Transcript lecture 12

Speech Language-Pathology and the
Professional Voice: An Overview
What does the SLP do?
Does
not provide special training: range, power,
control, stamina, esthetic quality
Analyze
Systematically the Vocal
Behaviors:Perceptual & Objective Measures
Analyze
Vocational, Educationally, &
Psychosocial Factors of Vocal Behaviors
Design
& Implement an Individualized Program
for Modifying Vocal Behavior
Who are Professional Voice Users?
 Use
the voice for artistic expression
 Professional Singers
 Actors/Actresses
 Those seeking to become professional
singers or actors
 Excluded
clergy
for this talk: Teacher, lawyer,
Levels of Vocal Usage

Elite Vocal Performer (Level I)- slight
aberration of voice may have dire
consequences: singers and actors, opera
singer

Professional Voice User (Level II)- moderate
vocal problem might prevent adequate job
performance: clergy, teachers, lecturers,etc.
Levels of Vocal Usage

Non-Vocal Professional (Level III)- severe
vocal problem would prevent adequate job
performance: lawyers, physicians,
businessmen, business women, etc.

Non-Vocal Non-Professional (Level IV)- vocal
quality is not a prerequisite for adequate job
performance: clerks, laborers.
The Vocal Tract: 4 Components

"Generator”- breath support provided by the lungs.

"Vibrator”- the larynx; specifically, the vocal folds
themselves.

"Resonator”- the space above the larynx, and includes
most of the pharynx. (trained opera singer-produce
resonance at 2,500 Hz).

"Articulator”-the tongue, lips, cheeks, teeth, and
palate. Shapes sound from below into words and
vocal gestures.
Anatomy & Physiology: Larynx
 Laryngeal
 Intrinsic
 Vocal
Cartilage's
& Extrinsic laryngeal Muscles
Fold Vibration: Speaking &
Singing
Laryngeal Framework
Epiglottis
Thyroid
Cuneiform
Corniculate
Arytenoid
Cricoid
Posterior
Anterior
Intrinsic Laryngeal Muscles
Action of
Cricothyroid

Cricothyroid: fan-shaped, 2 divisions, Lengthens
& tenses the vocal folds.
Intrinsic Laryngeal Muscles
Vocal ligament
Thyroarytenoid
Thyrovocalis
Thyromuscularis

Thyroarytenoid: muscle making up the true vocal folds, 2 parts:
thyrovocalis (bound to the vocal ligament) & thyromuscularis
(lateral to arytenoids).
Intrinsic Laryngeal Muscles
Action of Post.
Cricoarytenoid

Posterior
Cricoarytenoid
Posterior Cricoarytenoid: Abducts the vocal folds, actively
contracted at the end of phonation & any speech sound not
requiring v.f. vibration.
Intrinsic Laryngeal Muscles
Action of Lat.
Cricoarytenoid
Lateral
Cricoarytenoid

Lateral Cricoarytenoid: lies along upper surface of cricoid
cartilage, adducts vocal processes of arytenoids closing
membranous portion of v.f.’s.
Intrinsic Laryngeal Muscles
Transverse
Interarytenoids
Oblique
Interarytenoids

Interarytenoids (transverse & oblique): Unpaired, 2 part
muscle, adducts the v.f.’s in the cartilaginous portion by
pulling arytenoid tips together.
Extrinsic Laryngeal Muscles
Mandible
Anterior
Digastric
Posterior
Digastric
Mastoid Tip
Mylohyoid
Hyoid Bone
Stylohyoid
Thyrohyoid
Sternohyoid
Omohyoid
Sternothyroid
Sternum
Extrinsic Laryngeal Muscles
 Three
Main Purposes:
1) Fixation
2) Elevation
3) Depression
 Two major groups Suprahyoid & Infrahyoid
 Suprahyoid- one of the above
attachments lies above the larynx.
 Infrahyoid- one of the attachments lies
below the larynx.
Vocal Fold Vibration

Vibratory cycle- single vibration of the vocal
folds (or glottal cycle)
 “Begins
when subglottal pressure (Ps )
overpowers fold resistance just enough for
the v.f.’s to first blow open.”

Opening phase: v.f. continue to blow apart

Closing phase: escape of air reduces Ps
enough for fold resistance to overpower
airflow, then close.
Vocal Fold Vibration
Spread of glottal opening
Spread of glottal opening
Vertical phase difference

Note how the vocal folds open from bottom to top &
back to front.
Vocal Fold Vibration
CLOSED
OPENING
OPEN
CLOSING
1.
Normal Vocal Folds
2.
3.
4.
Vocal Abuse & Misuse

Hyperfunctional singing or speaking habits

Voice history taken to determine
speaking/singing patterns

Vocal techniques to reduce hyperfunctional
voice are discussed
Vocal Abuse & Misuse: Singing
Excessive muscle tension in tongue, neck, larynx
 Inadequate abdominal support
 Excessive volume
 Inadequate preparation
 limited practice
 rehearsal of a difficult piece
 limited vocal training for a given role
 Don’t go beyond your physical limits!

Vocal Abuse & Misuse: Speaking

Disassociation with speaking & singing voice is a
common abuse!
 Support,
muscular control, projection not
applied to speaking voice

Shouting, screaming (backstage, noisy rooms)

Conducting-Choral (Practice singing all parts)

Teaching singing (Long days, seated)
Vocal Abuse & Misuse: Speaking
Loud talking, yelling, screaming
 Hard glottal attack
 Outside acceptable physiologic range
 Excessive coughing/throat clearing
 Grunting (lifting, exercising)
 Excessive talking
 Loud, hard laughing
 Voice production when folds are inflammed

Vocal Abuse & Misuse: Exposure

Alcohol consumption

Medications

Caffeine

Recreational drugs

Smoke

Reflux
Vocal Abuse & Misuse: Symptoms

Hoarseness

Vocal fatigue

Reduced range of phonation

Breathiness

Strain/Struggle voice
Disorders of Singing: Upper Respiratory Infection

Symptoms Mucosal congestion
 Increased nasal secretions
 Nasal obstruction
 Pharyngitis
 Fever causing dehydration
 Productive or unproductive cough
Disorders of Singing: Upper Respiratory Infection

Medications
 Be knowledgeable about “over the counter
remedies”
 Avoid antihistamine (dry & thicken secretions)
 Early
infection only
 Tefenadine & Astemizole (non sedating)

Mucolytic agents & decongestants give greatest
relief
 Sleepiness

& anxiety
Avoid aspirin
 May
cause vocal fold hemorrhage with coughing
Disorders of Singing: Upper Respiratory Infection

Other therapies:
 Increase fluid intake
 Those
 Nasal
that don’t increase mucous production
irrigation's
 Thins
 Singing
secretions (saline)
only if no cord inflammation
Disorders of Singing: Laryngitis
URI may cause mucosal edema
 Voice rest considered
 Practice for short periods of time
 Few brief rather than one long session
 Singing- Narrow pitch range
 Other vocalizations minimized or avoided
 No whispering or whistling

Disorders of Singing: Laryngitis
Gargling no help
 Steam inhalation is beneficial Decreases inflammations & reduces
secretions
 Performance during laryngitis
 Limit pitch range & volume

Laryngitis/ Edema
Disorders of Singing: Vocal Fold Hemorrhage
Can occur with URI, laryngitis or coughing
 Vocal abuse- Single episode of shouting etc.
 Women- Onset of menstrual cycle
 Strict vocal rest
 Fibrosed tissue
 Frequent episodes- Prominent superficial
blood vessels
 Laser treatment

Vocal Fold Hemorrhage
Disorders of Singing: Vocal Fold Polyp
Typically unilateral
 Anterior middle one-third of fold
 Broad based or sessile
 May cause mild-severe dysphonia
 Caused by misuse or abuse, smoking
(cigarettes or marijuana (worse)

Disorders of Singing: Vocal Fold Polyp
Typical complaints:
 Harsh quality
 Diplophonia
 Loss of upper range
 Therapy:
 Resolve with voice therapy
 Surgery-polypoidectomy

Unilateral Polyp
Bilateral Polyps
Disorders of Singing: Vocal Nodules

Caused by overuse and abuse
 Singing outside range
 Nonsinging activities (most often)
 Speaking
 Job
environment
 Playing musical instrument
 Conducting
 Teaching
Disorders of Singing: Vocal Nodules

Other vocal abuses:
 Environment
 Noise
 Smoke
 Dust
 Poorly
ventilation
 Lack of proper humidity
 Poor acoustics
Disorders of Singing: Vocal Nodules
Symptoms Harsh, hoarse or breathy voice
 Loss of upper range
 Treatment 6-12 weeks of behavioral therapy
 If persist-surgery

 Microlaryngeal-
NO laser
Bilateral Singer’s Nodules
Bilateral Nodules
Prevalence of Disorder

Who Gets Voice Disorders?
 45%
are level I and II professional vocalists,
 43%
are level III and IV patients.
 Remaining
12% are children
Disorders of Singing: Most Common

Acute "emergencies":upper respiratory
infection: cold or stress-related.

Voice strain and/or extraesophageal reflux
(the back flow of stomach contents).

Vocal abuse and misuse syndromes are
common in professional voice
Disorders of Singing: Incidence

Infectious and Inflammatory Conditions:
 Laryngopharyngeal
 Chronic
 Upper

reflux (LPR)- 55%
tobacco use (smoking)- 25%
respiratory infection- 15%
Vocal Misuse/Abuse Syndromes:
 Muscle
 Acute
tension dysphonia(s)- 40%
vocal abuse- 2%
Disorders of Singing: Incidence

Benign and Malignant Growths:
 Reinke's
 Vocal
edema- 16%
nodules- 8%
 Granulomas Papillomas Carcinoma
7%
4%
(Cancer)- 4%
Disorders of Singing: Incidence

Neuromuscular Disorders:
 Dystonia
(spasmodic dysphonia)-8%
 Paralysis/paresis Degenerative

7%
conditions- 2%
Psychogenic Conditions:
 Conversion
 Relapsing
reactions- 2%
aphonia/dysphonia- 1%
10 Most Common Problems of Singers

Poor Posture

Poor Breathing & Inappropriate Breath Support

Hard Glottal or "Aspirate" Attack

Poor Tone Quality

Limited Pitch Range, Difficulty in Register Transition

Lack of Flexibiltiy, Agility, Ease of Production, Endurance

Poor Articulation

Lack of Discipline, Commitment, Compliance

Poor Vocal Health, Hygiene, Vocal Abuse

Poor Self-Image, Lack of Confidence
Disorders of Singing: Treatment Concerns
 Successful
treatment of voice disorders
depends on identification of "vocal needs"
of each patient.
 patient's
professional and social needs and
obligations.
 different
impact patients depending upon the
patient's profession or "level of vocal usage."
How to save your voice: Avoid Abuse
1) Do nothing to your voice resulting in
hoarseness and/or throat pain.
2) Avoid yelling or screaming to the point of
causing hoarseness.
3) Avoid singing so loudly that you develop
hoarseness, and avoid singing in situations
that you cannot hear yourself singing.
4) Cold or laryngitis: do not try to talk or sing
"over" the problem.
How to save your voice: Avoid Misuse
1) Careful using "character voices" not to strain, and use
especially good breath support.
2) Do not alter your "normal" speaking voice to create an
effect; avoid pitching your voice too low.
3) Avoid taking on roles you cannot do; don't attempt
roles that are out of your range.
4) Avoid using long run-on sentences and a rapid
speaking rate; good breath support for speech is as
important as good breath support for singing.
How to save your voice: Avoid overuse
1) Examine your "vocal schedule" carefully. Your
vocal demands are not of equal importance.
2) Avoid making a schedule that leaves no room
for rest and recovery.
3) Use amplification when available and
appropriate, especially for rehearsals.
How to save your voice: Monitor your diet/ life style.
1) Eat regularly, and eat a healthy diet.
2) Avoid fried and other fatty foods.
3) Avoid dehydration: drink plenty of water.
4) Avoid eating or drinking, particularly alcoholic
beverages, within three hours of bedtime.
5) Minimize consumption of caffeine-containing foods
and beverages.
6) Strictly avoid smoking or other tobacco consumption
7) Exercise regularly; aerobic exercise is best.
How to save your voice: Avoid unnecessary
medications.
1)Avoid drying medications such as
antihistamines.
2) Avoid anesthetic throat sprays.
Warming-Up the Voice

Allowing time to warm-up

Singers develop distinctive warm-up regimens appropriate to
their personal needs

Warm-up the entire body with gentle physical exercise (e.g.,
stretching, yoga, Tai Chi).

Begin vocalizing in the comfortable mid-range of the voice, and
gradually work out to the higher and lower extremes of pitch.

Test vocal register transitions during the warm-up. Exercises that
"blend" the "chest" ("heavy” laryngeal adjustment) and "head"
("light" laryngeal adjustment) registers eventually produce a
smooth passaggio.
Cooling Down the Voice

"warm-down" by vocalizing on "oo," for
example).

Singer using a "belting" voice, it is helpful to
sing in the "head" register (or falsetto) stretches
the vocal cords and alleviates
laryngeal tension
 Re-loosening

the articulatory muscles,
Massaging the jaw- the masseter, neck &
shoulders particularly the trapezius
Case Study: Opera Singer
2 days prior to Opera- Arrives in Tennessee
from Germany
 In 24 hours- Blocking, informal and dress
rehearsal
 Complaint- Mild changes in mid -range; not
noticed by others

Case Study: Examination

Laryngeal videoendostroboscopy- revealed
moderately large immature bilateral vocal fold
nodules

Cause: Sung during a cold 2 weeks prior
Case Study: Therapy

Elimination of all unnecessary vocal usage
 No
cast parties
 Minimal conversation
Transposition to a lower key was not an option
 Reduction of dynamic markings of solo parts
 Techniques used for 3 days of performancefollowed by 2 weeks of reduced vocal usage
 Problem was resolved
