voice center voicecenter.pitt.edu keep your voice healthy! · keep your voice healthy! how the...
TRANSCRIPT
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
Voicecenter.PITT.edu 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
Voicecenter.PITT.edu Voice Center
• 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
Voicecenter.PITT.edu Voice Center
Larynx Voice Production
Brain
Lungs
Larynx (vocal folds)
Pharynx
Nose/Sinuses (soft palate)
Oral cavity
– Tonsils, tongue, lips
EARS
Voicecenter.PITT.edu Voice Center
POWER
SOURCE
RESONATOR
Voicecenter.PITT.edu Voice Center
Where is the Larynx?
Voicecenter.PITT.edu Voice Center
Larynx Anatomy
• Paired vocal folds
– Open for breathing
– Come together for sound production
• Speaking
• Singing
Voicecenter.PITT.edu Voice Center
Voicecenter.PITT.edu Voice Center
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
Voicecenter.PITT.edu Voice Center
Vocal Fold Vibration
Voicecenter.PITT.edu Voice Center
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 !!!
Voicecenter.PITT.edu Voice Center
• Performed by an Ear, Nose and Throat doctor in the office
Laryngeal Examination
Voicecenter.PITT.edu Voice Center
• Specialized instrument to examine rapid vocal fold vibration
• Allows slow motion viewing and analysis of vocal fold vibration
Stroboscopy
Voicecenter.PITT.edu Voice Center
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
Voicecenter.PITT.edu Voice Center
Vocal Fold Vibration at 264 Hz
Voicecenter.PITT.edu Voice Center
Vocal Fold Vibration at 120 times per second !
Voicecenter.PITT.edu Voice Center
Outside and Inside of Singing
Voicecenter.PITT.edu Voice Center
“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
Voicecenter.PITT.edu Voice Center
–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
Voicecenter.PITT.edu Voice Center
Smoking
Laryngeal Cancer Irreversible changes to vocal
folds
Voicecenter.PITT.edu Voice Center
• 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)
Voicecenter.PITT.edu Voice Center
Voicecenter.PITT.edu Voice Center
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
Voicecenter.PITT.edu Voice Center
• 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
Voicecenter.PITT.edu Voice Center
• 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
Voicecenter.PITT.edu Voice Center
• 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?
Voicecenter.PITT.edu Voice Center
• 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?”
Voicecenter.PITT.edu Voice Center
Vocal fold hemorrhage
Voicecenter.PITT.edu Voice Center
• 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
“I Have a Cold, Can I Sing?”
Voicecenter.PITT.edu Voice Center
• 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
“I Have a Cold, Can I Sing?”
Mother
knows best!
Voicecenter.PITT.edu Voice Center
• 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
“I Have a Cold, Can I Sing?”
Voicecenter.PITT.edu Voice Center
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
Voicecenter.PITT.edu Voice Center
Vocal Fold Nodules
Voicecenter.PITT.edu Voice Center
Vocal Fold Lesions
Vocal fold polyps Vocal fold hemorrhagic polyp
Voicecenter.PITT.edu Voice Center
Vocal Fold Lesions
Reactive
lesion
Vocal
fold cyst
Voicecenter.PITT.edu Voice Center
Hoarseness is no laughing matter!
• Hoarseness is NEVER normal
• Especially repeated episodes
Voicecenter.PITT.edu Voice Center
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
Voicecenter.PITT.edu Voice Center
University of Pittsburgh Voice Center –412-232-SING (7464)
–UPMC Mercy
Voicecenter.PITT.edu Voice Center