Vocal Health: Is My Voice Healthy?
When I was 17 years old, I was performing as Tony in my high school’s production of WEST SIDE STORY. Three weeks before opening night, I had decided to meet with an Otolaryngologist, or ENT, due to my continuous sinus infections. I had thought I was going to be diagnosed as having a deviated septum. However, after having looked down my throat with a dental mirror, the doctor dramatically said, “You should never sing again. It is easier to accept this now at your age than to try and pursue a career in this and be disappointed. You have nodules”. Not only was opening night three weeks away, but I had already committed to NYU to study music. After having sought a second opinion, we discovered that the original otolaryngologist provided me with a misdiagnosis; I truly had scar tissue paired with some edema, or vocal inflammation. Suddenly, I became the center of conversations surrounding “vocal health” in my community. I served as an example of someone who was an “unhealthy singer”. Meanwhile, no one was explaining what it meant to be “vocally healthy” nor how to achieve the status of. 10+ years later, I share my thoughts on how I define what it means to be “vocally” healthy and the how to look out for the signs that may indicate to you that you should consult a competent laryngologist.
"The journey of a musical theater performer begins with nurturing and protecting their vocal instrument."
- Cynthia Erivo
Who should learn about vocal health practices?
Many people assume that vocal health is a subject that is only relevant to singers and actors. However, vocal health effects all professional voice users, or vocalists. A “professional vocalist [is] any person who 1) relies on his or her voice as a primary tool of trade and 2) would probably seek alternate employment if the voice were to become seriously impaired” (Titze et al. 12). They are not only actors and singers, but also teachers, clergy, receptionists sales personnel, physical therapists, etc. If you need your voice to make money, you are a Professional Voice User. In fact, the profession that is most likely to develop a voice disorder is not among the performance industry. School teachers have been estimated to be “two to three times more likely than the general population to develop a voice disorder” (Martins et al., 2014). It is estimated that “the mean prevalence of voice disorders among singers is 46%” (Pestana et al., 2017). Meaning that close to half of the singing population has experienced a voice disorder including, but not limited to, “Reinke’s edema, polyps, gastroesophageal reflux disease, laryngeal pain, and hoarseness” (Kwok & Eslick, 2019).
Among this community of professional voice users, singers must think of themselves as the professional vocal athletes - someone who is earning their income, not only because their voice is integral to the completion of the job at hand, but because the job itself demands an advanced coordination, flexibility, and consistency moreso than any other profession. Therefore, singer’s must be equipped with a higher sense of awareness and disciplined lifestyle that equates to that of a professional athlete. They must have the knowledge of how their behavioral choices impacts the instrument that they rely on to make money. In order to speak on these topics comprehensively, we must briefly discuss the anatomy and physiology of the vocal mechanism and understand how it works as a functional unit.
"Vocal health is not an option; it's a prerequisite for artistic and technical excellence in singing."
- Johan Sundberg
How does the voice work?
It is worth noting that this is meant to be a simplified description of the anatomy and physiology regarding the process of vocal phonation. Should you be interested to learn more about this subject, please contact me here.
According to vocal pedagogue, Barbara Doscher, the process of vocal phonation requires the coming together of a number of anatomical and physiological components. We can summarize these components into 4 major parts:
The lungs
The larynx
The resonance
The aperture
The air pressure, generated in the lungs, blows air through the vocal folds (that are in a nearly-closed position). The vocal folds, housed in thyroid cartilage of the larynx, become set into a vibratory pattern and generate sound wave. Those vibrations travel upward from the larynx and pass through the vocal tract or the resonator. Before exiting the body, the sound waves become altered by the shape of our lips and mouth, also known as the aperture.
Think of a garden hose. When you need to water plants, you turn a faucet so that water flows through the hose and out the spout. When you sing or speak, air is released so that the vocal folds vibrate, thus causing sound waves to flow through the vocal tract and out the mouth. In this comparison the faucet serves as the vocal folds, the tube of the hose serves as the vocal tract, the spout the water flows from serves as the aperture, and the flow of water serves as the flow of air.
How do we classify a voice as “healthy”?:
In the simplest of terms, a “healthy” voice is one that produces “normal” vocal function - meaning the four major components of the vocal mechanism listed above work in a balanced way to produce a vocal vibration that is clear, resonant, and easy in feel. However, what is considered “normal” vocal function varies from person-to-person. We are all equipped with different bodies that possess different abilities. Therefore, there are several characteristics to listen for when classifying a voice as “normal” or “healthy”.
Is your voice clear?: We want our voices to produce clear and intelligible sounds. Sometimes, if we hear qualities such as excessive breathiness, hoarseness, or raspiness, it can be an indication that there is a breakdown, or imbalance, of one or more of the systems involved in vocal production.
Does voicing feel easy to produce?: We want vocal production to feel easy, free, and released. If it feels effortful or uncomfortable during or after speaking or singing, it is an indicator that there is imbalance between the amount airflow being released and the amount of contact between the vocal folds.
Do you have full use of your voice to be expressive?: We want to feel as expressive with our voices as possible. Variables that determine maximum expressivity include, but are not limited to, pitch, intensity, and timbre. Do you have the ability to vary pitch in your speech patterns or do you find yourself tending towards the extremes? Would you identify as being an excessively loud speaker or as someone who is notably quiet? Does your voice maintain consistent quality over an extended period of time? The answers to these questions will vary from person to person - the important thing to consider is how each person feels about their ability to be expressive with their voices.
Do you become fatigued after an extended period of speaking, or singing?: We want a voice to feel as though it has endurance and stamina. It is normal to experience some mild fatigue as a byproduct to natural swelling that occurs after an extended period of vocal use. However, we want to ensure that an individual is not experiencing significant fatigue or strain after average usage of the voice. If you fatigue quickly and easily, it may be your body’s way of communicating that it is overworking due to an imbalance of the mechanisms involved in vocal production.
Classifying what is "vocally healthy” or “normal” is relative to each individual. Everyone’s “healthy” is different. One person may be doing something with their voice that is not necessarily “healthy” for another person to do with their voice and vise versa. However, by way of answering the questions listed above, an individual can assess if they are optimizing their vocal production or if there is more to be desired.
"A healthy voice is the result of understanding and respecting the natural physiology of the vocal instrument."
- Ingo Titze
What should I do if I want to know if my voice is “healthy”?
Regardless of if you are experiencing inconsistencies with your voice or not, consider getting a base-line imaging, or laryngoscopy, of your vocal folds. It is a procedure where a laryngologist uses either a rigid imaging tool that goes in your mouth, or a flexible imaging tool that travels up your nose, to get a look at your vocal folds at rest as well as in vibration. It is incredibly beneficial to have a point of reference for when, if ever, your voice is consistently behaving differently than normal. It also an opportunity to get any questions about how your individual voice functions from the perspective of a medical doctor.
To find a laryngologist, begin by asking your voice teacher if they have any recommendations. Ideally, they have worked with a number of laryngologists in your area that they can refer you to. If they do not have personal experience working with laryngologists, it is likely they know a colleague that has. You can also ask your peers if they’ve ever seen a laryngologist and learn what their experiences were like. If you are reading this and are not currently studying with a voice teacher, nor have any peers in the performing arts, research to see if you live near any voice centers. It is important to know that only laryngologists can provide you with a diagnosis - it is not within the scope of practice of a speech language pathologist to provide you with a diagnosis - even if they are certified in conducting laryngoscopies. Before scheduling with a laryngologist, check to see if they accept your insurance.
"Vocal health is not an option; it's a necessity for any serious singer."
- Joan Lader
Vocal health is a topic that many singers take pride in embodying without truly knowing what it means. And I think that stems from the fear associated with feeling as though your voice may be labeled “unhealthy”. Just because you take private voice lessons, attend a college program, or have never lost your voice doesn’t necessarily mean your vocal habits are “healthy”. Furthermore, a “healthy” voice does not necessarily equate to flawless, straight edges”. It is all relative to your what your individual desires are for your voice and what is demanded of it by your profession. And only you can define that for yourself! I hope this article has answered any questions you may have in figuring out if you consider your voice healthy as well as provided you with ways to learn more about your own vocal health!
This is the first of many articles having to do with Vocal Health. More articles will be coming soon that will touch upon behavioral tendencies that contribute to vocal consistency as well as what voice teachers listen to in the studio that indicates when it may be beneficial to check in with your voice doctor. If you have any questions pertaining to this article, or would like to discuss it’s content further please contact me here.
- Mackenzie Bykowski
M.M, Adv. Cert.
Citations
Titze, Ingo R., and Katherine Verdolini Abbott. Vocology: The Science and Practice of Voice Habilitation
National Center for Voice and Speech, Salt Lake City, UT, 2012, p. 12.
Martins, R. H. G., Pereira, E. R., Hidalgo, C. B., & Tavares, E. L. M. (2014). Voice disorders in teachers: A review.
Journal of Voice, 28(6), 716–724. https://doi.org/10.1016/j.jvoice.2014.02.008
Pestana, P. M., Vaz-Freitas, S., & Manso, M. C. (2017). Prevalence of voice disorders in singers: Systematic review and meta-analysis.
Journal of Voice, 31(6), 722–727. https://doi.org/10.1016/j.jvoice.2017.02.010
Kwok, M., & Eslick, G. D. (2019). The impact of vocal and laryngeal pathologies among professional singers: A meta-analysis.
Journal of Voice, 33(1), 58–65. https://doi.org/10.1016/j.jvoice.2017.09.002