Vocal health: tips and resources for keeping your voice healthy

I recently had several students come to me who I suspected might have vocal nodules. With fall allergies on the rise and flu season around the corner, I thought now would be a good time to revisit some thoughts on keeping the voice healthy. 

vocal health tips

Drink plenty of water. Aim for 64 ounces (or eight 8-ounce glasses) daily. Caffeinated beverages do not count towards this total, but the following beverages do: juice; decaffeinated coffee, soda, and tea; herbal tea; and milk. 

Get 7-8 hours of sleep each night. We tend to fall back on bad habits when we’re tired. Getting enough rest will keep your body energized so that it can properly support your voice. 

Practice nasal irrigation: use saline drops or a neti pot. This is especially important if you are prone to allergies or sinus infections. 

Avoid speaking over background noise. We easily learn to “tune out” background noise, but speaking over other sounds can fatigue the voice. Common examples of background noise include talking at parties or restaurants and traveling by car. 

Maintain proper humidity. If the humidity levels in your home or office fall below 40 percent, consider using a humidifier, especially at night. (It is important to use a humidifier that can easily be cleaned, as the bacteria build-up can make you sick.)

Practice healthy and efficient speaking habits.

Avoid clearing your throat. 

Get acid reflux treated. Stomach acid can literally burn the vocal cords. See a doctor if you experience reflux several times a week.

Rest your voice when it feels fatigued. Listen to your body. Warm up your voice before speaking extensively or before singing.

Avoid excessive use of Aspirin and non-steroidal anti-inflammatory drugs (Advil, Ibuprofin, Motrin, Anaprox, Naproxin, etc.) 

Practice relaxation techniques if you tend to experience physical tension. Examples include meditation, yoga, visualization, and hypnosis.

Keep your body strong and flexible and maintain optimal posture. There are many physical disciplines that can help: yoga, Pilates, tai chi, Alexander technique, dance, etc.)

Seek medical attention. See a doctor if you are experiencing vocal problems and are not otherwise ill. (Read more information on the reverse page.)

vocal health resources

when to see a voice doctor

Vocal problems can develop at any time, but they most often occur following an illness or after times of extended voice use. However, the voice generally recovers on its own within a week or two. See doctor if you are experiencing the following symptoms and are not otherwise ill:

• change in vocal quality, such as hoarsness, breathiness, vocal fatigue, loss of volume, or decreased vocal range (high or low)

• throat pain or discomfort

• recurring voice loss (full or partial)

finding a voice doctor

Look for a doctor with experience working with “professional voice users.” Other specialists - even ear, nose, and throat (ENT) doctors - may not fully understand voice use or vocal problems common to people who speak or sing frequently. If you’re looking for a voice doctor, or are curious about problems related to the voice, I highly recommend www.voiceproblem.org. 

voice doctors in the Philadelphia region

These two highly-experienced teams of ENTs and speech therapists specialize in treating professional voice users.

Joseph Spiegel Thomas Jefferson University
925 Chestnut Street, 6th floor Philadelphia, PA 19107 215-955-6760

Philadelphia Ear, Nose and Throat Associates
www.phillyent.com 219 N Broad St, 10th Fl Philadelphia PA 19107 215-762-5531

CHOP operates a world-class voice clinic for children. The staff is sensitive to the needs of children who perform at avocational and professional levels.

Children's Hospital of Philadelphia - Voice Clinic
www.chop.edu 215-590-1000 • 34th Street and Civic Center Boulevard Philadelphia, PA 19104

This large group practice treats a broad range of ENT issues, including voice problems of children and adults. 

Ear, Nose and Throat Associates of Chester County
www.entacc.com 610-363-2532 • offices in Exton, Coatesville, West Chester, and Kennet Square

other professionals

A voice doctor may recommend that you work with a speech and language therapist (SLP) as part of your recovery. Like ENTs, SLPs often specialize in various areas of their field. You will want an SLP who specializes in voice. If you are a singer, you may need a singing (or voice) teacher. Look for someone who has experience with injured voices and who teaches the vocal style you wish to sing.

Download this handout as a PDF.

Disclaimer: This blog post does not constitute medical advice, professional diagnosis, opinion, treatment, or services. It simply provides general information for educational purposes only. This information is not a substitute for medical or professional care, and you should not consider it a substitute for a consultation with a physician or other healthcare provider.

Guidelines for voice work

Teaching has taught me a lot about the average person’s conception of vocal training. Beginning students expect a teacher to talk about breathing, tone, and projection. Yet many of them - even those who have had vocal training before - are surprised by certain aspects of my classes.

They don’t expect me to ask questions about their health, talk about relaxation, inquire about their earliest vocal memories, or assign yoga exercises. Many are surprised that they feel uncomfortable talking about or exploring their voices. Others only want a few simple tips they can use on their own to suddenly bring their vocal skills from an amateur to a professional level.

As I have learned more about the expectations of my students, I have slowly developed some guidelines for beginners.

Guidelines for Voice Work

  • The voice is deeply personal. Along with our physical appearance, our voice is one of the primary ways in which we express ourselves to the world. Our voices reflect our upbringing, social influences, and self-image.
  • Voice work involves releasing tension and engaging the breath. Most voice problems are caused when some muscles are too tense and others are not working hard enough. Voice training can help you retrain your muscles, relaxing some and engaging others.
  • Voice work takes time. Be patient with yourself, and do not expect a quick fix. Poor vocal habits may take years to develop, and they will not disappear overnight.
  • Voice work involves replacing habit with choice. This requires 1) knowledge 2) attention 3) change and 4) repetition.
  • Voice work requires regular practice. You will get the most out of vocal training if you practice regularly. It is more effective to practice for 10-20 minutes several times a day than to practice for one hour once a week.

Download my Guidelines for Voice Work as a PDF.

Top 10 ways to begin your vocal warm up - without making a sound!

Sometimes the best vocal warm-ups don’t even involve the vocal cords. Here are my favorite ways to kick-start a practice session without waking the neighbors.

 

  1. Eat breakfast - Breakfast is a great way for morning practicers (like myself) to get started. The actions of chewing and swallowing warm up the face, jaw, and tongue muscles and trigger the salivary glands that moisten the throat. Here are some great breakfast ideas from Zen Habits, one of my favorite blogs.
  2. Take a shower - There’s nothing like warm water to open the sinuses, relax the body and mind, and prep your muscles for action. I recommend showers over baths since showers tend to steam up the bathroom (and hydrate the vocal cords) more quickly.
  3. Drink water - Most singers already know how essential proper hydration is, but just the act of swallowing is beneficial, too.
  4. Drink hot tea - For allergy sufferers like me, tea can help to wash down phlegm and clear the nasal passages. Other hot drinks will also work, but watch out for too much caffeine - it can dry the vocal cords. Besides, tea has additional health benefits (it’s loaded with antioxidants) and half the caffeine (or less) of coffee.
  5. Yawn - Yawning is the ultimate throat and palette stretch!
  6. Stretch - Singing involves the whole body, and unnecessary tension anywhere can have a negative effect on the voice. I find that a good side stretch helps open up the ribcage and free up my breath.
  7. Exercise - Yoga is my favorite because it combines stretching and breathing, but opera star Renee Fleming swears by Pilates and Thomas Hampson uses weights to tone his core support muscles.
  8. Meditate - Mindfulness meditation is the practice of focusing the mind, usually by observing the breath and disengaging from thoughts. It’s a great way to calm anxious nerves and tame self-criticism.
  9. Make faces - Like yawning, making funny faces is a great stretch for the face and jaw, as well as a wonderful way to practice improvisation. For inspiration, visit my post on “gurning” and watch a video of a face-making competition!
  10. Practice in your head - Studies have shown that mental practice can be as effective as an actual practice session. So go ahead …

Give yourself a head start on your warm-up without making a sound. You might discover something new - and your neighbors will thank you!

Photo: mikeautry1

Taking voice problems seriously

US News & World Report recently published an article on common causes of hoarseness. They include:

  • a cold
  • allergies
  • acid reflux (which, by the way, can actually burn the vocal cords!)
  • cancer of the larynx, thyroid, or lungs

The article gives five tips for dealing with a hoarse voice:

  • Talk to your doctor about getting a larygeal exam.
  • Protect your voice by drinking enough water, avoiding smoke, and not clearing your throat, coughing, shouting or yelling. 
  • Avoid decongestants, which can dry out the vocal cords.
  • Remember that the degree of hoarseness doesn’t correlate with the seriousness of the problem.  Don’t assume a really hoarse voice indicates cancer or that a little hoarseness isn’t an issue. 
  • Get voice training. If your speaking voice fatigues easily, you may be unintentionally misusing it. Just a few sessions with a speech and language pathologist can teach you how to use your voice more effectively. And your health insurance may pick up the bill. If you fatigue quickly while singing, look for a voice teacher with experience in working with injured voices.

Read the US News article here!

Finally, keep in mind that issues that affect the speaking voice often show up more dramatically when we sing. Even if you’re a casual singer, look for a doctor with experience in dealing with “professional voice users.” Any other specialist probably won’t understand the singing process and how problems that seem minor to a speaker can really hinder a singer. Read this previous post on how to find a qualified voice doctor.

How to find a voice doctor

My journey as a singer with vocal problems has been emotionally (and vocally) exhausting. One of the many lessons I’ve learned is the importance of seeking out qualified specialists.


Finding a voice doctor

It’s not that I didn’t try. But for years the doctors and voice teachers I went to never recognized what was going on. I realize now that most doctors (even ENTs) don’t have the experience it takes to treat singers. This may seem ignorant to anyone who has spent years training the voice, but think about it this way. ENTs treat disorders of the ears, nose, head, neck, and throat. Many choose one or more specializations like:

  • pediatric otolaryngology (children)
  • otology/neurotology (ears, balance, and tinnitus)
  • allergy
  • facial plastic and reconstructive surgery
  • head and neck
  • rhinology (nose)
  • sleep
  • laryngology (throat)

Even laryngologists may choose specialties, such as swallowing disorders or throat cancer, that focus on more than the voice. Singers will want to find a doctor who specializes in treating professional voice users. He or she will understand, for example, that a little breathiness can be a big deal. Or that losing the very top of your vocal range (notes most people don’t know the human voice is capable of) is a tragedy. Or that vocal fatigue can be an occupational hazard.

If you’re shopping for a voice doctor, or if you’re just curious about the voice, I highly recommend www.VoiceProblem.org.


Finding a teacher who rehabilitates voices

It’s understandable that not all doctors are sensitive to the needs of singers, but surely voice teachers should be able to recognize vocal problems, right? Yes … in an ideal world. But the reality is that most voice teachers have little to no experience with vocal disorders. They are typically trained first as singers, and may or may not receive training in vocal pedagogy (the art of teaching singing), much less vocal pathology (disorders of the voice) or vocal rehabilitation.

Today I feel very lucky to have found an excellent teacher who specializes in rehabilitating damaged voices. If you suspect you’ve had vocal damage, look for a teacher who has similar experience. Wondering where to start? Call up the nearest ENT who specializes in treating professional voice users.

Photo: bcostin

Yoga for your face

So I’ve taken my love for yoga (which I’ve blogged about before) to a new level. My inspiration is a book I got for Chrstimas: The Yoga Face: Eliminate Wrinkles with the Ultimate Natural Facelift by Annelise Hagen. Of course, I didn’t get it to zap wrinkles, but to warm up my face for singing.

The author is a yoga instructor and teaches a class called Yoga Face at the New York Health and Raquet Club. See her class in action on this video clip from NBC Today. Her book is full of specific exercises for toning and relaxing the facial muscles. Many of them teach you how to isolate tiny muscles that we don’t usually activate alone, a skill singers can use for refining vocal technique and for building a wider range of facial expressions.

One of the things that sets this book apart is that it’s not entirely focused on the face. Unlike a lot of similar works, Yoga Face also includes basic exercises that are generally relaxing, including a lot of inverted poses and poses that free up the breath. This is ideal for singers, who can turn to it to warm up body, mind, and breath. Plus, the emphasis on basic postures makes the book accessible to beginners and advanced yogis alike.

If you’re interested in facial exercises, here’s a list of additional resources, including books, website, and YouTube clips.