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Readings • McCoy (2004). Your Voice: An Inside View. Chapter 12 (pp. 158–174) • Miller (1996).
Readings
• McCoy (2004). Your Voice: An Inside View. Chapter 12 (pp. 158–174)
• Miller (1996). The Structure of Singing. Chapter 17 (pp.218–240)
• Shewell (2009). Voice Work. Chapter 27 & 28 (pp. 415–460)

Vocal Health & Voice Care

Readings • McCoy (2004). Your Voice: An Inside View. Chapter 12 (pp. 158–174) • Miller (1996).

Objectives:

  • 1. Discuss issues pertaining to vocal health

  • 2. Briefly examine vocal disorders resulting from misuse of the voice

  • 3. Review positive living practices that enhance overall vocal health.

Outcomes:

This module endeavours to highlight the everpresent challenge of ‘the singer is their instrument’. At the end of this session, the student should be more aware of the necessity for voice care and the impacts of environment and life practice on their general vocal health.

  • 1. Vocal Health

I have been presenting on the topic of ‘Vocal Health & Voice Care’ for nearly twenty years and it still amazes me how many singers roll their eyes when I stress the importance of the topic. Allow me to state upfront, I am not a vocal hypochondriac! I do not see vocal damage everywhere I look (or hear), nor do I believe every contemporary vocal sound is detrimental to the health of the voice. This being said, singers embody their instrument. 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. Allan Dawson (2005) states it quite simply: “Vocal health is an occupational concern for all singers” (p. 14). Not some…but all singers!

Before continuing; a disclaimer: “The material in this [module] is intended to provide rudimentary information about [vocal health and voice care]. It is not meant for use as a diagnostic or therapeutic tool, nor as a substitute for consultation with an otolaryngologist or voice therapist” (McCoy, 2004, p. 158).

Readings • McCoy (2004). Your Voice: An Inside View. Chapter 12 (pp. 158–174) • Miller (1996).

Voice: Art & Science (Djarts’ Manuals)

Normal Voice

Bank tellers are educated to identify counterfeit money by carefully studying genuine currency. And that is where we should start with the human voice: What does normal voice look and sound like? 1

Firstly, it is important to allow for some variance in what we consider ‘normal’. There are far too many ‘exceptions to the rule’ to categorically state fixed rules of normality. For example, the human voice 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) based singer Adam Lopez currently holds the Guinness world record for the highest note sung by a male voice: C sharp in the 8th octave (one note above the range of a piano!). Wow! That’s not normal.

Having acknowledged some wriggleroom when discussing normal voice, let’s briefly define how ‘normal voice’ should typically present:

Normal Voice Pathology: The healthy voice, when viewed under fixed or flexible scope, should present as a free (unobstructed) airway. The vocal folds should be lightpink or pearlywhite in colour with no observable lesions or dysfunction. There should be relative symmetry to the glottis position in accordance with the positioning of the arytenoids and the manner in which the arytenoids activate. 2 The majority of the true vocal fold length should be clearly visible.

Normal Voice Phonation: The healthy voice should present as a clear tone. Phonatory dysfunction might exhibit high levels of aspiration (breathiness) or raspy sound, reduced capacity for increasing volume and inconsistent phonatory patterns (e.g. the sound cutting in and out). It is important to note however that the presence of these characteristics does not automatically indicate reduced health or function. Christina Shewell (2009) reminds us that,

No voice practitioner can ever reliably identify the nature of the voice disorder by the sound of the voice. The sound of a voice may give clues about vocal tract and fold function, but it cannot specify the pathology that is creating that sound. Highlevel laryngeal examination is essential, and there are frequently surprises. (p. 416)

Voice: Art & Science (Djarts’ Manuals) Normal Voice Bank tellers are educated to identify counterfeit money

“Vocal longevity will be achieved by attending to vocal health through healthy voice production, following a vocal hygiene program, and avoiding vocal injury and not losing sight of the importance of general health.” (Harvey & Miller, 2006, p. 108)

  • 1 For a more detailed review of vocal anatomy the interested reader is encouraged to read “Vocal Anatomy 101” (Robinson,

2013).

  • 2 There is currently some debate about the impact of asymmetry of the arytenoids and whether or not this actually has any detrimental effect on phonatory patterns. Without seeking to solve the issue here, perhaps this is another area where ‘normal’ has a wide scope of variance. Further research may yet shed light on this ongoing discussion.

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The Disordered Voice

Of course, maintaining clear normal voice function is a challenge to the professional voice user; just as maintaining healthy functional physiology is the everpresent challenge for the professional athlete. But things do go wrong. A professional singer can perform successfully for decades without complaint, but then one day (usually through a series of colliding events) notices that their voice is not performing with its usual rigor or agility.

Shewell (2009) identifies the difference “between a voice disorder and a general voice problem” (p. 415) by nominating three groups: 3

  • 1. Impairment: temporary alteration to the normal function which might exhibit with some breathiness or soreness.

  • 2. Disability: prolonged changes to vocal sound and function; often preceded by impairment.

  • 3. Handicap: the disabled voice when exposed to disadvantage relative to others.

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 thought of as handicapped!

When identifying voice disorders practitioners typically classify the conditions into two groups: Organic and Functional. 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)

Let’s now look at the various voice disorders groups under these two headings.

  • 1. Organic: these vocal disorders often require surgical intervention, but this is generally conducted after the patient has adequately (to the surgeons satisfaction) addressed their vocal hygiene elements (e.g. hydration, alcohol, acid reflux), adjusted their overall vocal output and vocal loads (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 ailments including short term viral infection (leading to acute inflammation of the vocal folds and surrounding tissues) and chronic longterm inflammation which is often caused by irritants (reflux, smoking etc.).

  • 3 Shewell has derived these labels from the World Health Organisation (Shewell, 2009, p. 415).

  • 4 It is important to note that the line that separates organic and functional can often be blurred because at times it is difficult to identify what is ‘cause’ and what is ‘effect’.

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Vocal Fold Cysts: Small sacs of fluid can randomly appear anywhere in the body, including the larynx. Deceptive little critters 5 , vocal folds cysts (mucus retention cysts; Figure 1) will often swell with vocal use and then reduce in size with vocal rest, leaving the voice user believing they’re voice has ‘healed’. “This type of cyst occurs more commonly just below the leading edge of a fold…when cysts become large enough, they can impact on the other fold and can cause a nodular tissue reaction there” (Bastian, Thurman, & Klitzke, 2000, p. 533).

Voice: Art & Science (Djarts’ Manuals)  Vocal Fold Cysts: Small sacs of fluid can randomly

Figure 1: Cyst on Right Vocal Fold

Papillomas: Believed to originate from a wartlike virus, papillomas can occur suddenly, and in chronic cases can be life threatening (especially in small children) due to the manner in which they grow and obstruct the airway. The wartlike growths may need to be surgically managed; that is, removed regularly to ensure an unobstructed airway. Often the papillomas resolve themselves and discontinue growing; again, not dissimilar to the common wart.

Vocal Fold Paralysis and Paresis: The vocal folds and their surrounding musculature are driven by the right and left recurrent laryngeal nerve. If either (or both) of these nerves becomes damaged, paresis (partial) or paralysis (complete) can be sustained either temporarily or permanently. Vocal fold paralysis can be obtained during times of trauma to the neck (e.g. thyroid surgery). Vocal fold paralysis is generally treated with voice therapy and/or surgical intervention.

Spasmodic dysphonia/laryngeal dystonia: An intermittent disorder of the vocal folds, spasmodic dysphonia is evidenced by irregular and abrupt closure and/or opening of the glottis. This rare condition is often treated “by injections of botulinum toxin (botox) into the vocal folds, to weaken their closure patterns” (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, “presenting symptoms may include voice change, chronic sore throat with or without swallowing difficulty – and occasionally, a sense of breathing restriction” (Bastian, Klitzke, et al., 2000, p. 629). Treatment of laryngeal cancer is dependent on the size and type of the cancerous growth.

5 Of course, vocal fold cysts are not ‘critters’…I’m writing colloquially.

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  • 2. Functional: typically, these vocal disorders can be shown to originate from the functional activity of the voice the manner in which the vocalist has been using their voice. Again, it is important to note that the line that separates organic from functional is often blurred by the multiplicity effect of many contributing factors. That is, vocal disorders can (and often do) onset because of both organic and functional matters: e.g. the singer with nodules (functional) may have developed them because they chose to sing on a voice with chronic laryngitis (organic).

a) Primarily derived from muscle tension Muscle Tension Dysphonia (MTD): Usually related to speech patterns, MTD is the hypoadduction 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 intervention designed 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.

Vocal Fold Swelling (oedema 7 ): Like all muscles, the vocalis muscle (the muscular body of the true vocal folds) swells with use; i.e. the muscle is supplied with extra blood flow during heightened use. However, under extreme use and/or when the health of the voice 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 body’s physiology may distribute additional fluid to the lamina propria (second layer of the true vocal fold) in order to provide protection and healing. “Pitch can be altered by fluid engorgement (edema). The usual explanation for pitch drop in edema cases is that greater mass creates lower natural frequencies” (Scherer, 2006, p. 90). Often the best treatment for acute oedema is complete or relative vocal rest.

Reinke’s oedema: The labelling of this form of vocal fold swelling is socalled because it occurs in the Reinke’s space (the second layer of the true vocal fold). Not actually a cavernous space, Reinke’s space is a gelatinous layer that allows the epithelium (outer layer) to move freely (oscillate) over the top of it. An extreme and prolonged (chronic) case of vocal fold swelling (often observed in older people with a history of smoking or heavy alcohol consumption) is referred to as Reinke’s oedema. In some cases, Reinke’s oedema may be alleviated by voice therapy and/or the removal of excess fluid via surgery. Reinke’s oedema might also be observed in suffers of chronic reflux.

Nodules: Striking fear into the heart of most vocalists, nodules have earned widespread renown, but are mostly misunderstood by voice users. Nodules generally occur as a result of poor muscular function (e.g. MTD) or by using the voice during a time of compromised

  • 6 Titze and Abbott (2012) highlight that in some cases of MTD “the vocal folds are hyperadducted over their length, although this is the exception.” (p. 85)

  • 7 The 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, nodules are small benign swellings (typically bilateral) that interrupt the vocal fold ripple wave. Soft nodules (early in development) are often resolved with voice therapy, but if the swellings have been allowed to persist and harden, and if time is pressing (i.e. if a singer is 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 modification and relative voice rest, including avoidance of vocally abusive activities” (p. 255). Even when surgery is the chosen option, voice therapy (both spoken and singing) is highly recommended as the remedial route for learning new vocal habits designed to diminish the chance of the nodules redevelopment.

Polyps: Occurring as a protrusion anywhere along the vocal fold, polyps generally develop as a singular mass lesion (unlike nodules which typically occur bilaterally) 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 fold haemorrhage) and can occur suddenly; whereas nodules are often seen developing over prolonged periods of misuse.

Vocal Fold Haemorrhage: Perhaps one of the more debilitating functional disorders of the voice (in the acute stage) is the vocal fold haemorrhage (Figure 2). 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 abuse 8 , is the rupture of capillaries (blood vessels) either within the lamina propria (second layer) or the epithelium (outer layer) causing bruising of the vocal fold. The bleeding impedes normal vocal fold oscillation and if left untreated can lead to significant scarring. Immediate and complete vocal rest is generally prescribed, and in rare cases, due to continuous bleeding, surgery may be required. Again, voice therapy (speech and singing) is highly recommended following a vocal fold

Voice: Art & Science (Djarts’ Manuals) health (e.g. laryngitis). Similar to small calluses on the outer

haemorrhage.

Figure 2: Vocal Fold Haemorrhage (Left Vocal Fold)

8 Vocal fold haemorrhage can also be caused by coughing and crying. Shewell (2009) notes that “Sataloff’s (1997) says that aspirin and the premenstrual period make them more likely in women singers who sing hard and strongly” (p. 424). It is also important to note that drugs containing ibuprofen have been shown to heighten the risk of vocal fold haemorrhage.

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Vocal Fold Sulcus: Observed as a ‘groove’ along the vocal fold tissue, a sulcus vocalis runs “parallel 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 aggravated by heavy voice use and “in severe cases the biomechanical oscillator becomes a ‘double oscillator,’ with upper and lower tissues moving independently” (p. 58). Resulting in a highly fatigued voice with thin and reedy phonation, vocal fold sulcus may respond to voice therapy, but generally requires surgical intervention in order to improve vocal fold oscillation.

Vocal Process Granulomas & Ulcers: The vocal process granuloma (raised granulation tissue) and the vocal process ulcer (embedded abrasion) typically occur “on the cartilaginous portion of the vocal folds which are attached to the vocal processes of the 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, “and are actually the part of the healing process” (McCoy, 2004, p. 168). Often observed 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 spontaneously detach, others may require surgical removal.

Vocal Fold Bowing: Caused by the inability of the vocal folds to adduct (close) to the midline of the glottis, the characteristic ‘bowing’ of the vocal folds provides this disorder with 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, which sounds asthenic (weak), even though there is considerable effort to produce voice” (Titze & Abbott, 2012, p. 85). Ongoing research is required for suitable therapy’s for suffers of vocal fold bowing, but it is currently thought that focused muscular exercise can lead to a strengthening of the vocalis muscle, and the subsequent ‘more complete’ adduction of the glottis.

Voice: Art & Science (Djarts’ Manuals)  Vocal Fold Sulcus: Observed as a ‘groove’ along the

“Vocal folds are very strong, resilient structures. While they can take a lot of ‘punishment’, they are living tissue and there are limits to the number of impact and 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, and a specialist voice educator.” (Bastian, Thurman, et al., 2000, p. 535)

Voice: Art & Science (Djarts’ Manuals)

b) Primarily derived from psychogenic factors Puberphonia: Also known as mutational dysphonia, puberphonia is typically observed during and/or directly after the mutational transformation of the voice during puberty. This condition, generally treated with voice therapy, displays with the matured larynx (postmutational) continuing to perform premutational phonatory patterns. While commenting on mutational dysphonia, Ingo Titze (2000) further explains, “the pitch of the voice and the general pattern of vibration of the vocal folds assume the characteristics of the opposite sex…mutational dysphonia is treatable with voice therapy, especially if it is combined with some kind of psychological counselling” (p. 361).

Transgender/Transsexual Voice: Typically listed under ‘psychogenic’ voice disorders, the transgendered/transsexual voice differs from other vocal disorders insomuch as the voice user is intentionally seeking to alter their phonatory patterns. Often assisted with hormone therapy, the transgendered voice user is strongly advised to undergo voice transformation with the assistance of a qualified speech therapist experienced in this highly specialised field. During therapy, “it is important that vocal fold strain be avoided because muscle tension voice problems can result if the client constricts in [his/]her attempts to reach higher[/lower] pitches” (Shewell, 2009, p. 430).

  • 2. Voice Care

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, 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 spokenvoice. 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 biofunctional patterns of the larynx 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 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 wellbeing 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 fivenote 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 tessitura 9 ;

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

The final key to singing well is regular (45 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

Figure 3: Dr Dan's Voice Essentials (CD Cover)
Figure 3: Dr Dan's Voice Essentials (CD Cover)

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.

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  • 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 may impede regenerative processes and reduce the system’s capacity to transfer heat away from the vocal folds to surrounding tissue.

    • e) 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 fivenight run of shows may start to experience vocal fatigue by the middle of the 2 nd or 3 rd 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).

  • Voice: Art & Science (Djarts’ Manuals)

    • 5. Hydration: Most singers know that drinking 23 litres of water a day is important. Equally, most singers don’t do it! Beyond the many health benefits of the wellhydrated body, the wellhydrated 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, lightheadedness, dry mouth and eyes, burning sensation in the stomach, and dark urine with a strong odor” (Kleiner, 1999, p. 201).

    Voice: Art & Science (Djarts’ Manuals) 5. Hydration: Most singers know that drinking 2 ‐ 3

    “The singer who wants to set the microphone on fire must be well hydrated!”

    • 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 mostpart, 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 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 voice susceptible to heightened wear and tear.

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    • 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.

    Voice: Art & Science (Djarts’ Manuals) 8. Stay Physically Fit: Gone are the days when the
    • 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 selfexplanatory…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.

    Voice: Art & Science (Djarts’ Manuals)

    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 voicecare 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.

    Who is Dr Daniel K. 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 (2009–11) and National Secretary for the Australian National Association of Teachers of Singing (2006–11). 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 maintaining his own performance career, Daniel has instructed thousands of voices. This vast experience enables Daniel to effortlessly work with voices of all skill levels: beginners to professionals.

    Voice: Art & Science (Djarts’ Manuals)

    References

    Babbit, J. (2011). Working with your voice: The career guide to becoming a professional singer. Van Nuys, CA: Alfred Music Publishing. 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. 620–631). St. John's University, MI: The VoiceCare Network. Bastian, R., Thurman, L., & Klitzke, C. (2000). Limitations to vocal ability from userelated injury or atrophy. In L. Thurman