Vocal Health: Everything You Need to Know to Keep Your Voice Healthy

“Be content with what you have; rejoice in the way things are. When you realize there is nothing lacking, the whole world belongs to you.” ― Lao Tzu

Singers often ask me: How can I keep from getting sick, or if I do catch a cold, how can I get my voice back to normal as soon as possible?

During the winter months, good hand washing and sanitizing are extremely important. Germs are transmitted from the hands to the mucous membranes any time you touch your eyes or your nose. Carry a portable hand sanitizer with you at all times and use it frequently throughout the day. Sneeze and cough into the crook of your arm, rather than your hands, and encourage others to do likewise, to prevent the spread of germs. I wish the airlines would make this a part of their safety demonstration! When you fly you are stuck breathing recycled air and it seems incredible how many people seem to be totally oblivious about sneezing and coughing into the air.

Anything that can affect your health, body, skin, or mood can affect your delicate vocal folds, which swell (this is known as edema) when traumatized. When the folds are swollen, singing becomes difficult or impossible. Singing with compromised vocal folds will further injure the tissues and should be avoided.

The most important factor in good vocal health (other than good technique) is hydration (water). The vocal folds need to remain hydrated (wet) in order to function optimally. Most people do not drink enough plain water, and singers need to drink more water than the average person in order to maintain vocal health. The motto is “pee pale”. That’s right- the more clearly you tinkle, the happier your vocal folds are!

You should be aware that because of the functioning of the epiglottis, nothing you drink actually touches the vocal folds, so the old “tea and honey” remedy, while it might feel nice, does not affect the vocal folds (although it may provide a soothing effect to the tissues of the throat). The only way to affect the vocal cords is to inhale steam or mist onto them.Vocal Training Tips | Sing Like a Star

Humidity, steam, mist, drinking water, are hydrating and therefore good for your vocal folds; smoke, pollen, dry air, air conditioning and heating, caffeine, alcohol and drugs are dehydrating and therefore bad for them.

The following are some of the most common challenges to a singer’s vocal health:

Dairy: Some singers find that dairy products like milk or cheese cause thick mucus, so these products should be avoided on performance days.

Allergies: Allergies are also mucus producing, but you should avoid most antihistamines because they are too drying to the vocal folds and will make singing more difficult. If you must take them, counter their dehydrating effects with plenty of water and steam. Breathing through a warm wet towel will do in an emergency, as will inhaling steam from boiling water or the local gym’s steam room.

Illness: If you are sick or vocally tired, you need rest. Avoid talking or even whispering. Whispering is not a healthful solution when your vocal cords are swollen. Never talk loudly or sing when your vocal cords are swollen- you may be encouraging vocal nodules. Instead, silence, rest, and steam will get you on the road to recovery. Lip and tongue trills can be helpful once you are on the road to recovery.

Instead of singing during this time, just listen to your old voice lessons. In that way, you are training “aurally” instead of “orally”.

Caffeine and alcohol: These substances dehydrate the vocal folds, depleting them of needed lubrication. If imbibed, you need to drink at least as much water to counteract their dehydrating effects.

Environment: Re-conditioned air (AC or heating) depletes the moisture from the air in the environment. Some areas of the country are much more dry than other areas. If you live in a dry climate or you use AC and heating units you should use a humidifier at night. Air conditioning and heating units take moisture out of the air, affecting the hydration of the vocal folds. If possible try to avoid using forced air systems (heat or cold) while sleeping.

Flying: Airplane air is extremely dry- avoid alcohol and caffeine and drink at least 8 oz of water per hour while flying.

Throat Clearing and Coughing: Both throat clearing and coughing are very hard on the vocal folds (they actually go into a kind of spasm). When you need to clear mucus because of a cold, use this method: Take in a deep breath, hold your breath a moment and then expel the air with an energetic “Silent H”. Try to do anything you can to minimize trauma to the folds such as hard coughing and throat clearing.

Antihistamines: These are over-the counter drugs used to treat allergies and colds.

They should be avoided if possible because of their drying effects. Nasal sprays such as Nasacort, Nasonex, Flonase may relieve allergy symptoms without the drying effects of antihistamines.

Analgesics: Aspirin and anti-inflammatory drugs like ibuprofen may lead to bleeding and blood thinning, which may result in vocal fold hemorrhage. Tylenol is a better pain reliever for singers.

Expectorants: If you have to sing while sick (which is best avoided) an expectorant such as Mucinex may help to thin out thick secretions of mucus or post nasal drip. Make sure you are drinking 8 oz of water per hour all day long or this medication will not be effective.

Anesthetic Sprays: Do not use over the counter (or prescribed) anesthetic sprays on the throat before singing. As a singer you need to be fully aware of what is happening in the throat while you are singing; if you numb it, you may over use it unknowingly and cause damage to your vocal folds.

Progesterone and Other Hormones: Any hormone may cause alterations to the larynx- female body builders who use hormones to build muscle often sound like men and never regain the use of their former voice.

Acid Reflux: (Laryngopharyngeal Reflux Disease) Acid reflux is a problem many people do not even know they have. It occurs when stomach acid regurgitates up onto your esophagus, touching your vocal folds and damaging the folds and surrounding tissue.

Here is how it works: food travels down the esophagus to the stomach to be mingled with acid for digestion by passing 2 sphincters (bands of muscle fiber), one at the bottom and one at the top of the esophagus. In people suffering from acid reflux the food/acid mixture “refluxes” or flows backward through the sphincters through the esophagus and into the throat, bathing the vocal folds with acid.

GERD (Gastroesophageal Reflux Disease) is a reflux of stomach acid that goes through the lower sphincter into the esophagus.

LPRD (Laryngopharyngeal Reflux Disease) is where the stomach acid makes its way all the way through the upper sphincter through the esophagus and into the throat, causing damage to the vocal folds and pharynx. Many sufferers do not complain of heartburn, which is a result of the tissues of the esophagus becoming irritated. LPRD suffers are affected more directly on the larynx and throat and vocal folds. Symptoms include hoarseness, coughing, constant throat clearing, pain in the throat, and a bitter taste in the mouth, particularly in the morning.

Treatments for acid reflux include proton pump inhibitors, dietary changes, and sleeping with the body elevated.

Smoking: Smoking anything is anethema to good vocal health. Not only are inhaled substances irritating to the vocal tract; inhaling cigarette or marijuana smoke will alter the vocal folds and change the voice.

Good Health Habits for a Healthy Voice

1. Rest: Rest and sleep are essential for singers to maintain vocal health. If you don’t get enough rest and sleep the vocal folds are adversely affected, resulting in edema or swelling of the tissues. This means that, as the singer, unfortunately you must skip the after-show party and go straight home to bed. If you want to preserve your voice you must make rest a priority. This includes vocal rest- if you are rehearsing or performing you need to limit the amount of time you spend speaking during the day. Think of having a limited vocal “budget”. The voice is not a machine- you can use it safely for only a certain number of hours per day and then you are “cashed out”. If you are singing a lot or singing loudly you have even less “cash” in reserve. Pace yourself. Use your voice as little as possible on the days you have a performance. Give yourself a vocal rest day at least one day a week. Don’t talk or sing all day. Sound difficult? So is recovering from nodule surgery!

2. Hydration: Drink two quarts of water per day, until you consistently “pee pale”.

The vocal folds need to have some mucus on them in order to function efficiently, but we want thin rather than thick mucus. Lubrication is created in the vocal folds by drinking lots of water- at least 2 quarts per day. Dr Van Lawrence, a world-renowned ENT (ear, nose and throat specialist) has been credited with saying “Drink water until you pee pale”.

3. Exercise: Daily aerobic exercise is good for all the cells of the body including the vocal folds, and heart pumping deep breathing exercises help you stay in shape for performing.

4. Diet: Emphasize plenty of plain water, along with vegetables, fruits and plant based foods. Stay away from dairy, chocolate, and acid forming juices like orange juice which may create phlegm. Many people today are finding that they are gluten-intolerant and experience great improvements in health by avoiding gluten. Any food item that causes your body to secrete phlegm should be avoided-phlegm is the body’s way of reacting to a perceived toxin and inflammation. If you experience phlegm as a result of ingesting a particular food or drink your body is telling you to avoid it.

5. Avoid noisy environments: Don’t talk loudly in noisy environments or try to be heard over the crowd at a party. Stay away from outdoor sporting events that encourage screaming. Don’t even think about trying to be a cheerleader if you really want to sing. Screaming loudly at one event has been known to cause vocal nodules. Is it really worth it? If you must attend an outdoor sporting event or rock concert, an occasional woo-eee ! in the upper register should be ok. Do not scream or talk loudly, ever, but particularly in noisy outdoor environments.

5. Be aware of your speaking voice: You should be speaking in the area of the voice where you say “MMMM-HMMMMM” as if you are enthusiastically agreeing with someone. If you have to speak for long periods of time every day always use amplification. If you are a classroom teacher this can save your voice!

A portable cube amp with a microphone plugged in can easily travel with you anywhere you need to speak to a large group. These little amps pack a large punch and they are very small and easy to carry. Never raise your voice over large groups. If you direct musicals, working with large groups of excited singers, this tip could really save your voice.

6. Protect your voice during long rehearsals: When I attended a final dress rehearsal at the Metropolitan Opera Company in New York, most of the singers were “marking” (singing at half volumes or an octave lower), even with the hall fairly full of onlookers. These highly trained and powerful singers were saving their voices for the big event of opening night. The voice is a limited instrument and cannot be used at full volume for several hours every day as other instruments can. Do not allow yourself to be required by directors to sing “full voice” at every rehearsal. This will result in a less than stellar performance at opening night. Tell the director you are marking.

If you are in a rock band, resign yourself to the fact that you will never be able to sing louder or longer than an electric guitar. You can’t out-sing electricity!   Don’t allow yourself to be tempted to push and scream during rehearsals or performances even when the onstage volume is loud. (Which it always is, unfortunately). Protect your fragile and irreplaceable instrument by refusing to sing too long or too loud. A guitar string can be replaced but the vocal folds cannot be replaced. Even with vocal surgery there is no guarantee your voice will ever return to a pristine condition. And as soon as you start singing again with your prior habits, vocal problems come right back. If you want a long career, be smart about volume when singing and limit the time you spend singing full voice.

Even rock screamers know that to scream night after night in shows or while touring on the road, you have to do so at a moderate volume. You just have to make it LOOK like you are shredding your vocal folds- it’s called acting.

Of course a singer with good technique and training will be able to sing for longer periods of time than a singer who is not trained. Be sure to warm up the voice before rehearsals and to cool down after rehearsals with some semi-occluded exercises such as lip rolls or tongue trills.

7. Think Like an Athlete: An athlete warms up and cools down their muscles. A dedicated athlete knows they must exercise daily. They also know when to stop. They are disciplined about their body. When they are in training they avoid all harmful substances. They value and respect their body because it is the source of their income. You should do the same.

For singers exercising means vocalizing daily on scales and exercises that will encourage balanced registration and a good mix. You should vocalize enough each day to balance and develop the voice- but not so much that you get hoarse. Learn to pace yourself.

8. Gargling,Teas, Lozenges, Sprays: Though gargling does nothing for the vocal folds, gargling with salt water may help to soothe the tissues of the throat. Herbal teas such as Throat Coat (found at Whole Foods) contain slippery elm and may also be helpful for the throat (although, again, since these substances do not touch the vocal folds they won’t minimize swelling of the folds). Avoid caffeinated beverages, which dehydrate the folds.

Entertainer’s Secret throat spray helps to moisturize the tissues of the throat. (To order, call 800-308-7452). There is a natural throat spray called Sage Aloe Throat Shield Spray, made by Gaia Herbs, which can be purchased at Whole Foods. It contains Aloe Vera and is healing to the throat tissues. Thayer’s makes a variety of lozenges made with slippery elm, as well as throat sprays. To order, visit http://www.thayers.com. Their products are known as “natural remedies”. Rain, a mouth spray made with xylotol is moisturizing to the tissue of the mouth and throat, and is a great resource if you tend to get a dry mouth when you are nervous!

9. Steaming and Irrigating: Steam or mist, if inhaled, will hydrate the vocal folds and help minimize swelling. I encourage singers to invest in a portable facial steamer (found at any drug store) and to inhale steam several times a day if you are dealing with swollen vocal folds. Make sure you clean and sanitize the unit daily-they develop unhealthy bacteria if you don’t. A larger device such as a humidifier or a vaporizer should be used while sleeping to increase hydration of the vocal folds and soothe swollen tissues.

A nebulizer is a small, portable device that converts liquid medicine into a fine mist you inhale by breathing through a mouthpiece or mask. A nebulizer (also known as a jet nebulizer or a compressed-air nebulizer) is powered by a small air compressor. You can purchase a saline solution to insert in the nebulizer. This is a great way to hydrate the vocal folds; saline is healing and soothing to them.

You can purchase these on Amazon .

I also recommend using a neti pot to clear out sinus cavities. The use of a neti pot requires mixing up a saline solution that will be poured through the nasal passages.   Saline solution has been shown to be an effective treatment for hay fever, sinusitis, and other nasal conditions. Nasal irrigation is used on a daily basis by many professional singers; the sinuses should be flushed daily to clear the cilia of bacteria and other pollutants. The neti pot looks like an Aladdin’s lamp; the saline solution is poured into one nostril and comes out the other nostril. You should not use tap water with this product; most tap water contains chlorine which can be irritating to the membranes of the nose. Use distilled water.

You can purchase the neti pot on amazon or at your local pharmacy.

10. Straw phonation: Dr Ingo Titze, a world renowned vocal scientist, advocates vocalizing through a small straw to soothe and heal tired or swollen vocal folds. Dr Titze recommends straw phonation as an exercise for people with tired speaking voices, to help the voice recover; it works for tired singing voices as well.

He advocates doing slides and even vocalizing songs through the straw, which must be small enough to provide resistance.

The principle is to generate supraglottic (above the glottis) pressure so that the vocal folds can stretch and un-press. This reduces the load at the level of the larynx and can help to free up the muscles so the singer gets used to using less vocal fold mass during phonation.

The increased backpressure decreases subglottic (under the glottis) pressure during phonation, allowing the vocal folds to achieve maximum stretch more easily. It also encourages a low laryngeal position, which allows the thyroid cartilage tilt necessary to stretch and elongate the vocal folds, eliminating flips and voice breaks.

The singer may also find relief using any of the semi-occluded exercises such as lip trills and tongue trills, voiced fricative consonants such as V, Z, voiced TH, (as in “the), and the soft J (as in “azure).

You can see his demonstration at: https://www.youtube.com/watch?v=asDg7T-WT-0

Straw Phonation Routine:

1. Pitch glide from your lowest to highest notes for 1-2 minutes.

2. Glide up on “hills” like progressively gunning an engine more and more. Be sure you are accenting from the lower body and not from the throat.

3. Pick your favorite song and vocalize it through the straw.

With these good vocal health habits you should be able to maintain your voice with confidence throughout the winter and all year long!

Therapeutic Exercises for a Tired Voice

When vocally fatigued rest is essential for recovery and to avoid further trauma to the vocal folds. There are also specialized exercises that help with vocal fatigue- the Semi-Occluded Phonation exercises.

These exercises are great for warming up the voice, for experiencing proper appoggio, and for reducing hyper-function (too much effort, tightness or constriction in the vocal tract) and for reducing vocal fatigue due to over-use of the voice. The semi- occluded exercises reduce air flow through the vocal folds and provide a soothing and relaxing element to vocalization by un-pressing and stretching the folds. With semi-occluded exercises you will find it easy to vocalize throughout your entire range.

These exercises include lip rolls, tongue trills, certain voiced consonants such as Z or V, and straw phonation, as discussed in the previous article. They can be done on slides, sirens and scales, and should be repeated often throughout the day to keep the voice primed.

1. Lip rolls are made by blowing air across the lips as they are loosely vibrating or bubbling. Using your fingers on either sides of the lips can help to stabilize the vibrating lips. Although this may seem difficult to some singers at first, almost anyone can accomplish this exercise eventually. For those who have a hard time with the lip roll, a “raspberry” made by laying the tongue on the lower lip, closing the lips around the tongue, and blowing air usually works for just about anyone.

2. Tongue trills are the sound of a rolled “R”, and are made by flowing the air across a loose tongue tip. Many Romance languages such as Spanish and Italian use the rolled “R”.

3. Voiced Fricative Consonants include TH as in the word “the”, V as in the word “vibrant” , the softer Z as in the word azure, and Z as in the word “zebra”. These consonants tend to reduce air and maintain steady air flow.

4. Straw Phonation: Using a small stirring straw, insert the straw about a half-inch into the mouth. Close the lips completely and firmly around the straw. Using an “UH” feeling in the throat, glide from very low to as high as you can comfortably go without breaking into falsetto. Now try doing “hills”, first a low glide, then higher, and then higher still. Keep the tongue relaxed and loose.

5. Hand Over Mouth: If you place your hand over your mouth and vocalize, you will fee a nice back pressure that will soothe and stretch the vocal folds. This is effective if you can’t do a lip bubble or tongue trill.

6. Relaxation and Stretching: Take time throughout the day for relaxation and stretching exercises. Muscle massage using a small vibrator can also be very helpful in relaxing tension.

Tension is the enemy of good singing. To counteract muscular tension, stretching can be extremely beneficial.

For tongue tension, stick the tongue as far out of the mouth as possible, and then try to touch your nose, move it to the right, and finally to the left, holding each position for 5 seconds. Now draw a circle in the air with your tongue. This helps to disengage the muscles of the base of the tongue.

For neck tension, although the traditional “head roll” is not recommended, a good way to stretch the neck muscles is to bring your right ear toward the right shoulder and gently place the right hand on the left side of the face for a moment. Repeat on the other side. Then bring the head forward, resting it on the collarbone and rest the hand on the back of the head.

Another great exercise to relax tense neck and back muscles is to stand and reach for the ceiling, then let the torso come down toward the floor in a “rag doll” folding motion. Let the head hang straight toward the floor for at least a minute, then slowly come up, one vertebrae at a time, with the head coming up last. Now look to the right as far as possible, and then look to the left as far as possible. Repeat this process several times.

Then make “extreme faces” widening the mouth and eyes as far as possible, then scrunch the muscles of the face together as small as possible.

Massage the jaw hinge daily to release a tight jaw. And never chew gum! Chewing gum over-develops and tightens the hinge muscles of the jaw, which need to be loose and flexible.

Massaging the muscles of the neck, under the chin, the jaw hinge, and face will also help to relax tense muscles, thereby alleviating or preventing vocal fatigue.

Since the body is a system, with all parts affecting the other parts, tension in the body can affect the vocal folds. Doing muscle stretching exercises and massage will keep the body relaxed and will have a positive effect on the vocal folds.

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Essential oils such as doTERRA oils can aid in respiratory and immune support. You can order it here: http://www.amazon.com/doTERRA-Breathe-Essential-Oil-Blend/dp/B004O2916O