Good Vocal tips to a Healthy voice!

. Hydration

The vocal folds need to be lubricated with a thin layer of mucus in order to vibrate efficiently. The best lubrication can be achieved by drinking plenty of water. A good rule of thumb (if you have normal kidneys and heart function) is to drink at least two quarts of water daily. Dr. Van Lawrence, world renowned Laryngologist, often said, “Drink until you pee pale.”

Caffeine and alcohol pull water out of your system and deplete the vocal folds of needed lubrication. Caffeinated drinks include coffee, tea, and soft drinks. Small amounts of these beverages are acceptable but must be counterbalanced by drinking more water.

Another factor that can affect lubrication is a dry air environment. The cause can be from gas furnaces, air conditioners, and climates with a low amount of moisture in the air. Using a humidifier at night can compensate for the dryness.

The air in airplanes is extremely dry. It is recommended that you avoid alcoholic, caffeinated beverages and drink at least 8 ounces of water per hour while flying.

Dr. Lawrence often recommended a favorite gargle recipe: 1/2 tsp. of salt, 1/2 tsp. of baking soda, 1/2 tsp. of clear corn syrup, and 6 oz. of warmed, distilled water. Gargle quietly and gently for two long, boring minutes. Do not rinse and use as often as necessary to help your dry, irritated throat.

In addition, Entertainer’s Secret^® (800 308-7452) throat spray is an effective way to help moisturize the vocal folds (follow the directions on the label).

II. Throat Clearing & Harsh Coughing

Throat clearing and harsh coughing are traumatic to the vocal cords and should be reduced as much as possible. One of the most frequent causes for throat clearing and coughing is thick mucus (due to dry vocal folds) or too much mucus (as with a cold) on or below the vocal folds. The safest and most efficient way to clear mucus is by using a gentle, breathy productive cough where there is high airflow with little sound. This can be achieved by using the following strategy: take in as deep a breath as possible, momentarily hold your breath, and produce a sharp, silent “H” sound while you expel the air.

III. Drugs

Antihistamines: Antihistamines are sometimes prescribed to treat allergies and are present in some over-the-counter cold medications. Antihistamines should rarely be used because they tend to cause dryness. Prescription nasal steroid sprays such as Nasacort^® (Phone-Poulenc Rorer), Nasonex^® (Schering), Flonase^®(Allen & Hansburys), etc. will often relieve the symptoms of nasal allergy without the drying side effects of antihistamines.

Analgesics: Aspirin products and non-steroidal anti-inflammatory drugs (ibuprofen) should be used with caution as they cause platelet dysfunction and this may predispose to bleeding. Tylenol^® (McNeil Consumer Products) is the best substitute for pain relief.

Mucolytic Agents: The most common expectorant is a preparation of long-acting guaifenesin to help liquefy viscous mucus and increase the output of thin respiratory tract secretions. Drugs, such as Mucinex^®, may be helpful for singers who complain of thick secretions, frequent throat clearing, or postnasal drip. Awareness of postnasal drip is often caused by secretions that are too thick rather than too plentiful. Mucolytic agents need to be used with a lot of water through the day, to be effective.

Local Anesthetics: Avoid the use of over-the-counter local anesthetic preparations for the throat. Singing under their influence is like trying to play the piano with gloves on.

Progesterone: Question the use of progesterone-dominant birth control pills. They may cause virilization of the female larynx and a loss in the upper vocal range. There may be no other alternative for your individual situation, however, so consult your gynecologist.

IV. Laryngopharyngeal Reflux Disease and Recommendations to Prevent Acid Reflux

What is Reflux?

When we eat something, the food reaches the stomach by traveling down a muscular tube called the esophagus. Once food reaches the stomach, the stomach adds acid and pepsin (a digestive enzyme) so that the food can be digested. The esophagus has two sphincters (bands of muscle fibers that close off the tube) to help keep the contents of the stomach where they belong. One sphincter is at the top of the esophagus (at the junction with the upper throat) and one is at the bottom of the esophagus (at the junction with the stomach). The term REFLUX means “a backward or return flow,” and refers to the backward flow of stomach contents up through the sphincters and into the esophagus or throat.

What are GERD and LPRD?

Some people have an abnormal amount of reflux of stomach acid that goes up through the lower sphincter and into the esophagus. This is referred to as GERD or Gastroesophageal Reflux Disease. If the reflux makes it all the way up through the upper sphincter and into the back of the throat, it is called LPRD or Laryngopharyngeal Reflux Disease. The structures in the throat (pharynx, larynx, vocal folds and the lungs) are extremely sensitive to stomach acid, so smaller amounts of reflux into these areas can result in much more damage.

Why Don’t I have Heartburn or Stomach Problems?

This is a question that is often asked by patients with LPRD. The fact is that very few patients with LPRD experience significant heartburn. Heartburn occurs when the tissue in the esophagus become irritated. Most of the reflux events that can damage the throat happen without the patient ever knowing that they are occurring.

Common Symptoms of LPRD:
Hoarseness, chronic (ongoing) cough, frequent throat clearing, pain or sensation in throat, feeling of lump in throat, problems while swallowing, bad/bitter taste in mouth (especially in the morning), asthma-like symptoms, referred ear pain, post-nasal drip, singing difficulties (especially with high notes).

Medications for LPRD:
The most effective treatment for LPRD may be drugs in the class known as proton pump inhibitors. Included in this group are Prilosec^®, Prevacid^®, Protonix^®, Aciphex^®, or the new medication known as Nexium^®. Ask your physician which may be appropriate for you.

V. Self-Destructive Behaviors

Avoid smoking cigarettes. They are bad for the heart, lungs, and vocal tract. Also, avoid other irritant inhalant substances and mind-altering drugs. Tobacco and marijuana are irritants to the vocal tract. When you sing you must be in control of all body systems: physical, spiritual, and mental. Smoking is disastrous for the speaking and singing voice.

Vocal Use Practices

1. Avoid hyper functional use of your voice, i.e., learn to use your voice with as little effort and tension as possible. A high school or collegiate singer in training should be able to sing for 3-4 hours per day (when healthy) without debilitating the next day's singing activity. If one cannot sing for this length of time without some disablement, then one should consider a reevaluation of present singing or speaking habits.
2. Keep in mind that the degree of individual vocal conditioning and innate vocal capacity to endure wear and tear relate directly to the amount of singing or speaking one can do each day.
3. Avoid singing in a tessitura which is continually near the extremes of your own range (both high and low). Carefully pace the use of register extremes (such as pushing the chest voice into the upper range for effect, i.e, belting). MISUSE OR OVERUSE HERE CAN BE VOCAL SUICIDE.
4. Before singing or using the voice in unusual ways (public/dramatic speaking), do some vocal warm-ups. As in any physical activity, the warm-up should proceed from general stretching through less strenuous to more strenuous usage. Loud volume and high range are the most strenuous of usages,therefore, begin in the mid-range with easy production. At every stage along the way, evaluate your present day vocal condition, and adjust your rehearsal activity accordingly. Every voice is different, but 7-10 minutes of warm-up is usually the minimum.
5. Reduce general voice use prior to a concert. While riding the bus to the program, have a quiet period when everyone can conserve energy for the task that is at hand.
6. Avoid shouting, screaming,loud laughter, and heavy throat clearing. Necessary coughing and sneezing should be as gentle and as nonvocal as possible.
7. If it feels bad, don't do it.
Common Signs of Significant Vocal Abuse
1. Throat is tender to the touch after use.
2. Voice is hoarse at the end of singing.
3. Throat is very dry, with a noticeable "tickle" that is persistent. Check dehydration.
4. Inability to produce your highest notes at pianissimo volume.
5. Persistent hoarseness or an inability to sing with a clear voice after 24-48 hours of vocal rest.
Treat your voice and body sensibly when you feel vocally run down. This necessitates the development of accurate perceptions by the singer of why the voice is feeling tired. Accurate self-evaluation will lead one to therapeutic practices which will return you to vocal health in the shortest period of time. In doubt? seek professional help.

Vocal Nodes!!! (AHHHHHHH!!!!!!)

The term vocal cord lesion (physicians call them vocal “fold” lesions) refers to a group of noncancerous (benign), abnormal growths (lesions) within or along the covering of the vocal cord. Vocal cord lesions are one of the most common causes of voice problems and are generally seen in three forms; nodules, polyps, and cysts. 

Vocal Cord Nodules (also called Singer's Nodes, Screamer's Nodes) 

Vocal cord nodules are also known as “calluses of the vocal fold.” They appear on both sides of the vocal cords, typically at the midpoint, and directly face each other. Like other calluses, these lesions often diminish or disappear when overuse of the area is stopped.

Vocal Cord Polyp
 A vocal cord polyp typically occurs only on one side of the vocal cord and can occur in a variety of shapes and sizes. Depending upon the nature of the polyp, it can cause a wide range of voice disturbances.

Vocal Cord Cyst 

A vocal cord cyst is a firm mass of tissue contained within a membrane (sac). The cyst can be located near the surface of the vocal cord or deeper, near the ligament of the vocal cord.  As with vocal cord polyps and nodules, the size and location of vocal cord cysts affect the degree of disruption of vocal cord vibration and subsequently the severity of hoarseness or other voice problem. Surgery followed by voice therapy is the most commonly recommended treatment for vocal cord cysts that significantly alter and/or limit voice. 

Reactive Vocal Cord Lesion 

A reactive vocal cord lesion is a mass located opposite an existing vocal cord lesion, such as a vocal cord cyst or polyp. This type of lesion is thought to develop from trauma or repeated injury caused by the lesion on the opposite vocal cord. A reactive vocal cord lesion will usually decrease or disappear with voice rest and therapy. 

What Are The Causes Of Benign Vocal Cord Lesions? 

The exact cause or causes of benign vocal cord lesions is not known. Lesions are thought to arise following "heavy" or traumatic use of the voice, including voice misuse such as speaking in an improper pitch, speaking excessively, screaming or yelling, or using the voice excessively while sick. 

What Are The Symptoms Of Benign Vocal Cord Lesions? 

A change in voice quality and persistent hoarseness are often the first warning signs of a vocal cord lesion. Other symptoms can include:

• Vocal fatigue 
• Unreliable voice 
• Delayed voice initiation
• Low, gravelly voice
• Low pitch
• Voice breaks in first passages of sentences
• Airy or breathy voice 
• Inability to sing in high, soft voice
• Increased effort to speak or sing
• Hoarse and rough voice quality
• Frequent throat clearing
• Extra force needed for voice
• Voice "hard to find"

When a vocal cord lesion is present, symptoms may increase or decrease in degree, but will persist and do not go away on their own. 

Just be very careful in what you do with your voice avoid screaming at all costs,  and if you feel like you cant sing anymore....Don't!!!!!

~Emmett Gabriel Tross 

Vocal Use Practices

1. Avoid hyperfunctional use of your voice, i.e., learn to use your voice with as little effort and tension as possible. A high school or collegiate singer in training should be able to sing for 3-4 hours per day (when healthy) without debilitating the next day's singing activity. If one cannot sing for this length of time without some disablement, then one should consider a reevaluation of present singing or speaking habits.

2. Keep in mind that the degree of individual vocal conditioning and innate vocal capacity to endure wear and tear relate directly to the amount of singing or speaking one can do each day.

3. Avoid singing in a tessitura which is continually near the extremes of your own range (both high and low). Carefully pace the use of register extremes (such as pushing the chest voice into the upper range for effect, i.e, belting). MISUSE OR OVERUSE HERE CAN BE VOCAL SUICIDE.

4. Before singing or using the voice in unusual ways (public/dramatic speaking), do some vocal warm-ups. As in any physical activity, the warm-up should proceed from general stretching through less strenuous to more strenuous usage. Loud volume and high range are the most strenuous of usages,therefore, begin in the mid-range with easy production. At every stage along the way, evaluate your present day vocal condition, and adjust your rehearsal activity accordingly. Every voice is different, but 7-10 minutes of warm-up is usually the minimum.

5. Reduce general voice use prior to a concert. While riding the bus to the program, have a quiet period when everyone can conserve energy for the task that is at hand.

6. Avoid shouting, screaming,loud laughter, and heavy throat clearing. Necessary coughing and sneezing should be as gentle and as nonvocal as possible.

7. If it feels bad, don't do it.

Maintaining Vocal Health

1. Try your best to maintain good general health. Avoid viral colds (a regimen of washing hands hasbeen shown to reduce the transmission of cold viruses). Some advocate vitamin C and zinc lozenges, while I find these effective I would recommend their use these only after the student has consulted a physician.
2. Emotional and physical stress both contribute significantly to vocal distress. Exercise regularly. Using your major muscle groups in jogging,etc. is an excellent way to diminish stress. NOTE: extensive power weight lifting will place some wear on the vocal folds, this should be avoided during times of extended vocal use or vocal fatigue.
3. Eat a balanced diet. At times of extended vocal use avoid large amounts of salt and refined sugar, spicy food such as Mexican, Szechuan Chinese, as well as excessive amounts of food and/or alcohol. One may note hoarseness in the larynx or dryness of the throat after drinking significant amounts of alcohol, caffienated, as well naturally or artificially sweetened beverages. The body needs water to metabolize these foods and beverages, excessive consumption of these items will reduce the amount of water available to hydrate the voice.
4. Maintain body hydration (7-9 glasses of water a day) and avoid known dietary diuretics such as caffeine and alcohol. Moisture is a necessary lubricant of the vocal folds. When one's body is dehydrated laryngeal lubrication diminishes and wear takes place at a much greater rate than normal.
5. Avoid dry, artificial interior climates. Laryngologists recommend a humidity level of 40-50%. Much body moisture is lost while breathing air in low humidity climates, i.e., air conditioned or heated rooms (routinely 10-20% moisture), cars, buses, etc.
6. Avoid smoking cigarettes, cigars, pipes. These are bad for the heart, lungs, and vocal tract of not only yourself, but others around you as well. Avoid other irritant inhalants, i.e., marijuana. In addition to the debilitating effect on the vocal tract, you need your head on straight when you sing.
7. Avoid breathing smoggy, polluted air, i.e., car exhausts, smoky bars and lounges when you are vocally tired.
8. Avoid the use of local anesthetics when you are singing. The anesthetic effect masks any signs of injury, therefore encouraging further abuse of the folds. Additionally, singing under their influence is like playing the piano with gloves on (Chloroseptic, Parke-Davis Throat Discs, etc.).
9. Question the use of progesterone dominant birth control pills. These cause a virilization of the female larynx and a decrease of range in your upper register. There may be no other solution for your particular situation, however. The treatment of endometriosis often includes pharmaceuticals which cause permanent vocal changes. Inform your doctor that you are a singer if you are undergoing treatment for this disease.