Speech Language-Pathology and the Professional Voice: An Overview

What does the SLP do?Does not provide special training: range, power,

control, stamina, esthetic qualityAnalyze Systematically the Vocal

Behaviors:Perceptual & Objective MeasuresAnalyze Vocational, Educationally, &

Psychosocial Factors of Vocal BehaviorsDesign & Implement an Individualized Program

for Modifying Vocal Behavior

Who are Professional Voice Users?

Use the voice for artistic expression Professional Singers Actors/Actresses Those seeking to become professional

singers or actors Excluded for this talk: Teacher, lawyer,

clergy

Levels of Vocal Usage

Elite Vocal Performer (Level I)- slight aberration of voice may have dire consequences: singers and actors, opera singer

Professional Voice User (Level II)- moderate vocal problem might prevent adequate job performance: clergy, teachers, lecturers,etc.

Non-Vocal Professional (Level III)- severe vocal problem would prevent adequate job performance: lawyers, physicians, businessmen, business women, etc.

Non-Vocal Non-Professional (Level IV)- vocal quality is not a prerequisite for adequate job performance: clerks, laborers.

Levels of Vocal Usage

The Vocal Tract: 4 Components "Generator”- breath support provided by the lungs. "Vibrator”- the larynx; specifically, the vocal folds

themselves.

"Resonator”- the space above the larynx, and includes most of the pharynx. (trained opera singer-produce resonance at 2,500 Hz).

"Articulator”-the tongue, lips, cheeks, teeth, and palate. Shapes sound from below into words and vocal gestures.

Anatomy & Physiology: Larynx

Laryngeal Cartilage's

Intrinsic & Extrinsic laryngeal Muscles

Vocal Fold Vibration: Speaking &

Singing

Laryngeal Framework

Posterior Anterior

Cricoid

Corniculate

Cuneiform

Arytenoid

Thyroid

Epiglottis

Intrinsic Laryngeal Muscles

Cricothyroid: fan-shaped, 2 divisions, Lengthens & tenses the vocal folds.

Action of Cricothyroid

Intrinsic Laryngeal Muscles

Thyroarytenoid: muscle making up the true vocal folds, 2 parts: thyrovocalis (bound to the vocal ligament) & thyromuscularis (lateral to arytenoids).

ThyroarytenoidVocal ligament

Thyrovocalis

Thyromuscularis

Intrinsic Laryngeal Muscles

Posterior Cricoarytenoid: Abducts the vocal folds, actively contracted at the end of phonation & any speech sound not requiring v.f. vibration.

PosteriorCricoarytenoid

Action of Post.Cricoarytenoid

Intrinsic Laryngeal Muscles

Lateral Cricoarytenoid: lies along upper surface of cricoid cartilage, adducts vocal processes of arytenoids closing membranous portion of v.f.’s.

Action of Lat.Cricoarytenoi

d

LateralCricoarytenoid

Interarytenoids (transverse & oblique): Unpaired, 2 part muscle, adducts the v.f.’s in the cartilaginous portion by pulling arytenoid tips together.

ObliqueInterarytenoids

TransverseInterarytenoids

Intrinsic Laryngeal Muscles

Extrinsic Laryngeal Muscles

Mastoid Tip

Mylohyoid

Hyoid Bone

Sternohyoid

Omohyoid

Sternum

Mandible

AnteriorDigastric

PosteriorDigastric

Stylohyoid

Thyrohyoid

Sternothyroid

Extrinsic Laryngeal Muscles

Three Main Purposes:

1) Fixation

2) Elevation

3) Depression Two major groups-

Suprahyoid & Infrahyoid Suprahyoid- one of the above

attachments lies above the larynx. Infrahyoid- one of the attachments lies

below the larynx.

Vocal Fold Vibration Vibratory cycle- single vibration of the vocal folds (or

glottal cycle)

“Begins when subglottal pressure (Ps ) overpowers

fold resistance just enough for the v.f.’s to first blow open.”

Opening phase: v.f. continue to blow apart

Closing phase: escape of air reduces Ps enough for

fold resistance to overpower airflow, then close.

Vocal Fold Vibration

Note how the vocal folds open from bottom to top & back to front.

Spread of glottal opening

Vertical phase difference

Spread of glottal opening

Vocal Fold Vibration

OPEN

CLOSED OPENING

CLOSING

Normal Vocal Folds

1.

2. 3. 4.

Vocal Abuse & Misuse

Hyperfunctional singing or speaking habits

Voice history taken to determine

speaking/singing patterns

Vocal techniques to reduce hyperfunctional

voice are discussed

Vocal Abuse & Misuse: Singing

Excessive muscle tension in tongue, neck, larynx Inadequate abdominal support Excessive volume Inadequate preparation

limited practice rehearsal of a difficult piece limited vocal training for a given role

Don’t go beyond your physical limits!

Vocal Abuse & Misuse: Speaking

Disassociation with speaking & singing voice is a common

abuse!

Support, muscular control, projection not applied to

speaking voice

Shouting, screaming (backstage, noisy rooms)

Conducting-Choral (Practice singing all parts)

Teaching singing (Long days, seated)

Vocal Abuse & Misuse: Speaking Loud talking, yelling, screaming Hard glottal attack Outside acceptable physiologic range Excessive coughing/throat clearing Grunting (lifting, exercising) Excessive talking Loud, hard laughing Voice production when folds are inflammed

Vocal Abuse & Misuse: Exposure

Alcohol consumption

Medications

Caffeine

Recreational drugs

Smoke

Reflux

Vocal Abuse & Misuse: Symptoms

Hoarseness

Vocal fatigue

Reduced range of phonation

Breathiness

Strain/Struggle voice

Disorders of Singing: Upper Respiratory Infection

Symptoms- Mucosal congestion Increased nasal secretions Nasal obstruction Pharyngitis Fever causing dehydration Productive or unproductive cough

Disorders of Singing: Upper Respiratory Infection Medications

Be knowledgeable about “over the counter remedies”

Avoid antihistamine (dry & thicken secretions) Early infection only Tefenadine & Astemizole (non sedating)

Mucolytic agents & decongestants give greatest relief

Sleepiness & anxiety

Avoid aspirin May cause vocal fold hemorrhage with coughing

Other therapies: Increase fluid intake

Those that don’t increase mucous production Nasal irrigation's

Thins secretions (saline) Singing only if no cord inflammation

Disorders of Singing: Upper Respiratory Infection

Disorders of Singing: Laryngitis URI may cause mucosal edema Voice rest considered Practice for short periods of time

Few brief rather than one long session Singing- Narrow pitch range Other vocalizations minimized or avoided No whispering or whistling

Gargling no help Steam inhalation is beneficial-

Decreases inflammations & reduces secretions

Performance during laryngitis Limit pitch range & volume

Disorders of Singing: Laryngitis

Laryngitis/ Edema

Disorders of Singing: Vocal Fold Hemorrhage

Can occur with URI, laryngitis or coughing Vocal abuse- Single episode of shouting etc. Women- Onset of menstrual cycle Strict vocal rest

Fibrosed tissue Frequent episodes- Prominent superficial blood

vessels Laser treatment

Vocal Fold Hemorrhage

Disorders of Singing: Vocal Fold Polyp Typically unilateral Anterior middle one-third of fold Broad based or sessile May cause mild-severe dysphonia Caused by misuse or abuse, smoking

(cigarettes or marijuana (worse)

Typical complaints: Harsh quality Diplophonia Loss of upper range

Therapy: Resolve with voice therapy Surgery-polypoidectomy

Disorders of Singing: Vocal Fold Polyp

Unilateral Polyp

Bilateral Polyps

Disorders of Singing: Vocal Nodules Caused by overuse and abuse

Singing outside range Nonsinging activities (most often)

SpeakingJob environmentPlaying musical instrumentConductingTeaching

Other vocal abuses: Environment

NoiseSmokeDustPoorly ventilationLack of proper humidityPoor acoustics

Disorders of Singing: Vocal Nodules

Symptoms- Harsh, hoarse or breathy voice Loss of upper range

Treatment- 6-12 weeks of behavioral therapy If persist-surgery

Microlaryngeal- NO laser

Disorders of Singing: Vocal Nodules

Bilateral Singer’s Nodules

Bilateral Nodules

Prevalence of Disorder

Who Gets Voice Disorders?

45% are level I and II professional vocalists,

43% are level III and IV patients.

Remaining 12% are children

Disorders of Singing: Most Common Acute "emergencies":upper respiratory infection:

cold or stress-related.

Voice strain and/or extraesophageal reflux (the back flow of stomach contents).

Vocal abuse and misuse syndromes are common in professional voice

Disorders of Singing: Incidence Infectious and Inflammatory Conditions:

Laryngopharyngeal reflux (LPR)- 55%

Chronic tobacco use (smoking)- 25%

Upper respiratory infection- 15%

Vocal Misuse/Abuse Syndromes:

Muscle tension dysphonia(s)- 40%

Acute vocal abuse- 2%

Benign and Malignant Growths:

Reinke's edema- 16%

Vocal nodules- 8%

Granulomas- 7%

Papillomas- 4%

Carcinoma (Cancer)- 4%

Disorders of Singing: Incidence

Neuromuscular Disorders: Dystonia (spasmodic dysphonia)-8% Paralysis/paresis- 7% Degenerative conditions- 2%

Psychogenic Conditions: Conversion reactions- 2% Relapsing aphonia/dysphonia- 1%

Disorders of Singing: Incidence

10 Most Common Problems of Singers Poor Posture

Poor Breathing & Inappropriate Breath Support

Hard Glottal or "Aspirate" Attack

Poor Tone Quality

Limited Pitch Range, Difficulty in Register Transition

Lack of Flexibiltiy, Agility, Ease of Production, Endurance

Poor Articulation

Lack of Discipline, Commitment, Compliance

Poor Vocal Health, Hygiene, Vocal Abuse

Poor Self-Image, Lack of Confidence

Disorders of Singing: Treatment Concerns Successful treatment of voice disorders

depends on identification of "vocal needs" of each patient.

patient's professional and social needs and obligations.

different impact patients depending upon the patient's profession or "level of vocal usage."

How to save your voice: Avoid Abuse

1) Do nothing to your voice resulting in hoarseness and/or throat pain.

2) Avoid yelling or screaming to the point of causing hoarseness.

3) Avoid singing so loudly that you develop hoarseness, and avoid singing in situations that you cannot hear yourself singing.

4) Cold or laryngitis: do not try to talk or sing "over" the problem.

1) Careful using "character voices" not to strain, and use especially good breath support.

2) Do not alter your "normal" speaking voice to create an effect; avoid pitching your voice too low.

3) Avoid taking on roles you cannot do; don't attempt roles that are out of your range.

4) Avoid using long run-on sentences and a rapid speaking rate; good breath support for speech is as important as good breath support for singing.

How to save your voice: Avoid Misuse

How to save your voice: Avoid overuse

1) Examine your "vocal schedule" carefully. Your vocal demands are not of equal importance.

2) Avoid making a schedule that leaves no room for rest and recovery.

3) Use amplification when available and appropriate, especially for rehearsals.

How to save your voice: Monitor your diet/ life style.

1) Eat regularly, and eat a healthy diet.

2) Avoid fried and other fatty foods.

3) Avoid dehydration: drink plenty of water.

4) Avoid eating or drinking, particularly alcoholic

beverages, within three hours of bedtime.

5) Minimize consumption of caffeine-containing foods

and beverages.

6) Strictly avoid smoking or other tobacco consumption

7) Exercise regularly; aerobic exercise is best.

How to save your voice: Avoid unnecessary medications.

1)Avoid drying medications such as antihistamines.

2) Avoid anesthetic throat sprays.

Warming-Up the Voice Allowing time to warm-up

Singers develop distinctive warm-up regimens appropriate to their

personal needs

Warm-up the entire body with gentle physical exercise (e.g., stretching,

yoga, Tai Chi).

Begin vocalizing in the comfortable mid-range of the voice, and

gradually work out to the higher and lower extremes of pitch.

Test vocal register transitions during the warm-up. Exercises that

"blend" the "chest" ("heavy” laryngeal adjustment) and "head" ("light"

laryngeal adjustment) registers eventually produce a smooth passaggio.

Cooling Down the Voice

"warm-down" by vocalizing on "oo," for example). Singer using a "belting" voice, it is helpful to sing

in the "head" register (or falsetto)-stretches the vocal cords and alleviates laryngeal

tension Re-loosening the articulatory muscles, Massaging the jaw- the masseter, neck &

shoulders particularly the trapezius

Case Study: Opera Singer 2 days prior to Opera- Arrives in Tennessee

from Germany In 24 hours- Blocking, informal and dress

rehearsal Complaint- Mild changes in mid -range; not

noticed by others

Case Study: Examination Laryngeal videoendostroboscopy- revealed

moderately large immature bilateral vocal fold nodules

Cause: Sung during a cold 2 weeks prior

Case Study: Therapy Elimination of all unnecessary vocal usage

No cast partiesMinimal conversation

Transposition to a lower key was not an option Reduction of dynamic markings of solo parts Techniques used for 3 days of performance-

followed by 2 weeks of reduced vocal usage Problem was resolved