Voice Center Voicecenter.PITT.edu Keep Your Voice Healthy! · Keep Your Voice Healthy! How the voice works and how to keep it healthy Clark A. Rosen MD University of Pittsburgh Voice

Voicecenter.PITT.edu Voice Center

Keep Your Voice Healthy!

How the voice works and how to keep it healthy

Clark A. Rosen MD

University of Pittsburgh Voice Center


• How Does the Voice Work?

– Vocal Anatomy and Physiology

• What Can Go Wrong with the Voice?

– Medical Problems of the Voice

• How Can One Prevent Voice Problems?

– Voice Disorders Prevention: Vocal Hygiene Plan

Voice – Care and Treatment


• Where the body goes so goes the singing instrument

– Airplane, Steelers game, Pitt game…

• How the body goes, so goes the voice

– Fatigue

– Nutrition

– Hydration

Body -- Voice


Larynx Voice Production

Brain

Lungs

Larynx (vocal folds)

Pharynx

Nose/Sinuses (soft palate)

Oral cavity

– Tonsils, tongue, lips

EARS


POWER

SOURCE

RESONATOR


Where is the Larynx?


Larynx Anatomy

• Paired vocal folds

– Open for breathing

– Come together for sound production

• Speaking

• Singing



Layers of the Vocal Fold

• Edges vibrate together to produce the sounds of speaking or singing

– Fine muscle control

• Specialized covering of the vocal folds

– Lamina propria (superficial)

– Needed for vocal fold vibration

• Very sensitive to injury

• Very difficult to repair


Vocal Fold Vibration


Vocal Fold Vibration and Singing

• Vocal fold vibration speed = pitch

– Hertz = cycles per second (Hz)

– Speaking Voice

• Male ~ 100 Hz

• Female ~ 200 Hz

– Singing voice

• C below middle C (C3) = 136 Hz

• Middle C (C4) = 256 Hz

• A4 = 440 Hz

• High C (C6) = 1024 Hz

– Vocal folds are vibrating over 1,000 times per second !!!


• Performed by an Ear, Nose and Throat doctor in the office

Laryngeal Examination


• Specialized instrument to examine rapid vocal fold vibration

• Allows slow motion viewing and analysis of vocal fold vibration

Stroboscopy


Vocal Fold Vibration • Laryngeal Muscles Approximate Vocal Folds

• Tone, Length, Bulk

• Vibration Dependent on Covering of Vocal Folds (Lamina Propria)

– Bio-MECHANICAL

– Highly Elastic

– Sensitive to Injury

– Difficult to repair or replicate


Vocal Fold Vibration at 264 Hz


Vocal Fold Vibration at 120 times per second !


Outside and Inside of Singing


“You name it… It can/will happen!!!”

• Misuse / Overuse

• Laryngo-pharyngeal reflux disease

• Nasal and sinus diseases

• Dehydration

• Singing / Speaking sick

• Lumps and bumps of the vocal folds

Common Voice Problems


–Singing is an aerobic activity

–Avoid exposure to smoke-filled air

–Treat conditions affecting lungs, such as asthma

–Exercise

–DO NOT SMOKE!!!!!!!!!!!

Caring for Your Lungs


Smoking

Laryngeal Cancer Irreversible changes to vocal

folds


• Stomach acid content (acid) irritates the larynx (vocal folds) and pharynx, or referred sensation from stomach or esophagus

• Occurs in everybody to some extent

• May be associated with: – Hoarseness

– Heartburn

– Foreign-body or “lump in the throat” sensation

– Frequent throat clearing

– Excessive phlegm production

Laryngo-Pharyngeal Reflux Disease (LPR)



Laryngo-Pharyngeal Reflux Disease

• Worsened by

– Caffeine

– Alcohol

– Chocolate

– Mint

– Spicy foods

– Fatty foods

– Tomato-based foods

– Lying down with full stomach

– Tight clothes

– Obesity

– Singing


• Precautions:

– Avoid large meals several hours before bedtime

– Avoid substances that exacerbate reflux

– Use antacids for spicy foods, heartburn

– Seek treatment if regular problem

• Change in behavior

• Medication very successful

• Prilosec, Protonix, Prevacid, Nexium, Zegerid, Aciphex, Dexilant

Laryngo-Pharyngeal Reflux Disease


• Nasal breathing warms, humidifies and filters the air you breath

• Allergies or Infection can block nasal breathing and thus lead to mouth breathing which dries the throat and vocal folds

• Can affect voice resonance

• Causes post-nasal drainage – Frequent throat clearing

• Increased risk for vocal fold injury

Nasal and Sinus Disease


• Antihistamines (significant drying)

– Allergy & Cold Medications

– Benadryl, Claritin, Allegra, Zyrtec, Astelin,

– Tylenol PM, Contact, …

• Anti-Depressants

– Paxil, Zoloft, Effexor, Lexapro, …

• Anti-coagulants

– Aspirin, Ibuprofen, Coumadin, Plavix, Xarelto…

– Natural: fish oil, Echinacea, gingko biloba, ginger, …

– Tylenol = OK

• Accutane

• Advair

Medicine / Drugs Concerns

“Is this medication

going to effect my

voice?


• The practice of “singing sick” subjects the performer to a significant risk of serious vocal injury

– Vocal fold hemorrhage (bleed)

– Can lead to vocal fold scar formation

• VERY HARD TO FIX!!!

“I Have a Cold, Can I Sing?”


Vocal fold hemorrhage


• Most colds are caused by viruses and do not require (or benefit) from antibiotics

• What to do: (Early detection)

Back off from vocal demands

Seek treatment early



• Supportive treatment:

Increase rest and hydration

Mucous thinning medication

Guaifenesin (Mucinex)

Nasal saline rinse / Neti pot

Decongestants

Pseudoephedrine

but WILL dry you out!

Avoid antihistamines if you can


Mother

knows best!


• Limit vocal use

– Talking (phone, yelling……..)

– Mark through rehearsals

– Limit singing if the speaking voice is hoarse

– If you must sing, you should have a vocal fold examination prior to performance



Lumps and Bumps

• Usually arise from phonotraumatic voice use or singing sick….

– Nodules

– Polyp

– Cyst

• Maximize non-surgery treatment

– Voice rest

– Voice therapy

– Singing voice therapy


Vocal Fold Nodules


Vocal Fold Lesions

Vocal fold polyps Vocal fold hemorrhagic polyp


Vocal Fold Lesions

Reactive

lesion

Vocal

fold cyst


Hoarseness is no laughing matter!

• Hoarseness is NEVER normal

• Especially repeated episodes


Voice Care is a Team Sport

• University of Pittsburgh Voice Center

– Physicians

– Speech Pathologists

– Singing Voice Specialists

– Related Medical Specialists

– Mental Health

• 412-232-SING


University of Pittsburgh Voice Center –412-232-SING (7464)

–UPMC Mercy


Documents

Voice Center Voicecenter.PITT.edu Keep Your Voice Healthy! · Keep Your Voice Healthy! How the voice works and how to keep it healthy Clark A. Rosen MD University of Pittsburgh Voice