LaryngoSCOPE

A Singer's Guide to Vocal Care

Susan Vaughn

vocal symptoms was a shocking 33 py, although they may improve a bit. months. Some even may require surgery. Why the delays? Singers and The most common voice dam- their teachers tend to attribute the age arises in singers who have vocal problems to "poor vocal tech- "Show must go on, though I'm half- nique," "an undeveloped instru- dead" personalities. They perform ment," or a "second-class vocal with laryngitis, and cause injury to apparatus," notes Bastian. Some their vocal folds, says David Han- also blame stress, fatigue, allergies, son, chairman of the Department phlegm, and technical struggles for of Otolaryngology at Northwestern their complaints. But few allow for University Medical School in the possibility that their chronic Chicago. voice difficulties may have a physi- "This is very preventable," he Susan Vaughn cal cause. says. "But people are often tempted "The number one message I'd to try to sing when they shouldn't, What would you think of a top like to give singers is to be vigilant because they're being paid to per- violinist who refused to allow long- about self-detection and self-man- form. The problem is, the voice is needed repairs to his Stradivarius, agement," says Bastian. then affected for a longer period because it would interfere with a Take yourself seriously. Don't than if the singer had taken the time tight performance schedule? Or a be stoic. If you've had a voice prob- off." prima ballerina who ignored obvi- lem that hasn't resolved after 7-10 According to Benninger, singers ous signs of a foot fracture because days, consider visiting a medical pro- most frequently complain about she'd like to believe her pain was fessional for evaluation, suggests eight symptoms: hoarseness, vocal due to poorly fitting toe shoes? Michael Benninger, chairman of fatigue, breathiness, reduced range, You'd probably shake your head the Otolaryngology Department at aphonia (voice loss), pitch problems, and think, "what fools these mortals Henry Ford Hospital in Detroit and vocal strain, and tremor. Many also be." Yet classical singers, as a popu- coauthor of Vocal Arts Medicine: The report vocal difficulties like voice lation, are sometimes just as remiss Care and Prevention of Professional fatigue, irritation, and soreness after in seeking professional voice care Voice Disorders (Thieme Medical their performances. when they experience chronic Publishers, 1994). How do most vocal fold injuries singing difficulties. The sooner you seek help for occur? The mucosa that covers your Robert Bastian, director of your vocal problems, the more likely vocal folds is the main "moving Loyola University Medical Center's you'll be able to remedy the difficul- part" in your larynx during singing. Voice Institute at Chicago's Civic ties. According to Bastian, if you It's designed to withstand millions House, conducted a study of allow vocal fold abnormalities to of "collisions" each day, says Bast- 40 singers, and found that the mean remain untreated for months or ian. During an hour of continuous time that singers waited to schedule years, they may not totally resolve, sound, your vocal fold mucosa col- first exams after the onset of their even with highly skilled voice thera- lide about 792,000 times. If these

J4,4f4 4' 2001 53 S7, N. 3, CA 2001 N,,..4 4 Susan Vaughn

collisions are too forceful or the Loud laughter "snaps" the vocal Researchers don't yet have the com- mucosa is infected or dry, the vocal folds open and closed. This can plete answer. But they theorize that folds may swell up, says Bastian. cause swelling. this is because women's vocal folds Usually, with rest, the swelling will • Do you often attend loud parties are thinner and vibrate many more disappear. But if you exacerbate this or speak in noisy environments? times than do men's. condition through vocal abuse or You maybe straining your voice to Vocal trauma and abuse can trauma, you could end up with a be heard. result in hemorrhage, which may chronic problem and, in worst cases, • Do you speak lower or higher have serious consequences, says Sat- a condition that can only be treated than your normal voice range? aloff. It can prompt the formation of through surgery. Again, this can cause strain. a polyp (a projecting, swollen mem- "Hypochondriasis is rare among • Do you clear your throat or cough brane) on the vocal fold. Although serious singers and most other voice repeatedly? This can rupture some polyps resolve after vocal ther- professionals," notes Robert Sat- blood vessels. apy and rest, most require surgical aloff, Professor of Otolaryngology— • Do you often find yourself in excision. Scarring also can result Head and Neck Surgery at Jefferson smoky environments? Second- from hemorrhaging, and this can Medical College in Pennsylvania, hand smoke causes redness and ir- cause permanent voice change. At chairman of the Voice Foundation, ritation of your vocal mucosa and present, there is no successful surgi- and author of Professional Voice.- The has a drying effect upon your vo- cal technique to remedy this. Science and Art of Clinical Care (2d cal tract. In most cases, hemorrhages will ed., Singular Publishing Group, • Do you vocalize with "harsh glot- resolve on their own, says Sataloff. 1997). tal attacks"? Count from eighty to But singers who use their voices Be sure if you think some- ninety. Are you forcefully pro- heavily—particularly those who are thing's amiss, you don't too readily flouncing each starting vowel? high sopranos—must take extra care dismiss it. This is called "glottal attack" and not to tax their voices to the point As medical professionals will if it's too forced, it can harm your where vocal fold hemorrhaging tell you, most vocal disorders are vocal folds. might occur. caused by misuse. But let's destroy a All of these factors can detri- harmful myth: they're typically not mentally affect your singing. caused by bad singing. Much more Voice misuse can cause soft VIGILANCE IS KEY commonly, they're caused by speech- swelling in your vocal folds. With Hoarseness related abuses, says John Eisenbeis, rest, this can resolve in 24-48 hours. Associate Professor of Otolaryngolo- But in severe cases, vocal misuse can Do you suffer from chronic gy and director of the Voice Disor- cause nodules (callous-like growths) hoarseness? Consider visiting a ders Clinic at St. Louis University to form on your vocal folds. Nodules voice specialist for a check-up. School of Medicine. often go undetected by singers Hoarseness may be caused by vocal Here are some preliminary because they may only affect the fold scarring, lesions, and other questions to ask yourself about your singing voice, not the speaking voice, abnormalities on the edge of the daily voice use: says Bastian. vocal folds that impede vibration. Symptoms of nodules include Why not have a physician rule out • Are you allowing yourself ade- inability to sing high notes softly, these diagnoses, rather than bravely quate warm-up and cool-down? If increased breathiness, reduced vocal singing on, risking the possibility not, you may be risking vocal endurance, prolonged warm-ups, that you're permanently jeopardiz- strain, fatigue, and a decreased vo- and day-to-day variability of vocal ing your voice? cal range, notes Benninger. capabilities, says Bastian. • Are you a chatterbox? Voice Unfortunately for half the pop- Ref lux overuse can cause sustained injury. ulation, this condition is almost Singers as a group are particu- • Do you have a very hearty laugh? exclusively found in females. Why? larly susceptible to this ailment,

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LaryngoSCOPE

because those who perform at night coffee, tea, anti soft drinks), and ak'o Once voii'vc recocred ton often eat large meals shortly before hol. Eat smaller meals. Reduce your your cold, wait two days before retiring. When these singers lie fat intake. Don't eat within three singing, suggests Benninger. down to sleep, there is no gravity to hours of bedtime. Raise your bed's move their stomachs' acidic contents headrest about six inches, so that Thyroid Problems toward their intestines. Instead, the gravity can help move food through Our voices are affected by acid may migrate upward to irritate your gastrointestinal tract. And, if even slight changes in our hormone the singer's esophagus and vocal your doctor permits, consider taking levels. If you've recently been feel- folds. Drinking alcohol before bed- a dose of antacid at bedtime. ing tired all the time, and have time further exacerbates this condi- If your condition doesn't im- experienced hair loss, bloatedness, tion, because it inhibits the lower prove, visit a voice specialist and/or weight gain, hoarseness, intoler- esophagus' muscle tone, notes Ben- gastroenterologist. He or she may ance of cold, and a "muffling" of finger. prescribe an H2 blocker or protein your voice, you may wish to have Some singers experience symp- pump inhibitor to reduce your stom- your thyroid function checked by a toms of reflux the following morn- ach acid production. You should see a physician. Hypothyroidism can ing. These can include scratchy marked reduction in symptoms with- cause these symptoms. About 4% throat, bitter taste, coated tongue, in three to four weeks. of all adults have a form of thyroid heartburn, and hoarseness (which disease, according to Benninger. may subside as the day progresses). Respiratory Difficulties They may feel its symptoms as they Breathing through the nose VOICE IRRITANTS sit, stand, walk, or sing. Some may warms, filters, and humidifies air develop additional problems from before it reaches our lungs. When If you are highly allergic to dust, the condition: repeated throat-clear- you suffer from respiratory tract mold, or other irritants and you ing, excess phlegm, and a "lump-in- infections, colds, or allergies, your believe your singing is being affected the-throat" feeling, said Sataloff. nose stuffs up, and you may "mouth- by exposure to these substances, They also may require prolonged breathe" as compensation. Try not consider wearing a protective mask warm-up periods after a reflux bout. to do this. Mouth-breathing permits when you're near these substances. Reflux can cause chronic unfiltered, unhumidifled air to irri- Be extremely cautious around artifi- tate and dehydrate your vocal fold inflammation of the voice box, cial smokes and fogs, which Sataloff which can, in some cases, lead to mucosa. aptly calls a "deliberate form of air arthritis of the "cricoarytenoid If you live in a chilly climate, pollution." joint" that controls the opening of wear a warm hat and scarf when Singers tend to be more affected your vocal folds, notes Sataloff, who you go out, says Clark Rosen, direc- by these substances than other stage also authored Rfflux Larjngitis and tor of University of Pittsburgh's performers and musicians because Related Conditions (Singular Pub- Voice Center, and company physi- singers inhale air more deeply, and lishing Group, 2000). It also can cian for the Pittsburgh Opera. About expel breath more slowly, notes Sat- delay healing of vocal lesions, Ben- 75% of body temperature loss aloff. The result is that toxic chemi- finger says. occurs through your head. A hat will cals may remain in their lungs If you think you're suffering significantly reduce this, and a scarf longer and in higher concentrations. from reflux, don't ignore the prob- will prevent cold air from irritating Although loved by audiences lem. This condition can change your your voice box, Rosen adds. for their dramatic effect, some artifi- voice and, over years, cause serious Should you succumb to a cold, cial smokes and fogs are dangerous damage to your esophagus. drink lots of water to rid your body to singers because they contain toxic Try to avoid dietary products of infection. Stay hydrated. It will airborne chemicals. Glycol-based that can worsen your symptoms, reduce post-nasal drip and its resul- smokes and fogs, used in antifreeze such as spicy foods, citrus products, tant coughing and throat-clearing, products and to de-ice airplanes, can peppermint, tomatoes, caffeine (in says Rosen. trigger allergic responses and even

2001 55 Susan Vaughn

induce anaphylactic shock, notes speak and sing. Because they vibrate weight abruptly through fasting or Sataloff. against each other 100 to 1400 times fad diets. Not only can that lead to Petroleum-based smokes and a second, and require constant lubri- voice fluctuations, but it can be fogs in high concentration can cause cation, it's important that you drink extremely dangerous. lung problems because of a few of lots of water throughout your day, their inert mineral oils. They can and avoid caffeinated drinks that Medication Tips "remain in the lungs indefinitely," may cause dehydration or aggravate Be vigilant when self-medicating notes Sataloff. Inorganic smokes and reflux, says Sataloff. and taking prescriptions. Even seem- mists that contain chlorides can How do you know whether ingly harmless over-the-counter release irritating ammonia and you're properly hydrated? Excuse drugs can affect your singing. Anti- hydrochloric acid. And burned fra- the candor, but monitor your urine histamines, oral decongestants, and grances and dyes produce "toxic output. If it's pale, then you're prob- diuretics can dry and thicken secre- chemicals that should not be ably drinking enough water, says tions, causing your vocal folds to be inhaled," according to Sataloff. Even Bastian. more vulnerable to injury, note Sat- seemingly benign dry ice has been Some singers are adversely aloff and Bastian. Antidepressants known to cause breathlessness, affected by milk and milk products. can prompt these negative side headaches, and fatigue in some Their mucous secretions thicken effects, too. singers, when inhaled in high con- and this can affect their singing per- Aspirin, which thins the blood, centrations. formance. Others are negatively can cause vocal hemorrhaging, par- affected by alcohol. They develop ticularly if you take it while you're chronic laryngitis from its intake. prone to coughing. Some singers HEALTH ADVICE Avoid these beverages if you suffer who are allergic to aspirin develop from these symptoms. Dietary Tips allergic laryngitis after ingestion, Though achieving a healthy notes Benninger. Our vocal folds do an enormous weight through proper diet and exer- Although many health-con- amount of work for us when we cise is desirable, don't attempt to lose scious singers take vitamin and herbal remedies to treat various ail- ments, they must be extremely cau- tious, notes Jason Surow of the Northern Jersey Ear, Nose and The Conservatory Throat Associates. Some can make More than a Century of Excellence singers more vulnerable to hemor- rhage, because of their blood-thin- Voice faculty at Baldwin-Wallace College: fling effects, he says. These include Dr. Keith Brautigam, Associate Professor of Voice dong quai, willow bark, primrose, and Chai,; Voice Department garlic, vitamin E, gingko bioba, and Sophie Ginn-Paster. Professor of Voice ginger. Victoria Bussert, Associate Professor A few herbal remedies also can and Chai,; Musical Theatre Department trigger hormonal responses that can Nanette Canfield, Assistant Professor of Voice alter your voice, notes Surow. These and Assistant Director of the Conservatory include dong quai (which increases I )r. Joanne Uniatowski, Assistant Professor of Voice ovarian and testicular hormonal pro- Mary Klaehn, Lecturer in Voice duction); yam (which contains prog- Cynthia O'Connell, Lecturer in Voice esterone-like chemicals); licorice John Sikora. Lecturer in Voice root (which has estrogen- and prog- tracy Grady, Lecturer in Voice esterone-like effects); primrose (an 8uuId, or ( 1 .1i d—, pro).?:;, rip: n,-. ,. , ­ " estrogen promoter); melatonin

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(which plays a major role in estro- Vocal Training Tips become more fragile during this gen/progesterone production); and Keep learning! According to time. The result is "laryngopathia yohimbe (which may increase Benninger, one research study found menstrualis"—a hoarseness that can testosterone production). nodules present in 60% of singers adversely affect their performance. Some birth control pills also who had not received recent profes- Women who have this condition alter and character, says sional voice training. Other at-risk may experience voice breaks, diffi- Sataloff. About 5% of women who groups for nodules include singers culty controlling upper range notes, take birth control pills undergo some who are suddenly thrust into techni- fatigue, and also find themselves voice change, he adds. Fortunately, cally challenging jobs without ade- struggling with difficult pieces that, at other times, they had mastered. in most cases, vocal changes are tem- quate training; singers who train In Europe, some opera groups porary. The voice returns to normal sporadically; singers who tackle offer "grace days" to affected singers once the oral contraceptive use is inappropriate repertoire ("like the and excuse them from performing. discontinued, Sataloff says. baritone trying to sing the tenor's This practice is uncommon in the However, oral contraceptives high C's in 'Vesti la giubba" notes Sataloff); and singers who may United States. and other medications that contain If you're cramping or suffering androgens are particularly worri- switch teachers and suddenly find themselves required to vocalize very from headaches around the time of some, because they can permanently differently than before. menstruation, don't take aspirin or masculinize a woman's voice. And ibuprofen. They can cause hemor- birth control pills with high proges- Menstrual Changes rhaging in already fragile vocal folds. terone content can cause similar Some female singers—as many Instead, substitute acetaminophen vocal problems, Sataloff notes. So if or Celebrex , suggests Sataloff. as a third, according to Sataloff- ® you are taking birth control pills, be report a loss in vocal proficiency sure they do not contain androgens before menstruation. This is because Menopause or a high progesterone content. If hormonal changes cause their vocal After menopause, a woman's you're uncertain of your birth con- folds to swell. Their capillaries also estrogen production virtually ceases, trol pills' ingredients, consult your physician, and regularly monitor your voice.

Traveling Tips DISCOVER YOUR VOICE Airplane travel can be tough on How To Develop Healthy Voice Habits singers. If you find yourself seated By OREN L. BROWN near a person who's sneezing or nose-blowing, try to move to anoth- NIEL SEMER, I'm thoroughly engrossed in your er seat. Minimize your speaking wonderful book. It's such an important work. while in flight, and drink extra JAMES KING, But for you, I might never have had my water. Noise levels on planes can career. Your book says it all. I recommend it to all my students. reach 92 dB; trying to be heard over INGO TITZE, Ph.D., The principles you espouse make a lot that din can greatly stress your voice. of sense. I will recommend your book highly. New singers often get ill during JOHN SHACKELFORD, Your book is the finest on learning traveling after being exposed to new to sing and teaching singing that I have ever encountered. allergens, or because they are over- MINORU HIRANO, M.D., Your book is of great value whelmed by stress. If possible, they for singers, teachers, voice scientists and otolaryngologists. should schedule trips to include To Order: Call 800-354-9706, Ext.6 * Fax 606-647-5963 ample "rest time" before and after E-mail: [email protected] performances.

JJFe4u-i,j 2001 57 Susan Vaughn

but her ovaries continue to secrete Muscular strength declines and, in Physical exercise is of para- androgens (male sex hormones). some cases, coordination and reflex- mount importance to the aging This is why some women over fifty es slow down. These and other singer. It can improve circulation, have deeper voices than they did in changes can cause reduced vocal increase muscle tone, and even posi- their youth. range, increased wobble, loss of tively influence the neurological sys- Postmenopausal singers some- dynamic control, and decreased tem. Because some vocal experts times complain of cracks in their vocal depth and resonance, notes express concern about the impact of voices, difficulty making transitions Benninger. jogging upon the voice, older singers from chest to , breathi- Before you get depressed about (and all others) should consider ness, and an inability to support the sunset years, remember that, in "softer" exercises like swimming tones or sing certain scales and the words of one researcher quoted and walking. arpeggios fluently, notes Sataloff. by Benninger, "there are far more Such singers may want to con- old people than sold' voices." Vocal A VISIT TO THE VOICE DOCTOR sider hormone replacement therapy, decline is not a necessary condition after carefully weighing its pros and of age. In fact, with proper condi- A competent voice specialist cons. They must bear in mind there tioning and training, many of these will evaluate your vocal pitch, loud- exists a possibility that this therapy vocal difficulties may be reversible. ness, and quality, and will closely may increase a woman's risk of "With age, everyone has a voice question you about your daily voice endometrial and breast cancer. change," says Benninger, "but for use. Be sure to tell the physician the trained vocalist, it shouldn't be about your practice schedules, hours very dramatic." Aging spent singing, conditions under One problem with aging singers which you sing (e.g., large auditori- Older singers (from 40 on) is that many tend to get out of "con- um, noisy room), performance undergo bodily changes that may servatory mode," says Bastian. schedule, any possible exposure to affect their singing. Lungs lose elas- Rather, they should commit them- irritants, recent illnesses, medica- ticity, resulting in less breath sup- selves to regular coaching. "If any- tions taken, and travel frequency. port. Blood supply to the larynx thing, you have to be more disci- Also mention how long you've decreases, stiffening the vocal folds. plined at this point," he adds. had a problem; what symptoms you experience; and whether your vocal difficulties developed suddenly or Vocal Performance & Pedagogy Workshop slowly. wit4 4d '/td€e You can help the voice specialist detect changes in your voice by pro- Systematic Vocal Technique and Daily Master Classes for viding a high-quality audio or video Teachers, Performers, & Students recording of one of your best singing performances, so he or she can com- "I talked with a friend who attended the June 17-21, 2001 past year He had nothing but praise for pare your singing abilities before, in conjunction with Richard Miller and after this experience during, and after any therapy, sug- I most definitely agree. . - Miller gests Bastian. Vocal Institute for provided a balance of lecture and application of the material . . - it High School Singers changed not only the way 1 teach voice, Dr. Lloyd Linney, School of Music but gave me a systematic approach to my ABOUT VOCAL REST Stetson University, DeLand, FL 32724 own daily vocal workout... each time / (904) 822-8985 - FAX (904)822-8948 attend this workshop I learn something email: [email protected] new and feel re-energized. . I think Benninger quotes Shakespeare www.stetson.edu/schools/musicfmiller ojjering high school students a chance to on this important subject: "Mend attend a workshop like this one with such your voice a little, lest you mar your •' U N • I iiJS wonderful examples is a fantastic idea. - - It was a privilege to be here!" fortune." - Comments from 2000 participants You may be told by a vocal spe- Florida's First Private University cialist that you'll need to rest your

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voice. Sonic singers worry that pin- IF YOU'VE BEEN DIAG- practice and fellowships. Rememhcr, longed rest may cause "vocal cord NOSED AS HAVING NODULES, this person may operate on your atrophy," but this isn't so, if be sure to schedule periodic check- livelihood. It's not a time to be shy. "absolute voice rest" is undertaken ups with your voice doctor, and visit "When in consultation with the for no more than two weeks. More a licensed speech-language patholo- surgeon, make it very clear that you likely, though, your vocal specialist gist for therapy. are a singer relying on your voice for will ask you to markedly reduce all IF YOU ARE CONSIDERING a livelihood and you can't afford any vocalization activities during your SURGERY, be sure you've exhaust- damage to your vocal cords," says recovery. ed all other vocal remedies. Doctors Hanson. If you're told that you need to recommend that you try therapy for Discuss the risks of surgery limit your vocal activities, consider anywhere from six weeks to six with the physician whom you've canceling nonessential commit- months before undergoing surgical chosen. They may include voice ments, and "marking" during re- intervention. However, if you've deterioration or a modest improve- hearsals, says Sataloff. Don't whisper undertaken voice therapy and have ment below your expectations. Ask or whistle, he adds. They can be as reached a plateau where you remain the physician whether he or she taxing to your vocal folds as singing. unhappy with your voice capabili- thinks your condition might reoccur Agrees Bastian, "I don't recom- ties, then you may want to consider even after surgery. And discuss how mend [whispering]. People who surgery as your next option, says long your recuperation "down time" whisper tend to graduate to a stage Bastian. will be. Generally, singers can whisper, which is straining and Choose your surgeon carefully. assume brief lessons with teachers effortful, and then to vocalizing." Try to select a voice specialist who's two to six weeks after surgery. They Also refrain from subvocalizing successfully operated on many pro- are often able to return to public per- —reading silently with your lines— fessional singers, and has published formance about 60-90 days after because, in a great many cases, you'll peer-reviewed papers on voice-relat- surgical procedures, says Sataloff. end up straining your vocal folds ed topics, says Sataloff. Don't be There are two surgical tech- even more than you would by speak- afraid to ask for your surgeon's cur- niques commonly used by physi- ing softly in a normal voice. riculum vitae and to question the cians: laser and "cold instruments." When should you agree to total surgeon about his or her years in Many doctors say that "cold instni- or "absolute voice rest"? When a physician has told you that you've suffered a mucosal tear or vocal hemorrhage, according to Sataloff. Warm-up To prevent polyp formation, scar- III \IU. the singcr, \v,IrIII up v sIr %mLc. It jnnm,1 exercise CD & arin.qnfr the Howe, designed for beginning and ring, and other vocal fold injuries, Intermediate students, is available in four voice ranges: you must give your voice time to cassette tape \ted,iiin I ligh-Feii.ik Mediuji, High heal. Absolute voice rest is typically 110W available! Mc11111ii I.ow-Fcncile Medium prescribed for one week or less, says Price: $14.95*each + $2 shipping/ handling Sataloff. Altirr ll'iuning Rirrn-ups /i'r the 1 oice. which offers exercises based on Mozart. Handel, l)onizeto, and WINNING (oilers is now available for more advanced students 'u pr.iiio Mezzo SOME PARTING ADVICE \"ii..I&J\'I-1JPS price: S14.95*each + $2 shipping/ handling IF YOU BELIEVE YOU MAY FOP, '11-IF 1 diii pleased to endorse this program. It should he particularly helpful to young voices, while at BE MISUSING YOUR VOICE \T IcjE the same rime a very useful tool for more WHEN SPEAKING, consider get- - ...... experienced singers." —William 14.irfleid, ting formal speech training from a - Internationally-renowned singer and teacher professional, such as a speech-lan- Please fax or mail your order to: Domenico Productions, Inc., 4321 Lee. St., Skokie, 11, 60076 guage pathologist who specializes in Phone or Fax: (847) 675-0892 *Illinois residents please add 8.5% sales tax. visit us at: wwwdonienicoproducrs. cot n helping vocalists.

JM4 /JFd54.d.'5./ 2001 59 Susan Vaughn

ments" (used in microdissecflon) "bucking." Occasionally, they can ing until you've been able to correct are somewhat safer to use for even occur when all procedures have your bad habits. Don't rush back to singers. Laser surgery may leave a been done correctly. the stage too soon—the stress of a "divot" on the vocal fold, destroy But if you must have a proce- performance might trigger your old healthy tissue, result in swelling, dure requiring anesthesia, be sure to habits and cause damage anew. and/or cause a heat injury. check your anesthesiologist's cre- "Research and understanding "I currently believe that dentials. Ask whether he or she has of the voice is still infantile," said microdissection may be safer than intubated professional singers before. Eisenbeis. "It's similar to where we laser techniques, provided the sur- "If they look at you like they were with hearing and the ear in the geon is equally proficient in both," don't have a clue, you may want 1950s and 1960s. But we're generat- says Bastian. someone else to do your anesthesia," ing a lot of new data about how the Sataloff recommends that, says Benninger. voice is produced." whenever possible, singers try to Benninger also suggests that, As researchers learn more avoid procedures that require general before surgery, you ask your anes- about this amazing human feature, anesthesia. This is because, although thetist whether he or she can use a singers will benefit. They may gain rare, placement of the breathing tube smaller-than-average endotracheal prolonged vocal longevity, new ways can cause complications including tube for your procedure. to prevent injury, and improved vocal fold edema, granuloma forma- IF YOU'RE RECOVERING treatments for their vocal afflictions. tion, dislocation of the voice box's FROM A VOICE PATHOLOGY OR But for now, treat your voice arytenoid cartilage, vocal fold paraly- SURGERY, strictly follow your with great deference. It's your sis, tooth damage, pneumonia, vocal physician's recommendations. You Stradivarius. It will make brilliant fold hemorrhage, and reflux laryngi- may not be able to perform for a music for you, if you listen when it tis. These complications can result specified time—anywhere between speaks. from improper intubation, use of a six weeks to six months, depending wrong-sized endotracheal tube for upon how severe your vocal fold Susan Vaughn is a colunnistJbr the Los breathing, or if the anesthetist dis- Angeles Times, as well as a licensed emer- damage was, if you've been told that gency medical technician and certified continues anesthesia before remov- you've been misusing your voice, emergency trauma technician. ing the tube, which causes gagging or you'll need to refrain from perform-

SELF-SCREENING Would you like to test yourself to see if you might have need for professional evaluation and treatment? Bas- tian recommends that you try the following three tasks: TASK ONE: Sing the vowels hi and /e/ staccato at pianissimo dynamic level. Maintain precise rhythm and tempo. Keep the notes as short as possible. TASK TWO: Sing the opening phrase of "Happy Birthday to You" at pianissimo dynamic level. Withhold vibrato. Sing this "" style, and phonate softly. TASK THREE: Softly sing half-step trills on the vowel hi!. Modulate your fundamental frequency back and forth as fast as you can, but without resorting to "wobbly vibrato." You may have vocal fold swelling if, when taking these tests: • You can only sing upper notes loudly, with a great deal of support. • You become tired and your voice grows husky after short singing bouts. • Your upper register is "breathy"—there's a faint sound of escaping air present most of the time or at the start of each new syllable as you go higher. • The notes you sing have delayed onsets—a fraction of a second or longer passes between when you utter the sound and when it actually begins.

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