1. Speech Language-Pathology and the Professional Voice: An Overview

2. 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

3. Who are Professional Voice Users?
Use the voice for artistic expression
Professional Singers
Actors/Actresses
Those seeking to become professional singers or actors
Excluded for this talk: Teacher, lawyer, clergy

4. 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.

5. 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.

6. 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.

7. Anatomy & Physiology: Larynx
Laryngeal Cartilage's
Intrinsic & Extrinsic laryngeal Muscles
Vocal Fold Vibration: Speaking & Singing

8. Laryngeal Framework Posterior Anterior Epiglottis Thyroid Cuneiform
Corniculate
Arytenoid
Cricoid
Posterior
Anterior

9. Intrinsic Laryngeal Muscles
Action of Cricothyroid
Cricothyroid: fan-shaped, 2 divisions, Lengthens & tenses the vocal folds.

10. 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).

11. 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.

12. 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.

13. 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.

14. Extrinsic Laryngeal Muscles
Mandible
Mastoid Tip
Mylohyoid
Hyoid Bone
Sternohyoid
Omohyoid
Sternum
Anterior
Digastric
Posterior
Digastric
Stylohyoid
Thyrohyoid
Sternothyroid

15. 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.

16. 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.

17. Vocal Fold Vibration Spread of glottal opening
Vertical phase difference
Note how the vocal folds open from bottom to top & back to front.

18. Vocal Fold Vibration
CLOSED
OPENING
OPEN
CLOSING

19. 1.
Normal Vocal Folds 2. 3. 4.

20. Vocal Abuse & Misuse Hyperfunctional singing or speaking habits
Voice history taken to determine speaking/singing patterns
Vocal techniques to reduce hyperfunctional voice are discussed

21. 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!

22. 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)

23. 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

24. Vocal Abuse & Misuse: Exposure
Alcohol consumption
Medications
Caffeine
Recreational drugs
Smoke
Reflux

25. Vocal Abuse & Misuse: Symptoms
Hoarseness
Vocal fatigue
Reduced range of phonation
Breathiness
Strain/Struggle voice

26. Disorders of Singing: Upper Respiratory Infection
Symptoms-
Mucosal congestion
Increased nasal secretions
Nasal obstruction
Pharyngitis
Fever causing dehydration
Productive or unproductive cough

27. 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

28. Disorders of Singing: Upper Respiratory Infection
Other therapies:
Increase fluid intake
Those that don’t increase mucous production
Nasal irrigation's
Thins secretions (saline)
Singing only if no cord inflammation

29. 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

30. Disorders of Singing: Laryngitis
Gargling no help
Steam inhalation is beneficial-
Decreases inflammations & reduces secretions
Performance during laryngitis
Limit pitch range & volume

31. Laryngitis/ Edema

32. 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

33. Vocal Fold Hemorrhage

34. 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)

35. Disorders of Singing: Vocal Fold Polyp
Typical complaints:
Harsh quality
Diplophonia
Loss of upper range
Therapy:
Resolve with voice therapy
Surgery-polypoidectomy

36. Unilateral Polyp

37. Bilateral Polyps

38. 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

39. Disorders of Singing: Vocal Nodules
Other vocal abuses:
Environment
Noise
Smoke
Dust
Poorly ventilation
Lack of proper humidity
Poor acoustics

40. 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

41. Bilateral Singer’s Nodules

42. Bilateral Nodules

43. 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

44. 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

45. Disorders of Singing: Incidence
Infectious and Inflammatory Conditions:
Laryngopharyngeal reflux (LPR)- 55%
Chronic tobacco use (smoking)- 25%
Upper respiratory infection- 15%
Vocal Misuse/Abuse Syndromes:
Muscle tension dysphonia(s)- 40%
Acute vocal abuse- 2%

46. Disorders of Singing: Incidence
Benign and Malignant Growths:
Reinke's edema- 16%
Vocal nodules- 8%
Granulomas- 7%
Papillomas- 4%
Carcinoma (Cancer)- 4%

47. Disorders of Singing: Incidence
Neuromuscular Disorders:
Dystonia (spasmodic dysphonia)-8%
Paralysis/paresis- 7%
Degenerative conditions- 2%
Psychogenic Conditions:
Conversion reactions- 2%
Relapsing aphonia/dysphonia- 1%

48. 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

49. 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."

50. 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.

51. 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.

52. 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.

53. 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.

54. How to save your voice: Avoid unnecessary medications.
1)Avoid drying medications such as antihistamines.
2) Avoid anesthetic throat sprays.

55. 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.

56. 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

57. 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

58. Case Study: Examination
Laryngeal videoendostroboscopy- revealed moderately large immature bilateral vocal fold nodules
Cause: Sung during a cold 2 weeks prior

59. 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 performance- followed by 2 weeks of reduced vocal usage
Problem was resolved