Speech Language-Pathology and the Professional Voice: An Overview

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
  BehaviorsPerceptual 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
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 Omohy
oid 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
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
• Dont 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 dont 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 Singers 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