voice center voicecenter.pitt.edu keep your voice healthy! · keep your voice healthy! how the...
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Voicecenter.PITT.edu Voice Center
Keep Your Voice Healthy!
How the voice works and how to keep it healthy
Clark A. Rosen MD
University of Pittsburgh Voice Center
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Voicecenter.PITT.edu Voice Center
• How Does the Voice Work?
– Vocal Anatomy and Physiology
• What Can Go Wrong with the Voice?
– Medical Problems of the Voice
• How Can One Prevent Voice Problems?
– Voice Disorders Prevention: Vocal Hygiene Plan
Voice – Care and Treatment
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Voicecenter.PITT.edu Voice Center
• Where the body goes so goes the singing instrument
– Airplane, Steelers game, Pitt game…
• How the body goes, so goes the voice
– Fatigue
– Nutrition
– Hydration
Body -- Voice
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Voicecenter.PITT.edu Voice Center
Larynx Voice Production
Brain
Lungs
Larynx (vocal folds)
Pharynx
Nose/Sinuses (soft palate)
Oral cavity
– Tonsils, tongue, lips
EARS
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Voicecenter.PITT.edu Voice Center
POWER
SOURCE
RESONATOR
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Voicecenter.PITT.edu Voice Center
Where is the Larynx?
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Voicecenter.PITT.edu Voice Center
Larynx Anatomy
• Paired vocal folds
– Open for breathing
– Come together for sound production
• Speaking
• Singing
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Voicecenter.PITT.edu Voice Center
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Voicecenter.PITT.edu Voice Center
Layers of the Vocal Fold
• Edges vibrate together to produce the sounds of speaking or singing
– Fine muscle control
• Specialized covering of the vocal folds
– Lamina propria (superficial)
– Needed for vocal fold vibration
• Very sensitive to injury
• Very difficult to repair
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Voicecenter.PITT.edu Voice Center
Vocal Fold Vibration
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Voicecenter.PITT.edu Voice Center
Vocal Fold Vibration and Singing
• Vocal fold vibration speed = pitch
– Hertz = cycles per second (Hz)
– Speaking Voice
• Male ~ 100 Hz
• Female ~ 200 Hz
– Singing voice
• C below middle C (C3) = 136 Hz
• Middle C (C4) = 256 Hz
• A4 = 440 Hz
• High C (C6) = 1024 Hz
– Vocal folds are vibrating over 1,000 times per second !!!
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Voicecenter.PITT.edu Voice Center
• Performed by an Ear, Nose and Throat doctor in the office
Laryngeal Examination
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Voicecenter.PITT.edu Voice Center
• Specialized instrument to examine rapid vocal fold vibration
• Allows slow motion viewing and analysis of vocal fold vibration
Stroboscopy
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Voicecenter.PITT.edu Voice Center
Vocal Fold Vibration • Laryngeal Muscles Approximate Vocal Folds
• Tone, Length, Bulk
• Vibration Dependent on Covering of Vocal Folds (Lamina Propria)
– Bio-MECHANICAL
– Highly Elastic
– Sensitive to Injury
– Difficult to repair or replicate
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Voicecenter.PITT.edu Voice Center
Vocal Fold Vibration at 264 Hz
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Voicecenter.PITT.edu Voice Center
Vocal Fold Vibration at 120 times per second !
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Voicecenter.PITT.edu Voice Center
Outside and Inside of Singing
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Voicecenter.PITT.edu Voice Center
“You name it… It can/will happen!!!”
• Misuse / Overuse
• Laryngo-pharyngeal reflux disease
• Nasal and sinus diseases
• Dehydration
• Singing / Speaking sick
• Lumps and bumps of the vocal folds
Common Voice Problems
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Voicecenter.PITT.edu Voice Center
–Singing is an aerobic activity
–Avoid exposure to smoke-filled air
–Treat conditions affecting lungs, such as asthma
–Exercise
–DO NOT SMOKE!!!!!!!!!!!
Caring for Your Lungs
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Voicecenter.PITT.edu Voice Center
Smoking
Laryngeal Cancer Irreversible changes to vocal
folds
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Voicecenter.PITT.edu Voice Center
• Stomach acid content (acid) irritates the larynx (vocal folds) and pharynx, or referred sensation from stomach or esophagus
• Occurs in everybody to some extent
• May be associated with: – Hoarseness
– Heartburn
– Foreign-body or “lump in the throat” sensation
– Frequent throat clearing
– Excessive phlegm production
Laryngo-Pharyngeal Reflux Disease (LPR)
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Voicecenter.PITT.edu Voice Center
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Voicecenter.PITT.edu Voice Center
Laryngo-Pharyngeal Reflux Disease
• Worsened by
– Caffeine
– Alcohol
– Chocolate
– Mint
– Spicy foods
– Fatty foods
– Tomato-based foods
– Lying down with full stomach
– Tight clothes
– Obesity
– Singing
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Voicecenter.PITT.edu Voice Center
• Precautions:
– Avoid large meals several hours before bedtime
– Avoid substances that exacerbate reflux
– Use antacids for spicy foods, heartburn
– Seek treatment if regular problem
• Change in behavior
• Medication very successful
• Prilosec, Protonix, Prevacid, Nexium, Zegerid, Aciphex, Dexilant
Laryngo-Pharyngeal Reflux Disease
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Voicecenter.PITT.edu Voice Center
• Nasal breathing warms, humidifies and filters the air you breath
• Allergies or Infection can block nasal breathing and thus lead to mouth breathing which dries the throat and vocal folds
• Can affect voice resonance
• Causes post-nasal drainage – Frequent throat clearing
• Increased risk for vocal fold injury
Nasal and Sinus Disease
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Voicecenter.PITT.edu Voice Center
• Antihistamines (significant drying)
– Allergy & Cold Medications
– Benadryl, Claritin, Allegra, Zyrtec, Astelin,
– Tylenol PM, Contact, …
• Anti-Depressants
– Paxil, Zoloft, Effexor, Lexapro, …
• Anti-coagulants
– Aspirin, Ibuprofen, Coumadin, Plavix, Xarelto…
– Natural: fish oil, Echinacea, gingko biloba, ginger, …
– Tylenol = OK
• Accutane
• Advair
Medicine / Drugs Concerns
“Is this medication
going to effect my
voice?
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Voicecenter.PITT.edu Voice Center
• The practice of “singing sick” subjects the performer to a significant risk of serious vocal injury
– Vocal fold hemorrhage (bleed)
– Can lead to vocal fold scar formation
• VERY HARD TO FIX!!!
“I Have a Cold, Can I Sing?”
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Voicecenter.PITT.edu Voice Center
Vocal fold hemorrhage
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Voicecenter.PITT.edu Voice Center
• Most colds are caused by viruses and do not require (or benefit) from antibiotics
• What to do: (Early detection)
Back off from vocal demands
Seek treatment early
“I Have a Cold, Can I Sing?”
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Voicecenter.PITT.edu Voice Center
• Supportive treatment:
Increase rest and hydration
Mucous thinning medication
Guaifenesin (Mucinex)
Nasal saline rinse / Neti pot
Decongestants
Pseudoephedrine
but WILL dry you out!
Avoid antihistamines if you can
“I Have a Cold, Can I Sing?”
Mother
knows best!
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Voicecenter.PITT.edu Voice Center
• Limit vocal use
– Talking (phone, yelling……..)
– Mark through rehearsals
– Limit singing if the speaking voice is hoarse
– If you must sing, you should have a vocal fold examination prior to performance
“I Have a Cold, Can I Sing?”
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Voicecenter.PITT.edu Voice Center
Lumps and Bumps
• Usually arise from phonotraumatic voice use or singing sick….
– Nodules
– Polyp
– Cyst
• Maximize non-surgery treatment
– Voice rest
– Voice therapy
– Singing voice therapy
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Voicecenter.PITT.edu Voice Center
Vocal Fold Nodules
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Voicecenter.PITT.edu Voice Center
Vocal Fold Lesions
Vocal fold polyps Vocal fold hemorrhagic polyp
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Voicecenter.PITT.edu Voice Center
Vocal Fold Lesions
Reactive
lesion
Vocal
fold cyst
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Voicecenter.PITT.edu Voice Center
Hoarseness is no laughing matter!
• Hoarseness is NEVER normal
• Especially repeated episodes
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Voicecenter.PITT.edu Voice Center
Voice Care is a Team Sport
• University of Pittsburgh Voice Center
– Physicians
– Speech Pathologists
– Singing Voice Specialists
– Related Medical Specialists
– Mental Health
• 412-232-SING
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Voicecenter.PITT.edu Voice Center
University of Pittsburgh Voice Center –412-232-SING (7464)
–UPMC Mercy
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Voicecenter.PITT.edu Voice Center