vocal health and voice care

7/30/2019 Vocal Health and Voice Care

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VocalHealth&VoiceCare

2013DrDanielK.Robinson

VocalHealth&VoiceCare Objectives:

1. Discussissuespertainingtovocalhealth2. Brieflyexaminevocaldisordersresultingfrommisuseofthevoice3. Reviewpositivelivingpracticesthatenhanceoverallvocalhealth.

Outcomes:Thismoduleendeavourstohighlighttheeverpresentchallengeofthesingeristheirinstrument.Atthe

endofthissession,thestudentshouldbemoreawareofthenecessityforvoicecareandtheimpactsof

environmentandlifepracticeontheirgeneralvocalhealth.

1. VocalHealthIhavebeenpresentingon the topicof VocalHealth&VoiceCare fornearly twentyyearsand itstill

amazesmehowmanysingersrolltheireyeswhenIstresstheimportanceofthetopic.Allowmetostate

upfront,Iamnotavocalhypochondriac!IdonotseevocaldamageeverywhereIlook(orhear),nordoI

believe every contemporary vocal sound is detrimental to the health of the voice. This being said,

singersembodytheirinstrument.Everywherethesingergoes,everything

(and Imeaneverything) the singerdoesandall that the singer ishasa

bearingonthesingersvocalhealth.AllanDawson (2005)states itquite

simply:Vocalhealth isanoccupationalconcern forall singers (p.14).

Notsomebutallsingers!

Beforecontinuing;adisclaimer:Thematerialinthis[module]isintendedtoproviderudimentaryinformationabout[vocalhealthandvoicecare].It

is not meant for use as a diagnostic or therapeutic tool, nor as a

substitute for consultationwith an otolaryngologist or voice therapist

(McCoy,2004,p.158).

Readings

McCoy(2004).YourVoice:AnInsideView.Chapter12(pp.158174) Miller

(1996).

TheStructureofSinging.Chapter17(pp.218240)

Shewell(2009).VoiceWork.Chapter27&28(pp.415460)


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Voice:Art&Science(DjartsManuals)

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NormalVoiceBanktellersareeducatedtoidentifycounterfeitmoneybycarefullystudyinggenuinecurrency.Andthat

iswhereweshouldstartwiththehumanvoice:Whatdoesnormalvoicelookandsoundlike?1

Firstly,it

is

important

to

allow

for

some

variance

in

what

we

consider

normal.

There

are

far

too

many

exceptionstotheruletocategoricallystatefixedrulesofnormality.Forexample,thehumanvoice is

anatomically capable of three to three and a half octaves of phonatory range (Thurman, Theimer,

Grefsheim, & Feit, 2000, p. 773), but there are singers who exceed these so called normal limits.

Brisbane(Australia)basedsingerAdamLopezcurrentlyholdstheGuinnessworldrecordforthehighestnote sung by a male voice: C sharp in the 8thoctave (one note above the range of a piano!). Wow!

Thatsnotnormal.

Havingacknowledgedsomewriggleroomwhendiscussingnormalvoice,letsbrieflydefinehownormal

voiceshouldtypicallypresent:

NormalVoicePathology:Thehealthyvoice,whenviewedunder fixedor flexiblescope,shouldpresentasa free (unobstructed)airway.Thevocalfoldsshouldbe lightpinkorpearlywhite in

colour with no observable lesions or dysfunction. There should be relative symmetry to the

glottispositioninaccordancewiththepositioningofthearytenoidsandthemannerinwhichthe

arytenoidsactivate.2Themajorityofthetruevocalfoldlengthshouldbeclearlyvisible.

Normal Voice Phonation: The healthy voice should present as a clear tone. Phonatorydysfunctionmightexhibithighlevelsofaspiration(breathiness)orraspysound,reducedcapacity

forincreasingvolumeandinconsistentphonatorypatterns(e.g.thesoundcuttinginandout).It

is importanttonotehoweverthatthepresenceofthesecharacteristicsdoesnotautomatically

indicatereducedhealthorfunction.ChristinaShewell(2009)remindsusthat,

Novoicepractitionercaneverreliably identifythenatureofthevoicedisorderbythesoundofthe

voice.Thesoundofavoicemaygivecluesaboutvocaltractandfoldfunction,but itcannotspecify

thepathologythatiscreatingthatsound.Highlevellaryngealexaminationisessential,andthereare

frequentlysurprises.(p.416)

Vocal longevity will be achieved byattending tovocal health throughhealthy voice

production, following a vocal hygiene program, and avoiding vocal injury and not

losingsightoftheimportanceofgeneralhealth.(Harvey&Miller,2006,p.108)

1ForamoredetailedreviewofvocalanatomytheinterestedreaderisencouragedtoreadVocalAnatomy101(Robinson,

2013).2Thereiscurrentlysomedebateabouttheimpactofasymmetryofthearytenoidsandwhetherornotthisactuallyhasany

detrimental effect on phonatory patterns. Without seeking to solve the issue here, perhaps this is another area where

normalhas

awide

scope

of

variance.

Further

research

may

yet

shed

light

on

this

ongoing

discussion.


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TheDisorderedVoiceOfcourse,maintainingclearnormalvoicefunctionisachallengetotheprofessionalvoiceuser;justas

maintaininghealthyfunctionalphysiologyistheeverpresentchallengefortheprofessionalathlete.But

things

do

go

wrong.

A

professional

singer

can

perform

successfully

for

decades

without

complaint,

but

thenoneday(usuallythroughaseriesofcollidingevents)noticesthattheirvoiceisnotperformingwith

itsusualrigororagility.

Shewell(2009)identifiesthedifferencebetweenavoicedisorderandageneralvoiceproblem(p.415)

bynominatingthreegroups:3

1. Impairment: temporary alteration to the normal function which might exhibit with somebreathinessorsoreness.

2. Disability:prolongedchangestovocalsoundandfunction;oftenprecededbyimpairment.3. Handicap:thedisabledvoicewhenexposedtodisadvantagerelativetoothers.

Clearly, a vocal impairment, if left unattended, may develop into a vocal disability. The disabled

professional voice is most definitely exposed to disadvantage when seeking income arising from the

regular and sustained use of their voice. Thus, the professional singer with a damaged voice can be

thoughtofashandicapped!

Whenidentifyingvoicedisorderspractitionerstypicallyclassifytheconditionsintotwogroups:Organic

andFunctional.4

Traditionally,organic pathologies are those for which a specific lesion, disease, or malfunction can be

identified in some organ of the body relevant to voice production. Functional pathologies usually are

defined as those for which there is no identifiable lesion, but voice production is somehow abnormal.

(Titze&Abbott,2012,p.51)

Letsnowlookatthevariousvoicedisordersgroupsunderthesetwoheadings.

1. Organic:thesevocaldisordersoftenrequiresurgicalintervention,butthisisgenerallyconductedafter the patient has adequately (to the surgeons satisfaction) addressed their vocal hygiene

elements(e.g.hydration,alcohol,acidreflux),adjustedtheiroverallvocaloutputandvocalloads

(e.g. relative and/or complete vocal rest), and attended speech therapy for 510 sessions

(Bastian,Klitzke,

&

Thurman,

2000).

Laryngitis: The term laryngitis is used synonymously for a range of vocal ailmentsincludingshorttermviralinfection(leadingtoacuteinflammationofthevocalfoldsand

surrounding tissues) and chronic longterm inflammation which is often caused by

irritants(reflux,smokingetc.).

3ShewellhasderivedtheselabelsfromtheWorldHealthOrganisation(Shewell,2009,p.415).

4Itisimportanttonotethatthelinethatseparatesorganicandfunctionalcanoftenbeblurredbecauseattimesitisdifficult

toidentify

what

is

cause

and

what

is

effect.


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VocalFoldCysts:Smallsacsof fluidcanrandomlyappearanywhere in the body, including the larynx. Deceptive

little critters5, vocal folds cysts (mucus retention cysts;

Figure1)willoftenswellwithvocaluseandthenreducein

size

with

vocal

rest,

leaving

the

voice

user

believing

theyrevoicehas healed.Thistypeofcystoccursmore

commonlyjust below the leading edge of a foldwhen

cystsbecomelargeenough,theycanimpactontheother

fold and can cause a nodular tissue reaction there

(Bastian,Thurman,&Klitzke,2000,p.533). Papillomas:Believedtooriginate fromawartlikevirus,papillomascanoccursuddenly,

and in chronic cases can be life threatening (especially in small children) due to the

mannerin

which

they

grow

and

obstruct

the

airway.

The

wart

like

growths

may

need

to

be surgically managed; that is, removed regularly to ensure an unobstructed airway.

Oftenthepapillomasresolvethemselvesanddiscontinuegrowing;again,notdissimilarto

thecommonwart. VocalFoldParalysisandParesis: Thevocal foldsand theirsurroundingmusculatureare

drivenbytherightand leftrecurrent laryngealnerve.Ifeither(orboth)ofthesenerves

becomes damaged, paresis (partial) or paralysis (complete) can be sustained either

temporarilyorpermanently.Vocalfoldparalysiscanbeobtainedduringtimesoftrauma

to the neck (e.g. thyroid surgery). Vocal fold paralysis is generally treated with voice

therapyand/or

surgical

intervention.

Spasmodic dysphonia/laryngeal dystonia: An intermittent disorder of the vocal folds,spasmodicdysphoniaisevidencedbyirregularandabruptclosureand/oropeningofthe

glottis.Thisrareconditionisoftentreatedby injectionsofbotulinumtoxin(botox)into

thevocalfolds,toweakentheirclosurepatterns(Shewell,2009,p.435). Laryngeal Cancer: Cancer of the larynx is a relatively uncommon occurrence. Typically

found in older people with a history of heavy smoking and alcohol consumption,

presentingsymptomsmay includevoicechange,chronicsorethroatwithorwithout

swallowingdifficulty

and

occasionally,

asense

of

breathing

restriction

(Bastian,

Klitzke,

etal.,2000,p.629).Treatmentoflaryngealcancerisdependentonthesizeandtypeof

thecancerousgrowth.

5Of

course,

vocal

fold

cysts

are

not

crittersIm

writing

colloquially.

Figure1:CystonRightVocalFold


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2. Functional:typically,thesevocaldisorderscanbeshowntooriginatefromthefunctionalactivityofthevoicethemannerinwhichthevocalisthasbeenusingtheirvoice.Again,itisimportant

tonote thatthe linethatseparatesorganic from functional isoftenblurredby themultiplicity

effectofmanycontributingfactors.Thatis,vocaldisorderscan(andoftendo)onsetbecauseof

both

organic

and

functional

matters:

e.g.

the

singer

with

nodules

(functional)

may

have

developedthembecausetheychosetosingonavoicewithchroniclaryngitis(organic).

a) Primarilyderivedfrommuscletension MuscleTensionDysphonia (MTD):Usuallyrelated tospeechpatterns,MTD is thehypo

adduction of the vocal folds.6 Muscle Tension Dysphonia is generally evidenced by a

large posterior glottal chink, which produces a breathy voice with much air leakage

(Titze & Abbott, 2012, p. 85). MTD requires therapeutic interventiondesigned to assist

complete symmetrical adduction (closure) of the vocal folds along the full line of the

glottis.

If

left

untreated,

MTD

can

develop

secondary

concerns

such

nodules.

VocalFoldSwelling(oedema7):Likeallmuscles,thevocalismuscle(themuscularbodyofthe true vocal folds) swells with use; i.e. the muscle is supplied with extra blood flow

duringheighteneduse.However,underextremeuseand/orwhenthehealthofthevoice

is compromised (e.g. laryngitis) the natural levels of heightened blood flow can move

beyond a tippingpoint, and become detrimental to healthy phonatory patterns. This

compensatory response of the bodys physiology may distribute additional fluid to the

laminapropria (second layer of the true vocal fold) in order to provide protection andhealing.Pitchcanbealteredby fluidengorgement (edema).Theusualexplanation for

pitch

drop

in

edema

cases

is

that

greater

mass

creates

lower

natural

frequencies

(Scherer,2006,p.90).Oftenthebesttreatmentforacuteoedemaiscompleteorrelative

vocalrest.

Reinkesoedema:The labellingof this formofvocal foldswelling issocalledbecause itoccurs in the Reinkes space (the second layer of the true vocal fold). Not actually acavernous space, Reinkes space is a gelatinous layer that allows the epithelium (outer

layer)tomove freely(oscillate)overthetopof it. Anextremeandprolonged(chronic)

caseofvocal foldswelling (oftenobserved inolderpeoplewithahistoryofsmokingor

heavyalcohol

consumption)

is

referred

to

as

Reinkes

oedema.

In

some

cases,

Reinkes

oedema may be alleviated by voice therapy and/or the removal of excess fluid via

surgery.Reinkesoedemamightalsobeobservedinsuffersofchronicreflux. Nodules:Strikingfearintotheheartofmostvocalists,noduleshaveearnedwidespread

renown,butaremostlymisunderstoodbyvoiceusers.Nodulesgenerallyoccurasaresult

ofpoormuscularfunction(e.g.MTD)orbyusingthevoiceduringatimeofcompromised

6TitzeandAbbott(2012)highlightthatinsomecasesofMTDthevocalfoldsarehyperadductedovertheirlength,although

thisistheexception.(p.85)7The

American

spelling

of

oedema

(English

spelling)

is

edema.


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health (e.g. laryngitis). Similar to small calluses on the outer edge of the vocal folds,

nodulesaresmallbenignswellings(typicallybilateral)thatinterruptthevocalfoldripple

wave.Softnodules (early indevelopment)areoftenresolvedwithvoice therapy,but if

the swellings have been allowed to persist and harden, and if time is pressing (i.e. if a

singeris

on

tour

and

the

show

must

go

on),

then

surgical

removal

might

be

entertained

as a quickfix solution. Leading Otolaryngologist, Dr Robert T. Sataloff (2006) writes,

Vocal nodules resolve with proper voice use and should be treated with voice

modificationandrelativevoicerest, includingavoidanceofvocallyabusiveactivities(p.

255).Evenwhensurgeryisthechosenoption,voicetherapy(bothspokenandsinging)is

highly recommended as the remedial route for learning new vocal habits designed to

diminishthechanceofthenodulesredevelopment.

Polyps:Occurringasaprotrusionanywherealongthevocalfold,polypsgenerallydevelopas

a

singular

mass

lesion

(unlike

nodules

which

typically

occur

bi

laterally)

and

may

vibrate with the vocal fold oscillation. Sometimes described as a nodule with a stalk

(Dayme, 2009, p. 163), these lesions rarely respond well to voice therapy in the first

instance; and typically require surgical removal followed by remedial voice therapy.

These functionally derived growths onset due to vocal abuse (often preceded by vocal

foldhaemorrhage)andcanoccursuddenly;whereasnodulesareoftenseendeveloping

overprolongedperiodsofmisuse.

VocalFoldHaemorrhage:Perhapsoneofthemoredebilitatingfunctionaldisordersofthevoice(intheacutestage) isthevocalfoldhaemorrhage(Figure2).McCoy(2004)points

out

that,

a

person

who

experiences

a

vocal

fold

haemorrhage

will

almost

certainly

realise something is wrong with his or her voice (p. 164). As the name suggests this

disorder, typically occurring due to highlevel vocal abuse8, is the rupture of capillaries

(bloodvessels)eitherwithinthe laminapropria

(second layer) or the epithelium (outer layer)

causingbruisingof thevocal fold.Thebleeding

impedesnormalvocalfoldoscillationand ifleft

untreated can lead to significant scarring.

Immediateandcompletevocalrest isgenerally

prescribed,andinrarecases,duetocontinuous

bleeding,surgerymayberequired.Again,voice

therapy (speech and singing) is highly

recommended following a vocal fold

haemorrhage.

8Vocalfoldhaemorrhagecanalsobecausedbycoughingandcrying.Shewell(2009)notesthatSataloffs(1997)saysthat

aspirinandthepremenstrualperiodmakethemmorelikelyinwomensingerswhosinghardandstrongly(p.424).Itisalso

importantto

note

that

drugs

containing

ibuprofen

have

been

shown

to

heighten

the

risk

of

vocal

fold

haemorrhage.

Figure2:VocalFoldHaemorrhage(LeftVocalFold)


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VocalFoldSulcus:Observedasagroovealongthevocalfoldtissue,asulcusvocalisrunsparallel to the vocal fold margin (Titze & Abbott, 2012, p. 57). One of the least

understood vocal fold disorders (in regards to its origin), the vocal fold sulcus can be

aggravatedbyheavyvoiceuseandinseverecasesthebiomechanicaloscillatorbecomes

a

double

oscillator,

with

upper

and

lower

tissues

moving

independently

(p.

58).

Resultinginahighlyfatiguedvoicewiththinandreedyphonation,vocalfoldsulcusmay

respondtovoicetherapy,butgenerallyrequiressurgicalinterventioninordertoimprove

vocalfoldoscillation. Vocal Process Granulomas& Ulcers: The vocal process granuloma (raised granulation

tissue) and the vocal process ulcer (embedded abrasion) typically occur on the

cartilaginousportionofthevocalfoldswhichareattachedtothevocalprocessesofthe

arytenoid cartilages (the rear twofifths of the vocal folds) (Bastian, Thurman, et al.,

2000,p.

532).

It

is

thought

that

granulomas

precede

the

development

of

contact

ulcers,

andareactuallythepartofthehealingprocess(McCoy,2004,p.168).Oftenobserved

in suffers of reflux disease and in voice users who expose the mechanism to extreme

vocal loads, these formations can be experienced as painfully intrusive sensations that

develop over time. Treatment is often directed at the cause (e.g. alleviating reflux

through diet and medication), and while some granulomas may mature and

spontaneouslydetach,othersmayrequiresurgicalremoval.

VocalFoldBowing:Causedbytheinabilityofthevocalfoldstoadduct(close)tothemidlineoftheglottis,thecharacteristicbowingofthevocalfoldsprovidesthisdisorderwith

its

namesake.

Considered

by

some

to

be

caused

by

extended

use

of

forced

falsetto

(McKinney, 1994; Titze & Abbott, 2012), this vocal disorder create[s] a leaky voice,

whichsoundsasthenic(weak),eventhoughthereisconsiderableefforttoproducevoice

(Titze & Abbott, 2012, p. 85). Ongoing research is required for suitable therapys for

suffers of vocal fold bowing, but it is currently thought that focused muscular exercise

can leadtoastrengtheningofthevocalismuscle,and thesubsequent morecomplete

adductionoftheglottis.

Vocal

folds

are

very

strong,

resilient

structures.

While

they

can

take

a

lot

of

punishment,theyarelivingtissueandthereare limitstothenumberof impactand

shearing forces they can take before they begin to defend themselves or break

down. Recovery from these conditions can occur with help from one or more

members of a team of voice professionals including laryngologist, a speech/voice

therapist,andaspecialistvoiceeducator.(Bastian,Thurman,etal.,2000,p.535)


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b)Primarilyderivedfrompsychogenicfactors Puberphonia: Also known asmutational dysphonia, puberphonia is typically observed

during and/ordirectly after themutational transformation of the voice during puberty.

This condition, generally treated with voice therapy, displays with the matured larynx

(postmutational)

continuing

to

perform

pre

mutational

phonatory

patterns.

While

commenting on mutational dysphonia, IngoTitze(2000) further explains, the pitch of

the voice and the general pattern of vibration of the vocal folds assume the

characteristicsoftheoppositesexmutationaldysphoniaistreatablewithvoicetherapy,

especiallyifitiscombinedwithsomekindofpsychologicalcounselling(p.361).

Transgender/TranssexualVoice: Typically listedunder psychogenicvoicedisorders,thetransgendered/transsexualvoicediffersfromothervocaldisordersinsomuchasthevoice

user is intentionally seeking to alter their phonatory patterns. Often assisted with

hormone

therapy,

the

transgendered

voice

user

is

strongly

advised

to

undergo

voicetransformation with the assistance of a qualified speech therapist experienced in this

highlyspecialisedfield.Duringtherapy,it is importantthatvocalfoldstrainbeavoided

because muscle tension voice problems can result if the client constricts in [his/]her

attemptstoreachhigher[/lower]pitches(Shewell,2009,p.430).

2. VoiceCareIngoTitzeandKatherineVerdoliniAbbott(2012)definevoicedisordersaccordingtotheWorldHealth

Organisations classification summarising, the relative health status of an individual involves three

domains:(1)bodyandmind,(2)anindividualsactivities,and(3)anindividualsparticipationinsociety.

Bothenvironmentandpersonalfactorscomeintoplayineverydomain(p.39).

UsingScottMcCoys(2004)twelveheadings(pp.158160)letsnowoutlinearangeofareasthatmight

improveyourchancesofpreservingyourvocalhealth(p.158).

1. Speak Well: As stated at the commencement of this module, the challenge facing everyprofessionalvoiceuseristhattheyaretheirvoice.Predominantly,thevoiceisusedforspeech.

Evenprofessionalsingersutilisetheirvoiceforspokencommunicationfarmorethansinging.Itis

therefore necessary to ensure that the voice is used expertly during this dominant activity.

Plainly,ifyourvoiceisbeingfatiguedanddamagedwithpoorspeechpatterns,thenitwillmost

probablyperformpoorlywhenitisemployedforsinging.As with all things associated with phonation, well managed breathing is essential to healthy

spokenvoice.LeonThurmanandhiscolleaguesnotethatactiveexhalation isrequiredduring

skilledspeakingandsinging,butinwidelydifferentdegreesdependingonthevocalvolumelevel

needed for the expressive purposes at hand. (Thurman, Theimer, Welch, Grefsheim, & Feit,

2000,p.349).Vocalexpressionisgenerallydrivenbyalterationtothebiofunctionalpatternsof

thelarynx

and

the

manner

in

which

the

vocal

tract

shapes

the

sound

as

it

travels

along

the

highly


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mouldable pathway.Vocal actions such as glottal attacks, aspirate tone and overtalking (in

ordertobeheardinloudenvironments)canallcontributetothewearandtearofthevoicefor

bothspeakingandsinging.ScottMcCoy (2004),whilerecommendinghabituallyclear toneand

resonantvoicequalityalsosuggestsfindinganoptimumspeakingrange,whichmightbehigher

orlowerthanyouusuallyspeak(p.158).

It is also important to note the deleterious effect of clearing the throat on the general

wellbeingof the voice.Heueretal. (2006) state that clearing the throat is generally outof

habit,ratherthanneed(p.235).Statingthe traumatic impactofthroatclearingonthevocal

folds,theirarticle,VoiceTherapy,recommendsreplacingthethroatclearwitha dryswallow,takingsmallsipsofwater,lighthummingand,forsingers,vocalis[ing]lightlyonfivenotescales

in a comfortable range on //, or slide up on [an] octave softly on //, and crescendo (get

louder)(p.235).

2. Sing Well: Itwill surprise no one to read here that I strongly advocate for the necessity ofqualifiedtechnicalinstructionwhenitcomestoacquiringahealthysingingvoice.Sataloff(2006)

highlights theneed for singing lessonswhenheaptly states, singing skillsare to speakingas

runningskillsare towalking (p.25).When thevoice isbeingoperatedduring theheightened

activityofsinging,manychallengespresentthemselves.McCoy(2004)providesahelpful listof

considerationswhenonedesirestosingwell(p.158):a)Maintaineffectivebreathsupportandcontrol;b)Keepextrinsiclaryngeal,tongueandjawmusclesfreefromexcesstension;

c)Avoidexcessiveglottalonsetsandoffsetsoftone;d)Avoid air pushing during tone initiation, betweenconsecutivetones,andatphraseterminations;

e)Singinyouroptimumtessitura9;f) Singwithproperbodyalignmentandcorrectlaryngealposition(neithertoohighnortoolow).

Thefinalkeytosingingwellisregular(45timesperweek)

disciplined and structured practice. There are many

excellentexercisecompilationsfordevelopingthesinging

voice;includingDrDansVoiceEssentialsCD(Figure3).10

9Tessitura(It.).Termusedtodescribethepartofavocal(orinstrumental)compassinwhichapieceofmusicpredominantly

lies.Thetessituraofapieceisconcernedwiththepartoftherangemostused,notbyitsextremes(Sadie,1994,p.813).10DrDansVoiceEssentialsvocalexerciseCDisavailableviathedjartsonlinestore(www.djarts.com.au)orthroughiTunes.

Figure3:DrDan'sVoiceEssentials(CDCover)


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3. Moderation:Thehumanbody isnotdesigned (somewouldsay, unfortunately)tokeepgoingandgoingandgoing.So toowith thevoice. It is important tomonitor theamountofusethe

voice receives. Importantly, like most muscular systems in the body, the voice can develop

increasedstaminawithregularexercise;buteventhiswillhavea limit.Ofcourse,yourvoice is

uniqueand

will

perform

at

its

optimum

for

different

lengths

when

compared

to

other

vocalists;

so it is important to establish your own personal limits and stick to them (allowing for

development/improvement of vocal stamina). JohannSundberg(1987) submits, It is a rarely

realizedfactthatanindispensablesideofasingerscareeristolearnnotonlyhowbutalsohow

muchtosingunderwhatconditions(p.185).

Muscularfatigueisobservedduringandafterprolongedmuscularexercise.Vocalfatigue,similar

(inpart)togeneralmusclefatigue limitsvocalendurancebyreducingthepliabilityofthevocal

foldsrequiredforhealthyoscillation.Titze(2000)offersfiveobservationsofthefatiguevoicein

his

text,

Principlesof

Voice

Production

(p.

362):

a) Fatigueoflaryngealmusclesthatnormallyprovidetensioninthevocalfoldsandstabilityofthelaryngealconfiguration.

b) Strainingofnonmuscularlaryngealtissue(ligaments,joints,membranes).c) Increase in tissue viscosity of the vocal folds, making it harder to maintain vibration

becauseofincreasedinternalfriction.Thismaybetheresultofdehydrationorchemical

changesinfluidcomposition.

d) Loss of blood circulation due to the constricted blood vessels in phonation. This mayimpederegenerative processesandreduce thesystemscapacity to transfer heataway

fromthe

vocal

folds

to

surrounding

tissue.

e) Lossofsubglottalpressurecausedbyfatigueoftherespiratorymuscles.4. Rest:Theanswertogeneralvocalfatigueisrest.Plainandsimple!?Actually,achievingtimesof

vocalrestfortheprofessionalvoiceuserisnotalwaysplainandsimple.Sometimesfindingthe

opportunitiestorestthevoicecanbedifficult.Forexample,agiggingsingerwhohasafivenight

runofshowsmaystarttoexperiencevocalfatiguebythemiddleofthe2nd

or3rd

nights.They

cant simply cancel the remaining shows. But they can clear their schedules of other, less

pressingevents;suchastheSaturdayBBQwith friendswheretalkingwillbethemainactivity.

Itsatthesetimesthatthejoboftheprofessionalsingerbecomesworkrequiringdisciplineand

agooddoseofdelayedgratification.Remember:novoice=nowork.Itsnotonlythelarynxthatrequiresrestthewholeinstrument(theentirebody)needstimesof

recuperation also. It is important therefore to ensure that adequate amounts of sleep are

obtainedandmaintained.Sataloff(2006)indicatesthatthatthefunctionsofanumberofbody

systems are optimized with approximately 8.25 hours of sleep (p. 124). And as Jaime Babbit

(2011) writes, The singer who gets enough sleep will always feel more confident, be more

productiveandgenerallysoundwaybetterthanthesingerwhodidnt(p.24).


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5. Hydration:Mostsingersknowthatdrinking23litresofwateradayisimportant.Equally,mostsingers dont do it! Beyond the many health benefits of the wellhydrated body, the well

hydrated voice is advantaged by consistent lubrication of the vocal folds. Additionally, Judith

Wingate (2008), inher text,Healthy Singing,advises thatwhen

the

singer

is

well

hydrated,

the

air

pressure

needed

beneath the vocal folds to set them into vibration is

reduced, giving the singer a feeling of reduced effort to

sing (p. 21). This is another case of work smarter, not

harderandallyouhavetodoisdrinkwater!

Its importanttostateherethattherearebeveragesthat

work in opposition to good hydration by actively

dehydrating the body. Specifically, caffeinated and

alcoholic

beverages

are

known

diuretics;

i.e.

they

promote

thebodysproductionofurine.Earlysignsofdehydration

include headache, fatigue, loss of appetite, flushed skin,

heat intolerance, lightheadedness, dry mouth and eyes,

burning sensation in the stomach, and dark urine with a

strongodor(Kleiner,1999,p.201).

6. UseGoodHygiene:Practicinggoodhygieneisanabsolutemustforsingers.Iliketotravelwithasmall bottle of antibacterial hand gel because viruses often infect our bodies through hand

contactwithmouth,noseandeyes.Washingthehandsfrequently(especiallyafterexposureto

public articles such as hand rails and door knobs) helps reduce the risk of viral and bacterial

transfer(McCoy,2004,p.159).

7. AvoidUnnecessaryDrugUse:Pharmaceuticalsareanormalpartofwesternsociety living.Thewonder of modern medicines supports our bodies in the fight against everything from the

commoncoldtocancer.Thesedrugs,forthemostpart,arenotwithouttheirsideeffectsonthe

voice.TitzeandAbbott(2012)identifytheiraffectonthenervoussystem,thebloodsupply,the

muscles,andparticularlythetissuesinvibration(p.105).Thedetrimentaleffectsofmedication,

and their impact on the voice can include: dry mouth, Candida, cough, hoarseness, muscular

tremor, reflux and slurred speech. Many drugs have a drying effect on the throat and larynx.

Whenmedicationsareprescribed,particularlyantihistaminesanddecongestants,itisimportant

toreplenishthebodysgeneralhydrationwithextrawaterintake.

Of course, for all the wellknown reasons, illicit drugs (narcotics, stimulants, depressants

(sedatives),hallucinogens, and cannabis) should be avoided by the professional voice user not

only because they are typically illegal to purchase and consume; but they generally leave the

voicesusceptible

to

heightened

wear

and

tear.

Thesingerwhowantstosetthemicrophoneonfiremustbewellhydrated!


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8. StayPhysicallyFit:Gonearethedayswhenthearchetypalsingerwaspicturedasanoverweight(obese)personsinginganoperaticnumber.Therigorsoftodaysprofessionalworldrequiresthe

modernsinger(classicalandcontemporary)tobephysicallyfit(andmentallyalso).Thephysically

fit singer is able to maintain harsh schedules and is less likely to succumb to sickness.

McCoy(2004) also notes that good physical appearance aids in winning competitions and

getting roles (p. 159). Harsh, but true! The realities of todays industry are the better you

lookthebetteryousound!Furthermore,JohnLyon(1993)statesthatSingerssingbetterandmoreonpitchwhentheyare

alertphysicallyandmentally(p.21).Beingphysicallyalertrequiresstamina;staminaincreases

withgeneralfitness.

9. Practice Safe Sex: Remember that Istatedat thebeginningof themodule

(Page 1) Everywhere the singer goes,everything(and Imeaneverything)thesingerdoesandallthatthesingerishasa bearing on the singers vocalhealthandthatincludessex!Without

explicitly stating where your mouth

mightgoduring sex, it is important to

note what your mouth (and throat)

might be exposed to during sex.

Specifically, herpes and gonorrhoea

areeasily transmitted to themouth,pharynxand larynx throughunprotectedoralsexwithan

infectedpartner(McCoy,2004,p.159).Amomentofpassion,canleadtomonthsofdiscomfort,

pain,andinsomecases,reducedvocalcapacity.Yoursexualactivitiesdohaveabearingonyour

vocalhealth.

10.WearYourSeatbelt:ThismightappeartobeselfexplanatorybutinAmericaitisestimatedthat1 in7peopledontbuckleup!Yourvoice (thewholebody)andyou larynxareathigh riskof

extremedamageeveninthelightestofbingleswhenyoudontwearacarrestraint.Thisheading

alsoremindsus,yetagain,thateverythingyoudoyourvoicedoestoo!

11.DontSingifYouAreIll:Singingwhenyouaresickistobeavoidedatallcosts.Andinsomecasesthiswillmeancancellinga(ormany)gig.Remember,youcanseriouslydamageyourvoiceinone

set of singing!And you voice is extremely vulnerable to damagewhen you are ill.Meribeth

BunchDayme(2009)leavesnoroomfornegotiationwhenaddressingthesicksinger.Shewrites,

Clearlywithaseverecoldallsingingmustcease.Singingwithavoicemadehoarsebyswollen

mucousmembranes has producedmany vocal cripples by leading to chronic hoarseness (p.

160).Therewillbetimeswhenajudgementcallneedstobemade.Assessingthelevelofriskinthesecircumstancesisanimportantconsiderationinthedecisionmakingprocess.


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12.KnowaGoodENT:Ittakesavillagetoraiseachildandittakesavocalteamtoraiseasinger.Itis important,early inthecareerofthedevelopingsinger,toestablisha trusted teamofvoice

care professionals including an ENT (Otolaryngologist) who specialises in voice, a Speech

TherapistandSingingVoiceSpecialist.McCoy(2004)recommendsawellvisit[totheENT]so

thedoctor

can

establish

abaseline

and

document

laryngeal

appearance

when

healthy

(p.

160).

SomesingersbaulkattheideaofvisitingtheENT,butthishesitationisgenerallydrivenbyfear

andshouldbeaddressedwithsupportive(andassertive)instructionconcerningthebenefitsand

thepossiblerisksassociatedwithavoidance.

Importantly, prevention is always better than cure. The developing singer is well advised to

addresstheirtechnicalprowess insupportofahealthyvoice, inadditiontopracticingmanyof

thelifestyledisciplineslistedinthismodule.Whendoingso,thesmartsingersavesthemselvesa

lotoftime,money,andagreatdealofstressbyinsuringagainstthedifficultandlengthyroadof

vocalremediation.

Who is DrDanielK. Robinson?Daniel is a freelance artist and educator. In 2011 Daniel completed his Doctor of Musical Arts degree at the Queensland

Conservatorium Griffith University. He has served as National Vice President (200911) and National Secretary for the

Australian National Association of Teachers of Singing (200611). Daniel is the principal Singing Voice Specialist for Djarts

(www.djarts.com.au) and presents workshops to singers across Australia and abroad. Over the past two decades, while

maintaininghisownperformancecareer,Danielhas instructedthousandsofvoices.ThisvastexperienceenablesDanielto

effortlesslyworkwithvoicesofallskilllevels:beginnerstoprofessionals.


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ReferencesBabbit,J.(2011).Workingwithyourvoice:Thecareerguidetobecomingaprofessionalsinger.VanNuys,

CA:AlfredMusicPublishing.

Bastian,R.,

Klitzke,

C.,

&

Thurman,

L.

(2000).

Vocal

fold

and

laryngeal

surgery.

In

L.

Thurman

&

G.

Welch

(Eds.), Bodymind and voice: Foundations of voice education (Vol. 3, pp. 620631). St. John'sUniversity,MI:TheVoiceCareNetwork.

Bastian, R., Thurman, L., & Klitzke, C. (2000). Limitations to vocal ability from userelated injury or

atrophy. InL.Thurman&G.Welch(Eds.),Bodymindandvoice:Foundationsofvoiceeducation(Vol.3,pp.527537).St.John'sUniversity,MI:TheVoiceCareNetwork.

Dawson, A. (2005).Voice training and church singers: The state of vocal health of church singers ofcontemporary commercial styles in charismatic evangelical churches. Unpublished MastersDissertation,QueenslandConservatorium,GriffithUniversityBrisbane,QLD.

Dayme,M.B.(2009).Dynamicsofthesingingvoice(5thed.).Austria:SpringerWienNewYork.Harvey, P. L.,& Miller, S. H. (2006).Nutritionand theprofessionalVoice. InR. T. Sataloff (Ed.),Vocal

healthandpedagogy:Advancedassessmentand treatment (2nd ed., Vol. 2, pp. 99120). SanDiego,CA:PluralPublishingInc.

Heuer, R. J., Rulnick, R. K., Horman, M., Perez, K. S., Emerich, K. A., & Sataloff, R. T. (2006). Voice

Therapy.InR.T.Sataloff(Ed.),Vocalhealthandpedagogy:Advancedassessmentandtreatment(2nded.,pp.227251).SanDiego,CA:PluralPublishingInc.

Kleiner, S. M. (1999). Water: An essential but overlooked nutrient.Journal of theAmericanDieteticAssociation,99(2),200206.

Lyon,J.T.(1993).Teachingallstudentstosingonpitch.MusicEducatorsJournal,80(2),2059.McCoy,S.(2004).Yourvoice:Aninsideview(2ed.).Princeton,NJ:InsideViewPress.McKinney,

J.

C.

(1994).

Thediagnosis&correctionofvocalfaults:amanualforteachersofsingingand

forchoirdirectors(2nded.).Nashville,USA:GenevoxMusicGroup.Robinson, D. K. (2013). Vocal anatomy 101. 15. Retrieved 21 August 2013 from

http://www.djarts.com.au/articles/voiceanatomy101/

Sadie,S.(Ed.)(1994)Thegroveconcisedictionaryofmusic.London,UK:TheMacmillanPressLtd.

Sataloff,R.T. (Ed.). (2006).Vocalhealthandpedagogy:Advancedassessmentandtreatment (2nded.Vol.2).SanDiego,CA:PluralPublishingInc.


15/15


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Scherer, R. C. (2006). Laryngeal function during phonation. In R. T. Sataloff (Ed.), Vocal health andpedagogy:Scienceandassessment(2nded.,Vol.1,pp.85102).SanDiego,CA:PluralPublishingInc.

Shewell,C.

(2009).

Voicework:Artandscienceinchangingvoices.WestSussex,UnitedKingdom:Wiley

Blackwell.

Sundberg,J.(1987).Thescienceofthesingingvoice.Dekald,IL:NorthernIllinoisUniversityPress.Thurman,L.,Theimer,A.,Grefsheim,E.,&Feit,P.(2000).Classifyingvoicesforsinging:Assigningchoral

partsandsololiteraturewithoutlimitingvocalability.InL.Thurman&G.Welch(Eds.),Bodymind&voice:Foundationsofvoiceeducation(2nded.,Vol.5,pp.772782).St.John'sUniversity,MI:TheVoiceCareNetwork.

Thurman, L., Theimer, A., Welch, G., Grefsheim, E., & Feit, P. (2000). Creating breathflow for skilled

speakingandsinging.InL.Thurman&G.Welch(Eds.),Bodymind&voice:Foundationsofvoiceeducation(2nded.,Vol.2,pp.339355).St.John'sUniversity,MI:TheVoiceCareNetwork.

Titze, I. R. (2000).Principlesof voiceproduction (2nd Printing ed.). Iowa City, IA: National Center forVoiceandSpeech.

Titze,I.R.,&Abbott,K.V.(2012).Vocology:Thescienceandpracticeofvoicehabilitation.SaltLakeCity,UT:NationalCenterforVoiceandSpeech.

Wingate,J.(2008).Healthysinging.SanDiegoCA:PluralPublishing.

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