Saturday, September 6, 2008

Vocal Health Information

Vocal Health Information
Care and Feeding of the Voice: An Overview of Vocal Health

Compiled by Tom Burke, Andrew Byrne and Beth Morrison


Foods to Include:

  • To increase hydration: watermelon, canteloupe, honeydew melon, apple juice, aloe vera juice (George’s Aloe Vera Juice is recommended for taste)
  • To reduce swelling: green/black olives
  • To improve overall laryngeal function: foods containing antioxidants (dark green leafy vegetables, cruciferous vegetables, berries, etc.)
  • For reflux: foods with a ph balancing quality, such as aloe vera juice and papaya/papaya juice

    Foods to Avoid:
  • Foods with lactic acid: dairy products (before singing)
  • Fried foods
  • If reflux is an issue: chocolate, spicy food, caffeine products, alcohol, mint, tomato based products
  • Alcohol (promotes capillary fragility which could lead to vocal cord hemorrhage)


    Medications to avoid and/or use with care:
  • Antihistamines (drying agents.)
  • Anti-depressants (can cause dry mouth and thick phlegm.
  • Anticoagulants such as aspirin and ibuprofen (increase risk of vocal hemorrhage--these medicines stay in the body for 7-10 days after taking them.) When looking for an analgesic, it is best to take Tylenol instead.
  • Advair and other steroid asthma inhalers (promotes yeast infection on vocal cords.) If you suffer from asthma, it’s a good idea get a spacer for your inhaler, or ask for an aerosolized form of the drug.
  • Always gargle/rinse with water after use.
  • Any medicine containing menthol (drying agent.) Also, be careful of gargling with mouthwash that is alcohol-based, which is also drying.
  • Steroids: Should be used sparingly and only if vocal rest is not an option (i.e. you have no understudy and the show must go on.) If a course of steroids is the only viable option, then you should ask for it in the form of inhaler or nebulizer; this reduces the systemic effects of the steroids.

    Some suggested herbal/holistic remedies for throat care:
  • Slippery elm lozenges
  • Throat Coat tea
  • EmergenC and/or Airborne
  • Neilmed Sinus Rinse (available at Duane Reade)
  • Steaming (using a personal steamer [preferred], hot shower, steam room at gym, etc.)
  • Glycerin lozenges
  • Zinc lozenges

  • If you suffer from allergies, you should be working with allergist who can give you options beyond over-the-counter antihistamines; I can provide a referral for you if you need one. If you do need to take OTC medicine for allergies, Claritin and Allegra are less drying than Benadryl.
  • If you do have allergies, consider getting an air purifier. Two of the best brands are IQAir and BlueAir. I would avoid the Ionic Breeze models sold at The Sharper Image, since they do little to nothing for dust/mold allergies.
    Dust allergies can be drastically improved by wrapping your pillows, comforter and mattress in allergy barriers; dust mites thrive in bedding, and containing them will greatly reducing allergy symptoms.

  • “Sing Wet, Pee Pale.” The kidneys are the best indicator of hydration; if you are well-hydrated, your urine will be clear.
  • Electrolytes are important: Gatorade will provide electrolytes, but Smartwater is an even better option, as it contains no sugar.
  • 8-10 glasses of water per day is a good guideline; an even better goal is to drink half your body weight in ounces each day (i.e. a 180 pound man should drink 90 ounces.)
  • If your home is especially dry, consider getting a humidifier.
  • However, be aware that if you have a dust or mold allergy, a room that is too humid may increase your allergy symptoms.
  • When you are feeling thirsty, you should drink twice as much liquid as planned.
  • During a voice lesson, you should consume at least one 16-24 oz. bottle of water.
  • Instead of just drinking water, it’s a good idea to sip-swish-swallow. This gets water into the little nooks and crannies in your mouth and throat, and helps keep you hydrated longer. This is especially important when working in a dry theater.
  • You should be swallowing roughly every 20-30 seconds.
  • Adding a little lemon juice to water stimulates saliva glands in the vocal cords (yes, you actually have saliva glands in your cords), which increases hydration at the laryngeal level.
  • It takes about 8 hours for exercise to affect hydration level of larynx; consider planning your workouts closer to the performance (i.e. working out at noon means dehydration at 8pm!)

    Warm Up/Cool Down:
  • Lip and tongue trills
  • “ng” siren
  • humming
  • Other exercises as prescribed by your voice teacher
  • Cool down ideally happens 2-5 minutes after the last note is sung: “oo” and “ee” tend to be good cool-down vowels, and descending patterns are better than ascending.
  • Vocal range should be exactly the same after performance or practice as it was at the beginning.

    Dealing with Phlegm:
  • When you feel phlegmy, it’s not that you need to dry out the phlegm, it’s that you need to THIN it out. Hydration is the key here (see above.)
  • The number one sign of reflux is phlegm/clearing of throat, not heartburn. If you find that you are clearing your throat a lot, you should be checked for reflux. A good way to deal with reflux in a performance situation is to dab baking soda on your tongue; this neutralizes the acid.
  • When phlegm is thick, you will feel dry; this may seem counterintuitive, but remember that it’s not a question of whether you have phlegm or not, it’s a question of viscosity.
  • If you feel phlegmy before performing, eat a little bit of melon; the fructose molecules in melon bind to phlegm and help to thin it out. Some people also find that garlic helps to thin phlegm.
  • If you are experiencing a thick phlegm due to illness, you may consider taking Mucinex (i.e. guafenisin); however, this is not something that you should take chronically, as it also thins out secretions in your lungs which should not be thinned out.

    Lifestyle Choices:
  • Sleep! You know best what your body needs, but the good ol’ 8 hour minimum still applies.
  • Eat a healthy, balanced diet that is rich in antioxidants, and minimize alcohol consumption.
  • When speaking/singing in noisy environments, remember to retract and use twang; this will reduce fatigue from a night on the town.
  • When sitting in a restaurant, try to choose as seat which faces the wall; this will help your voice carry better at the table with less effort.
  • Menstruation: women should be careful of strenuous singing two days before and for the first two days of their period. The vocal fold capillaries are more fragile on those days, and this can make you more susceptible to a hemorrhage.

    Dealing with Tension:

  • If your tongue tends to be tight, try sticking it straight out of your mouth and/or rolling it out of your mouth by putting the tip behind your lower teeth; this is an excellent way to loosen the base of the tongue. You can also run your tongue along your teeth, both upper and lower, on the inside and outside of teeth. This gives the whole tongue a stretching.
  • Alternate shoulders when carrying purses or shoulder bags. The omohyoid muscle, which connects the area where the shoulder and neck come together to the larynx is often one of the culprits in Muscular Tension Dysphonia (MTD).
  • Consider purchasing a myo-release ball (available at, which is a closed-cell foam ball that can be rolled over tense muscles to help them release much more effectively than stretching alone.
  • If you are not familiar with Alexander Technique, you should be. It is a system of bodywork invented by F.M. Alexander; he was an actor who continually lost his voice, and through a series of experiments with body alignment, he was able to eliminate his voice problems. If you suspect that your head/neck alignment is affecting your production, I would strongly suggest some Alexander lessons. I have a wonderful teacher to recommend if you are interested.

    To Sing or Not to Sing?:

    The following are some signs that your cords are quite swollen and that should not be singing:
  • Inability to siren through your range clearly
  • Needing to use an inordinate amount of pressure to maintain phonation
  • Difficulty with staccato
  • Pitch breaks
  • Inability to onset tone clearly
  • Loss of upper register
  • “Hole” in range

    There are two different types of vocal rest:
  • Absolute rest = no singing or talking whatsoever
  • Relative Voice Rest = 350 words per day, humming and light warm-ups are ok


    Optimal humidity for vocal cords is 65-70%. On an average cross-country flight, the starting humidity is only 5-8% and at the end of the flight, it is 17-23%; this increase in humidity comes solely from people exhaling, which makes it quite clear why we tend to catch colds from planes.

    To reduce the drying effects of flying, carry a thick washcloth in a Ziploc bag. Once you are in the air, moisten the cloth with hot water, and apply to face for 10 minutes; repeat this procedure every 90 minutes.

    When on professional gigs, some useful items for your toiletry bag include: Mucinex, glycerine lozenges (no menthol), antacids, Tylenol (not Advil or aspirin), nasal saline spray, Neilmed Sinus Rinse.

    Don’t drive on highway in a convertible or with windows fully open and air blasting on your face; this reduces risk of Trigeminal Neuralgia or “Bell’s Palsy.”

    Miscellaneous Voice Issues:
  • To find the median pitch for your speaking voice, say “mm-hmm” in an energetic and affirmative manner. If you speak too low with too much pressure, this can lead to vocal problems.
  • If you do require surgery for a vocal injury, pursue at least 1-2 sessions of vocal therapy PRIOR to surgery; also ask surgeon to use smaller endotracheal tube to reduce risk of injuring the tissues surrounding the vocal folds (granuloma on arytenoids.) Total voice rest is rarely prescribed following surgery except in cases of hemorrhage. Voice therapy typically takes 4-6 weeks. New onset of nodules can resolve with therapy in relatively few sessions and do NOT require surgery.
  • To get an idea of the dimensions of the vocal cords, think of a penny; the cords are roughly the same thickness and length as a penny.

    Vocal Anatomy Development:

  • At age 24-25 the calcification of the cartilages in the larynx allows for more powerful singing
  • At age 27 the major solidification of the vocal mechanism occurs.
  • At age 54 there is a major change in the anatomy of the larynx and consistency of hydration can become an issue.
  • Around age 75 there can be a major negative change in the mechanism which can create pitch, quality, and function issues.

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