Voice Care by Daniel K. Robinson


Extract of Dr Dan's article Vocal Health & Voice Care (located here) which we recommend you read in full.


Ingo Titze and Katherine Verdolini Abbott (2012) define voice disorders according to the World Health Organisation’s classification summarising, “the relative health status of an individual involves three domains: (1) body and mind, (2) an individual’s activities, and (3) an individual’s participation in society. Both environment and personal factors come into play in every domain” (p. 39). Using Scott McCoy’s (2004) twelve headings (pp. 158–160) let’s now outline a range of areas that might “improve your chances of preserving your vocal health” (p. 158).

1. Speak Well: As stated at the commencement of this module [see here for reference], the challenge facing every professional voice user is that ‘they are their voice’. Predominantly, the voice is used for speech. Even professional singers utilise their voice for spoken communication far more than singing. It is therefore necessary to ensure that the voice is used expertly during this dominant activity. Plainly, if your voice is being fatigued and damaged with poor speech patterns, then it will most probably perform poorly when it is employed for singing.

As with all things associated with phonation, well managed breathing is essential to healthy spoken‐voice. Leon Thurman and his colleagues note that “active exhalation is required during skilled speaking and singing, but in widely different degrees depending on the vocal volume level needed for the expressive purposes at hand. (Thurman, Theimer, Welch, Grefsheim, & Feit, 2000, p. 349). Vocal expression is generally driven by alteration to the bio‐functional patterns of the larynx and the manner in which the vocal tract shapes the sound as it travels along the highly mouldable pathway. Vocal actions such as glottal attacks, aspirate tone and ‘over‐talking’ (in order to be heard in loud environments) can all contribute to the wear and tear of the voice for both speaking and singing. Scott McCoy (2004), while recommending habitually clear tone and resonant voice quality also suggests finding an “optimum speaking range, which might be higher or lower than you usually speak” (p. 158).

It is also important to note the deleterious effect of ‘clearing the throat’ on the general well‐being of the voice. Heuer et al. (2006) state that clearing the throat is generally “out of habit, rather than need” (p. 235). Stating the ‘traumatic’ impact of throat clearing on the vocal folds, their article, Voice Therapy, recommends replacing the throat clear with a ‘dry swallow,’ taking small sips of water, light humming and, “for singers, vocalis[ing] lightly on five‐note scales in a comfortable range on /ɑ/, or slide up on [an] octave softly on /ɑ/, and crescendo (get louder)” (p. 235).


2. Sing Well: It will surprise no one to read here that I strongly advocate for the necessity of qualified technical instruction when it comes to acquiring a healthy singing voice. Sataloff (2006) highlights the need for singing lessons when he aptly states, “singing skills are to speaking as running skills are to walking” (p. 25). When the voice is being operated during the heightened activity of singing, many challenges present themselves. McCoy (2004) provides a helpful list of considerations when one desires to ‘sing well’ (p. 158):

a) Maintain effective breath support and control;

b) Keep extrinsic laryngeal, tongue and jaw muscles free from excess tension;

c) Avoid excessive glottal onsets and offsets of tone;

d) Avoid air pushing during tone initiation, between consecutive tones, and at phrase terminations;

e) Sing in your optimum tessitura9

f) Sing with proper body alignment and correct laryngeal position (neither too high nor too low).

The final key to singing well is regular (4‐5 times per week) disciplined and structured practice. There are many excellent exercise compilations for developing the singing voice; including Dr Dan’s Voice Essentials CD (Figure 3).10

3. Moderation: The human body is not designed (some would say, ‘unfortunately’) to keep going and going...and going. So too with the voice. It is important to monitor the amount of use the voice receives. Importantly, like most muscular systems in the body, the voice can develop increased stamina with regular exercise; but even this will have a limit. Of course, your voice is unique and 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). Johann Sundberg (1987) submits, “It is a rarely realized fact that an indispensable side of a singer’s career is to learn not only how but also how much to sing under what conditions” (p. 185). Muscular fatigue is observed during and after prolonged muscular exercise. Vocal fatigue, similar (in part) to general muscle fatigue limits vocal endurance by reducing the pliability of the vocal folds required for healthy oscillation. Titze (2000) offers five observations of the fatigue voice in his text, Principles of Voice Production (p. 362):

a) Fatigue of laryngeal muscles that normally provide tension in the vocal folds and stability of the laryngeal configuration.

b) Straining of nonmuscular laryngeal tissue (ligaments, joints, membranes).

c) Increase in tissue viscosity of the vocal folds, making it harder to maintain vibration because of increased internal friction. This may be the result of dehydration or chemical changes in fluid composition.

d) Loss of blood circulation due to the constricted blood vessels in phonation. This mayimpede regenerative processes and reduce the system’s capacity to transfer heat away from the vocal folds to surrounding tissue.

f) Loss of subglottal pressure caused by fatigue of the respiratory muscles.

4. Rest: The answer to general vocal fatigue is rest. Plain and simple!? Actually, achieving times of vocal rest for the professional voice user is not always ‘plain and simple’. Sometimes finding the opportunities to rest the voice can be difficult. For example, a gigging singer who has a five‐night run of shows may start to experience vocal fatigue by the middle of the 2nd or 3rd nights. They can’t simply cancel the remaining shows. But they can clear their schedules of other, less pressing events; such as the Saturday BBQ with friends where talking will be the main activity. It’s at these times that the job of the professional singer becomes ‘work’ requiring discipline and a good dose of delayed gratification.

Remember: No voice = No work.

It’s not only the larynx that requires rest...the whole instrument (the entire body) needs times of recuperation also. It is important therefore to ensure that adequate amounts of sleep are obtained and maintained. Sataloff (2006) indicates “that that the functions of a number of body 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 productive and generally sound way better than the singer who didn’t” (p. 24).

5. Hydration: Most singers know that drinking 2‐3 litres of water a day is important. Equally, most singers don’t do it! Beyond the many health benefits of the well‐hydrated body, the well‐ hydrated voice is advantaged by consistent lubrication of the vocal folds. Additionally, Judith Wingate (2008), in her text, Healthy Singing, advises that“when 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 harder’...and all you have to do is drink water!It’s important to state here that there are beverages that work in opposition to good hydration by actively ‘dehydrating’ the body. Specifically, caffeinated and alcoholic beverages are known diuretics; i.e. they promote the body’s production of urine. “Early signs of dehydration include headache, fatigue, loss of appetite, flushed skin, heat intolerance, light‐headedness, dry mouth and eyes, burning sensation in the stomach, and dark urine with a strong odor” (Kleiner, 1999, p. 201).

6. Use Good Hygiene: Practicing good hygiene is an absolute must for singers. I like to travel with a small bottle of antibacterial hand gel because “viruses often infect our bodies through hand contact with mouth, nose and eyes. Washing the hands frequently (especially after exposure to public articles such as hand rails and door knobs) helps reduce the risk of viral and bacterial transfer” (McCoy, 2004, p. 159).

7. Avoid Unnecessary Drug Use: Pharmaceuticals are a normal part of western society living. The wonder of modern medicines supports our bodies in the fight against everything from the common cold to cancer. These drugs, for the most‐part, are not without their side effects on the voice. Titze and Abbott (2012) identify their affect on the “nervous system, the blood supply, the muscles, and particularly the tissues in vibration” (p. 105). The detrimental effects of medication, 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. When medications are prescribed, particularly antihistamines and decongestants, it is important to replenish the body’s general hydration with extra water intake.Of course, for all the well‐known 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 voice susceptible to heightened wear and tear.

8. Stay Physically Fit: Gone are the days when the archetypal singer was pictured as an overweight (obese) person singing an operatic number. The rigors of today’s professional world requires the modern singer (classical and contemporary) to be physically fit (and mentally also). The physically 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 today’s industry are ‘the better you look...the better you sound!’

Furthermore, John Lyon (1993) states that “Singers sing better and more on pitch when they are alert – physically and mentally” (p. 21). Being physically alert requires stamina; stamina increases with general fitness.


9. Practice ‘Safe Sex’: Remember that I stated at the beginning of the module (Page 1) “Everywhere the singer goes, everything (and I mean everything) the singer does and all that the singer is has a bearing on the singer’s vocal health”...and that includes sex! Without explicitly stating where your mouth might go during sex, it is important to note what your mouth (and throat) might be exposed to during sex. Specifically, “herpes and gonorrhoea are easily transmitted to the mouth, pharynx and larynx through unprotected oral sex with an infected partner” (McCoy, 2004, p. 159). A moment of passion, can lead to months of discomfort, pain, and in some cases, reduced vocal capacity. Your sexual activities do have a bearing on your vocal health.

10. Wear Your Seatbelt: This might appear to be self‐explanatory...but in America it is estimated that 1 in 7 people don’t buckle up! Your voice (the whole body) and you larynx are at high risk of extreme damage even in the lightest of bingles when you don’t wear a car restraint. This heading also reminds us, yet again, that everything you do – your voice does too!

11. Don’t Sing if You Are Ill: Singing when you are sick is to be avoided at all costs. And in some cases this will mean cancelling a (or many) gig. Remember, you can seriously damage your voice in one set of singing! And you voice is extremely vulnerable to damage when you are ill. Meribeth Bunch Dayme (2009) leaves no room for negotiation when addressing the sick singer. She writes, “Clearly with a severe cold all singing must cease. Singing with a voice made hoarse by swollen mucous membranes has produced many vocal cripples by leading to chronic hoarseness” (p. 160). There will be times when a judgement call needs to be made. Assessing the level of risk in these circumstances is an important consideration in the decision making process.

[See Dr Dans great article on how to make the call if you're too sick to sing]

12. Know a Good ENT: It takes a village to raise a child...and it takes a vocal team to raise a singer. It is important, early in the career of the developing singer, to establish a trusted team of voice‐ care professionals including an ENT (Otolaryngologist) who specialises in voice, a Speech Therapist and Singing Voice Specialist. McCoy (2004) recommends “a ‘well’ visit [to the ENT] so the doctor can establish a baseline and document laryngeal appearance when healthy” (p. 160).

Some singers baulk at the idea of visiting the ENT, but this hesitation is generally driven by fear and should be addressed with supportive (and assertive) instruction concerning the benefits and the possible risks associated with avoidance.

Importantly, prevention is always better than cure. The developing singer is well advised to address their technical prowess in support of a healthy voice, in addition to practicing many of the lifestyle disciplines listed in this module. When doing so, the smart singer saves themselves a lot of time, money, and a great deal of stress by insuring against the difficult and lengthy road of vocal remediation.

9 “Tessitura (It.). Term used to describe the part of a vocal (or instrumental) compass in which a piece of music predominantly lies. The tessitura of a piece is concerned with the part of the range most used, not by its extremes” (Sadie, 1994, p. 813). 10 Dr Dan’s Voice Essentials vocal exercise CD is available via the djarts online store (www.djarts.com.au) or through iTunes.

A link to the original article (and many more that delve deeper into the world of vocal care) can be found here, courtesy of Dr.Dan: http://www.djarts.com.au/articles/vocal-health-voice-care/

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