Voice Difficulties

Who we are in the world as individuals and as a species is expressed in speech and language. Voice requires harmonious cooperation among structures whose primary tasks are unrelated to communication.

Voice  starts in the flow of exhaled air from the bellows-like chest cavity and lungs whose primary task is breathing.

The stream of air passes through the larynx which contains the vocal cords which break the stream into sound pulses.  The larynx, called the voice box, keeps liquids and solids out of the lungs when we swallow.

The dominant pitch of the larynx depends upon the length of the vibrating vocal  folds, or cords.  Adult cord length is determined by the surge of hormones during puberty. The male hormone creates elongation of the cords and causes the basic voice pitch to lower. The change in the relative balance between androgenic (male activity) and estrogenic (female activity) in the circulating hormonal environment during menopause creates echoes of this phenomena in women.

The sound produced by the larynx is amplified, resonated and turned into voice by the structures of the throat, otherwise the main highway for food. The oral cavity articulates the voice into the elements of speech using the structures it otherwise uses to analyze and adjus the consistency of foods.

The linings of the nose and throat are lubricated and  protected by a thin layer of mucus. This mucus is partially composed of water and the thickness or thinness (viscosity) depends on the proportion of water to other complicated chemicals. Mucus keeps the membranes underneath from drying out and helps protect the body from invasion by germs.

Conversation, public speaking, choral singing, and solo singing each impose different requirements and stresses on this system.  Gentle face-to-face conversation, the least taxing of these activities,  requires a wide range of pitch and loudness in order to convey accurately our messages.

Professional voice use, especially singing, is an athletic activity requiring good fundamental health habits. We must discipline to avoid influences which are clearly damaging to the voice box. Efficient, appropriate techniques of voice protection increase our range and duration. Proper diet, with special attention to adequate  hydration to assure necessary mucus viscosity , proper rest to allow involved musculature to rid itself of the waste products of heavy use are basic considerations. A properly humidified environment is to the voice  box what the velvet lining is to the musician's instrument case.

Breathing dry air for long periods makes the mucus layer thick and ineffective.  The nose dries first.  The body's first response  makes the lining inside the nose swell up.  The nose mucus becomes more watery in an attempt to correct this problem.

When the nose becomes stuffy,  we begin to breathe through our mouths and the  mouth becomes dry. The drying extends to the back of the throat and on to the voice box, causing sore throats laryngitis.  Drying wakes us up in the middle of the night looking for that glass of cold water.  We can measure environmental  moisture by using a hygrometer, a device like a thermometer, to tell us the relative humidity.  When static electricity occurs, we know that the air is probably not suitable for breathing for prolonged periods of time.

We recommend a cold mist type of two gallon vaporizer where there are children about or the hot mist version where there are only adults.  Such a device should be used in at least the bedroom, the one place where most of us spend a few fixed hours a day. Distilled water is all that is necessary. No medicated additives are required or desirable. Ultrasonic nebulizers are the best and are finally becoming affordable.  Of course, the purchase of such devices should be considered a tax deductible item since you'll be doing it primarily for health purposes.  They are vital and important to vocal health.

Smoking bathes the cords in dry, toxic fumes and cannot be condemned strongly enough.  Dehydration means having a diet inadequate in plain water. Exposure to a dry environment, whether a natural desert or the artificial desert of air conditioning and airline cabins, requires us to increase the amount of plain water that we drink.  Shouting and screaming causes us to stretch our cords and lower their working life expectancy.

The development and maintenance of the voice, in addition to being profoundly affected by these basic  considerations, are affected both by maturation and vocal techniques.

Women should maintain the best possible endocrinological balance. Regular visits to the gynecologist have special importance to the  professional speaker or singer. Timely estrogen replacement may be voice maintaining in women.

Vocal abuse occurs when the voice is used improperly. Proper training prevents vocal abuse. Most of us would not buy an instrument at a music store and take it home expecting to use it effectively without lessons. So it is  with our voices; we cannot expect to obtain the maximum from our voices without the proper training and support available from qualified voice coaches.

Dedicated singers and speakers should identify and rely on a support team  devoted to the voice.  Interested otolaryngologists can directly examine the voice mechanism, assess any damages, and coordinate the blend of medical, surgical and pedagogical techniques that develop, repair, and maintain the miraculous human voice.  Those who use their voices professionally should regularly turn to speech pathologists and voice teachers for evaluation and advice on techniques.