The human voice is nothing other than a miraculous instrument, however unlike the replaceability of a misused piano, guitar, or drumkit, we only get one voice! To ensure it functions optimally, please read the following article.
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Table Of Contents
Why is hydration so important?
Hydration is vital to safeguard and maintain a healthy voice. During phonation (when we hum, speak, or sing), the vocal folds vibrate generating sound. Well lubricated vocal folds is paramount to ensuring that the vocal folds are vibrating with the least amount of friction.
When our voices are dehydrated, the epithelium (outermost layer of the vocal folds) loses a portion of it’s elasticity and becomes more susceptible to trauma. The layer beneath the epithelium (the superficial lamina propria), responsible for the vibratory action of the vocal folds, relies heavily on hydration in order to function optimally.
How Far in Advance Do I Need to Drink Water?
It is important to note that guzzling water at the last moment during, or immediately prior to a performance or vocal lesson unfortunately will do little to help your voice. Dr Jeffrey Lehman (The chairman of otolaryngology at Florida hospital), recommends drinking water (preferably warm) 24 hours before using your voice. The need to preemptively hydrate is due to the time it takes for water to be absorbed into the body's tissue from the circulatory system after it has entered the body.
What is the best form of hydration?
Yup you guessed it, water, and plenty of it! Aim for 8 glasses of water a day spread throughout the course of the day. The exact requirement will vary depending on the person, and will fluctuate based on lifestyle and external environmental factors, however 8 glasses or 2 liters is a good rule of thumb. A good way to gauge how hydrated you are, is to check that your urine is pale in colour and free of odour. Note that bladder secretions first thing in the morning are often darker - heck for consistency throughout the day.
Note that the throat is not synonymous with vocal folds, therefore any liquid you swallow will not touch the vocal folds. Steam is the only way to fast track hydration to the vocal folds. Steaming is recommended up to three times a day (especially good before a performance or to sooth irritated vocal folds).
Using a humidifier is an additional way to increase moisture and off-set the drying effects of heating and air-conditioning in the home or office. Choose a hot-water vaporiser over a cool-mist vaporiser, as the later can cause chemicals and germs to permeate the air.
Things to avoid prior to a vocal session of performance
- Caffeinated drinks and alcohol due to their diuretic effect on the body and vocal folds.
- Carbonated water (including mineral and soda water) as they can increase acid reflux(see below for information on reflux and the voice).
- Milk and sugary drinks as these can encourage the body to produce thick mucus secretions, often leaving you feeling phlegmy and prompting throat clearing (which can cause trauma to the vocal folds).
Cold and Flu
If you are struck down with a cold or flu, think of it as your bodies call to rest! Be extra cautious during this time to avoid any unnecessary strain on your voice.
Tips to help with a cold, flu and sore throat
- Be sure to keep fluids up during this time. If swallowing is painful, try sipping warm water or herbal tea (liquorice, ginger or peppermint are great options).
- Avoid pharmaceutical decongestants as they are very drying. For nasal congestion, try nasal irrigation with a salt water spray. Fess is a recommended brand for vocalists that can be purchased at your local chemist.
- Steaming the voice can assist in and loosening mucus and clearing up congestion.
- If tonsillitis is the cause of your sore throat, Dr Harris (otolaryngologist and one of London's most respected voice experts) recommends gargling salt water. The solution won't touch the vocal folds, but helps to inhibit the build-up of infection lingering around your tonsils.
- Though it may seem obvious, ensure that you get plenty of sleep. The body needs to rest to repair itself.
Laryngitis arises from inflammation and swelling of the vocal folds. This swelling affects the wave action of the vocal folds, causing the voice to sound raspy, horse, and in some cases result in complete voice loss.
Leading Causes of Laryngitis
Laryngitis has 4 leading causes: vocal misuse, allergies, viral infection or acid reflux (see below for more information on acid reflux and allergies). Viral laryngitis usually lingers between 1-3 weeks, while laryngitis resulting from vocal misuse commonly takes a few days to subside with complete voice rest provided no severe damage has occurred.
The effects of Coughing
Laryngitis caused by chronic or violent coughing is a common problem for voice users. While coughing is the body's way of expelling irritant substances from the airways, it can be quite traumatic for the vocal folds. As the body works to effectively clear the airways, the velocity of air passing through the vocal folds can reach 500 miles an hour (greater than the speed of the world's fastest bullet train).
It goes without saying that dislodging thick mucus secretions from the lungs can be particularly laborious and problematic to the voice! Dr Harris (one of London most respected otolaryngologists) warns against suppressant medications as suppressants inhibit the body’s process of eliminating mucus, and can ultimately prolong the bodies healing. Alternatively Dr Harris recommends drinking plenty of water and considering a demulcent such as honey to soothe mucus membranes in the mouth.
Throat clearing can be very traumatic for the voice. Vocalists are cautioned against excessive and/or violent throat clearing as it can lead to hoarseness, laryngitis and injury to the voice. Be aware that throat clearing can become habitual. Though it may not be an easy habit to shake, try some of the following tips:
- Humming - the vibration of the vocal folds during humming can help rid the folds of mucus secretions.
- Dry swallowing (no liquids). Dry swallowing (with your own saliva) closes the vocal folds and can help shift mucus.
- Silent laugh and then swallow.
- Use a gentle throat clear without forcing the breath. It will sound like a puff of air produced in the throat.
Misuse of the Voice
The Duke Voice Care Centre in North Carolina references clapping your hands together as an analogy for the voice. If you clap your hands together gently, you make a sound, but your hands don't hurt. If you clap your hands together forcefully, it can cause them to become red and irritated. Yelling, screaming, coughing, and violent throat clearing, are all acts that bring the vocal folds together by way of force and can be very traumatic to the voice.
Despite our propensity to whisper when we are confronted by the loss of voice, the act of whispering actually does more harm than good. Not only does whispering dry out the voice, but it is also a strenuous act for the vocal folds and does not aid vocal recovery.
Caring for your voice during during laryngitis
Any strenuous use of the voice during laryngitis can cause damage to the voice. It is very important to take extra care when our voice is in a compromised state. Avoid performances, parties, concerts, sports events, loud venues and any environments that may prompt you to strain your voice.
It is important to ensure you are really well hydrated by drinking plenty of water and omitting caffeine, alcohol and other dehydrating substances. Avoid smoke filled environments that irritate the vocal folds, and wherever possible use a steamer and a hot-water vaporiser to increase hydration to the vocal folds (see Hydration).
Complete voice rest (both speaking and singing) is highly advised. If you must speak, be sure to do so softly (no whispering) and avoid any unnecessary stress on the voice, as laryngitis indicates the voice is in a fragile state.
Acid Reflux And The Voice
Acid Reflux (also referred to as heartburn or indigestion) affects almost all of us at some stage and occurs when the acid from our stomach (hydrochloric acid) migrates upward toward the oesophagus, sometimes spilling into the larynx. Stomach acid is strong and can be very corrosive, causing irritation, burning and edema (swelling) of the vocal folds.
Some typical symptoms of acid reflux include;
- Chest pain
- Bloating and/or gas
- Tooth decay or gum disease
- Increase in mucus (prompting coughing or clearing the throat)
- Sensation of a lump in the throat
- A burning or gurgling sensation in the throat
- Sour taste in the mouth (caused by regurgitation)
- Soreness or hoarseness of the voice (often present in the morning)
- A tickling sensation in the throat
- Pain or difficulty swallowing
- Reflux laryngitis
Note that some people don’t exhibit typical symptoms and can suffer from what is known as ‘silent reflux’ or laryngopharyngeal reflux. This form of reflux is more difficult to detect and symptoms (as described by the American Academy of Otolaryngology) can include:
- A bitter taste
- Sensation of burning
- Feeling of something being stuff in the back of the throat
- Difficulty swallowing
- An increased need for throat clearing
- Sensation of mucus drainage from the back of the nose down the throat known as ‘postnasal drip’
There are some over the counter remedies that work to pacify gastrointestinal upsets, however for persistent symptoms, you are best to consult a doctor or gastroenterologist.
A few natural tips on how to minimise reflux include;
- Eating smaller meals
- Avoid eating for several hours before bed
- Try elevating the head when lying down to encourage gravity to keep the acid down
- Avoid acidic drinks such as juice and caffeine
- Avoid acidic or spicy food, fatty foods, chocolate, and peppermint, carbonated beverages
Ahhh the joy of allergies! Allergies can be seasonal or year round, but regardless of which can certainly pose a great deal of frustration for singers. Allergy sufferers may experience irritation to the lining of the nose and nasal cavities. This irritation can activate a runny nose, and postnasal drip (mucus drainage into the throat) and infection of the sinus cavities (sinusitis). Such symptoms of allergy can result in changes of voice quality. Mucus migrating to the throat can cause irritation to the vocal folds, increasing stiffness of the vocal folds and changing the resonance of the voice. If the mucus secretions are thick, it can prompt throat-clearing, which can cause swelling and irritation of the vocal folds.
Some allergy medications such as decongestants and antihistamines can be very drying on the voice. Please consult your doctor to learn more about your options.
Harvard Medical School encourages asthma sufferers who inhaled corticosteroid medicine to use a spacer device to assist in helping to prevent vocal fold weakness. The spacer works to catch larger droplets of the medicine that were too heavy to be carried deep into the lung airways and can settle on the throat and trachea where they can cause side effects on the voice. Please speak to your doctor before changing any medication.
PMS And The Voice
The effect the endocrine system has on the voice can be significant, particularly in the week leading up to menstruation. It is important for females to understand the impact that hormonal fluctuations can have on the voice, and be mindful of not passing it off as a flaw on their behalf. The conjecture of what actually causes PMS is not entirely known, however it can certainly affect the voice.
PMS and its effect on the voice
Higher levels of oestrogen as well as progesterone (which are present before a woman's period and after ovulation) can cause water retention. This water retention directly affecting laryngeal tissue and can lead to water retention in the vocal folds as well as the walls of the pharynx (which serves as amplifier and resonator for the voice). As a result singers may experience a temporary loss of high notes and loss of power. Additional changes to the voice may include, hoarseness, uncertainty of pitch and vocal fatigue.
Dr Sataloff (professor and chairman of the department of Otolaryngology - Drexel University College of Medicine) discusses how vessels on the nasal passages may also dilate, initiating changes in patency and altering how the singer perceives her own voice.
Hormonal changes that occur during puberty, pregnancy, and menopause can also impact the voice.
Take care of your voice
Vocal health is of the utmost importance for all voice users. Due to the paucity of nerve endings within parts of the voice (the vocal folds themselves having no nerve endings), we are not always able to feel when the voice is in a affected or in a fragile state. As it is therefore possible not to feel pain associated with trauma to the voice, it is important to observe other cues such as hoarseness, that indicate a distressed voice. Below are a few tips to further assist you in maintaining a healthy voice.
Vocal Health Tips
- Always warm-up and warm-down before and after you sing.
- Ensure you always carry a bottle of water and stay hydrated.
- Avoid smokey environments (smoke is very irritating to the vocal folds).
- Don't overwork your voice. If you are tired, you technique will be affected. Try to make sure you get plenty of sleep and rest your voice before your voice reaches the stage of feeling tired.
- Avoid Throat-clearing.
- Eat well, exercise and gets plenty of sleep.
- Ensure that you can hear yourself during performance and during band practise. If you practise with a band ensure you use monitors and that your sound is not drowned out by other instruments.
- As we speak much of our time speaking, ensure that you are speaking in a way that best supports your voice. If you experience ongoing vocal discomfort or hoarseness, please see a reputable ENT and/or speech pathologist.
- Follow up on ways of managing allergies, acid reflux and hydration.
- Limit vocal demands if experiencing PMS symptoms.
*If you experience discomfort to the voice, we recommend you seek the immediate advice of a medical professional or ENT.
If you have any questions relating to this blog, please feel free to contact Melbourne Voiceworks at firstname.lastname@example.org.