How often do we consider taking care of our voice? Yet it is important since it is one of the markers of human individuality. Tips to cultivate a good voice.
YOUR voice identifies you. It differentiates the masculine from the feminine, the child from the adult and the human from the animal. It helps humans to communicate, to express one's feelings, to express our emotions. And yet, how often do we take care of this organ of speech, the larynx. Your voice are your vices destroying it? Or are you wise? The larynx, commonly called the voice box, produces the voice. It consists of a framework of cartilages. The thyroid and epiglottis are connected by ligaments and membranes and lined on the inner aspect by respiratory mucosa and muscles. Movement of air in and out of the lungs and trachea causes vibrations of the vocal cords and produces speech. The larynx helps in breathing. It protects the lower respiratory tract by its sphincter action and prevents anything going down into the lungs by its strong cough reflex, and produces the identity and individuality of human being.
How is the voice produced? Vocalisation begins with the air or power supply. The lungs supply the essential energy for sound production by presenting the larynx (oscillator) with a stream of air. The diaphragm inter-costal, back and abdominal musculature and the elastic recoil of the chest wall, work together during inspiration and expiration to control the release of air. The vibratory sound produced by the larynx has a fundamental frequency that is modulated by the supraglottic vocal tract into a rich spectrum of harmonics.
Change of voice: A hoarse voice is the first complaint of a person with a problem in the voice box. Roughness results from variation of periodicity and intensity of consecutive sound waves. For production of normal voice, the vocal cord should be
able to approximate properly with each other; have a proper size and stiffness; have an ability to vibrate regularly in response to the air column; any condition that interferes with these functions causes hoarseness.
How often have you lost your voice after a bad cold or a throat infection? When the vocal cords get congested and inflamed the voice becomes hoarse. It alters the identity of the individual.
Causes for hoarseness: Acute inflammatory infection includes acute laryngitis, influenza and other such. Chronic involves chronic laryngitis, T.B. and Syphilis. Tumours could be benign, malignant (carcinoma) or tumour-like masses vocal nodule, vocal polyp contact ulcers or cyst. Trauma involves foreign body intubations, laryngeal trauma, submucosal haemorrhage. Paralysis of recurrent or superior laryngeal nerve or both nerves. Fixation of cords due to arthritis or fixation of cricoarytenoid joint. Functional Hysterical aphonia.
Professional voice patients are a diverse group. Limiting the definition to singers and actors is too narrow. Any person who depends on speaking or singing skills for employment salesmen, receptionists, telephone operators, lawyers, teachers, politicians, public speakers and most physicians should be considered a professional voice user because of the varying demands on their voices.
Problems in singers
1. Extra esophageal reflux
Gastroesophageal reflux is common problem often manifested by symptoms of heartburn, or an acidic taste on waking. Patients can have significant reflux with no abdominal and chest complaints, in what is called extra oesophageal reflux. The symptoms are often frequent throat clearing, mild dysphonia, cough, a sensation of phlegm, or a foreign body sensation in the throat, vocal fatigue, or decreased singing range.
Singers and other vocal professionals with extra oesophageal reflux often have hoarseness in the morning and require longer vocal warm up. Conservative management directed at diet and general lifestyle is initiated. Following these measures may be difficult for performers with a demanding travel schedule. Drugs to reduce acidity are effective in these cases.
2. Laryngeal hygiene
The key to good laryngeal hygiene is adequate hydration. Poor hydration causes a decrease in mucus viscosity resulting in less efficient vocal fold vibrations. Singers should drink increased amounts of water. At least eight glasses (64 ounces) of water per day appear to be needed, and should be increased if the voice user is travelling by air, is ill, or, has a demanding or excessive performance schedule. The use of caffeine is discouraged because of its diuretic effect. Dairy products also appear to increase the viscosity of secretions and hinder the healthy smooth vibratory function of the vocal folds. The use of tobacco also contributes to poor laryngeal hygiene.
3. Vocal abuse and misuse
Vocal abuse often leads to vocal fold abnormality and resultant dysphonia. Vocal abuse is characterised by gradually wearing down the voice by over rehearsing, spending too long in the studio, singing too loud, singing outside the capable range, excessive interviews, shouting, excessive talking in areas of loud background noise. Chronic misuse can eventually lead to organic vocal fold changes, which appear as vocal nodules and will disrupt the normal laryngeal vibratory pattern causing dysphonia.
Muscular tension dysphonia
The singer attempts to maintain a normal voice while the vocal fold or pharynx is swollen and develops inappropriate vocal behaviours. Patients often complain of hoarseness, vocal fatigue, loss of range and neck or ear discomfort.
The management of this would involve vocal training, warming up before singing and singing classical musical styles to decrease muscular tension. Retraining the patient to improve speaking and singing efficiency is necessary.
Laryngitis: Acute laryngitis (inflammation of the laryngeal mucosa), is common in adults and can be devastating to the professional voice patient. Inflammation of the vocal folds leads to irritation and oedema, leading to dysphonia.
Management of mild cases: Increase fluid intake and humidify the room.
If cough is significant, cough syrups and cough suppressants may help.
The singer should speak little, if at all, before a performance.
Speak in a normal, unforced voice without whispering.
Vocalists with severe laryngitis should be advised not to perform.
Pulmonary disease: Any respiratory ailment alters the amount of power available for singing and limits the vocalist's ability to modulate it. Pulmonary health and good conditioning are important for proper voice support.
Vocal fold varices: It is a dilated tortuous or elongated vessel stemming from the microcirculation of the vocal fold. It occurs mainly in the female vocalist and suggests that hormones are a major factor. The patient's symptoms correlate with menstrual cycle. It can be managed by improvement of vocal hygiene, increased water intake and avoidance of caffeine.
Management of more serious problems:
Maintain adequate hydration.
Humidifier should be used when travelling and sleeping in rooms with inadequate humidity.
Avoidance the irritants like tobacco and caffeine.
Avoidance of inhaled and topical corticosteriods, antihistamines, decongestants, aspirin, topical analgesics and mentholated preparation. Systemic corticosteroids can be given.
Surgical therapy: Surgery is only performed when it is apparent that the patient cannot perform at the required level to maintain an acceptable performance schedule.
Voice is an extremely sensitive indicator of emotional status and general heath. Therefore when evaluating a voice disorder, the entire body and psychological status should be considered. The body itself is the vocal instrument and the larynx is the most sensitive part of the instrument. Altered function in nearly any area of the body can result in vocal changes. The larynx, therefore, should not be evaluated as an isolated entity. Hence, any factor that alters the normal body physiology can directly affect your voice.
When a person in normal circumstances nearly always uses a poor voice, it is termed habitual dysphonia. The quality of the voice has no relation with stressful events and seems to be a habit. If the following questions are answered with "yes" the diagnosis is more likely to be psychogenic dysphonia.
Before the voice problems began, was the voice quality good? Has the change in voice quality arisen abruptly? Is the quality of the voice inconsistent, changing with the circumstances? Has the voice failed repeatedly in situation of emotional stress?
If the following are affirmative, the complaint is probably a habitual dysphonia.
Has the quality of voice always been poor? Has the voice problem been of gradual onset? Is the quality of the voice nearly constant? Has the voice failed repeatedly after prolonged speaking?
Endocrine dysfunction like decreased thyroid function can cause a muffling of the voice, decreased range and vocal fatigue. Hormonal changes in women, before and during menstruation can cause voice changes. Diseases that affect the lungs, posture and hydration can affect the voice. Asthma, emphysema or chronic bronchitis, which reduce pulmonary function, will decrease the power supply to the voice. Musculoskeletal injuries will alter posture and can lead to vocal dysfunction. Drugs that decrease body secretions alter voice. In women, oral contraceptives and hormonal drugs will affect the voice.
Your voice is a gift. Use it, not abuse it.
Dr. RAVI K. VISWANATHAN
Dr. SUSHMA SINGH
Dr. NARASIMHAN KRISHNAPPA
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