Vocal Health

ABCD Convention25th August 2012

Dr Jenevora Williamswww.jenevorawilliams.com

Rate of reported voice problems among teachers

“Have you ever experienced voice problems that you feel could have been caused by your job?”

Association of Teachers & Lecturers’ Survey of 490 teachers, 2008.

No32%

Yes68%

Causes of voice loss

• infections

•the way we use our voice

•our lifestyle

•the result of anxiety levels

•non-abuse related vocal illness

• These factors may only be partly within our control, but awareness can help us lessen symptoms, shorten recovery time or avoid problems

Infections - exposure to germs and viruses

•Young people - many more infections

• Solution 1: Hand washing

• Solution 2: Healthy immune system

• Staying fit• Sleep•Healthy diet •Keeping stress at bay

The way we use our voice - Vocal Loading

•Vocal loading is increased by:

•Amount of use: the number of hours you are speaking or singing

•Level of use: louder voicing requires the vocal folds to collide harder

•Emotional stress: Anxiety creates tension in the voice

Increased vocal loading

➡vocal fold mucosa irritation

➡vocal fold mucosal oedema

➡huskiness and vocal struggle

➡increased vocal fold mucosa irritation

The way we use our voice - Speaking or Shouting?

•Background noise

•at work

•socially

•Room acoustics

The way we use our voice - Speaking with bad posture

•Leaning forward/bending

•Twisting

•Solution: upright posture before you speak

Speaking during physical exertion

•Physical exertion = constricting the throat

•Solution: Save the speaking until after you have done the lifting or reaching for something

The way we use our voice - Different vocal colours

The way we use our voice - pacing

✔✘✘

Voice use while under emotional stress

•Voice user is more prone to fatigue or injury• Solutions: • Low belly breathing•The stress-busting breathing cycle

Always warm up your own voice• Maximise ease and range of motion• Reinforce good vocal habits• Prevent injury

Singing rehearsal - best practice for reducing vocal loading

•Posture

•Good vocal technique

•Varied vocal qualities

•Pace your own voice use (frequent rests)

•Don’t demonstrate everything - use a keyboard or a good singer from the group

•Don’t sing along

Swallowing - what happens?

• Larynx lifts and closes

• Food/liquid passes over epiglottis into oesophagus

• Any mucous around larynx is redistributed

• Nothing from the mouth goes near the larynx or vocal folds

Hydration

• Topical

• distribution of mucous (preferably thin) across vocal folds

• Systemic

• internal hydration of individual cells of the body

Medications: Throat pastilles and lozenges

dehydrate (e.g. menthol)

anaesthetic

swallowing (which lubricates the vocal folds)

placebo

Sipping water is cheaper and can be just as effective.

Drinking and eating

•Late-night meals

•Dehydration

•Caffeine

•Alcohol

•Dairy products

Exposure to irritants

•House dust

•Pollens

•Fumes

•Smoke

Smoking★ Tar = irritant directly on vocal folds + lungs

★ At best this causes lessening in efficiency, at worst husky voices and long-term illness.

Medications: Decongestants

• Up to five days

• Dehydrating effect

Medications: Cough medicines

•Codeine or antihistamines (drying effect)

•Guafanesin (thins mucous)

•Cough – if from dust, asthma or gastric reflux – cough medicine no use

Other common medications

• Antihistamines: ?dehydrating, check with the pharmacist

• Steriod nasal spray (rhinitis) e.g. flixonase - vocal fold irritation/dryness

• Antidepressants - can be drying

• Contraceptive pill - significant benefits

• Aspirin - increase possibility of haemorrhage

• High-Dosage Vitamin C supplements also drying

Women’s issues: monthly

• Day 24 to 28, hormone shifts ➞ swelling in vocal folds

• pitch uncertainty

• decreased vocal efficiency

• huskiness

• reduced vocal power or flexibility

• drier larynx

• less lung power

• weakened laryngeal muscles

• stiffer laryngeal cartilages

• thickened vocal folds

• more "man-like" voice

• fewer elastic and collagen fibres

Women’s issues: menopause

Ageing voices

•Post 55/65 – reduced flexibility (pitch range)

•Muscle ageing - bowing of vocal folds and instability

• Persistent aching in the throat

• Lack of stamina in the voice

• Voice is routinely groggy when you wake up

• Other people’s comments – are you ill?

How can you tell if you have a voice problem?

What to do when the voice goes wrong

•Rest

•Steam

•Sleep

• If these are not enough after 2-3 weeks, ask a GP to refer you to a Voice Clinic

• Diagnosis with endoscopic camera

• Laryngologist and speech therapist

• Also singing teacher, osteopath, physiotherapist

What to do when the voice goes wrong:

At the Voice Clinic

•Infections

•Symptoms : croaky or breathy voice to complete voice loss.

•Cause: viral, bacterial, allergy, reflux or over-use.

•Pharyngitis, tonsillitis, sinusitis and rhinitis will not directly affect the action of the vocal folds unless there is post-nasal drip.

Voice disorders: Inflammatory

•Allergies are common and may need ongoing treatment.

•Symptoms = hoarseness, nose-blowing, sneezing

•Common allergens = pollen, mould spores, dust, foods or cigarette smoke.

Voice disorders: Inflammatory

•Acid reflux – sore throat and hoarseness.

•Treatment may include antacids to neutralise the pH, PPIs and/or to raise the bed head.

Voice disorders: Inflammatory

• Cysts: fluid-filled dilated mucosal ducts

• Causes: unclear

• Symptoms: hoarseness or coughing

• Treatment: surgical removal

• Polyps: associated with healing after vocal trauma

• Voice therapy: beneficial

• Surgery: only a last resort

• Tumours: benign or cancerous, some of which require surgery

Voice disorders: Structural

•Nodules: mass of fibrous tissue, similar to callouses

•More frequent in boys than girls, but in more women than men

•Cause: high vocal loading over a prolonged period, often exacerbated by stress or anxiety

•Treatment: voice therapy in the first instance

Voice disorders: Structural

•Parkinson’s disease

•Stroke

•Vocal fold paralysis

Voice disorders: neuromuscular

•Muscle Tension Dysphonia

Voice disorders: Functional