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Preachers/Speakers Guide to Vocal Health – Guest Blogger: Dr. Randy Resser, M.D.

May 29, 2013

A star athlete will go to great lengths to condition his body, before during and after a sporting event. Violinists will spend time polishing, tuning and protecting the instrument they play. Any professional knows that in order to perform their trade to the best of their abilities, they need to know how to care for the tools that they use in their profession.  It is no different for those chosen to preach God’s word.  Pastors need to be able to take care of their tool of their trade: their voice.

What does the voice box do?

The larynx, or “voice box,” is a complex combination of muscles, nerves, and tendons, housed in a “box” of cartilage that sits right at the separation of our esophagus (“swallowing pipe”) and trachea (“windpipe”.) It has two very important functions: protection and vocalization. The first function (and probably the most important), is to protect the trachea from food, dusts and fumes. When we swallow, the larynx has a series of valves that close off the trachea, and allow the food to slide into the esophagus. If we breathe in dusts or fumes, the sensitive lining of the larynx gets irritated and triggers a cough reflex so that the foreign particles can be expelled. This is why vocal cord problems can also be associated with swallowing problems and chronic coughing. The second function of the larynx is to provide a vibration or sound that the upper airway (tongue, mouth lips and sinuses) can shape into the sounds that we recognize as an individual voice.

How is the voice make a sound?

The way we make sounds and words is very similar to the way sound is made on a clarinet. The way a clarinet makes a sound by vibrating air across a reed is similar to the way a breath is passed over our vocal cords to make a sound. Just by themselves, the sounds of a clarinet reed or the vocal cords alone are very harsh and sound like the buzzing of an insect. In a clarinet, this sound is then shaped into pleasant notes by the keys and shaft of the instrument. Similarly, the vocal cord vibration is shaped by the tongue, mouth, nose and sinuses into the pleasant sounds of a voice. The vocal cords are composed of paired string- like tendons that run from the front of the voice box to the back. On the surface of this tendon is a very delicate lining called the mucosa. These two areas are separated by a jelly- like connective tissue that allows the mucosa to glide freely over the tendon. When air from the lungs passes over the vocal cord, the mucosa glides back and forth over the tendon, like waves on the ocean. This shapes the air passing through the separation of the two vocal cords and causes a vibration to be made.  The vocal cords are controlled by very specific muscles that allow the cord to move back and forth, tighten or loosen, and also lengthen or shorten the cord. When we want to generate a high note, the muscles elongate the vocal cord and make it very stiff, like the high strings of a guitar. This creates a very fast vibration that we hear as a high pitch. Conversely, when we need a low-pitched sound, the vocal cords loosen and shorten, like the low strings on a guitar. The vibration is then slower and makes a low pitch.

What causes problems with the voice?

Hoarseness is a generic term that describes a symptom of disturbed vocal cord function. When someone is talking with vocal cords that are not vibrating correctly, it is similar to a musician trying to play the clarinet with a broken reed. When hoarse, the voice may sound breathy, raspy, strained, or there may be changes in volume (loudness) or pitch (how high or low the voice is). Anything that disturbs the movement of the vocal cords or the “wave” of the lining of the mucosa can cause hoarseness. The causes can range from a generalized swelling of the vocal cords (like an infection -“acute laryngitis” or allergies) to a mass on the surface (as in polyps, nodules or cancer of the vocal cords).  Any irritation to the vocal cords can lead to swelling of the vocal cords and disturb voice production. These sources can include viral and bacterial infections, allergies, acid reflux and irritants like dusts and tobacco smoke. These also can lead to increased mucous production causing coughing and throat clearing that can further traumatize the vocal cords over time.  Overuse or straining of the voice can cause both short term and long term damages. Initially, overuse of the voice can cause swelling and inflammation just like an infection. With rest, this will usually resolve. However, over time, continued strain to the voice can lead to vocal cord nodules or polyps.  Nodules form from repeated trauma to the surface of the vocal cords that can lead to thickening of the lining similar to the formation of calluses on the palms of the hands. Polyps are discrete areas of swelling that occur on a single vocal cord as opposed to nodules that occur on both cords. These can develop spontaneously, after bleeding under the vocal lining, or after the formation of a cyst in the vocal cord. Occasionally these need to be surgically removed to improve the voice. Any prolonged or unexplained  hoarseness needs to be evaluated by a doctor especially in those who smoke. Vocal cord cancer, though rare, is very treatable in its early stages.

How can I take care of my voice?

  • If you smoke, quit. Smoke irritates the vocal cords and can eventually cause cancer
  • Avoid agents that dehydrate the body, such as alcohol and caffeine. Avoid secondhand smoke, pollens and dusts that might irritate the voice.
  • Drink plenty of water (at least 6-8 glasses a day). Staying well hydrated keeps the mucous produced on the vocal cords very thin and helps to lubricate the vocal cords. This is especially important right before singing or preaching.
  • Consider using a mucous thinner such as Mucinex, Robitussin or other forms of guaifenesin before you preach. (make sure you only use the plain form  and not the forms with decongestants or cough suppressants). These medications are over the counter and help to thin out secretions to lubricate the vocal cords.
  • Humidify your home.
  • Watch your diet–avoid spicy and fatty foods.
  • Avoid eating a big fatty meal right before laying down to sleep. This helps to reduce the chance of gastroesophageal reflux.
  • Try not to use your voice too long or too loudly.
  • Sing within your range
  • Try to avoid vigorous throat clearing and coughing.
  • Avoid speaking or singing when your voice is injured or hoarse. This can lead to more damage, polyps and nodules.
  • If they are available, use a microphone and a PA system. Make sure that you have a “monitor” speaker set properly so that you can hear your own voice. This will help prevent you from having to raise the volume of your voice unnecessarily.
  • Rest your voice, especially after singing or preaching events. Let your voice recover to prevent adding to inflammation from previous voice usage. Even God rested on the seventh day!

When should I see the doctor?

One should seek an evaluation by a voice specialist (an Otolaryngologist,  i.e. Ears Nose and Throat Specialist) if one experiences:

  • hoarseness lasts longer than 2-3 weeks especially if you have a history of smoking
  • hoarseness that is associated with any of the following symptoms: pain not from a cold or flu, coughing up blood, excessive weight loss, difficulty swallowing, or a lump in the neck;
  • loss or severe change in the voice lasting longer than a few days.

J. Randall Resser, MD

Graduated University of Cincinnati College of Medicine 1994 residency in Otolaryngology, Head and Neck Surgery at Vanderbilt University 1994-2000 in private practice at Purchase ENT 2000- present

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