Voice Center
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Medical Treatment of
Voice Problems
VyVy Young, MD
Assistant Professor
UPMC Voice Center
412-232-7464 (SING)
Voice Center
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Singing Instrument: The Body
 Violinist – Singer
 Instrument Case
 Body
• Singer’s Instrument
– Knee caps to Scalp
Voice Center
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Body >>> Voice
• Where the Body goes, so goes………… the
Singing Instrument
– Smoky or Noisy Party, Sporting Event, Airplane…
• How the Body goes, so goes the Voice!!!
You NEED:
– Hydration
– Sleep
– Nutrition
Voice Center
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Voice – Care and Treatment
• 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 Wellness Plan
Voice Center
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Anatomy of Voice Production
• Brain
• Lungs
• Larynx (voice box)
– Vocal folds (cords)
• Throat and Nose/Sinuses
• Mouth
– Tongue
– Lips
• EARS
Voice Center
Where is the Larynx?
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Voice Center
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Larynx Anatomy
• Paired Vocal Folds
• Fine Muscle Control
– Open for breathing
• Specialized Covering
of the Vocal Folds
– Come together for
sound production
• Speaking
• Singing
• Edges vibrate together
to produce the sounds
of speaking or singing
– Called Lamina Propria
– Creates/allows Vocal
Fold Vibration
Voice Center
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Voice Center
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Physiology of Voice Production
• POWER – ENERGY
– Lungs
• SOUND SOURCE
– Vocal Folds
• RESONATOR
– Throat, Nose, Sinuses, Mouth
Voice Center
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RESONATOR
SOURCE
POWER
Voice Center
Vocal Fold Anatomy
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Voice Center
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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
Voice Center
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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
– Vocal Folds are
vibrating over 1,000
times per second !!!
Voice Center
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Laryngeal Examination
• Performed by an Ear, Nose and Throat
doctor in the Office
– Looking at throat through mouth or nose
Voice Center
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Stroboscopy
– Specialized instrument to examine rapid
vocal fold vibration
– Allows slow motion viewing and analysis of
vocal fold vibration
Voice Center
Vocal Fold Vibration at 264 Hz
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Voice Center
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Common Voice Problems
“You Name It, It Can Happen!!!”
• Misuse / Overuse
• Laryngo-pharyngeal Reflux Disease
(LPR)
• Nasal and Sinus Diseases
• Dehydration
• Singing / Speaking Sick
• Lumps and Bumps of the Vocal Folds
Voice Center
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Laryngo-Pharyngeal Reflux Disease
• Stomach contents (acid) irritate the Larynx
(vocal folds) and Pharynx
• Occurs in everybody to some extent
• May be associated with:
– Hoarseness
– Heartburn (but you DO NOT ALWAYS FEEL THIS!)
– “Lump in the throat” sensation
– Frequent throat clearing
– Excessive phlegm production
Voice Center
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Voice Center
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Laryngo-Pharyngeal Reflux Disease
• Worsened by:
 Caffeine
 Alcohol
 Lying down with
full stomach
 Chocolate
 Eating late at
night
 Mint
 Tight clothes
 Spicy foods
 Obesity
 Fatty foods
 Stress
 Tomato-based
foods
 Singing
Voice Center
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Laryngo-Pharyngeal Reflux Disease
 Precautions:
 Avoid large meals several hours before
bedtime
 Avoid foods that exacerbate reflux
 Use antacids for spicy foods, heartburn
 Seek treatment if regular problem
 Change in behavior
 Medication very successful
Voice Center
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Nasal and Sinus Disease
• Nasal breathing warms, humidifies and filters
the air you breath
• Allergies or sinus 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:
• HARD SWALLOW WATER or SALIVA INSTEAD!
Voice Center
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Treatment of Nasal and Sinus Disease
• Allergy medications (pills)
– Avoid decongestants
• Nasal sprays
– Prescription: Flonase, Nasonex, Nasacort, etc
– Saline
• Nasal rinses
– NetiPot
– Sinus rinse
Voice Center
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Medicine / Drugs Concerns
• Antihistamines
(significant drying)
– Allergy & Cold
Medications
– Benadryl, Claritin,
Allegra, Zyrtec, Astelin,
– Tylenol PM, Contact, …
• Anti-Depressants
– Paxil, Zoloft, Effexor,
Lexapro, …
• Anticoagulants
– Aspirin, Ibuprofen
– Tylenol = OK
• Accutane
• Advair
• Ask your doctor about
any medication
prescribed …
– IS THIS GOING TO
AFFECT MY VOICE?
Voice Center
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“I Have a Cold, Can I Sing?”
• 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!!!
Voice Center
Vocal Fold Bleed
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Voice Center
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Bilateral vocal fold hemorrhages
Voice Center
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“I Have a Cold, Can I Sing?”
• 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
Voice Center
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“I Have a Cold, Can I Sing?”
• Supportive treatment:
 Increase REST and HYDRATION
 Guaifenesin (Mucinex)
 Thins mucus
 Nasal saline rinse (Ocean Spray)
or Neti pot
 Decongestants WILL dry you out!
 Avoid antihistamines if you can
Voice Center
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“I Have a Cold, Can I Sing?”
• 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
Voice Center
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Lumps and Bumps of the
Vocal Folds
• Usually Arise from
Phonotraumatic Voice
Use (including singing
sick…)
– Nodules
– Polyp
– Cyst
• Maximize NonSurgery Treatment
– Voice Rest
– Voice Therapy
– Singing Voice Therapy
Voice Center
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NORMAL VOCAL FOLDS – no bumps!!!
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Vocal Fold Nodules
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Voice Center
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Vocal Fold Lesions
Vocal
Fold
Polyp
Reactive
Lesion
Voice Center
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Vocal Fold Lesions
Vocal
Reactive
Lesion
Fold
Cyst
Voice Center
Vocal Fold Lesions
Vocal
Fold
Cyst
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Voice Center
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Voice Care Suggestions
• Maintaining a healthy voice requires a proactive
approach!
– Avoiding phonotrauma and other vocal dangers!
– Making GOOD CHOICES for your VOICE
– Active Exercises
• This is similar how you maintain
healthy teeth:
– You have to think about it
EVERY DAY!
Voice Center
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Caring for Your Lungs
–Singing is an aerobic activity
–DO NOT SMOKE!!!!!!!!!!!
–Avoid exposure to smoke-filled air
–Treat conditions affecting lungs,
such as asthma
–Exercise
Voice Center
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Smoking
Irreversible changes to
Laryngeal Cancer
Vocal Folds
Voice Center
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Voice and Water
• Lungs, Vocal Folds, Throat, Mouth...
• Mucous Production – Lubrication
• Caffeine, Antihistamines…
– Have a drying effect
• Relative Dehydration
– Dry Air
– Caffeine
– Sleeping
Voice Center
Dehydration
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Voice Center
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Water, Water, Water,…
1
2
3
4
5
6
7
8 !!!!!!!!!
Voice Center
STEAM!!!
• Personal Steamer:
• SURFACE hydration
• DO NOT use menthol pads or
anything but plain water in it!
• Use at least 5 minutes before
singing or performance
speaking – or when you feel
vocally fatigued
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Voice Center
THROAT COAT?
- Doesn’t DIRECTLY help
vocal folds – but can help
by soothing THROAT
- Same goes for honey, and
ANYTHING you drink/swallow
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Voice Center
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Hoarseness is no
laughing matter!
• Hoarseness is
NEVER
normal
• Especially
repeated
episodes
Voice Center
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Healthy Voice 2014
• Your voice requires active measures to stay
healthy.
• Proper care of the voice will result in years of
voice use without any problems.
• Persistent or recurrent hoarseness should be
evaluated by a laryngologist if at all possible!!!