Friday Focus: Vocal Health – Care

In the partner article to this piece, we discussed vocal hygiene.  Vocal Hygiene is an umbrella for those behaviors that assist one in maintaining the daily health of the voice.  This week we will delve into vocal health care which is more specifically about how to spot potential issues, how to determine when a vocal issue needs medical intervention and how to build a support structure for your voice use.
Like any athletic endeavor, high-level voice use comes with a few potential complications.    In order to best navigate these challenges, a voice user must assemble the best possible team.

The Voice Users Support Squad

At a minimum, the voice user’s team should include a voice teacher, Laryngologist and potentially an SLP (specialty – Voice Pathologist).  There are other professionals that can be part of a support structure depending on the voice user’s specific needs.  For example, my team also includes a chiropractor, an acupuncturist, and a massage therapist.
At the center of your team is you and you are the first line of defense for your voice.  Your general health, hydration, sleep habits and diet are the building blocks of a healthy voice.  The voice does not exist in isolation from the body.  In addition, you will likely be the first to know if something is wrong with your voice.
Some things to develop awareness of:

1. Changes in how your voice feels
2. Hoarseness
3. Changes in flexibility and/or range
4. Breathiness and/or raspiness
5. Peculiar sounds during voice production (not that common)
6. Pain

This list is not exhaustive but gives you a good starting point on the types of changes that require attention.  This does not mean that the symptoms listed are always signs of serious issues.  Let’s delve a little deeper.

1. Changes in how your voice feels – A solid practice and experience in using your voice well will also train you to perceive changes in your “normal” sensation.  If you also learn how the vocal mechanism works, then you can even sleuth out what might be changing.  Not all changes are bad, but you should trust your gut when things feel off.
2. Hoarseness – Unless you possess the famed “cords of steel” it is unlikely that you will never feel hoarse even if you have solid vocal technique.  The fact is that some of us are using our voices at the extremes of stamina and sometimes the voice is just tired.   Still, probably the best advice on this comes from Dr. Adam Rubin’s book The Vocal Pitstop: Keeping your Voice on Track, “Hoarseness does not equal Laryngitis”.  Laryngitis is a specific inflammation in the vocal cords.  While that can, in fact, cause hoarseness, there are other causes both mostly benign and quite serious.
3. Changes in Flexibility and/or range – If you are finding that your voice is not responding with the same access to your range and/or volume, as usual, there may an issue with the vocal cords, the breath or both.  Anything that impairs the natural movement of the vocal cords will affect the flexibility and range, as well as, the sound in general.
4. Breathiness and/or Raspiness – The vocal cords work by opening and closing to regulate air.  When you hear breathiness or raspiness in the sound, with or without a sensation of an issue, the vocal cords are not coming together fully.  This affects volume as well as the quality of the sound.
5. Peculiar sounds during voice production – These go beyond the occasional voice ‘crack’ to include wheezing, whistling, and highly strained sounds in the vocal production.  These can indicate a neurological dysfunction rather a specific vocal tract issue and should be addressed promptly.
6. Pain – Pain is the body’s way of getting your attention.  If you are experiencing throat pain there is definitely something amiss and while that could easily be an infection, it might point to something more serious.

The other members of your team

The voice teacher is tasked with teaching healthy voice techniques for application in speech and/or singing to enable a voice user to produce their desired sound efficiently and in a functionally sound way.  Some teachers are also able to coach content and vocal repertoire.  Some are acting and/or movement specialists in addition to vocal pedagogues.  When the stars align you encounter a teacher that is well-rounded in all of these areas.  What any voice teacher should be able to do is teach you about the structure and function of the vocal instrument and guide you as you learn the sensations and structures for efficient voice use.
The voice teacher should be able to perceive:

1. Faults in the vocal function such as breathiness or roughness in the sound
2. Changes in, or faults in, the transitions between registers
3. Changes in voice quality (volume, resonance, tone)
4. Physical changes such as tension, breath support issues, and alignment issues

When vocal issues present there are many technical tools a voice teacher can use to resolve them, especially if the cause is known such as a cold, allergies or a known medical condition that is already being managed.  If however, the symptoms are persistent and potentially expanding then it is time to refer the student to another team member.  Voice teachers are not medical professionals.  Some of us do know a lot about voice function, but we simply don’t have all of the training or diagnostic tools that voice medical professionals possess.  In general, if an issue persists without improvement for a couple of weeks, it requires an evaluation from a Laryngologist.
The Laryngologist is a medical doctor with a specialty in otolaryngology (ear, nose, and throat) and a sub-specialty in laryngology.  These specialists have extra training and expertise in voice disorders.  Sadly, not every region has a specialist such as this available but as a voice user whenever possible you should see a Laryngologist.  Here is a list of laryngologists (voice specialist ENTs).
This is where I highly encourage all voice users to have a laryngologist on your team and have a baseline, healthy videostroboscopy (VS) in your medical files.  Individual voices can have structural peculiarities that are normal for that voice.  It is much easier for your doctor to determine what is a problem and what is normal for you if there is a healthy VS on file.  Besides, there is nothing more stressful than having to figure out whether you have selected the best doctor for you when you are under duress.
Laryngologists have a great deal of diagnostic, therapeutic, and surgical options at their disposal for the treatment of vocal dysfunctions.  Sometimes there is no intervention required beyond voice therapy to be conducted by a voice pathologist.  Laryngologists and voice pathologists often work as a team based in the same medical office.
The Voice Pathologist is a speech and language pathologist (SLP) with a sub-specialty in voice disorders and voice therapy. Some of them further specialize in singing voice therapy.  Voice therapy is like physical therapy for an injured voice.  It can stand alone or be a post-surgical rehabilitation.  Voice pathologists sometimes work in concert with the voice teacher as the voice user resumes activity during the therapeutic process. In fact, some voice centers also employ in-house voice teachers (some of them also SLPs) to support this process.
This is a very basic outline for what to look for when you think there might be a problem with your voice and who should be on your team.  Next week, I will list some of my favorite voice soothers (and poke some holes in vocal care voodoo) as we enter cold and flu season. I wish you exceptional vocal health.