Speech Language-Pathology and the Professional Voice: An Overview

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Presentation transcript:

Speech Language-Pathology and the Professional Voice: An Overview

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

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

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.

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.

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.

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

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

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

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).

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.

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.

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.

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

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.

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.

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

Vocal Fold Vibration CLOSED OPENING OPEN CLOSING

1. Normal Vocal Folds 2. 3. 4.

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

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!

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)

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

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

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

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

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

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

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

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

Laryngitis/ Edema

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

Vocal Fold Hemorrhage

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)

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

Unilateral Polyp

Bilateral Polyps

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

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

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

Bilateral Singer’s Nodules

Bilateral Nodules

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

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

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%

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

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%

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

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."

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.

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.

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.

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.

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

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.

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

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

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

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