryngologist

Speech Language Pathologist Speech Language Pathologist (specialized in voice)(specialized in voice)

Voice Scientist (Researchers) Voice Scientist (Researchers) Voice Teachers (Private, choral directors, Voice Teachers (Private, choral directors,

etc.) and voice coaches (private)etc.) and voice coaches (private)

Our GroupOur Group

Performance Voice Solutions is a division Performance Voice Solutions is a division of Northside ENT, Inc., and together of Northside ENT, Inc., and together consists of one slp and four ENTs. consists of one slp and four ENTs.

Model of Care reflects strong autonomy Model of Care reflects strong autonomy and respect between clinician/physician and respect between clinician/physician with frequent, nearly daily, consultation with frequent, nearly daily, consultation re: patients and current research.re: patients and current research.

““Voice Specialist”??Voice Specialist”?? Besides traditional speech pathology training, a voice Besides traditional speech pathology training, a voice

specialist has additional training, which includes specialist has additional training, which includes training in the use of videostroboscopy, training in training in the use of videostroboscopy, training in normal vs. abnormal anatomy, and therapy techniques.normal vs. abnormal anatomy, and therapy techniques.

My background:My background: Masters of Music (1990) in Performance and Pedagogy – Masters of Music (1990) in Performance and Pedagogy –

NIU NIU Masters of Arts (2000) in Speech Language Pathology – Masters of Arts (2000) in Speech Language Pathology –

IUIU National Boards (2000) = Certificate of Clinical National Boards (2000) = Certificate of Clinical

Competency in Speech Language Pathology (CCC-SLP) Competency in Speech Language Pathology (CCC-SLP) from ASHAfrom ASHA

State Boards(2000) – licensed to practice in IndianaState Boards(2000) – licensed to practice in Indiana

““What do you do, What do you do, anyway”?anyway”?

Voice EvaluationVoice Evaluation Indexes to baseline issues Indexes to baseline issues

of reflux (Reflux Symptom of reflux (Reflux Symptom Index), the Voice-Related Index), the Voice-Related Quality of Life (V-RQOL) Quality of Life (V-RQOL) and the Voice Handicap and the Voice Handicap Index (VHI), or the Index (VHI), or the Singer’s Voice Handicap Singer’s Voice Handicap Index (S-VHI).Index (S-VHI).

Acoustic evaluation, using Acoustic evaluation, using PRAAT software to PRAAT software to evaluate Fundamental evaluate Fundamental frequency, Relative frequency, Relative Average Perturbation, Average Perturbation, Intensity, and MPT and s/z Intensity, and MPT and s/z ratio.ratio.

““What do you do, What do you do, anyway”?anyway”?

VideostroboscopyVideostroboscopy Slow motion Slow motion

photography of the photography of the vocal folds, as they vocal folds, as they are vibrating.are vibrating.

Immediate, magnified Immediate, magnified imaging for presence imaging for presence or absence of or absence of pathology.pathology.

Allows clinician to Allows clinician to view even very small view even very small changes in the changes in the vibratory capacity of vibratory capacity of the vocal foldsthe vocal folds

VideostroboscopyVideostroboscopy Gives the patient Gives the patient

immediate feedback immediate feedback and opportunity to and opportunity to view their vocal folds view their vocal folds – great educational – great educational tool.tool.

Once strobe Once strobe obtained, then obtained, then complete the Reflux complete the Reflux Finding Score Finding Score (Belafsky, Kouffman, (Belafsky, Kouffman, et al.)et al.)

The most common diagnostics noted The most common diagnostics noted with teachers, choral directors, singers with teachers, choral directors, singers

and voice students .and voice students . At Performance Voice Solutions, the top At Performance Voice Solutions, the top

four diagnostics associated with teachers, four diagnostics associated with teachers, including singing teachers, choral including singing teachers, choral directors, singers (professional and non-directors, singers (professional and non-professional) and voice students includeprofessional) and voice students include::

Singers nodulesSingers nodules Polyps/cystsPolyps/cysts Hyperfunctional dysphonia (depending on Hyperfunctional dysphonia (depending on

the type of singing)the type of singing) Laryngopharyngeal Reflux DiseaseLaryngopharyngeal Reflux Disease

Occupational Risks for Voice Occupational Risks for Voice Problems (Verdolini and Problems (Verdolini and

Ramig, 2001)Ramig, 2001) In the United States, roughly 3-9% of the In the United States, roughly 3-9% of the

generalgeneral population has some type of population has some type of voice abnormality at any given moment.voice abnormality at any given moment.

With the advent of the information age, With the advent of the information age, voice has assumed an increasingly voice has assumed an increasingly important role in job function.important role in job function.

Conservative estimates indicate that Conservative estimates indicate that over 25% of the working population (i.e. over 25% of the working population (i.e. 28,000,000 people) list voice as a critical 28,000,000 people) list voice as a critical aspect in their job.aspect in their job.

Occupations at Risk for Voice Occupations at Risk for Voice Problems (Verdolini and Problems (Verdolini and

Ramig, 2001)Ramig, 2001) The occupational risk factors for voice The occupational risk factors for voice

disorder in US and Sweden:disorder in US and Sweden: SingerSinger Counselor/social workerCounselor/social worker TeacherTeacher LawyerLawyer ClergyClergy TelemarketerTelemarketer Ticket salesTicket sales Health careHealth care

Rebecca Risser

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Ramig, 2001)Ramig, 2001) Let’s talk teachers…Let’s talk teachers…

Various studies have been completed, with a Various studies have been completed, with a range of responses, but in general at the time range of responses, but in general at the time of this study, 32%-47.5% of responding of this study, 32%-47.5% of responding teachers reported that they were currently teachers reported that they were currently hoarse.hoarse.

20-30% indicated they had missed work the 20-30% indicated they had missed work the previous school year because of voice problems.previous school year because of voice problems.

38% reported negative effect of teaching on 38% reported negative effect of teaching on voicevoice

39% were currently reducing work (reducing 39% were currently reducing work (reducing teaching activities) due to voice.teaching activities) due to voice.


Ramig, 2001)Ramig, 2001) ““Considering only lost work Considering only lost work

days and treatment expenses, days and treatment expenses, the societal cost of voice the societal cost of voice problems in teachers alone problems in teachers alone may be…about $2.5 billion may be…about $2.5 billion annually in the U.S.”annually in the U.S.”


Ramig, 2001)Ramig, 2001) More on teachers…More on teachers…

Female teachers reported voice Female teachers reported voice problems more frequently than males problems more frequently than males (38% vs. 26%).(38% vs. 26%).

Physical education teachers presented Physical education teachers presented highest risk, independent of gender, highest risk, independent of gender, hours of teaching per day, number of hours of teaching per day, number of years teaching or ageyears teaching or age

Rebecca Risser

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Ramig, 2001)Ramig, 2001) Other studies:Other studies:

55% of respondents indicated dry throat55% of respondents indicated dry throat 45% had vocal fatigue45% had vocal fatigue 36% had scratchy sensation36% had scratchy sensation 32% had throat discomfort32% had throat discomfort 31% had to make an effort to talk after 31% had to make an effort to talk after

teachingteaching


Ramig, 2001)Ramig, 2001) Now, singing teachers…Now, singing teachers… 125 singing teachers with 49 control 125 singing teachers with 49 control

subjects completed questionnaires.subjects completed questionnaires. 21%of singing teachers had voice dysfunction 21%of singing teachers had voice dysfunction

(18% of controls) = not a significant difference(18% of controls) = not a significant difference HOWEVER, 64% of singing teachers had voice HOWEVER, 64% of singing teachers had voice

problem in past (33% of controls)…problem in past (33% of controls)…SIGNIFICANTSIGNIFICANT

A history of voice dysfunction in the past A history of voice dysfunction in the past increased likelihood of current voice problem increased likelihood of current voice problem by a factor of FIVE.by a factor of FIVE.


Ramig, 2001)Ramig, 2001) Singing teachers continued…Singing teachers continued…

The current use of dehydrating medications The current use of dehydrating medications increased the likelihood of current voice increased the likelihood of current voice problem by THREE.problem by THREE.

Hmmmm….an increase in the estimated Hmmmm….an increase in the estimated hours of LOUD singing per day appeared to hours of LOUD singing per day appeared to have a protective effect; an increase in the have a protective effect; an increase in the number of hours of loud singing number of hours of loud singing inversely inversely predicted the likelihood of a current voice predicted the likelihood of a current voice problem by a factor of three. (authors problem by a factor of three. (authors interpreted this as an effect of healthy voice interpreted this as an effect of healthy voice not a cause of a healthy voice).not a cause of a healthy voice).


Ramig, 2001)Ramig, 2001) Singing voice teachers…Singing voice teachers…

Congratulations! Congratulations! Large proportion of singing teachers with Large proportion of singing teachers with

current (56%) or past (83%) voice problems current (56%) or past (83%) voice problems sought professional help.sought professional help.

HOWEVER…in this study, no singer or HOWEVER…in this study, no singer or control respondent with a current voice control respondent with a current voice problem had received voice therapy for problem had received voice therapy for it. Only 4% of respondents with a past it. Only 4% of respondents with a past voice problem had received therapy.voice problem had received therapy.


Ramig, 2001)Ramig, 2001) Choral singers: Choral singers:

National Convention of Gospel Choirs National Convention of Gospel Choirs and Choruses (NCGCC) and American and Choruses (NCGCC) and American Choral Directors Association (ACDA) Choral Directors Association (ACDA) were polled. were polled.

Most of the NCGCC members were Most of the NCGCC members were African American; most of the ACDA African American; most of the ACDA members were Caucasian. members were Caucasian.


Ramig, 2001)Ramig, 2001) 50% of gospel singers reported 50% of gospel singers reported

current perceived hoarseness in current perceived hoarseness in comparison to 35% of classical comparison to 35% of classical singerssingers

Hoarse AA singers were neutral Hoarse AA singers were neutral about seeking voice treatment; about seeking voice treatment; hoarse Caucasian singers were hoarse Caucasian singers were “likely” to seek treatment or “likely” to seek treatment or “intended” to seek treatment.“intended” to seek treatment.


Ramig, 2001)Ramig, 2001) For AA respondents, For AA respondents, others’ opinionsothers’ opinions

about treatment appeared to predict the about treatment appeared to predict the likelihood of seeking treatment for likelihood of seeking treatment for current voice problem. In other words, a current voice problem. In other words, a cultural biascultural bias influenced them. influenced them.

For Caucasian respondents, one’s own For Caucasian respondents, one’s own opinion or “feelings” about seeking opinion or “feelings” about seeking treatment predicted the likelihood of treatment predicted the likelihood of seeking treatment. In other words, a seeking treatment. In other words, a personal biaspersonal bias influenced them. influenced them.

So how can we So how can we fix the fix the

problem?problem?

Novel thought #1…Novel thought #1…

Let’s start Let’s start talking talking

with each with each other!other!

Thoughts from my choral Thoughts from my choral director/patientsdirector/patients

““I wish someone had told me about the I wish someone had told me about the connection between my singing voice and connection between my singing voice and my speaking voice.”my speaking voice.” What’s this about?What’s this about?

How do we achieve vocal rest in a healthy How do we achieve vocal rest in a healthy functional way apart from “shutting functional way apart from “shutting down”?down”?

““Tell them that the speaking voice Tell them that the speaking voice requires a warm-up before the teaching requires a warm-up before the teaching day begins.”day begins.”

Thoughts from my choral Thoughts from my choral director/patientsdirector/patients

““Talk about female teachers Talk about female teachers demonstrating for male choirs”demonstrating for male choirs” Recording parts on “smart music” and Recording parts on “smart music” and

emailing the parts to the students;emailing the parts to the students; Having a high school male record the Having a high school male record the

singing parts for extra credit.singing parts for extra credit. For noisy groups: visual cues mounted For noisy groups: visual cues mounted

on craft sticks.on craft sticks.

Novel thought #2…Novel thought #2…

It It ISIS possible to possible to use a healthy use a healthy

voice to teach, voice to teach, sing, AND even sing, AND even

have a voice have a voice that’s that’s as good as good or betteror better at at

the end of the the end of the day!day!

Vocal Fold Wound Vocal Fold Wound HealingHealing

In 2003, Branski, et. al found that In 2003, Branski, et. al found that low levels of dynamic, biomechanical low levels of dynamic, biomechanical stress inhibited IL-1Beta (associated stress inhibited IL-1Beta (associated with inflammation) in injured tissue. with inflammation) in injured tissue.

Vocal tissue from rabbits were Vocal tissue from rabbits were exposed to variable levels of cyclic exposed to variable levels of cyclic tensile strain (repetitive rotating tensile strain (repetitive rotating vibratory movement similar to vocal vibratory movement similar to vocal cord vibrations). cord vibrations).

ResultsResults

1.1. CTS reduced inflammation by inducing CTS reduced inflammation by inducing the increase of “collagen synthesis” the increase of “collagen synthesis” (i.e. a marker for healing of injured (i.e. a marker for healing of injured tissue) tissue) in the presencein the presence of IL-1Beta. of IL-1Beta.

2.2. Therefore, low-levels of biomechanical Therefore, low-levels of biomechanical stress stress inducedinduced wound healing by wound healing by decreasing the time it took to move decreasing the time it took to move from inflammation to tissue rebuildingfrom inflammation to tissue rebuilding..

ResultsResults

Another Branski study compared two Another Branski study compared two groups of performers, one with vocal fold groups of performers, one with vocal fold nodules and one with healthy larynxes. nodules and one with healthy larynxes.

Both groups were able to produce a resonant Both groups were able to produce a resonant voice as compared to a pressed , a normal, voice as compared to a pressed , a normal, and a breathy voice.and a breathy voice.

““resonance” approximated the configuration resonance” approximated the configuration in Branski’s study, in which low-level in Branski’s study, in which low-level biomechanical stress induced wound healing biomechanical stress induced wound healing faster. faster.

The missing link…The missing link…

““Resonant voice” also corresponded Resonant voice” also corresponded to easy, clear resonance advocated to easy, clear resonance advocated by Lessac Madsen Resonant Voice by Lessac Madsen Resonant Voice Therapy, and to the “mask” Therapy, and to the “mask” resonance advocated by singing resonance advocated by singing teacher of solo singers.teacher of solo singers.

Voice therapy or tissue Voice therapy or tissue re-engineering?re-engineering?

Therefore, voice therapy Therefore, voice therapy techniques enhance techniques enhance

biological phases of wound biological phases of wound healing in recurrent, acute healing in recurrent, acute

phonotraumaphonotrauma..

So, what should I look for?So, what should I look for?

Let’s start Let’s start with your with your students…students…

““How do I know if my How do I know if my student needs to see a voice student needs to see a voice

specialist?”specialist?” 1. Speaking voice and singing voice 1. Speaking voice and singing voice

should both be smooth and easy, with should both be smooth and easy, with no roughness, no breathiness.no roughness, no breathiness.

2. If they become hoarse, it should last 2. If they become hoarse, it should last no more than two weeks, and this no more than two weeks, and this should be no more than 1-2 times each should be no more than 1-2 times each YEAR.YEAR.

3. Extroverted individuals will likely 3. Extroverted individuals will likely have vocal fold nodules; introverted will have vocal fold nodules; introverted will likely have muscle tension dysphonia.likely have muscle tension dysphonia.

But what if it’s not the But what if it’s not the student !?!student !?!

Now let’s Now let’s take a look take a look

at at

YOUYOU

““That ain’t right”That ain’t right”

1. Hoarseness is not normal.1. Hoarseness is not normal. 2. Breathiness is not normal.2. Breathiness is not normal. 3. The “Monday-Friday effect” is not 3. The “Monday-Friday effect” is not

normal.normal. 3. Missing whole sections of your 3. Missing whole sections of your

voice? voice? NOT NORMALNOT NORMAL..

What can we do?What can we do?

1. Amplify. Get a microphone 1. Amplify. Get a microphone system either through your school system either through your school (no, really, they sometimes do this…) (no, really, they sometimes do this…) or rig something up at Radio Shack.or rig something up at Radio Shack.

2. Warm up your speaking voice 2. Warm up your speaking voice before your first class (Vocal before your first class (Vocal Function Exercises).Function Exercises).

What can we do?What can we do?

3. When you teach, it’s better to 3. When you teach, it’s better to speak 10 minutes “on” then 10 speak 10 minutes “on” then 10 minutes “off” throughout your day.minutes “off” throughout your day.

4. Restore your voice through easy, 4. Restore your voice through easy, resonant glides to regain focus and resonant glides to regain focus and reduce effortreduce effort

5. Listen to your body – where it is 5. Listen to your body – where it is tight?tight?

The “Take Home” The “Take Home”

Let’s learn a Let’s learn a fantastic fantastic warm up warm up

together…together…

Vocal Function Exercises Vocal Function Exercises (Joseph C. Stemple, Ph.D.)(Joseph C. Stemple, Ph.D.)

In our current climate of self-In our current climate of self-improvement, voice improvement is improvement, voice improvement is not only for the disordered voice but not only for the disordered voice but also for those who want to enhance also for those who want to enhance vocal health and image.vocal health and image.

Voice is one part of the physical, Voice is one part of the physical, emotional and life-style status of an emotional and life-style status of an individual.individual.

Wellness LineWellness Line

Disordered voiceDisordered voice Outstanding voice Outstanding voice

________________________________________________________________Normal voiceNormal voice

The programThe program

1. Sustain “ee” vowel for as long as 1. Sustain “ee” vowel for as long as possible on F3 for adult males, F4 possible on F3 for adult males, F4 for adult females and childrenfor adult females and children Goal: should be equal to sustained /s/ in Goal: should be equal to sustained /s/ in

terms of time. Vocal quality is forward terms of time. Vocal quality is forward but not quite nasal. Voice should be but not quite nasal. Voice should be engaged and not breathy. (I encourage engaged and not breathy. (I encourage a “twang” sound to narrow the AES)a “twang” sound to narrow the AES)

The programThe program 2. Glide from lowest note to highest on 2. Glide from lowest note to highest on

“whoop”.“whoop”. Goal: no voice breaks. It engages all the Goal: no voice breaks. It engages all the

laryngeal muscles, and encourages a slow laryngeal muscles, and encourages a slow engagement of the cricothyroid muscles.engagement of the cricothyroid muscles.

3. Glide from highest note to lowest note 3. Glide from highest note to lowest note on “boom”on “boom” Goal: no voice breaks. By keeping an open Goal: no voice breaks. By keeping an open

throat, it encourages the engagement of the throat, it encourages the engagement of the thyroarytenoid muscles without the presence thyroarytenoid muscles without the presence of a back-focused “growl” – No Growling!of a back-focused “growl” – No Growling!

The programThe program

4. Sustain musical notes (C-D-E-F-G) 4. Sustain musical notes (C-D-E-F-G) for as long as possible (for lower for as long as possible (for lower voices, A-B-C-D-E) on the word voices, A-B-C-D-E) on the word “knoll” or “moe” or “no”. “knoll” or “moe” or “no”. Goal: should be equal to sustained /s/ in Goal: should be equal to sustained /s/ in

terms of time. Vocal quality is forward terms of time. Vocal quality is forward but not quite nasal. Voice should be but not quite nasal. Voice should be engaged and not breathy. This is engaged and not breathy. This is considered a low impact, adductory considered a low impact, adductory power exercise.power exercise.

Program “Notes”Program “Notes”

All exercises are done as softly as All exercises are done as softly as possible, per the author’s notes. In possible, per the author’s notes. In keeping with other literature, it keeping with other literature, it should be kept as soft as possible, should be kept as soft as possible, while maintaining a clear tone.while maintaining a clear tone.

Let’s keep our Let’s keep our conversation going…(I’m conversation going…(I’m

in Booth 419!)in Booth 419!)

GO FORTH GO FORTH AND AND

PHONATE!PHONATE!

BibliographyBibliography Blaylock, Thomas R., Blaylock, Thomas R., Effects of Systematized Effects of Systematized

Vocal Warm-Up on Voices With Disorders of Vocal Warm-Up on Voices With Disorders of Various EtiologiesVarious Etiologies. Journal of Voice. Vol. 13, No. . Journal of Voice. Vol. 13, No. 1, pp. 43-50.1, pp. 43-50.

Branski R.C., Verdolini, K., Sandulache, V., Branski R.C., Verdolini, K., Sandulache, V., Rosen, C.A., and Hebda, P.A. Rosen, C.A., and Hebda, P.A. Vocal Fold Wound Vocal Fold Wound Healing: A Review for CliniciansHealing: A Review for Clinicians. Journal of . Journal of Voice 20(3): 432-442 September 2006.Voice 20(3): 432-442 September 2006.

Branski, RC, Verdolini, K, Rosen, CA, Hebda, PA. Branski, RC, Verdolini, K, Rosen, CA, Hebda, PA. Markers of wound healing in vocal fold Markers of wound healing in vocal fold secretions from patients with laryngeal secretions from patients with laryngeal pathologypathology. The Annals of Otology, Rhinology, & . The Annals of Otology, Rhinology, & Laryngology 113 (1): 23-29, 2004.Laryngology 113 (1): 23-29, 2004.

BibliographyBibliography Branski , R, Perera, P, Verdolini, K, Rosen, CA, Branski , R, Perera, P, Verdolini, K, Rosen, CA,

Hebda, P, Agarwal S. Hebda, P, Agarwal S. Dynamic Biomechanical Dynamic Biomechanical Strain Inhibits IL-1β-induced Inflammation in Strain Inhibits IL-1β-induced Inflammation in Vocal Fold FibroblastsVocal Fold Fibroblasts. Journal of Voice, 21(6): . Journal of Voice, 21(6): 651-660 2007.651-660 2007.

Branski R, Verdolini K, Rosen, CA, Hebda, PA. Branski R, Verdolini K, Rosen, CA, Hebda, PA. Acute vocal fold wound healing in a rabbit modelAcute vocal fold wound healing in a rabbit model. . The Annals of Otology, Rhinology & Laryngology The Annals of Otology, Rhinology & Laryngology 114(1): 19-24 2005.114(1): 19-24 2005.

Ford, J.K., Ford, J.K., Preferences for Strong or Weak Preferences for Strong or Weak Singer’s formant Resonance in Choral Tone Singer’s formant Resonance in Choral Tone QualityQuality. International Journal of Research in . International Journal of Research in Choral Singing, Vol. 1(1) 2003.Choral Singing, Vol. 1(1) 2003.

BibliographyBibliography Jiang, J. Jiang, J. Vocal Fold Impact Stress AnalysisVocal Fold Impact Stress Analysis. .

Journal of Voice, 15(1): 4-14. 2001Journal of Voice, 15(1): 4-14. 2001 Johns, MM, Johns, MM, Update on the etiology, Update on the etiology,

diagnosis, and treatment of vocal fold diagnosis, and treatment of vocal fold nodules, polyps and cystsnodules, polyps and cysts. Laryngology and . Laryngology and bronchoesophagology, Current opinion in bronchoesophagology, Current opinion in Otolaryngology & Head & Neck Surgery. Otolaryngology & Head & Neck Surgery. 11 (6): 456-461, December 2003.11 (6): 456-461, December 2003.

Krishna, P, Rosen, CA, Branksi, R, Wells, A, Krishna, P, Rosen, CA, Branksi, R, Wells, A, Hebda P, Hebda P, Primed fibroblasts and exogenous Primed fibroblasts and exogenous decorin: Potential treatments for subacute decorin: Potential treatments for subacute vocal fold scarvocal fold scar. Otolaryngology-Head and . Otolaryngology-Head and Neck Surgery, 135(6): 937-945 2006.Neck Surgery, 135(6): 937-945 2006.

BibliographyBibliography Li, NYK, Verdolini K, Clermont G, Mi Q. Li, NYK, Verdolini K, Clermont G, Mi Q.

Rubinstein EN, et al. (2008) Rubinstein EN, et al. (2008) A Patient-A Patient-Specific Specific in silicoin silico Model of Inflammation and Model of Inflammation and Hearing Tested in Acute Vocal Fold InjuryHearing Tested in Acute Vocal Fold Injury. . PLoS ONE 3(7): e2789. doi: PLoS ONE 3(7): e2789. doi: 10.1371/journal.pone.0002789.10.1371/journal.pone.0002789.

Ruotsalainen JH, Sellman J., Lehto L, Ruotsalainen JH, Sellman J., Lehto L, Jauhiainen M, Vrbeek JH. Jauhiainen M, Vrbeek JH. Interventions for Interventions for preventing voice disorders in adultspreventing voice disorders in adults. . Cochrane Databse of Systematic Reviews Cochrane Databse of Systematic Reviews 2007, Issue 4 Art No:CD006372. DOI: 2007, Issue 4 Art No:CD006372. DOI: 10.1002/14651858. CD006372; pub2.10.1002/14651858. CD006372; pub2.

BibliographyBibliography

Thomas, L., Stemple, J.C., Thomas, L., Stemple, J.C., Voice Therapy: Voice Therapy: Does Science Support the ArtDoes Science Support the Art? ? Communication Disorders Review. Volume Communication Disorders Review. Volume 1, Number 1, pp. 49-77.1, Number 1, pp. 49-77.

Verdolini, K, Drucker, D, Palmer, P, Samawi, Verdolini, K, Drucker, D, Palmer, P, Samawi, H., H., Laryngeal Adduction in Resonant VoiceLaryngeal Adduction in Resonant Voice. . Journal of Voice, 12(3): 315-327, 1998.Journal of Voice, 12(3): 315-327, 1998.

Verdolini, K., Ramig, L.O., Review: Verdolini, K., Ramig, L.O., Review: Occupational risks for voice problems. Log. Occupational risks for voice problems. Log. Phon Vocol 2001; 26: 37-46.Phon Vocol 2001; 26: 37-46.

Documents

THE VOICE Teacher, Conductor, Singer, Student ! Rebecca Miles Risser, M.M.,M.A., CCC-SLP Clinical Speech Pathologist, Voice Specialist Performance Voice