Rehab for Damaged Voices- How to Fix Vocal Problems

1. Rest

Rest and sleep are essential for singers to maintain vocal health. Lack of sleep produces edema or swelling of the tissues.

This means that, as the singer, unfortunately, you must skip the after-show party and go straight home to bed. If you want to preserve your voice, you must make rest a priority. This includes vocal rest- if you are rehearsing or performing you need to limit the amount of time you spend speaking during the day.

Think of having a limited vocal budget. The voice is not a machine- you can use it safely for only a certain number of hours per day and then you are cashed out. If you are singing a lot or singing loudly, you have even less cash in reserve.

Pace yourself. Use your voice as little as possible on the days you have a performance. Give yourself a vocal rest day after performances, and at least one day a week. Don’t talk or sing all day.

Sound difficult? So is recovering from surgery!

2. Hydration

Drink two quarts of water per day, until you consistently “pee pale.” The vocal folds need to have some mucus on them to function efficiently, but we want thin rather than thick mucus. Lubrication is created in the vocal folds by drinking lots of water- at least 2 quarts per day.

Dr. Van Lawrence, a world-renowned ENT (ear, nose and throat specialist) has been credited with saying Drink water until you pee pale.

3. Exercise

Daily aerobic exercise is good for all the cells of the body including the vocal folds, and heart pumping deep breathing exercises help you stay in shape for performing.

4. Diet

Emphasize plenty of plain water, along with vegetables, fruits, and plant-based foods. Stay away from dairy, chocolate, and acid forming juices like orange juice which may create phlegm. Many people today are finding that they are gluten-intolerant and experience great improvements in health by avoiding gluten.

Any food item that causes your body to secrete phlegm should be avoided-phlegm is the body’s way of reacting to a perceived toxin and inflammation. If you experience phlegm as a result of ingesting a particular food or drink your body is telling you to avoid it.

5. Avoid noisy environments

Don’t talk loudly in noisy environments or try to be heard over the crowd at a party. Stay away from outdoor sporting events that encourage screaming. Don’t even think about trying to be a cheerleader if you want to sing.

Screaming at one event has been known to cause vocal nodules. Is it really worth it? If you must attend an outdoor sporting event or rock concert, an occasional WOO-EEE! in the upper register should be ok. Do not scream or talk loudly, ever, but particularly in noisy outdoor environments.

6. Be aware of your speaking voice

You should be speaking in the area of the voice where you say MMMM-HMMMMM as if you are enthusiastically agreeing with someone. If you have to speak for long periods of time every day always use amplification. If you are a classroom teacher, this can save your voice! A portable cube amp with a microphone plugged in can easily travel with you anywhere you need to speak to a large group.

These little amps pack a large punch, and they are very small and easy to carry. Never raise your voice over large groups. If you direct musicals, working with large groups of excited singers, this tip could save your voice.

7. Protect your voice during long rehearsals

When I attended a final dress rehearsal at the Metropolitan Opera Company in New York, most of the singers were marking (singing at half volume or an octave lower), even with the hall fairly full of onlookers. These highly trained and powerful singers were saving their voices for the big event of the opening night.

The voice is a limited instrument and cannot be used at full volume for several hours every day as other instruments can. Do not allow yourself to be required by directors to sing full voice at every rehearsal. This will result in a less than stellar performance at opening night. Tell the director you are marking.

If you are in a rock band, resign yourself to the fact that you will never be able to sing louder or longer than an electric guitar. You can’t out-sing electricity! Don’t allow yourself to be tempted to push and scream during rehearsals or performances even when the onstage volume is loud. Which it always is, unfortunately.

Protect your fragile and irreplaceable instrument by refusing to sing too long or too loud. A guitar string can be replaced, but the vocal folds cannot be replaced. Even with vocal surgery, there is no guarantee your voice will ever return to a pristine condition.

And as soon as you start singing again with your prior habits, vocal problems come right back. If you want a long career, be smart about volume when singing and limit the time you spend singing full voice.

Even rock screamers know that, if you want to scream night after night in shows or while touring on the road, you have to do so at a moderate volume. You just have to make it LOOK like you are shredding your vocal folds- it’s called acting.

Of course, a singer with good technique and training will be able to sing for longer periods of time than a singer who is not trained. Be sure to warm up the voice before rehearsals and to cool down after rehearsals with some semi-occluded exercises such as lip rolls or tongue trills.

8. Think Like an Athlete

An athlete warms up and cools down their muscles. A dedicated athlete knows they must exercise daily. They also know when to stop. They are disciplined about their body. When they are in training, they avoid all harmful substances. They value and respect their body because it is the source of their income. You should do the same.

For singers, exercising means vocalizing daily on scales and exercises that will encourage balanced registration and a good mix. You should vocalize enough each day to balance and develop the voice- but not so much that you get hoarse. Learn to pace yourself.

9. Gargling, Teas, Lozenges, Sprays

Though gargling does nothing for the vocal folds, gargling with salt water may help to soothe the tissues of the throat. Herbal teas such as Throat Coat (found at Whole Foods) contain slippery elm and may also be helpful for the throat (although, again, since these substances do not touch the vocal folds they won’t minimize swelling of the folds).

Entertainer’s Secret throat spray helps to moisturize the tissues of the throat. (To order, call 800-308-7452).

There is a natural throat spray called Sage Aloe Throat Shield Spray, made by Gaia Herbs, which can be purchased at Whole Foods. It contains Aloe Vera and is healing to the throat tissues. Thayer’s makes a variety of lozenges made with slippery elm, as well as throat sprays.

To order, visit http://www.thayers.com. Their products are known as natural remedies. Rain, a mouth spray made with xylitol is moisturizing to the tissue of the mouth and throat and is a great resource if you tend to get a dry mouth when you are nervous!

Avoid caffeinated beverages, which dehydrate the folds.

10. Steaming and Irrigating

Steam or mist, if inhaled, will hydrate the vocal folds and help minimize swelling. I encourage singers to invest in a portable facial steamer (found at any drug store) and to inhale steam several times a day when dealing with swollen vocal folds. Make sure you clean and sanitize the unit daily-they develop unhealthy bacteria if you don’t.

A larger device such as a humidifier or a vaporizer should be used while sleeping to increase hydration of the vocal folds and soothe swollen tissues.

A nebulizer is a small, portable device that converts liquid medicine into a fine mist you inhale by breathing through a mouthpiece or mask. A nebulizer (also known as a jet nebulizer or a compressed-air nebulizer) is powered by a small air compressor. You can purchase a saline solution to insert in the nebulizer.

This is a great way to hydrate the vocal folds; saline is healing and soothing to them. You can purchase these on Amazon.

I also recommend using a neti pot to clear out sinus cavities. The use of a neti pot requires mixing up a saline solution that will be poured through the nasal passages. Saline solution has been shown to be an effective treatment for hay fever, sinusitis, and other nasal conditions.

Nasal irrigation is used on a daily basis by many professional singers; the sinuses should be flushed daily to clear the cilia of bacteria and other pollutants. The neti pot looks like an Aladdin’s lamp; the saline solution is poured into one nostril and comes out the other nostril.

You should not use tap water with this product; most tap water contains chlorine which can be irritating to the membranes of the nose. Use distilled water. You can purchase the neti pot on Amazon or at your local pharmacy.

THERAPEUTIC EXERCISES

When vocally fatigued, vocal rest is essential for recovery and to avoid further trauma to the vocal folds.

There are also specialized exercises that help with vocal fatigue- the Semi-Occluded Vocal Tract (SOVT) exercises.

These exercises are great for warming up the voice, for experiencing proper appoggio, and for reducing hyper-function (too much effort, tightness or constriction in the vocal tract) and for reducing vocal fatigue due to over-use of the voice.

The semi-occluded exercises reduce air flow through the vocal folds and provide a soothing and relaxing element to vocalization by un-pressing the folds. With semi-occluded exercises, you will find it easy to vocalize throughout your entire range. These exercises include lip rolls, tongue trills, certain voiced consonants such as Z, V, [ʒ], [θ], and straw phonation.

They can be done on slides, sirens, and scales, and should be repeated often throughout the day to keep the voice primed.

1. Lip rolls:  lip rolls are made by blowing air across the lips as they are loosely vibrating or bubbling. Placing three fingers on either side of the cheeks along the line of the teeth can help to stabilize the vibrating lips. Press up slightly on the cheeks.

Although the lip roll may seem difficult to some singers at first, almost anyone can accomplish this exercise eventually. For those who have a hard time with the lip roll, a “raspberry” made by laying the tongue on the lower lip, closing the lips around the tongue, and blowing air usually works for just about anyone.

2. Tongue trills: tongue trills are the sound of a rolled R, and are made by flowing the air across a loose tongue tip. Many Romance languages such as Spanish and Italian use the rolled R.

3. Voiced Fricative Consonants:  These include [θ] TH as in the word the, V as in the word vibrant, the softer [ʒ] as in the word azure, and Z as in the word zebra. These consonants tend to reduce air while maintaining steady air flow.

4. Straw Phonation: Using a small to medium sized stirring straw, insert the straw about a half-inch into the mouth. Close the lips completely and firmly around the straw. With an UH feeling in the throat do hills, first a small glide up and down, then higher, and then higher still. Finally, glide from very low to as high as you can. Keep the tongue relaxed and loose. Don’t let air escape from the mouth area around the straw.

Dr. Ingo Titze, a world-renowned vocal scientist, advocates vocalizing through a small straw to soothe and heal tired or swollen vocal folds. Dr. Titze recommends straw phonation as an exercise for people with tired speaking voices, to help the voice recover; it works for tired singing voices as well.

He advocates doing slides and even vocalizing songs through the straw, which must be small enough to provide resistance.

The principle is to generate supraglottic (above the glottis) pressure so that the vocal folds can stretch and un-press. This reduces the load at the level of the larynx and can help to free up the muscles, so the singer gets used to using less vocal fold mass during phonation.

The increased back pressure decreases subglottic (under the glottis) pressure during phonation, allowing the vocal folds to achieve maximum stretch more easily. It also encourages a low laryngeal position, which allows the thyroid cartilage tilt necessary to stretch and elongate the vocal folds, eliminating flips and voice breaks.

Straw Phonation Routine:

• Pitch glide from your lowest to highest notes for 1-2 minutes.
• Glide up on “hills”, like progressively gunning an engine more and more. Be sure you are accenting from the lower body and not from the throat.
• Pick your favorite song and vocalize it through the straw.

For videos on the benefits of straw phonation, please visit www.ncvs.org.

THE SCIENCE BEHIND THE STRAW

These videos were created by Karen Titze Cox. More information can be found at www.ncvs.org.

5. Hand Over Mouth: If you place your hand over your mouth and vocalize, you will feel a back pressure that will soothe and stretch the vocal folds. This is effective for those who cannot do a lip roll or tongue trill.

6. Relaxation and Stretching: Take time throughout the day for relaxation and stretching exercises. Muscle massage using a small vibrator can also be very helpful in relaxing tension.

Tension is the enemy of good singing. Stretching can be extremely beneficial to counteract muscular tension.

For tongue tension, stick the tongue as far out of the mouth as possible, and then try to touch your nose, move it to the right, and finally to the left, holding each position for 5 seconds. Now draw a circle in the air with your tongue. This helps to disengage the muscles of the base of the tongue.

For neck tension, although the traditional head roll is not recommended, a good way to stretch the neck muscles is to bring your right ear toward the right shoulder and gently place the right hand on the left side of the face for a moment.

Repeat on the other side. Then bring the head forward, resting it on the collarbone and rest the hand on the back of the head.

Another great exercise to relax tense neck and back muscles is to stand and reach for the ceiling, then let the torso come down toward the floor in a rag doll folding motion.

Let the head hang straight toward the floor for at least a minute, then slowly come up, one vertebra at a time, with the head coming up last.

Now look to the right as far as possible, and then look to the left as far as possible. Repeat this process several times.

Then make extreme faces, widening the mouth and eyes as far as possible, then scrunching the muscles of the face together as small as possible.

The STRETCHING ROUTINE in Step One is a great way to start a lesson, or begin your day!  The music is very soothing.

Massage the jaw hinge daily to release a tight jaw.

Massaging the muscles of the neck, under the chin, the jaw hinge, and face will also help to relax tense muscles, thereby alleviating or preventing vocal fatigue.

And never chew gum! Chewing gum over-develops and tightens the hinge muscles of the jaw, which need to be loose and flexible.

Since the body is a system, with all parts affecting the other parts, tension in the body can affect the vocal folds. Doing muscle stretching exercises and massage will keep the body relaxed and will have a positive effect on the vocal folds.

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